text:
Clinical Course of Pain in Acute Osteoporotic Vertebral Compression Fractures
ABSTRACT The authors prospectively determined the natural course of pain in patients with conservatively treated acute osteoporotic vertebral compression fractures (VCF). In addition, the type of conservative therapy that these patients received was assessed.
Patients older than 50 years, referred for spine radiography for acute back pain, were asked to complete a baseline clinical questionnaire. Patients with an acute VCF were followed up at 6 and 23 months with a questionnaire that included a Visual Analog Score (VAS) and type of pain medication and other conservative treatment. Significant pain relief was defined as a decrease in VAS of 50% or more.
Forty-nine patients (mean age, 78 years; range, 51-95) with acute VCF were followed up for almost 2 years. Significant pain relief was noted in 22 of 35 patients (63%) at 6 months and in 25 of 36 (69%) at 23 months. In patients with persisting pain at 23 months (mean VAS 6.4), some decrease in VAS was apparent at 6 months but not in the 6-23 months interval. No predictors for significant pain relief could be identified. Patients with significant pain relief used less pain medication and had less physical therapy.
In most patients with an acute VCF, pain decreases significantly with conservative therapy, predominantly in the first 6 months. However, almost 2 years after an acute VCF, a third of patients still had severe pain necessitating pain medication and physical therapy in the majority. No predictors for transition from acute to chronic pain could be identified.
Full-textDOI: · Available from: Jolanda De Vries, Sep 29, 2015
- SourceAvailable from: Jae Hyup Lee
[Show abstract] [Hide abstract]
- "However, a number of patients still have severe pain after several months. Klazen et al.1) showed a third of patients still had severe pain, necessitating pain medication and physical therapy 2 years after the onset of acute VCFs. In some cases, surgical treatment may be helpful for patients with long-standing back pain. "
ABSTRACT: Background: Dynamic radiographs are recommended to investigate non-healing evidence such as the dynamic mobility or intravertebral clefts in osteoporotic vertebral compression fractures (VCFs). However, it is difficult to examine standing flexion and extension lateral radiographs due to severe pain. The use of prone cross-table lateral radiographs (PrLRs) as a diagnostic tool has never been proposed to our knowledge. The purpose of this study is to clarify the usefulness of PrLRs in diagnosis and treatment of VCFs. Methods: We reviewed 62 VCF patients examined with PrLRs between January 1, 2008 and June 30, 2011. To compare the degree of pain provoked between standing extension lateral radiographs (StLRs) and PrLRs, numeric rating scale (NRS) scores were assessed and compared by a paired t-test. Vertebroplasty was done for 40 patients and kyphoplasty was done for 9 patients with routine manners. To assess the degree of postural reduction, vertebral wedge angles (VWA) and vertebral height ratios (VHR) were calculated by using preoperative StLRs, PrLRs, and postoperative lateral radiographs. Two variables derived from changes in VWA and VHR between preoperative and postoperative radiographs were compared by a paired t-test. Results: The average NRS scores were 6.23 ± 1.67 in StLRs and 5.18 ± 1.47 in PrLRs. The degree of pain provocation was lower in using PrLRs than StLRs (p < 0.001). The average changes of VWA between preoperative and postoperative status were 5.24° ± 6.16° with PrLRs and 3.46° ± 3.47° with StLRs. The average changes of VHR were 0.248 ± 0.178 with PrLRs and 0.148 ± 0.161 with StLRs. The comparisons by two variables showed significant differences for both parameters (p = 0.021 and p < 0.001, respectively). The postoperative radiological status was reflected more precisely when using PrLRs than StLRs. Conclusions: In comparison with StLR, the PrLR was more accurate in predicting the degree of restoration of postoperative vertebral heights and wedge angles, and provoked less pain during examination. The PrLR could be a useful diagnostic tool to detect intravertebral cleft or intravertebral dynamic instability.Clinics in orthopedic surgery 09/2013; 5(3):195-201. DOI:10.4055/cios.2013.5.3.195
Article: The Intravertebral Cleft in Painful Long-Standing Osteoporotic Vertebral Compression Fractures Treated With Percutaneous Vertebroplasty[Show abstract] [Hide abstract]
ABSTRACT: Prospective follow-up study. Evaluation of the diagnostic assessment and clinical significance of the intravertebral cleft in painful, long-standing osteoporotic vertebral compression fractures (OVCFs) treated with percutaneous vertebroplasty (PVP). Patients with painful OVCFs with intravertebral clefts provide a unique and possibly superior indication for PVP. However, comparative studies are scarce, and the results are conflicting. The extent of the difference attributable to interobserver variation in the identification of an intravertebral cleft is currently unknown. A total of 102 patients received PVP for 197 painful long-standing OVCFs and were prospectively observed, using a pain-intensity numerical-rating scale for back pain, the 36-Item Short Form Health Survey quality-of-life questionnaire, and routine spinal radiographs. Three experienced examiners retrospectively examined all preoperative radiographs and magnetic resonance imaging (MRI) T1-weighted and short-tau-inversion-recovery (STIR) sequences and the direct postoperative computed tomographic scans for the presence of an intravertebral cleft. Disagreements were re-examined and discussed for consensus. Interobserver agreement for the detection of an intravertebral cleft was moderate on preoperative radiography (κ, 0.55-0.59) and substantial on preoperative MRI (κ, 0.71-0.79) and postoperative computed tomography (κ, 0.67-0.85). On the basis of consensus, 42 (21.3%) clefts were detected. The associated sensitivity of preoperative radiography was low (31.7%-48.8%), but the specificity was high (94.7%-99.3%). The diagnostic performance of preoperative MRI T1-weighted and STIR sequences was excellent, with both high sensitivity (85.7%-88.1%) and high specificity (89.7%-98.1%). Pain decrease and increase in quality of life obtained from PVP were ultimately comparable with patients without intravertebral clefts but was obtained more gradually during the first postoperative year. An intravertebral cleft was a strong risk factor for the occurrence of cortical cement leakage (odds ratio, 4.29; 95% confidence interval, 1.51-12.2; P = 0.006). There is variation between observers in the identification of an intravertebral cleft, and the identification of an intravertebral cleft is not always straightforward. For preoperative assessment, we recommend MRI with T1-weighted and STIR sequences. Regarding patient-reported outcome, patients with long-standing OVCFs with intravertebral clefts benefit from PVP, but, compared with patients with OVCFs without intravertebral clefts, the benefit obtained was not superior and may be delayed.Spine 10/2011; 37(11):974-81. DOI:10.1097/BRS.0b013e318238bf22 · 2.30 Impact Factor
Article: Treatment of an osteoporotic vertebral compression fracture with the StaXx FX system resulting in intrathoracic wafers: a serious complication[Show abstract] [Hide abstract]
ABSTRACT: To report a serious complication of the StaXx FX system used to stabilize an osteoporotic vertebral fracture. A 76-year-old woman presented with a painful vertebral fracture. Treatment by means of a PEEK wafer kyphoplasty was complicated by malposition of the wafers. The patient recovered fully after removal of the wafers by means of a thoracotomy. New treatment modalities have their own pitfalls and possible complications, as demonstrated in this case report. Caution regarding implementation of new treatment modalities should be practiced.European Spine Journal 11/2011; 21 Suppl 4(S4):S445-9. DOI:10.1007/s00586-011-2053-6 · 2.07 Impact Factor


text:
|Early adolescence is a challenging stage in the development of all children. They are growing physically, intellectually, and socially more during these years than they have at any other time in their lives. The Franklin Avenue Middle School community recognizes this fact and provides students with the proper support and encouragement so that they may leave middle school with the skills requisite for a successful career in high school and beyond.
The Anti-Bullying Bills of Rights Act designates the week beginning the first Monday in October of each year as a Week of Respect in the entire state of New Jersey. School districts are directed to observe the week by providing age-appropriate instruction focusing on preventing harassment, intimidation, or bullying. In this light, below are the FAMS activities for The Week of Respect.
**All week a daily quote will be read on FAMS live centering around respect, tolerance and caring for others**
Monday, 10/5 - National Blue Shirt Day- World Day of Bullying Prevention
All students and staff are asked to wear a blue shirt today in honor of this national day. By wearing blue, the FAMS community is pledging to help bullying and cyber-bullying.
More information about this movement can be found on www.stompoutbullying.org
Camfel Productions Assembly
- All grades will go to an assembly by Camfel Productions entitled, Be Amazing. This is a motivational program that highlights the importance of striving to be our best. Many people have the desire or want to be amazing without putting the work in to be truly amazing. Those who are amazing let their actions speak for them. These people are focused on their goals and help others achieve and be successful!
Tuesday, 10/6 Dissolving Hate
Camfel Assembly Follow-up (extended homeroom) Teachers will use this time to discuss the follow-up questions from the Camfel assembly.
Dissolving Hate Activity (Lunchtime Activity)
- During lunch periods, students can write down any words of hate on slips of paper with marker and toss them into a small pool at lunchtime. As the words fade away in the water, students will feel the hurtful words symbolically disappear.
- Students are asked to wear red, white, and blue to show respect for veterans & those in the armed forces as well as school spirit!
- Students will have the opportunity to write thank you notes to service men and women during lunch periods
- Students will write down in homeroom on sheet provided a way that they can help put an end to bullying. These will then be posted in an area in the school that all students can read and be remind of ways that they can help others.
Students can wear sports team shirts/or jerseys to school this day.
Friday, October 23rd
6pm - 9pm
Please join us for PLC's largest fundraiser of the year! Your donations will help support over 25 different local and national service organizations. The dance is open to all 6th, 7th, and 8th grade students. There will be food, drinks, games, your friends, and prizes given away all night long! Everything you need to know can be found in the dance-a-thon packet. Simply bring your donation packet to the dance and help FAMS make a difference!
- Click here: http://www.ptcfast.com/schools/Franklin_Avenue_Middle_School
- Select the appropriate teacher(s)
- Fill in the required information
- An email will be sent with a link to select a conference time
- Click on the available conference time
- Click Confirm Selection at the bottom of the page
- A confirmation email will be sent to the email address you provided
Living Lessons is a community-wide program that was funded by FLEF, FAMS PTA, FLEA, and the Municipal Alliance and helped students, staff, and volunteers to realize the importance of reaching out to others, embracing their differences, respecting diversity, and learning how to deal with and overcome challenges by exploring stereotypes, prejudices, bias, discrimination, and noting how people have risen above these hardships to succeed in life. Living Lessons has been a part of FAMS since 2012 and is offered on an every other year basis. It is our sincere hope that this fantastic program and collection of presenters continues to touch the lives of the children and adults in Franklin Lakes for years to come.
If you plan to participate in any sports you must contact Mrs. Vinci to submit health records.
October 7 - 9: Frost Valley Trip (6th Grade)
For sports information, see Athletic Schedules and Direction link on the side bar.
Click here for link to directions to athletic events.
If you have any questions, please contact Mrs. Hartman or stop in the music room!
*REMINDER TO ALL STUDENTS: You should ALWAYS be prepared to go outside for recess everyday. Students must go to their lockers before arriving in the MPR with all the items that you will need.
LOST & FOUND - If you have lost school supplies, clothes, a lunchbox, or other personal items, PLEASE stop in the office.
Attention students:
We remind all students to examine their clothing choices each morning before arrival to school. Be reminded that FAMS has guidelines that can answer your questions regarding appropriateness of attire. We all appreciate your cooperation. Stop by the office with any questions.
Some reminders about school procedures:
- Please arrive to school on time! Attendance is taken at 8:05.
- Remember we only allow walking in the hallways. Safety first!
- Follow all bus safety rules. There are no assigned seats.
- Notice the rotation for recess for each marking period. It is posted in all homerooms and of course the MPR. We will only use the rotation when the weather is warm enough to go outside.
- If you plan to leave the MPR for any reason at lunch time, you MUST sign out first. If you will be with a teacher, you will need to show a pass!
- Large bags and backpacks are not permitted to be used throughout the day.
*Note that the school store is open to students during their lunch periods on Monday, Wednesday & Fridays. Snacks are available for .75 cents. Please do not bring in bills larger than $5.00 as we are not able to make change.
- When students arrive to school in bad weather, you will be waiting inside the building until the 8:00 am bell. All students will enter through the door by the gym and then proceed to the following locations:
- 6th grade - front hall by Rooms 157 and 158
- 7th grade - MPR
- 8th grade - gym lobby
> If going to Alternate Lunch or the Library, remember your sign-out number and use the same number when signing in at your destination. Alternate Lunch eats in the Alt. Lunch room, Library eats in MPR-no food is allowed in the Library.
> If parent is dropping off your lunch, it is your responsibility to look for you lunch in the white basket near the stage. If you need assistance, ask an adult for help.
> Remember that students must adhere to the guidelines regarding bags and backpacks and dress code. If you have any questions, please stop by the office.
COMPUTER LAB - Is open in room 225
*Before school at 7:15 am
*After school until 3:30 pm
- Animal Club - see Miss Mora
- Book Club -
- Chemisrty Club -
- Drama Club - Please see Miss Stein or Miss Kayser.
- Art Club - Mrs. Behrens
- Environmental Club -
- Photography Club - See Mr. V. for more info!
- Tennis -
- Year Book - Miss Burnup & Mr. Colon
- 7th Grade meets on Day 1
- 8th Grade meets on Day 2
2015-2016 CHORUS: (click for registration form) The 7th & 8th Grade Concert Choir is open to all students and meets during the school day rotating with your physical education period. Forms are available from Mrs. Hartman and in the main office.
- 6th Grade
- 7th Grade meets day 2
- 8th Grade
SPORTS: See Our Athletics Page

subset: commoncrawl


text:
October 15, 2011
FSU makes quick work of Duke, rolls to 41-16 win
D.C. Reeves
Related Links:
Talk about it in The Main Board
DURHAM, N.C - Florida State's simmering frustration over a month-long losing skid struck the facemasks of the Duke Blue Devils from the start on Saturday.
Reeling from three straight losses and a free fall from its lofty preseason perch, FSU wasted no time, jumping all over the Blue Devils en route to a 41-16 win at Wallace-Wade Stadium.
"It feels good to get back on a winning track," FSU coach Jimbo Fisher said. "We came out, played aggressive early, played smart early. We were able to establish the running game and make big plays. I'm proud of the way our kids battled and fought, we've got a long way to go, but we're 1-0 at the end of the week. And that's our goal, to be 1-0 at the end of each week. "
For a team that couldn't seem to find any fluidity the past three games, FSU (3-3, 1-2 ACC) flaunted plenty of it in all three phases on the way to its first conference win of the year.
Quarterback EJ Manuel dialed up the deep passes, connecting on a trio of 50-plus yard completions in the first quarter alone. The Seminoles (3-3) jumped out to a 17-3 lead after the first period and never looked back.
Manuel was 3-of-5 for 160 yards with a 51-yard scoring strike to Rodney Smith in the first 15 minutes.
"I think we just saw the looks in practice, we watched a lot of film on these guys," said Manuel, who finished the day 9-of-14 passing for 239 yards and two touchdowns. "We felt like we had the opportunity, a lot of times (the Duke safeties) kind of squatted instead of dropping back so we knew we could have a good chance running by those guys and those (receivers) went up and made good catches for me."
The Florida State running game also posted its best performance of the season, totaling 242 yards on 22 carries. True freshman Devonta Freeman was the focal point of the attack, rushing 19 times for 109 yards and a touchdown. Manuel added 62 yards and two scores on the ground.
"Devonta did a nice job and our offensive line did a really nice job of staying, kept pounding and getting better with the run," Fisher said.
And the defense, which set a school record for the fewest turnovers created through the first five games (4), nabbed two turnovers from Duke (3-3, 1-1 ACC) in the first half. Duke was held to 110 total yards in the first half as FSU built a 27-3 halftime lead and the defense tallied a season-high five sacks.
"It felt great as a defense to get some turnovers finally," said defensive end Bjoern Werner who tipped a pass that led to a first quarter interception and collected his team-best fifth sack of the year. "Nobody was quitting after last week, and we had a good practice week this week. We had a great attitude, a great game and everyone was on the same page."
FSU stretched its lead to 34-3 in the third quarter on tight end Nick O'Leary's first career touchdown catch and Manuel put the game away with a six-yard scoring run to make it 41-16 midway through the fourth.
After a month of coming up empty in different phases at different times, the Seminoles mustered a all-cylinder performance.
"We executed, we played with some consistency," Fisher said. "That's a sign of a good football team - a mature team that can execute - play-in and play-out - a team that can stay focused and do what it does."
Get premium access to Warchant.com. Sign up today for a 7-day FREE trial !!
Football Recruiting News
Jones sure of one official visit
BC grabs Texas receiver
Crawford back from Oregon
IMG Day 1: Top performers defense
Rivals.com is your source for: College Football | Football Recruiting | College Basketball | Basketball Recruiting | College Baseball | High School | College Merchandise
Site-specific editorial/photos �2012 Yahoo! Inc. All rights reserved. This website is an officially and independently operated source of news and information not affiliated with any school or team.
About | Advertise with Us | Contact | Privacy Policy | About our Ads | Terms of Service | Copyright/IP policy | Yahoo! Sports - NBC Sports Network
Statistical information �2007 STATS LLC All Rights Reserved.


text:
Download the App
CPAC 2016 will be March 2nd – 5th, 2016 at the Gaylord National Resort & Convention Center. Sign up for the latest updates about CPAC 2016.
This gives conservatives and our like-minded friends the best opportunity to influence the selection of one of our own to be our nominee for President. Help us select the next President of the United States!
With so much at stake, at home and abroad, CPAC 2016 could…
The Iran Nuclear Deal: What Can We Expect?
This summer, President Obama and Secretary Kerry seek to establish a nuclear deal with Iran that they claim is the only alternative to war. However, Iran has a long history of ignoring calls from the international community to cease nuclear proliferation, causing many to mistrust possible Iranian concessions.
Our leading experts will discuss threats posed by Iran, U.S. policy toward this state…
Tweets by @ACUConservative


text:
Inside Lacrosse by MAZ Digital Inc. Inside Lacrosse is the source for everything within the countryâs fastest-growing team sport: from in-depth coverage of … 5,000+ downloads, Rating 3.95 (40) Free
HOTFM (Official) by Julius Burbulis Apie: www.hotfm.lt HOT FM muzika - tai paskutinių 15 metų kūriniai, jau tapę hitais. Misija: HOT FM – MUZIKA, SU KURIA … 1,000+ downloads, Rating 4.35 (48) Free
Fast Access (Floating Toolbox) Updated by Fast Access Fast Access  is a similar application to the Samsung galaxy S5 Toolbox, but with Fast Access you can add i … 100+ downloads, Rating 4.50 (28) Free
BBA by ITN The BBA, along with ITN Productions, is providing a brand new app for this year's conference. It allows you to view excl … 1,000+ downloads, Rating 4.11 (54) Free
Yes, I Can! - Free eBook by Nixon Publishing This eBook is for anyone who ever said "I wish I could be like that person". Deep down we know that we all have the pote … 100,000+ downloads, Rating 4.09 (1408) $1.67
KiraKiraHeart(ko666) by STACK inc. You can set the stylish Live Wallpaper "KiraKira-Heart" created with a lot of glitters, lovely hearts and sweet images f … 10+ downloads, Rating 5.00 (1) Free
Tic Tac Toe by Teuf Labs Now you have the option to play the best Tic Tac Toe game for FREE in your Android device! You can play against the comp … 50,000+ downloads, Rating 3.52 (619) Free
Real Euro Train Simulator 2015 by Mobile Apps Globe It's time get into the fast driving simulation as you command the controls of a high end steam engine train. Pace throug … 100,000+ downloads, Rating 3.68 (2781) Free
Хадисы Сахих Муслим by Your Smart Apps Сборник хадисов «Сахих» имама Муслима на русском Мухтасар «Сахих» имама Муслима является кратким изложением одного из н … 10,000+ downloads, Rating 4.85 (445) Free
iDatank lite by APPZIL One man, no man? What about the robot armed with onboard replicator? This is a three-dimensional story of the scout dro … 10,000+ downloads, Rating 4.12 (408) Free
ポップンノートSP β2 by Roo & Qoo pop'n musicのクリア状況管理アプリ「ポップンノート(https://play.google.com/store/apps/details?id=com.rooandqoo.popnmanager)」のSunny Park対応バージ … 1,000+ downloads, Rating 4.57 (51) Free
U Mobile Top-up by I-SERVE TECHNOLOGY SDN BHD With iServe U Mobile Top-up, you can get your prepaid reload anytime and anywhere, quickly and securely without leaving … 500+ downloads, Rating 4.67 (12) Free
Circle Push by Thorntree Studios Your goal is simple: Move all circles to their destination. This game requires a lot of thought at times, so you may hav … 500+ downloads, Rating 4.48 (21) Free
Fandom for D-UNIT by Fandom Co., Ltd. "The app for the fans, by the fans, of the fans who love Idol –Fa … 1,000+ downloads, Rating 3.65 (40) Free
Jewels Gems Crush New by cool games Jewels Gems Crush is a fantastic game in which you have to line up three 3 or more items of the same color jewel. Creati … 1+ downloads, Rating 4.00 (1)


text:
Vidro homers and Mariners end skid, beat Blue Jays
TORONTO (AP)—Trade rumors may be a distraction for Jarrod Washburn, but they're not keeping him up at night. They aren't even getting in the way of nap time.
The veteran left-hander curled up on a clubhouse sofa for his customary pre-game snooze, then pitched eight strong innings to help the Mariners beat the Toronto Blue Jays 5-1 on Sunday, snapping Seattle's season-long seven-game losing streak.
"I've been sleeping all right," Washburn joked.
The New York Yankees reportedly have interest in Washburn (5-9), who shook off the speculation to win for the first time in four starts. He gave up one run and four hits, walked two and struck out two.
"I'd be lying if I said it wasn't on my mind before the game with all the rumors and stuff that's out there," Washburn said. "I don't know if anything is going to happen. It's been on my mind, but it was nice to get out there and be able to forget about it for a while."
Jose Vidro added a two-run homer for the Mariners, who won for the first time since beating Cleveland 8-2 on July 18. The Mariners are 2-7 since the All-Star break.
"Unfortunately we've had quite a few bad streaks this year," Washburn said. "I can't put a finger on why. We're a talented ball club, we've got a lot of the right pieces in place. Unfortunately, things haven't been going well for us this year. It's nice to turn it around and get a W today."
Washburn has allowed more than two earned runs just once in his past nine starts, lowering his ERA to 4.50. The difference, he said, is he's "matured" by finally perfecting the change-up, a pitch he's spent his entire career struggling to master.
"I've figured some things out," Washburn said. "Mechanically, I'm very sound right now, being consistent every pitch, and that's allowed me to get better with my off-speed pitches. My change-up right now is by far the best I've ever had."
J.J. Putz worked the ninth for Seattle in a non-save situation.
Toronto's season-high five-game winning streak ended, but manager Cito Gaston remains confident that his team is headed in the right direction. The Blue Jays have won 11 of 16.
"If we go two out of three the rest of the way, I'll be real happy," Gaston said.
With the game scoreless in the fourth, Jose Lopez tried to score from first on Jeremy Reed's two-out double. Lopez was thrown out by right-fielder Kevin Mench.
John McDonald's solo homer gave Toronto a 1-0 lead in the fifth, but Seattle replied with a four-run, bat-around sixth against right-hander Shaun Marcum (5-5).
Ichiro Suzuki drew a leadoff walk and scored when Vidro homered to right, his seventh.
Vidro ended an 0-for-11 slump by connecting on a hit-and-run fastball.
"When you're struggling and you see a hit-and-run sign, you kind of shorten your swing a little more," Vidro said. "That worked out good for me."
Later in the inning, Kenji Johjima chased Marcum with a two-run double to right.
Shawn Camp came on and gave up a single to Bryan LaHair, but struck out Yuniesky Betancourt to end the inning.
Marcum allowed four runs and six hits in 5 2-3 innings. He is 0-1 with an 8.70 ERA in two starts since missing 27 games because of a sore elbow.
"I wasn't locating my fastball today and I didn't do it in Baltimore, either," Marcum said. "It's tough to pitch when you can't throw that over for a strike because they can sit on everything else."
The Mariners added one more against Camp in the seventh on an RBI single by Lopez, who extended his hitting streak to a career-high 14 games.
"It says something for him that he's got a little hitting streak going and you're willing to take the walks," manager Jim Riggleman said. "It was good baseball on his part."
Suzuki tripled in the ninth and finished 2-for-4, giving him a combined 2,998 hits between the major leagues and the Japanese League. He has 1,720 hits for Seattle.
Seattle finished 5-4 against Toronto this season, their only winning record against an American League opponent. … McDonald's homer was his first since May 30, 2007, against the New York Yankees, his only home run of the 2007 season. … Mariners broadcaster Dave Niehaus received the Ford C. Frick award at Sunday's Hall of Fame induction ceremony.


text:
I decided to start charting temps at the end of last week following a m/c earlier this month. I followed FF's instructions on noting my D&C on the chart and started observing CP and CM and entering temps (I started the observation before the temp taking) and started to notice some signs of ovulation and then BAM! A cold. My cervix slammed shut, CM dried up, and I even ran a fever.
So I tossed out three days' worth of temps. And am waiting for ovulation to maybe pick up again
I am in the odd position of wanting to get this first AF so we can start trying again, and this stinkin cold was timed just perfectly to delay my ovulation and AF. Ugh.


text:
Ecology of Desert Riversby Richard Kingsford
Summarises current understanding of desert river ecology and its dependence on unpredictable river flows.See more details below
Summarises current understanding of desert river ecology and its dependence on unpredictable river flows.
Product Details
- 9780521818254
- Publisher:
- Cambridge University Press
- Publication date:
- 03/31/2006
- Pages:
- 368
- Sales rank:
- 1,087,079
- Product dimensions:
- 5.98(w) x 8.98(h) x 0.87(d)
Table of Contents
Part I. Natural Disturbance in Desert River Systems: 1. Desert or dryland rivers of the world - an introduction R. T. Kingsford and J. Thompson; 2. Flow variability in large unregulated dryland rivers W. J. Young and R. T. Kingsford; 3. Variability, complexity and diversity - the geomorphology of river ecosystems in dryland regions M. C. Thoms, P. H. Beyer and K. H. Rogers; 4. Aquatic productivity and food webs of desert river ecosystems S. E. Bunn, S. R. Balcombe, P. M. Davies, C. S. Fellows and F. J. McKenzie-Smith; 5. Disturbance of plant communities dependent on desert rivers M. A. Brock, S. J. Capon and J. L. Porter; 6. Natural disturbance and aquatic invertebrates in desert rivers A. J. Boulton, F. Sheldon and K. M. Jenkins; 7. Vertebrates of desert rivers - meeting the challenges of temporal and spatial unpredictability R. T. Kingsford, A. Georges and P. J. Unmack; Part II. Human Disturbance in Desert River Systems: 8. Impacts of dams, river management and diversions on desert rivers R. T. Kingsford, A. D. Lemly and J. R. Thompson; 9. Serial weirs, cumulative effects: the Lower River Murray, Australia K. F. Walker; 10. Salinisation as an ecological perturbation to rivers, streams and wetlands of arid and semi-arid zones P. C. E. Bailey, P. I. Boon, D. W. Blinn and W. D. Williams; 11. Water scarcity: politics, populations and the ecology of desert rivers M. Wishart; 12. Changing desert rivers R. T. Kingsford; Index.
Customer Reviews
Average Review:
and post it to your social network
Most Helpful Customer Reviews
See all customer reviews >


text:
Bob Garfield:
Garfield at Large
Barbara Lippert:
J. Max Robins:
TV Everywhere
MediaPost Week in Review
Online Spin
Current Stories
MediaPost Home
Today's News
Today's Opinions
Agencies &
The Agency Business
MAD: MediaPost's Agency Daily
Accounts in Review
Events Calendar
Out to Launch
People on the Move
Stan Mack's Real Mad
MAD - London
Online Media, Marketing
and Advertising
OMMA Today
Daily Online Examiner
Email Marketing Daily
Email Insider
Email Insider Europe
Mobile Shop Talk
Mobile Insider
Search Marketing Daily
Search Insider
Social Media & Marketing Daily
The Social Graf
Social Insider
Online Media, Marketing
and Advertising
Real-Time Daily
RTB Insider
Data & Targeting Insider
Video Daily
Video Critique
Video Insider
Publishing & Publishers
Publishers Daily
The Daily Blog
Publishing Insider
Native Insider
Internet of Things
IoT Daily
Connected Thinking
Media Buying/Planning/Research
& The Media
Audience Buying Insider
Metrics Insider
Research Brief
TV Watch
TV Everywhere
Brand and Product Marketing
Around the Net in Brand Marketing News
Thom Forbes: Top of the News
Engage Target Market Newsletters
Industry Sector Newsletters
Marketing Tools & Strategies
Content Marketing,
Events Home
Upcoming Events
Masters of Media Selling
October 6 - 7, 2015, Chicago
Publishing Insider Summit
October 11 - 14, 2015, NC
OMMA Chicago
October 27 - 28, 2015, CHI
Digital Out of Home Awards
November 3, 2015, NYC
Marketing: Automotive
November 9, 2015, NYC
Marketing: Sports
November 10, 2015, NYC
Masters of Media Selling
November 17 - 18, 2015, NYC
Email Insider Summit
December 6 - 9, 2015, UT
Masters of Media Selling
December 8 - 9, 2015, LA
Search Insider Summit
December 9 - 12, 2015, UT
Creative Media Awards
January 21, 2016, NYC
Programmatic Insider Summit
February 21 - 24, 2016, AZ
Cross-Channel Marketing Insider Summit
February 24 - 27, 2016, AZ
Appy Awards
May 16, 2016, NYC
Complete 2016 Events Calendar
Recently Concluded
OMMA Programmatic Display
October 1, 2015, NYC
OMMA Programmatic Mobile
October 1, 2015, NYC
OMMA Programmatic Video
September 30, 2015, NYC
OMMA Programmatic TV
September 30, 2015, NYC
OMMA Audience Buying
September 29, 2015, NYC
OMMA Attribution
September 29, 2015, NYC
OMMA Programmatic in New York
September, 2015, NYC
OMMA Awards
September 28, 2015, New York
Masters of Media Selling
September 23 - 24, 2015, SF
Engage: Hispanics
September 17, 2015, NYC
Engage: Millennials
September 16, 2015, NYC
Cross-Channel Marketing Insider Summit
August 19 - 22, 2015, CA
Programmatic Insider Summit
August 16 - 19, 2015, CA
IOT: Shopping
August 6, 2015, NYC
July 21 - 22, 2015, LA
More Events
Agency of the Year
Content Marketing Insider Summit
Email Insider Summit Europe
Future of Media
IOT: Advertising
Marketing: Health
Marketing: Politics
Media Agency of the Year
Mobile Insider Summit
OMMA at SXSW
OMMA mCommerce
OMMA Miami
Online All Stars
Outfront Forum
Social Media Insider Summit
Video Insider Summit
Awards Home
Agency of the Year (January 13, 2015, NYC)
Appy Awards (May 16, 2016, NYC)
Creative Media Awards (January 21, 2016, NYC)
Digital Out of Home Awards (November 3, 2015, NYC)
Media Agency of the Year (January 14, 2014, NYC)
OMMA Awards (September 28, 2015, New York)
Online All Stars (January 15, 2015, NYC)
Become A MediaPost Member
Subscribe to your choice of industry specific newsletters, save $100 on conferences, search member directories, comment on stories and more. Free to qualified media, marketing and advertising professionals.
Join Now
Member Resources
All Member Directory
Manage My Account
Manage My Subscriptions
Additional Resources
Feedback Loop (Comments)
Job Postings
Research Briefs
Industry Events
About and Contacts
About MediaPost
Contact Editorial
Media Kit
Sign in
Register Now
Remember me
Forgot your password?
Advanced Search
Results for January 2011
Digital IPO Hunger Resembles Dot.com Boom: Frenzy Before Fiscal Sense
On Media, Diane Mermigas - Friday, January 28, 2011
The stock market is getting frothy again over hefty bets being placed ...
Chief Information Officer, Meet Chief Marketing Officer
Around the Net In Brand Marketing, Karl Greenberg - Friday, January 28, 2011
As marketing has become a digital affair, the silos between CMO and ...
PwC: Media M&A Best, But Not Great
Around the Net In Online Marketing, Gavin O'Malley - Friday, January 28, 2011
While it outpaced the overall U.S. deal market, entertainment and media industry ...
Shaun White Gets Behind The Wheel For BFGoodrich
Marketing Daily, Karl Greenberg - Thursday, January 27, 2011
The Olympic medalist, uber-decorated X Games athlete, and superhuman practitioner of all ...
The Daily To Go Daily Feb. 2nd
MediaDailyNews, - Friday, January 28, 2011
News Corp. Thursday confirmed that it will launch
The Daily
, it's much ...
Mag Bag: PixelMags Unveils Digital Publishing Portal
MediaDailyNews, Erik Sass - Thursday, January 27, 2011
Magazine publishers are getting more resources for creating digital editions for Apple's ...
Super Bowl Scores More Digital Viewers
MediaDailyNews, Wayne Friedman - Wednesday, January 26, 2011
Young Super Bowl TV watchers 18-34 who have smartphones will be using ...
Why Digital Music Has (Sort Of) Failed
Around the Net In Online Marketing, Gavin O'Malley - Wednesday, January 26, 2011
Forrester Research analyst Mark Mulligan is (sort of) sticking by his contention ...
Kia Pulls Out Stops To Promo '11 Optima
Marketing Daily, Karl Greenberg - Tuesday, January 25, 2011
This year, Kia is taking a page out of sibling Hyundai's big-voices, ...
Meredith Registers Rev Growth Cross-Platform
MediaDailyNews, Wayne Friedman - Tuesday, January 25, 2011
Local television continues to be strong for TV station operators: Meredith Corp. ...
Thomson Reuters Campaign Touts 'Knowledge'
Marketing Daily, Aaron Baar - Monday, January 24, 2011
"What professionals need [is] highly qualified, customizable information," Gus Carlson, chief marketing ...
Coup On: AOL, Valassis Combine Digital Couponing Networks
Online Media Daily, Joe Mandese - Tuesday, January 25, 2011
Old school couponing and consumer promotion giant Valassis this morning announced a ...
Hyundai Effort Urges 'Don't Be A Sheep!'
Marketing Daily, Karl Greenberg - Thursday, January 20, 2011
You don't have to be a sheep and you don't have to ...
Pizza Hut Offers Movies-On-Demand Promos
Marketing Daily, Karlene Lukovitz - Thursday, January 20, 2011
What to do with that awkward window of time after you've ordered ...
The Three 'R's To Building A Successful OTC Digital Campaign
Marketing: Health, - Friday, January 21, 2011
Have you ever thought about what you'd do if you were tasked ...
RerunCentral Aggregates Web Links To Classic TV
MediaDailyNews, Wayne Friedman - Thursday, January 20, 2011
Another new digital video venture has launched -- this one more as ...
Digital Video Grabs 180 Million Visitors Monthly
MediaDailyNews, Wayne Friedman - Wednesday, January 19, 2011
San Francisco -- Big video usage numbers continue to come to the ...
Bakish Heads Viacom Media International
MediaDailyNews, Fern Siegel - Wednesday, January 19, 2011
Robert Bakish has been promoted to president and CEO of Viacom International ...
Ross Steps Down As Digitas Chief Growth Officer
Online Media Daily, - Thursday, January 20, 2011
Liz Ross is out as chief growth officer of Digitas. Details could ...
Companies To Buy 10 Million Tablets In 2011
Around the Net In Media, Fern Siegel - Wednesday, January 19, 2011
Companies will buy more than 10 million tablet computers this year, consultancy ...
Magna Global Forecast: Trad TV, Digital Reign
MediaDailyNews, David Goetzl - Tuesday, January 18, 2011
Magna Global predicts the U.S. ad economy will grow at a 3.1% ...
Falco Returns To TV Roots, Joins Univision As COO
MediaDailyNews, Diane Mermigas - Tuesday, January 18, 2011
Following a contentious stint at the helm of AOL, Randy Falco is ...
Agencies: Demand For Digital Media Services Wanes For First Time, Mobile Fails To Live Up To Hype
Online Media Daily, Joe Mandese - Wednesday, January 19, 2011
In a surprising development, demand for digital media and advertising services appears ...
ESPN Could Be Digital Sports Nirvana
On Media, Diane Mermigas - Friday, January 14, 2011
ESPN, one of television's most powerful brands, has everything it takes to ...
Raising Disclosure's Digital Profile
Marketing Daily, Rosanna Fiske - Friday, January 14, 2011
Buzzwords abound in the marketing, public relations and advertising industries. But one ...
Report: The Daily Won't Launch Next Week
MediaDailyNews, - Friday, January 14, 2011
News Corp and Apple are delaying the launch of
The Daily
, a ...
Digital Reach: Cox Media Acquires Internet Broadcasting Sales Group
MediaDailyNews, Wayne Friedman - Thursday, January 13, 2011
Cox Media Group, the big TV station sales rep, is further expanding ...
New Cox Division to Mix and Match Media
Around the Net In Media, Fern Siegel - Wednesday, January 12, 2011
Cox Cross Media, the digital sales arm of Cox Reps, has combined ...
Q&A: Crabtree & Evelyn Dials Up Digital, Direct
Marketing Daily, Sarah Mahoney - Wednesday, January 12, 2011
Tom Woodside is the new VP/marketing and e-commerce. He says that while ...
Ando's Krasinski Moves To Arbitron
MediaDailyNews, Erik Sass - Wednesday, January 12, 2011
Paul Krasinski, who recently served as COO for online measurement and analytics ...
Page 1 of 2.
Next Articles »
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
All Archives >
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008
About MediaPost
Contact Editorial
RSS Feeds
Privacy/Terms & Conditions
©2015 MediaPost Communications. All rights reserved.
15 East 32nd Street, 7th Floor, New York, NY 10016
tel. 212-204-2000, fax 917-591-3261,


text:
How Parents Influence Their Children's Education
Do You Push College More on Your Kid Than Your Parents Did?
Like us on Facebook
Image Source: Thinkstock
POPSUGAR, the #1 independent media and technology company for women. Where more than 75 million women go for original, inspirational content that feeds their passions and interests.


text:
Stationery Cards by ScriptShirts
Popular / New
Lotus Flower Bomb4$12 – $20 ScriptShirts
COTTON CANDY CLOUDS2$12 – $20 ScriptShirts
To add items to your wishlist, simply click the "Add to Wishlist" link from any product page.
Don't see Wishlist items you've previously added? Create an account or login now on all devices to sync your Wishlist.


text:
Coast Cottage
from £65 /night help Price for guests, Nights approx:
2 reviews
from £65 /night help Price for guests, Nights approx:
Estimated nightly price based on a weekly stay. Contact the advertiser to confirm the total cost.
Cottage / 3 bedrooms / sleeps 6 Home 275051
Availability Your dates are available
Cottage / 3 bedrooms / sleeps 6
|Key Info
Imagine gorgeous sea views through wrap-around patio doors. Imagine luxury leather sofas in a stylish and light living space. In the fridge is your complementary bottle of chilled wine ... Coast Cottage is a new and contemporary holiday house and the perfect place for year round memorable holidays. Ideal for families, golfers, surfers and walkers.
The beach, the rugged coast path and breath-taking scenery are just a short walk through your private gate at the end of the large secluded garden. You've got space to enjoy al fresco meals and wonderful sunsets. Explore deserted beaches during a winter break or simply stay indoors and enjoy the warmth of the wood-burner and Aga.
Locally you are spoilt for choice with shops, organic farm food, village pubs and Rick Stein's and Jamie Oliver's restaurants. Padstow, the fabulous Eden Project and many other attractions, including the Camel Trail are waiting within easy driving distance. Coast Cottage will prove an excellent coast retreat
|Sleeps up to 6, 3 bedrooms
|Nearest beach
|400 m
|Car advised
|Nearest travel links
|Nearest airport: Cornwall Newquay Airport 4.5 km
|Family friendly
|Great for children of all ages
|Some pets are welcome - please contact the owner, No smoking at this property
Features and Facilities
|Log fire, Internet access, DVD player, Sea view
|Central heating, TV, CD player, Telephone, Table tennis, Wi-Fi available
|Kettle, Toaster, Iron, Hair dryer
|Clothes dryer, Dishwasher, Cooker, Microwave, Fridge, Freezer, Washing machine
|3 bedrooms, 2 bathrooms of which 1 Family bathrooms and 1 En suites
|Double beds (1), Single beds (4), Cots (1), Dining seats for 6, Lounge seats for 6
|Linen provided, High chair
|Balcony or terrace, Private garden, BBQ
|Parking, Suitable for people with restricted mobility, Wheelchair users
|Further details indoors
Large double doors lead from the decking to contemporary open plan living and dining space. Striking artwork, lighting and luxury leather furniture give the house a unique and welcoming feel. Settle down in front of the wood-burner in winter. Watch flat screen TV, DVD, use the WiFi, or listen to CD player with iPod connection. Dine at the oak dining table that seats 6 looking out at the sea views.
The kitchen is designed for easy holidays with electric oven, gas hob, microwave & dishwasher. Families will find children's cutlery and crockery. The Aga gives you warmth and a taste of country living. Look in the fridge freezer for your complementary bottle of wine.
The main bedroom, with its white king size iron bed, looks towards the sea. Take your morning coffee straight into the garden from the bedroom - a great way to start the day. Each of the other 2 bedrooms has twin beds. Pillows, duvets, and sheets are included.
The large family bathroom includes a bath and walk-in shower, whilst the en-suite bathroom has a large luxury shower. The laundry room has a washer/dryer and the new high spec boiler for the gas central heating. All the rooms have radiators.
|Further details outdoors
The secluded southwest facing large garden is exceptional. You can kick a ball or throw a frisbee, enjoy barbecues or just laze away the summer sunshine. You can also use the outside shower to clean wetsuits and wash off the sand after a long day at the beach.
The large terrace area allows you to enjoy sunsets, outdoor meals during long summer evenings and games including table tennis on the full size table. There is a large drive for cars and also space for a boat. You can store your surf boards and hang up your wetsuits in the garage and there is a woodstore of logs available.
|Further details
• Power and heat are included. Gas central heating, electric oven, gas hob and hot water.
• Gas Aga and wood burner (logs provided).
• Bedding and linen are all incuded in the costs (except for the cot)
• Towels are available to hire.
• Use of the washer dryer is included.
• Coast Cottage is no smoking.
• Well behaved dogs welcome from September to March.
• Baby-sitting can be arranged. We will send you information with your booking details.
• High chair and cot included.
• Baby sitting service available
The Cornwall region
• A wealth of attractions within easy reach.
• The dramatic cliffs at Bedruthan Steps are just 1 mile away.
• Padstow is 20 minutes drive along the scenic coast road.
• The fantastic Eden project is 45 minutes away and the Lost Gardens of Heligan, Pencarrow House and Prideaux Place are very easily accessible.
• The National Trust also has several local properties, including at Lanhydrock.
• Walk down through the garden to the Scarlet Hotel for morning coffee on the sun deck, sea water hot-tubs overlooking the beach or treatments in their luxurious spa.
• Why not speed round the Go-Kart circuit at St Eval (only 5 minutes away), hire bikes and ride the Camel Trail or visit the Camel vineyard.
• Cornwall has so much to more to offer, such as the Tate Gallery in St Ives or Heartlands the new Cornwall World Heritage Site gateway.
• Fabulous golf courses nearby ranging from the championship course at the Trevose and the St Enodoc Golf Club at Rock, through to the Merlin Golf course (less than 1 mile away).
• Enjoy wonderful food and the fresh catch of the day - one of our favourites is the Falcon Inn at St Mawgan.
• Breakfast is fantastic at Jamie Oliver's Fifteen and needs no reservation or the Beach Hut at Watergate Bay. For special occasions book Rick Stein's Seafood Restaurant.
• Fish and chips from the Blue Fish Bar near the beach or on the harbour side in Padstow have become family favourites.
Mawgan Porth
• Mawgan Porth beach features in the official Good Beach Guide. Trained RNLI lifeguards are on duty from May to September.
• The surf at Mawgan Porth is ideal for both beginners and experienced surfers. Surf lessons available
• An amazing choice of excellent beaches including Watergate Bay to the south and north towards Constantine and Trevone.
• Down the road - Fire beachside restaurant and the Merrymoor Inn.
• Nearest pub ½ mile
• Local shops ½ mile
• 2 minute walk to hotel for beauty treatment
• Organic farm shops
• Home shopping delivery available to your door
Build your perfect trip, with Holiday Lettings & TripAdvisor
Real opinions, real reviews
Genuine guest feedback from 100,000+ reviews
Quick response times
Know where you're staying within 24 hours
Guest reviewsPowered by TripAdvisor
Guest reviews no reviews
Guest reviews Powered by TripAdvisor
- 5 star
- 2
- 4 star
- 0
- 3 star
- 0
- 2 star
- 0
- 1 star
- 0
Excellent 5/5
Help other travellers decide where to stay
Add your voice to the conversation about this holiday home and your review will appear on TripAdvisor too.Write a review
This advert is created and maintained by the advertiser; we can only publish adverts in good faith as we don't own, manage or inspect any of the properties. We advise you to familiarise yourself with our terms of use.
You're booking with
Rick & Joy W.
- 2 Years listed
100% Response rate
Calendar last updated:29 Sep 2015
Based in United Kingdom
- English


text:
NPR Newscast
4min 45sec
Teachers interact differently with students expected to succeed. But they can be trained to change those classroom behaviors.
hide caption
September 17, 2012 Teachers' expectations about their students' abilities affect classroom interactions in myriad ways that can impact student performance. Students expected to succeed, for example, get more time to answer questions and more specific feedback. But training aimed at changing teaching behavior can also help change expectations.
<iframe src="http://www.npr.org/player/embed/161159263/161248981" width="100%" height="290" frameborder="0" scrolling="no">
A less complicated time? Petula Clark holds her 1965 gold record for "Downtown," an uptempo song in a major key.
R. McPhedran/Getty Images
hide caption
September 4, 2012 Every Top 40 hit in 1965 was in a major key and had a fast tempo. In 2009, more than half of the Top 40 songs were in a minor key. Has there been a shift in the emotional content of music in the past five decades, and why are we drawn to sadness and ambiguity in music?
<iframe src="http://www.npr.org/player/embed/160548025/160562636" width="100%" height="290" frameborder="0" scrolling="no">
Research shows that under certain circumstances, we can train ourselves to forget details about particular memories.
hide caption
September 3, 2012 Our capacity to forget is as important, and certainly as interesting, as our ability to remember. But can we train ourselves to suppress certain memories, or the meaning we attach to life events?
<iframe src="http://www.npr.org/player/embed/160126283/160489181" width="100%" height="290" frameborder="0" scrolling="no">
August 17, 2012 A new study suggests using the term psychopath adds an average of five years to criminal sentences. But once a biological explanation was included, the length of the sentence dropped. In other words, our sympathy for the idea that biology might be responsible for criminal behavior is powerful.
<iframe src="http://www.npr.org/player/embed/158944525/158972090" width="100%" height="290" frameborder="0" scrolling="no">
Wanda Kaczynski and her son David Kaczynski (right background) are escorted to their car by defense lawyers after Unabomber Theodore Kaczynski pleaded guilty Jan. 22, 1998, in Sacramento, Calif.
John G. Mabanglo/AFP/Getty Images
hide caption
August 1, 2012 In the wake of mass murder, the families of victims must navigate a complicated emotional landscape. But so, too, must the families of those charged with the crimes. Among the questions such families must grapple with are troubling ones about their own responsibility.
<iframe src="http://www.npr.org/player/embed/157737038/157743017" width="100%" height="290" frameborder="0" scrolling="no">
July 16, 2012 Politics has been a profession ruled by gut instinct, gurus and polls. But over the past 15 years, the primary method of scientific advance — the randomized controlled study — has been wheedling its way into politics. Bit by bit, it's challenging a lot of the conventional wisdom that dominates current political campaigns.
<iframe src="http://www.npr.org/player/embed/156571493/156869007" width="100%" height="290" frameborder="0" scrolling="no">
Kimberly Payton, a teacher at the Small Savers Child Development Center, reads to a group of preschoolers in Washington, D.C., in 2010. Researchers say that teachers who make small changes in how they read to 4-year-olds can improve kids' reading skills later on.
Ricky Carioti/The Washington Post/Getty Images
hide caption
May 29, 2012 Researchers say that changing what 4-year-olds see and think about when a book is being read can improve kids' reading skills later on. The key: Focus their attention on the words instead of the pictures.
<iframe src="http://www.npr.org/player/embed/153927743/153935261" width="100%" height="290" frameborder="0" scrolling="no">
May 1, 2012 Enron, Worldcom, Bernie Madoff — the past decade has brought us a long parade of headlines involving unethical behavior. And that's led researchers to a disturbing conclusion: The vast majority of us are not only capable of behaving in profoundly unethical ways, but without realizing it, we do it all the time. Exhibit A: the story of Toby Groves.
<iframe src="http://www.npr.org/player/embed/151764534/151793586" width="100%" height="290" frameborder="0" scrolling="no">
People who are interested in and paying close attention to each other begin to speak more alike, a psychologist says.
hide caption
April 30, 2012 A psychologist says he can predict whether two people will end up on a date by analyzing their language style and use of certain words. His research on language can also help explain power dynamics between people.
<iframe src="http://www.npr.org/player/embed/151550273/151670960" width="100%" height="290" frameborder="0" scrolling="no">
Republican presidential candidates Rick Santorum and Mitt Romney clashed often during Wednesday's GOP debate.
Jae C. Hong/AP
hide caption
March 5, 2012 Why are politicians and those of us who vote for them so obsessed with inconsistency?
<iframe src="http://www.npr.org/player/embed/147807206/147948078" width="100%" height="290" frameborder="0" scrolling="no">
February 21, 2012 The March issue of the medical journal Pediatrics features an editorial looking at gender identity disorder in children. Pediatricians apparently are seeing more young patients who express an interest in changing their gender.
<iframe src="http://www.npr.org/player/embed/147180163/147180136" width="100%" height="290" frameborder="0" scrolling="no">
February 7, 2012 A fresh analysis finds no increase in suicide among young people taking Prozac. The results add a wrinkle to the long-running debate over the safety of the medicines for the treatment of depressed young people.
The antidepressant Prozac selectively targets the chemical serotonin.
Paul S. Howell/Getty Images
hide caption
January 23, 2012 The antidepressant Prozac selectively targets the chemical serotonin. When the drug was introduced in the 1980s, it helped solidify the idea in many minds that depression was the result of a chemical imbalance. But the real story is far more complicated.
<iframe src="http://www.npr.org/player/embed/145525853/145627739" width="100%" height="290" frameborder="0" scrolling="no">
U.S. soldiers at Long Binh base, northeast of Saigon, line up to give urine samples at a heroin detection center in June 1971, before departing for the U.S.
hide caption
January 2, 2012 In the 1970s, a sizable number of U.S. servicemen in Vietnam self-identified as heroin addicts. But when they returned stateside, the number of these soldiers who continued their addiction was surprisingly low. Why? Turns out a massive disruption in their environment and routine played a big role in helping them change their behavior.
<iframe src="http://www.npr.org/player/embed/144431794/144570176" width="100%" height="290" frameborder="0" scrolling="no">
Indian firefighters attempt to put out a fire as smoke billows out of the historic Taj Mahal Hotel in Mumbai, which was stormed by armed gunmen in November 2008.
Indranil Mukherjee/AFP/Getty Images
hide caption
December 23, 2011 When a Mumbai hotel was besieged by terrorists in 2008, something extraordinary happened: Workers didn't flee. They stayed behind to help save guests at the risk of their own lives. What could possibly explain it? A new study attempts to answer that question.
<iframe src="http://www.npr.org/player/embed/144184623/144197420" width="100%" height="290" frameborder="0" scrolling="no">
NPR thanks our sponsors
Become an NPR sponsor


text:
Page 1
Integrated optical tools for minimally invasive diagnosis
and treatment at gastrointestinal endoscopy
Eladio Rodriguez-Diaza, Irving J. Bigioa,b, Satish K. Singha,b,n
aSection of Gastroenterology, Department of Medicine, School of Medicine, Boston University Medical Campus, Boston, MA, USA
bDepartment of Biomedical Engineering, Boston University, Boston, MA, USA
a r t i c l e i n f o
Gastrointestinal Endoscopy
Confocal Microscopy
Gastrointestinal Cancer
Minimally Invasive Surgical Procedures
a b s t r a c t
Over the past two decades, the bulk of gastrointestinal (GI) endoscopic procedures has shifted away
from diagnostic and therapeutic interventions for symptomatic disease toward cancer prevention in
asymptomatic patients. This shift has resulted largely from a decrease in the incidence of peptic ulcer
disease in the era of antisecretory medications coupled with emerging evidence for the efficacy of
endoscopic detection and eradication of dysplasia, a histopathological biomarker widely accepted as a
precursor to cancer. This shift has been accompanied by a drive toward minimally invasive, in situ
optical diagnostic technologies that help to assess the mucosa for cellular changes that relate to
dysplasia. Two competing but complementary approaches have been pursued. The first approach is
based on broad-view targeting of ''areas of interest'' or ''red flags''. These broad-view technologies
include standard white light endoscopy (WLE), high-definition endoscopy (HD), and ''electronic''
chromoendoscopy (narrow-band-type imaging). The second approach is based on multiple small area
or point-source (meso/micro) measurements, which can be either machine (spectroscopy) or human-
interpreted (endomicroscopy, magnification endoscopy), much as histopatholgy slides are. In this paper
we present our experience with the development and testing of a set of familiar but ''smarter'' standard
tissue-sampling tools that can be routinely employed during screening/surveillance endoscopy. These
tools have been designed to incorporate fiberoptic probes that can mediate spectroscopy or
endomicroscopy. We demonstrate the value of such tools by assessing their preliminary performance
from several ongoing clinical studies. Our results have shown promise for a new generation of
integrated optical tools for a variety of screening/surveillance applications during GI endoscopy.
Integrated devices should prove invaluable for dysplasia surveillance strategies that currently result in
large numbers of benign biopsies, which are of little clinical consequence, including screening for
colorectal polyps and surveillance of ''flat'' dysplasia such as Barrett's esophagus and chronic colitis due
to inflammatory bowel diseases.
& 2010 Elsevier Ltd. All rights reserved.
1. Introduction
biopsy,'' is a rapidly emerging field within the field of biopho-
tonics [1]. Ideally when using spectroscopy, some form of
spectroscopic analysis is performed on measurements collected
from precisely the volume of tissue that will be examined
histopathologically. The ultimate goal then is to attempt to obtain
a diagnosis of the tissue based on these measurements, in situ,
with minimal invasion and in real-time. Clearly, there is the
potential for the reduction of overall procedure costs, patient
distress, and risks as a consequence of biopsying and processing
only diseasedtissue.Some
Raman spectroscopy [2], autofluorescence spectroscopy [3–6],
fluorescencespectroscopy [7–11],
[7,8,11–14], and elastic-scattering spectroscopy [1,15–17]. Much
work has focused primarily on UV-induced fluorescence spectro-
scopy, given the assumption that important biochemical changes
associated with disease alter the intrinsic fluorescence spectrum
of tissue. Elastic Scattering Spectroscopy (ESS), however, is
capable of reporting cellular and subcellular architectural features
that are a typical part of a pathologist's microscopic assessment
and diagnosis. ESS measurements can be performed via fiberoptic
probes and hold great promise for in vivo screening and
identification of neoplastic tissues. ESS diagnosis can be based
either on heuristic models [18] that predict changes in the
scattering spectrum corresponding to altered ultrastructure, or on
quantitative models [19] that have been used to determine
nuclear size in epithelial layers.
Indeed, with the appropriate optical geometry, ESS can report
the size, structure, and index of refraction of subcellular
Contents lists available at ScienceDirect
journal homepage: www.elsevier.com/locate/rcim
Robotics and Computer-Integrated Manufacturing
0736-5845/$-see front matter & 2010 Elsevier Ltd. All rights reserved.
nCorresponding author at. Section of Gastroenterology, Department of Medicine,
School of Medicine, Boston University Medical Campus, Boston, MA, USA.
E-mail address: email@example.com (S.K. Singh).
Robotics and Computer-Integrated Manufacturing 27 (2011) 249–256
Page 2
[18–20]. ESS spectra relate to the wavelength-dependence and
angular-probability of scattering efficiency of tissue micro-
structures (as well as to absorption bands), generating spectral
signatures that correlate with histolgical features such as the size/
shape of subcellular components, nuclear-cytoplasmic ratio, and
cell/organelle clustering patterns. Scattering is generated by
gradients of the optical index of refraction and ESS spectral
signatures will be altered if the refractive index of subcellular
structures changes, say, due to an increase in the amount and/or
granularity of chromatin. Since the dimensions of subcellular
components are on the order of the wavelength of visible-near-IR
light, approximations of scattering theory (e.g. Rayleigh approx-
imation) are not suitable for mathematical simulations and
methods such as Mie theory are more appropriate for under-
standing the spectral changes [21].
There are a number of clinical correlations of scattering spectra
with mucosal histopathology. The potential clinical utility of ESS
for endoscopic dysplasia and/or cancer detection biopsy has been
reported in hollow organs including the urinary bladder [21],
esophagus [22–26], and colon [27–29]. ESS was first applied
in vivo in the urinary bladder by Mourant, Bigio, and colleagues,
where sensitivity and specificity for the detection of malignant
tissue in a retrospective analysis from a small sample size (110
biopsy sites from 10 patients) were excellent [21]. More recently,
ESS has been studied for the diagnosis of luminal gastrointestinal
tract neoplasms. Bigio et al. used colorectal ESS measurements
(60 sites from 16 patients) to develop a spectral metric based
on regions of the hemoglobin absorption bands (400–440 and
540–580 nm) to identify 8 sites that were neoplastic, adenoma-
tous, and/or cancerous, also with good retrospective statistics
[22]. In a larger study by Ge et. al., neoplastic and hyperplastic
colonic polyps could be distinguished using ESS and neural-
network pattern recognition for spectral classification [28]. In
addition, Zonios et al. have published a study applying ESS to the
classification of colon polyps [29]. Wallace et al. have also adapted
ESS to identify dysplastic Barrett's esophagus with a sensitivity
and specificity of 82% and 80%, respectively [30].
All of these studies were validated by taking ESS mucosal
readings (''optical biopsy'') with a fiberoptic probe inserted
through the working channel of an endoscope. The probe was
then removed and a surgical tissue-sampling tool, usually a
forceps, was introduced to obtain a pinch biopsy of what was the
best estimate of the location from which the ESS measurement
had been obtained. The physical biopsy specimens were then
assessed by ''gold standard'' histopathology and correlated to
spectra. The experience from those studies reveals a strong
rationale for incorporating ESS probes into biopsy tools. ESS is a
site-specific measurement that samples a tissue volume of
o0.5 mm3of the tissue surface at the point of contact of the
fiber probe. As such, with small mucosal areas being interrogated,
co-registration of separate optical and physical biopsies is subject
to imperfect co-registration of the optical reading and the tissue
sample removed for histopathological analysis. Indeed, the fact
that ESS studies have performed as well as they have in detecting
dysplasiadespite imperfect
ESS would perform even better when validated with absolute
co-registration of optical and physical biopsies. Equally impor-
tant, integrated tools would be familiar, more convenient, less
disruptive to endoscopic flow and would improve throughput by
shortening procedure times.
Compared to endomicroscopic approaches like confocal micro-
scopy and optical coherence tomography (discussed below), ESS is
potentially much more cost-effective and accessible to the general
GI community. Confocal endomicroscopy, while a powerful
commercially available technology, remains costly, requires the
that changeuponneoplastictransformation
co-registration suggests that
administration of an IV fluorescent dye and presently requires
that microscopic images be interpreted by the operator. As such, it
is a technology more appropriate for specialized centers of
advanced endoscopy [31]. Similarly, intravital optical coherence
tomography (OCT) [32–37] is another sophisticated high-resolu-
tion mucosal imaging technique that is not optimally suited for
widespread use, as it requires non-standard image interpretation
by the endoscopist. For both confocal microscopy and OCT, the
operator requires substantial competence from specialized train-
ing to become both a skilled advanced endoscopist/intervention-
alist as well as ''real-time pathologist,'' capable of interpreting
histopathological images in real-time.
Indeed, confocal laser endomicroscopy (CLE) is receiving
increasing interest and adoption by advanced centers as an
endoscopic modality for obtaining very high-resolution magnified
images within the mucosal layer of the GI tract. The CLE
technology is based on tissue illumination with a low-power
laser followed by detection and creation of an optically sectioned
image by rejecting out-of-focus fluorescent light using variations
of the scanning ''pinhole'' principle [38,39]. Because CLE detects
fluorescence and because endogenous tissue autofluorescence is
low, use of a fluorophore-containing contrast agent, administered
either locally or intravenously, is required to generate high-
quality images that are comparable with traditional histologic
examination [40,41]. Recently, a confocal laser endomicroscope
has been developed that uses a probe that can be passed to the
distal tip of virtually any conventional endoscope via the
accessory channel to enable subsurface imaging of living tissue
during procedures [42]. This approach, while usable with any
endoscope, still poses the same issues of a probe-based spectro-
scopic approach in that the probe must be removed to allow
passage of a biopsy tool whenever a biopsy is required further
disrupting clinical flow and increasing procedure time.
2. Materials and methods
2.1. Elastic-scattering spectroscopy
Our group at Boston University (continuing earlier work by
Bigio and colleagues, started at Los Alamos National Laboratory)
[18,21,43–46] developed the method of ESS. ESS, when performed
with specific fiberoptic geometries, is sensitive to the absorption
spectra of major chromophores (e.g. oxy-/deoxy-hemoglobin)
and, more importantly, reports morphological features from
superficial tissues. ESS spectra derive from the wavelength-
dependent optical scattering efficiency (and the effects of changes
in the scattering angular probability) caused by optical index
gradients exhibited by cellular and subcellular structures. Unlike
Raman and fluorescence spectroscopy, ESS provides largely
micro-structural, not biochemical information. Thus, ESS is
sensitive to features such as nuclear size, crowding and
and organellar size and density (Fig. 1A). Because abnormal
tissues are often associated with changes in subcellular, nuclear
and organellar features, scattering signatures represent the
spectroscopic equivalent of a histopathological interpretation.
However, the ESS method senses these morphology changes in a
semi-quantitative manner,without
microscopic structure [47,48].
In practice, ESS is a point-spectroscopic measurement taken
over a broad wavelength range (320–900 nm) – not an imaging
modality – and samples a tissue volume ofr0.50 mm3. Probes
are, typically, used in optical contact with the tissue under
examination and have separate illuminating and collecting
fibers (Fig. 1B). Collected light transmitted to the analyzing
actuallyimaging the
E. Rodriguez-Diaz et al. / Robotics and Computer-Integrated Manufacturing 27 (2011) 249–256
Page 3
spectrometer must first undergo one or more scattering events
through a small volume of the tissue before entering the
collection fiber(s). No light is collected from surface Fresnel
reflection. The standard ESS catheter-type probe consists of a pair
of fibers (each with a core diameter of 200 mm) with center-to-
center separation of about 250 mm. Due to the small separation of
the source and detector fibers, the collected light predominantly
samples the mucosal layer, which is typically 300–400 mm thick
in the GI tract. Novel tilted-fiber designs can restrict the collected
light to even shallower depths [49]. Given the small source–
detector separation of the ESS geometry, the method is more
sensitive to scattering properties than to absorption [20],
although strong absorbers such as oxy- and deoxy-hemoglobin
can be quantified. Fig. 2 shows a schematic diagram of the
primary system components and photos of the current-generation
experimental system. Each measurement takes about 30 ms, and
it is possible to perform several measurements per second,
limited by the time to move the probe from spot to spot.
While small-area measurements with ESS are a disadvantage
for screening large mucosal regions, surveillance of larger areas
can be achieved by making many point measurements in rapid
succession. The fact that ESS provides specific information about
small areas of tissue provides the rationale for incorporating ESS
probes into biopsy forceps tools, especially for gastrointestinal
applications. Development and validation studies require precise
co-registration of optical measurement sites and surgical biopsies,
currently not reliably achieved by existing methods. Presently,
fiber probes are passed endoscopically to the mucosa of interest
and measurements are taken. The probe is then removed and a
forceps is passed to obtain a pinch biopsy of a best estimate of the
ESS measurement spot. This process does not reliably correlate
the optical measurement to the physical biopsy for validation
studies and unnecessarily extends procedure time.
2.2. Confocal endomicroscopy
Laser-scanning confocal microscopy is an adaptation of light
microscopy, whereby focal laser illumination is combined with
pinhole limited detection to geometrically reject out-of-focus
light. In single-point scanning confocal microscopes, the point is
typically scanned in a raster pattern, and measurement of light
returning to the detector from successive points is digitized, so
that an image of the scanned region can be constructed.
Importantly, each resultant image is an ''optical section'' repre-
senting approximately one focal plane within the specimen [50].
The device in this study uses a miniaturized confocal microscope
in which a single optical fiber acts as both the illumination point
source and the detection pinhole, allowing the small scale
required for integration into a biopsy tool [51].
Thecomponents of the confocal
(Cellvizio, Mauna Kea Technologies, Paris, France) are shown in
Fig. 3. The miniprobe used to integrate into the CLE-guided snare
tool was designed for intra-biliary imaging (CholangioFlexTM). This
probe is 1.2 mm in diameter, images at a fixed depth of 55 mm,
with a maximal field of view of 320 mm and lateral resolution of
3.5 mm [52–54]. The fiber probe consists of a bundle of 10,000
optical fibers with a distal lens and proximal precision connector.
The probe is designed with a semiconductor that oscillates a
488 nm laser light at a rate that enables an acquisition frame rate
of 12 images per second. The fluorescence signal returning from
the tissue is converted into an image using a detector (avalanche
photodiode) and software/hardware systems for image correction,
stabilization and display [55,56]. These instruments are encased in
an FDA-approved clinical laser-scanning unit.
laser endomicroscope
2.3. Integrated optical biopsy tools
The business of endoscopic polyp surveillance has a major
efficiency barrier: At present, it is virtually impossible to
distinguish a neoplastic from a non-neoplastic polyp by its
fiber probe
Fig. 1. Cartoon illustration of optical scattering from density gradients in cells (A)
and a diagram of the optical geometry for the fiberoptic tissue measurements (B).
Fiber tips are in optical contact with the tissue surface. Only light that has
scattered elastically within the epithelial layer is collected.
Fig. 2. Schematic diagram of the ESS system (A), photos of the ESS instrument (B)
and the flexible fiberoptic catheter-type probe used for previous ESS studies (C).
Fig. 3. Cellvizio confocal laser endomicroscopy system (A). Laser-scanning unit
(B). CholangioFlexTMminiprobe (C).
E. Rodriguez-Diaz et al. / Robotics and Computer-Integrated Manufacturing 27 (2011) 249–256
Page 4
endoscopic view. As such, the current standard of practice is to
remove and examine all polyps histopathologically. While the
term ''polypectomy'' implies a straightforward process, removing
polyps using a standard colonoscope, in fact requires several
discrete, time-intensive steps: (1) identification of the polyp, its
size, margins and extent; (2) optimal repositioning of the
endoscope to effect polypectomy; (3) definitive excision and/or
ablation of the polyp; (4) retrieval of polyp tissue and; (5)
histopathological processing and interpretation of the biopsy.
Small polyps can be removed or electro-ablated in jaw-type
forceps and retrieved through the endoscope channel within
closed jaws either in toto or piecemeal. Larger polyps, however,
require the use of a snare or ''garroting'' device to excise them. If
the tissue fragments areo4 mm, it is often possible to retrieve
them by removing the snare device and sucking the tissue into a
trap via scope's accessory/suction channel. If44 mm, however,
the polyp will not fit into the accessory/suction channel and must
be retrieved by (1) removing the snare, (2) passing a grasping
device or expandable basket through the lumen, (3) stabilizing
the excised tissue at the end of the scope within the grasping
device/basket, while (4) withdrawing the entire scope from the
patient, and (5) harvesting the tissue. The scope is then (6)
reintroduced and (7) once again negotiated to the site of the last
polypectomy. It follows that this process can be tedious and time-
consuming, especially in patients with multiple large polyps.
Thus, depending on the number of larger polyps a patient has, he/
she will effectively undergo multiple colonoscopies or passes of
the scope, greatly prolonging total procedure time. There is need
for a reliable way to identify instantly whether a polyp is
neoplastic in situ.
An integrated tool combining an ESS probe with a biopsy
forcep/snare is needed, as it would shorten the time required to
obtain a biopsy of a measured spot and would greatly increase the
spatial correlation of biopsies with the precise spot from which
ESS measurements were made. An ESS probe integrated into a
biopsy forceps simplifies the process and guarantees accurate co-
registration of physical biopsies with ESS measurement spots.
Thus, optically guided biopsy tools represent a major step forward
for dysplasia detection in the GI tract. Our group has designed and
prototyped two ESS optical biopsy tools that address distinct
applications: the ESS optical forceps and the ESS optical snare. The
ESS optical forceps, used for interrogating and biopsying suspect
tissue, consists of an ESS probe comprising two 200 mm fibers,
installed in a traditional jaw-type biopsy forceps tool, modified
with a hollow central channel along its length. The design is such
that the probe is actuated to protrude out from between the jaws
when open, permitting optical contact with the mucosa, while
measurements are obtained (Fig. 4). In this earliest incarnation,
SpectraScience, Inc., which uses only one fiber and is intended
for fluorescence spectroscopy of the tissue.
The snare technique is the standard approach used to remove
pedunculated polyps at colonoscopy. A nickel-titanium ''shape-
memory alloy'' wire loop is lassoed over the top of the polyp and
pulled snugly around the stalk. The stalk is then ''garroted'' by
pulling the wire until the stalk is transected with or without
electrocautery. The tissue is retrieved and forwarded to pathol-
ogy, fixed, sectioned, stained, and assessed for dysplastic or
neoplastic tissue within the polyp, down the stalk and to the
resection margin. A ''smart'' snare system could identify the lower
border of dysplastic tissue prior to transection of the stalk. The
smart snare would have utility for the piecemeal removal of flat
and sessile polyps as well, where mucosa bunched up and grasped
by the snare could be assessed for dysplastic mucosa and
removed. To this end we developed the ESS optical snare, which
uses a custom-extruded dual-lumen tubing permitting passage of
the cautery snare as well as of the optical probe (Fig. 5).
Subsequent resections of the surrounding tissue could be guided
by ESS measurements to ensure that all dysplastic tissue has been
excised and/or ablated. The same approach was used to develop a
''smart'' snare system using confocal endomicroscopy. In this case
the confocal miniprobe is passed through the custom extruded
dual-lumen tubing as in the ESS optical snare. This arrangement
permits real-time imaging of the mucosal layer of polyps prior to
polypectomy or after to confirm complete resection of dysplasia.
Optically guided biopsy would enable excision and/or ablation
to be performed, while polyp retrieval might be rendered
optional, only adenomatous polyps need to be retrieved for histol-
ogy and consequent risk assesment. Additionally, the reduced
number of retrieved samples would yield savings in the cost of
histopathology. The rare case of a false-negative by the optical
diagnosis would impart no risk to the patient, because it would be
excised anyway (and excreted naturally)—simply not retrieved.
The improved efficiency and efficacy of the colonoscopy/
treatment procedure itself would impart significant patient
design is essentiallysimilar toa forcepsmade by
Biopsy Forceps
Side ViewSide View
End View
End View
Biopsy Forceps
Side View
Optical Fibers
Fig. 4. A 2-dimensional diagram of the forcep tip is depicted. The optical forcep is
a modified traditional endoscopic jaw-type biopsy forcep (A) with a central
channel through which fiberoptic probes can be introduced for tissue measure-
ments (B). A photograph of a clinically-usable unit (C), standard biopsy forceps
(left), ESS integrated optical forceps (right).
Fig. 5. Cross-section and prototype of an ESS optical snare. Custom extruded dual-
lumen tubing permits passage of both the cautery wire and 2-fiber ESS probe.
E. Rodriguez-Diaz et al. / Robotics and Computer-Integrated Manufacturing 27 (2011) 249–256
Page 5
benefits, allowing more physician time for careful inspection, and
would further reduce the burden on the health care system.
3. Results and discussion
In this section preliminary results from ongoing IRB-approved
clinical studies are presented. Unlike earlier reported results, this
endoscopic approach to scattering spectroscopy with integrated
tools provides absolute co-registration of optical and physical
biopsies. For each of the studies, patients from our existing
screening/surveillance pool for colonoscopy, or upper GI endoscopy
in the case of Barrett's Esophagus surveillance, were recruited and
consented. Their examinations followed current standard of care,
with the only difference being the use of the integrated optical
tools whenever endoscopic tissue sampling was indicated accord-
ing to accepted standards. Optical measurements were then taken
prior to biopsy or resection, and the tissue obtained was submitted
for standard histopathological diagnosis, and reviewed by three
independent pathologists. ESS spectra were correlated to the
consensus majority of the histopathology results. Following
spectral feature selection by principle component analysis (PCA)
[57] a linear support vector machine classifier [58,59] was trained
on the extracted features. Leave-one-out cross-validation was used
to obtain performance estimates. This type of pattern recognition
based spectral analysis is similar to approaches used in [24,27,28]
for classification of light scattering spectroscopy data.
3.1. ESS optical forceps
The ESS optical forceps were tested for detecting colonic
neoplasia during routine colonoscopies. When a polyp was
encountered, as determined by the endoscopist, the optical probe
in the forceps was put in gentle contact, with jaws open, against
the polyp mucosa. Optical readings were then taken before
closing the forceps' jaws to complete the biopsy. By using the ESS
optical forceps we are assured that the optical reading will
precisely correlate to the location of the biopsy. As seen in Table 1,
data from 65 patients has been collected, 96 spectra from 52
neoplastic polyps and 172 spectra from 89 non-neoplastic polyps
(normal or hyperplastic histology). From this preliminary dataset,
a sensitivity of 0.83, specificity of 0.81 and negative predictive
value (NPV) of 0.90 were obtained (Table 2). The negative
predictive value, which is the most important statistic for this
application, could be increased even further at the expense of a
modest reduction in specificity. Thus, integrated ESS optical
forceps are able to co-register optical and physical biopsies and
analysis to date is highly encouraging for device's ability to
reliably classify neoplastic colonic polyps.
The ESS optical forceps have also been used for surveillance of
Barrett's esophagus. Patients who were scheduled for an upper
endoscopy for Barrett's esophagus, or those in whom disease has
advanced (dysplastic Barrett's or carcinoma) were candidates for
the study. All patients received standard treatment i.e., routine
esophageal endoscopy with random multiple physical biopsies
using the standard or intensive Seattle Protocol as appropriate. As in
the colon study, the optical readings were obtained by first touching
the tissue while the jaws of the ESS forceps are open, placing the
optical fibers in contact with the mucosa. At the end of the
acquisition of optical data, the jaws were closed, thus physically
biopsying precisely the same tissue that was read optically. A total
of 33 patients have been recruited for the study (Table 1), resulting
in 105 ESS spectra of non-dysplastic Barrett's esophagus (NDBE), 16
spectra of dysplastic Barrett's esophagus (DBE) and 64 of gastric
columnar epithelia (GCE). A sensitivity of 0.81 and specificity of 0.88
was obtained for distinguishing DBE from NDBE, 0.88 and 0.94 for
DBE from GCE, and of 0.90 and 0.83 for distinguishing NDBE from
GCE (Table 2). These results show promise for using the ESS optical
forceps in the screening of Barrett's esophagus.
3.2. ESS optical snare
Recent clinical testing has also begun with the ESS optical
snare. In a separate study, subjects were recruited from a pool of
patients referred for routine colonoscopy. When polypectomy of
larger polyps (44–5 mm) was indicated, an ESS optical snare was
used to obtain ESS readings from tissue prior to electrocautery.
The tip of the closed optical snare device was placed in contact
with polyps and spectra were obtained, followed by electro-
cautery excision of the polyp. Thus far, from a total of 10 patients,
45 spectra from 13 neoplastic polyps and 60 spectra from 10 non-
neoplastic polyps have been taken with the ESS optical snare
(Table 1). From this, a sensitivity of 0.80 and specificity of 0.87
have been obtained for distinguishing neoplastic from non-
neoplastic polyps (Table 2). From these results, we can see that
the ESS optical snare is a promising technology for diagnosing and
snaring larger colonic polyps in real time at colonoscopy.
3.3. Confocal endomicroscopy snare
The confocal endomicroscopy snare is currently being used in a
clinical study on patients undergoing routine colonoscopy. Once a
polyp is identified using standard white light endoscopy, the
patient is subsequently given 1 mL of fluorescein intravenously.
The confocal snare is inserted through the working channel of the
endoscope and used to examine every macroscopically visible
lesion. The distal tip of the confocal probe is placed in gentle
contact with the identified tissue and the position of the focal
plane within the specimen is adjusted using the buttons on the
endoscope control body (Fig. 6A). The probe was used to confirm
complete resection of the polyp (Fig. 6B) once polypectomy has
been finished. Video loops of each colonic polyp are obtained and
stored as digital files using the Cellvizio platform. After image
interpretation by an expert, the presence of neoplasia can be
observed on the acquired images from the polyp (Fig. 7A), as well
as its absence once the polyp has been completely removed
(Fig. 7B).
Table 1
Preliminary data breakdown for each of the studies.
Subjects Pathology Number of polyps Number of spectra
Forceps – CRC screening65 Non-Neoplastic
Forceps – Barrett's screening33
Snare – Polypectomy1013
E. Rodriguez-Diaz et al. / Robotics and Computer-Integrated Manufacturing 27 (2011) 249–256


text:
Kukla's Korner Hockey
Fakeout Yashin
by Paul on 04/18/07 at 01:21 AM ET
Comments (0)
from Mark Herrmann of Newsday,
Here's the plan: Everybody immediately starts praising Alexei Yashin. Writers opine about how much he means to the Islanders, fans chant his name during long stretches when he is off the ice and shriek uncontrollably when he takes a rare shift.
Anyone who goes to Game 4 Wednesday night against the Sabres must reminisce about the good times and mention he is just inches from turning it all around. Finally, and pay careful attention because this is the most important part, shamelessly beg that the Islanders keep Yashin.
Filed in: NHL Playoff Talk, New York Islanders, | KK Hockey | Permalink
Be the first to comment.
Add a Comment
Please limit embedded image or media size to 575 pixels wide.
Add your own avatar by joining Kukla's Korner, or logging in and uploading one in your member control panel.
Captchas bug you? Join KK or log in and you won't have to bother.
Most Recent Blog Posts
Brendan Shanahan is a very thorough man
NHL Play Could Be Even Quicker This Season
The Message Mike Babcock Is Trying To Send
The New Jersey Devils Will Retire Martin Brodeur's Jersey
A Youth Movement May Have Started In Vancouver
About Kukla's Korner Hockey
Paul Kukla founded Kukla's Korner in 2005 and the site has since become the must-read site on the 'net for all the latest happenings around the NHL.
From breaking news to in-depth stories around the league, KK Hockey is updated with fresh stories all day long and will bring you the latest news as quickly as possible.
Email Paul anytime at firstname.lastname@example.com


text:
Promotional products are an extremely important aspect of most successful marketing campaigns. These useful and powerful marketing items help to reinforce your message in a tangible way that connects your business with people. These powerful promos can bring the main point of your marketing message to life and continue to do so for much longer than a billboard, radio ad, television commercial, or newspaper ad.
While all mediums of advertising and marketing can be important parts of the puzzle for a successful campaign, this article will address how to best determine your budget, specifically, for promotional products.
Often, budgets are created with an arbitrary number chosen by a higher executive who has no working knowledge of the event or campaign. However, to arrive at a realistic budget that will actually accomplish your goal, you must put in a little research and planning time.


text:
12 remain, click here
177 remain, click here
42 remain, click here
It's the most fashionable time of the year! We want to treat one of our loyal fans to an...
Plato's Closet Woodbury and Burnsville are giving away 4 passes to The Haunt at ValleySCARE.
You're invited to a howling affair! Join monstrous hosts in 5 all new silly, spooky zones Friday...


text:
Menlo Park Newswire
Comprehensive Real-Time News Feed for Menlo Park, CA.
Results 1 - 5 of 5 for "u:utsandiego.com" in Menlo Park, CA
These commencement speeches are still best ever 10 years later w/Photo
Ten years after they were given , commencement speeches by author David Foster Wallace at Kenyon College on May 21, 2005, and by Apple co-founder Steve Jobs at Stanford University on June 12, 2005, are widely considered the best graduation speeches of all time. They are the first two speeches listed on Time 's "Top 10 Commencement Speeches." Comment?
Police search for suspect who shot at officers in Menlo Park w/Photo
Police are searching for a robbery suspect who opened fire on officers following a chase that ended near the Facebook headquarters in Menlo Park. Police from Fremont and Newark pursued the suspects' vehicle on surface streets and on State Route 84 through East Palo Alto. Comment?
Source of $5M legal contract... w/Photo
The question of how state utility regulators found more than $5 million for criminal defense lawyers being paid up to $882 an hour was answered this past week. Turns out, the California Public Utilities Commission is tapping operating funds created by vacancies that have gone unfilled, Interim Executive Director Timothy Sullivan told lawmakers on Wednesday. Comment?
Trial begins in high-profile Silicon Valley sex bias case w/Photo
In this April 4, 2006 file photo, Kleiner Perkins Caulfield and Byers senior partner John Doerr poses for a portrait with partner Ellen Pao outside of their office in Menlo Park, Calif. A jury is set to hear opening arguments this week in a multimillion-dollar sexual harassment lawsuit filed by Pao, currently interim chief of the news and social media site Reddit, against the prominent Silicon Valley venture capital firm. Comment?
Now someone can manage your Facebook account after you die w/Photo
In this March 15, 2013, file photo, a Facebook employee walks past a sign at Facebook headquarters in Menlo Park, Calif. Facebook is giving more options to decide what happens to users' accounts after they die. Comment?
- « Previous
- 1
- Next »
Copyright © 2015 Topix LLC


text:
Weymouth Swimming Club
We continue swimming throughout the summer holidays on Monday & Friday evenings (except bank holiday). The Tuesday nights sessions will cease 21st July and restart 8th September and the Thursday sessions will finish 23rd July and restart 10th September.
Weymouth Swimming Club – A club for everyone
Weymouth Swimming Club was established in 1825 and has a 187 year long tradition of swimming teaching, originating in open water work in the Weymouth Bay. It is a friendly club with in some 380 members affiliated to the Dorset County Amateur Swimming Association (DCASA), South West ASA [South West Amateur Swimming Association] (SWASA), the Royal Lifesaving Society (RLSS), the Modern Pentathlon Association of Great Britain (MPAGB) and the Amateur Swimming Association (ASA).
The club caters for beginners, improvers and competitive swimmers to County, District and National qualifying levels. A range of swimming related activities are undertaken including teaching, lifesaving, open water, synchronised swimming with an active master's section.
The club is based at the Weymouth & Portland Borough Swimming pool at Knightsdale Road in Weymouth with the main club sessions are on a Monday and a Friday between 6.30 pm and 9.30 pm. Training is available four nights a week with galas held, usually, on Saturdays both home and away. The club participates in the Southern Junior League.
Learning to swim is a vital skill that could save your child's life. Living by the sea, makes it a priority to ensure that your child can swim competently. If you are looking for a safe and friendly environment for your child to learn, Weymouth Swimming Club can provide you with all you need. Please contact us and enroll today.


text:
product details-Tab
Centrum Silver Adults contains key nutrients to help protect the health of your heart, eyes, and bones.*
Centrum® is the # 1 Doctor Recommended multivitamin brand
Personalized for Adults 50 +
The experts at Centrum bring you complete multivitamins, with solutions delivered without compromise....
Centrum Under 50, Centrum 50 + & Centrum Specialist.
Questions? Comments? Call 1-877-CENTRRUM
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.
Long term intake of high levels of vitamin A (excluding that sourced from beta-carotene) may increase the risk of osteoporosis in adults. Do not take this product if taking other vitamin A supplements.
Keep out of reach of children.
Store at room temperature. Keep bottle tightly closed.
Bottle sealed with printed foil under cap. Do not use if foil is torn.
©Pfizer, Inc.
(based on 1 review)
Ratings Distribution
5 Stars
4 Stars
3 Stars
2 Stars
1 Stars
Reviewed by 1 customer
Displaying review 1
Back to top
(3 of 4 customers found this review helpful)
Same quality, bettter price
By allpa
from Delray Beach, FL
describe yourself Health Conscious
See all my reviews
Best Uses
Comments about Centrum Silver Adults 50+ Multivitamin, Tablets, 125 ea:
Drugstore quality at discount prices
Service and delivery comments:
Drugstore service is great. The prices are excellent and the delivery is very prompt.
Bottom Line Yes, I would recommend this to a friend
Was this review helpful? Yes / No
- You may also flag this review
Suggested Use: Adults - Take one tablet daily with food. Not formulated for use in children. Do not exceed suggested use. As with any supplement, if you are pregnant, nursing, or taking medication, consult your doctor before use.