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|Table of Contents
|Vol. 35, No. 1-3, 2013
Issue release date: June 2013
|Section title: Original Paper
Sensitivity of Blood Volume Monitoring for Fluid Status Assessment in Hemodialysis PatientsMaduell F. · Arias M. · Massó E. · Fontseré N. · Carrera M. · Vera M. · Cases A. · Campistol J.M.
Department of Nephrology, Hospital Clinic Barcelona, Barcelona, Spain Corresponding Author
Francisco Maduell Canals, MD
Servicio de Nefrología, Hospital Clinic Barcelona
C/Villarroel, 170
ES-08036 Barcelona (Spain)
E-Mail email@example.com
Background/Aims: This study investigates the use of blood volume monitoring (BVM) markers for the assessment of fluid status. Methods: Predialysis fluid overload (FO) and BVM data were collected in 55 chronic hemodialysis patients in 317 treatments. Predialysis FO was measured using bioimpedance spectroscopy. The slope of the intravascular volume decrease over time normalized by ultrafiltration rate (Slope4h) was used as the primary BVM marker and compared against FO. Results: Average relative blood volume curves were well separated in different FO groups between 0 and 5 liters. Receiver-operating characteristics analysis revealed that the sensitivity of BVM was moderate in median FO ranges between 1 and 3 liters (AUC 0.60-0.65), slightly higher for volume depletion of FO <1 liter (AUC 0.7) and highest for excess fluid of FO >3 liters (AUC 0.85). Conclusion: Devices that monitor blood volume are well suited to detect high FO, but are not as sensitive at moderate or low levels of fluid status.
© 2013 S. Karger AG, Basel
Despite many technological advances in hemodialysis therapy, the management and optimization of fluid status remains a major challenge in the field of renal replacement therapy [1]. Fluid overload (FO)-related hospitalizations are high [2] and it has been shown that patients who present long-term FO suffer from increased mortality [3]. A multicenter study in eight European dialysis centers has revealed that 25% of all patients are volume overloaded [4].
Fluid management comprises two main aspects: (i) the short-term (intradialytic) preservation of blood volume to avoid hypotensive episodes, and (ii) the long-term maintenance of fluid status below a critical level beyond which cardiovascular damage may occur.
Usually, patients with high FO tend to be more stable during the treatment because of increased vascular refilling [5,6]. Some patients, however, may present high FO but still suffer from intradialytic episodes, possibly due to cardiac impairment, antihypertensive medication or other factors degrading vascular refilling [7]. It has been proposed that careful long-term fluid reduction in these patients may improve their cardiac status and subsequently lead to more intradialytic stability [4].
Blood or plasma volume monitoring was originally introduced as a tool to deal with the first aspect, i.e. to reduce intradialytic morbid events by controlling the ultrafiltration rate (UFR). Recently however, its utility for fluid status assessment has come more into focus [8,9,10,11]. Some authors have proposed to categorize patients' fluid status by the shape of their intradialytic blood volume reduction or postdialytic volume rebound curves [12,13,14,15]. Others have developed quantitative markers based on blood volume monitoring (BVM) to assess fluid status [11,16].
Even though relationships with other clinical signs linked to fluid status like blood pressure (BP) or inferior caval vein diameter were found, concerns were raised about the high intraindividual variations [17,18]. Moreover, it has been reported that BVM markers allowed detecting excess fluid but not depletion [16], suggesting that BVM markers may not have the same sensitivity over a wide range of FO. Finally, calibration of the markers against an absolute level of FO measured in liters is still lacking.
It is the aim of this work to investigate the aforementioned points by using a quantitative measure of FO based on bioimpedance spectroscopy as a reference.
Fifty-five clinically stable hemodialysis patients were selected in this observational cross-sectional study in March 2011 in the Hospital Clinic Barcelona (Spain). All patients underwent standard 4-5 h online HDF treatments on Fresenius 5008 machines. The UFR was kept constant within most treatments. Each patient was followed up over 7 consecutive treatments. BVM was performed during each of the seven treatments using a Fresenius blood volume monitor which provided relative blood volume (RBV) curves. FO was measured once in each patient. Pre- and postdialysis body weights were collected and systolic BP (SBP) and diastolic BP (DBP) were measured before and after dialysis. All data (including dialysis machine data such as ultrafiltration volume (UFV)) were stored in a database (Therapy Monitor and NefroLink; Fresenius Medical Care, Germany) for later analysis. Intradialytic BVM data was stored at a rate of one sample per minute.
FO was determined before cannulation using a bioimpedance spectroscopy device (BCM body composition monitor; Fresenius Medical Care). The device measures whole-body bioimpedance over a frequency range from 5 kHz to 1 MHz, and determines extracellular and total body water resistance by means of Cole modeling [19]. Unlike single- or mono-frequency devices, the BCM determines extra- and intracellular water volumes independently of each other, and it calculates FO independently of body composition by using the Chamney model which takes into account differences in adipose and lean tissue hydration [20]. FO is defined in this context as excess extracellular water. The device has been validated against dilution reference methods [21], dual-energy x-ray absorptiometry and the Fuller 4C model [22] in healthy subjects, dialysis patients, liver cirrhosis and palliative cancer patients. The difference between pre- and postdialysis measured FO corresponded very well with the removed UFV (mean paired difference 0.02 liter); a complete validation overview has been published elsewhere [23].
None of the patients had been measured with the BCM before, and the clinical staff was blinded to the BCM results in order not to influence UFV. FO was measured once in each patient. In order to increase the number of FO values, FO was additionally estimated on the three consecutive treatments before and after the BCM measurement day, using differences in preweight according to the following equation:
FOestimation = FOBCM_day + preweightestimation_day - preweightBCM_day
This approach assumes that treatment-to-treatment changes in preweight over no more than a few days reflect mainly changes in FO, and that body composition remains stable within this short time period.
An overview of the different volume markers is provided in table 1. Three markers based on BVM were used: (1) the Slope4h which was defined as the linear slope of the RBV decrease over the whole treatment, normalized by UFR [%/h/(l/h)]; (2) RBV in [%] that was reached at the end of the treatment, and (3) volume index, defined as the RBV slope over the full treatment and normalized by UFR over postweight (ΔRBV/h/(UFR/postweight)) as proposed by Agarwal et al. [16].
Slopes were determined by means of robust iterative weighted least squares regression as provided by the statistical software in order to attenuate the effect of outliers on the results. Receiver-operating characteristic (ROC) curves were used to assess the discrimination abilities of a marker. They depict the true-positive rate over the false-negative rate. A ROC curve on the identity line indicates a completely random assignment, while a curve that quickly rises to >90% and stays there for increasing false-negative rates indicates very good classification ability. ROC curves for the volume markers were determined for different cutoff values of FO, including area under the ROC curve (AUC) as a measure of discriminatory power and their 95% confidence intervals (CI). AUC confidence intervals were determined by bootstrapping, using 5,000 iterations for each AUC value. All analyses were performed using Matlab R2011a.
Patient characteristics are listed in table 2. Each of the 55 patients was measured over a 7-treatment observation period, giving a total number of 55 × 7 = 385 treatments. BVM readings were available in 317 of 385 treatments. The UFR was kept constant in 89% of these 317 measurements; in the remaining 11%, UFR was either changed manually during the treatment or BVM feedback control was activated. The UFR in these treatments was averaged over the complete treatment.
Subgroup analysis was performed including only treatments within the interquartile UFR range (25th to 75th percentile, corresponding to 400-675 ml/h, n = 164), in order to become independent of the effects of extreme UFRs on blood volume.
Figure 1 depicts average RBV curves grouped by six different FO levels between 0 and 5 liters (table 3). Only treatments with a treatment time >245 min (corresponding to the 10th percentile of treatment times) and UFR in the interquartile range as described above were included (n = 148). Table 3 shows that average UFVs and UFRs were comparable in all six FO groups. Every patient contributed no more than once to each of the six curves in the diagram. If a patient had more than one RBV curve in one of the FO groups which was the case in most patients, then these RBV curves were averaged individually before being assigned to the respective group average. This procedure ensured that all patients had the same relative contribution to the average RBV curves. The number of treatments that each patient contributed is summarized in table 3. RBV curves were steep for low FO and became flatter with increasing FO. Predialysis SBP steadily increased with FO (from 113 mm Hg in the 0-liter group to 153 mm Hg in the 5-liter group).
Figure 2 shows ROC curves for three different FO cutoff values (2, 3, and 4 liters), using the Slope4h marker as the continuous variable (n = 317). The AUC to predict FO was 0.63, 0.69, and 0.84 for FO >2, 3, and 4 liters, respectively. The best discriminatory power was therefore achieved for FO >4 liters.
Figure 3 shows the AUCs for the Slope4h marker together with the corresponding 95% CI for all data. The AUC curve had the shape of a bathtub, with lowest values between 1.5 and 2.5 liters, and increasing to both lower and higher FO levels. The highest AUC values were achieved at FO levels >4 liters, indicating better performance of the Slope4h marker in detecting high FO. The subgroup analysis revealed even higher AUC levels (up to 0.90) when compared with the complete dataset.
The correlations between the different volume markers and FO are listed in table 1. The strongest correlation was found in Slope4h, both in all data and the subgroup analysis (R = 0.33 and 0.52, respectively). The correlation between SBP and Slope4h was R = 0.14 (p = 0.02) for all data, and R = 0.27 (p = 0.001) in the subgroup analysis.
The average RBV drop was slightly lower in diabetic patients than in non-diabetics (RBVend = 90 vs. 88%, respectively, p = 0.048). FO was about 1 liter higher in diabetic patients.
BVM is used mostly to assess intradialytic vascular depletion due to extensive ultrafiltration in order to avoid hypotensive episodes. This work concentrates on a different aspect - the use of BVM for fluid status assessment.
We found that (i) BV monitoring appears well suited for an overall qualitative fluid status assessment in patient groups, but suffers from a high variability on the individual level, and (ii) the sensitivity of BVM markers over a wide FO range has the shape of a bathtub, being moderate in middle FO ranges between about 1 and 3 liters, slightly better in low fluid status <1 liter, and best in detecting high FO >3-4 liters.
BVM assesses the balance between refilling and UFR in respect to the absolute blood volume. FO is one of many factors influencing this relationship. It has often been reported that flat RBV curves are a sign of excessive FO [6,8,9,11]. According to Guyton and Hall [24], about two thirds of FO contribute to the interstitial space, and the remaining third contributes to the blood volume. Both effects result in a flatter RBV curve: firstly, interstitial FO provides a fluid reservoir that facilitates refilling from the interstitial to the vascular space and secondly, a 1-liter decrease in blood volume will lead to a smaller relative change if the absolute blood volume is higher.
The correlation that we found between Slope4h and FO (R2 = 0.11) indicates that only 11% of the variability of the BVM marker can be explained by FO. The explained variability increases to 27% in a subgroup analysis where we used only treatments with comparable UFRs. The remaining variability is likely to be caused by non-FO-related effects like individual differences in absolute blood volume, albumin levels, fluid shifts induced by postural changes or the mixing of blood from different vascular beds and different hematocrit levels (Fåhræus-Lindqvist effect). It is obvious that these limitations are independent of the measurement technique used by different manufacturers (e.g. optical or ultrasound based), and that the results apply to all devices measuring on the extracorporeal blood line. Other markers like the slopes of the first and last 30 min of the treatments were not as well correlated with FO as the slope over the complete treatment. Predialysis SBP was a good marker of FO in all data, but did not further improve in the subgroup analysis. The finding that BP correlated well with FO raises questions about the effectiveness of antihypertensive medication. Normalizing FO may be an important alternative to antihypertensive drugs in a significant number of patients. Even though the individual variability is high, figure 1 demonstrates that average RBV curves of many treatments and patients are well linked to predialysis FO. The lower the FO, the more pronounced was the RBV curve decrease. Interestingly, the groups 1-4 liters are relatively close together, while 0 and 5 liters have a greater distance to the other curves. It also appears that the 0-liter group, after almost plateauing at 150 min, continues to drop steeply towards the end of the treatment, indicating a more rapid depletion of blood volume as compared to the other groups. Mitra et al. [25] have related the transition from an RBV plateau into an RBV drop to depletion of interstitial fluid space when dry weight has been reached. In this situation, refilling is no longer sufficient to maintain constant blood volume.
The fact that the 5-liter curve is well separated from the other curves indicates that a flat curve is indeed a rather reliable indicator of excessive FO. Dasselaar et al. [26] noted that RBV curves normalized by UFR were flatter during the first session of the week as compared to the second and third sessions, which is consistent with our results assuming FO levels are higher after the long interdialytic interval. FO levels were also higher in the subgroup of diabetic patients, which is probably the reason why they presented slightly less average RBV drop than non-diabetics, even though their average UFR was about 15% higher.
In order to assess the sensitivity of BVM markers for identifying different FO levels, we performed a ROC analysis for three different FO cutoff levels (2, 3, and 4 liters), as shown in figure 2. The largest AUC is reached for the 4-liter cutoff, demonstrating that the Slope4h marker is well suited to discriminate between FO levels >4 and <4 liters, irrespective of UFR. The ROC curve for the 2-liter cutoff is much lower, indicating less performance for the assessment of moderate FO. Figure 3 provides a more detailed insight into the sensitivity over a wide FO range. The sensitivity rises strongly for FO levels >3 liters, a result which is in accordance with the findings of Agarwal et al. [16] who were able to detect excess fluid but not depletion when compared against echocardiographic markers of volume status. The Slope4h sensitivity in figure 3 increases also at low FO levels, but not as strongly as compared to excess volume. One may speculate that the sensitivity would further increase at more negative predialysis FO levels, but in our study -0.1 liter represented the lower 10th percentile of predialysis FO, thus not enough data was available to prove this hypothesis.
Our patients had a relatively constant intraindividual predialysis FO over the seven treatments, therefore we could not demonstrate the effect of within-patient differences in predialysis fluid status on RBV slopes. Furthermore, we performed only one real FO measurement per patient. Additional FO values were calculated from preweight differences which may have added additional variability to the results arising for example from clothing differences. This would potentially underestimate the true correlation between FO and PV markers, but not change the general finding of different sensitivity ranges. Finally, given the retrospective nature of our investigation, it is not possible to extrapolate these findings to the general dialysis population. Further studies are needed which isolate the effect of FO on PV reduction by prospectively controlling factors that influence refilling (e.g. UFR or albumin). These studies should also compare different predialysis FO levels in the same patient, e.g. by measuring treatments after the long and short interdialytic interval.
BVM may assist fluid management in hemodialysis patients by identifying states of volume excess or depletion, but its utility for fine tuning at normal or moderate FO levels is questionable.
Francisco Maduell Canals, MD
Servicio de Nefrología, Hospital Clinic Barcelona
C/Villarroel, 170
ES-08036 Barcelona (Spain)
E-Mail email@example.com
Received: August 28, 2012
Accepted: December 11, 2012
Published online: March 12, 2013
Issue release date: June 2013
Number of Print Pages: 7
Number of Figures: 3
Number of Tables: 3
ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)
For additional information: http://www.karger.com/BPU
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


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|Sylvain Wallez <sylvain.wal...@anyware-tech.com>
|Re: cvs commit: cocoon-2.1/src/java/org/apache/cocoon/components/flow ContinuationsDisposer.java
|Sun, 31 Aug 2003 18:40:14 GMT
firstname.lastname@example.com wrote: >mpo 2003/08/26 02:04:39 > > Added: src/java/org/apache/cocoon/components/flow > ContinuationsDisposer.java > Log: > Adding the new ContinuationsDisposer interface declaring the callback for implementation specific Clean-up of continuations. > > See initial proposal of http://marc.theaimsgroup.com/?l=xml-cocoon-dev&m=105948225805344&w=2 > Sorry for being late on this, but is this new ContinuationsDisposer interface really needed ? The use case explains that the interpreter will implement ContinuationsDisposer. Since it's the interpreter that creates WebContinuation instances, why can't it create a specialized subclass that does the call back on invalidate() ? And if finally this proves to be really needed, the name doesn't seem adequate, as this interface is notified of the disposal and doesn't do the disposal job. So this could be a ContinuationsManagerListener (which can also be notified on creation). Sylvain -- Sylvain Wallez Anyware Technologies http://www.apache.org/~sylvain http://www.anyware-tech.com { XML, Java, Cocoon, OpenSource }*{ Training, Consulting, Projects } Orixo, the opensource XML business alliance - http://www.orixo.com
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After years of working in the demanding and difficult world of fashion and film as a premier makeup artist, Alessandra Amabile decided to change career paths and open an academy to help others passionate about the art of makeup.
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In console I get:
Tue May 28 2013 23:07:31
Error: TypeError: Components.classes[cid] is undefined
Source file: resource://calendar/modules/calUtils.jsm -> file:///Users/richi/Library/Thunderbird/Profiles/vhf50963.default/extensions/%7Be2fda1a4-762b-4020-b5ad-a41df1933103%7D/calendar-js/calUtils.js
Line: 16
Tue May 28 2013 23:07:31
Error: NS_ERROR_XPC_GS_RETURNED_FAILURE: Component returned failure code: 0x80570016 (NS_ERROR_XPC_GS_RETURNED_FAILURE) [nsIJSCID.getService]
Source file: resource://calendar/modules/calUtils.jsm -> file:///Users/richi/Library/Thunderbird/Profiles/vhf50963.default/extensions/%7Be2fda1a4-762b-4020-b5ad-a41df1933103%7D/calendar-js/calUtils.js
Line: 92
Most probably the registration of the binary component doesn't work correctly. Comparing win32 and macosx xpi I see:
> lightning-2.6a1.en-US.win32.xpi\components\libical.manifest
> binary-component calbasecomps.dll
> lightning-2.6a1.en-US.mac.xpi\components\components.manifest
> binary-component Darwin_x86-gcc3/libcalbasecomps.dylib ABI=Darwin_x86-gcc3
> binary-component Darwin_x86_64-gcc3/libcalbasecomps.dylib ABI=Darwin_x86_64-gcc3
> lightning-2.6a1.en-US.mac.xpi\components\libical.manifest
> binary-component libcalbasecomps.dylib
Should the platform specific information that is now in components\components.manifest in components\libical.manifest?
Indeed, it should be in libical.manifest. Likely this is a problem with the unify process done during the mac build.
Created attachment 762123 [details] [diff] [review]
put binary-component into libical.manifest
Patch is untested because I don't have access to Mac OS X. Please test if it fixes the problem.
Comment on attachment 762123 [details] [diff] [review]
put binary-component into libical.manifest
Review of attachment 762123 [details] [diff] [review]:
Since this is the universal packaging and my mac isn't doing universal builds, its probably easier to just push this and see what the new builds say. It can't be more broken than it is now. Code looks good though. r=philipp
Pushed to https://hg.mozilla.org/comm-central/rev/788084ca950a
Still the same errors in console. Lightning build ID: 20130614030626
Ok, in that case someone with access to Mac OS X should take over.
Richard, do you know if other versions like Lightning 2.5a2 or Lightning 2.4b1 are broken too?
I have only Daily installed and can't say if this versions are broken.
I can confirm that Lightning 2.5a2 for Thunderbird 23.0a2 (Earlybird) is broken too on Mac OS X !!!
Philipp, I suspect this might be problem regressed by the ical.js changes. Could you have a look before this problems hits comm-beta?
Yes, I'll take a look at this some time this week.
Sorry for the delay, I really need to get to this - this week! :)
When traveling this week I switched from Linux to OSX and have not been able to use my calendar. The error I see in EarlyBird is:
Timestamp: 6/27/13 11:41:49 AM
Error: [Exception... "Component returned failure code: 0x80570018 (NS_ERROR_XPC_BAD_IID) [nsIJSCID.createInstance]" nsresult: "0x80570018 (NS_ERROR_XPC_BAD_IID)" location: "JS frame :: resource://calendar/modules/calUtils.jsm -> file:///.../extensions/%7Be2fda1a4-762b-4020-b5ad-a41df1933103%7D/calendar-js/calUtils.js :: _calIcalCreator/< :: line 16" data: no]
Source File: resource://calendar/modules/calUtils.jsm -> file:///.../extensions/%7Be2fda1a4-762b-4020-b5ad-a41df1933103%7D/calendar-js/calUtils.js
Line: 16
it is obvious that only me and, for now, you, are using Earlybird and/or Daily for OSX.
So relax and wait, as me, for a month or more. :)
Created attachment 769632 [details] [diff] [review]
Fix - v1
This should take care. The interfaces line was missing from the merged file.
Comment on attachment 769632 [details] [diff] [review]
Fix - v1
Cannot test or verify if the patch works or not. Therefore trust you and blank r+
Pushed to comm-central changeset 089f43fe715b
Will push to aurora/beta as soon as we have builds that work.
Backported to releases/comm-aurora changeset 0f58049a758d
Backported to releases/comm-beta changeset 7dfe4b899bca


text:
The increasing prevalence of chronic disease in the aging U.S. population presents substantial challenges to delivering medical care that is both patient-centered and consistent with evidence-based guidelines. Dr. Boyd's prior work demonstrated that the application of disease-specific guidelines to older patients with multimorbidity is limited by the complexity, expense, and burden ofthe recommended therapeutic regimens and monitoring requirements. Optimal care for our aging society entails the development of practical evidence-based treatment models for medically-complex older patients that permit flexible goal-setting according to patient preferences and perceived treatment burden. The overall goal of this project is therefore to develop a practical tool for assessing treatment burden among older patients with multimorbidity, to assist in medical decision making. Toward this end, Dr. Boyd proposes to study older individuals with an index diagnosis of diabetes in combination with other comorbid conditions as a model for examining treatment burden in multimorbidity. We propose to characterize the domains and moderators of treatment burden in this population via a secondary analysis of data from the Guided Care project, a study of older adults with multi-morbidity (Aim 1), as well as through a series of focus groups (aim 2). We will synthesize these data and data from the literature to develop a clinically practical measure of treatment burden (Aim 3), and, finally, we will pilot test this instrument in a clinical setting (Aim 4), as preparation for an ROl study to evaluate the clinical utility of the instrument for improving patient adherence and outcomes for a broader population of patients with multi-morbidity. This work will provide the foundation for a clinical research career focused on improving decision making and outcomes for older people with multimorbidity. Dr.
Boyd aims to become an independent clinical investigator dedicated to improving care for older people with multimorbidity. In concert with her sponsors, Dr. Boyd has charted a research path that is a direct extension of her prior work, and will be conducted within a structured career development plan that includes coursework, mentoring, and a multidisciplinary research advisory committee.
Many older adults have multiple co-existing conditions, but it is not known how to best manage these conditions simultaneously. Dr.
Boyd aims to improve clinical decision-making and outcomes for older people with multimorbidity.
|Chamberlain, Alanna M; St Sauver, Jennifer L; Gerber, Yariv et al. (2015) Multimorbidity in heart failure: a community perspective. Am J Med 128:38-45
|Trikalinos, Thomas A; Segal, Jodi B; Boyd, Cynthia M (2014) Addressing multimorbidity in evidence integration and synthesis. J Gen Intern Med 29:661-9
|Wolff, Jennifer L; Roter, Debra L; Barron, Jeremy et al. (2014) A tool to strengthen the older patient-companion partnership in primary care: results from a pilot study. J Am Geriatr Soc 62:312-9
|Boyd, Cynthia M; Lucas, Gregory M (2014) Patient-centered care for people living with multimorbidity. Curr Opin HIV AIDS 9:419-27
|Boyd, Cynthia M; Wolff, Jennifer L; Giovannetti, Erin et al. (2014) Healthcare task difficulty among older adults with multimorbidity. Med Care 52 Suppl 3:S118-25
|Boyd, Cynthia M; Kent, David M (2014) Evidence-based medicine and the hard problem of multimorbidity. J Gen Intern Med 29:552-3
|Rocca, Walter A; Boyd, Cynthia M; Grossardt, Brandon R et al. (2014) Prevalence of multimorbidity in a geographically defined American population: patterns by age, sex, and race/ethnicity. Mayo Clin Proc 89:1336-49
|Frei, Anja; Muggensturm, Patrick; Putcha, Nirupama et al. (2014) Five comorbidities reflected the health status in patients with chronic obstructive pulmonary disease: the newly developed COMCOLD index. J Clin Epidemiol 67:904-11
|Uhlig, Katrin; Leff, Bruce; Kent, David et al. (2014) A framework for crafting clinical practice guidelines that are relevant to the care and management of people with multimorbidity. J Gen Intern Med 29:670-9
|DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R et al. (2013) Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions. J Healthc Qual 35:58-69
Showing the most recent 10 out of 23 publications


text:
Ahead of the 1999 World Cup in England, few people knew what a brilliant bowler Kiwi Geoff Allott was. But with prodigious late swing, his fast left arm catapulted him to the top of the wicket-taking rankings for that tournament. Now 22-year-old Tim Southee (above) could repeat the trick. Over the weekend, the great fast bowler Allan Donald, who is coaching the Kiwis, said Southee "could become the world's best swing bowler", responding to his 15 wickets at 17 in seven games. Though it might irk his fellow South African Dale Steyn to hear that, Donald is right. Just like Allott, and indeed Kiwi Simon Doull, Southee has a superb wrist-action for the outswinger. He also has a very good off-cutter, where he rolls his wrist over the ball, and an excellent slower ball. If he can add the in-swinger to his repertoire, and avoid the injuries that sadly curtailed the brilliant career of Kiwi Shane Bond, he might yet scale the heights Donald himself reached.
The mystery of the spinner lives on
Even the most venerated commentators seem destined never to understand the rudiments of spin bowling. One eminent analyst yesterday referred to Sri Lankan Rangana Herath's mystery ball, as "a 'slider' flicked out of the front of the hand". This is a conflation of categories. The "slider" (or "zooter") is the leg-spinner's delivery that skids straight on (not to be confused with the "flipper"). Herath's mystery ball is a left-handed version of the Carrom Ball flicked out by his team-mate Ajantha Mendis. More on this subject soon. For now, suffice to note that, as so often in the history of mystery, the spinner's best weapon is his opponent's ignorance.
Van Zyl choking on the choker tag
South Africa coach Corrie van Zyl said that the "choker" tag was keenly felt by his players, who lost their quarter-final to New Zealand, having lost four previous knockout World Cup games. But the Proteas' fans didn't help. "When our own fans keep reminding us of the past, it doesn't provide motivation, it just brings extra pressure," he said yesterday. I doubt it's much consolation but Wayne Rooney, who sarcastically said to camera "Nice to see your own fans booing you" after England's goalless draw against Algeria, knows how he feels.
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- Sri Lanka


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Dear Kent,
Enjoy your iris. It is a Walking Iris. After it blooms, the stalk bends
over and plants a new iris which is growing at the end of the stalk(called a
proliferation). It has beautiful foliage and lovely blooms. Enjoy.
It also comes in different colors. I have two
different colored African Walking Irises and you have a third different
colored variety. I have a blue and white one, and a smaller yellow and brown
one. Yours appears to be white with yellow and lavender. My smaller yellow and
brown variety is the most prolific and gets up to 12 new proliferations per
year, but my blue one gets only 1 or 2 a year.
I live in Lexington, KY, but have a son in
Annette Milch (President of the Blue Grass Iris
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To highlight the 30th anniversary of the discovery of the AIDS virus, MTV Staying Alive Foundation alongside curators The Future Tense, will hold a benefit art auction and exhibition titled "RE:DEFINE." This public event will take place at the Goss-Michael Foundation in Dallas, Texas from September 16-23. A roster of 30 artists will be part of this exhibit as their works will go on an exclusive auction on the 24th. Hosted by Simon de Pury, chairman of Phillips de Pury & Company, the proceeds from the exclusive auction will go to the MTV Staying Alive Foundation.
Source: Arrested Motion


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Former Rep. Ray LaHood, R-Ill., won unanimous Senate confirmation on Thursday to head President Barack Obama's Department of Transportation. The 63-year-old LaHood called the Cabinet post "the capstone of my public service career," and said "it shows the whole idea of bipartisanship and working with people across party lines was not just a political slogan." In his confirmation hearings, LaHood vowed openness and fairness in overseeing the flood of public money expected for transportation projects under the president's stimulus plan.
Full Story:Peoria Journal Star (Ill.), Google, CQPolitics.com


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Photo 16-MAR-37
Copyright © Vintage Aerial. Duplication strictly prohibited. Sharing encouraged. Photo not shown to scale.
Visitor Comments
McNally's with the general store. The only place open on Sundays for miles.
It's McNelly's not McNally
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Winger Jerome Thomas has agreed a one-year contract with Portsmouth, who have decided to make his loan move from Charlton permanent.
Pompey will pay Charlton an undisclosed fee if the 25-year-old, who joined last week and made his debut as a substitute in the 4-0 Barclays Premier League defeat at Chelsea, makes a specified number of appearances.
Chief executive Peter Storrie said: "Jerome could have been recalled by Charlton in January under the terms of his loan, but that's no longer a factor now."
Under Premier League rules, clubs are allowed only four loans per season - and Portsmouth already have striker Ben Sahar on a six-month stay from Chelsea.
The league have also confirmed no club is allowed to have more than two players from any one other on loan at the same time.
That rules out any immediate Pompey loan move for England winger Shaun Wright-Phillips, who is also at Chelsea.Reuse content


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Classification (taxonomy, categorization) is to content as mapping is to geography. It is an essential tool that allows the person visiting a Web site to navigate it quickly and efficiently. Without professional classification, a Web site becomes a jumble of content that is confusing and time wasting.
Despite its importance, classification is poorly implemented on a great many Web sites. The following are some of the reasons why this is the case:
- Classification is historically associated with libraries and as such is not seen as critical function of a commercial organization.
- Classification is seen as something technical rather than strategic. Senior managers thus rarely get involved in designing classification.
- There is rarely a link between the act of classification and its impact. The organization does not see frustrated and confused Web site visitors as they click their way through a poorly designed classification.
Classification design is a complex and difficult process for the following reasons:
- There is no "right" way to classify content. If you give 10 experts a Web site to classify, chances are they will all come up with slightly different classification designs for the Web site. The more content, the more divergent these designs will become.
- Web site classification impacts both the "map" and the "geography." Classification is not simply about mapping content that is already on a Web site. It also dictates the very structure of the Web site.
- Web site classification is an ongoing process prone to error. Each time a new document is published on the Web site, it needs to be classified. If the document is classified incorrectly, then it undermines the entire classification design.
- Web site visitors are impatient. They demand a classification that is simple and intuitive. While highly desirable, this is not always possible where large quantities of content are involved. Thus, there is often a trade-off between designing a classification that is comprehensive and designing one that is user friendly.
- The organization often has a preexisting classification that is understood by its employees but not by its customers. A difficult decision needs to be made with regard to whether to design two classifications or create a single unified classification that is understood by both.
However complex classification is, it needs to be embraced. Here are some things to keep in mind when approaching its design:
- Get senior management involved, particularly for the design of the top level of the classification. Whether, for example, you choose "Products," "Services," or "Solutions" says a lot about what type of organization you are.
- Treat classification like it is the foundation and architecture of your Web site. It thus requires careful design upfront and is not something you should be constantly changing.
- Design the classification for the person who is most likely to use it. Make sure that the terms you are using are understandable to this person.
- Mock up and test the classification. Watch how people use it.
- Strive to have consistent classification across your Web sites. This will be easier to manage and will create a more familiar environment for Web site visitors.
Before the Web, classification was some peripheral activity that happened deep in the bowels of the library. But the Web is a library. It is a place where people come to quickly find content. Quality classification facilitates their doing that.
Related reading
Bridging the gap between marketing and IT
According to data gathered for the report,'Communications Infrastructure: The Backbone of Digital,' 88% of IT professionals and 61% of marketers ranked their company's current communication infrastructure as 'cutting-edge' or 'good.'
President Trump is a savvy domain name buyer
President Trump's digital savvy isn't limited to social media. As it turns out, the Trump Organization owns thousands of domain names, possibly even more than 10,000.
You don't need a "Growth Hacker," just a data-driven marketer
Silicon Valley loves fancy job titles. It's just something we do, and software and technology lend themselves to it. But it's not always helpful.
7 tips for successful client strategy meetings
In an often fragmented workplace, where various departments have varying opinions and goals, it can be challenging to get everyone on the same page and make strategy meetings productive.


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Leontios the Myrrh-Streamer of Argos
Aitherios the Martyr of Nicomedia
Acts of the Apostles 21:26-32
IN THOSE DAYS, Paul took the men, and the next day he purified himself with them and went into the temple ... |
John 16:2-13
The Lord said to his disciples, The hour is coming when whoever kills you will think he is offering ... |
Grant us to glorify you all night long that we may praise and bless and glorify your all honorable and magnificent name, of the Father and the Son and the Holy Spirit, now and forever and to the ages of ages. Amen.
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Monthly Calendar of Saints and Feasts
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Greek New Testament
The authorized 1904 text of the Ecumenical Patriarchate of Constantinople
Love Your Enemies
by Fr. Andrew Demotses


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The Pilot Studies Program continues to play a crucial role in promoting the UCONN ARC'S vitality and growth. During the past 5 years, several innovative studies including: (1) microRNA regulation of HTR1B gene expression;(2) exercise as a behavioral intervention for hazardous drinking in college students;(3) examining genes that may affect problem drinking and obesity risk;and (4) examining the safety and efficacy of dutasteride as a treatment for heavy drinking were supported. One of these projects inspired a major component of this Center renewal application. Others have led, or are likely to lead, to applications for other types of extramural support. The Pilot Studies Program will continue to be managed by the PI and Executive Committee in consultation with internal and external advisors. Following an open call for proposals, applications will be reviewed to: (1) judge scientific merit;(2) improve the quality of the research through feedback, revision, and mentorship (if needed);(3) create a system whereby resources are allocated fairiy and equitably;and (4) ensure that the research meets ethical standards. Several projects are proposed. The first project will examine dermal fibroblasts, sampled from alcoholdependent and non-dependent subjects that are reprogrammed into induced pluripotent stem (iPS) cells and differentiated into neurons. The goal is to detect changes in NMDA receptor and GABAergic signaling in response to acute and chronic alcohol exposure. A second project will survey the fidelity and acceptance of Contingency Management for alcohol dependence as it is disseminated in clinical settings throughout the VA health care system. The third project will take advantage of the screening, brief intervention and referral to treatment (SBIRT) initiative mandated by JCAHO and CMS for hospitals in New England, including UCHC. This study will develop process measures needed to evaluate the mechanisms of change attributable to factors other than the intervention. Projects proposed for the out years will be designed around new alcohol research collaborations being developed with the Connecticut Department of Corrections, the Jackson Laboratories'personalized medicine research facility now under construction on our campus.
The Pilot Study Component allows UCONN ARC investigators to pursue and develop innovative projects related to the etiology and treatment of alcohol dependence and related behaviors, the theme of the Center. This component provides an incubator for new ideas, provides for a critical and collegial review of proposals, and provides resources to pilot test potentially important ideas. It is an especially important resource for new and junior investigators.
|Petry, Nancy M; Alessi, Sheila M; Byrne, Shannon et al. (2015) Reinforcing adherence to antihypertensive medications. J Clin Hypertens (Greenwich) 17:33-8
|O'Hara, Ross E; Armeli, Stephen; Tennen, Howard (2015) College students' drinking motives and social-contextual factors: Comparing associations across levels of analysis. Psychol Addict Behav 29:420-9
|Petry, Nancy M; Alessi, Sheila M; Barry, Danielle et al. (2015) Standard magnitude prize reinforcers can be as efficacious as larger magnitude reinforcers in cocaine-dependent methadone patients. J Consult Clin Psychol 83:464-72
|O'Hara, Ross E; Armeli, Stephen; Tennen, Howard (2014) College students' daily-level reasons for not drinking. Drug Alcohol Rev 33:412-9
|O'Hara, Ross E; Armeli, Stephen; Tennen, Howard (2014) Drinking-to-cope motivation and negative mood-drinking contingencies in a daily diary study of college students. J Stud Alcohol Drugs 75:606-14
|Andrade, Leonardo F; Barry, Danielle; Litt, Mark D et al. (2014) Maintaining high activity levels in sedentary adults with a reinforcement-thinning schedule. J Appl Behav Anal 47:523-36
|Arias, Albert J; Covault, Jonathan; Feinn, Richard et al. (2014) A GABRA2 variant is associated with increased stimulation and 'high' following alcohol administration. Alcohol Alcohol 49:1-9
|Weiss, Lindsay M; Petry, Nancy M (2014) Substance abuse treatment patients with early onset cocaine use respond as well to contingency management interventions as those with later onset cocaine use. J Subst Abuse Treat 47:146-50
|Milivojevic, Verica; Feinn, Richard; Kranzler, Henry R et al. (2014) Variation in AKR1C3, which encodes the neuroactive steroid synthetic enzyme 3?-HSD type 2 (17?-HSD type 5), moderates the subjective effects of alcohol. Psychopharmacology (Berl) 231:3597-608
|Kranzler, Henry R; Armeli, Stephen; Feinn, Richard et al. (2014) GRIK1 genotype moderates topiramate's effects on daily drinking level, expectations of alcohol's positive effects and desire to drink. Int J Neuropsychopharmacol 17:1549-56
Showing the most recent 10 out of 87 publications


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Alex Color a Fashion Bag is fashion kids design and decorate themselves. Six markers can be used to fill in the shapes. Plus, outside pockets are ideal for extra storage.
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- 08-24-2014, 11:24 AM Thread Author #1
android connecting to ios hotspot problem
I'm currently using a zync cloud android(4.0.4) phone that was recently flashed (due to.. too many pattern attempts) and I have noticed that when I am connecting to my hotspot from my iphone it suddenly loses it's internet! At first I will be able to have the connection but suddenly gone! I can still see that my android is connected because it still has the wifi connection on top. I was wondering if it was caused by the flashing(or ehat ever process it eas called). My iod hotspot is working perfectly on other devices. But in mu zync cloud z5 I have no luck! Can someone please help me? I will appreciate it. Thanks in advance!
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Re: android connecting to ios hotspot problem
Are you using a preloaded app to use your hotspot?
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"A sensitively restored Art Deco gem in the beating heart of Buenos Aires, with vast rooms and splendid city views from the roof terrace"
The 39 rooms are immense by any city's standards, feeling more like studio apartments than hotel rooms. They go from Large to Extra Large to Extra Extra Large, with even bigger Lofts and Big Lofts on the higher floors, which will buy you 67sq.m of space.
High ceilings and huge windows allow ample natural light, and the décor is minimalist, masculine and classy. The cool Deco lamps, retro alarm clocks and custom-built red-leather sofas or armchairs add to the period feel; but soft Egyptian cotton, free WiFi, electronic keys, cordless phones and foldaway flat-screen TVs bring it bang up-to-date. All rooms have kingsize or twin beds, sitting areas and ample wardrobe and drawer space. The Lofts and Big Lofts also come with coffee- and tea-making facilities, and some have balconies or terraces.
Bathrooms are polished and modern, with dark-wood decking in the power showers (some rooms have a tub instead) and chic circular sinks with shiny silver fittings. Soft white towels, toiletries and hairdryers are provided, and slippers and bathrobes are available on request.
Be sure to ask for one of the higher front-facing rooms, which give glorious views over the domes and turrets of the nearby San Francisco basilica.
The hotel's ritzy restaurant and bar, Aldo's, occupies the ground floor and is open from 11am to midnight for brunch, lunch, afternoon tea, drinks and dinner. It was created by sommelier Aldo Graziani and its 500-bottle cellar is central to the concept, with dishes designed to complement the wines available. We have yet to sample the fare ourselves, but we've heard good things about the international cuisine (truffle risotto, veal milanese, pan-fried salmon) and jazzy ambiance.
Breakfast is served on the roof terrace between 7-11am and is a more scaled-down affair, consisting of toast, fruit, yoghurts and pastries. If the weather allows, you can take it up on the roof terrace and gaze over Buenos Aires as you eat.
The streets immediately surrounding the hotel don't throw up many good options for eating out, but just a few blocks south are the lively bars and restaurants of San Telmo. Check out Brasserie Petanque (Defensa 596) for well executed French bistro food, El Desnivel (Defensa 855) for a rowdy traditional parrilla (steak house), and super-swanky 647 Dinner Club (Tacuarí 647) for cocktails and modern Argentine food.
The ultra-spacious rooms make the Moreno a good option for families. Cots for under-2s can be added to all rooms free of charge, and most can take extra beds for a supplement. However, the busy narrow streets around the hotel may be challenging terrain with buggies and the area has few open spaces for kids to let off steam. Babysitters can be booked via reception.
Cots Available
Babysitting is available by arrangement.
Baby cots are available on request.
Remember baby and child equipment may be limited or need pre-booking
For more family-friendly places, see our Kids Collection


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11 August 2014
11 August 2014 Last updated at 20:59 BST
Rural crime in the UK has risen by more than 5% in the last year, according to latest figures from a farm insurance company.
Insurers NFU Mutual say the cost of crime to the rural economy reached more than £44m in 2013.
An increase in sheep rustling and the theft of farm equipment contributed to the rise.
Ed Thomas reports.


text:
In a large bowl combine slaw mix, diced apples, and chopped walnuts; set aside.
In a small bowl, stir to combine mayonnaise and poppy seed dressing. Pour dressing over slaw mixture and toss to combine. Cover and refrigerate 1 hour before serving.
Recipe courtesy of Sandra Lee
The best comfort food is comforting both to cook and to eat, like Ree's pork chops.


text:
Seth Timpano
Seth has been climbing for the past 14 years and this will be his 9th year as a mountain guide. He enjoys all types of climbing but finds his greatest adventures to be steep rock and ice climbs in the mountains done in the best style and with great friends.
Significant Ascents
Personal Climbs:
First Ascents in Alaska, Canada, India, Kyrgyzstan, Montana and
Antarctica, in addition to several climbing trips to Argentina, Nepal, Spain,
Thailand, Italy, Chile, France & New Zealand including:
FA of Reality Face on Peak 13,100 ft (Alaska)
FA of Private Spacibo on Peak 4150m (Kyrgyzstan)
FAs on Barnaj I & Barnaj II (6400m) – no summit (India)
Mount Huntington (Alaska)
6 of the 7 summits in the Fitz Roy Massif
Guided climbs:
Several FAs in the Ellsworth Mountains including the Soholt Peak Traverse
Mount Shinn
Ski The Last Degree
Travel Safety Manager
Mount Frances
Peaks in the SW Fork
Mount Stuart
Torment-Forbidden Traverse
Granite Peak (Montana)
Aconcagua (Argentina)
Leave No Trace Trainer
Wilderness First Responder/ CPR
Avalanche Level II
Awards & Recognition
2014 Mugs Stump Award
2014 Lyman-Spitzer AAC Grant
2010 McNeill-Nott Award (AAC) Grant Recipient
Denali Pro Pin 2010


text:
Cantaloupe and Chicken Salad
The Cantaloupe and chicken salad is a refreshing salad with an amazing combo of fruits and meat with a tangy dressing. A healthy easy to make salad it is a great tasting salad that is perfect for any occasion.
|Plain yogurt
|1⁄4 Cup (4 tbs)
|Mayonnaise/Salad dressing
|1⁄4 Cup (4 tbs)
|Lemon juice
|1 Tablespoon
|Chopped chives
|1 Tablespoon
|1⁄4 Teaspoon
|5 Cup (80 tbs) (1 1/2 Inch Piece)
|Cut up cooked chicken
|2 1⁄2 Cup (40 tbs)
|Red grapes/Green grapes
|1 Cup (16 tbs), cut in half
|1 Medium, cut into strips
1. Mix yogurt and mayonnaise in large bowl. Stir in lemon juice, chives and salt.
2. Stir in remaining ingredients. Serve immediately, or refrigerate until chilled, at least 2 hours but no longer than 24 hours.
Recipe Summary
Difficulty Level:Very Easy
Preparation Time:10 Minutes
Rate It
Nutrition Rank
Nutrition Facts
Serving size
Calories 404 Calories from Fat 206
% Daily Value*
Total Fat 23 g35.2%
Saturated Fat 4.5 g22.6%
Trans Fat 0 g
Cholesterol 80.8 mg26.9%
Sodium 284.5 mg11.9%
Total Carbohydrates 27 g9.1%
Dietary Fiber 2.5 g9.8%
Sugars 23.4 g
Protein 25 g49.4%
Vitamin A 142.8% Vitamin C 137.9%
Calcium 6% Iron 9.8%
*Based on a 2000 Calorie diet
Cantaloupe And Chicken Salad Recipe


text:
Car Route Map Bike Route Map Walk Route Map
The distance from Suffolk, Virginia to Hampton, Virginia is 30.6 miles by the driving route, 30.6 miles by the biking route, and 30.6 miles by the walking route. The straight line distance between Suffolk and Hampton is 30.6 miles (airplane route). The distances via different routes and the durations needed to travel from Suffolk to Hampton are summarized in Table 1. The estimated gasoline cost of driving from Suffolk to Hampton is summarized in Table 2.
|Travel Route
|Distance (mi)
|Distance (km)
|Travel Time
|30.6 mi
|49.2 km
|30.6 mi
|49.2 km
|30.6 mi
|49.2 km
|30.6 mi
|49.2 km
|3.7 minutes
|Note: Distances of driving, bicycling, and walking routes and travel durations are calculated using Google Maps services API. Airplane distance and travel time are calculated using straight line and flying speed of 500 miles per hour [reference].
|Fuel Economy
|Distance (driving)
|Fuel Cost
|20 mpg
|30.6 miles
|25 mpg
|30.6 miles
|30 mpg
|30.6 miles
|35 mpg
|30.6 miles
|40 mpg
|30.6 miles
|50 mpg
|30.6 miles
|Note: Gasoline price used in the calculation is $2.20 per gallon.
|From Suffolk, VA to Franklin, VA
|17.0 miles
|From Suffolk, VA to Chesapeake, VA
|18.5 miles
|From Suffolk, VA to Smithfield, VA
|19.0 miles
|From Suffolk, VA to Portsmouth, VA
|19.1 miles
|From Suffolk, VA to Rushmere, VA
|25.9 miles
Also see Distance from Suffolk to other countries; Distance from Suffolk to other world cities; Distance from Suffolk to nearby airports.


text:
|Message view
|« Date » · « Thread »
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|peter royal <pro...@apache.org>
|Re: [jelly] 1.0-final problem wrt tag caching
|Sat, 13 Aug 2005 16:25:34 GMT
On Aug 10, 2005, at 6:14 PM, Paul Libbrecht wrote: > I'm annoyed... I don't obtain the same results as you do. > With the default cacheTags value as false, I obtain only your test > failing. > > With the default cacheTags value as true, I obtain many failed tests. > > Did you not say that with your commit, all jelly-core tests were > passing ? > > If not then we really need to push the NeedCaching and > RefusesCaching interfaces. Right ? yes, with the change I made, all the tests in jelly-core were passing. can you give an example or two of a test that's failing for you? -pete -- peter royal
|View raw message


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Phone: 763.785.5649
Phone: 763-717-3229 firstname.lastname@example.com
The Stick it to Cancer Hockey Tournament is a benefit to support the fight against breast cancer. Each team volunteers a combined total of six hours, and all referees donate their time to tournament operations, resulting in an even larger donation to cancer research.
Thank you to all of our participating teams! The 2016 Tournament was a huge success and we proudly made a donation in the amount of $37,200 to the University of Minnesota Cancer Center.
Don't have a team? You can still help!
New to 2017 our adult women's divisions will now be sanctioned through USA Hockey.
Refund Policy: No refunds will be given to teams dropping inside 30 days of tournament start date.
Tournament rules are presented here in PDF format for convenient download and printing.
March 20, 2017 or until brackets fill
Each team must provide two volunteers to work in the score box at each of their games. Volunteers must be 16 years of age or older. Contact Tournament Director for more information on volunteers, donations, sponsorship and vendors.
"Well we had the best time this weekend! Thank you for putting on such a wonderful tournament! I am proudly wearing my "Stick-It" sweatshirt today and thanking all my friends…and today would have been my mother's birthday."
"Hi ladies, I can't even begin to express how wonderful your tournament was this past weekend. You are totally organized and ran a wonderful event.
Thanks for giving us such a great tournament- We will be back next year!"
"Thank you all for a very well coordinated tournament. Great time had by so many."
We know teams often need fundraising help to offset the costs of participating in events.
Schwan's Cares: A Fundraising Network has you covered. Find out how your team can start an easy, simple to manage fundraising campaign.