text:
Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy
© Alpendurada et al; licensee BioMed Central Ltd. 2011
Received: 6 July 2011
Accepted: 31 October 2011
Published: 31 October 2011
Cardiac resynchronization therapy (CRT) is an established treatment in advanced heart failure (HF). However, an important subset does not derive a significant benefit. Despite an established predictive role in HF, the significance of right ventricular (RV) dysfunction in predicting clinical benefit from CRT remains unclear. We investigated the role of RV function, assessed by cardiovascular magnetic resonance (CMR), in predicting response to and major adverse clinical events in HF patients undergoing CRT.
Sixty consecutive patients were evaluated with CMR prior to CRT implantation in a tertiary cardiac centre. The primary end-point was a composite of death from any cause or unplanned hospitalization for a major cardiovascular event. The secondary end-point was response to therapy, defined as improvement in left ventricular ejection fraction ≥ 5% on echocardiography at one year.
Eighteen patients (30%) met the primary end-point over a median follow-up period of 26 months, and 27 out of 56 patients (48%) were considered responders to CRT. On time-to-event analysis, only atrial fibrillation (HR 2.6, 95% CI 1.02-6.84, p = 0.047) and RV dysfunction, either by a reduced right ventricular ejection fraction-RVEF (HR 0.96, 95% CI 0.94-0.99, p = 0.006) or tricuspid annular plane systolic excursion-TAPSE (HR 0.88, 95% CI, 0.80-0.96, p = 0.006), were significant predictors of adverse events. On logistic regression analysis, preserved RVEF (OR 1.05, 95% CI 1.01-1.09, p = 0.01) and myocardial scar burden (OR 0.90, 95% CI 0.83-0.96, p = 0.004) were the sole independent predictors of response to CRT. Patients with marked RV dysfunction (RVEF < 30%) had a particularly low response rate (18.2%) to CRT.
Right ventricular function is an important predictor of both response to CRT and long-term clinical outcome. Routine assessment of the right ventricle should be considered in the evaluation of patients for CRT.
Keywordsheart failure cardiac resynchronization therapy right ventricular function cardiovascular magnetic resonance
Cardiac resynchronisation therapy (CRT) is an established therapeutic option for selected patients with symptomatic heart failure (HF). Amongst its benefits are reduced mortality, improved exercise tolerance and quality of life [1, 2]. However, a proportion of patients do not gain any significant benefit, the reasons for which are unclear. Thus a number of devices are being implanted with no discernible clinical benefit, which has important healthcare costs implications, as well as exposing patients to unnecessary risks. Our current strategy for assessing benefit with CRT is mainly focused on assessing symptomatic or functional response, but it is increasingly clear that this does not necessarily translate into improved clinical outcomes. It is therefore important to refine the selection criteria for device implantation to better identify those who would benefit-both in terms of response and improved clinical outcomes.
Whilst much attention has focused on remodelling of the left ventricle (LV), the role of the right ventricle (RV) in the appropriate selection of patients for CRT remains unclear [3]. Previous studies assessing RV function have utilised echocardiography and radionuclide imaging [4–7]. However, accuracy of RV volumes and function by these techniques may be inaccurate due to the anatomical location and complex geometric structure. Cardiovascular magnetic resonance (CMR) offers superior three dimensional representation of the RV, leading to a more accurate and reproducible assessment of RV function [8]. We therefore sought to assess the impact of RV function on outcomes in HF patients undergoing CRT implantation using CMR.
Study population
We studied 60 consecutive patients attending the Royal Brompton Hospital heart failure pacing clinic between January 2005 and March 2010 who fulfilled the following criteria: 1. New York Heart Association (NYHA) class III/IV at the time of CRT implantation; 2. QRS width ≥ 120 ms; 3. LVEF ≤ 35% by echocardiography, and; 4. CMR study within 3 months before CRT implantation.
These patients were evaluated for clinical (aetiology of heart failure, symptom status and medication, heart rate, blood pressure) and electrocardiographic (rhythm and QRS width) parameters at the time of device implantation. As this study involved review of local patient medical records, individual consent was not required by our Ethics Committee who approved the study.
Cardiovascular magnetic resonance studies were performed in 1.5T Sonata or Avanto scanners (Siemens, Erlangen, Germany). A short-axis stack from atrio-ventricular level to the apex was acquired using a steady-state free-precession cine sequence (echo time 1.6 ms, repetition time 3.2 ms, flip angle 60°, slice thickness 7 mm with a 3 mm gap, acquisition time of 8-12 cardiac cycles) to quantify left and right ventricular volumes. Long-axis cines were also acquired to define the valve plane throughout the cardiac cycle. An inversion recovery gradient echo sequence was used 10 minutes after gadolinium injection (Magnevist® or Gadovist® , 0.1 mmol/kg) to assess myocardial scar. Inversion times were set to null the normal myocardium with images repeated in two stacks of identical short-axis planes but separate phase-encoding directions to exclude artefact.
Valvular regurgitation was graded as mild (n = 1), moderate (n = 2) or severe (n = 3) by blinded observers, based on the echocardiographic and CMR findings. LVEF was also calculated by echocardiography before and 1 year after device implantation using the Simpson's method from the 2-chamber and 4-chamber views. Pulmonary artery systolic pressure was determined by echocardiography using standard methodology.
Contrast imaging with gadolinium was performed to assess the aetiology of the heart failure. Assessment of late gadolinium enhancement (LGE) in the left or right ventricle was interpreted by blinded observers. When present, the amount of LGE was quantified in a 16-segment model based on the "full width at half maximum" technique by customized analysis software (MRI-MASS, Medis, Leiden, the Netherlands) [11].
All patients were followed-up in a heart failure clinic and standard medications were adjusted and optimized at these appointments. Data was collected from local hospital records, nation-wide summary case records and the Office of National Statistics. The primary end-point was a composite of all-cause mortality or an unplanned hospitalization for a major cardiovascular event; only the first event in each patient was included in this analysis [2]. The secondary end-point was echocardiographic response to CRT, defined as an improvement in LVEF by more than 5% by echocardiography 12 months after CRT implantation [12, 13].
Statistical analysis
Categorical variables are presented as frequency and percentage. Continuous variables are presented as mean ± standard deviation (SD) if normally distributed, or as median plus inter-quartile range (IQR) as appropriate. Continuous variables were compared with Student's t-test or the Mann-Whitney for non-parametric data. Correlation was assessed with Pearson's or Spearman's methods as appropriate.
Time to first event analysis was performed using Cox's proportional hazard models. Log-rank test was used to compare Kaplan-Meier cumulative event curves. Logistic regression was used to assess response to CRT at 12 months. Multivariate logistic regression analysis using a forward stepwise approach was performed on parameters that were significant on univariate analysis.
A two-tailed value of p-value < 0.05 was considered significant. All statistical analysis was performed using SPSS 19.0 (IBM, Chicago, Illinois, USA).
Baseline characteristics of the patients
Age, years
65.3 ± 12.5
Male gender
46 (76.7%)
Heart failure, aetiology
Dilated cardiomyopathy
27 (45.0%)
29 (48.3%)
3 (5.0%)
1 (1.7%)
46 (76.7%)
Atrial fibrillation
13 (21.7%)
Atrial flutter
1 (1.7%)
43 (71.7%)
ACE inhibitors/ARB
58 (96.7%)
Aldosterone antagonists
39 (65.0%)
Loop diuretics
52 (86.7%)
12 (20.0%)
23 (38.3%)
19 (31.7%)
30 (50.0%)
QRS width (ms)
156 ± 21
Heart rate
Beats per minute (bpm)
76 ± 15
Blood pressure
Systolic (mmHg)
120 ± 20
Diastolic (mmHg)
72 ± 13
Left ventricle
EDV (mL/m2)
169 ± 62
ESV (mL/m2)
124 ± 55
27 ± 8
Mass (g/m2)
113 ± 30
Right ventricle
EDV (mL/m2)
82 (65-123)
ESV (mL/m2)
38 (27-76)
52 (37-62)
TAPSE (mm)
13.5 ± 5.6
Peak wall thickness (mm)
3.6 ± 0.9
Pulmonary artery pressure (mmHg)
38.7 ± 8.7
Late gadolinium enhancement
20 (33.3%)
19 (31.7%)
Subendocardial + mid-wall
6 (10.0%)
15 (25.0%)
Right ventricle
5 (8.3%)
Left ventricle
Both mean left ventricular indexed end-diastolic and end-systolic volumes were high (169 ± 62 and 124 ± 55 mL/m2, respectively). The indexed left ventricular end-diastolic volume was increased in 93% of the patients, while the indexed left ventricular end-systolic volume was increased in 99% of the patients compared to normal reference values [9]. The mean LVEF was 27 ± 8%, and the mean mass index was increased at 113 ± 30 g/m2.
Mitral regurgitation was seen in 90% of the patients, and was significant in 25% of patients (18% moderate, 7% severe). Aortic regurgitation was seen in 25% of patients, and was moderate in only one patient.
Right ventricle
Right ventricular indexed volumes and ejection fraction were non-normally distributed, and hence presented as median plus inter-quartile ranges. The median end-diastolic and end-systolic volumes were 82 (65-123) mL/m2 and 38 (27-76) mL/m2, respectively. Right ventricular indexed end-diastolic volume was increased in 38% of patients, while the indexed end-systolic volume was increased in 53% of patients [10]. The median RVEF was 52% (IQR 37-62%), with 53% of patients having a RVEF ≥ 50%.
The mean TAPSE was 13.5 ± 5.6 mm, with 40% of patients having values within normal limits when the standard echocardiographic cut-off value of 15 mm was considered. The mean peak RV wall thickness was 3.6 ± 0.9 mm.
In the 52 patients (87%) in whom it could be measured, the mean PASP was 38.7 ± 8.7 mmHg, with 37% of patients having a PAP > 40 mmHg. Tricuspid regurgitation was seen in 57% of the patients, and was significant in 14% of patients (12% moderate, 2% severe). No significant pulmonary regurgitation was identified in any patient.
There was a moderately strong correlation between RVEF with TAPSE (r = 0.58, p < 0.01), and a moderate correlation between RVEF and LVEF (r = 0.41, p < 0.01). Severity of mitral regurgitation was associated with a higher PAP (p = 0.01) and a lower RVEF (p < 0.01). Modest inverse correlations were observed between RVEF and pulmonary artery pressure (r = -0.37, p < 0.01), RV wall thickness (r = -0.28, p = 0.03) and severity of tricuspid regurgitation (p = 0.03). TAPSE was inversely related with RV wall thickness (r = -0.29, p = 0.03), but not with pulmonary artery pressure (r = -0.15, p = 0.28) or LVEF (r = 0.09, p = 0.48).
RVEF was similar in patients with an ischaemic and non-ischaemic aetiology (46.9 ± 14.8% vs. 49.5 ± 18.9, p = 0.56), and in patients with AF compared to those in sinus rhythm (45.4 ± 14.9% vs. 49.2 ± 17.8%, p = 0.48).
Myocardial fibrosis
Left ventricular LGE was present in two-thirds of the patients: 19 patients (31.7%) had sub-endocardial enhancement suggesting myocardial infarction, 15 patients (25.0%) had a mid-wall enhancement pattern indicating fibrosis, and the remaining 6 patients (10.0%) had a mixed pattern of myocardial infarction and mid-wall fibrosis. Myocardial infarction was therefore present in 25 patients (41.7%): the septal wall was affected in 11 patients; the inferolateral wall was involved in 15 patients. The median percentage of scar in the myocardium was 4% (IQR 0-18%).
Right ventricular LGE was present in 5 patients (8.3%). All these patients had coronary artery disease with inferior myocardial infarctions of the LV extending to the inferior free wall of the RV.
Univariate analysis: Primary end-point (time to death from any cause or an unplanned hospitalization for a major cardiovascular event).
Events (n = 18)
No Events (n = 42)
P value
Age (years)
69.6 ± 11.9
63.3 ± 12.3
Male gender
14 (78%)
32 (76%)
10 (56%)
17 (41%)
Atrial fibrillation
6 (39%)
8 (17%)
Heart rate (bpm)
79.2 ± 19.4
74.1 ± 12.5
SBP (mmHg)
124 ± 22
118 ± 19
QRS width (ms)
151 ± 25
158 ± 21
Left ventricle
EDV index (mL/m2)
159 ± 54
173 ± 64
ESV index (mL/m2)
120 ± 52
126 ± 56
26.9 ± 9.5
28.9 ± 7.6
Mass index (g/m2)
106 ± 25
115 ± 32
Mitral regurgitation
1.3 ± 0.6
1.2 ± 0.8
13 (72%)
27 (64%)
9.5 (0-20)
3 (0-17)
Myocardial infarction
9 (50%)
16 (38%)
Right ventricle
EDV index (mL/m2)
95 (76-138)
77 (60-103)
ESV index (mL/m2)
52 (35-102)
34 (21-66)
39 (25-54)
55 (43-66)
TAPSE (mm)
11.0 ± 4.4
14.5 ± 5.9
Wall thickness (mm)
3.9 ± 1.0
3.5 ± 0.9
PAP (mmHg)
42.5 ± 8.3
37.5 ± 8.5
After documenting AF as a predictor of outcomes, we performed a post-hoc analysis on delivery rate, defined as the percentage of paced left ventricular beats. Data was collected from routine pacing clinic visits during the first year of implantation. Unlike AF, delivery rate was not associated with the primary end-point (HR 0.97, 95% CI 0.88-1.08, p = 0.56).
Response to therapy
Univariate analysis: Response to cardiac resynchronization therapy (improvement of LVEF ≥ 5% at one year).
Response (n = 27)
No Response (n = 29)
P value
64.0 ± 12.2
65.8 ± 12.2
Male gender
18 (67%)
25 (86%)
7 (26%)
19 (66%)
Atrial fibrillation
4 (15%)
7 (24%)
Heart rate (bpm)
76 ± 15
76 ± 16
SBP (mmHg)
120 ± 20
119 ± 19
QRS width (ms)
161 ± 21
150 ± 22
Left ventricle
EDV index (mL/m2)
156 ± 46
177 ± 71
ESV index (mL/m2)
111 ± 40
133 ± 63
30.5 ± 8.5
26.5 ± 7.2
Mass index (g/m2)
108 ± 26
118 ± 34
Mitral regurgitation
1.1 ± 0.6
1.3 ± 0.8
13 (48%)
24 (83%)
0 (0-7)
13 (3-22)
Myocardial infarction
6 (22%)
18 (62%)
Right ventricle
EDV index (mL/m2)
77 (67-104)
83 (61-139)
ESV index (mL/m2)
36 (23-54)
40 (31-96)
56 (45-63)
44 (28-61)
TAPSE (mm)
15.3 ± 5.8
11.8 ± 4.2
Wall thickness (mm)
3.3 ± 0.7
4.0 ± 1.0
PAP (mmHg)
36.9 ± 8.5
40.5 ± 9.0
Multivariate analysis: Response to cardiac resynchronization therapy (improvement of LVEF ≥ 5% at one year).
Response (n = 27)
No Response (n = 29)
P value
0 (0-7)
13 (3-22)
56 (45-63)
44 (28-61)
This study shows that RV dysfunction is associated with non-response and adverse outcomes in patients on CRT. Despite meeting the standard criteria for CRT implantation, there was a heterogeneous distribution of RV function in our study population. Since LVEF was narrowly distributed by accepted indications for CRT, the wide RVEF distribution observed may indeed explain why RV function was an independent discriminator in this population with advanced HF. A lower RVEF was associated with a lower LVEF, more significant mitral regurgitation, and a higher PAP. This suggests that the RV dysfunction may derive from two fundamental mechanisms, the importance of which may vary from patient to patient: 1) an impairment of global biventricular intrinsic contractility; 2) pulmonary hypertension secondary to elevated LV filling pressures and mitral regurgitation.
Adverse RV function may reflect more extensive and severe cardiac disease, to which improving myocardial synchrony has little impact. Of note, the response rate of the subgroup of patients with RVEF < 0.3 was less than 20%. Thus, patients with poor RV function were unlikely to benefit from CRT. This may have implications in stratifying patients for device therapy.
Previous work
Few studies have investigated RV function and dyssynchrony. Previous work has shown that anything up to 20-40% of RV systolic pressure and volume load may originate from contraction from the LV [14]. Conversely, left bundle branch block (LBBB) may interfere with ventricular activation and induce mechanical dyssynchrony. Hence LBBB not only affects LV function but may impair RV function as well.
RV functional indices have been previously evaluated in CRT populations. Initial work by Field et al assessed RV function on adverse outcomes in a population of 77 patients undergoing CRT. This study showed that RV dysfunction measured by the Doppler-derived Tei index was a predictor of the composite end-point of death, transplantation and the implantation of left ventricular assist devices [4]. More recent work focused on RV function and response to CRT. In a study of 44 patients undergoing CRT, echocardiographic indices of RV function (TAPSE and RV fractional area change) were significantly worse in non-responders versus responders to CRT [5]. The value of TAPSE in predicting reverse remodelling was further validated in the CARE-HF population [6]. A further radionuclide imaging study in 44 patients undergoing CRT showed that those with a low baseline RVEF were less likely to improve in NYHA class, and tended to improve less in functional capacity and LVEF [7].
The results of our study are in line with the above publications. However, we used CMR as the gold-standard technique for assessment of the RV, and RVEF as the reference marker of RV performance. Along with myocardial infarction, RVEF was an independent predictor of response to CRT. Among an array of established prognostic markers in HF, RVEF and TAPSE emerged as the strongest predictors of events. Our findings correlated response with outcomes over a clinically relevant timeframe, thus supporting the potential of RV function as a predictor of short-term response as well as longer-term outcome following CRT.
Tricuspid annular plane systolic excursion
Although available to all imaging modalities, and despite its validated prognostic value amongst cardiac and pulmonary conditions, RVEF estimation can be challenging as the right ventricle is a complex structure which cannot be modelled with simple geometric assumptions. Therefore, there is some interest in finding simpler ways for assessing RV performance. Of these, tricuspid annular plane systolic excursion (TAPSE) is the most described alternative to RVEF in the literature [15]. This marker of RV longitudinal function is reproducible and easy to obtain, and has shown to be a predictor of adverse outcomes in heart failure, irrespective of NYHA status and LV function [16, 17]. In this study, TAPSE not only identified which patients would respond to CRT, but also the patients more likely to have major adverse events. Thus, TAPSE may be used by CMR as an alternative to RVEF for assessing RV function pre CRT when the latter cannot be estimated.
Pulmonary hypertension
Increased pulmonary artery pressures have shown to be associated with non-response to CRT [5]. As ejection fraction is influenced by the afterload, it is expected for increasing pulmonary pressures to be associated with decreasing RVEF. A significant negative correlation was indeed observed between PAP and RVEF in our study. However, this correlation was modest and not as strong as other parameters such as LVEF, suggesting that factors other than pulmonary hypertension play a role in RV function. There was a trend for non-response to CRT and adverse outcomes in patients with increased pulmonary pressures, but statistical significance was not reached, probably explained by the smaller study population compared to other studies [18]. On the other hand, markers of RV function were significantly associated with response and adverse events. This suggests that RV function is more important than pulmonary pressure alone for both mechanical response and long-term prognosis in patients on CRT.
Myocardial fibrosis
Late gadolinium enhancement CMR detects myocardial infarction accurately, with superior histological correlation compared to nuclear techniques [19]. This has become an active area of research in the CRT setting, with several subsequent studies documenting the value of scar burden, location and transmurality of myocardial infarctions as a predictor of response to CRT [20–24]. Consistent with this work, our study showed myocardial infarction and scar burden (as determined by percentage of LGE mass) to portend an adverse response to CRT. Although the amount of septal and lateral scar was associated with non-response to therapy (OR 0.99, 95% CI 0.98-1.00, p = 0.02; and OR 0.98, 95% CI 0.97-1.00, p = 0.02, respectively), scar location did not remain significant after including the total amount of scar in a multivariate model.
The lack of response observed with the above parameters did not translate into poorer outcomes. It is possible that this study was underpowered to detect more adverse events, as larger studies have shown ischaemic heart disease and location of myocardial infarction to portend a worse prognosis in CRT [25–27].
Atrial fibrillation
Atrial fibrillation was the other predictor of outcomes besides RV dysfunction. This mirrors findings of long term studies of patients on CRT [28]. It is recognised that AF with a high ventricular rate may impair the delivery of biventricular pacing, and consequently undermine the clinical benefit of CRT [29]. Despite the paucity of data from randomized control trials in AF populations, recent guidelines support the use of CRT in AF patients, although restricted to a slightly wider QRS duration > 130 ms [30]. A recent European registry suggests that around 20% of patients undergoing CRT are actually in permanent AF, which is in keeping with our findings [31]. Of note, all but one AF patient in this study had QRS > 130 ms. Rate control was satisfactory in our AF cohort, the ventricular delivery rate was high (median 97%, IQR 91-99%), and none of the patients underwent AV nodal ablation. Unlike RV dysfunction, AF was not associated with a lower response rate, suggesting that the impact of AF on adverse outcomes was not altered by device implantation.
In addition to the hard clinical endpoints, we assessed the role of RV function on response to CRT. Response is a contentious topic, with various proposed definitions but no consensus amongst different criteria. The response rate varies widely, depending on the study population and the response criteria used. In a recent paper comparing 15 response criteria from the most cited papers, the response rate ranged from 32% to 91%. The same study showed that the agreement between different criteria was poor in 75% of the time, especially between clinical and echocardiographic criteria [32]. For our study, we used LVEF to assess response because it is an objective parameter and is also one of the selection criteria for CRT. In keeping with previous work, response for this study was an improvement in LVEF ≥ 5% at 12 months [12, 13]. The response rate observed was relatively low (48%), but still in accordance with the available literature [32]. Using this criterion, RV dysfunction predicted a failure of response to CRT in terms of LV remodelling, thus supporting previous echocardiographic and radionuclide studies [5–7]. It is possible that significant RV dysfunction marks extensive and irreversible adverse remodelling, preventing reverse remodelling and functional recovery after CRT implantation. Improvement in LVEF ≥ 5% was significantly associated with event-free survival in this cohort of patients (likelihood ratio 4.7, p = 0.01). Mechanical remodelling thus appears to be a good surrogate marker of response to therapy, in line with a recently published analysis of the MADIT-CRT trial, where it was demonstrated that echocardiographic improvement in LV volumes and ejection fraction was associated with improved outcomes [33].
This was a retrospective study with a relatively small number of patients and events limiting multivariate analysis on outcomes. Nonetheless, both RVEF and TAPSE emerged as the most significant prognostic markers, suggesting that RV function as assessed by CMR has a powerful role in advanced HF undergoing CRT.
This was a single centre study in a tertiary referral hospital, but it allowed for consistent CMR scanning protocols, and consistent patient selection for CRT and close follow-up of all patients. To ensure a representative cohort, consecutive patients were identified.
The CRT devices implanted during this time period were non-MRI compatible and hence necessitated an alternative imaging modality for consequent follow-up. The development of CMR-compatible CRT devices could overcome this current limitation and may provide new insights on the response of both left and right ventricle to CRT.
Right ventricular function appears an important predictor of response and major adverse events following CRT implantation. As current selection criteria only include patients with poor LV function, it is reasonable to assume that RV function will act as an important discriminative prognostic marker in patients undergoing CRT. Furthermore, poor RV function appears to identify a subgroup of patients with extensive ventricular remodelling unlikely to change their natural history. Therefore, CRT may be of no benefit in this subgroup of patients. The presence and amount of myocardial fibrosis, by contrast, was a predictor of response but did not predict outcomes.
The results of this study suggest that assessment of RV function can provide valuable information pre CRT implantation. Further work in larger cohorts is required to ascertain the precise role of RV evaluation in the selection of patients for CRT as well as the mechanisms for this dysfunction.
List of abbreviations
cardiovascular magnetic resonance
cardiac resynchronization therapy
ejection fraction
heart failure
interquartile range
left bundle brunch block
left ventricle
pulmonary artery systolic pressure
right ventricle
standard deviation
tricuspid annular plane systolic excursion.
This project was supported by the NIHR Cardiovascular Biomedical Research Unit of Royal Brompton & Harefield NHS Foundation Trust and Imperial College London. Research support was also received from the BHF and CORDA.
Authors' Affiliations
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- Wagner A, Mahrholdt H, Holly TA, Elliott MD, Regenfus M, Parker M, Klocke FJ, Bonow RO, Kim RJ, Judd RM: Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet. 2003, 361: 374-9. 10.1016/S0140-6736(03)12389-6.View ArticlePubMedGoogle Scholar
- Bleeker GB, Kaandorp TA, Lamb HJ, Boersma E, Steendijk P, de Roos A, van der Wall EE, Schalij MJ, Bax JJ: Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation. 2006, 113: 969-76. 10.1161/CIRCULATIONAHA.105.543678.View ArticlePubMedGoogle Scholar
- Ypenburg C, Roes SD, Bleeker GB, Kaandorp TA, de Roos A, Schalij MJ, van der Wall EE, Bax JJ: Effect of total scar burden on contrast-enhanced magnetic resonance imaging on response to cardiac resynchronization therapy. Am J Cardiol. 2007, 99: 657-660. 10.1016/j.amjcard.2006.09.115.View ArticlePubMedGoogle Scholar
- White JA, Yee R, Yuan X, Krahn A, Skanes A, Parker M, Klein G, Drangova M: Delayed enhancement magnetic resonance imaging predicts response to cardiac resynchronization therapy in patients with intraventricular dyssynchrony. J Am Coll Cardiol. 2006, 48: 1953-1960. 10.1016/j.jacc.2006.07.046.View ArticlePubMedGoogle Scholar
- Chalil S, Foley PW, Muyhaldeen SA, Patel KC, Yousef ZR, Smith RE, Frenneaux MP, Leyva F: Late gadolinium enhancement-cardiovascular magnetic resonance as a predictor of response to cardiac resynchronization therapy in patients with ischaemic cardiomyopathy. Europace. 2007, 9: 1031-1037. 10.1093/europace/eum133.View ArticlePubMedGoogle Scholar
- Marsan NA, Westenberg JJ, Ypenburg C, van Bommel RJ, Roes S, Delgado V, Tops LF, van der Geest RJ, Boersma E, de Roos A, Schalij MJ, Bax JJ: Magnetic resonance imaging and response to cardiac resynchronization therapy: relative merits of left ventricular dyssynchrony and scar tissue. Eur Heart J. 2009, 30: 2360-7. 10.1093/eurheartj/ehp280.View ArticlePubMedGoogle Scholar
- Leyva F, Foley PW, Chalil S, Ratib K, Smith RE, Prinzen F, Auricchio A: Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011, 13: 29-10.1186/1532-429X-13-29.PubMed CentralView ArticlePubMedGoogle Scholar
- Woo GW, Petersen-Stejskal S, Johnson JW, Conti JB, Aranda JA, Curtis AB: Ventricular reverse remodeling and 6-month outcomes in patients receiving cardiac resynchronization therapy: analysis of the MIRACLE study. J Interv Card Electrophysiol. 2005, 12: 107-113. 10.1007/s10840-005-6545-3.View ArticlePubMedGoogle Scholar
- Zhang Q, Fung JW, Chan JY, Yip G, Lam YY, Liang YJ, Yu CM: Difference in long-term clinical outcome after cardiac resynchronisation therapy between ischaemic and non-ischaemic aetiologies of heart failure. Heart. 2009, 95: 113-118. 10.1136/hrt.2008.145698.View ArticlePubMedGoogle Scholar
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- Koplan BA, Kaplan AJ, Weiner S, Jones PW, Seth M, Christman SA: Heart failure decompensation and all-cause mortality in relation to percent biventricular pacing in patients with heart failure: is a goal of 100% biventricular pacing necessary?. J Am Coll Cardiol. 2009, 53: 355-60. 10.1016/j.jacc.2008.09.043.View ArticlePubMedGoogle Scholar
- Dickstein K, Vardas PE, Auricchio A, Daubert JC, Linde C, McMurray J, Ponikowski P, Priori SG, Sutton R, van Veldhuisen DJ, ESC Committee for Practice Guidelines, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Tendera M, Anker SD, Blanc JJ, Gasparini M, Hoes AW, Israel CW, Kalarus Z, Merkely B, Swedberg K, Camm AJ: 2010 Focused Update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC Guidelines for cardiac and resynchronization therapy. Europace. 2010, 12: 1526-36.View ArticlePubMedGoogle Scholar
- Dickstein K, Bogale N, Priori S, Auricchio A, Cleland JG, Gitt A, Limbourg T, Linde C, van Veldhuisen DJ, Brugada J: The European cardiac resynchronization therapy survey. Eur Heart J. 2009, 30: 2450-60. 10.1093/eurheartj/ehp359.View ArticlePubMedGoogle Scholar
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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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Exclusive knowledge, tips, and advice from Gold&Silver that you can't find anywhere else.
Mike Maloney explains when the U.S. Dollar could lose its world reserve currency status, what new currency he expects will replace it, and which banks are backing it.
In this video Mike explains how government has kicked the can down the road only to hit them back and how they plan to ban cash and why.
Jim Rickards: The Fed constantly flip flops and literally does not know what it's doing.
The stock market is soaring, jobs report gives a rosy outlook. Are we in for good times...or are the hard times just around the corner?
In this Insider's Report, Mike looks at how much the world's currencies have depreciated compared to gold over the past century. You'll see that the U.S. Dollar has lost over 98% of its purchasing power and that once again, precious metals are the ultimate store of value.Mike also provides an update on the Commitment of Traders Report and forecasts where gold and silver prices might be headed next.
In this presentation, Mike Maloney uses articles from fee.org and mises.org to give concrete examples of the stupidity of protectionism, showing that rather than helping an economy... it kills prosperity. What kind of protectionist policies will Trump burden the USA with? Please leave your thoughts below.
Chris Martenson Brings this incredible interview with Danielle DiMartino Booth a former Senior Financial Analyst for the Fed and author of Fed Up: An Insider's Take On Why The Federal Reserve Is Bad For America a currently #1 best seller on Amazon.Chris get's some straight answers on what's going on with the fed from this insider that has spent almost a decade at the Dallas Federal reserve.
Federal Reserve Chairwoman Janet Yellen on Tuesday will deliver the semiannual monetary policy outlook before the Senate Banking Committee.
Rogers: We're going to have the worst economic problem's in our lifetime
The US government debt is now bigger than the debt of any other government in human history. This video ask's you does the size really matter?
Of all the investment banks on Wall Street, Goldman Sachs enjoys the most incestuous relationship with Washington, where it has a revolving door at the Treasury Department.
In this video Mike is asked a question from the audience "Will Shanghai set the prices for Silver instead of New York City"?
This is an excellent presentation on Gold and the markets by Grant Williams. He puts together the dot's that ties to gold and how naysayers in the media constantly poo poo the gold market. Grant also goes on to explain how gold has out performed the stock and bond markets.Grant is portfolio and strategy advisor to Vulpes Investment Management in Singapore and also one of the founders of Real Vision Television — an online, on-demand finance channel showcasing the brightest minds in finance.Published on Feb 7, 2017
Grant is concerned that a return of volatility will act as a wrench tossed into the gears, quickly throwing the world financial system into panic.
Jeff Clark, Senior Precious Metals Analyst at GoldSilver.com on the dwindling supply of gold and how it will effect you the markets.
Grant give's his reasons why gold is getting closer to fruition on the debt ticking time bomb.
Politicians are experts at shuffling deck chairs on a sinking ship. As President Trump's tax plan is eventually revealed, here are a few things to look out for:
In this video Mike explains the expanding currency supply and how to mathematically calculate valuation.
"What if you knew what the markets were going to do before they did it? What if you knew the ultimate destiny of stocks, real estate, and gold and silver?"
The Kondratieff Winter Cycle is now turning down & what to expect with people waking up, savings, markets, policies. They go on to tell that it's time to deleverage the debt and the possible consequences.
If a picture is worth a thousand words, then videos must be worth a million of them. At Goldsilver.com™, you'll find a library of gold and silver investment videos that will provide you with the critical information you need to understand the hows and whys and whens of investing in precious metals, to help you protect and grow your wealth.
Curious about why Mike Maloney thinks the dollar has cancer? Have you ever wondered whether there is a difference between investing in gold and silver mine stocks and investing in physical gold and silver? Is there a way to properly time your investments in commodities, real estate, and other valuables to ensure long-lasting wealth? You'll find the answers to these questions and more in the GoldSilver.com™ knowledge center video library.
From videos about gold investing that walk investors through the basics of cyclical markets and gold's ability to revalue itself as governments devalue their flat currencies to videos about types of investments you should avoid, GoldSilver.com™ offers investors a truly expansive collection of information that takes the mystery out of precious metals investing.
When you buy gold online, you need to have the peace of mind of knowing you are dealing with experts who understand the intricate details of successfully timing investments to maximize wealth creation. The GoldSilver.com™ knowledge center video library offers you access to Mike Maloney, who talks in detail about the relevant issues surrounding your decision to buy silver online, invest in gold, and why you would consider selling.
The investment education available through the GoldSilver.com™ knowledge center video library is, as the expression says, worth its weight in gold. Don't miss out on your opportunity to be a GoldSilver Insider and have access to an extraordinary volume of information designed to help you be an informed and decisive investor.

subset: commoncrawl


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Each month, Rated People connects over 50,000 homeowners with quality tradesmen - simply enter your job details in the form above to get started.
We'll match your job to the relevant tradesmen in your area - those interested will pay to see your contact details and call you to quote.
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I use an old digital camera... sony mavica with a 14X optical zoom
1024X768 Pixels limit---MVC-FD91 for those who would like to know. I
have had it for -- ever. I can usually get a decent photo of anything
with it. Even some that try to allude me. (I am hoping Santa brings me a
new one, as it is on it's last legs)
But Kitty I think you are right, might have to bring out that 35mm one
that has been in the closet for the last 15 (?) years :(... But do I
remember how to use it?
I am also taking these inside a greenhouse. Seemed bright enough, but
wondering if the additional florescent lighting is another problem.
Maybe I should have turned it off. Another issue is trying to do this
while they are planted in a tray of plugs size. They are all so darn
close together!
Very challenging for a non-profession photographer......
> > Although my attempts at getting a so to speak
> > bark / stem close up
> > didn't come out very good... any photographers
> > want to share the secret?
> Donna,
> Give us more info. What kind of camera are you using? If digital,
> may be
> hampered by the depth of field it allows. On a 35mm SLR with a good
> and
> decent light, it is possible to get greater depth of field. Lower
> lighting
> may require a greater aperature, decreasing depth. The quality of the
> optics
> in the lens itself play a big part in this. I dabble, but Chris L.
> I'm
> sure, be able to give you a much more accurate answer.
> Kitty
To sign-off this list, send email to email@example.com with the
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text:
Youtube clone
This project received 13 bids from talented freelancers with an average bid price of $227 USD.Get free quotes for a project like this
Project BudgetN/A
Total Bids13
Project Description
We need a youtube clone but we dont want users to upload the videos, only the members we select will be able to do so. We need people be able to rate and comment on the videos. There must be an admin area to be able to delete videos and create categories (we need 30 created for now, but if possible want the ability to create more). Links such as send to friend thru email also needed. For more info pm us.
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by Unknown
(New Zealand)
Pine, cedar, walnut, macrocarpa and anything else I can get for free or at a low cost. All of the above are either on our block or one of the neighbours so it's easily accessible to us.
Comments for Best Firewood In New Zealand
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Want to make sure your firewood is ready for winter? Here are 10 how to season firewood tips.
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Use these easy to follow firewood rack assembly instructions to build your own rugged and durable outdoor firewood rack.
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Removing ashes from a wood stove is a concern for many people. Find out the best way to remove ashes without creating a mess in your house.
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As the old boundaries between journalism and PR continue to shift with the development of the internet, some news organisations are finding innovative ways to work with partner organisations and amplify the impact of stories.
The youth-orientated Vice has skilfully aligned itself with the gay-rights group Stonewall to ensure maximum exposure for its new film, Young and Gay in Putin's Russia, which highlights a rise in homophobic attacks.
By bringing Stonewall on board soon after the footage was shot, Vice ensured that the film will get the constant support of the campaign group's large social-media network in the run-up to the Winter Olympics.
Stonewall said it had "advised" on the narrative of the film but that Vice retained editorial control. It's a tactic we are likely to see more of, rather than relying on the old model of simply publishing and waiting for the world to take notice.Reuse content


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Description how to fix a bike spoke
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402 S Howard Ave
Tampa, FL 33606
Neighborhood: South Tampa
Description Taqueria Quetzalcoatl (Closed) - Restaurant
Cinnamon Bunz Mobile BronzingTampa and Surrounding Areas , Tampa FL, 33607
Don't lose your summer tan! Look more gorgeous than you already are with a Cinnamon Bunz spray tan! We use only the best sunless solutions that are hypoallergenic,...
Connect Call DirectionSouth Tampa
Features: Beauty Salons, Cosmetic Surgery, Cosmetics, Hair Salons, Nail Salons
Special Olympics Florida3104 N Armenia Ave , Tampa FL, 33607
Special Olympics is a global movement of people creating a new world of inclusion and community, where every single person is accepted and welcomed, regardless...
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Just posted a bunch of my original sketches for the new "Do What You Love" shirt: http://www.ugmonk.com/2011/06/24/inside-my-sketchbook/
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Church faith in forum
A HONG KONG Lutheran spokesman was optimistic last night that a church celebration planned for 1997 would go ahead despite objections from China.
Lam Tak-ho of the Lutheran Theological Seminary said he was not concerned about religious freedom after the handover.
Mr Lam, the chairman of the local preparation committee for the Lutheran World Federation's 50th anniversary assembly, said China was acting with 'good intentions' when it said the meeting should be postponed.
'The Chinese Government has all along welcomed the holding of the assembly, but hopes such an important event will be held smoothly. We still hope that it can be held in Hong Kong,' he said.
Less than a fortnight ago, the federation's general secretary, Dr Ishmael Noko, received a letter from four Hong Kong church members saying that they had received 'verbal advice' from Xinhua (the New China News Agency) that the assembly should be deferred, because it was too close to the handover.
There are about 56 million Lutheran church followers in the world, with 40,000 in the territory.
More than 2,000 people including 400-500 church representatives and their families were expected to attend the assembly, due to be held at the Convention and Exhibition Centre from July 8-16 next year.
Despite a preference that the assembly be held in October or November Mr Lam said the federation had fixed the meeting for July to match with the timetables of various Lutheran church leaders and the availability of the venue.
The committee has also booked hotel rooms for about 1,200 people.
The chairman of Justice and the Peace Commission of the Hong Kong Catholic Diocese, Chan Siu-chiang, said: 'It's unreasonable for the Chinese Government to manhandle a religious event and interfere with religious freedom by asking the organisation to seek its approval first.
'There is clearly no conflict between the handover celebrations and a purely religious assembly,' she said.
But Sun Po-loi a spokesman for Buddhist laymans' organisation, Soka Gakkai International, said there was no need to worry that religious freedom would be compromised after 1997.
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By Naseem Roberts 2nd November 2012 | International Solidarity Movement, West Bank One Palestinian Youth was arrested and four others: two Israelis and two internationals were detained during the Friday non-violent weekly demonstration in Nabi Saleh. People from the village ...Read More »
Bassem Tamimi injured and arrested with 3 others at Boycott Israel protest
24 October 2012 | International Solidarity Movement, West Bank VIDEO from the action: Dozens of Palestinians and internationals protest at Rami Levy Supermarket near the illegal settlement of Sha´ar Benyamin on October 24th. This direct action aims to highlight the ...Read More »
Teenager Injured By Tear Gas Canister at Weekly Protest in Nabi Saleh
By: Naseem Roberts 06 October 2012 | International Solidarity Movement, West BankRead More »
Israeli Army shoots resident of Nabi Saleh following settler attack
By Paddy Clark 14 September 2012 | International Solidarity Movement, West Bank On Sunday evening, settlers entered Nabi Saleh village. In clashes that followed Israeli soldiers shot Omar al-Tamini, 25, with live ammunition in the abdomen, and then arrested him ...Read More »
Israeli army uses surveillance drone at Nabi Saleh weekly demonstration
By Paddy Clark September 13, 2012 | International Solidarity Movement See photos from demonstration here and get up to date information from Nabi Saleh Solidarity here Weekly Demonstration On Friday, September 7, Israeli forces sealed off the village early in ...Read More »
Live ammunition in Nabi Saleh
By Paddy Clark 31 August 2012 | International Solidarity Movement, West bank Three Palestinians were injured and 5 arrested today during Nabi Saleh's weekly demonstration. Israeli military set up road blocks surrounding the village early this morning in order to ...Read More »
Video: Soldiers attack children in Nabi Saleh and forcibly separate them from their detained mother
August 25 2012 | Popular Struggle Coordination Committee, Occupied Palestine Army held six detainees over eight hours, raided houses in the village, injuring several residents and using live ammunition Pictures: see here, here, here, and here During the weekly demonstration in the village of Nabi ...Read More »
Nabi Saleh: "The resistance is for our kids' future"
By Markus Fitzgerald 15 August 2012 | International Solidarity Movement, West Bank On the evening of July 26, social media lit up with messages from residents of the village Nabi Saleh. "Four army jeeps and around 20 soldiers standing at ...Read More »
Nabi Saleh: 11 arrested in weekly demonstration
By Hakim M. 16 July 2012 | International Solidarity Movement, West Bank The weekly demonstration in Nabi Saleh faced brutal repression from the Israeli military on Friday, July 13. Beginning at 1:30 p.m., Palestinian and solidarity activists walked down the ...Read More »
Nabi Saleh: Over 15 protesters injured when Israeli army opened fire
By Mia and Rosa 17 June 2012 | International Solidarity Movement, West Bank Tear-gas, skunk water, and rubber-coated bullets were fired against demonstrators in Nabi Saleh on Friday, June 15, injuring over 15 individuals. In the West Bank village of ...Read More »


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Nina Simone
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Eunice Kathleen Waymon, 21 February 1933, Tryon, North Carolina, USA, d. 21 April 2003, Carry-le-Rouet, Bouches-du-Rhône, France. An accomplished pianist as a child, Eunice Waymon made her public debut at the age of 10 in her native North Carolina. She later moved to Philadelphia and studied at New Yorks Juilliard School Of Music but left in 1954 after struggling to make headway in the tradition bound classical music world. Her rejection by the prestigious Curtis Institute was a crucial incident in the artists development, ruining her dreams of becoming a classical pianist and informing her passionate stance on racial injustice.
Waymon began working as a singer-pianist in the Midtown Bar and Grill in Atlantic City, taking her stage surname from the French actress Simone Signoret and Nina from nickname given to her by a boyfriend. Now known as Nina Simone, she secured a small fanbase for her club act of jazz,...
- MatchNina Simone
- 100%Billie Holiday
- 98%Ella Fitzgerald
- 92%Sarah Vaughan
- 85%Aretha Franklin
- 85%Aretha Franklin & Elton John
- 85%Aretha Franklin & George Michael
- 74%Dinah Washington
- 74%Etta James
- 72%Carmen McRae
- 57%Ray Charles


text:
Freeride Bike Co. located in Gilbert, Arizona, is a family owned Boutique Style Bike Shop offering amazing bikes with amazing service. When you shop at Freeride Bike Co. you're not only getting an amazing bike and amazing service, but you're joining a great bike community. We offer the best in Mountain Bikes, Lifestyle Bikes, BMX Bikes and bicycle accessories. Come in and see the great brands we carry like Fit, SE Bikes, Fuji, Breezer and many more.
Store type: Bike Shop
Address: 3143 E Williams Field Rd, Gilbert, AZ 85295, United States show on map


text:
Indoor Water Parks at Timber Ridge Lodge
Wisconsin's favorite Indoor / Outdoor Water Park!
Climbing. Swimming. Going fast. The occasional run in with a moose. All in a day's play at Moose Mountain Falls: Timber Ridge Lodge's 50,000 square-foot indoor/outdoor water park.
35-foot-high slides take you on an epic 300-foot adventure of twists and turns, which finally comes to an end in a heated pool*. For a tamer ride, The Lazy River drifts more than 500 calm, relaxing feet.
When you stay at Timber Ridge Lodge, receive four free water park passes with a one-bedroom suite, and six passes with a two-bedroom suite. So go ahead. Get soaked. (Ages 12 months and up are required to have a waterpark pass to enter the waterpark)
Moose Mountain Falls Waterpark Hours of Operation: Monday-Thursday 10am-8pm, Friday 10am-9pm and Saturday and Sunday opens at 9am. Hours are subject to availability. Please call ahead to confirm for specific dates.
Moose Mountain Falls Waterpark will be closed for annual maintenance Sunday, September 10 through Friday, September 15 and will re-open on Saturday, September 16.


text:
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Mens Imatra Lt Trainers
rrp £59.99
Mens Imatra Lt Trainers
rrp £59.99
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Presenting the Lacoste Mens Imatra Lt Trainers pump in a classic white tone. These casual pumps will ensure you are at the height of sporty fashion and are suitable for all day wear. Featuring a useful four-eyelet fastening and a matching white mid sole, these Mens Trainers have all of the foundations found in traditional athletic styles. They feature brown leather panels to the heel and tongue as well as the signature Lacoste embroidered Crocodile on the side of the shoe. The Imatra Trainers by Lacoste is a smart footwear essential offering that looks ultra stylish when worn with chinos and a polo shirt. Upper and inner: Textile. Sole: Other materials. Smart Casual Lacoste Mens Trainers with fantastic value for money.
Delivery info
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Michael Phelps surprised even himself with a record-breaking start to his bid for an unprecedented eight Olympic gold medals as Britain's swimmers struggled on the opening day of competition in Beijing.
Phelps, who won six gold and two bronze medals in Athens four years ago, broke his own Olympic record in the heats of the 400 metre individual medley to cruise through to Sunday's final.
Teenager Hannah Miley, 19, was Britain's only swimmer to advance to an individual final in the women's event, while Chris Cook was 15th of the 16 qualifiers for the 100m breaststroke semi-finals and Jemma Lowe slowest of those to advance to the semis of the 100m butterfly.
Phelps was inside his own world-record pace after the opening butterfly leg and just 0.02 seconds outside it after the second backstroke leg.
And although the 23-year-old American dropped off record pace after the breaststroke, he still posted a record time of four minutes 7.82 seconds, 2.57secs outside his world record set earlier this year.
"I'm pretty satisfied with the time, I didn't think I'd swim that fast in the preliminaries," said Phelps. "All I know is that I wanted to be in the middle lane of the pool tomorrow."
Britain's Thomas Haffield, fourth fastest in the world this year coming into the Games, could only finish a disappointing seventh in his heat in a time four seconds slower than his personal best, while compatriot Euan Dale also missed out after finishing sixth in his heat.
Haffield was mystified by his poor performance, the 20-year-old from Neath saying: "I will have to go back and talk to my coach and go back to the drawing board.
"I think it was just one of those days. Everything was going great up until I got in. I got in the water and nothing happened. I did the first two strokes and it didn't feel right."
In the women's 400m individual medley, Miley - ranked fourth in the world this year - was the slowest qualifier for tomorrow's final as team-mate Keri-Anne Payne missed out.
Miley, who celebrated her 19th birthday on Friday, was second in her heat behind American world-record holder Katie Hoff and eighth quickest overall in 4min 36.56secs. Payne was fifth in her heat and 15th overall in a high-quality event.
"I knew it would be tough because everyone is swimming PBs just to make it into the final," Miley said. "But I'm over the moon to have made it.
"I just need to go away, get plenty of sleep, a good meal and come back tomorrow and give it my all."
In the women's 100m butterfly, Lowe and team-mate Francesca Halsall were in the last of seven heats but only Lowe made it through to Sunday's semi-finals as the slowest of the 16 qualifiers.
The 18-year-old from Hartlepool said: "It was the hardest race I have ever done, everyone was so close.
"I was trying to focus on myself and make it to the semis and I did it. I hope I can go quicker tomorrow. My personal best is 57.78 (today's quickest qualifier swam 57.58) so who knows what can happen. Tomorrow is another day."
Aberdeen's David Carry broke his own British record with a time of 3:47.17 in the 400m freestyle but still failed to advance to tomorrow's final.
The 26-year-old was fifth in his heat and 15th fastest overall with team-mate Dean Milwain seventh in his heat and 21st overall.
Carry said: "You come here dreaming of swimming fast in the Olympics and that's what I did today. I knew it was going to take a massive step up to make the final.
"I knew it was going to take 3:45 and I thought I was in the shape to do that but they pulled away from me at the end. I can't be unsatisfied with the way I swam. I was puking my way up the pool so I think that shows I was giving 100%!"
In the 100m breaststroke, Cook scraped into tomorrow's semi-finals by finishing fourth in his heat and 15th fastest overall.
Cook, one of just five men to break the one-minute barrier this year, clocked 1:00.70 but team-mate Kristopher Gilchrist failed to advance after managing just seventh in his heat in 1:01.34.
"I had a terrible start, I need to get in there and get going tomorrow," Cook said.
Norway's Alexander Oen set a new Olympic record of 59.41secs in winning the seventh heat - and the fastest five qualifiers were all inside the old mark - while Ireland's Andrew Bree was only 30th fastest overall despite setting a new personal best of 1:01.76.
In the final event of the session, Britain's quartet of Francesca Halsall, Caitlin McClatchey, Julia Beckett and Melanie Marshall made the final of the 4x100m freestyle relay as the slowest qualifiers in a time of 3:39.18.
- More about:
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Cats are never long out of the news: currently we have Maya, whose right to a family life caused the fur to fly at the Tory party conference, and Beauty, the kitten stolen from her love rival by MP's wife Christine Hemming. And let's not forget Guinness world-record-holder Smokey, whose purr is as loud as a lawnmower.
Cute! But not to everyone. There are people who, if their partner was out might, purely in the interests of science, let Smokey play with the strimmer, then see what noise it made. In a world with an estimated 500 million cats, almost 11 million in the UK, there is no doubting our fondness for what Linnaeus named Felis Catus, the domestic cat. Yet in south China the cat-meat and fur trade puts paid to thousands of them. Here, the Cats Protection League, which handles around 6,000 unwanted cats at any one time – some found in garbage chutes or taped into cardboard boxes and left to die – says that adoptions were down this summer, due to the downturn.
As writer Jeff Valdez said: "Cats are smarter than dogs. You can't get eight cats to pull a sled through snow." Not only that, but cat households apparently boast a higher percentage of degrees. In the binary world of the human psyche, in which transference is all (big car, large –), there are cat-lovers and dog-lovers. We get round the probable myth that more cat-owners are women by saying that women with more than two cats are mad.
But not all cats are smart. You get the cat you deserve. I knew a girl who got a sweet rescue cat, let's call it Mittens. In the middle of the night, she was woken by a terrifying metallic banging noise, went down to the kitchen, and found Mittens trying to remove a kitchen stool that had got fixed to its magnetic collar, by bashing its head against the fridge.
My own life has been led as a sort of cat-magnet, besieged by delinquent, dropsical or half-dead cats. First there was Holland Park Angel Darling, a prolapsed tabby who barricaded my French windows with her enormous bulk and then, when she had scored, slept each night wrapped round my head like a 1960s fur bonnet with ear-flaps. Next came Whitechapel Boris, a black-and-white outbreak of cat-shaped mange who spent a month rutting my knees. Where do these derelict bits of parka-trimming come from? They steal your heart, vomit on your keyboard and cost more than a Lamborghini.
Cats can hear ultrasound, which helps with hunting mice. But they can also hear ultra-soft-touch. Ultra-cushy-berth. Sniff it out. Colonise. Purr and conquer. Yet, if I had to choose between saving my cat or my house, I would save the cat. Stupid? Doubtless. Unusual? No.
Because I love the cat and, as far as I can tell, when he is snuggled up next to me at night, his paw clasped in my hand (rather than biting my nose to ask for food or hacking up grass on the just-changed duvet), the cat loves me. History says I am not alone in loving the grace, charm, beauty, companionship and limitless comic potential of this responsive animal, who chases water from a hose round and round the lawn, or who, when he was a tiny, worried kitten in a rescue centre, selected me by tottering round my ankles and then unexpectedly pissing on them, as if I were a tree. He marked me. I took him home.
Science finds that stroking pets reduces blood pressure and stress. Technically, while having a cat does not make one happier, ownership has been shown to reduce unhappiness. But into this beatific vision, a furball. In the United States, cats are officially recognised as trip hazards. Any cat owner who has tried getting downstairs in the morning with a hangover knows the way Fluffy picks this moment for a determined bout of twined intimacy with one's legs.
We know Egyptians liked, worshipped, and kept cats because of cat-formed representations of the goddess Bastet, and because of carefully mummified cats, sometimes left with saucers of milk or mice. Elsewhere, it is said Muhammad cut a hole out of his coat rather than disturb a cat that was snoozing on it; while the proximity of a human and domestic-cat skeleton in a Neolithic grave in Cyprus, dated around 7,500BC, makes the connection much earlier.
Artists and writers have not only kept cats for companionship (Ernest Hemingway had a pack of around 30), but also used them as subjects. Samuel Johnson bought his cat, Hodge, oysters, to save the servants extra work. Colette, who herself looked feline, wrote with her Chartreuse cat on her desk, as well as putting it into a love triangle in one of her most disturbing novellas, The Cat. When it died, she could not bear to replace it. T S Eliot wrote dedicated poetry; Edward Bawden, who lived alone with a cat once his wife died, made illustrations.
In the 19th century, Théodore Géricault and Francisco Goya did beautiful, unsentimental paintings of cats, whose familiarity betokens both liking and intimacy; particularly Gericault's White Cat, a masterpiece of relaxed muscular repose; or Goya's sketchy, scratchy fighting cats, Riña de Gatos. Spectre mastermind Blofeld strokes his white cat obsessively in three James Bond stories. Then there are cartoon cats. Felix, grandfather of them all, conceived around 1900 by Otto Messmer, and so popular that Charles Lindbergh used him as a mascot on his transatlantic flight, rather than exposing his beloved pet Patsy (whom he occasionally took flying) to the risk; naughty 1961 American gang-cat Top Cat "He's the most tip-top, Top Cat!"; or cuddly Bagpuss, created by Oliver Postgate in 1974. Postgate only made 13 episodes, yet Bagpuss is still remembered.
What else do we love? Cats are vaguely baby-size. When you cuddle them, instead of dribbling rancid milk, they purr. Their fur is soft. They snuggle at the drop of a hat. A well-cared-for cat will return the love of its owner, which is more than any human relationship guarantees, and which in a human might prove irksome. It's one thing to watch telly with a cat on your lap, quite another a large person.
In fact, it is most likely this neoteny (the enduring kittenhood response) of an adult cat that endears it to us. Or – as Mrs Hemming, unhappy in love and trying to justify her apparent theft of a kitten – put it more simply: "I remember the warmth."
Philippa Stockley's most recent novel is 'A Factory of Cunning', a sequel to 'Les Liaisons Dangereuses'
Cats at the centre of power
The first known Downing Street cat was Peter, installed in 1929, followed by Peter II and Peter III, who appeared on the Tonight programme in 1958. His replacement was a female Manx cat named Peta. Wilberforce took office with Edward Heath in 1970, leaving in 1988 after serving four prime ministers. The big name however was Humphrey, a stray named after the unhelpful mandarin in Yes, Minister. He was the official mouser for the Cabinet Office from 1988 to 1997 and gained notoriety after an accusation that he killed four robins nesting in the garden in 1994, but John Major declared him innocent. After a 10-year hiatus, Sybil arrived in 2007 but left in 2008. The current encumbent is Larry, a rescue cat introduced in February after a rat was spotted during a TV news report.
Chris StevensonReuse content


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- Home
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Home » Magazine » Contributors » Elaine Kendall
Elaine Kendall
Articles by this Contributor
June 1973
The prevailing Colonial feeling toward female education was unanimously negative. Learning to read was the first feminist triumph.
February 1975
The founders of the first women's colleges weren't necessarily crusaders or even educators; one savored a vision of himself as the second Great Emancipator, and another was motivated chiefly by hatred of her brother
Why do we need a national nonprofit membership society for American history?
"Save America's Treasures" has been totally eliminated—the largest Federal program supporting preservation of such treasures as the original Star Spangled Banner and George Washington's tent.
65% of Americans don't know what happened at the Constitutional Convention, according to a recent survey by Newsweek.
The "Teaching American History" grants—the largest Federal program supporting history education—have been completely eliminated.
Visits to the Top 20 Civil War battlefields have dropped in half from 1970 to 2009 according to official National Park Service statistics.
40% of Americans can't identify whom we fought in World War II, according to a recent survey by Newsweek.
A quarter of Americans believe Congress shares power over U.S. foreign policy with the United Nations, according to a recent Annenberg survey.
"There is little that is more important for an American citizen to know than the history and traditions of his country," John F. Kennedy wrote in American Heritage.
The "We the People Program," which touched some 30 million students and 90,000 teachers over 25 years, has been completely eliminated.
Two-thirds of Americans could not correctly name Yorktown as the last major military action of the American Revolution, according to a recent national Gallup survey.
The National Heritage Areas and Scenic Byways program, the only major Federal program encouraging visits to historic places, has been completely eliminated in Congressional committee.


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Inspired by a gloomy day
Uplifted by a cloudy sky.
Energized by a negative action
I am a strong believer that I have the power to turn water into the current that will move my potential.
I have all the tools I need to build a master pieces to my satisfaction.
Your reaction...
Is like a leaf on a tree, you need me to grow for you have a place to breath.
I supply the oxygen needed for you to achieve.
I am have the ability to turn a negative into a positive so what you speak into the atmosphere here will never limit me.
© Copyright 2017 UnknownToWritersBlock. All rights reserved.
Status: Finished
Genre: Poetry
How inspiring is this! I agree we should find a way to make a lesson of everything negative. This is a great piece . Awesome job !
This is soemthig I need to learn to do. This inspired me and it's bitesized info easy to take in in a very neat poetic way.
I like the inspiring message. You conveyed it wonderfully. Nice work and welcome to Booksie! Lovely to meet you.
Poem / Poetry
Poem / Poetry
Article / Editorial and Opinion
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Miami's best pizza restaurants
Discover the best pizza Miami has to offer, from classic Italian pies to artisanal thin-crust versions and regional American twists on the theme
If you're in the mood for pizza, you're in luck. An array of great Miami pizza joints and Italian restaurants abounds—whether you want to grab a slice on-the-go at Pizza Rustica in South Beach, or get your wood-oven pizza fix at a chic eatery like Timo.
Best pizza restaurants in Miami
Michael's Genuine Food & Drink
This buzzy restaurant is a true star. Decor and menu are classy yet casual, and the service also strikes just the right note. The interior mixes industrial chic—concrete floors, exposed ducts—with warmth (red lamps, flickering candles, modern art and a brick oven glowing from the open kitchen). With an emphasis on local ingredients, the high-end comfort food ticks all the right boxes. Mains change daily but might include a selection of wood-fired pizzas; a whole "poulet rouge" chicken with plumped raisins, toasted pine nuts and rocket; and duck confit with tangerine marmalade and spiced pumpkin seeds. Hedy Goldsmith's innovative desserts—including bread pudding and weekend pop tarts—are indeed a grand finale.
Rustic and homey, this off-the-beaten-path Italian (from the same folks behind the Pubbelly family of restaurants) is full of locals looking to escape the madness of South Beach. Luckily, they've found a place to do it where the laid-back vibe is totally authentic and the food is damn good, too. Antipasti includes a creamy burrata cheese (locally made) served with pickled aubergine. A small pasta menu ticks all the right flavor notes (the short rib lasagna is a customer favorite). Pizza, too, is dependably delicious and well thought out, with fried eggs, meatballs and mushroom fricassée as toppings.
Pizza fans make the out-of-the-way trek to this Upper East Side gem to chow down on gourmet pizza in a former garage (complete with functioning carwash). Brick oven delicacies take their cue from every corner of the country: New England clam, Trenton tomato, South Philly cheese and Hawaiian pineapple are just some of the options.
A pioneer of the Wynwood Arts District culinary scene, Joey's boasts a vast menu of classic (and affordable) Italian dishes. But it's the thin-crust pizza that keeps diners coming back—it was named as one of the country's best by Food & Wine Magazine. The inventive menu includes the Dolce e Piccante (fig, gorgonzola, honey and hot peppers) and the signature Joey (tuna in olive oil with spicy salami, gorgonzola, capers and spinach). There's live music to accompany your gorging every Thursday evening and happy hour specials on Fridays.
Chef Tim Andriola made his culinary mark with Timo. It's a fine Italian restaurant that's been the subject of much talk among the snowbirds (that's wintering Yankees and Canadians) since its opening in early 2003. The rustic chic atmosphere is abuzz with noise, thanks to happy eaters enjoying a top-notch menu of dishes such as burrata ravioli with fresh tomato, and any one of Andriola's wood-oven pizzas. It seats 120 but, even so, good luck getting a reservation.
Pizza Rustica
South Beach's refuelling pit stop par excellence, Rustica is a tiny, standing-room-only space that's packed in the early hours with clubbers who come to boost their carbs and sponge up the booze. But the Tuscan-style pizza is good enough to eat sober, with excellent toppings including meatball with sweet red onions, rosemary potato and goat's cheese, and the classic four cheeses. One slice is a meal.
See the best pizza in America
The best pizza in America
Who bakes the best pizza in America? For top wafer-thin pies and deep-dish slices, we say it's these pizza restaurants.


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- Reel Reviews: 2017 Oscar picks
- 'American Idiot' at EPAC
- Warwick grad producing 'Million Dollar Quartet' at Dutch Apple
- 'Somewhereville Station' revisits the 50s and 60s
- St. Patty's musical at Ephrata Main
- Dance, concert will benefit Jamaica missions
- Happy Anniver5ary, St. Boniface!
- Downtown diversity
- Travelogue will explore Colorado River this Saturday
John Lehman Jr., 55, Atacs inspector, fire volunteer
John David "BJ" Lehman, Jr., 55, of Ephrata, passed away Sunday, Aug. 18, 2013, at Ephrata Community Hospital.
He was born in Bethesda, Md. to the late John and Dorothea Mae (Groom) Lehman.
John was a 1976 graduate of Ephrata High School. He dedicated a lot of his time to the Brickerville Fire Co., and worked as a QAQC inspector for Atacs Co.
John is survived by step-mother: Thelma L. Kellenberger Lehman of Manheim and three siblings: Russel E. Lehman of Stevens; Kellie Jo Hassler of Ephrata and Daniel K. Hassler of Lancaster.
A memorial service was held Aug. 26 at the Ephrata Church of the Nazarene, Ephrata, with Pastor Rocklin Hambrick and Pastor Joe Birdsall officiating.
Interment will take place in the Brickerville United Lutheran Cemetery.
Memorial contributions in John's memory may be made to Ronald McDonald House, 745 W. Governor Road, Hershey, PA 17033.
Arrangements by Stradling Funeral Homes, Inc., Akron/Ephrata. Online condolences can be given at stradlingfuneralhome.com.


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Industry News
VinSolutions Ranked on the Inc. Magazine 500|5000 List for Third Consecutive Year
VinSolutions has been named the 51st fastest growing software company and is ranked the 616th fastest growing company in America overall for 2012.
"VinSolutions is honored to be acknowledged on this exclusive list for a third year in a row," said Sean Stapleton, Vice President of Sales at VinSolutions. "I would like to thank our employees, automotive dealer customers and the AutoTrader Group for their fantastic support and faith in our organization. It's an accomplishment made possible by a first-class team."
The achievement is particularly notable as a company that has thrived in a stagnant economic environment. Median growth rate of 2012 Inc. 500|5000 companies remains an impressive 97 percent. The companies on this year's list report having created over 400,000 jobs in the past three years, and aggregate revenue among the honorees reached $299 billion.
"Now, more than ever, we depend on Inc. 500|5000 companies to spur innovation, provide jobs and drive the economy forward. Growth companies, not large corporations, are where the action is," says Inc. Editor Eric Schurenberg.
About VinSolutions (http://www.vinsolutions.com)
VinSolutions, headquartered in Overland Park, KS, consolidates data from all areas of an automotive dealership - helping dealers to find, sell and keep customers more profitably with their fully-integrated "Complete Dealership Solution." VinSolutions'
VinSolutions was named on the Inc. 500|5000 in 2010, 2011 and 2012,and has received many industry accolades including the Automotive Website Award for Best Integrated Website Platform and the Driving Sales Innovation Cup for VinLens™. VinSolutions is certified by GM, Ford, Chrysler, Honda, Hyundai, Acura, Mazda, Toyota, Subaru, Volkswagen, Audi, Volvo, Kia, Saab, Mitsubishi, Infiniti, Jaguar Land Rover North America and Nissan and is ADP, Reynolds and Reynolds and DealerTrack DMS certified. Other alliances include, but are not limited to, Kelley Blue Book, Black Book, Galves, NADA, CARFAX, R.L. Polk, AIS Rebates, KnowMe, AutoSoft, Arkona, Autodata and RouteOne. Founded in 2006, VinSolutions became a subsidiary of the AutoTrader Group in 2011.
About Inc. Magazine (http://www.inc.com)
Founded in 1979 and acquired in 2005 by Mansueto Ventures, Inc. is the only major brand dedicated exclusively to owners and managers of growing private companies, with the aim to deliver real solutions for today's innovative company builders. Total monthly audience reach for the brand has grown significantly from 2,000,000 in 2010 to over 6,000,000 today.
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Clamps designed to securely hold two AA922 magazines together for rapid reloading. Using two clamps can connect three magazines together for even more available ammunition. Durable polymer construction with steel hardware.
Note: Not compatible with the AA922 dress up sleeve (AA110).
- Material: Polymer with Steel Hardware
- Color: Black


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|Language Courses
Learn German step by step, day by day, phrase by phrase with the Radio Lingua Network
September 26th, 2008
Episode 122 of 122 episodes
Happy European Day of Languages to all our listeners! By way of joining in this international celebration of languages and language-learning we're delighted to introduce eight new podcasts today. We're adding Catalan, Danish, French, Japanese, Mandarin and Romanian to our One Minute Languages series; we're introducing our first podcast for English learners - Write Back Soon will help learners master Phrasal Verbs; and we're finally announcing the long-awaited sequel to Coffee Break Spanish: it's Show Time!
You'll need to sign in to write a comment.
Welcome to the daily audio workout for your head.


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Comfortable Executive Apartment (111)
Size36 m²
Floor No.(with elevator)
- Family/child friendly
- Kitchen
- Air conditioning
- Washer/dryer
- Suitable for events
- Elevator in building
- Internet/WiFi
Accommodation summary
|Carrer de Blas Fernández Lirola, 08902 L'Hospitalet de Llobregat, Spain
|Property type
|Property ID
|Acceptance rate
|< 50%
|Response time
|A few hours
|Calendar updated
The apartment contains a bedroom with a large wardrobe, twin beds and an en suite bathroom with a shower. The living area contains a double sofa bed and a flat-screen TV. The open-plan kitchen is fully fitted, and includes a dining table.
Guests can reach Ildefons Cerdà Metro Station within a 2-minute walk. From here, Placa d'Espanya Square is just 5 minutes. The Magic Fountain of Montjuic is 10 minutes away.
The surrounding streets offer a range of restaurants, cafes and bars for guests to enjoy. The nearest supermarket is just a 5-minute walk away.
House rulesA refundable security deposit of €200 or a credit card imprint is required in cash on check-in.
Late check-in after 9pm can be arranged for an additional fee of €30.
|Price for > 2 guests
|$ 15 US per guest/night extra
|Check-in after
|Check-in before
|On arrangement
|Check-out before
|Cancellation Policy
Reviews for this host's other properties
Great appartment for an amazing experience in the heart of Barcelone. I recommand it for groups of 8-12 persons.
top location, nicely furnished apartment, good service.
I definitely recommend dthis apartment!
We booked at Wimdu for the first time and hoped everything would be fine. We are very happy to congratulate Jaume for doing everything perfectly for us. We are very satisfied with the airport transfer, the reception at the appartment, the mails to remind us ahead. We had asked for a baby bed and chair - both were there. Nice appartment, clean and well equiped. It was just a few metres from the Rambla and the Metro. We would like to use Wimdu again and thanks a lot to Jaume.
The apartment is new, clean and was perfect
El apartamento , es nuevo, estaba limpio y resulto perfecto
The apartment at Ali Bei was perfect! The apartment had all the ammenities and was centrally located: within walking distance to Nord Bus Terminal, Arc de Triunf train station, and many attractions. You can also walk to the beach but a little bit further (25 minute walk). There are 24hr Supermarkets within 100 meters. I would definitely recommend this apartment to anyone staying in Barcelona.
Apartment very comfortable at 30 meters from the central Rambla, consisting of living room kitchen three bedrooms and two bathrooms. A very spacious bedroom with attached bath, a smaller bedroom with two single beds, and a tiny room with a single bed.
Unfortunately the accommodation has only one opening to the outside of a door window of the living room that overlooks a small balcony.
The air conditioning works well and whi fi. Perfect welcome and key delivery punctual and reliable. recommended !!!!
Appartamento molto comodo a 30 metri dalla centralissima Rambla, formato da salotto cucina tre camere da letto e due bagni. Una camera da letto molto spaziosa con annesso bagno, una camera più piccola con due letti singoli, ed una camera piccola piccola con un letto singolo.
Purtroppo l'alloggio ha una sola apertura verso l'esterno su di una porta finestra del salotto che da su un piccolo balcone.
Funziona bene l'aria condizionata e la whi fi. Perfetta l'accoglienza e la consegna chiavi puntuale ed affidabile. consigliato !!!!
This appartement does not have acces to pool, which was one of our search criterias. Nice and clean, close to public transport. Sofa bed not so good.
Perfect and clean apartment, kind and professional staff.
The apartment is not in the city center, but the location is very well attainable by metro /train.
Neat receipt, neat apartment and easily accessible. However, on a busy (and noisy street).
Nette ontvangst, keurig appartement en goed bereikbaar. Wél aan een drukke (en rumoerige straat).
apartment near the metro well served to you by public transport, the owner is a kind and professional
appartamento vicino alla metropolitana ben sevito dai mezzi pubblici, il proprietario è una persona gentile e professionale
- Quality assured accommodation
- Every host is verified by telephone
- Secure payment via SSL encryption


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Spicy Mutton Biryani
|Lamb/Goat meat
|1 1⁄2 Pound, cut into 1 inch cubes
|Finely sliced onion
|1 Cup (16 tbs)
|4 , ground
|10 , ground
|Tomato puree
|1 Tablespoon
|Meat masala
|1 Tablespoon
|1⁄2 Cup (8 tbs)
|Garlic paste
|1 Tablespoon
|Ginger paste
|1 Tablespoon
|Onion paste
|2 Tablespoon
|Mustard oil
|4 Tablespoon
|For rice
|Bay leaf
|Green chili
|Cooking oil
|1 Tablespoon
|Basmati rice
|3 Cup (48 tbs), washed and soaked in water for 30 min
|2 Tablespoon
|Kewra water
|2 Tablespoon
|1 Pinch, soaked in 2 tbsp hot milk
|4 1⁄2 Cup (72 tbs)
|To Taste
1. The preparation is 3 step process. First is to make the mutton curry, along with the rice, and then finally mixing them together. The ingredients lists are arranged in that order also. First to prepare the spicy Mutton curry.
2. Heat 4 tbsp of mustard oil (or any other cooking oil) in a pressure cooker. Add the grinded cardamom, peppercorns and bay leaf. Fry for one minute.
3. Add the sliced onions and fry till light golden brown.
4. Add the mutton cubes and keep on frying till it is fried properly (light brown).
5. Add ginger, garlic and onion paste and mix properly. Fry for 5 minutes.
6. Add the tomato puree, meat masala, yogurt and mix properly. In medium heat keep on frying till oil starts leaving the side of the pan.
7. Make sure the mutton is cooked properly, otherwise steam it 4 or 5 times in the pressure cooker. Keep it aside.
8. Steps to make the rice:
9. In a saucepan add everything from bay leaf (for rice) to Basmati Rice. Boil the rice till it is half cooked. NOTE: Do not overcook the rice.
10. Remove the rice by draining the water mixed with spices. DO NOT THROW THIS SPICY WATER AWAY. It will be used later.
11. Final Step to make the biryani:
12. In a pressure cooker, add one layer of mutton, then one layer of rice, then again mutton and so on. Add Kewra water, 1/4 cup of spicy water, ghee, and saffron.
13. Steam for 15 minutes without the whistle. Check in between to see if the rice is cooked. For those who are not comfortable using pressure cooker, you can use rice cooker instead.
Recipe Summary
Rate It
Nutrition Rank
Nutrition Facts
Serving size
Calories 773 Calories from Fat 316
% Daily Value*
Total Fat 35 g54.6%
Saturated Fat 13.2 g65.9%
Trans Fat 0 g
Cholesterol 91.3 mg30.4%
Sodium 173.4 mg7.2%
Total Carbohydrates 82 g27.3%
Dietary Fiber 2.5 g10.1%
Sugars 3.6 g
Protein 29 g57.8%
Vitamin A 3% Vitamin C 34.1%
Calcium 8.2% Iron 18.4%
*Based on a 2000 Calorie diet


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Common Sense Oat Bran Bread
|Bread flour
|1 3⁄4 Cup (28 tbs)
|Whole wheat flour
|1 Cup (16 tbs)
|Oat bran cereal
|1 1⁄2 Cup (24 tbs) (Kellogg'S Common Sense, Any Variety)
|1⁄2 Teaspoon (Optional)
|Active dry yeast
|2 1⁄4 Teaspoon (1 Package)
|Firmly packed brown sugar
|2 Tablespoon
|Skim milk
|1 Cup (16 tbs)
|1⁄4 Cup (4 tbs)
|Egg whites
1. Stir together flours and in a large electric mixer bowl, combine 1/2 cup of the flour mixture, KELLOGG'S COMMON SENSE Oat Bran cereal, salt, yeast and sugar.
2. Heat milk and margarine such that very warm (120°-130°F).
3. Slowly add to cereal mixture and beat 2 minutes on medium speed, scraping bowl occasionally.
4. Put in egg whites and 1 cup of the flour mixture. Beat 2 minutes on high speed.
5. Using dough hooks on electric mixer or by hand, stir in remaining flour mixture.
6. Knead on low speed or by hand for 5 minutes or until dough is smooth and elastic.
7. Place dough in lightly greased bowl, turning once to coat top.
8. Cover and let rise in warm place until double in volume and punch down dough and let rest 10 minutes.
9. Roll dough on lightly floured surface into 14 x 8 1/2-inch rectangle.
10. Starting with short-side, roll dough lengthwise.
11. In a lightly greased 9 x 5 x 3-inch loaf pan place seam side down.
12. Let rise until double in volume, about 1 1/2 hours.
13. Let it bake in 375°F oven about 30 minutes or until golden brown.
14. Take out of the pan and cool on wire rack.
Recipe Summary
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Nutrition Rank
Nutrition Facts
Serving size
Calories 463 Calories from Fat 110
% Daily Value*
Total Fat 13 g19.5%
Saturated Fat 2.9 g14.7%
Trans Fat 0 g
Cholesterol 0.77 mg0.26%
Sodium 212.2 mg8.8%
Total Carbohydrates 78 g26%
Dietary Fiber 12.5 g49.9%
Sugars 7.1 g
Protein 19 g37.7%
Vitamin A 6.6% Vitamin C 0.67%
Calcium 9.5% Iron 16.3%
*Based on a 2000 Calorie diet