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Focal ischemia of the brain after neuroprotected carotid artery stenting
Author + information
- Received December 2, 2002
- Revision received January 24, 2003
- Accepted February 6, 2003
- Published online September 17, 2003.
Author Information
- Michael Schlüter, PhD*,
- Thilo Tübler, MD*,
- Johann C Steffens, MD*,
- Detlef G Mathey, MD, FACC* and
- Joachim Schofer, MD*,* (schlueter{at}center-for-cardiology.de)
- ↵*Reprint requests and correspondence:
Dr. Joachim Schofer, Center for Cardiology and Vascular Intervention, Othmarscher Kirchenweg 168, 22763 Hamburg, Germany.
Objectives This study sought to assess the incidence of cerebral ischemia in nonselected patients undergoing neuroprotected carotid angioplasty and stenting (CAS) without preceding multiple-vessel diagnostic angiography.
Background Protection devices to prevent distal embolization during CAS are presently under clinical investigation. Diffusion-weighted magnetic resonance imaging (MRI) visualizes recent ischemia of the brain and may aid in assessing the efficacy of protection devices.
Methods Elective CAS was performed in 42 consecutive patients (15 female, 27 male; mean age, 67 ± 9 years) using six different types of cerebral protection systems. All patients underwent MRI of the brain before and after a total of 44 interventions.
Results Placement and retrieval of the devices and stent deployment was achieved in all procedures. New ischemic foci were seen on postinterventional MRI in 10 cases (22.7%). One patient had sustained a major stroke, whereas no adverse neurological sequelae were associated with the other nine procedures. In the latter, one to three foci (maximum area 43.0 mm2) were detected in cerebral regions subtended by the ipsilateral carotid artery in eight cases and by the contralateral carotid artery in one case. In the stroke patient, 12 ischemic foci (maximum area 84.5 mm2) were exclusively located in the contralateral hemisphere. Follow-up MRI at 4.1 months (median, n = 7) identified residuals of cerebral ischemia only in this patient.
Conclusions Neuroprotected CAS is associated in about 25% of cases with predominantly silent cerebral ischemia. Our findings suggest manipulation of endoluminal equipment in the supraaortic vessels to be a major risk factor for cerebral embolism during neuroprotected CAS.
Diffusion-weighted magnetic resonance imaging (MRI) has been shown to be a highly sensitive tool for the detection of cerebral ischemia, visualizing recently ischemic regions as hyperintense areas within minutes of onset (1,2). The technique has been used as an adjunct to diagnostic cerebral angiography (3)as well as "unprotected" carotid artery stenting preceded by three- or four-vessel cerebral angiography (4). In both settings, clinically silent cerebral ischemia was detected with an incidence of 26% and 37%, respectively.
Ever since the inception of endovascular treatment of carotid artery stenoses, interventionists have been concerned about the risk of stroke secondary to procedure-related distal embolization (5). However, following the recent advent of neuroprotective devices to prevent embolic complications, carotid angioplasty and stenting (CAS) has gained considerable momentum as an alternative to carotid endarterectomy. The most extensively studied of these devices has been the PercuSurge GuardWire (Medtronic AVE, Santa Rosa, California) (6,7). Despite distal occlusion of the target artery via an inflatable balloon, severe neurological sequelae have been observed in interventions performed with the device in place (7,8). Technological efforts presently focus on filter-based protection devices; a feasibility study of three of these devices has recently been published (9). In 16 selected patients undergoing CAS preceded by three- or four-vessel cerebral angiography and using the AngioGuard filter device (J & J Cordis, Miami Lakes, Florida) for cerebral protection, clinically silent ischemia has been detected by diffusion-weighted MRI in 25% (10).
The present study sought to prospectively assess the incidence of cerebral ischemia, by way of serial diffusion-weighted MRI, in an unselected, consecutive cohort of patients subjected to CAS without preceding diagnostic angiography and with a variety of devices, other than the GuardWire, utilized for embolic protection.
Between February 14, 2001, and December 31, 2001, 50 consecutive patients underwent elective CAS at our institution. Forty-two patients who underwent a total of 44 interventions (corresponding to 44 vessels/hemispheres treated) consented to pre- and postinterventional diffusion-weighted MRI of the brain. All patients were informed about the investigational nature of CAS in general and the use of neuroprotective devices in particular and gave their written consent. Patient and lesion characteristics are summarized in Table 1.
Protection devices
Six different cerebral protection systems were used in this study, selected by availability. They were the second- and third-generation MedNova NeuroShield (Abbott Vascular, Redwood City, California; n = 14), the FilterWire (Boston Scientific, Maple Grove, Minnesota; n = 14), the TRAP (ev3, Plymouth, Minnesota; n = 11), the AngioGuard (J & J Cordis; n = 2), and the Distal Protection Device (Medtronic AVE; n = 2). These systems have in common that, before angioplasty, a self-expanding basket-type filter of varying pore size (80 to 130 μm) is deployed distal to the lesion to maintain cerebral perfusion and capture any debris liberated during the intervention. In one patient, an "endovascular clamping" device with two balloons attached to a single guiding catheter was used (MO.MA, Invatec s.r.l., Roncadelle, Italy). The balloons can be inflated separately to occlude the external and common carotid artery and thereby block antegrade flow across the targeted internal carotid artery lesion. Close to the proximal balloon, the exit port of the guiding catheter enables the advancement of angioplasty equipment and the aspiration of debris.
CAS procedure
Patients received clopidogrel (75 mg/day) and aspirin (100 mg/day) at least three days preintervention. In patients not premedicated, a loading dose of clopidogrel (300 mg) and a bolus of intravenous aspirin (500 mg) were administered before the intervention. A 100-cm 5F Vitek catheter (Cook Inc., Bloomington, Indiana) introduced into the target lesion-related common carotid artery was used for brachiocephalic angiography. Subsequently, a 0.035-inch guidewire was introduced through the lumen of the Vitek catheter into the external carotid artery.
For patients in whom a filter-based protection system was to be employed, the Vitek catheter was exchanged for a long 7F introducer sheath (Cook Inc.). With the sheath placed in the common carotid artery and the 0.035-inch guidewire withdrawn, a bolus of 70 to 100 IU/kg of heparin was administered and an angiogram taken in anteroposterior and lateral views to document cerebral blood flow. After advancement of the introducer sheath towards the carotid bifurcation, a magnified "worst view" angiogram of the lesion was taken. Subsequently, the filter systems were deployed by way of delivery catheters that ranged in crossing profile between 3.5F (1.16 mm [TRAP]) and 5.5F (1.82 mm [AngioGuard]).
In the remaining patient, the Vitek catheter was withdrawn and the 11F MO.MA system advanced over the 0.035-inch guidewire. With the distal tip in the external carotid artery, both balloons were then inflated.
After placement of the protection devices, the lesions were predilated, supplied with self-expanding stents (predominantly Wallstents, Boston Scientific), and postdilated (Bypass Speedy, Boston Scientific). The procedures were completed by retrieval of the protection systems. Retrieved filters were flushed with saline solution and their contents visually assessed. In case of the MO.MA device, 20 ml of aspirate was withdrawn after pre- and postdilation, filtered through a 40-μm mesh and rinsed with saline solution. Patients were discharged on a regimen of clopidogrel (75 mg/day for one month) and aspirin (100 mg/day).
Magnetic resonance imaging scans were obtained within 24 h before and after the intervention, utilizing a 1.5-T whole-body system (Intera, Philips Medical Systems, Andover, Massachusetts). Identical single-shot echo-planar sequences were used at both diagnostic sessions, with the trace of the diffusion tensor sampled in three orthogonal acquisitions. All images were reviewed by an experienced radiologist (J.C.S.). Hyperintense foci on MRI were described by their number, location in the brain, and size. Areas covered by hyperintense foci were calculated using the formula for an ellipse: π/4×(long axis)×(short axis) . Patients with hyperintense foci on postinterventional MRI were asked to undergo follow-up MRI (including post-contrast T1 sequences) three to six months after the intervention.
Neurological examination
An independent neurologist established the indication for intervention. The neurological examination included a calculation of the National Institutes of Health Stroke Scale and was repeated after intervention and before discharge.
Continuous variables are presented by their mean ± 1 SD. Comparisons were made utilizing Mann-Whitney's Utest. A p value <0.05 was considered statistically significant. Exact 95% confidence intervals (CIs) based on the binomial distribution were calculated for proportions (11).
All protection devices could be used as intended and procedures were completed successfully in all patients within 57 ± 23 min. A mean of 184 ± 66 ml of contrast agent had been administered. One (female) patient, the 31st in our series, gradually developed dysarthria and amnesic aphasia within 2 h of an intervention that utilized the TRAP device; symptoms had not completely resolved at 30 days and the event was classified as a major stroke. Another female patient (Patient #21 in our series) sustained a transient ischemic attack (scotoma of ipsilateral eye) for 3.5 h after the 10th of 14 interventions that utilized the NeuroShield device.
Before intervention, no patient showed signs of recent cerebral ischemia on MRI. After intervention, MRI exhibited no changes between pre- and postinterventional scans in 34 cases, including the patient with a transient ischemic attack.
Hyperintense foci were detected on postinterventional MRI in nine patients and 10 hemispheres (22.7% [Table 2]; 95% CI 11.5% to 37.8%). They were observed in three patients with bilateral disease (23.1%, 95% CI 5.0% to 53.8%) and six patients with unilateral disease (20.7%, 95% CI 7.8% to 39.7%). With respect to the symptomatic status of the lesions treated, positive MRI findings were noted after three (23.1%) of 13 interventions at symptomatic lesions (95% CI 5.0% to 53.8%) and 7 (22.6%) of 31 interventions at asymptomatic lesions (95% CI 9.6% to 41.1%). In these 10 procedures, session duration and the amount of contrast agent administered were not statistically different from in the other 34 procedures. The mean baseline diameter stenosis of the targeted lesion was 91 ± 7% and 86 ± 10% in procedures with positive and negative MRI findings, respectively (p = 0.124); also, no statistically significant difference was found in the mean crossing profile of the filter devices used (1.23 ± 0.11 mm vs. 1.32 ± 0.17 mm, respectively; p = 0.058).
Eight patients who had undergone nine of these procedures (Patient #5 [Table 2] had bilateral disease and was treated in two sessions on both left and right carotid artery) did not experience any periprocedural neurological complications. The foci were small in number (median 1, range 1 to 3) and had a mean size of 6.9 × 2.7 mm. In the two patients with three foci each, these were located in adjacent tomographic layers (Fig. 1). Cerebral regions containing ischemic foci were supplied by the targeted (ipsilateral) carotid artery in eight cases yet by the contralateral circulation in Patient #4. Follow-up MRI scans were obtained in six of nine cases within a median of 4.2 months and revealed no persistent ischemic lesions.
In Patient #6 (Table 2), who sustained a major stroke, 12 hyperintense foci distributed over five adjacent tomographic layers were seen on the postinterventional MRI scan (Fig. 2). The largest focus covered an area of 84.5 mm2, which was almost twice as large as the largest focus (43.0 mm2) observed in any of the other positive MRI findings (Table 2). Of note, all foci in this patient were located in the contralateral hemisphere. On follow-up MRI at 3.7 months, five (42%) of the 12 foci persisted, namely, the two largest and three of the smaller foci.
Utilizing diffusion-weighted MRI, this study showed that focal ischemic lesions in the brain are seen in about 23% of patients undergoing neuroprotected CAS exclusively, without extensive preinterventional diagnostic cerebral angiography. Neuroprotection was provided by a variety of systems chosen by availability. The incidence of positive MRI findings was not dependent on the presence of bilateral carotid disease nor on the symptomatic status of the lesion treated. Of the 10 cases with cerebral ischemic lesions, nine were not associated with overt periprocedural neurological symptoms, and follow-up MRI showed that the lesions were reversible. In eight of these nine cases, basket-type filters had been placed distal to the target lesion and ischemic foci were all found in the cerebral region supplied by the targeted carotid artery. In contrast, the one patient in whom the balloon-based MO.MA system was employed exhibited focal ischemia in the contralateral cerebellum.
One major periprocedural neurological complication, namely, a major stroke, was encountered in our series. In this patient, postinterventional MRI exhibited a markedly higher number of ischemic foci (12 vs. a median of 1 [maximum 3] in procedures not associated with neurological complications), the largest of which was nearly twice as large as the largest focus on the other positive MRI findings. Interestingly, in this patient, too, ischemic foci were all contained in the contralateral hemisphere, whereas the cerebral region supplied by the targeted carotid artery remained free of ischemic lesions. Follow-up MRI revealed persistence of 42% of the ischemic foci at 3.7 months.
The transient ischemic attack, namely, scotoma of the ipsilateral eye, experienced by one of our patients had no correlate on MRI, probably because retinal ischemia cannot be visualized by this technique.
In concordance with previous studies (2,3,12), our findings suggest embolism as the underlying mechanism of cerebral ischemia. Several scenarios are conceivable.
1) Manipulation of catheters, guidewires, and sheaths within the supraaortic vasculature before deployment of the protection device may have resulted in small pieces of vessel wall to be scraped off. Such pieces would have had free access to the cerebral circulation. This mechanism is apparently corroborated by the fact that in two of our patients ischemic lesions were located in the contralateral hemisphere. In the MO.MA case, introduction of the bulky 11F system may have released a particle from the aortic wall that ended up in an artery supplying the contralateral cerebellum. In the patient who sustained a stroke, access to the right common carotid artery was extremely difficult and a considerable amount of time was spent with attempts to cannulate this vessel using a variety of endoluminal devices. Most likely, particulate matter released during introduction and/or withdrawal of these devices had entered the patient's brain by way of the contralateral cervical vasculature.
2) Particulate matter liberated during the intervention may have passed through the filter pores (∼100 μm in diameter) and occluded one or more ipsilateral arteries in the terminal vascular bed of the brain. This mechanism would likely be related to the composition of the stenotic plaque and the amount of debris liberated during predilation, stenting, and/or postdilation.
3) Withdrawal of the protection device may have liberated particles from the device itself (in case of filter systems), the lesion site, or from vessel walls.
The incidence of cerebral ischemia found in this study was on the same order of magnitude as that reported in previous studies involving either diagnostic cerebral angiography alone (3)or unprotected and protected CAS preceded by multiple-vessel cerebral angiography (4,10). In the latter, no distinction could be made as to whether the diagnostic or the therapeutic part of the intervention was "responsible" for cerebral embolism; in the former, patients were not systemically anticoagulated and may therefore not be strictly comparable with the patients of our study. However, anticoagulation would not prevent the liberation from vessel walls, and subsequent entry into the cerebral circulation, of atherosclerotic matter, which has been found to constitute the debris collected or aspirated from carotid artery lesion sites (8,9).
Clinical relevance
Clinically, the ischemic lesions detected in our patients remained silent in nine out of 10 cases and were not related to the targeted carotid artery in the remaining patient who sustained a major neurological complication. Transcranial Doppler studies have shown that increased counts of microembolic signals are observed during wire crossing of the lesion, predilation, stenting, and postdilation (13,14). Although it is not known how these findings relate to cerebral ischemia on diffusion-weighted MRI, one may assume that microembolic particles possibly released during predilation, stenting, and/or postdilation would increase the incidence of cerebral ischemia over that observed during diagnostic angiography (3). As this was not the case, neuroprotection in our study had apparently been effective. With filter devices, lesion crossing as a possible source of cerebral embolism remains an issue. This may be related to the degree of stenosis and the crossing profile of the filter device used. We observed no statistically significant differences in the mean degree of stenosis or in the mean crossing profile between procedures associated with positive and those with negative MRI findings, but this is not conclusive evidence.
Our study therefore suggests that cerebral ischemia was related to the manipulation of endoluminal equipment in the supraaortic vasculature before the deployment of the neuroprotective device. This is primarily supported by the fact that in two patients cerebral ischemia occurred in the contralateral hemisphere. Preinterventional transesophageal echocardiographic or MRI scanning of the aortic arch may have aided in assessing the embolic risk of the intervention.
In an MRI study on patients undergoing carotid endarterectomy, Barth et al. (12)reported an incidence of silent cerebral ischemia of only 4.2% (2 out of 48 patients). This significantly lower incidence points to an increased risk of periprocedural cerebral embolism during CAS as opposed to carotid endarterectomy. In consideration of the fact that inevitable interventional maneuvers before actual lesion treatment may lead to serious neurological complications, it appears imperative: 1) for the interventionist to be extremely wary of adverse vessel anatomy, and 2) for the medical industry to develop less traumatic endoluminal materials to be used in supraaortic vessels.
The "true" clinical significance of cerebral ischemia that is not associated with overt neurological symptoms is not known. Impairment of cognitive function as demonstrated in patients after cardiac surgery (15)may also be present in patients with "silent" cerebral ischemia after CAS and warrants further investigation.
Study limitations
The number of patients in this study was too small to infer general conclusions on the clinical efficacy of the neuroprotective devices investigated. The study lacked a control group of patients. Histological analysis of filter contents has not been performed; therefore, no relation of its amount and composition with the incidence, number, and size of ischemic cerebral lesions could be established. Transcranial Doppler monitoring has not been performed. To possibly determine the actual interventional maneuver "responsible" for cerebral ischemia, monitoring of the vascular access routes to both hemispheres would be mandatory. However, although continuous Doppler monitoring is possible, continuous peri-interventional MRI scanning of the brain is not. Thus, the value of peri-interventional transcranial Doppler to elucidate postinterventional MRI findings appears limited. A shorter follow-up time would have been desirable for a more precise assessment of the persistence of the ischemic lesions.
This study was not designed as a comparative study aimed at detecting differences in efficacy between neuroprotective devices. Rather, it is an observational study on the incidence of procedure-related cerebral ischemia in consecutive patients undergoing CAS and consenting to pre- and postinterventional MRI.
Neuroprotected CAS is associated with a 23% incidence of focal, predominantly clinically silent, cerebral ischemia on diffusion-weighted MRI. This incidence is not different from that reported for diagnostic cerebral angiography. Cerebral ischemia mostly occurs in the ipsilateral hemisphere, but the finding, in 2 of 10 patients, of contralateral cerebral ischemia is cause for concern—particularly because a major neurological complication not related to the targeted carotid artery was encountered in one study patient. Our results suggest manipulation of endoluminal equipment in the supraaortic vasculature to be a major risk factor for cerebral embolism during neuroprotected CAS. Conclusive evidence as to the actual mechanism of cerebral embolism could not be provided and warrants further studies to elucidate the safety of CAS, even when neuroprotection is employed.
- Abbreviations
- carotid angioplasty and stenting
- confidence interval
- magnetic resonance imaging
- Received December 2, 2002.
- Revision received January 24, 2003.
- Accepted February 6, 2003.
- American College of Cardiology Foundation
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subset: commoncrawl


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Okay, so we are half way through March and it's still freezing. Awesome. Well, hopefully our call for #nomorepuffers is answered soon enough and we can get into the world of Spring jackets. But as we hit late March and April, and start the layering, having a legit vest in the closet is a must.
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SPARTANBURG, S.C. – Five Southern Conference men's lacrosse student-athletes earned spots on the College Crosse All-Freshman teams, with another eight earning honorable mention, the organization announced Monday.
Bellarmine midfielder Riley Seay, the SoCon Freshman of the Year, earned a spot on the second team, as did Jacksonville defenseman Jordan Young and short stick midfielder Zack Deaken and Mercer faceoff Ashton Wood. Air Force defenseman Quentin Carlile was selected to the third team.
Meriting honorable mention from the SoCon were: Mercer attack Sean Goldsmith, High Point midfielder Hunter Vines, Richmond defenseman Ray Baran, Jacksonville defenseman Jack Heed, VMI short stick midfielder Trejan Cannon, Mercer short stick midfielder Garrett LeClaire, Mercer short stick midfielder Princeton Oppong and High Point short stick midfielder Joel Scerbo.
For College Crosse's full release, click here.


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Sarah Sanders Says It's "Disgraceful and Laughable" to Suggest President Unfit for Office
White House Spokesperson Sarah Sanders call questions about the president's mental fitness for office "disgraceful and laughable," saying he has been a successful leader who won his party's nomination in a widely considered talented field.
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If I told you that I lost 7 pounds in nine days you might be intrigued. If I said that my weight varied by 7 pound in nine days then that is just a statistic.
That is what I call weight variability. So if you appear to have lost 2½ pounds on day 2 of your new diet, you haven't.


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Source: starrfmonline.comThe Ghana Integrity Initiative is demanding that former Sports Minister Elvis Afriyie Ankrah be re-invited by the Commission investigating Ghana's participation at the 2014 World Cup.
The call follows revelations that caterers taken to the tournament were paid 35 dollars daily for feeding each fan instead of 34 Ghana Cedis agreed before the start of the tournament.
The World Cup Grounds, Events and Logistics sub-committee chairman, Horace Ankrah, was taken on by the Presidential commission for failing to explain the discrepancy.
Programs Officer for the anti-graft body Mary Addah speaking to Starr News stated that the revelation at the commission amounts to fraud and must not go unpunished.
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text: Author Archives: Broomfield Newsletter 5 Things I'm Thankful for in the World of Real Estate A Thriving Colorado Real Estate Market Our market continues to be quite healthy, and part of that is because Colorado is a great place to live. Here is… Written by Broomfield Newsletter November 18, 2019 No Comments Recessions and the Real Estate Market: Trick or Treat? Unless you've been living off the grid, I'm sure you've recently heard or read talk about tariffs, trade wars, political drama, Fed rate adjustments, and perhaps even a looming… Written by Broomfield Newsletter October 9, 2019 No Comments iBuyers: Know Your Options iBuyers: Know Your Options There are more options than ever before for homeowners thinking about selling their home. Colorado is at the forefront of these options, as multiple "iBuyer" companies… Written by Broomfield Newsletter September 11, 2019 No Comments End of Summer Listings: Last Minute or Lingering End of Summer Listings: Last Minute or Lingering Although school is right around the corner and summer vacations are coming to a close, the real estate selling season isn't quite… Written by Broomfield Newsletter August 15, 2019 No Comments The Midsummer Market Relaxation The Midsummer Market Relaxation There is one thing in real estate, and Colorado in general, that is rather predictable year after year. We love to vacation in the summer.… Written by Broomfield Newsletter July 16, 2019 No Comments Is the "Market Chill" for Real? Is the "Market Chill" for Real? I have to admit, whenever I read an article that references the Colorado market as "cooling", I wonder what they're referring to or what… Written by Broomfield Newsletter June 12, 2019 No Comments Property Tax Assessments Have Arrived – What Now? 2019 is an odd numbered year and that means new tax assessments. Property values along the Front Range have continued to rise, so don't be surprised to see some… Written by Broomfield Newsletter May 13, 2019 No Comments Timing the Colorado Real Estate Market Last month I discussed how the seasons can affect the local real estate market. Ironically, the newsletter was titled "Winter's End" and it was emailed on the day of the… Written by Broomfield Newsletter April 17, 2019 No Comments Winter's End, and What to Expect Next Colorado is one of the hottest real estate markets in the nation. I've shared with you details about the demand to live in Colorado, as well as the excellent job… Written by Broomfield Newsletter March 12, 2019 No Comments I ❤ Being Your Realtor February can be a cold winter month, but it's also a month that celebrates love. In the spirit of Valentine's Day, I wanted to reflect on why I love being… Written by Broomfield Newsletter February 13, 2019 No Comments 123 Communities FAQs Home Valuation Contact Us Now First Name Last Name Email Address Phone Number Message Any questions, comments, or feedback Submit Now!


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A Secondary IP Set is a set of one or more master name server IP addresses for a secondary DNS domain. A secondary DNS domain must have an IP Set applied to it at all times. You can modify or of switch IP Sets if required. If the IP Set you want to use is not available, create a new one.
Step 1: Enter Managed DNS
At the top of the Control Panel, Click the DNS Menu and select Managed DNS from the drop down.
Step 2: Choose your domain
Select a domain from the either the Recently Updated Domains box, or start typing the domain name in the textbox on the "Select Domain" tab.
Step 3: Add the IP Set to the domain
Click on the IP Set drop down menu to select another IP Set to assign to the domain. Then, click Submit


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Yes, I know, we're all shocked —– shocked, I say, to hear and read that May Day "celebrations" turned violent. It happens all over the world every May 1. But, it is pretty disheartening to read about it happening in the U.S.
Seattle May Day protests marred by Molotov cocktails, violence
(CNN)May Day protests in Seattle turned violent on Sunday, as protesters lit fireworks and threw rocks and Molotov cocktails at police, Seattle Police said.
After a peaceful march was held earlier in the day, nine people were arrested and five officers were injured in the clashes, according to police.
Flash bangs deployed on crowd on 2nd #MayDaySea #komonews pic.twitter.com/MCxKVWEOgQ
— Thomas Lin (@TLinkomo4) May 2, 2016
Seattle Mayor Ed Murray thanked police for their "extraordinary work" in a statement.
"It is unfortunate and deeply regrettable that in a city that goes to incredible lengths to respect First Amendment rights, there are some who disregard our values and engage in senseless acts of violence and property destruction," he said. "My thoughts are with the officers who were injured."
One officer sustained a facial laceration, another was bitten and a third was hit by a Molotov cocktail but not burned. …….
The person who threw the Molotov cocktail deserved to be shot and killed for that action. It is a horribly violent act and is life threatening making this picture pretty ironic.
This is what happens when you let communists educate our children.


text: Osteopathy Course fees UK & EU students starting 2019/20 (per year) and 2020 /21 (per year) FEES Full-time degree £9,250 per annum* *For students who graduate with a BOst the final year fee will be £4,625 The part-time fee is pro rata to the full time fee according to the number of credits taken. 75 credits = £5,781 90 credits = £6,938 120 credits = £9,250 Number of credits studied in each year by part-time students In year 1 & 2: 75 credits – (all students) In year 3: 90 credits – (all students) In year 4 & 5: 120 credits (MOst) 90 credits (BOst) STUDENT LOANS If you're from the UK or EU and you're applying to university for the first time, you don't have to pay for your course upfront. You can can get a Government loan to pay your tuition fees. You can apply for a Tuition Fee Loan that'll cover the cost of your course. Visit Student Finance England* to get started. APPLY NOW


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My Content
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Track Listing: Ritual: Circles Drawn, Ritual, Interiority, Conjurations, Circles Broken
Personnel: Abbey Rader: drums, percussion; Kyle Motl - double bass; Drew Ceccato - tenor sax.
Title: Ritual | Year Released: 2017 | Record Label: ABRAY Productions
Start your music shopping from All About Jazz and you'll support us in the process. Learn how.


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Produce a Romanticism information sheet.
One side of A4.
Include what Romanticism is, when it was, who was part of it (in Literature, arts, music, etc), what the main ideas/concerns of the movement was.
Add pictures (especially of art work), key quotations, famous works – make it appealing for display!
Use the following websites to help you:


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This article chronicles the most recent in the Michael Vick story and what the NFL should face as they enforce the brand new Code of Conduct. The Rain Maker was a very actual portrayal of what occurs when massive enterprise loses touch with humanity and the protection a financially crushed household has is a decided and compassionate lawyer. Your lawyer is aware of tips on how to skillfully negotiate with insurance coverage corporations and other attorneys to just remember to obtain the honest compensation you need. You ought to positively consult a lawyer in such circumstances as a result of special guidelines apply to authorized actions introduced in opposition to governments. A private injury lawyer is knowledgeable educated to handle these kinds of cases. Choose the lawyer that has the abilities for the job and the one that you could absolutely trust.
If you might be happy with the method and the best way your consultant is handling your claim, you have got the top private damage lawyer for your case. Keep the product in its original state, get photographs along with your harm, get the receipts and the guarantee and are available to us. One of our glorious personal harm attorneys will look into your case and advise you on the most effective plan of action.
If you had been in a part of the property you were not meant to be in, for instance, or weren't taking note of your surroundings, then the property proprietor may not be liable to your injury. If your damage was caused by a canine jumping up & knocking you over, evidence that the canine ceaselessly jumps up is sufficient, whether or not or not anybody has been knocked down earlier than. If you get the sensation the lawyer simply needs your case for the money then keep away.
Attorney Inna Demin has been licensed to apply regulation for five years and her space of apply are personal harm and automobile accidents. Whatever the situation, in case you've suffered an harm because of an accident that wasn't your fault, our legally educated advisors shall be completely happy to help you with making a private damage declare. We can alleviate a few of that burden of attempting to determine who pays for the costs of your damage so as to focus your power on recovery and getting your life again to regular. Mr. Hopkins's conservator hired a personal injury regulation firm to sue for the accident.


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Genre: Platform
Release year: 2001
Developer: Treyarch
Publisher: Activision
Regions: Europe, USA
Region tested: USA
Age rating: Everyone
Playability status: Excellent
Need help configuring emulators? Click.
Here's your chance to be everyone's favourite web slinging hero. In this platform/action adventure game you will need to weave your way through the city and thwart the evil plans of Doctor Octopus.
Emulators tested
Demul 0.5.8.2 (DirectX 10) – Game runs very well with no noticeable glitches.
Demul 0.5.8.2 (DirectX 11) – Untested.
Makaron T12.7 – Untested.
Special configuration options
None required.
Percentage of game played
Couple of training missions.
Videos and screenshots
Coming soon.
Reviews and other information
Other versions
The game also released for the Sony PlayStation, Nintendo 64 and Game Boy Colour and for Microsoft Windows PCs.
Did we get anything wrong?
Let us know in the comments if we missed anything or got anything wrong when testing this game.


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| Products from TUBBY TABLE TOYS
View: By latest product added | By earliest product added
Below are some of the products TUBBY TABLE TOYS has shared with ToyDirectory and TDmonthly
Specialty: Yes (as of 2015)
Gender: Boys And Girls
The New Tubby Table is the first and ONLY activity table for the bathtub that keeps water and toys INSIDE the bathtub and not on the bathroom floor. Parents and grandparents love this gift item because it has 3 different play areas for their kids to keep them entertained and focused during bathtime, AND it makes bathtime a calm and more peaceful experience for parents because the play is kept inside the tub. Grandparents often will purchase one Tubby Table for their home and another for their grandchild's home. It's unique, useful, and fun and at the right "gifting" price point of $39.99. The add-on activity mats + toys also make a perfect second gift for a birthday at only $14.99 each.
ToyDirectory Product ID#: 37375 (added 8/3/2015)
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QLICK Gallery is a photography gallery in the heart of Amsterdam. We present talented artists who show us their fresh innovative view of the world. QLICK aims to create a diverse collection of emerging and acclaimed artists who investigate each in their own way the medium photography and give their interpretation of it.
Besides hosting exhibitions at the gallery and the presentation of +15 artists, QLICK Gallery participates in several international art fairs and organizes events in a joint venture where we seek for new alliances with the aim to change the current art scene.
On Friday September 6 we are opening the new cultural season at QLICK Gallery with the first solo exhibition of American artist Charlie Kitchen.
"Interpolations" will be on show till October 12, 2019.
If you want to receive more information or an inquiry, please send us an email.
We hope to welcome you at the gallery this Friday!


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You've preferred your date, booked your venue and began purchasing dresses. Now you are seeking a wedding day photographer. You'll find a lot of forms of wedding images out there, and though people from the business could know these types within out they be confusing for partners chicago engagement photographers . Recall likewise that not simply will you be finding a mode of photography, but several types of wedding day pictures might make distinctive needs on your own time on the marriage working day.
Picking the style of photography you would like at your wedding ceremony boils right down to three items. What design and style of illustrations or photos you would like, how much time you want to shell out having a photographer in your marriage day, and most importantly of all of your possess character and comfort in front of the digital camera.
There are plenty of unique photography buzzwords available. Classic, editorial, artistic or present-day are only a handful of. Maybe a lot more confusingly they are utilized by distinct photographers in different techniques. In the end it can be up to couples to check with a great deal of issues and do a lot of investigation ahead of finding a photographer, also to rely on seeing whole list of shots from concluded weddings Usually do not count to the very best five or six pictures from several weddings to make a choice.
Wedding ceremony images designs are a compromise involving developing superb function and trying to keep to some timetable. A photographer might make amazing shots, but if he normally takes much too prolonged to produce them you probably will never get pleasure from the practical experience.
Traditional (or Posed) Wedding day Images
Lots of people consider of conventional wedding ceremony pictures as unlimited stuffy team images in which every person seems stiff to be a board. Even worse nevertheless, different collections of people appear to go on for good. I think there is a manner being down on classic marriage ceremony images, nevertheless the precise operating framework remains the same for most wedding ceremony photographers. The pictures could be much more stylish however the true expertise over the working day to the bride and groom is rather similar.
There is certainly generally a trade off between the sort of work a photographer does as well as the time it takes to shoot it. Much more official posed photos will acquire for a longer period to put in place and reach. Any photographer who provides artistic posed get the job done will need a specific amount of time to supply his very best function. It truly is important that you learn the way a great deal time he'll want, and function out how it will match into your working day. You'll find photographers who expend a couple of hours on official shots. Ensure you are joyful with supplying in excess of that quantity of your time in your marriage ceremony day. For anyone who is not that comfortable in front of the digital camera you might find this kind of images harder. An excellent photographer must manage to enable you to and place you at your ease but for lots of men and women it could possibly nevertheless feel a bit daunting.
Reportage Wedding day Images (Wedding day Photojournalism)
If conventional is all about posed photographs, then reportage marriage pictures may be the reverse. It depends on capturing moments since they occur, and it is more similar to a fly within the wall documentary. This kind of marriage pictures signifies which the photographer spends most of his time while in the history, and so happens to be significantly popular with partners. Weddings can also be progressively considerably less formal than they was. Documentary wedding photography needs a unique skill set from regular wedding pictures so you must be certain that your photographer has the proper photographic qualifications and might show you comprehensive weddings to back again this up. Wedding ceremony photojournalism is much more about a complete list of photographs in the complete working day than the usual list of a dozen highlights. You can find photographers available who'll soar within the newest bandwagon to get enterprise, but nonetheless use the standard design and style they constantly have. Wedding ceremony photojournalism is centered on anticipation and becoming within the ideal location with the ideal time. It's not about intently directing individuals, so it places several common wedding ceremony photographers beyond their ability established. There are several less ethical photographers who'll utilize the hottest buzzwords to improve their internet search engine presence, but nonetheless shoot precisely the same exhausted old photographs.
Should you be reticent about acquiring your image taken, wedding photojournalism might be your best decision. The pictures happens devoid of you really recognizing and you will glimpse your natural very best.
Though both of these ways may well seem polar opposites, the truth is most wedding photographers will provide a blend of these two designs. You'll find not lots of marriage photojournalists who do not shoot at least some official images and traditional marriage photographers will shoot informal images also. Locate out what proportion of each a photographer likes to shoot, and improved still check with them whatever they wish to shoot one of the most – chances are this can be what they are very best at.
Classic Marriage Images
Vintage wedding day images can be a design and style that has been coming into vogue a short while ago, but in lots of approaches its a hard a single one to quantify. Classic can signify nearly anything from making use of old film cameras in the course of some of the wedding to only a unique approach to put up creation to make 'vintage' on the lookout digital data files. There are several fantastic photographers on the market, but remember that if you're getting data files which can be seriously edited in a specific fashion, you run the potential risk of your pictures wanting somewhat dated some a long time later. If I had been employing a vintage model photographer, I individually would want not less than a few of the wedding shot on film, I'm not an enormous lover of faking matters. As generally check with concerns, see illustrations and make an educated determination.


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I wonder, who is that man who hold the cam in second picture ......
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This is a discussion on Orchids and Feng Shui within the Phalaenopsis ('moth orchid') Information forums, part of the Frequently Asked Questions category; Phals for feng shui is not a fad among Chinese Canadians (which where I live ...
Phals for feng shui is not a fad among Chinese Canadians (which where I live are mostly cantonese) and butterfly sounds like 'wu', only almost sounds like 'fu' (luck). So maybe this word play is a little twisted by the feng shui people trying to make money which then gained popularity. In anycase most flowering plants are a lucky thing, so it doesn't matter.
And surely chinese people are interested in growing orchids. It's a common sight for a good number of the crowd at orchid shows to be Chinese here. Though many of them do not join orchid societies and do not grow them like the hobbyists do. And many ask where I get my 'rare' orchid forms from
But the orange trees are popular. I have one myself.
I wonder, who is that man who hold the cam in second picture ......
Hehehe, that's me, Dawn Green.
This episode was aired last February 23, 2008 on GMA channel 7 a local Philippine television
I was one of the chef cooking different orchid dishes!!! hehehe
Here is the link:
Kapuso Mo, Jessica Soho: Orchids - Video - GMANews.TV - Official Website of GMA News and Public Affairs - Latest Philippine News
Thanks, Rence. I watched the video on orchids.It was really interesting and I only wish I could understand Tagalog. Now which one of the chefs is you? I have only tasted orchids fried with tempura flour in Thailand and, of course, ice cream and other dishes using vanilla.
hi rence, how nice to see you in action,
thanks for the video!
Hi Cattan and all, nice thread that I have missed.
Cattan, I would like to ask if you know in what section of BAGUA we should put the phals or orchids? hehe...interesting
Hehehe Rosalia, sorry I'm not a feng shui master. Any way I understand that the flow of chi keeps on shifting,( according to feng shui masters) depending on the time, season, planetary alignment etc. and only the feng shui masters seem to know. That's how they make a living! HAHAHAHAAAA.
As for me I can't even find the magnetic north and true north with the BAGUA!!


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Best from Pink
2012 American Music Awards Beauty2012 American Music Awards went yesterday gathering celebs on the red carpet which means more beauty looks to get inspired by.
Pink Is Shape's November 2012 Cover StarPink covers November 2012 issue of Shape magazine looking fit and happy. The athletic singer took some time for herself before returning to workout with celebrity ...
Celebrity Beauty News: Janelle Monáe Is A New CoverGirl And MoreIn celebrity beauty news: Janelle Monáe has joined the ranks of celebrity CoverGirls; Kim Kardashian spends £5,500 per month on beauty treatments, and Miley Cyrus has swapped her long locks for a boyish haircut.
Beauty News: Pink Is CoverGirl's New Face, Natalie Portman's Dior Nude Skin Glowing Makeup Collection Ad And MorePink has posed for a new ad campaign for CoverGirl. The star wears bright makeup with electric blue eyeshadow and hot pink lipstick.
Looks from American Music Awards 2010American Music Awards 2010 is one lam event celebrities take a chance to show off at. New hairstyles, designer clothes and other things to care about. Get to see Taylor Swift's and Rihanna's new hairstyles, ...
Top 10 timeless chic hairstylesLet's distract from latest beauty and fashion trends and peruse over some timeless chic hairstyles that always look good and appropriate. There are feminine, sexy hairstyles for short, long or medium hair. Apart from luxurious ...
Celebs' Hairdos at Grammy Awards 2010Grammy Awards 2010, held last night (Jan 31) at the Staples Center in Los Angeles, it's great event that provides us with info to chatter about: the styles, make up and hairdos of the winners ...
Pink CoverGirl Women's Health Jan. 2010The Women's Health Mag caught up the amazingly-shaped Pink for the January 2010 issue. It's a really January cover! It seems as if Pink just woke up after the New Year Party still in a glam ...
2016 Tony Awards: Best Beauty Moments »
2016 Tony Awards were glam and fab. You have to see these beauty looks as they are truly the best inspiration for summer.13-06-2016 | Read Full Article
Beauty Rumor Is That Gigi Hadid To Create Her Own Makeup Line »
Model Gigi Hadid is taking after her BFF Kendall and partnering up with the beauty brand she's currently representing, Maybelline, to create her very own makeup line.11-06-2016 | Read Full Article
Redhead Christina Aguilera Is Playing Hair Chameleon »
Christina Aguilera is at it again trading her platinum blonde for a new hair color that turns her into living Jessica Rabbit.09-06-2016 | Read Full Article
How To Survive Summer If You're Pale »
Pale skin is prone to burns and freckles as well as hard to tan so be sure to use our summer survival guide for pale to avoid these skin problems.07-06-2016 | Read Full Article
Watch A Beauty Blogger Create Thermal Highlighter Effect »
Highlighter is now a major beauty staple with strobing being such a huge trend. Some beauty bloggers though are taking it to a whole new level with their highlighting makeup experiments.03-06-2016 | Read Full Article
Why Bella Hadid Is Perfect For Dior Beauty »
Bella Hadid has been named the new face of Dior beauty and she's a great fit. Sharing the fame of Jennifer Lawrence (and some facial resemblance) and poise of a professional model the next Dior beauty campaign is going to be a treat to watch.01-06-2016 | Read Full Article
5 Self-Tanning Tips That Will Give You Flawless Summer Glow »
Self-tanner mistakes are such a faux pas, but with UV tanning beds and natural tanning harming your skin so much, what a girl to do? Well, here are a few tips to get that perfect summer glow without giving away you've been slathering on the self-tanner.30-05-2016 | Read Full Article
Black Blue Is Kylie's Next Lip Kit Color »
Kylie Jenner is releasing a new badass lip kit color that start Halloween early this year. The starry night shade is all a glam goth would love back in the day. Now the daring beauty junkies27-05-2016 | Read Full Article
Undercut Tattoos Are A Perfect Summer Hair Trend »
Get an undercut tattoo this summer to cool off and try out a design. Regardless of whether you are into rainbow hair or not an undercut tattoo can inject some freshness into your style.25-05-2016 | Read Full Article
Billboard Music Awards 2016 Beauty Highlights »
Celebs flocked to the 2016 Billboard Music Awards to celebrate top artists in the biz (it's Adele this year) and perform their hits. Britney Spears, Rihanna, and newcomers like Zendaya and Ariana Grande have dominated the red carpet both fashion and beauty-wise.23-05-2016 | Read Full Article
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You might have noticed that here on the blog I admire all sorts of elements of an anime's package–which sometimes means more than just the stories and characters. For example, I discuss anime music a lot, because it's a special part of the story!
Well, last season I had a lot of fun sharing my favorite eyecatches and I decided to do it again for the Summer! Eyecatches are those artistic cards that pop up in the middle of certain anime when it generally goes to the commercial. Sometimes they're just the title, but other times they demonstrate some beautiful art that ties into the story! Let's see which were the best this past season!
Honorable Mention: Ore Monogatari!!
These are so cool! Very simple; you need very little explanation from me as to what these are. I did find it hilarious that one week they used an English word instead (included), but it just doesn't look as cool, lol.
Third Place: Himouta! Umura-chan
These are all pretty simple, but I love them because they dispaly each character's personality really well! Himouto! Umura-chan was all about their characters reacting to each other and otaku "problems", so it was fitting that between the ten minute stories we saw the characters on display. I like how simple they are; these would make nice desktop backgrounds! XD
Second Place: Gangsta.
LOOK AT THESE. They almost look real, like real photographs! For all I know, that might be what they are! Gangsta. was a grimy, bloody, yet intimate anime, and you can see that reflected in these images. Almost each one is a close up on a small item; I love the detail, the darker colors, and the grainy effect. Very atmospheric!
First Place: Gakkou Gurashi!
Gakkou Gurashi! takes first place for several reasons. Each image is simple, bright, and clean, with appealing pinks and yellows. But the star of each image is more than just a trinket of the high school girls. While watching, I was surprised by how meaningful these little things were because of how they were used in the story. The creators put wonderful thought into even the eyecatches of their story and for that, these win first place of Summer 2015!


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WELLFLEET – The Wellfleet Harbor Actors Theater will present on screen performances of the Bolshoi Ballet in Cinema Series beginning this month.
The performances captured live from Moscow's Bolshoi Theatre will be screened on Select Sundays.
Shows begin November 11 with the oldest surviving ballet in history "La Sylphide."
"Don Quixote" will be screened on December 2, with "The Nutcracker" wrapping up the series just in time for Christmas on December 23.
All shows begin at 12:55 p.m.
Tickets for each show are $18 and $12 for students.
To purchase tickets and for more information, visit what.org.


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For a long time, pet guardians have been told to brush their pet's teeth. For years now, your vet has helpfully suggested/nagged about cleaning your dog's — or cat's — teeth, hasn't he or she?
But things are changing.
Vets advise against using human toothpaste — it's toxic to animals, so use pet toothpaste instead.
But this isn't much of an incentive to get you to start brushing your pet's teeth. What people want is a product with proper benefits that make a real difference. This is where the latest pet toothpastes come in.
Pet Toothpaste Benefits
When you pick the right product, a good pet toothpaste goes above and beyond doing no harm. It also:
- Changes the pH of your pet's mouth, making it a more hostile place for bacteria
- Prevent food debris from gluing itself together to form plaque
- Is antibacterial and kills the bugs that turn sticky plaque into hard tartar
- Improves gum health
- Has a lingering effect after brushing has finished
Add all this up and you get cleaner teeth, healthier gums and fresher breath.
In the long term, this means dodging disease and the dreaded de-scale under anesthetic, which is better for your pet and your pocketbook.
Why Pets Can't Use Human Toothpaste
Dogs and cats don't rinse and spit — they swallow. This means toothpaste becomes food.
But toothpaste contains fluoride, which is hazardous when swallowed. Therefore, pets can't use human toothpaste.
Let's look at some figures.
Around 5–10 mg/kg of fluoride is fatal to a dog. For a 10 kg dog, this means 50 mg of fluoride could kill, with a much lower dose of 10 mg being enough to cause clinical signs of illness.
When you cover the toothbrush head with a strip of human toothpaste, this contains about 2.5 mg of fluoride, so 4 brush-loads and your dog is in trouble.
The bottom line? Stick to pet toothpaste.
Brushing Effectiveness
Brushing without toothpaste and just water is of some benefit because it rubs away food debris.
However, the benefits pretty much end there.
If your dog has infected gums, then brushing alone could make matters worse as you catch the gums, make them bleed and give bacteria an entry point into circulation.
Various Pet Toothpastes
Pet toothpastes vary widely in how they work and their effectiveness.
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Indeed, what's puzzling to me is that some "natural" toothpastes contain tea tree oil. This is a little perplexing because this oil is toxic when swallowed, so how do you square that circle?
At the other end of the scale, the gold standard toothpaste is Petsmile (affiliate link) because it is the only toothpaste that holds the Veterinary Oral Health Council (VOHC) seal of approval.
The VOHC is a body of specialist veterinary dentists who use research and scientific data to work out if products are effective or not.
Petsmile gets a big thumbs-up because as well as working to reduce plaque and bacteria, it has a lingering effect. Indeed, the brushing part is recommended but not essential.
You can even apply this toothpaste to a chew toy – what matters is that the paste ends up in the pet's mouth.
Pick up some helpful tips from this vet's video on brushing dogs' teeth:
Enzymatic Toothpaste
The silver standard toothpastes — with no VOHC certification — are "enzymatic."
Enzymes are biological chemicals — in this case, GOx (glucose oxidase) and LPO (lacto peroxidase — an enzyme derived from milk). The GOx converts to hydrogen peroxide in the mouth, which activates the LPO to kill bacteria. It is bacteria that form part of plaque and cause it to harden into tartar.
They also include humectants to keep the paste spreadable. Sorbitol is commonly used as a humectant. But don't panic — sorbitol is perfectly safe (unlike xylitol, a chemical that has a similar name but is deadly).
And last but not least are microbeads of polishing agents to help shift stains.
Cost and Taste
Yes, a good pet toothpaste is more costly than a human one, but I hope you can now see why.
There is much more than meets the eye to that bland-looking tube. There's a whole load of science that went into making it safe and effective for your pet.
Pet toothpastes taste just great (to pets). When you use a great-tasting pet toothpaste, most pets become eager to incorporate teeth brushing into their daily routine because they think you're rubbing delicious spreadable meat around inside their mouth.
Nom nom nom. Definitely something to smile about.


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was told to always make a wish at 12:12. So I do. My wishes change each time. So today at 12:12, I will make a wish and its for all of us!
Even though you are not supposed to tell anybody, I am disclosing my wish (es)
My wish is for all of us to be the best human beings we can be! I wish for us to be mentally healthy. I wish for people to work together for the common good. I wish for all of us to have a happy and safe holiday season!


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Mango Rava Cake – Eggless In Pressure Cooker
Print RecipeMango Rava Cake - Eggless In Pressure Cooker Yum
Mangoes! Who Doesn't Love it <3 ? I am a die heart fan of these yellow, sweet, juicy tropical fruit. There are more than 100 varieties of mangoes found in India, and because of that, we have so many mango recipes Like Mango Pickle, Mango Sweets, Mango Papri, Mango Curry, Mango Chutney, Mango Khata & So on. Now that It's that time of the year when everyone becomes an Aam Aadmi, sharing with you the Easiest, Healthy & Tasty Cake Recipe made with Mango. Its one of the most relishing cake recipe in my list. The main ingredient used to prepare this cake are Mangoes Pulps & the Semolina. I am using a very little sugar as i am using a very sweet variety of mango. As many of the indian families dont have access to microwave/oven and I receive a lot of requests to share cake recipes which can be baked on a pressure cooker, sharing this recipe which can be baked easily on a pressure cooker. Follow my step and step guide to Bake this Yummy Delicious Eggless mango cake at home & Amaze your friends next time when they will visit your home 🙂 ..
|Prep Time
|15 Minutes
|Cook Time
|20-30 Minutes
|Passive Time
|45 Minutes
- 1 Cup Mango Pulp
- 1 Cup Rava (Semolina)
- 1/2 Cup Sugar
- 11/2 Tbsp Butter
- 1 Tsp Baking powder
- 1/2 Tsp Baking soda
- 1 Tbsp Almonds/ Pistachio Cuts (Optional)
- 2-3 Tbsp Cherry (Optional)
- 1/4 Salt
- Take a big bowl, Add 1 cup of fine Semolina, Add Sugar, Salt & Butter. Mix well.
- Now Add the Mongo Pulp, Baking Powder & Baking Soda. Mix again, Let it sit for 10 Minutes.
- Heat Pressure Cooker (Remove Whistle), Add salt & keep a Stand. (Preheat)
- Grease & Flour the Baking tin, Pour the Mixture & Garnish With chopped Almonds & pistachio.
- Now Put the Baking Tin in Pressure Cooker. Cover The lid & Bake for 20-30 Minutes.
- Check After 20 minutes with the help of toothpick .
- Allow the cake to cool completely.
- Enjoy Anytime.
Share this Recipe


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Australia - 20 Photos
Victoria (Australia) - Wikipedia. .1200 x 600 px
Spain in Australia (@EmbajadaEspAust) | Twitter. ... 2017 to remember those who died or suffered in Australia's cause in all wars, conflicts and peacekeeping operations #AusNavypic.twitter.com/2PEfsU1VLD.1000 x 698 px
Shop Australia T-Shirts online | Spreadshirt. australia T-Shirts - Men's Premium T-Shirt.400 x 400 px
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Property Prices in Australia | Australian Real Estate Prices. Australia price index.250 x 258 px
The 10 Best Australia Ski Packages & Hotel Deals 2017/18 - SnowPak. Thredbo Australia.800 x 800 px
Australia Day: Thousands of Australians support national flag .... australia-flag.jpg.620 x 270 px
Blue Label Diving Technical Diving Courses Brisbane Australia .... BLUE LABEL DIVING IN AUSTRALIA.400 x 379 px
Australia Map Stock Vector 4354288 - Shutterstock. australia map.450 x 386 px
Australia Marks the Death of Its Auto Industry - Bloomberg. Australia's car industry traces its roots to 1901, when land surveyor Harley Tarrant built the first petrol-driven car in a small workshop in Melbourne..800 x 438 px
Parliament of Australia - Wikipedia. Australian Senate (current composition).svg.250 x 137 px
Bureau of Meteorology, South Australia (@BOM_SA) | Twitter. 0 replies 5 retweets 8 likes.680 x 467 px
How many time zones are there in Australia? - Answers. Map of Australia showing the different time zones of the Country.800 x 592 px
Australia Day Clip Art, Vector Images & Illustrations - iStock. ... Happy Australia Day vector art illustration ....612 x 612 px
Contrasts of Australia & New Zealand 2017 | Grand European Travel. 30 Day Refund Guarantee.640 x 609 px
Great Cruise, Rail & Tour Deals from Holidays of Australia .... Western Australia and the Treasures of Asia.417 x 433 px
Indispensable economic partners: The US-Australia investment .... Indispensable economic partners: The US-Australia investment relationship — United States Studies Centre.600 x 338 px


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Median Home Price sets new records in San Francisco
San Francisco's median home sale prices have continued to soar, hitting a record high of $1.225M in April. That surpasses the recent March benchmark of $1.15M. For reference, at this time last year, the median price hadn't yet cracked $1M.…Read more


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Monthly Archives: May 2011
Squarko.com is ready to go!
We are very excited to announce that squarko.com is now up and running! Happy Squarking! The Squarko Team
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5 Ways to Use the Internet When Learning a Language
Language studies are evolving. With the increase in tuition fees, many students are shying away from language studies in traditional institutions, opting instead for more vocational studies in the hope of securing a career. Rising fuel costs make traditional face-to-face … Continue reading
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Insider tips to become an excellent online tutor.
Moving you tuition online opens up a vast client base to which most tutors would not have access. Students living in rural, hard to reach areas for example have the pick of the best online, rather than finding their choices … Continue reading
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Hitomi Kaikawa's "Kiss My Eyes" iPhone photobook for free
Again this is more like a preview to the full "Kiss My Eyes" photobook of Japanese gravure idol/race queen Hitomi Kaikawa. The girl is cute in bikinis in this photo album. The app has 1.1 MB worth of photos.
Hitomi Kaikawa is a celebrity/gravure idol/race queen from Aichi. She was born on August 25, 1984. Standing at 160 cm tall, her BWH proportion is 83 – 57 – 82 cm. She began her modeling career in 2001 and has since released numerous DVDs/CDs.
Sexy 3D girl for you iPhone "Peek3D Lite – Full 3D Sexy Model Viewer"
Here's something a little different. Peek3D Lite features 3D bikini/lingerie clad girls . You get to look around your chosen model 360 degrees by tilting the iPhone/iPod touch and can zoom in and out by pinching the screen. The publisher promises more models each week through updates. You can view the 3D girls without internet connection but the publisher suggests you connects to the internet the first time you launch the app to get some updates. The app is 5.0 MB in download size which is the same for the full version that costs $1.99.
Ann Nanba gives you her little photo book for free
Japanese AV actress (porn star) cutie Ann Nanba releases a new iPhone app for free. The app is a photo album featuring sexy pics of the girl in skimpy outfits (bikini/lingerie). The download size is 0.7 MB which looks very much like a preview.
Ann Nanba was born on March 7th 1983 in Nagasaki Japan. She's 154 cm tall. Her body BWH proportion is 87 – 60 – 87 cm. She wears cup E bra. She began her adult movie acting career in 2002 at the age of 18 and has released nearly countless adult videos since. Ann Nanba has stopped adult film acting since 2008.
Anri Nonaka and Anri Kawai's Lolita Photo Gallery Volume 1
iPhone app "SEXY JAPANESE LOLITA Photo Gallery Volume 1" by e-STATION features Japanese AV actresses (porn stars) Anri Nonaka and Anri Kawai in gothic lolita cosplay and maid bathing suits. There's a paid version with more photos of the girls.
Anri Kawai is from Tokyo. She was born on September 3, 1988. Standing at 145 cm tall, her body's BWH proportion is 82 – 57 – 80 cm. She began her adult movie acting in in 2007 at the age of 19 and has released over 27 adult films since.
Anri Nonaka was born on November 25, 1988. She is 154 cm tall and has BWH proportion of 74 – 56 – 84 cm. She had her adult video debut in 2007 at the age of 19 and has since released well over 50 titles.
Sexy iPhone app "bikini festival" from Sexy Carnival is free
Sexy Carnival's "bikini festival" app has a free sample version. The app has 1.4 MB worth of preview photos of sexy Japanese gravure idols including: Ayako (the one with dimple), Ako Ito, and Kana. In the paid version, there are 75 photos of the girls in bikinis.
Sexy iPhone app "AA Asian Boobs " is free
For now, AA Asian Boobs iPhone app is free on iTunes app store. The 0.9 MB app has online photo album of sexy Asian girls with nice boobs though that is not the case for some of the photos (as you can see in the preview images)
Sexy iphone app "AAA Asian Babes" is free
"AAA Asian Babes" is a free iPhone app featuring sexy photos Asian (Japanese) idols in bikinis. No internet connection is required to view the photos. All photos can be saved to iPhone/iPod photo library and then used as wallpaper.
Maria Ozawa's "Sexy Carnival" free sample iPhone app
Japanese AV actress/gravure idol Maria Ozawa released a free version of "Sexy Carnival @Ozawa Mania" iPhone app. The app includes sample photos of Maria Ozawa's sexy photobook "Sexy Carnival." The full (paid) version includes 62 photos of Maria in bikinis, maid cosplay, secretary cosplay, Chinese dress, bunny girl, nurse cosplay and more. This free version is 1.3 MB in download size.
Maria Ozawa was born on January 8, 1986. She's internationally know as an exotic Japanese porn star with tight body. Her father is Canadian while her mother is Japanese. She's 162 cm tall. Her body's BWH proportion is 88 – 58 – 86 cm and she wears E-cup bras. She began her adult video acting in 2005 at the age of 19. She has released numerous adult videos since.
14000+ Wallpapers Lite iPhone app got some sexy girls
Free iPhone app "14000+ Wallpapers Lite" has some sexy girls to grace your iPhone/iPod touch. The app is only 0.6 MB in size which suggests the photos/wallpapers are online (need internet connection to view photos). The publisher promises update everyday. You can download the full (paid) version which has no ads and let you search or browse categories. You can shake the iPhone/iPod to get random wallpaper.
The iPhone app "1,200+ Asian Boobs for FREE!" is all free. For now that is. There isn't much to add to the very obvious title. The app features Asian girls in bikinis, lingerie, school girl uniforms, cosplay and all the sexy outfits showing off cute bodies. All photos can be saved to the iPhone/iPod photo album and then used as wallpaper. The photos can be viewed without internet connection. plus more updates promised by the publisher. All come in a 31.5 MB download.


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We collect your laundry & dry cleaning from your Barnes location
Choose a convenient pick-up time
Free pick-up & delivery to your home or office 48h turnaround available with our service Pick-up & delivery times from 7a.m. to 11p.m.
Barnes Dry Cleaning & Laundry Delivery Service
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Free pick-up & delivery to your home or office
48h turnaround available with our service
Pick-up & delivery times from 7a.m. to 11p.m.
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Zipjet now offers Barnes our premiere London laundry service and Ironed Laundry & Dry Cleaning service, both with 48 hour turnaround. We've designed our service to help you in the daily quest to regain your free time and do the things you actually enjoy.
If this sounds like a dream, then you're ready for Zipjet. First, let's talk about our free laundry pick-up and delivery service, which every Zipjet order is treated to. All you have to do it choose your desired collection & delivery times, and we'll be there in no time - whether it's your home, office or even a hotel. Read to begin your Zipjet adventure? Download our free laundry service app, available on iOS and Android, and let's go!
Once you've made the important choices: collection & delivery times, location and service class - we'll take over from there. When your order has been placed, our efficient Pickup Pilots begin their journey to you. We choose our Pickup Pilots based on their experience and knowledge of London, making them one of our greatest assets.
Upon your first collection, your Pickup Pilot will bring you two branded Zipjet bags. When you choose whichever bag suits your need, you can have your dry cleaning & laundry returned in as little as 48 hours.
Interested? Keep on reading to learn more about our services, and check out our comprehensive price list as well.
Even wonder if there's dry cleaning service that somehow makes life easier instead of more complicated? Well then, we have news for you! Zipjet is the answer you've been waiting for! Having laundered and dry cleaning thousands of items, we'll provide you with an efficient, high-quality service. Ready to get started?
If it's dry cleaning you're after, you're in the right place. You'll need to choose our Ironed Laundry & Dry Cleaning service when deciding between our cleaning options. But what is dry cleaning, exactly? It's a pretty cool process, and we're happy to share our knowledge.
First thing's first, special solvents are mixed with your clothing. Their job is to clean your garments without actually making them wet - hence: 'dry' cleaning. These solvents then loosen your item's fabric and remove dirt and odours.
Finally, a light heat is applied to each and every load, which tightens the fabrics and - voila - reverts them back to their original condition. Except now, they're spotlessly fresh & clean.
Wondering what we dry clean? It's a long list. But to name a few:
Want to keep your home as fresh as your wardrobe? Then our premium London duvet cleaning service in Barnes is for you. We deliver hotel-quality finish on sheets, pillowcases and duvets every time.
Zipjet's laundry & dry cleaning services are also available in neighbouring areas of Fulham, Hammersmith and Putney. Order now using our free laundry service app, or alternatively on our website. Ready to give us a spin?
Priced per item, our Ironed Laundry & Dry Cleaning option is for individual cleaning. Items are washed or dry cleaned as per their care label, ironed & delivered folded or on hangers
Priced per bag, our Folded Laundry option is for your everyday laundry. Items are washed at 30°C, gently tumble dried and folded neatly for delivery
Doing laundry is - more often than not - a huge pain. Finding the time to wash, dry, fold and put away all your dirty clothing can seem like an endless task. That's where Zipjet comes in. With our efficient London laundry service, you can wave goodbye to your wasted hours, and say hello to more free time.
Every Zipjet order in Barnes, and across London, receives free laundry collection & delivery service. After we pick-up your clothing, we'll wash, fold and return your fresh & clean items to your home, office or hotel. When choosing our Folded Laundry service, remember that it's suited for everyday laundry - items that are machine washing and tumble dry safe. What can you send in for this service? How about:
These items are washed, tumbled dry on a low heat to prevent shrinking and neatly folded. They're then returned to your home ready to place back in your wardrobe or wear immediately. Hey - we all have a favourite sweater that we perhaps wear a bit too often. We don't judge, we just simplify your life.
Have a number of shirts you need dry cleaned on a regular basis? Then Zipjet is the answer. Want to try our premium London shirt service? Just place your shirts in the black Ironed Laundry & Dry Cleaning bag, and they'll receive a top-notch wash. Then, they'll either be pressed or hand-finished - whichever you prefer.
If you're interested in our pricing, our Folded Laundry service is priced by the bag (£15.00 per 8kg bag), whereas our Ironed Laundry & Dry Cleaning service is priced on an individual basis.
Ready to begin your Zipjet journey? We're happy to have you. Order today!


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A good article in the FT (behind the paywall sorry) but the core point is that the supply chain had better get used to a low cost procurement environment for a long time:
[C]uts have been made across the industry, pushing investment down to historic lows. The average number of new oil and gas developments given the go-ahead globally has fallen from 35 a year between 2010 and 2014 to just 12 since 2015, according to Patrick Pouyanné, Total chief executive. This number will have to increase, he said, if a supply crunch is to be avoided in the 2020s. He and other executives stress that reduced spending also reflects efficiency gains in the industry, allowing companies to do more for less…
Many of the savings stem from cuts forced on suppliers, such as rig operators, which were in no position to resist as business dried up after the oil price crash. But Bernard Looney, head of exploration and production for BP, insisted that two-thirds of reductions are structural, rather than cyclical, and would be sustainable. "It's as much a story of how bad the past was as how good we have become," he said. "We got the cost of Mad Dog 2 [a development in the Gulf of Mexico] down from $20bn to $8bn but frankly we should never have been at $20bn in the first place."
The fact is for both rigs and vessels there is huge latent capacity and this will mean the supply chain is under pricing pressure for years. Offshore supply has structurally changed: it will become dominated by a few large players with massive fleets and low margins that mean scale is vital. Subsea contracting looks set to be dominated by a few large profitable contractors, in a flight to quality, while offshore support vessel owners who supply them will find it harder to make money due to long-lived over capacity. All this is a structural change in the industry and there is likely to be lower industry profitability regardless of how big a rebound is (when compared to 2010-2014).
When the number of projects starts to rebound, and it will take a long time to re-employ the engineering capacity required to do this, there will be a cyclical upswing as overall demand for these assets increases. But this is unlikely to see the entire industry benefit as a smaller number of companies at the contracting end of the market will still be able to use their market power to charter in excess capacity at a low marginal cost.
Whereas pretty much al business models used to work in offshore that is patently not the case now.


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About Valentine's Day Roses
Roses are a traditional romantic choice for Valentine's Day. But who said roses have to be red? Choose from our variety of colors and designs or delight them with a classic bouquet of fresh red blooms.
Personalize your gift with our wide selection of chocolates, precious stems, huggable plush toys and more. Click to view the options we have available to select at checkout.


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This product includes the webinar and CME/CMLE credit.
This webinar will review the most recent revision of the World Health Organization (WHO) classification of acute leukemia with a particular focus on acute myeloid leukemia. A summary of changes to the classification of lymphoblastic leukemia/lymphoma and acute leukemias of ambiguous lineage will also be summarized.
A collaborative educational event presented by Association for Molecular Pathology (AMP) and Society for Hematopathology (SH).
Speaker: Daniel A. Arber, MD
Host: Mark D. Ewalt, MD
Duration: 1 hr
Level of Instruction: Intermediate
Last day to purchase course and claim credit: January 22, 2021
Maxiumum CME/CMLE credit available: 1.0
How to claim credit: To earn CME/CMLE credit, all learners must watch the webinar and then complete the online survey. To access the online survey, click "Submit credit" on the course homepage, or click on "My Credit" on the menu to the left.
AMA PRA Category 1 Credit(s)™
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of American Society for Clinical Pathology (ASCP) and Association for Molecular Pathology (AMP). The American Society for Clinical Pathology (ASCP) is accredited by the ACCME to provide continuing medical education for physicians.
The ASCP designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only credit commensurate with the extent of their participation in the activity.
This continuing medical laboratory education activity is recognized by the American Society for Clinical Pathology for 1.0 hours of CMLE credit. ASCP CMLE credit hours are acceptable for the ASCP Board of Certification (BOC) Certification Maintenance Program (CMP). CMLE credit hours meet the continuing education requirements for the ASCP Board of Certification Credential Maintenance Program (CMP) and state relicensure requirements for laboratory personnel. Participants should claim only the credit commensurate with the extent of their participation in the activity.
* You may not submit SAMs and CME/CMLE credit for the same content.
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Course Information
Course Date:
January 22, 2018
Course Objectives
American Medical Association
Continuing Medical Education: 1.00
American Society for Clinical Pathology
Arber Presentation (+CME)
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King Suits Up for Football Night
NBC has added NFL reporter Peter King to its new Sunday night football studio show, Football Night in America.
King will join a Football Night in America lineup that already includes Bob Costas as host and former players Cris Collinsworth and Jerome Bettis as analysts.
King is currently a reporter and managing editor for HBO's Inside The NFL (on which Collinsworth is an analyst) and a senior writer for Sports Illustrated magazine.
His television experience also includes a stint as a halftime analyst for ABC's Monday Night Football in 1994 and 1995, and a job as the primary NFL commentator for CNN's NFl Preview and the now-defunct CNN/SI sports network.