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Onion Herb Baked Bread
|Italian bread loaf
|1 , halved lengthwise (About 16 In. Long, French Bread)
|1⁄2 Cup (8 tbs), softened
|Golden onion soup mix
|3 Ounce (1 Envelope, Lipton)
|1 Clove (5 gm), finely chopped
|Basil leaves
|1 Teaspoon
|1 Teaspoon
|1⁄8 Teaspoon
1. Preheat the oven to 375°F.
2. To make the spread, in a mixing bowl, use a butter knife to blend the butter with onion soup mix, garlic, herbs and pepper.
3. Spread the flavored butter on the bread halves.
4. Arrange the bread, buttered side up on a baking sheet.
5. Place the baking sheet in the preheated oven and toast the buttered bread for 15 minutes, until crisp and golden brown.
6. Remove bread from the oven and cool slightly before slicing.
7. Arrange on a platter and serve hot.
Recipe Summary
Rate It
Nutrition Rank
Nutrition Facts
Serving size
Calories 473 Calories from Fat 225
% Daily Value*
Total Fat 26 g39.5%
Saturated Fat 15.1 g75.7%
Trans Fat 0 g
Cholesterol 60.5 mg20.2%
Sodium 2150.4 mg89.6%
Total Carbohydrates 53 g17.5%
Dietary Fiber 4 g16.1%
Sugars 1.7 g
Protein 9 g17.4%
Vitamin A 17.2% Vitamin C 3.3%
Calcium 12% Iron 17.2%
*Based on a 2000 Calorie diet


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Right now this cake mix is on sale at Harris Teeter so this is what the deal will look like:
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subset: commoncrawl


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text:
No other info. I expect that the $8.95 is basically a cutting - maybe a 4
inch pot. The $20+ size might be a 1-2 year shrub. That is assuming
they're available for mailorder. You really can't ship much bigger than
that safely or economically. Have not yet heard back from them whether
it's even possible. Will post if I receive anything.
> [Original Message]
> From: Donna <email@example.com>
> To: <email@example.com>
> Date: 6/18/2003 9:23:08 PM
> Subject: RE: [CHAT] Re: found woodlander
> Not being the greatest of searchers on this list....
> Did you find out how big / small these were? Found them listed, as you
> posted, but not any other info.
> Donna
> > Sorry to keep correcting myself, but by George, I think I've got it!
> > North River Nursery in Chatanooga is the nursery that carries the
> plant
> > in 2 sizes. but their website setup seems to only offer hardgoods for
> > sale on line and gives directions to their nursery. But I scouted
> around
> > on various pages and I now THINK they may accept plant orders (waiting
> > to hear back from them) If you're interested try:
> >
> > www.wotministries.org
> >
> > 30351M Hydrangea Serrata "Woodlander" $8.99
> > 30355M Hydrangea Serrata "Woodlander" $27.99
> >
> > Kitty
> ---------------------------------------------------------------------
> To sign-off this list, send email to firstname.lastname@example.com with the
> message text UNSUBSCRIBE GARDENCHAT
To sign-off this list, send email to email@example.com with the
message text UNSUBSCRIBE GARDENCHAT


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Hey ^-^ Nice meeting you. I just want to say, take care of my big brother! x3
and.. hmm, oh, I'm glad your watching Naruto! =D
How are you by the way? =3


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Lordship Colonial with front to back living room with fireplace, open floor plan with kitchen and dining room, three ample bedrooms with hardwood floors, one and a half baths, partially finished basement, and fenced backyard with two car garage. Walk to school, beach, deli, churches, etc. Great home! Also for sale at $269.900.
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Kathy Griffin has a new scheme for leaving the D-list.
"I am looking to have a Twitter war because that's something that could help me get ont he A-list," she told press on Monday (April 26). "I saw Demi Moore was having a Twitter war with Kim Kardashian, so I am on a mission to find a high-profile celebrity to have a Twitter war with. I put it out there. I do my own twats on Twitter, so please follow me. My twats have a lot to say."
Her Twitter war wishlist started out pretty ambitious, but quickly devolves into D-list celebs.
"Oprah would be my dream, but if not Oprah, maybe Dr. Phil or maybe
someone from 'Jersey Shore,'" she mused. "Maybe myself and The
Situation could have a Twitter war — not that he can read, but
somebody could translate it into Jersey.
]]>Follow Zap2it and Zap2itHanh on Twitter and Zap2it on Facebook for the latest TV, movie and celebrity news.
More Kathy Griffin/Speidi dish:
Kathy Griffin and Levi Johnston knock on Sarah Palin's door
'The Hills': Spencer Pratt goes off on Audrina Patridge via Twitter
'The Hills': Stephanie Pratt hasn't spoken to Spencer or Heidi Montag Photo credit: Getty


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Wag Bags® poop pickup RED Refill Pack, with 60 Floral scented bags.
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Top Definition
(Sometimes No-Sir-Ree-Bob)
1. Definitly Not.
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<George W. Bush> No Sir Ree Bob.
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Karam & Missick seeks to consistently provide professional, legal and corporate services to both our local and international clientele in a manner that is friendly, cost-effective and thorough. We also seek to make a positive impact on our community through various avenues. We are good stewards of our in-house resources and we effectively utilize various marketing channels to gain maximum client and community awareness. Finally, we are leading the way in business/legal etiquette, entrepreneurial thinking and business development in the Turks and Caicos Islands and The Bahamas.
Karam & Missick is today one of the leading and most well-respected law offices in Providenciales, Turks and Caicos. We combine our many years of collective expertise with personal, friendly service to provide our international and local clients with strong professional results that establish personal trust and confidence in our representation of your business and legal affairs.
Karam & Missick delivers professional, timely cost-effective business and legal solutions. We provide services to companies and individuals both locally and internationally. Our goal is to provide the best attorney-client relationship through friendly service and competent representation. Our commitment is your success. Our highly trained staff is highly skilled, motivated, focused and work together selflessly for the overall success of the firm and its clients.
Peter is a Quebec trained attorney with 23 years of experience. He has practiced in the fields of Commercial, Corporate and Tax Law. Peter has lived and worked in the Turks and Caicos Islands for over 10 years, providing him with vast knowledge of the local laws and landscape to make him well-versed in successfully navigating many complex commercial matters and negotiations.
Peter is a licensed attorney in the Turks and Caicos, and was called to the Quebec Bar in 1988/89. He is a graduate of McGill University in Montreal [LLB] and Ottawa University Law School [LLL]. He is a former member of the Bar Association of Quebec and a member of the Turks and Caicos Bar, and is fluent in English and French.
George is a co-founder and managing partner of Karam & Missick Turks & Caicos and Bahamas. George is a fierce and fearless litigator with a strong background in Commercial Litigation, Personal Injury, Admiralty, Insolvency and Company Law. He graduated from the University of Buckingham with Honours in 2000 and passed the Bar Vocational Course in 2001 at the University of the West of England & Wales, Bristol. George is admitted to three Bars: England & Wales (2001), The Bahamas Bar (2001) and the Turks and Caicos Bar (2007). He is also certified in dispute resolution from the Dispute Resolution Foundation in Jamaica. Prior to starting the partnership of Karam & Missick, George worked as a senior associate at the law firm of Callenders & Co. in the Bahamas where he handled detailed civil and commercial litigation, and conveyancing matters throughout the Bahamas. He also worked on a variety of litigation and commercial matters for the Grand Bahama Port Authority Group of Companies including the GB Harbour Company, GB Airport Company, GB Power & Utility Company and the GB Shipyard.
George has enjoyed much success in both the Supreme Court and Appeals Court and has won many high profiled cases in the civil courts as well as the Labour Tribunal. George has been involved in multi-million dollar insolvency claims, world wide freezing injunction claims, ship arrest and other maritime related matters. He regularly advises commercial banks, trust companies, resorts and large corporations on banking and commercial matters.
More generally, George provides advice in relation to high value personal injury and fatal accident claims and has successfully litigated or settled claims totaling in the millions.
George is a former President of the Turks and Caicos Islands Bar Association having served 3 consecutive terms and is a former member of the Rotary Club of Providenciales and conducts regular legal aid clinics within the community.He was sworn in as a Notary Public of the Turks and Caicos by HE Governor Ric Todd in Providenciales on 22nd April 2012 and is also a Notary Public in the Bahamas.
Alecia is a co-founder and the managing partner of Karam & Missick Bahamas. Her legal career is complimented by her very diverse background spanning more than 20 years in the hospitality and banking industries. Alecia is a dynamic, decisive and diligent Attorney who is a trendsetter in her style, approach and delivery. She goes beyond the usual standards of practice to meet and exceed her client's expectations. Although she is firm and forceful in her practice, her approach is principled and highly respected by her clients. Mrs. Bowe is a former partner of Chancellors Chambers.
Alecia specializes in real estate development, resort development, banking and securities, mediation, assets recovery and corporate and commercial matters.
Alecia is a graduate of The University of Buckingham, England and is a Member of The Honourable Society of The Middle Temple and The Bahamas Bar Association. She is also a director on the board of Consolidated Water Bahamas Ltd.
Colin is an experienced commercial attorney whose expertise includes Real Estate, Immigration, Probate and Estate Law. His areas of practice include preparation of commercial documents, applications to the Bahamas Investments Authority, Central Bank of The Bahamas, Probate Registry and the Department of Immigration. Colin also has over twenty-five (25) years experience with investigation of land titles and research in related areas.
Colin is a graduate of the Government High School and completed his legal studies at the University of Hull, Hull, England and the Bar Vocation Course at University of Northumbria, Newcastle, England.
Colin has served his country being a former member of the Royal Bahamas Defence Force and upon invitation by the Training Department he has conducted presentations to graduating Recruits pertaining to the importance of purchasing property as investment.
He is a Member of The Honourable Society of Inner Temple and The Bahamas Bar Association.
Neale Coleman is an experienced civil and commercial litigator. He was as admitted a Solicitor in England and Wales in 1996 and called to the Bar of the Turks and Caicos Islands in 2007 as an Attorney at Law. Neale joined Karam & Missick as a Senior Associate in February 2011. Neale has practiced as an attorney in the Turks and Caicos Islands since 2007 formerly being a partner at the law firm of Bishop Papachristou & Prudhoe. Prior to his arrival in the Turks and Caicos Islands Neale practiced as a commercial litigator in London working for a large international law firm.
Neale is a member of the Law Society of England and Wales, Turks and Caicos Bar Association, and a member of the Society of Trust and Estate Practitioners. Neale also undertakes a broad range of commercial and civil litigation appearing as counsel in the Magistrates Court, the Supreme Court, the Court of Appeal and the Labour Tribunal.
Neale has many impressive victories in the Courts and is often referred complex litigation from other senior attorneys.
Dale is a Senior Associate at Karam & Missick who specialises in Real Estate and Commercial Law. He is called as an attorney in Canada since 1981 and in the Turks and Caicos since 1989 bringing with him a wealth of knowledge internationally and locally.
The focus of Dale's practice is the consultation with and provision of legal services to existing and new clients to meet their needs and requirements, from taking instructions for wills and simple real estate transactions, the drafting of documentation to meet those ends, accepting the challenges involved in the preparation of Trust Deeds, revocable, irrevocable, discretionary and those for asset protection purposes.
Dale is also involved as a key player in corporate commercial transactions and the security documentation required in raising funds for small start up enterprises and reverse take over negotiations of publicly traded companies by the start up enterprises.
Jeffrey is a senior attorney, having been in active practice since 1990. He completed his education at Memorial University of Newfoundland (B.A. 1984) and the University of New Brunswick Law School (LL.B. 1989).
Jeffrey was called to the Nova Scotia Barristers' Society (1990), the Law Society of Prince Edward Island (1991), and the Turks and Caicos Islands (TCI) Bar Association (1995). In 1999, he was admitted as a solicitor to the Law Society of New South Wales (Australia).
Jeffrey's practice focuses on real estate, corporate-commercial, estates & trusts, finance, banking, immigration, regulatory, tax, and asset protection law. Along with an emphasis on the purchase and sale of residential, commercial and condominium properties, he has been involved in the mutation/sub-division and development of land, and has represented clients with their respective applications for business licenses, work permits and residency certificates. He has provided advisory opinions to both local and international clients, and has experience in incorporating, structuring, reorganizing, and amalgamating corporations.
Jeffrey holds permanent residence status in both the Turks and Caicos and the United Kingdom. In his spare time, he enjoys traveling, participating in sporting events, and photography.
Having obtained her Undergraduate Degree in Law (LLB) in 2012 from Oxford Brookes University and her Postgraduate Diploma in Legal Practice in 2014 from the Oxford Institute of Legal Practice.
Since being called to the Bar in 2014, Jerwina has practiced mainly in the areas of Employment Law, Property Law, Family Law and Civil Litigation. She has both prior to and after her call, gained experience in employment conciliation as well as more contentious unfair dismissal matters lodged in the Labor Tribunal. She has represented local Banks in Court applications for the sale of foreclosed properties pursuant to s.72 of the Registered Land Ordinance, and has also had conduct of both contentious and non-contentious divorces. Jerwina has in addition, been actively involved in matters ranging from Judicial Review, Debt payment claims and Breach of Contract suits.
Aisha is a 2000 graduate of The University of Buckingham and is called to the Bar of England & Wales. Aisha works closely with other attorneys in the firm representing lending institutions and lenders and purchasers in land transactions. She also has vast experience in litigation and domestic matters and has worked on many high profile litigation cases.
Christian has over 20 years specialist experience advising on Turks and Caicos Islands Law. His practice areas include corporate and commercial law, with a particular emphasis on real estate and resort development, where he has acted for purchasers, vendors, developers and financial institutions.He also regularly advises high net worth individuals on a range of non-litigious private client matters.
Christian has lived in the Turks and Caicos Islands, of which he is a citizen, since 1994 and has in-depth knowledge of the local marketplace. Having obtained a law degree from the University of Ottawa in 1987, he was called to the Bar in Quebec (Canada) in 1988.
He then went on to complete a postgraduate diploma in business studies at the London School of Economics. Christian is admitted to the bar in the Turks and Caicos Islands and the British Virgin Islands and is also admitted as a Solicitor in England.
Christian served as the Warden of the Canadian High Commission in the Turks and Caicos Islands from 2003 to 2011, providing assistance to Canadian residents and visitors. Christian is fluent in English and French and has basic proficiency in Greek, German and Spanish.
Anthony D'Aniello formerly counsel of Global Legal Group (Turks & Caicos), an international law firm with associates in ten countries, specialising in wealth and asset protection. He has held several senior executive positions with both on shore and offshore banks and trust companies most notably with HSBC in Canada. Anthony was part of the Tax, Trust and Corporate Commercial practice group for the offshore law firm of Bishops to which he was of Counsel since 1994 until he joined Karam & Missick in 2015.
With more than 21 years of progressive responsibility, experience and tested expertise, Anthony is no stranger to all aspects of investment banking, asset management, fund raising, complex commercial structuring/transactions, loan syndications, private equity and hedge funds, international taxation, trust and intellectual property law. He has a proven track record in setting up and building trust companies and financial institutions from inception taking them through the planning, regulatory, implementation, and operational stages. Anthony has had extensive dealings with various governmental and regulatory bodies in several on shore and
Anthony has managed teams of professionals delivering a full range of asset management, personal trust and advisory services to high net worth individuals and corporations. He has focused on advising and representing high net worth international private clients and international businesses in the area of trust, tax and estate planning.
His key interest has always been in developing and maintaining client relationships with the view to providing added value and service for the customer. Anthony has written several articles and has been published in two separate Trust and Trustees-World Survey Issues and in IFC Review.
He has sat on several think tank committees and has reviewed and edited statutes and regulations for several offshore jurisdictions. He has been a guest speaker at several international trust and estate planning conferences in Canada, the USA, the Turks and Caicos Islands, Cayman, Panama, Mexico, Ecuador, Venezuela, Colombia, Switzerland and Dubai.
Anthony received a Juris Doctor in Laws from University of Detroit, a Bachelor of Laws from the University of Windsor, a Masters in Business Administration from Lake Superior State University, and a Bachelor of Arts Degree (with a Double Major in Political Science and Modern Languages) from McGill University. He is admitted to practice as a barrister and solicitor in Ontario, Canada (Member of the Law Society of Upper Canada) and Turks and Caicos Islands. He has also held the designation (T.E.P.) from the Society of Trust and Estate Practitioners since 1998.–
David is a senior London based silk with an established international reputation as a strategist, advocate and arbitrator in the field of Commercial Litigation and Dispute Resolution. He is admitted to the Turks and Caicos Islands Bar and has been associated with Karam and Missick since 2013. David is admitted to the Bar or is otherwise licensed to practise in England & Wales, Ireland, Turks and Caicos Islands, British Virgin Islands, Eastern Caribbean (Anguilla circuit), Trinidad & Tobago (pro hac), and Gibraltar (pro hac).
David's commercial practice encompasses all aspects of financial, business and regulatory work. He is also highly regarded in the fields of Sport, Professional Negligence, and EU Transport Regulation. Over recent years David has conducted extensive litigation in substantial constitutional, commercial and judicial review cases in the Turks and Caicos Islands. He appears regularly in the Supreme Court, in the Court of Appeal and in the Privy Council both on behalf of the Government of the Turks and Caicos Islands, and on behalf of private individuals and institutions. David has also conducted and has provided expert evidence in high profile litigation in other Caribbean territories including Anguilla, BVI, the Bahamas, and Trinidad & Tobago as well as in Bermuda, Ireland, Scotland, New York and Hong Kong.
David was appointed Queen's Counsel in 1997, and is a Fellow of the Chartered Institute of Arbitrators. He appears in arbitrations and sits as an arbitrator as a sole arbitrator, as a legal chairman, and as a party appointed arbitrator in a variety of commercial fields, where he has considerable experience of both institutional and ad hoc arbitrations. Most recently he conducted a 10 week arbitration originating in the Caribbean, but heard at the International Dispute Resolution Centre in London. David sits in England and Wales as a Deputy High Court Judge (Queen's Bench Division, and Chancery Division) and is a Recorder of the Crown Court, where he is authorised to sit in Civil, Mercantile, and Technology & Construction matters.
David wins plaudits for being a highly effective, no-fuss, easy to work with practitioner. He is rated as a Leader in his Fields in both the Legal 500 and Chambers Directories where not only has he been described as "disarmingly talented" but also as "a barrister who does not make a song and dance about things but who just gets them done". More recently Chambers commented that "his advocacy contains razor-sharp insight camouflaged by gossamer-soft presentation".
Real Estate and Development
We are experienced in providing service to commercial and private clients in a wide variety of real property transactions. We have acted in the sale and purchase raw land, condominiums, homes, and other substantial commercial properties. Our services include: Large resort development agreements and conveyancing, sale and purchase of land; Mortgages of land; Title opinions and quieting titles actions, Hotel Development, stratification of property.
Litigation We posses the knowledge and experience to help you or your business identify and manage potential risks, respond to existing or threatened litigation and pursue resolution both in and out of a courtroom. We help you analyze the costs and benefits of taking action and also explore various alternatives for resolving a disagreement. Our trial lawyers carefully weigh the potential impact of a lawsuit and develop practical litigation plans that include both trial and settlement strategies. Our lawyers develop solutions that enable you to get on with your life.
Immigration and Employment
We are well-versed in undertaking a variety of employment and immigration matters including applications for Belonger Status, work permits, permanent residence certificates and annual residency.
We specialize in immigration. Our team of attorneys is here to help you with any problems you may have about entering, or settling in, the Turks and Caicos or The Bahamas. Whether you want to enter the Turks and Caicos or The Bahamas to work, to set up your own business, to seek political asylum or to settle with a partner, the best advice is only a phone call away.
Please remember that TCI immigration law is very complex and it is essential that you seek legal advice from a specialist immigration lawyer in your particular case.
Company Incorporation and Administration Lex Corporate Services Ltd. (LCSL) is an affiliate company of Karam & Missick, which is licensed and regulated under the Company Management (Licensing) Ordinance, 1999 and Subsidiary Regulations of the Turks and Caicos Islands. With our highly qualified team, our basic aim is to efficiently provide residents and the offshore industry with a wide range of affordable corporate services including incorporation, preparation of Director and Shareholder minutes, annual maintenance, application for various licenses, registration of intellectual property, facilitation of the opening of bank accounts, and much more.
Business & Corporate In today's economy, we possess the strategic business, legal and industry savvy needed to provide practical counsel on business organization, operations, and in complex transactions. We strive to enable you to focus on your business while receiving quality advice and representation. From local entrepreneurs to large corporations, we provide a broad compass of services to businesses ranging from the preparation and review of contracts and leases, mergers and acquisitions, financing, executive compensation, litigation, and matters before governmental boards and agencies.
Personal Injury & Fatal Accidents Are litigation team has nearly 30 years of combined experience in personal injury and fatal accidents claims. We are vigorous advocates for victims in personal injury lawsuits and surviving family members in wrongful death lawsuits. Our team prepares itself to fight your case up to and including in court, but also understands that sometimes reaching a resolution in a timely manner is more in line with our goals. We seek accountability through financial compensation but also provide guidance through available options.
Divorce Amid the emotions of ending a marriage, we will help you stand your ground as issues are resolved. We will take the time to explain the litigation process step –by-step, are accessible to address your concerns, assist in making decisions and keep you updated. We listen and determine what's important to you, then devise strategies and pursue a course of action aligned with your needs and goals. We are also experienced in dealing with issues arising in domestic matters between non married couples.
Local or International... let Karam & Missick help set-up your business.
Lex Corporate Services Ltd. (LCSL) is an affiliate company of Karam & Missick licensed and regulated under the Company Management (licensing) Ordinance, 1999 and Subsidiary Regulations of the Turks and Caicos Islands. We cater to both the local community and offshore clients and our basic aim is to provide both residents and the offshore industry with a wide range of corporate needs. We provide fast, efficient and reasonably priced service to our clients.
Proposed company names can be confirmed within hours and companies can usually be formed within 48 business hours of returning a completed company application form together with all of the necessary supporting documents.
Such incorporations would include the preparation of Memorandum and Articles of Association for the company using documents approved by the company's attorneys-at-law, registering and filing the same with the Registrar of Companies and obtaining the corporate seal.
In addition to offering incorporations we provide a host of additional corporate serviced based on the requests and needs of our clients. These services include the following:
Keep up on all of the latest news, information & events with our blog.View All
Karam and Missick Bahamas pdf Announcement 090315
Another Turks and Caicos Islander has joined the ranks of the local legal profession. On Monday, 22 December 2014, Miss Jerwina Taylor was admitted to the Bar of Turks and Caicos Islands by way of a Hearing, which took place at the Supreme Court on Leeward Highway, Providenciales. Jerwina's call was presided over by Her… Read More
Does a purchaser have any redress against a seller who pulls out of a land sale? What happens if you put an offer down on a house, had a survey carried out and arranged a mortgage, only to have the seller pull out leaving you with lots of wasted expenses? This is known as… Read More


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Is Philippine National Bank ATM incorrect or missing key business information? Update your Hotfrog listing today.
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Hotfrog Philippines provides information regarding Philippine National Bank ATM in La Trinidad Benguet. Philippine National Bank ATM is located at La Trinidad Road, La Trinidad Benguet 2601 and provides Financial services. Contact them on (074) 422 1135.
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Distances are calculated in a straight line and may not reflect actual travel distance.
Call us between our extended opening hours of 6 - 9PM Monday to Thursday to arrange an appointment.
A well proportioned three bedroom apartment in this sought after secure development with underground parking, gym and 24hr concierge.
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Doctors at St George's Hospital Medical School and the Chelsea and Westminster Hospital in London have applied for ethical approval to begin the drugs trial which they expect to start at the end of next month.
Professor Angus Dalgleish, an Aids researcher at St George's, said he had been applying to start a trial of thalidomide as an anti-Aids drug for 'the best part of a year'.
He said 40 patients had volunteered, the drug had been bought from a company in Brazil and the EC had agreed to fund the study. 'We're just waiting for final ethical approval,' he said.
'We're hoping to start as soon as possible, possibly the end of August. I think it should be OK because we've had our submission before (the ethical panel) several times now.'
Thalidomide, which was initially sold as a sedative and is now used to treat leprosy, is believed to 'damp down' a part of the immune system that Professor Dalgleish believes is responsible for helping to bring on Aids in people infected with HIV.
Researchers at the Rockefeller University in New York reported earlier this year that they believed thalidomide could alleviate the symptoms of Aids and slow or even halt its progress.
Professor Dalgleish believes that HIV causes the body's immune system to attack its own cells, similar to other so-called 'auto-immune' diseases. However, many other scientists disagree, which has frustrated Professor Dalgleish's attempts to begin a trial of thalidomide in the UK, he said.
Another problem has been the terrible notoriety of the drug itself. 'No drug company wants to have its name associated with it. We've had to buy it from a company in Brazil that is making it for leprosy treatment.'
He said the ethical protocol of the drugs trial made it 'absolutely mandatory' for all 40 volunteers to be men because of the risk of birth defects in women.
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Variability and homogeneity of cardiovascular magnetic resonance myocardial T2-mapping in volunteers compared to patients with edema
© Wassmuth et al.; licensee BioMed Central Ltd. 2013
Received: 26 November 2012
Accepted: 8 March 2013
Published: 27 March 2013
The aim of the study was to test the reproducibility and variability of myocardial T2 mapping in relation to sequence type and spatial orientation in a large group of healthy volunteers. For control T2 mapping was also applied in patients with true edema. Cardiovascular magnetic resonance (CMR) T2-mapping has potential for the detection and quantification of myocardial edema. Clinical experience is limited so far. The variability and potential pitfalls in broad application are unknown.
Healthy volunteers (n = 73, 35 ± 13 years) and patients with edema (n = 28, 55 ± 17 years) underwent CMR at 1.5 T. Steady state free precession (SSFP) cine loops and T2-weighted spin echo images were obtained. In patients, additionally late gadolinium enhancement images were acquired. We obtained T2 maps in midventricular short axis (SAX) and four-chamber view (4CV) based on images with T2 preparation times of 0, 24, 55 ms and compared fast low angle shot (FLASH) and SSFP readout. 10 volunteers were scanned twice on separate days. Two observers analysed segmental and global T2 per slice.
In volunteers global myocardial T2 systematically differed depending on image orientation and sequence (FLASH 52 ± 5 vs. SSFP 55 ± 5 ms in SAX and 57 ± 6 vs. 59 ± 6 ms in 4CV; p < 0.0001 for both). Anteroseptal and apical segments had higher T2 than inferior and basal segments (SAX: 59 ± 6 vs. 48 ± 5 ms for FLASH and 59 ± 7 vs. 52 ± 4 ms for SSFP; p < 0.0001 for both). 14 volunteers had segments with T2 ≥ 70 ms. Mean intraobserver variability was 1.07 ± 1.03 ms (r = 0.94); interobserver variability was 1.6 ± 1.5 ms (r = 0.87). The coefficient of variation for repeated scans was 7.6% for SAX and 6.6% for 4CV. Mapping revealed focally increased T2 (73 ± 9 vs. 51 ± 3 ms in remote myocardium; p < 0.0001) in all patients with edema.
Myocardial T2 mapping is technically feasible and highly reproducible. It can detect focal edema und differentiate it from normal myocardium. Increased T2 was found in some volunteers most likely due to partial volume and residual motion.
In acute myocardial infarction or inflammation T2-weighted cardiovascular magnetic resonance (CMR) can detect myocardial edema in vivo [1–4]. Increased myocardial water content changes magnetic relaxation properties that influence the CMR signal [5, 6]. This can be clinically helpful to differentiate acute from chronic myocardial lesions [7, 8] and to detect even small acute myocardial damage very early [9, 10]. T2-weighted short tau triple inversion recovery fast spin echo (STIR) can result in pronounced contrast between bright edema and hypointense normal myocardium [11]. However, T2-weighted imaging may suffer from signal loss in higher heart rates and arrhythmias as well as imperfect blood suppression in areas of slow blood flow hampering delineation of edema [12–14]. Therefore alternatives for more stable detection of edema and easier quantification are clinically warranted [15].
CMR T2-mapping is a promising tool for characterizing myocardial edema [16–19]. While initial reports focused on the depiction of focal lesions the aim of this study was to assess the variability of myocardial T2 relaxation times in volunteers and patients and the influence of sequence type, spatial orientation and spatial resolution.
The local ethical committee approved the study. All participants were enrolled after informed consent was obtained.
The study complies with the declaration of Helsinki. The ethical committee of Charite Medical University approved the study on January 27th, 2011. The application number was EA1/276/10.
We scanned 73 healthy volunteers (13 female, 20–70 years, mean 35 ± 13 years, median 30 years, BMI 23 ± 3 kg/m2) without any cardiovascular disease, no symptoms of inflammation and a normal electrocardiogram. All participants were seen by a cardiologist. We discouraged alcohol intake one day before the scan to avoid inflammatory reaction [20]. Ten volunteers were scanned twice (time delay 469 ± 219 days, median 381 days) to assess interstudy variability.
We investigated a group of consecutive patients (n = 28; 8 females, age 55 ± 17 years, range 20–81 years) with acute myocardial damage. Edema was defined as a regional area of hyperintense signal on T2-weighted fast spin echo images corresponding to evidence of focal myocardial damage like wall motion abnormality or late gadolinium enhancement (LGE). The group comprises 20 patients with acute myocardial infarction (imaging 3 ± 1 days after admission), 5 patients with acute myocarditis (four male, median age 22 years, positive troponin and typical LGE lesions in all of them, CMR on 1 ± 1 day after admission), 2 postmenopausal female patients with Takotsubo cardiomyopathy (typical presentation and history, no scar, but transient apical ballooning) and 1 patient with cardiac sarcoidosis (acute admission with positive troponin, focal edema corresponding to typical LGE lesion).
Using a 1.5 T scanner (Magnetom Avanto, Siemens Erlangen, Germany, software version B17) with a 12-channel chest coil we obtained steady state free precession (SSFP) cine loops (repetition time 2.8 ms, echo time 1.2 ms, slice thickness 8 mm, flip angle 80 degrees, in-plane resolution 1.8 mm/pixel) during breathhold in three long and at least one midventricular short axis matching the slice position for mapping. T2-weighted STIR images (repetition time = 2 RR-intervals, echo time 58 ms, slice thickness 8 mm, in-plane resolution 1.3 × 1.3 mm/pixel, imaging in mid-diastole) were obtained in the same short axis as cine and additionally in long axis, if a focal abnormality was seen. In patients we additionally acquired fast low angle shot (FLASH) inversion recovery gradient echo LGE images in short and long axes (slice thickness 8 mm, in-plane resolution 1.8 × 1.4 mm/pixel) after 0.2 mmol/kg Gadolinium-DTPA.
We scanned a spherical phantom of 20 cm diameter filled with manganese chloride doped distilled water. The RR-interval was simulated to be 1000 ms. A 2D multi contrast spin echo sequence (repetition time = 2000 ms, 32 echo times equally spaced from 7 ms to 224 ms) in conjunction with a mono-exponential three-parameter-fit served as T2 reference measurement [21]. We additionally obtained measurements using the FLASH and SSFP sequences with identical parameters as used for imaging volunteers and patients.
Data analysis
For signal analysis we used Osirix (version 3.9.1 http://www.osirix-viewer.com) and QMASS (version 7, Medis, Leiden, The Netherlands) in all subjects. The endocardial and epicardial contours were manually drawn on the last corresponding T2-weighted raw image with the echo time of 55 ms. The myocardium was then segmented (manually in Osirix, automatically in QMass) into 6 segments according to the AHA segmentation scheme [22]. Contours were copied to the map, corrected when necessary and global and segmental T2-values were recorded. Two independent observers analysed all the volunteer data. Both do have considerable experience in CMR image analysis (> 15 years and > 3 years, respectively) and put much effort in avoiding inclusion of blood or fat while drawing regions of interest. Interstudy reproducibility was measured for SAX and 4CV. The coefficient of variation (CoV) was calculated as the ratio of the standard deviation of the interscan difference divided by the mean of the measurement. Anteroseptal enddiastolic myocardial wall thickness was measured on short axis and four-chamber-view cine frames and compared to T2-times in the same segment. To assess residual diastolic wall motion M-mode-like myocardial signal intensity projections over time were generated from 2D SSFP short axis and four-chamber-view cine images in selected patients using an in-house developed implementation in Matlab 7.1 (The Mathworks, Natick, MA).
The same investigator analyzed all SSFP volunteer maps twice. In patients areas of focal abnormality matching hyperintense signal in STIR and LGE were selected and compared to remote myocardium. We excluded hypointense infarction cores indicating microvascular obstruction [17].
Data are given as mean ± standard deviation unless indicated otherwise. We compared results from different sequences and orientations and repeated scans with paired student´s t-test and Pearson correlation coefficient r. P-values < 0.05 were considered significant. 95% confidence intervals (CI) were calculated. Bland-Altman-plots were obtained to analyse intra- and interobserver variability. Volunteer and patient data were compared using 95% tolerance intervals with 90% coverage. These tolerance intervals cover 90% of all observations of a normal distribution with 95% confidence when the mean and the standard deviation are known. Influencing factors were identified by sequence using the candidates age, gender, heart rate, body surface area, body mass index and the interaction terms in an analysis of variance with forward selection (criterion for selection p < 5%). We compared the data on healthy volunteers and patients using a mixed linear model with compound symmetry as working correlation matrix to account for the multiple measurements of up to four sequences by subject. Gender and age (35 years or younger, more than 35 years) were included as covariates. We performed a multivariate analysis including wall thickness, diastolic motion and a combination thereof to assess the impact on myocardial T2.
Four volunteers were excluded from analysis due to pathological findings (pleural effusions, tachycardic atrial fibrillation and left ventricular hypertrophy). The remaining 69 formed the healthy study group.
Global T2 measurements in volunteers
Global myocardial T2 relaxation times (ms) in volunteers
52 ± 5
55 ± 5
p < 0.0001
57 ± 6
59 ± 6
p < 0.0001
p < 0.0001
p < 0.0001
Segmental T2 measurements in volunteers
With both sequences anteroseptal segments had higher T2-values than inferior segments in SAX (59 ± 6 vs. 48 ± 5 ms for FLASH and 59 ± 7 vs. 52 ± 4 ms for SSFP; p < 0.0001 for both, Figure 3). In 4CV the apical septal segment had higher T2 than the basal lateral segment for both FLASH (61 ± 8 vs. 55 ± 6 ms; p < 0.0001) and SSFP (64 ± 9 vs. 55 ± 6 ms; p < 0.0001; Figure 3). In SAX the mean absolute difference between a single segment and the whole slice was 4 ± 1 ms and 3 ± 2 ms for FLASH and SSFP, respectively. In 4CV the mean absolute difference between a single segment and a global measurement was 5 ± 2 ms for both, FLASH and SSFP.
Variability in volunteers
Outliers among volunteers
Measurements in patients
T2-mapping is technically feasible with low intra-, interobserver and inter-scan variability and does not depend on heart rate. Overall our mapping results with mean T2 around 55 ms for normal myocardium match previous experiences [6, 16, 23–27].
As far as T2 mapping in patients with acute myocardial damage is concerned we can confirm earlier small patient studies [17, 19]. In patients with acute myocardial infarction or inflammation T2-mapping detects focal edema and reveals increased myocardial T2-values with small variability. Our results for remote myocardium nicely match those for our elderly male volunteers.
Therefore it appears straightforward to characterize a clearly delineated pathologic lesion in clinical routine. However, it might be more challenging to exclude any lesion in a subject with no or mild disease.
Our systematic analysis in a large group of volunteers revealed, that SSFP-based T2-mapping resulted in slightly higher values than FLASH. In early phantom studies as well as our own experiment (Figure 2) mapping with FLASH showed good agreement with "true" T2 values [28]. Therefore SSFP tends to overestimate true T2 as demonstrated before [16, 27]. On the other hand SSFP-based mapping offers more signal to noise [27] and suffers less from image artefacts than FLASH due to centric readout of FLASH-based mapping [16].
Partial volume and motion effects most likely explain higher global T2 in 4CV than in SAX as well as spatial inhomogeneity with higher T2 in anterior and anteroseptal segments. Wall thickness (i.e. thin walls) and residual diastolic motion were related to higher myocardial T2. Close observation of cine loops and analysis with m-mode-like projection confirm diastolic wall motion in particular in young volunteers with thin walls [29]. The low intra- and interobserver variability indicates that these outliers are not simply a problem of suboptimal contouring.
Inclusion of even small amounts of neighbouring entities like blood (T2 of about 200 ms) and pericardial fat (T2 of about 80 ms) can grossly influence the measurement of myocardial T2. Improving spatial resolution should minimize partial-volume effect, however this also prolongs the acquisition window increasing motion artefacts. We found T2-values of up to 80 ms even in our volunteer group, where as the T2 for edema associated with acute infarction has been reported to be 69 ± 6 ms [17]. Therefore care has to be taken not to generate false-positive findings of edema in subjects with thin and highly mobile walls. In patients with true edema this is less a problem due to increased wall thickness in the presence of edema [30].
For the future imaging at individually optimized time points within the cardiac cycle should be considered if cine imaging indicates abundant myocardial motion even in mid-diastole. Depending on individual wall motion across the cardiac cycle in cine loops systole or early diastole may be chosen. However, previous T1 mapping experiments in volunteers indicate that results might slightly differ between systole and diastole [31].
We enrolled patients with focal lesions only. Theoretically mapping offers the potential to quantify diffuse tissue damage that is less obvious on conventional CMR images. Future studies including patients with known diffuse disease might enlighten this phenomenon. We included two cases of typical Takotsubo cardiomyopathy and one case of sarcoidosis with typical late Gadolinium enhancement corresponding to focal edema. Edema has been previously described in both entities including a large multicentre study for Takotsubo cardiomyopathy [32–35].
The power calculation took into account the differentiation of patients and volunteers as a whole group. The study and its sample size were not designed to reveal subtle differences among e.g. women of different decades of age. There is no dedicated gold standard for true edema. We assumed edema in myocardial areas where it made sense clinically based on concomitant late gadolinium enhancement or obvious wall motion abnormalities in patients with evidence of acute myocardial damage in laboratory results and electrocardiogram.
Myocardial T2 mapping is technically feasible and highly reproducible in a large number of normal volunteers. Differences in sequences and spatial resolution result in small differences in myocardial T2 values. Quantifying T2 easily detects focal myocardial edema and differentiates it from remote myocardium. T2 mapping may offer a more stable and truly quantitative alternative for edema detection in cases when conventional T2-weighted imaging fails. Mapping in thin and rapidly moving myocardial walls can result in overestimation of myocardial T2 and must not be confused with true edema.
Cardiovascular magnetic resonance
Short tau triple inversion recovery
Steady state free precession
Fast low angle shot
Short axis
Four-chamber view
Confidence interval
Late gadolinium enhancement
We cordially thank all participating volunteers for their generous commitment. We gratefully acknowledge statistical support by Carsten Schwenke (scossis.com), technical advice by Saurabh Shah and the technical expertise of Denise Kleindienst, Kerstin Kretschel and Evi Polzin.
Authors' Affiliations
- Abdel-Aty H, Boye P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D, Bock P, Dietz R, Friedrich MG, Schulz-Menger J: Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J Am Coll Cardiol. 2005, 45: 1815-1822. 10.1016/j.jacc.2004.11.069.View ArticlePubMedGoogle Scholar
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- Friedrich MG, Kim HW, Kim RJ: T2-weighted imaging to assess post-infarct myocardium at risk. JACC Cardiovasc Imaging. 2011, 4: 1014-1021. 10.1016/j.jcmg.2011.07.005.PubMed CentralView ArticlePubMedGoogle Scholar
- Lurz P, Eitel I, Adam J, Steiner J, Grothoff M, Desch S, Fuernau G, de Waha S, Sareban M, Luecke C: Diagnostic performance of CMR imaging compared with EMB in patients with suspected myocarditis. JACC Cardiovas Imaging. 2012, 5: 513-524. 10.1016/j.jcmg.2011.11.022.View ArticleGoogle Scholar
- Scholz TD, Martins JB, Skorton DJ: NMR relaxation times in acute myocardial infarction: relative influence of changes in tissue water and fat content. Magn Reson Med. 1992, 23: 89-95. 10.1002/mrm.1910230110.View ArticlePubMedGoogle Scholar
- Boxt LM, Hsu D, Katz J, Detweiler P, McLaughlin S, Kolb TJ, Spotnitz HM: Estimation of myocardial water content using transverse relaxation time from dual spin-echo magnetic resonance imaging. Magn Reson Imaging. 1993, 11: 375-383. 10.1016/0730-725X(93)90070-T.View ArticlePubMedGoogle Scholar
- Abdel-Aty H, Zagrosek A, Schulz-Menger J, Taylor AJ, Messroghli D, Kumar A, Gross M, Dietz R, Friedrich MG: Delayed enhancement and T2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction. Circulation. 2004, 109: 2411-2416. 10.1161/01.CIR.0000127428.10985.C6.View ArticlePubMedGoogle Scholar
- OhIci D, Ridgway JP, Kuehne T, Berger F, Plein S, Sivananthan M, Messroghli DR: Cardiovascular magnetic resonance of myocardial edema using a short inversion time inversion recovery (STIR) black-blood technique: diagnostic accuracy of visual and semi-quantitative assessment. J Cardiovasc Magn Reson. 2012, 14: 22-10.1186/1532-429X-14-22.View ArticleGoogle Scholar
- Abdel-Aty H, Cocker M, Meek C, Tyberg JV, Friedrich MG: Edema as a very early marker for acute myocardial ischemia: a cardiovascular magnetic resonance study. J Am Coll Cardiol. 2009, 53: 1194-1201. 10.1016/j.jacc.2008.10.065.View ArticlePubMedGoogle Scholar
- Cury RC, Shash K, Nagurney JT, Rosito G, Shapiro MD, Nomura CH, Abbara S, Bamberg F, Ferencik M, Schmidt EJ: Cardiac magnetic resonance with T2-weighted imaging improves detection of patients with acute coronary syndrome in the emergency department. Circulation. 2008, 118: 837-844. 10.1161/CIRCULATIONAHA.107.740597.View ArticlePubMedGoogle Scholar
- Abdel-Aty H, Simonetti O, Friedrich MG: T2-weighted cardiovascular magnetic resonance imaging. J Magn Reson Imaging. 2007, 26: 452-459. 10.1002/jmri.21028.View ArticlePubMedGoogle Scholar
- Kellman P, Aletras AH, Mancini C, McVeigh ER, Arai AE: T2-prepared SSFP improves diagnostic confidence in edema imaging in acute myocardial infarction compared to turbo spin echo. Magn Reson Med. 2007, 57: 891-897. 10.1002/mrm.21215.PubMed CentralView ArticlePubMedGoogle Scholar
- Walls MC, Verhaert D, Min JK, Raman SV: Myocardial edema imaging in acute coronary syndromes. J Magn Reson Imaging. 2011, 34: 1243-1250. 10.1002/jmri.22737.PubMed CentralView ArticlePubMedGoogle Scholar
- Wince WB, Kim RJ: Molecular imaging: T2-weighted CMR of the area at risk–a risky business?. Nat Rev Cardiol. 2010, 7: 547-549. 10.1038/nrcardio.2010.124.View ArticlePubMedGoogle Scholar
- Ferreira VM, Piechnik SK, Dall'Armellina E, Karamitsos TD, Francis JM, Choudhury RP, Friedrich MG, Robson MD, Neubauer S: Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012, 14: 42-10.1186/1532-429X-14-42.PubMed CentralView ArticlePubMedGoogle Scholar
- Giri S, Chung YC, Merchant A, Mihai G, Rajagopalan S, Raman SV, Simonetti OP: T2 quantification for improved detection of myocardial edema. J Cardiovasc Magn Reson. 2009, 11: 56-10.1186/1532-429X-11-56.PubMed CentralView ArticlePubMedGoogle Scholar
- Verhaert D, Thavendiranathan P, Giri S, Mihai G, Rajagopalan S, Simonetti OP, Raman SV: Direct T2 quantification of myocardial edema in acute ischemic injury. JACC Cardiovasc Imaging. 2011, 4: 269-278. 10.1016/j.jcmg.2010.09.023.PubMed CentralView ArticlePubMedGoogle Scholar
- Ugander M, Bagi PS, Oki AJ, Chen B, Hsu LY, Aletras AH, Shah S, Greiser A, Kellman P, Arai AE: Myocardial edema as detected by Pre-contrast T1 and T2 CMR delineates area at risk associated with acute myocardial infarction. JACC Cardiovasc Imaging. 2012, 5: 596-603. 10.1016/j.jcmg.2012.01.016.PubMed CentralView ArticlePubMedGoogle Scholar
- Thavendiranathan P, Walls M, Giri S, Verhaert D, Rajagopalan S, Moore S, Simonetti OP, Raman SV: Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping. Circ Cardiovasc Imaging. 2012, 5: 102-110. 10.1161/CIRCIMAGING.111.967836.PubMed CentralView ArticlePubMedGoogle Scholar
- Zagrosek A, Messroghli D, Schulz O, Dietz R, Schulz-Menger J: Effect of binge drinking on the heart as assessed by cardiac magnetic resonance imaging. JAMA. 2010, 304: 1328-1330.View ArticlePubMedGoogle Scholar
- Poon CS, Henkelman RM: Practical T2 quantitation for clinical applications. J Magn Reson Imaging. 1992, 2: 541-553. 10.1002/jmri.1880020512.View ArticlePubMedGoogle Scholar
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- Huang TY, Liu YJ, Stemmer A, Poncelet BP: T2 measurement of the human myocardium using a T2-prepared transient-state TrueFISP sequence. Magn Reson Med. 2007, 57: 960-966. 10.1002/mrm.21208.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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Zend Prepares for PHP 7 With Tailored Products, Services
At ZendCon 2015, Zend Technologies announced a suite of products and services to prepare developers for PHP 7.Zend Technologies announced a suite of products and services to empower companies and developers to harness the power of the soon-to-be released PHP 7. PHP 7, which was expected to be released this month, according to its timeline, will be the latest version of the PHP programming language and includes features that improve performance, speeding up PHP applications by between 25 percent and 70 percent, among other enhancements and refinements. The open source developers at Zend have taken a leading role in developing PHP 7, and developers are poised to reap the optimized performance and efficiency benefits. Zend made its announcement at ZendCon 2015, the company's annual PHP conference, in Las Vegas. Zend is launching a suite of products specifically crafted to take advantage of the benefits of PHP 7. Zend Server, Zend Studio, and the Zend Professional Services offerings are available for companies that are migrating from PHP 5.4 and earlier, or that are building new applications to capture the power of PHP 7.
"Our team has been working incredibly hard to make PHP 7 satisfy industry expectations of performance and functionality," said Andi Gutmans, co-founder of Zend, in a statement. "This is the 'year of PHP' and we are enjoying a PHP renaissance. The entire PHP ecosystem is evolving so quickly, and the differences between PHP 5.6 and 7.0 are simply staggering. Zend engineers have achieved performance gains ranging from 25 percent to 70 percent on real-world apps -- and all from simply upgrading PHP, without having to change a single line of code."
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Welcome to my little web site, Simply Fan. Now, It's a place where I keep the fanlistings that I joined.
Here a little explanation about Fanlistings : they are sites where the goal is to rejoin fans together about a particular subject. So, here the list!
Select the listing category you want to see below. The list only shows categories with listings listed under them.


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Should you buy these stocks too?
What would it take to make you feel wealthy?
Join the NASDAQ Community today and get free, instant access to portfolios, stock ratings, real-time alerts, and more!
Street research for Erickson Air-Crane, which provides aerial
firefighting and timber harvesting service on heavy-lift
helicopters, is expected to be released on 5/21/12. On 4/10/12,
the company raised $38.4 million by offering 4,800,000 shares at
$8.00, the low end of the range of $8.00 to $9.00. Stifel
Nicolaus Weisel, Oppenheimer and Lazard acted as joint
bookrunners on the deal.
The views and opinions expressed herein are the views and opinions of the author and do not necessarily reflect those of Nasdaq, Inc.
Enter up to 25 symbols separated by commas or spaces in the text box below. These symbols will be available during your session for use on applicable pages.
You have selected to change your default setting for the Quote Search. This will now be your default target page;
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Grave to my lovely Father,
Its a design for grave to my lovely Father that constructed in Norway - Trondheim.
I tried to make an indication of the soul by the openness in the center; that return to the sky. And the name of my lovely father that shaped by Arabic calligraphy in the half-moon (Crescent) inside of the monument. The wings that shaped the monument from the outside gives an indication for the goodness that my lovely father have it. And the main idea that I tried to use in this monument is the openness and simplicity.
The grave constructed by red & black granite, and the Islamic ornamentation that shaped by water-jet technique.
All what I tried to do is to giving a small thing back to my big Hero and my best friend (My lovely Father).
3D navigate: http://sketchfab.com/nlhgfeca


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All Topics
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Infectious Diseases
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Track topics on Twitter Track topics that are important to you
This is an investigator-initiated study. The primary goal is to evaluate the efficacy of two different cervical disc devices (prosthesis vs rigid spacer) with respect to postoperative change in neck disability index. The evaluation will include clinical and radiological parameters.
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Intervertebral Disc Displacement
Anterior cervical discectomy with prosthetic disc replacement / ESP., Anterior cervical discectomy with prosthetic disc replacement / Squale.
Uniklinikum Dresden
Technische Universität Dresden
Published on BioPortfolio: 2016-10-19T02:38:21-0400
Comparison of Software-assisted Implantation of Elastic Spine Pad (TM) With Respect to Postoperative Change in Neck Disability Index (NDI) With the Conventional Disc Prosthesis Rotaio (TM) After Anterior Cervical Discectomy for Cervical Disc Prolapse
This is an investigator-initiated study. The primary goal is to evaluate the efficacy of two different cervical disc prosthetic devices with respect to postoperative change in neck disabil...
Advent™ Cervical Disc Versus Anterior Cervical Discectomy and Fusion(ACDF) for Treatment of One Level Degenerative Disc Disease (IDE Study)
The purpose of this study is to establish the safety and effectiveness of the Advent™ Cervical Disc compared to Anterior Cervical Discectomy and Fusion (ACDF) in treating degenerative di...
Safety and Efficacy Study of NeoFuse in Subjects Undergoing Multi-Level Anterior Cervical Discectomy and Fusion
The purpose of this study is to evaluate the safety and preliminary efficacy of NeoFuse in subjects with a diagnosis of degenerative disc disease (DDD) at 2 or more adjacent cervical verte...
Cervical Spine; Movement Before and After Anterior Cervical Discectomy, With or Without a Cervical Disc Prosthesis
The purpose of this study is to find out if use of a cervical disc prosthesis in the treatment of a cervical disc herniation preserves or restores normal mobility and movement in the cervi...
Investigation of the Simplify™ Cervical Artificial Disc
This study is intended to demonstrate that the Simplify™ Disc is at least as safe and effective as conventional anterior cervical discectomy and fusion (ACDF) when used to treat one leve...
345 Elective Anterior Cervical Discectomy and Fusion vs Cervical Artificial Disc Replacement: A Comparison of Perioperative Morbidity and Early Outcomes.
We conducted a retrospective cohort analysis of early outcomes after elective anterior cervical discectomy and fusion (ACDF) vs cervical artificial disc replacement (C-ADR) using the National Surgical...
Anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for two contiguous levels cervical disc degenerative disease: a meta-analysis of randomized controlled trials.
Anterior cervical discectomy and fusion (ACDF) has been considered as a gold standard for symptomatic cervical disc degeneration (CDD), which may result in progressive degeneration of the adjacent seg...
3-Tesla Kinematic MRI of the Cervical Spine for Evaluation of Adjacent Level Disease After Monosegmental Anterior Cervical Discectomy and Arthroplasty: Results of 2-Year Follow-Up.
We prospectively evaluated adjacent disc levels after anterior cervical discectomy and arthroplasty (ACDA) using kinematic magnetic resonance imaging (MRI) and plain functional radiographs.
159 Neurological Outcomes of Two-Level Total Disk Replacement Versus Anterior Discectomy and Fusion: 7-Year Results From a Prospective, Randomized, Multicenter Trial.
Studies suggest significant biomechanical and clinical differences exist between total disk replacement (TDR) and anterior cervical discectomy and fusion (ACDF) patients treated at multiple cervical l...
Clinical Outcomes of Outpatient Cervical Total Disc Replacement compared to Outpatient Anterior Cervical Discectomy and Fusion.
A single-center, retrospective study.
Anterior Wall Myocardial Infarction
MYOCARDIAL INFARCTION in which the anterior wall of the heart is involved. Anterior wall myocardial infarction is often caused by occlusion of the left anterior descending coronary artery. It can be categorized as anteroseptal or anterolateral wall myocardial infarction.
Uveitis, Anterior
Inflammation of the anterior uvea comprising the iris, angle structures, and the ciliary body. Manifestations of this disorder include ciliary injection, exudation into the anterior chamber, iris changes, and adhesions between the iris and lens (posterior synechiae). Intraocular pressure may be increased or reduced.
Anterior Capsular Rupture, Ocular
A breach in the continuity of the ANTERIOR CHAMBER of the eyeball.
Infarction, Anterior Cerebral Artery
NECROSIS occurring in the ANTERIOR CEREBRAL ARTERY system, including branches such as Heubner's artery. These arteries supply blood to the medial and superior parts of the CEREBRAL HEMISPHERE, Infarction in the anterior cerebral artery usually results in sensory and motor impairment in the lower body.
Substantia Innominata
Tissue in the base of the forebrain inferior to the anterior perforated substance, and anterior to the GLOBUS PALLIDUS and ansa lenticularis. It contains the BASAL NUCLEUS OF MEYNERT.
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Arthroplasty is a surgical procedure to restore the integrity and function of a joint. A joint can be restored by resurfacing the bones. An artificial joint (called a prosthesis) may also be used. Various types of arthritis may affect the joints. Osteo...
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Children's Place is offering a 15% off printable coupon (click banner above) valid until November 16, 2009. This is just in time as we have assessed our closets and realize the kids need a few more fall/winter items!
When you shop The Children's Place, be sure to use Ebates as you will receive 3% back! If you are new to Ebates, you can read my past posts on how you can earn money back on your online purchases! Plus, you get a $5 bonus just for signing up!


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Statement of Values and Purpose:
Janesco, Inc. is a Family owned business which is driven to market and workplace excellence, while guided by our Christian morals and our family values of fairness and respect.
Our mission is to achieve growth oriented manufacturing companies by matching customer requirements with technology, innovation, quality and service. By sustaining this match, we can create an environment of stable stakeholder relations where there is personal and financial growth for all.
By using the word "stakeholder" in our mission, we are not only including ourselves as a family, but are including our extended family of customers, employees, suppliers and community as those who have a meaningful stake in the success of our company.


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Marvel, Sony cast new Spider-Man for next film in 2017
Sony Pictures announced Tuesday that "The Impossible" star Tom Holland would be taking over the role of Peter Parker.
Sony Pictures announced Tuesday that "The Impossible" star Tom Holland would be taking over the role of Peter Parker.
Dick Van Patten died Tuesday in Santa Monica, California, of complications from diabetes, according to his publicist, Daniel Bernstein.
Concertgoers were ejected mostly for fighting, harassment and extreme intoxication.
Facebook is now bigger than Wal-Mart, at least when it comes to its value on the stock market.
A landspout appeared Monday night between Cimarron, Kansas and Dodge City. KSN viewers sent these photos.
The British singer got the last laugh after calling out his friend during a concert Friday in Oslo, Norway.
A plane registered to Oscar-winning "Titanic" composer James Horner has crashed in Southern California.
Diddy, 45, was arrested at UCLA's Acosta Athletic Training Complex on suspicion of assault with a deadly weapon.
New "Nightly News" anchor Lester Holt says he doesn't believe the broadcast needs to take special steps to rebuild trust among viewers.
Critics have lashed out at the video package and how "Meet the Press" host Chuck Todd has handled the situation.
Bill Cosby's lawyers have asked a federal judge to throw out a defamation lawsuit filed by three women.
A public memorial is planned for a longtime Oklahoma sportscaster who was killed in an automobile accident.
Apple announced Sunday that it will pay royalties to artists and record labels during a trial of its new streaming service.
Gunther Schuller died Sunday at age 89.
Hundreds of thousands of devotees now also flock to the psychedelic Electric Daisy Carnival rave.


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Found links to Lau Ching Wan profile, fansite, biography, photos or trailers? Your participation is appreciated.
Qie Ting Feng Yun
as Johnny
Year: 2009
Sun Taam
as Inspector Chan Kwai Bun (as Lau Ching Wan)
Year: 2007
Sip Si 32 Doe
as Long Shek
Year: 1996
Ging Chaat Goo Si Juk Jaap
as CID Man
Year: 1988
©2010 asiacue.com — Contact us — Privacy policy


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Invaluable cannot guarantee the accuracy of translations through Google Translate and disclaims any responsibility for inaccurate translations.
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Lot 3: Late Victorian Macintyre two-handled vase with
Specialist Collector's
by Reeman Dansie
March 12, 2012
Colchester, United Kingdom
Looking for the realized and estimated price?
Description: Late Victorian Macintyre two-handled vase with blue floral decoration - printed marks to base, 17cm
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So many people engaged in this discussion started by Matthew Holt, that I felt obliged to say something and make it sound important.
My favorite follow up is by Bob Coffield of Health Care Law Blog. Bob gets to the heart of the matter by teasing out the real issues that must be addressed, for EMRs to be really adopted by physicians en masse.
Quite a few of the comments on Matthew's blog, summarized by The Healthcare Guy, reek of frustration. Everyone offers reasons on why something cannot be done. But I would rather follow the advice of HHS Secretary Mark Leavitt, as quoted by Newt:
Anyone who claims to have the American people's best interests in mind when tackling Medicaid reform should embrace this philosophy: the key to progress is saying "Yes, if…," not "No, because…"
With this "YES IF" mindset, let me answer Bob's questions:
1) Do EMRs and technology allow doctors to provide better care?
YES, IF doctors commit to changing their practice patterns. No one would get any benefit from "paving a cowpath"
2) Will EMRs allow for the growth and potential benefit of evidence based medicine?
YES, IF the products are designed to do so and are easy enough to use by doctors and consumers. Evidence guidelines must be trusted.
3) Do EMRs impact patient safety?
YES, IF the EMR systems are flexible enough, not used to lock in bad processes and are kept current with data. Garbage in, garbage out.
4) Do EMRs streamline health care and make providing it more efficient?
YES, IF they are designed for ease of use and promote collaboration across the entire health care delivery chain. We have ways to go.
5) Will EMRs ultimately reduce the cost of health care even if there is a increase in costs to implement and maintain the technology?
YES, IF they are implemented in the way consistent with addressing most of the questions on this list.
6) Does better data mean better service?
YES, IF consumers can switch providers based on quality data and there are real pay-for-performance incentives to provide better service.
7) How can health insurers use data coming out EMRs to better manage costs?
THIS WAY: Design fair pay-for-performance plans, supported by the evidence coming from the population statistics out of EMR.
8) Will the data be used to negatively or positively impact the provision of care?
EITHER WAY: This is a matter of designing the right policies of who owns and controls access to data. Data itself does not do anything.
9) How will the clinical encounter data coming from EMRs be used in the claims process? Will it have a positive or negative impact.
THIS WAY: Individual claims should not be affected by the encounter data, aside from finding the right codes. But I am not so certain.
10) What are the real motivations behind federal and state politicians jumping on the EMR bandwagon?
VOTES, VOTES, VOTES. No one wants to be caught saying "No because".
11) How will we be able to get non-tech health care providers to efficiently and effectively use technology to provide better care? (If you think health care professionals are bad at using technology just visit your local law firm)
THIS WAY: Money makes the world go around. As the technology creates a pay differential they will get serious about using EMR. Technology of course must work and be easy to use.
13) Will patients even listen to good advice about preventative care, eating better and smaller portions, reducing weight, exercising more, etc. Will the data improve doctors ability to convince patients to make these lifestyle changes?
YES, IF they bear a larger cost of non-compliance instead of abidcating responsibility to employers or governments. That is why some form of consumer-directed care is necessary.
14) Will the benefits of lower utilization as a result of changing health care lifestyle ultimately benefit the consumer, employers, the doctor, the hospital or will the insurer reap the financial benefits?
YES, IF insurers are kept from monopolizing the savings through the right design of data use policies, backed by regulation.
Of course we are a long way off from satisfying these "IF" conditions. But remember, it was the president of IBM who said that "there is a world market for maybe 5 computers", back in 1948.
We will be returning for more details on these points.
A major
US survey has shown lately that majority of doctors think implementing
electronic medical records is necessry at this time.


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WELLINGTON (Reuters) - A nagging hamstring injury has forced New Zealand paceman Chris Martin out of next month's one-day international series in Bangladesh.
New Zealand Cricket general manager Lindsay Crocker said Martin had injured himself playing county cricket in England and would be replaced on the tour by Michael Mason.
"While he was able to fully contribute to their most recent four-day match, we have come to the conclusion his longer term interests are best served by him cutting short his obligations at Warwickshire, returning home for full treatment and rehabilitation before hopefully being able to head to Bangladesh to take full part in the test series," Crocker said.
New Zealand are scheduled to play three one-day internationals in Bangladesh from Oct. 9-14 before the first of their two tests starts on Oct. 17.


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need an expert freelancer
This project received 27 bids from talented freelancers with an average bid price of $240 USD.Get free quotes for a project like this
Project Budget$30 - $250 USD
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Project Description
hi i need to hire expert freelancer for 2 weeks works
1)expert with phph
2)expert with wordpress
3)expert with plugins
4)fast worker
5)good touch of design
6)Need to work only with me in this 2 weeks mean no another project in progress done waste your time if you have more than 2 projects
start immediatly !! and work 7 days
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