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Acute Coronary Syndrome
- Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD more...
Practice Essentials
Acute coronary syndrome (ACS) refers to a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (STEMI) to presentations found in non–ST-segment elevation myocardial infarction (NSTEMI) or in unstable angina. It is almost always associated with rupture of an atherosclerotic plaque and partial or complete thrombosis of the infarct-related artery.
The image below illustrates an algorithm for triaging patients with chest pain.
See Are You Missing Subtle MI Clues on ECGs? Test Your Skills, a Critical Images slideshow, to help identify a variety of electrocardiographic abnormalities.
Essential update: ACP releases guidelines on screening for coronary heart disease
In 2015, the American College of Physicians (ACP) released guidelines on screening for coronary heart disease, including the following[1] :
There is no evidence that cardiac screening improves patient outcomes in asymptomatic, low-risk adults.
Potential harms of cardiac screening include false-positive results causing patients to undergo potentially unnecessary tests and procedures.
Among adults at low risk, prevalence of coronary heart disease is low, and cardiac screening is of low predictive value. Therefore, cardiac screening is of low yield, and the probability that positive findings will influence therapeutic decision making is low.
Clinicians should therefore emphasize strategies to reduce cardiovascular risk even further among low-risk adults by treating modifiable risk factors (smoking, diabetes, blood pressure, hyperlipidemia, overweight, and exercise).
Clinicians should not screen asymptomatic, low-risk adults for cardiac disease using resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging.
Clinicians should conduct cardiovascular risk assessment with a global risk score combining individual risk factor measurements into a single quantitative estimate of risk.
The ACP recommendations do not apply to symptomatic patients or to screening athletes before participation in various events.
Signs and symptoms
Atherosclerosis is the primary cause of ACS, with most cases occurring from the disruption of a previously nonsevere lesion. Complaints reported by patients with ACS include the following:
Pain, which is usually described as pressure, squeezing, or a burning sensation across the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either arm
Exertional dyspnea that resolves with pain or rest
Diaphoresis from sympathetic discharge
Nausea from vagal stimulation
Decreased exercise tolerance
Physical findings can range from normal to any of the following:
Hypotension: Indicates ventricular dysfunction due to myocardial ischemia, myocardial infarction (MI), or acute valvular dysfunction
Hypertension: May precipitate angina or reflect elevated catecholamine levels due to anxiety or to exogenous sympathomimetic stimulation
Pulmonary edema and other signs of left heart failure
Extracardiac vascular disease
Jugular venous distention
Cool, clammy skin and diaphoresis in patients with cardiogenic shock
A third heart sound (S 3) and, frequently, a fourth heart sound (S 4)
A systolic murmur related to dynamic obstruction of the left ventricular outflow tract
Rales on pulmonary examination (suggestive of left ventricular dysfunction or mitral regurgitation)
Potential complications include the following:
Ischemia: Pulmonary edema
Myocardial infarction: Rupture of the papillary muscle, left ventricular free wall, and ventricular septum
See Clinical Presentation for more detail.
Guidelines for the management of non-ST-segment elevation ACS were released in 2011 by the European Society of Cardiology (ESC).[2] The guidelines include the use of the CRUSADE risk score (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines).
In the emergency setting, electrocardiography (ECG) is the most important diagnostic test for angina. ECG changes that may be seen during anginal episodes include the following:
Transient ST-segment elevations
Dynamic T-wave changes: Inversions, normalizations, or hyperacute changes
ST depressions: These may be junctional, downsloping, or horizontal
Laboratory studies that may be helpful include the following:
Creatine kinase isoenzyme MB (CK-MB) levels
Cardiac troponin levels
Myoglobin levels
Complete blood count
Basic metabolic panel
Diagnostic imaging modalities that may be useful include the following:
Chest radiography
Myocardial perfusion imaging
Cardiac angiography
Computed tomography, including CT coronary angiography and CT coronary artery calcium scoring
See Workup for more detail.
Initial therapy focuses on the following:
Stabilizing the patient's condition
Relieving ischemic pain
Providing antithrombotic therapy
Pharmacologic anti-ischemic therapy includes the following:
Nitrates (for symptomatic relief)
Beta blockers (eg, metoprolol): These are indicated in all patients unless contraindicated
Pharmacologic antithrombotic therapy includes the following:
Glycoprotein IIb/IIIa receptor antagonists (abciximab, eptifibatide, tirofiban)
Pharmacologic anticoagulant therapy includes the following:
Unfractionated heparin (UFH)
Low-molecular-weight heparin (LMWH; dalteparin, nadroparin, enoxaparin)
Factor Xa inhibitors (rivaroxaban, fondaparinux)
Additional therapeutic measures that may be indicated include the following:
Percutaneous coronary intervention (preferred treatment for ST-elevation MI)
Current guidelines for patients with moderate- or high-risk ACS include the following:
Early invasive approach
Concomitant antithrombotic therapy, including aspirin and clopidogrel, as well as UFH or LMWH
See Treatment and Medication for more detail.
The image below depicts a 62-year-old woman with a history of chronic stable angina and a "valve problem."
Acute coronary syndrome (ACS) refers to a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (STEMI) to presentations found in non–ST-segment elevation myocardial infarction (NSTEMI) or in unstable angina. In terms of pathology, ACS is almost always associated with rupture of an atherosclerotic plaque and partial or complete thrombosis of the infarct-related artery. (See Etiology.)
In some instances, however, stable coronary artery disease (CAD) may result in ACS in the absence of plaque rupture and thrombosis, when physiologic stress (eg, trauma, blood loss, anemia, infection, tachyarrhythmia) increases demands on the heart. The diagnosis of acute myocardial infarction in this setting requires a finding of the typical rise and fall of biochemical markers of myocardial necrosis in addition to at least 1 of the following[3] (See Workup.):
Ischemic symptoms
Development of pathologic Q waves
Ischemic ST-segment changes on electrocardiogram (ECG) or in the setting of a coronary intervention
The terms transmural and nontransmural (subendocardial) myocardial infarction are no longer used because ECG findings in patients with this condition are not closely correlated with pathologic changes in the myocardium. Therefore, a transmural infarct may occur in the absence of Q waves on ECGs, and many Q-wave myocardial infarctions may be subendocardial, as noted on pathologic examination. Because elevation of the ST segment during ACS is correlated with coronary occlusion and because it affects the choice of therapy (urgent reperfusion therapy), ACS-related myocardial infarction should be designated STEMI or NSTEMI. (See Workup.)
Attention to the underlying mechanisms of ischemia is important when managing ACS. A simple predictor of demand is rate-pressure product, which can be lowered by beta blockers (eg, metoprolol or atenolol) and pain/stress relievers (eg, morphine), while supply may be improved by oxygen, adequate hematocrit, blood thinners (eg, heparin, IIb/IIIa agents such as abciximab, eptifibatide, tirofiban, or thrombolytics), and/or vasodilators (eg, nitrates, amlodipine). (See Medications.)
In 2010, the American Heart Association (AHA) published new guideline recommendations for the diagnosis and treatment of ACS.[4]
Acute coronary syndrome (ACS) is caused primarily by atherosclerosis. Most cases of ACS occur from disruption of a previously nonsevere lesion (an atherosclerotic lesion that was previously hemodynamically insignificant yet vulnerable to rupture). The vulnerable plaque is typified by a large lipid pool, numerous inflammatory cells, and a thin, fibrous cap.
Elevated demand can produce ACS in the presence of a high-grade fixed coronary obstruction, due to increased myocardial oxygen and nutrition requirements, such as those resulting from exertion, emotional stress, or physiologic stress (eg, from dehydration, blood loss, hypotension, infection, thyrotoxicosis, or surgery).
ACS without elevation in demand requires a new impairment in supply, typically due to thrombosis and/or plaque hemorrhage.
The major trigger for coronary thrombosis is considered to be plaque rupture caused by the dissolution of the fibrous cap, the dissolution itself being the result of the release of metalloproteinases (collagenases) from activated inflammatory cells. This event is followed by platelet activation and aggregation, activation of the coagulation pathway, and vasoconstriction. This process culminates in coronary intraluminal thrombosis and variable degrees of vascular occlusion. Distal embolization may occur. The severity and duration of coronary arterial obstruction, the volume of myocardium affected, the level of demand on the heart, and the ability of the rest of the heart to compensate are major determinants of a patient's clinical presentation and outcome. (Anemia and hypoxemia can precipitate myocardial ischemia in the absence of severe reduction in coronary artery blood flow.)
A syndrome consisting of chest pain, ischemic ST-segment and T-wave changes, elevated levels of biomarkers of myocyte injury, and transient left ventricular apical ballooning (takotsubo syndrome) has been shown to occur in the absence of clinical CAD, after emotional or physical stress. The etiology of this syndrome is not well understood but is thought to relate to a surge of catechol stress hormones and/or high sensitivity to those hormones.
Baseline blood glucose levels appear to be an independent risk factor for a major adverse cardiac event (MACE) in emergency department (ED) patients with suspected ACS.[5, 6] In an analysis of data from 1708 Australian and New Zealand patients in a prospective observational study, investigators noted a MACE occurred within 30 days of presentation in 15.3% of patients whose ED admission blood glucose levels were below 7 mmol/L (about 126 mg/dL); however, in the same time period, a MACE occurred in twice as many patients (30.9%) whose blood glucose levels were above 7 mmol/L.[6] After controlling for various factors, patients who had admission blood glucose levels of 7 mmol/L or higher were at 51% higher risk of experiencing a MACE compared with patients who had lower baseline blood glucose levels.[6] Other significant predictors of MACE included male sex, older age, family history, hypertension, dyslipidemia, ischemic findings on ECG, and positive troponintests.[5, 6]
Six-month mortality rates in the Global Registry of Acute Coronary Events (GRACE) were 13% for patients with NSTEMI ACS and 8% for those with unstable angina.
An elevated level of troponin (a type of regulatory protein found in skeletal and cardiac muscle) permits risk stratification of patients with ACS and identifies patients at high risk for adverse cardiac events (ie, myocardial infarction, death) up to 6 months after the index event.[7, 8] (See Workup.)
The PROVE IT-TIMI trial found that after ACS, a J-shaped or U-shaped curve association is observed between BP and the risk of future cardiovascular events.[9]
LeLeiko et al determined that serum choline and free F(2)-isoprostane are also predictors of cardiac events in ACS. The authors evaluated the prognostic value of vascular inflammation and oxidative stress biomarkers in patients with ACS to determine their role in predicting 30-day clinical outcomes. Serum F(2)-isoprostane had an optimal cutoff level of 124.5 pg/mL, and serum choline had a cutoff level of 30.5 µmol/L. Choline and F(2)-isoprostane had a positive predictive value of 44% and 57% and a negative predictive value of 89% and 90%, respectively.[10]
Testosterone deficiency is common in patients with coronary disease and has a significant negative impact on mortality. Further study is needed to assess the effect of treatment on survival.[11]
A study by Sanchis et al suggests renal dysfunction, dementia, peripheral artery disease, previous heart failure, and previous myocardial infarction are the comorbid conditions that predict mortality in NSTEMI ACS.[12] In patients with comorbid conditions, the highest risk period was in the first weeks after NSTEMI ACS. In-hospital management of patients with comorbid conditions merits further investigation.
Patients with end-stage renal disease often develop ACS, and little is known about the natural history of ACS in patients receiving dialysis. Gurm et al examined the presentation, management, and outcomes of patients with ACS who received dialysis before presentation for an ACS. These patients were enrolled in the Global Registry of Acute Coronary Events (GRACE) at 123 hospitals in 14 countries from 1999-2007.
NSTEMI ACS was the most common in patients receiving dialysis, occurring in 50% of patients (290 of 579) versus 33% (17,955 of 54,610) of those not receiving dialysis The in-hospital mortality rates were higher among patients receiving dialysis (12% vs 4.8%; p < 0.0001). Higher 6-month mortality rates (13% vs 4.2%; p < 0.0001), recurrent myocardial infarction incidence (7.6% vs 2.9%; p < 0.0001), and unplanned rehospitalizations (31% vs 18%; p < 0.0001) were found among those who survived to discharge. Outcomes in patients who received dialysis was worse than was predicted by the calculated GRACE risk score for in-hospital mortality (7.8% predicted vs 12% observed; p < 0.05). This suggests that the GRACE risk score underestimated the risk of major events in these patients.[13]
In a study that assessed the impact of prehospital time on STEMI outcome, Chughatai et al suggest that "total time to treatment" should be used as a core measure instead of "door-to-balloon time."[14] This is because on-scene time was the biggest fraction of "pre-hospital time." The study compared groups with total time to treatment of more than 120 minutes compared with 120 minutes or less and found mortalities were 4 compared with 0 and transfers to a tertiary care facility were 3 compared with 1, respectively.
STEMI mechanisms and stenting outcome similar in women and men
Despite their smaller coronary vessels and higher risk profile, women with STEMI appear to respond just as well as men to primary PCI and stenting, according to the Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty (OCTAVIA) study.[15] OCTAVIA, which was designed to examine gender differences at the time of primary PCI, included 140 STEMI patients at 14 Italian centers, matched by age and risk factors, who received an everolimus-eluting stent.[15]
On initial OCT, no differences by gender were found in the proportion of ruptured or eroded plaques, thus suggesting that the pathophysiology of STEMI is nearly identical in men and women.[15] On repeat OCT at nine months, intended to assess stent healing, more than 90% of both men and women had fully covered stent struts. Although OCTAVIA was not powered for clinical end points, no significant differences in death, reinfarction, stroke, stent thrombosis, or target vessel reintervention were evident at one year.[15]
Patient Education
Patient education of risk factors is important, but more attention is needed regarding delays in door-to-balloon time, and one major barrier to improving this delay is patient education regarding his or her symptoms. Lack of recognition of symptoms may cause tremendous delays in seeking medical attention.
Educate patients about the dangers of cigarette smoking, a major risk factor for coronary artery disease (CAD). The risk of recurrent coronary events decreases 50% at 1 year after smoking cessation. Provide all patients who smoke with guidance, education, and support to avoid smoking. Smoking-cessation classes should be offered to help patients avoid smoking after a myocardial infarction. Bupropion increases the likelihood of successful smoking cessation.
Diet plays an important role in the development of CAD. Therefore, prior to hospital discharge, a patient who has had a myocardial infarction should be evaluated by a dietitian. Patients should be informed about the benefits of a low-cholesterol, low-salt diet. In addition, educate patients about AHA dietary guidelines regarding a low-fat, low-cholesterol diet.
A cardiac rehabilitation program after discharge may reinforce education and enhance compliance.
The following mnemonic may useful in educating patients with CAD regarding treatments and lifestyle changes necessitated by their condition:
A = Aspirin and antianginals
B = Beta blockers and blood pressure (BP)
C = Cholesterol and cigarettes
D = Diet and diabetes
E = Exercise and education
For patients being discharged home, emphasize the following:
Timely follow-up with primary care provider
Compliance with discharge medications, specifically aspirin and other medications used to control symptoms
Need to return to the ED for any change in frequency or severity of symptoms
For patient education resources, see the Heart Health Center and Cholesterol Center, as well as High Cholesterol, Cholesterol Charts (What the Numbers Mean), Lifestyle Cholesterol Management, Chest Pain, Coronary Heart Disease, Heart Attack, Angina Pectoris, Cholesterol-Lowering Medications, and Statins for Cholesterol.
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Prevacid (lansoprazole). Prescribing information revised October 28, 2011. Takeda Pharmaceutical Company LTD. Available at http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020406s076,021428s023lbl.pdf.
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Simon T, Steg PG, Gilard M, Blanchard D, Bonello L, Hanssen M, et al. Clinical Events as a Function of Proton Pump Inhibitor Use, Clopidogrel Use, and Cytochrome P450 2C19 Genotype in a Large Nationwide Cohort of Acute Myocardial Infarction: Results From the French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) Registry. Circulation. 2011 Feb 8. 123(5):474-82. [Medline].
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Sorensen JT, Terkelsen CJ, Norgaard BL, et al. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. Eur Heart J. 2011 Feb. 32(4):430-6. [Medline].
Damman P, Hirsch A, Windhausen F, Tijssen JG, de Winter RJ. 5-year clinical outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial a randomized comparison of an early invasive versus selective invasive management in patients with non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol. 2010 Mar 2. 55(9):858-64. [Medline].
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James S, Angiolillo DJ, Cornel JH, Erlinge D, Husted S, Kontny F, et al. Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J. 2010 Dec. 31(24):3006-16. [Medline]. [Full Text].
[Guideline] Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009 Dec 1. 120(22):2271-306. [Medline]. [Full Text].
Lopes RD, Alexander KP, Manoukian SV, Bertrand ME, Feit F, White HD, et al. Advanced age, antithrombotic strategy, and bleeding in non-ST-segment elevation acute coronary syndromes: results from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol. 2009 Mar 24. 53(12):1021-30. [Medline].
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Mehta SR, Tanguay JF, Eikelboom JW, Jolly SS, Joyner CD, Granger CB, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet. 2010 Oct 9. 376(9748):1233-43. [Medline].
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|Risk Score
|Age ≥65 years
|At least 3 risk factors for coronary heart disease
|Previous coronary stenosis ≥50%
|Use of aspirin in previous 7 days
|At least 2 anginal episodes in the previous 24 hours
|ST-segment elevation on admission ECG
|Elevated levels of serum biomarkers
|Total Score
|Note: Event rates significantly increased as the TIMI risk score increased in the test cohort in the TIMI IIB study. Rates were 4.7% for a score of 0/1, 8.3% for 2, 13.2% for 3, 19.9% for 4, 26.2% for 5, and 40.9% for 6/7 (P < .001, χ2 test for the trend). The pattern of increasing event rates with increasing TIMI risk score was confirmed in all 3 validation groups (P < .001).


text:
Buffer for Twitter, Instagram, Pinterest & Social Media Scheduling
By Buffer, Inc.
Open iTunes to buy and download apps.
Share to Twitter, Facebook, Instagram, Google+, Pinterest and LinkedIn – all from one place, on your schedule.
Any link, text, picture or video you want to share, just add it to your Buffer. Your updates will automatically be scheduled and spaced out throughout the day to post to your favorite social networks. Plus, you can custom schedule or "post now" right inside the app.
Say you find 5 great articles and 2 funny photos you want to share. If you post them all in a row, you might flood your friends and followers who are online – and totally miss those who aren't. Instead, add these posts to your Buffer, and you'll have great social updates for the next few days.
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subset: commoncrawl


text:
This Great American lodge is mind boggling. It was as grand and memorable as the glaciers. Huge trees serve as the columns inside. Stairs and furniture are made from logs that are polished to show the rings and beauty. If I could do the trip again, I would stay the night, or have a drink in the lobby, and absorb the history, art, and atmosphere of the place.
- Official Description (provided by the hotel):
- Experience the western charm of the historic Glacier Park Lodge, which was completed in 1913. Its comfortable feel combined with some of the world's most spectacular scenery, makes Glacier Park Lodge a truly unique vacation destination. Although steeped in culture and history of the Great Northern Railway and Blackfeet Indians, Glacier Park Lodge features modern amenities such as a heated swimming pool, nine-hole golf course, in-room telephones, nine-hole pitch-n-putt golf course, gift shop, Lounge and the outstanding Great Northern Rib and Steak House. Glacier Park Lodge is in East Glacier Park, Montana on Highway 2. Glacier Park Amtrak Train Station is located just across the street from the hotel where guests are picked up daily in our antique red Checker taxi. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Hotels.com, Booking.com, Orbitz, Expedia, Cheap Tickets and Odigeo so you can book your Glacier Park Lodge reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.
- Also Known As:
- Glacier Park Hotel East Glacier Park


text:
Seiji Ozawa. Carole King. Cicely Tyson. Rita Moreno. George Lucas.
These are the five legendary talents who are being feted at the 38th Annual Kennedy Center Honors to be broadcast on Tuesday, December 29th (CBS, 9/8C).
Follow the jump to check out the program for the evening.
Continue reading The Annual 38th Annual Kennedy Center Honors Five Legends!


text:
|Publication number
|Publication type
|Application number
|Publication date
|Jul 15, 1986
|Filing date
|Jun 22, 1984
|Priority date
|Jun 22, 1984
|Fee status
|Also published as
|Publication number
|Ronald L. Pastorino
|Original Assignee
|U.S. Peroxygen Company
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (9), Referenced by (6), Classifications (10), Legal Events (6)
|External Links: USPTO, USPTO Assignment, Espacenet
This invention relates to the making of foams from unsaturated polyester resins. More particularly, it relates to compositions useful in methods for creating a foam structure in polyester resin products by providing a source of gas for expansion of the resin.
There is a well developed body of prior art designed to foam unsaturated polyester resins with gaseous blowing agents. Over the years unsaturated polyesters have been foamed by generating CO2 gas through the acid decomposition of carbonate and bicarbonate salts. Typically the carbonate salt per se is mixed directly into the unsaturated resin mass and acid added. Typical references employing such techniques include U.S. Pat. Nos. 3,479,303, 4,016,112, 4,028,289, 4,119,583, 4,122,047, 4,347,331 and British Pat. No. 2,029,834.
To date there has been only limited commercial success utilizing carbonate salts for generating CO2. One of the drawbacks which apparently limits wide spread industry acceptance of the process includes the requirement for a significant amount of acid such as acetic acid and water to be added to the resin to help solubilize the carbonate granules and to start their decomposition for gas formation. In general, there has been a lack of consistent results in terms of the desired uniform foam structures. This lack of uniformity is most likely due to difficulties in dispersing a relatively coarse inorganic salt in the organic medium presented by the unsaturated polyester resin.
Foams from unsaturated polyester resin having a uniform and fine cell structure are now consistently possible utilizing carbonate and bicarbonate salts. This goal is accomplished by utilizing a composition including a salt selected from sodium and potassium carbonates and bicarbonates, or mixtures thereof, and water intermixed with a sufficient amount of finely divided solid free flow agent to absorb the water and render the composition a free flowing powder. In the preferred embodiment the salt is initially dissolved in the water before intermixture with the free flow agent. The free flowing powder containing the inorganic salt is readily mixable with, and uniformly dispersable in, the organic resin media. The salt is present in the powder as relatively uniform fine particles. While the composition is a free flowing powder, water is present on the free flow agent to provide an efficient reaction media between acid and the carbonate or bicarbonate salt in the formation of CO2 gas. The free flow agent can also act as a nucleating agent in the foaming process.
The present composition is used in a process in which liquid unsaturated polyesters are converted to a foam structure. Polyester resins useful in this invention are disclosed in detail in U.S. Pat. No. 4,216,294, incorporated herein by reference. Typically, the unsaturated polyester resin is preliminarily combined with an accelerator or promoter, also as described in U.S. Pat. No. 4,216,294. Promoted unsaturated polyester resins are generally contemplated for use in the present invention.
The unsaturated polyester is cured and crosslinked with an organic peroxide initiator, preferably a ketone peroxide such as methyl ethyl ketone peroxide. The organic peroxide will generally be present in an amount of about 0.5-5 weight percent of resin, more typically about 1-2 weight percent. The peroxide composition may contain diluents so that the peroxide content of the composition used may only be about 50% by weight. Amounts given here are based on peroxide content of such compositions.
The present invention is consistent with the prior art in that various additives may be included in the resin formulation to be foamed. For example, silicone surfactants have been utilized to insure entrapment and uniform dispersion of the gas liberated by the blowing agent. Again, typical silicone surfactants are disclosed in U.S. Pat. No. 4,216,294, incorporated herein by reference, and may be used in the present process.
The novel composition used in the present invention includes one of the highly water soluble sodium and potassium carbonates and bicarbonates, or mixtures thereof. The selected salt is preferably initially dissolved in water. In the preferred embodiment a saturated solution is sought. Higher concentrations of saturated solutions are obtained by utilizing an elevated temperature for the water. Beneficially, the salt is added to water at about 50�-90� C., and for convenience, at a temperature of about 60�-70� C.
The saturated liquid is then intermixed with a finely divided solid free flow agent present in an amount to absorb all of the water and thereby precipitate the dissolved salt. In doing so, the salt is dispersed on the free flow agent in a finely divided uniform state. In this form the salt and the water are most easily dispersed in the organic polyester media.
In using the present compositions, sufficient composition is added to provide about 1-10 weight percent of salt with respect to the polyester resin. The amount of salt in the composition will depend in part upon the concentration of salt in the water combined with the free flow agent. Where a preferred preformed saturated aqueous salt solution is used, the amount of salt in the composition will depend upon the temperature of the water being saturated with the salt. As will be seen, typical formulations will include compositions in which the salt comprises about 26% by weight of the composition which also contains water and free flow agent, and in which the salt was dissolved to saturate water at about 60� C. In the preferred embodiment the composition is added to provide about 3-6 weight percent of salt with respect to the polyester resin. While higher concentrations can be used, there does not appear to be any substantial benefit in density reduction, whereas lower salt concentrations may not provide the same degree of density reduction in the foamed resin product.
The free flow agent is selected from natural and synthetic silica and silicates and is generally a hydrophilic finely divided solid material capable of absorbing water and carrying precipitated carbonate and bicarbonate salts thereon. Typical materials are synthetic amorphous silica available under the trademark SIPERNAT 22 and utilized in the working examples herein. Other materials which are suitable as a free flow agent are diatomaceous earth and fumed silicas such as the commercial product known as AEROSIL 972. Typical silicate materials are synthetic alkaline earth metal silicates such as hydrous magnesium and calcium silicates. A typical commercial material in this latter category is the calcium silicate offered by Johns-Manville under the name MICRO-CEL.
While the invention is preferably practiced by dissolving the carbonate salt in heated water and precipitating the salt out of the solution onto the free flow agent while taking up the water on the free flow agent, improvements in the foamed products can be obtained by simply mixing the water, salt and free flow agent concurrently or sequentially adding salt and water to the free flow agent, instead of initially dissolving the salt in water and then combining the free flow agent.
During the making of the foamed product a gas is liberated from the carbonate or bicarbonate salt by reaction with a source of acid. Separate acids may be added to the reaction mixture for this purpose. Both inorganic and organic acids may be added for this purpose and in amounts which may facilitate the rate and extent of the foaming process beyond that obtained from any acid component already present in the particular polyester resin being used. The amounts utilized will generally be similar to the amounts of acid utilized in prior art processes employing CO2 producing blowing agents. In the present process it is generally found that the polyester resin used in the process already contains sufficient acidic component to react with the carbonate or bicarbonate salt. Therefore, no additional acid will generally be required in the present process.
The following will more specifically illustrate the invention.
60 grams of KHCO3 was dissolved in 100 grams of water heated to 58�-60� C. With slow mixing, the solution was added to 70 grams SIPERNAT 22. The resulting powder was free flowing. This product is designated "D mix".
To 50 grams of CARGILL PE 8245 promoted unsaturated polyester resin was added 0.50 grams of Union Carbide's L5340 silicone surfactant, 10 grams "D mix," and 1.5 grams of Esperfoam FR ketone peroxide solution. This was hand mixed for approximately 45 seconds in an 8 ounce polyester jar.
Within 3 minutes there was about a two-fold increase in resin volume. At about 14 minutes the rise reached a maximum. Curing was evident at approximately 23 minutes and at 31 minutes the foamed resin was removed from the jar. The foam was uniform with a relatively fine cell structure.
The resultant density was 0.278 grams/cc or 17.4 lbs/ft3.
Utilizing the above general procedure the data shown below in Table I was obtained. Trial #2 represents a control run where no blowing agent was used and no density reduction afforded. Other trials as indicated did not predissolve the salt in water. These are designated "hand mix".
TABLE I__________________________________________________________________________Room Temperature 68-73� F.__________________________________________________________________________ Trial #:resin PE 8245 1 2 3 4 5 6 7 8 9 10__________________________________________________________________________wt resin 50 50 50 50 50 50 50 50 50 50L5340 0.25 0.25 0.28 0.25 0.25 0.50 0.50 0.50 0.10"A mix".sup.(1) g 26.8"D mix".sup.(2) g 2.6 3.1 5.0 8.0 10.0 10.0 6.0 10.0"F mix".sup.(3) gNaHCO3 gKHCO3 gH2 O gSipernat 22 gEsperfoam FR g 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5Quickset 90 gQuickset Super g 1.5Demold time 60' 120' 67' 38' 26' 29' 31' 29' 20' 36'(˜ min.)Densityg/cc 0.58 1.15 0.57 0.51 0.41 0.33 0.28 0.35 0.34 0.32lbs/ft3 36.2 71.8 35.6 32.1 25.2 20.3 17.4 22.0 21.3 20.2Rating of fair no fair good good good good good good goodCell Structure: foam toExtent of goodSmall UniformCells__________________________________________________________________________ Trail#:resin PE 8245 11 12 13 14 15 16 17 18 19 20__________________________________________________________________________wt resin 50 50 50 50 50 50 50 50 50 50L5340 0 0.25 0.25 0.25 0.25 0.25 0.25 0.30 0.30 0.30"A mix".sup.(1) g"D mix".sup.(2) g 10.0 4 4.1 0 5.0 9.0"F mix".sup.(3) g 8.0 3.0NaHCO3 g 1.8KHCO3 g 2.7 1.8.sup.(4)H2 O g 3.0 3.0Sipernat 22 g 2.2Esperfoam FR g 1.5 1.5 2.0 1.5 1.0 1.5 1.5 1.5 1.5Quickset 90 g 1.5Quickset Super gDemold time 23' 36' 24' 44' 29' 54' 32' 24' 30' 25'(˜min)Density/g/cc 0.46 0.45 0.43 0.94 0.43 0.43 0.54 0.43 0.30 0.47lbs/ft3 28.8 28.4 26.9 58.9 26.9 26.9 33.4 26.9 19.0 29.6Rating of poor good fair poor good poor fair good good goodCell Structure: (split) to toExtent of good poorSmall UniformCells__________________________________________________________________________ .sup.(1) A mix = hand mix of 86.7% KHCO3, 6.9% Aerosil R972 + 6.4% L5340 .sup.(2) D mix = 26.0% KHCO3, 43.1% H2 O, 30.9% Sipernat 22 .sup.(3) F mix = 24.8% KHCO3, 4.9% NaHCO3, 41.3% H2 O, 28.9% sipernat 22 .sup.(4) hand mixed "D mix " at room temperature
FIG. 1 graphically represents some of the data obtained with particular reference to using various concentrations of "D mix". Also included in the graph are points obtained when using 2.0 and 4.0 pphr (parts per hundred based on the resin) of Esperfoam FR showing that peroxide concentration changes does not produce significantly different results. Use of different peroxide compositions (Quickset 90 and Quickset Super) resulted in somewhat higher densities. (These are all ketone peroxide formulations available from U.S. Peroxygen Company, Richmond, Calif.)
The following examples illustrate the use of different polyester resins.
100 parts MR-643
1.1 parts L5340 silicon surfactant
20.0 parts "C mix".sup.(1)
3.0 parts Esperfoam FR (MEKP)
Demold time: 27'
Density: 0.335 g/cc (20.9 lbs/ft3)
Appearance of foam cell structure: fair to good
100 parts MR-12184
0.9 parts L5340
28 parts "C mix".sup.(1)
3.0 Esperfoam FR
Demold time: 23'
Density: 0.445 g/cc (27.8 lbs/ft3)
Appearance of foam cell structure: fair to good
100 parts Aropol 8821 Casing Resin
0.71 parts L5340
17.6 parts "H mix".sup.(2)
0.23 parts Esperfoam FR
2.7 parts benzoyl peroxide 40% suspension (BZQ-40)
Demold time: 60'
Density: 0.25 g/cc (15.5 lbs/ft3)
Appearance of foam cell structure: fair to good
100 parts Aropol 8821
0.71 parts L5340
17.6 parts "H mix".sup.(2)
0.53 parts Hi-Point 90 (MEK Peroxide)
Demold time: 55'
Density: 0.25 g/cc (15.5 lbs/ft3)
Appearance of foam cell structure: fair to good
100 parts Aropol 8821
0.71 parts L5340
17.6 parts "Room temp H mix".sup.(3)
0.53 parts Hi-point 90
Demold time: 67'
Density: 0.268 g/cc (16.7 lbs/ft3 )
Appearance of foam cell structure: poor to fair
______________________________________Trial: 1 2 3 4 5 6 7 8______________________________________resin (g): 50 50 50 50 50 50 50 50L5340 (g) -- -- -- -- -- -- -- --"J mix" (g)4 10 10 10 10 10 -- 10 5.1KHCO3 (g) 10 gglacialAcetic acid (g) 0.25 0.50 0.75 1.25 0.50 0.50proprionic 0.75acid (g)Esperfoam FR 0.75 1.0 1.0 1.0 1.0 0.75Quickset 1.0 1.0ExtraDemold time 20' 13' 18' 18' 37' 16' 20' 18'(˜ min)Density;g/cc: 0.578 0.428 0.299 0.215 0.181 1.14 0.258 0.346lb/ft3 : 36.1 26.7 18.7 13.4 11.3 71.1 16.1 21.6Cell good good good good good no good goodStructure foam______________________________________1 "C mix": 23% KHCO3, 43% H2 O, 34% Sipernat 22.Prepared by dissolving KHCO3 in H2 O at approxi-mately 65� C. and then added to Sipernat.2 "H mix": 23.1% KHCO3, 11.5% K2 CO3, 38.5% H2O,26.9% Sipernat 22. Prepared by dissolving theKHCO3 + K2 CO3 in H2 O at approximately 65� C.andadding to the Sipernat 22.3 "Room temp. H mix": A physical mixture of the "Hmix" components made by adding each to the Sipernat22 and mixing at room temp.4 "J mix": Prepared by dissolving KHCO3 in H2 O atapproximately 60� C. and added to mixture of Kenite,L5340 and Sipernat 22.KHCO3 25.1%H2 O 42.0%Kenite 6.3%(diatomaceousearth)L5340 3.5%Sipernat 22 23.0%
|Cited Patent
|Filing date
|Publication date
|Jul 2, 1965
|Nov 18, 1969
|Huels Chemische Werke Ag
|Process for the production of molded foam bodies of polyesters
|Feb 14, 1975
|Apr 5, 1977
|Teijin Limited
|Process for production of foamed resin structure
|Oct 5, 1976
|Jun 7, 1977
|Vast Products Inc.
|Foamed polyester resin
|Jan 31, 1977
|Oct 10, 1978
|Klf Inventions And Patent Development And Marketing Corporation Ltd.
|Foamed articles and methods for making same
|Apr 5, 1977
|Oct 24, 1978
|Isaac Meisels
|Production of polyester foam
|May 30, 1978
|Aug 5, 1980
|Argus Chemical Corporation
|Unsaturated polyester resin foams and methods of preparation
|Jul 9, 1981
|Aug 31, 1982
|Tanner Chemical Company, Inc.
|Foamed, low density, highly extended unsaturated polyester resin syrup composition, a shaped article comprised of the composition and a process for preparing such article
|Title not available
|Title not available
|Citing Patent
|Filing date
|Publication date
|Nov 25, 1986
|Sep 8, 1987
|Witco Corporation
|Dispersions and the preparation of foamed resins therefrom
|Apr 3, 1987
|Dec 8, 1987
|Witco Corporation
|New dispersions and the preparation of foamed resins therefrom
|Jun 27, 2002
|May 31, 2011
|Wenguang Ma
|Polyester core materials and structural sandwich composites thereof
|Jun 27, 2002
|Jan 1, 2004
|Wenguang Ma
|Polyester core materials and structural sandwich composites thereof
|Feb 28, 2006
|Mar 15, 2007
|Edwards Walter L
|Low density foamed polymers
|Aug 14, 2009
|Feb 17, 2011
|Chemische Fabrik Budenheim Kg
|Sch�umungsmittel f�r Kunststoffe
|U.S. Classification
|521/82, 521/182, 521/138, 521/99, 521/125, 521/92
|International Classification
|Cooperative Classification
|European Classification
|Sep 28, 1984
Owner name: U.S. PEROXYGEN COMPANY, 850 MORTON AVE., RICHMOND,
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST.;ASSIGNOR:PASTORINO, RONALD L.;REEL/FRAME:004306/0551
Effective date: 19840924
|Feb 12, 1990
|Fee payment
Year of fee payment: 4
|Feb 12, 1990
|Surcharge for late payment
|Feb 13, 1990
|Maintenance fee reminder mailed
|Dec 22, 1993
|Fee payment
Year of fee payment: 8
|Jan 14, 1998
|Fee payment
Year of fee payment: 12


text:
Tina's desire to be the soloist may brand her un-kissable and Linda tries her hand as an entrepreneur.
Gene leads the Belcher kids and their friends on an expedition to find a mystical creature supposedly living nearby. Back at the restaurant, the downtime sends Linda's competitive nature into overdrive.
Tina partners with Darryl to win a contest at the school Valentine's dance, while Linda schedules an adventurous week of copious holiday activities with Bob.
Billy Billions, Captain Nemesis, and Kangaroo Commando join forces to take Ben's place as the hero of Bellwood.
On the Season 5 premiere, Gene's musical based on "Die Hard" isn't selected as the school's fall play, so he, with help from Louise, stages a production to run on the same night as Wagstaff Middle School's performance of a "Working Girl"-inspired musical that features Tina.moreless
After Mr. Frond forces the kids to write an essay about why they like Wagstaff Middle School, the kids get their revenge in a most creative way.
Ben wants to surprise Leslie on the day before her anniversary, but Leslie is too busy to notice; when Donna flakes out of work, April seeks revenge on the internet; Ron starts a letter-writing campaign.moreless
Leslie throws a farewell party for her best friend but another department threatens to derail Leslie's special secret party highlight. While the girls work to get that event back on track, the guys have their own crisis as they struggle to come up with a thank you/farewell gift for Chris.moreless
Leslie and Ben argue about the right way to sell products at the farmers market. Meanwhile, Ann searches for a way to vent about her pregnancy, while April supports Andy as he starts a new creative venture.moreless
Leslie and Ben begin new jobs.
On Leslie's last day on city council, a new sex scandal breaks for councilman Dexhart and Leslie decides to run for his seat. However, no one supports her decision and an old friend helps to consider her options. Tom searches for new business ideas. Andy returns from London, but has a hard time adjusting and Ann and Chris find out the sex of the baby.moreless
To help him reunite with Lord Hater, Wander and Sylvia pretend to be the prisoners of a tiny Watchdog named Westley.
With less than a month left before her term in office ends, Leslie, determined to keep her dream project alive, attempts to work out a deal with Councilman Jamm regarding The Pawnee Commons. As Ben begins his new job at the accounting firm, Ron agrees to let Tom, April and Donna help him sell his cabin.moreless
Leslie campaigns to improve the quality of Pawnee's water supply.
User Score: 41
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Pam Carey's new book, Minor League Mom, is much more than a sentimental journey. Pam has thoughtfully chronicled not one but two sons who were signed into the Boston Red Sox Farm Teams just days apart. Both boys grew-up in New England playing ball in the neighborhood and in Little League. They were natural athletes with the prerequisite trait of self determination. Their pursuit of the game progressed into high school and later into playing in the Ivy League (Brown and Dartmouth) which were big accomplishments on their own rights. While playing college baseball can be tumultuous, nothing can compare to the highs and lows of being a Minor League Ball Player. Pam and Charley Carey were there every step of the way - and that is what makes the book so interesting. It is written from a parent's perspective. Anyone who has been a parent of boys has probably wondered at least once, "Could my kid make it to the majors?" For most of us that dream slips away rather quickly, but for Pam and Charley and their two sons it seemed it could be right around the corner. So where do you draw that line between manager and coach and supportive loving parent? Undoubtedly you cross it all the time. When do you pursue your own judgment over that of your child? Does the second guessing ever stop, - is it really worth it? Their son Todd summed it up by saying, "I never regretted it for a moment." Which is what you'll say after reading Pam's book.
-Mike Years, childhood friend of Tim and Todd.
Minor League Mom is published by Barking Cat Books and can be ordered through http://www.minorleaguemom.net or any of the places fine books are sold. Read Pam's blog at http://minorleaguemom.blogspot.com


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School of Music
How to Apply
Learn more about applying to the School of Music and access online application and entrance audition forms.
Debut Release from BU Violinist
Internationally-acclaimed musician and teacher Kerry DuWors joins forces with pianist Futaba Niekawa to present BALLADE.
Reimagining Tradition
River Measures is the newest project within music professor Dr. Leanne Zacharias' Music for Spaces performance research initiative.
Degree Programs
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- Aug10
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School of Music News
- BU Music faculty among talented performers at Clear Lake Chamber Music Festival
- June 30, 2016
- New research institute at Brandon University will study music and community
- June 2, 2016
- More than 500 BU students receive degrees at 2016 Spring Convocation
- May 27, 2016
- Greg Gatien appointed Dean of Brandon University School of Music
- May 19, 2016
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Using Acoustic Enhancement to Improve Speech Intelligibility
The last decade, acoustic enhancement has been developed as an advanced tool of implementing variable acoustics in auditoria by electronic means. The implementations, however, have been limited to increasing the reverberation time of a hall, for instance to make a speech auditorium suitable for symphonic music. This paper describes the application of an acoustic enhancement system to improve the speech intelligibility of an auditorium only by adding early reflections, that is without increasing the reverberation time.
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UPPER TOWNSHIP — Converting the B.L. England power plant from coal and oil to natural gas will bring cleaner air, jobs, tax revenue, energy reliability and even peace and quiet to the surrounding community, officials said Thursday night.
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Moist Corn Bread Recipe
—Christine Mazzarella, Brockport, New York
- 1 egg, lightly beaten
- 1-1/2 cups fresh or frozen corn, thawed
- 1 can (8-1/4 ounces) cream-style corn
- 1 package (8-1/2 ounces) corn bread/muffin mix
- 1 cup (8 ounces) fat-free plain yogurt
- 1/4 cup reduced-calorie stick margarine, melted
- 1. In a large bowl, combine all the ingredients. Pour into an 8-in. square baking dish coated with cooking spray.
- 2. Bake at 350° for 35-40 minutes or until edges are lightly browned and a toothpick inserted near the center comes out clean. Let stand for 10 minutes before cutting. Serve warm. Yield: 9 servings.
Nutritional Facts
1 each: 197 calories, 7g fat (1g saturated fat), 25mg cholesterol, 452mg sodium, 31g carbohydrate (0g sugars, 3g fiber), 5g protein Diabetic Exchanges:2 starch, 1 fat
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Reviewed Jul. 29, 2012
"Hands down THE best corn bread recipe. This could be a dessert!"
Reviewed Mar. 14, 2011
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© 2016 RDA Enthusiast Brands, LLC


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Thursday July 28, 2016; 09:26 pm EDT
Thru Sept. 27: Tu 8pm, Reynolds Tavern Outdoor Courtyard, Annapolis. $30/discounts; rsvp: www.annapolisshakespeare.org.
June 25-Aug 28: Infinity Theatre at Children's Theatre of Annapolis, $39 w/discounts, rsvp/times: www.infinitytheatre.com.
Aug. 5-14: Annapolis Shakespeare Company, Studio 111, $15-$25, rsvp: www.annapolisshakespeare.org.
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4-6pm, Crofton Country Club: www.croftonfarmersmarket.com.
Live music plus half-price wine carafes every Wednesday. 6pm, Brick Wood Fired Bistro,...
Take a dockside seat to watch some 130 crews compete in midweek races. First gun 6:10pm, Annapolis Harbor, free: www.annapolisyc.com.
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The United States Naval Academy Band, "The Navy's Oldest and Finest," has been providing music for the Brigade...


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UK: Zara opens eco-flagship on Oxford Street
By Petah Marian | 4 December 2012
Zara's latest flagship store on Oxford Street, in London
Zara is set to open its London flagship store tomorrow, a 15,000 square metre store at the Marble Arch end of Oxford Street.
The store will be the retailer's fourth on the shopping strip, and showcases the retailer's brand image - focusing on "beauty, clarity, functionality and sustainability".
The new store features a stripped back aesthetic, with clothing displayed in cube-like spaces.
Inditex UK managing director Dilip Patel told just-style: "People will be surprised when they come in here and see how luxurious it is and then see the prices, which are still Zara prices."
Inditex said the store uses the latest eco-efficiency standards for its lighting, heating and cooling, water use, materials, recycling and waste management systems. The newly built site has achieved BREEAM certification. Compared to the retailer's traditional stores, the Park House site uses 40% less water and 25% less electricity, emitting 80 fewer tonnes of carbon emissions each year.
The retailer said its eco-efficient stores are the most "ambitious and far-reaching" part of its sustainability plans, given that the "store lies at the heart of the Inditex business model", with the retailer working to lower its CO2 emissions in stores by 10% by 2015 and by 20% in 2020.
Zara has halved its stores' per square metre lighting energy use since 2005 by constantly updating stores with the most energy efficient lighting on the market. It has installed motion detectors in the stock room, which dims the light by 80% when not in use. The company has also installed motion detectors in other areas such as toilets, internal corridors and staff rooms that are not in constant use.
Store lighting also dims to 66% during cleaning shifts and merchandise unloading periods.
Sectors: Retail
Companies: Zara, Inditex SA
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Fast Retailing, the owner of Japanese casual clothing brand Uniqlo, is continuing to review the Accord on Fire and Building Safety in Bangladesh....
just-style's most read stories this week...
The most-read stories on just-style this week include a rush by apparel brands and retailers to sign the new Accord on Fire and Building Safety in Bangladesh, a report on what the agreement entails, a...
US: Apparel groups unveil own Bangladesh safety plans
A group of North American retailers has gone its own way on strengthening safety efforts at Bangladesh garment factories, setting up a new initiative said to offer a long-term solution that also offer...
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Milimani is chill. Very chill. Ordering food? It'll take awhile (but it's good.) Wanting to use internet? It'll take awhile (but it works.) Want to just lounge around and watch tv? No problem.
I stayed with a group of 60, so I'm not too sure what it's like staying on your own. The rooms worked just fine for me. Same with the showers.
The outdoor area is awesome in the evening, especially if there's a fire on. Met some really interesting folks when I was there.
As far as the safari went...I think it was a little overpriced, but I had a geat time and don't regret it at all. Milimani isn't the greatest...but it's far, far from the worst. Some of the other reviews on here seem a little extreme if you ask me.
- Official Description (provided by the hotel):
- We provide budget oriented, sociable accommodation for guests; Travel and Tourism related services & a Location for hosting events. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Booking.com so you can book your Milimani Backpackers & Safari Centre reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.
- Also Known As:
- Milimani Backpackers & Safari Centre Hotel Nairobi
- Milimani Backpackers And Safari Centre


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Walgreens has added an "Answers" tab to its Facebook page, offering a Q&A tool for drugs, supplements, and health queries. The move represents how Walgreens and other major brands are increasingly utilizing the social site as a customer care hub.
Sona Chawla, president of e-commerce for the Deerfield, IL-based retailer, said in a prepared statement: "With the success of our online health initiatives, such as the ability to chat live with a Walgreens pharmacist 24/7, this is yet another example of our commitment to innovation in the digital space that gives people greater access to Walgreens pharmacists and other clinical experts."
While the Q&A tool on its face looks like a service, it's also a product search feature. For instance, a "cold sores" query produces a link to a branded remedy only one spot below the top result, which offers a definition for the fever blisters condition. Viewers can tap a "Pharmacy Chat" button while clicking through to a Walgreens.com page, where they can live chat with a rep.
Like other brands in 2011, Walgreens showed it's serious about emerging media by hiring its first social media marketing director, cherry-picking an ad agency for talent. The brand, which has 1.9 million Facebook fans/likes, is using technology from Sharecare for the new Q&A service.
Meanwhile, CRM products like Sharecare's could become a bigger marketplace in the coming months. Now that Facebook marketers can direct message with consumers, app developers will likely offer brands tools in order to take advantage of the social site's one-to-one communications channel. The features could include the ability to capture email addresses and phone numbers, letting brand reps follow up through additional channels to alleviate consumer concerns.
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The high school football season kicks off tonight, and football.dailyherald.com is the place to go for live streams, photos and recaps tonight.
We'll have the following games live tonight. Click on the link to watch the game.
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Naperville North at Neuqua Valley
St. Charles North at Elk Grove
Downers Grove North at Lockport
Crystal Lake South at Marian Central
Metea Valley at Plainfield East
You can also follow all the area action with our scoreboard.
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