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Happy first day back to real life in 2016, y'all! Let me just say that our back-to-back vacation and holidays spoiled my family and I WAY too much. Getting going this morning was tough for most of us…the exception being the 2 teens who were told that they could play video games this morning (never allowed on a school day!) as long as they were done by 7:30. So they were up at 6. What they don't realize is that now they've shown me what they're capable of. I won't be buying their whole groggily stumbling out of their room at 8:15 gig anymore. 😉
Today was my first day to put my plans into action for getting up earlier and working in the morning before the little kids are up. On the surface I was successful…I was up by 6:30. Buuuuuut….I did have to lie down with my 4-year-old for about 45 minutes during his nap time. Tomorrow should get a little bit easier. I can't go to bed earlier if I'm not tired. So it will take a few days of forcing myself to get up early before going to bed early really becomes doable.
But anyway…
The Christmas decorations have (mostly) come down, which means Valentine's decor can go up soon. Last month I made my own version of these cute blocks that I found on Pinterest. As I was finishing them up, I had this great idea to flip them over and decorate the other side for Valentine's Day so I could use them all the way through February. I took a few photos so this could be a mini-tutorial of sorts.
To make these, start with 4 wooden blocks (these are from a 4″x4″ that had been cut into cubes, so their actual size is about 3.5″ on all sides) and sand them down well, especially the edges and corners.
Then give them a couple coats of white craft paint. I put the little "x" marks there to remember which sides I wanted to be the fronts of the blocks.
For a lightly distressed look, sand down the edges and corners again. I have several bottles of this Distress Stain, so I put a little on a felt pad and lightly rubbed it on the edges/corners to darken them up a bit. You could also just leave the edges as-is.
(These were actually pre-distressed by my boys, who upon finding my bin of wood blocks in the garage decided they would make great props for reward and immunity challenges in their neighborhood kids edition of Survivor, which they play regularly in the back yard in nice weather. Leaving wooden blocks strewn about the lawn really helps them age, crack, and discolor quickly. Now you know.)
Next, cut 4 pieces of scrapbook paper slightly smaller than the cube face. I used my Silhouette (and one of the designs that came pre-loaded) but you could just as easily use decorative-edged scissors or even a large punch to make these. They don't all have to be squares. You could mix up your shapes if you like. It's all good! I painted a layer of Mod Podge onto the surface of the block, stuck down the square, and then painted a layer of Mod Podge over it.
Here are all 4 of my cubes showing their Christmas side…
Next you'll need letters. I used NOEL for the Christmas blocks just like my example from Pinterest, and LOVE for the Valentine's Day side. Again I used my Silhouette to cut these out of vinyl, but there are so many alphabet sticker options out there that I'm sure you could find some that work.
To finish it up, cut 2 strips of fabric for the tie and bow. To tie the blocks together, cut a piece that is 2.5″ wide and about 42″-44″ long. Wrap it around the outer edges of your 4 blocks and tie a knot at the top center. Leave the 2 long ends for now. For the bow, cut another strip that is the same width but 48″ long and starting at one edge, wrap the fabric around an 8″ wide piece of cardboard or similar. You'll end up with 2 loops and 2 ends on each side. Carefully slide the fabric off the cardboard, center your bundle of loops on top of the knot on top of your blocks, and tie the loose ends from the first piece of fabric around the center of the bundle of loops, making a tight knot. Then just pull out and twist to fluff the two loops on each side, and you'll have a floppy fabric bow.
Now if you really wanted to keep it simple you'd use red on both sides of your blocks, since red works for both Christmas and Valentine's. Then you only need one bow. But I only had pink Valentine's paper, so I'm switching my bow out. I found that if I tie that first knot snugly but not super tight/stretched, then I can easily slide one tie/bow off the blocks and slide the other one on. This would also be handy if you wanted to do 2 holidays that don't have colors that coordinate at all.
So there you have it…one craft, 2 seasons. What a deal!
I'm making up a few more things to add to my Valentine's Day decor this year. I'll post some photos once everything is decorated. It might be a little while. 😉
So how about y'all? Do you decorate for Valentine's Day right after your Christmas decor comes down, or do you wait until February? Why or why not? Leave me a comment and let me know!


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News 28 February 2012 / 15:29GMT Android Jelly Bean coming in autumn 2012? Google exec hints that Android 5.0 will come a year after Ice Cream Sandwich
News 16 February 2012 / 11:38GMT Android 5.0 Jelly Bean due summer 2012? It looks like Google is preparing a new operating system to take on Windows 8, soon

subset: commoncrawl


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You can send February 23 Gifts to Argentina in the following cities.
What our Customers Say about our Service |
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"Well, my wedding dress isn't white and it isn't ivory but it's not ivory ivory it's light ivory but not buttery". It's silk white...oh, I give up!"
Have you been there...done that? Are you frustrated with trying to figure out what veil color matches with which dress tone?
There's no perfect science to it. It seems every dress designer has a different "ivory". So, to help guide you a little, here's a few tips on the basics of that classic veil colors...
Bridal veils in white are often a stark white and go well with classically white bridal gowns. Makes sense right? However, there are some tones of wedding veils in "silk white"? What does that mean? It means it has a very slight tint of ivory that is not quite "diamond white" (which we'll explain in a minute) but leans more in the "white" toned category. Silk white will generally match wedding dresses made of natural silks that are called "white".
Diamond White
"Diamond white" is a color between white and ivory. This is confusing for some brides because "diamond" seems like it would imply this color should be a brighter "white". However, if you think about it, diamonds have a tinge of ivory or yellow. Thus the color "diamond white". Ta da!
Diamond white wedding veils are too light for a ivory wedding dress and too ivory for a white wedding dress. But, they are just right for a diamond white or what might be called a "light ivory" bridal gown depending on the dress designer. This has been and is one of the most popular colors in the last decade for brides.
So the quintessential ivory. The Queen of all bridal veil colors. You say, "The Queen"? Yes, ivory is by far the most popular wedding veil color for the last 15 years or more. Many bridal gown designers have met the demand of brides seeking the less traditional gown for the off white or ivory toned wedding dress. Thus, the need to have the coordinating ivory bridal veil.
Now, the problem is there seems to be a 1000 (not really, but feels like it) of hues in ivory! They run the gamut, from a light tone to a buttery tint to a deep dark vintage ivory. Forget the number of names for ivory such as pearl, cream, vanilla, eggshell, powder, bisque...well this list goes on. So, what's a bride to do?
The good news is even though there are a ton of names for ivory, typically each will fall into a general "hue family" within that gamut. It will either in reality be a light ivory (creamy), classic ivory (buttery to yellow), or a dark ivory (vintage tone) regardless of the "name" the designer gave it. So, now you might be asking...ok, so now what?
Now, if you're confident about the color your ivory dress think about the "category" it falls into and look for a wedding veil in that tone.
However, if you're unsure, it's good to ask for a swatch from your veil designer to ensure it really matches your dress.
SWATCH TIP: Keep in mind a swatch does come from a dye lot. What the heck is a dye lot? A dye lot is the color a specific bolt of fabric has be "dyed" in. So, these "lots" will vary ever so slightly from one to the other although the same color. The swatch will give you an idea of the color so you can confirm it will match your dress. Therefore, do not be alarmed your veil will be significantly different from the tone of the swatch.
White is typically not dyed. Therefore, you probably don't need a swatch of white. It's white. Notice, they're not so clever with the names for "white". Because, it's white. Okay, off my soap box. But, if you must, feel free to make that request.
Side Bar: So, Why Do Some Bridal Businesses Charge for Swatches While Others Don't?
Well brides, quality fabric cost quality money. Most bridal businesses especially those who make wedding dresses and wedding veils customize or make the garment to order. Lots of time and resources go into creating something just for you. These materials although swatches still cost the designer. Well, that's great for them, but what's in it for you?
Paying a dollar or less for a swatch can really prevent a bride from making the more costly mistake of "guessing" on a color and having it made then finding it really did not work with her dress. You can't return it, you can't exchange, you can't do anything. And that really stinks! There's a common saying..."Pay now or pay later".
So, invest that dollar or two. You can see and feel the fabric in person and match it up. This will give you real peace of mind. Some businesses will even allow you to apply amount paid to your final order for swatches that costs you a little more. So, hopefully that helps to explain. It'll be worth it.


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Friday, February 19, 2010
A Sweet Tooth
So here is the second installment of the "Chefs of Fort McMurray". I decided to do Candace Cheney who has a home based business called "Nice and Sweet" as well as being the Pastry Chef at the Sawridge Inn and Conference Centre. I chose Candace for a million reasons...but mostly because she maintains my "Girlish Figure" with oodles and oodles of sweet things.
Alot of people in town have contacted me thru various means to ask if I could make a cake for "such and such" reason...I suck as a baker...I can do it, but my male "lack of patience" does not allow me to do it well. Candace on the other hand Rocks at it...and she is the person I always hand people off to. She pushes the limits daily...and it shows in both appearance and taste in her work.
The final reason for doing her Bio is she doesn't get mad at me when I say "Nice Shitter!" hehe
You can contact Candace for all your Baking needs at : email@example.com or 780-715-5064
Name: Candace Diana Cheney
Age: 26
Position: Pastry Chef
Company: Sawridge Inn and Conference Centre / Nice and Sweet
Where did you attend Culinary School / or did you??
College of the North Atlantic in St Johns , Newfoundland. But I have been in the business since I was 14!
What did you find most difficult about this training?
Bread....not because it is hard to make, and I do it well....but because I dont have the patience to let it rise!! I love bread.....mmmm!!!
Thursday, February 18, 2010
Girl Cook.....
So today I wanna post a blog by my Wife....Christina! You can visit her blog at : http://acookswife.blogspot.com
She is starting to get some traffic at her site...so I thought I would help the cause and post a link here. Everyone check it out :)
Have women changed the face of professional cooking?
Traditionally all through time a womans stereotypical place has always been in the kitchen, the home kitchen that is. Actually I take that back it wasn't so much a stereotype as it just was what it was. I actually think traditionally that is where most women wanted to be, taking care of the home and spending time with the children. Whether thats because of the maternal instinct or because that is what they felt society expected of them, I don't know. But oh how the times have changed, we see more and more men staying at home being the caretaker and more women being the career focused, financial provider.
With the help of many rights activists, world wars and social and economic upturns and downturns women have been able to explode into the work force, not without many challenges. This is true of the cooking industry, professional cooking is a male dominated industry, it has been very hard for women to break into this career. Which seems strange to me since as I said before a womens place was traditionally in the kitchen, it has been said that it is too labor intensive for women, but we have set out to prove them wrong and I think we have done a pretty good job. With the likes of Alice Waters, the great Julia Child and more recently Anna Olson, Lynn Crawford and the list goes on, women have been taken more seriously in the professional kitchen.
I have been working in kitchens for a very long time and yes it has been with mostly men, but over the years I have seen more more women entering the industry actually I have worked in one kitchen where there was more women than men, not something you see too often. Currently where I work the head pastry chef is a woman and the last place I worked the only sous chef was a woman . But I have never had the pleasure of having a women executive chef. There are more male head chefs than women... do I believe that is because they are better cooks, or women just are not getting the recognition they deserve, no not all, being that there is more men in the industry it seems to only make sense that more men would be head chefs.
Monday, February 15, 2010
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'Oliver Sacks is a perfect antidote to the anaesthetic of familiarity. His writing turns brains and minds transparent' Observer When Oliver Sacks, a physician by profession, injured his leg while climbing a mountain, he found himself in an unusual position -- that of patient. The injury itself was severe, but straightforward to fix; the psychological effects, however, were far less easy to predict, explain, or resolve: Sacks experienced paralysis and an inability to perceive his leg as his own, instead seeing it as some kind of alien and inanimate object, over which he had no control. A Leg to Stand On is both an account of Sacks' ordeal and subsequent recovery, and an exploration of the ways in which mind and body are inextricably linked. 'In every way a marvellously rich and thoughtful tale' Sunday Telegraph 'Oliver Sacks is a neurologist, a man of humane eloquence, and a genuine communicator. The value of this book lies in its willingness to combine the technical and the demonic, to admit poetry and philosophy and the religious impulse. It is also intensely personal, and affirms the community of human experience' Observer 'A remarkable, generous, vivid and thoroughly intelligent piece of writing' Sunday TimesCreate a review
About Author
Oliver Sacks is a physician and the author of many books, including The Man Who Mistook His Wife for a Hat, Awakenings (which inspired the Oscar-nominated film) and Musicophilia. Born in London and educated at Oxford, he now lives in New York City, where he is Professor of Neurology and Psychiatry at Columbia University. He is the first, and only, Columbia University Artist, and is also a Fellow of the Royal College of Physicians. In 2008, he was appointed Commander of the British Empire. For more information, visit www.oliversacks.comProduct Details
- publication date: 05/07/2012
- Format: Paperback
- Number Of Pages: 224
Delivery Information
- Saver Delivery: Yes
- 1st Class Delivery: Yes
- Courier Delivery: Yes
- Store Delivery: Yes


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Jaunita earings
Tassels earrings adorned with silver Ethiopian beads.
This piece was inspired by Juanita Daniel who is a South African Events Manager and Design Co-ordinator
She is a skilled Creative and Art Director, Producer and Choreographer.
*The Beads are imported from Ethiopia by Traders who travel to South Africa twice a year.
Please note this piece is subject to the availability of the silver beads


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I've been working hard on making some preparations for Lent not only for my children, but also for my 5th grade Faith Formation class. It's nice that I can use the same resources for both! A Lenten activity we have done in the past is making a sacrifice/good deed jar. It's a great way to get kids more involved during Lent.
So I decided to go ahead with this activity for my 5th grade class as well. In the past, I would have my kids put a bean into a jar for every good deed or sacrifice they did. This year I am changing things up a bit to make it easier for classroom use. I created "Lenten Deeds" tickets to put in a bowl instead. Each ticket has a certain deed that has to be done in a week. The "deeds" correspond to prayer, fasting, and almsgiving. Whether it be giving up video games for a week (fasting), reading from the Bible (prayer), or collecting food for the needy (almsgiving)...it's something that kids can do and feel good about.
The tickets have a space for the kids to sign their name once they complete their deeds as well as a space for the parents to sign as well. Coming up with good deeds and sacrifices was a lot harder than I thought!! But I think I have a good mix to keep things going all through Lent. Take a look at my tickets below!
I'll probably be printing this on some light purple, colored paper. But I'm loving that it's done and am excited to have it out for both my Faith Formation class and my kids at home!
Love it too? Well, just click on the links below and you can print them out for personal use! I made 3 different pages. Yes...I'm just that nice. ;)
Lenten Deeds Page 1
Lenten Deeds Page 2
Lenten Deeds Page 3
Saturday, March 5, 2011
4 comments:
- Laura O in AK said...
I LOVE these. Do you mind if I share about it on my blog??
daybydayinourworld.blospot.com - March 5, 2011 at 3:27 PM
- Liz said...
Thanks Laura! I'm glad you like them. Go ahead and share! Just make sure you link back to my page! :)
Liz - March 5, 2011 at 7:01 PM
- Gabrielle said...
Hi! These are great, and I'd love to use them with my classes, but I can't seem to print them. Is there a place I can find them elsewhere? Thank you!!
- March 17, 2013 at 12:28 PM
Thanks for granting me access! Will be sharing with my fifth grade Religious Ed group!
Nancy - February 1, 2016 at 4:43 PM
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Payments made easy with the Swiss mobile payment solution.
Pay using Paymit at some small merchants from today
The first shops and restaurants now accept Paymit, the most used mobile payment app in Switzerland. The one-month pilot phase for the first Paymit solution for cashless, mobile payments is starting today.


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If the children's room of small dimensions, it stands up to the parents the eternal question: how to do everything so that the child had the place to play, learn and receive friends.
now become very fashionable to combine the workplace (place to play) with the bed.Here's how:
This decision is overdue for a child at any age.If your kid goes to kindergarten, it will be is not only convenient, but also interesting. For what child does not like to sleep on top, and all the while climbing the stairs.
If your child is a pupil of the school, then the upper bunk is very conveniently located working place with everything you need: books, shelves, a computer and a desk.
big plus of such furniture is the use of almost the entire space. Stairs to the "second floor" can serve as boxes for toys or things. «Feet" second tier may also serve as shelves or shelving for books or any amenities.
creating room for your offspring, make sure that the furniture was the most convenient.To a child, working at the table, I could not concentrate on their studies and not to suffer too hard (or soft) chair and back pain.
These furniture sets produced only companies that have a variety of products and their manufacture by virtue of the exclusive. Without exception, furniture kits have the original design, which attracts the attention of children of all ages. Furniture kits can be chosen separately for girls and boys.
Correctly pick colors.Remember, furniture aggressive tones - disturbing the peace of your offspring, and even can lead to mental disorders.Keep it in warm colors, and the world will seem to your kiddies kind and calm.Furniture kits, made in warm colors affect the child's development in a creative direction.
choosing furniture, pay attention to its security.Sometimes, hurrying somewhere or sparkle, the child may not notice projecting an acute angle, and cause injury. sure that the furniture had sharp and protruding elements.If such still present, the buy in any furniture store set for children's safety, which will hide all sharp angles.
Furniture kits manufactured in such a way that they can be transformed.For example, a table for pre-school child in the future you can turn the table in the student.
buying such furniture can periodically change the situation in the nursery.


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Saturna Capital Corporation, investment adviser to the Amana, Sextant, and Idaho Tax-Exempt Mutual Funds, has launched the Sextant Global High Income Fund, which bets on a globally diversified portfolio of debt and equity securities.
The fund is co-managed by Bryce Fegley and John Scott, who have been members of the Saturna investment team since 2001 and 2009, respectively. They will work closely with Saturna's chief investment officer Nicholas Kaiser.
Sextant Global High Income Fund will be marketed to baby boomers as well as to risk-averse, income-seeking investors.
"The baby boomer generation is expected to face challenges in generating income for retirement, due to lower economic growth, lower yields on U.S. government bonds, and potential inflation," said Fegley, in a statement.
"On top of that, the ratio of retirees to workers in the U.S. will increase by 75% over the next 15 years, potentially triggering a generational wave of market sell-offs as retirees draw on their 401(k)s. Our new fund is a solution to the downward pressure we expect to negatively impact U.S. security values," he added.
On the fund's prospectus, the management fee is listed as 60 basis points, but the prospectus says it will vary based on performance.
The assets that the fund will target include the 1200 largest dividend-paying common stocks, targeting yields above 4%; global high yield bonds, including sovereigns and U.S. high-yield corporates; and, to a lesser extent, preferred stocks.
Tommy Fernandez writes for Money Management Executive.


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Web usage on tablets and smartphones is growing quickly and set to pass laptop and desktop usage. On our own site, Gogobot, we saw a 133% increase in mobile usage and a 300% increase in tablet usage over the last year. And by now more than 40% of our travel reviews and photos are coming from mobile. These new phones have huge screens and tablets have high-resolution displays (most notably, Apple's Retina screens). Naturally, users now…
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Career Jam is our largest on-campus networking event of the year! Held during Celebration Weekend, this event brings parents, alumni, employers, and students together for conversation around a topic on every student's mind: CAREERS! This is an opportunity for students to connect with professionals in their field of interest to learn about graduate school, interviews, resumes and potential job or internship opportunities! Join us on Friday October 20th from 3-5 pm at Murray-Aikins 2nd Floor. If you have any questions regarding this program, please contact Lauren Sisson at email@example.com.
Students: If you are interested in attending, please RSVP using your MyCDC Account! |
Mentors: If you are interested in attending, please RSVP by filling out this form! |


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General editor Lloyd J. Ogilvie brings together a team of skilled and exceptional communicators to blend sound scholarship with life-related illustrations.
The design for the Preacher's Commentary gives the reader an overall outline of each book of the Bible. Following the introduction, which reveals the author's approach and salient background on the book, each chapter of the commentary provides the Scripture to be exposited. The New King James Bible has been chosen for the Preacher's Commentary because it combines with integrity the beauty of language, underlying Hebrew and Greek textual basis, and thought-flow of the 1611 King James Version, while replacing obsolete verb forms and other archaisms with their everyday contemporary counterparts for greater readability. Reverence for God is preserved in the capitalization of all pronouns referring to the Father, Son, or Holy Spirit. Readers who are more comfortable with another translation can readily find the parallel passage by means of the chapter and verse reference at the end of each passage being exposited. The paragraphs of exposition combine fresh insights to the Scripture, application, rich illustrative material, and innovative ways of utilizing the vibrant truth for his or her own life and for the challenge of communicating it with vigor and vitality.
Contributor(s) | James Philip |
About the Contributor(s) | James Philip Dr. James Philip retired in 1997 after fifty years of pastoral ministry, the last forty as minister of Holyrood Abbey Church of Scotland in Edinburgh. His scholarly and prophetic expository ministry was widely influential in Scotland and beyond. His Bible notes and many books continue to help ministers, teachers, and theological students throughout the world. Serving the Word of God, a collection of essays celebrating his life and ministry was published to mark his eightieth birthday in January, 2002. |
Release Date | Jul 30, 2004 |
Weight (lbs) | 1.2000 |
Height | 8.9 |
Width | 6 |
Length | 336 |
Length Unit | Pages |
Publisher | Thomas Nelson |
Price | $19.99 |
Who It's For | Pastor |
Series | The Preacher's Commentary |
Format | Paperback |
Language | English |


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Group therapy is a recognised means of helping people to develop self-awareness and overcome their problems. Unfortunately, there are a number of factors that can hamper the individual and the group process. Resistance is a major issue that often emerges in group therapy. In this essay the nature of resistance and the reasons for its prevalence will be explored, together with strategies the facilitator can implement to manage this issue within the group process and dynamics. Before this can be achieved it is important to provide an overview of group process.
According to Corey, group process consists of six stages. These are the formation (pre group issues), initial (orientation), transition, working, final stages and post group concerns including evaluation and follow-up issues (Corey, 2004). Corey goes on to explain the stages. In the formation phase the facilitator is preparing the group, announcing the group, formatting and structuring the group, recruiting, screening and selecting members. The initial stage consists of the group members spending time in becoming oriented with the group and exploration within the group context (eg. building trust, self-identity within the group, identifying goals etc). The transition stage is about dealing with resistance, conflict, defensiveness and other behaviours that may arise in the group participation. In the working stage, is a more in-depth exploration of significant problems and issues in order to bring about changes that better address the personal struggles of group members. The final stage is about consolidating and integrating what has been learned in the group and putting it into practice in the group member's every day life issues. The last stage, the post group issues, looks at the evaluation, termination and follow-up aspects of the group.
"The concept of resistance began to take shape in psychology with the development of psychoanalytic theory" (Buetler et al, 2001: 431). The Oxford English Dictionary defines resistance as "withstand the action or affect of. Try to prevent by action or argument. Refrain from (something tempting). Struggling against" (Oxford English Dictionary). Corey develops this in the group context, noting that: "The term 'resistance', as applied to a client's behaviour, implies the refusal to co-operate or change and is a form of active opposition to the therapist's influence". Resistance can be classified as a behaviour that can keep members from exploring personal issues or painful feelings in depth (Corey, 1995: 16).
Resistance is a common struggle or problem within the context of group dynamics and process. This behaviour can occur at any stage of any group process and can impede the group dynamics and process and can be projected in many and various ways. Human beings are all different and all develop different coping mechanisms. The different ways in which we cope or do not cope in various situations, become ingrained into our beings. There are many different reasons and causes of a group member's resistance, as well as different levels of resistance within that. Egan suggests that: "Many socio-psychological variables such as sex, prejudice, race, religion, social class, upbringing and cultural and subcultural blueprints can play a part in resistance" (Egan 1982: 297). Examples of this kind of resistance include, for instance a man resisting being helped by a woman, a black person resisting help from a white person and vice versa.
Resistance may occur in all stages of group process, but mainly occurs in the earlier stages and mostly in the transitional stage. Members are starting to self-disclose, find their place within the group, build trust and out of this conflict and tension may arise. My own experiences of resistance occurred in the early stages of group process (from the beginning), especially in finding my place within the group and self-disclosing. However, resistance may also occur...


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Kubernetes Networking Internals
Kubernetes works on the principle of assigning IP addresses to pods, called as "IP-per-pod" model. The IPAM (IP address management) task is left to third party solutions. Some of these solutions include Docker networking, Flannel, IPvlan, contive, OpenVswitch, GCE and others. The Kubernetes architecture consists of master node, replication controller..


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Ziti with Honey Mustard Salmon
Rich salmon, roasted and flaked into a creamy, honey-mustard sauce is an ideal counterpoint to toothsome ziti here.
- 1 lb. salmon fillet
- 1 tbsp. honey
- ½ tsp. fresh-ground black pepper
- 1 tbsp. Cooking oil
- 1 onion
- ⅓ c. dry white wine
- 1 tsp. grainy or Dijon mustard
- ¾ c. heavy cream
- 1¼ tsp. salt
- 2 tbsp. chopped fresh parsley
- ¾ lb. ziti
- Heat the oven to 400°F. Lightly oil a small roasting pan. Put the salmon in the pan, skin side down. Spread the honey over the salmon and then sprinkle with 1/4 teaspoon of the pepper. Roast the salmon until just barely done, about 12 minutes, depending upon the thickness of the fillet. Remove from the oven.
- In a medium saucepan, heat the oil over moderately low heat. Add the onion and cook, stirring occasionally, until translucent, about 5 minutes. Add the wine and simmer until about 1 tablespoon remains, about 2 minutes. Whisk in the mustard, cream, salt and the remaining 1/4 teaspoon pepper. Turn off the heat. Flake the salmon and stir it and the parsley into the sauce.
- In a large pot of boiling, salted water, cook the ziti until just done, about 13 minutes. Drain the pasta and toss with the sauce.
- Wine Recommendation: With the sweetness of the honey and the heat and acidity of the mustard, a fruity red wine such as a slightly chilled California pinot noir would be an excellent choice.
like this
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Our guest speaker program is for the current faculty and student community to gain exposure to additional educational experiences by bringing in experts on various topics throughout the year.
September 13 October 25 |
Chef Pink On Sunday, September 13th , CHEF PINK aka Crystal DeLongpré and her wife, Courtney Rae DeLongpré, owners of local restaurant Bacon and Brine gave a lecture at Midland entitled NOSE TO TAIL EATING. The DeLongprés discussed how important it is to utilize the whole animal when consuming meat as part of a diet and advised on how to create zero waste with whole animal butchery, while ensuring maximum nutrition. Bacon and Brine, and Chef Pink, have been featured in many articles, including in the Huffington Post, and the Santa Barbara Independent. Chef Pink was featured on the Food Network in Cutthroat Kitchen, a popular television show. Gary Margolis |
November 26 January 18 |
Thanksgiving MLK Day |
February 21 |
Wilrich Lecture Jane Woodward and Karl Knapp, Consulting Professors in Stanford University's Department of Civil and Environmental Engineering and CEO and Vice President of Energy Education at MAP, spoke to the Midland community about the present and future of renewable energy in California, the United States, and the World. Jane, who has taught energy classes at Stanford since 1991, and Karl, who has co-taught with Jane for many years, drew from their Stanford lectures as they take turns describing several key ideas about renewable energy with Midland students. |


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Results 1 to 7 of 7
Anyone know of a decent free one for Windows? Thanks, Jay
itunes ? Doesn't itunes do AAC etc for windows ? Chris
Originally Posted by fizbin Anyone know of a decent free one for Windows? Thanks, Jay Nero AAC Codec. Free and excellent quality. Mac .
Mac Don't be worried about your anosognosia. Being a professional is not about how good you are at your best, but how good you are at your worst. Creating complex solutions is easy.
Originally Posted by MacGregor Nero AAC Codec. Free and excellent quality. Mac . Thanks - that one worked great - no iTunes necessary - just a little command line thingy.
Last edited by fizbin; April 19th, 2008 at 09:23 PM.
We normally post this info in the "Post It" thread, but since you're asking, here's more about AAC... AAC Files (aka MP4 or M4A) We prefer AAC (aka MP4) files to MP3. They sound better, use more efficient data compression, + are much better @ handling audio frequencies above 16 kHz. If you care about sound, you should be using AAC files instead of MP3. You can read more about them here on wikipedia. Recommended AAC Encoding Applications:foobar2000 (requires Nero AAC Codec) Winamp RealPlayer iTunes
Facebook | MySpace | eSession "Digital banjos sound just as bad to me as analog ones." -Pimp-X
For Windows, I've been using the free MelodyCan for a long time. It works great.
Hi, I can recommend you a good converter I often download video files for my iPod. I have Windows 7 and I usually I use Convert-tune Convert-tune , it is easy to use and it converts video to MP4, WMV, AVI and 3gp. In addition, it features free CD ripper and CD burner.
Forum Rules


text: Anderson Anderson is 29 years old male from Cianorte, Brazil. He is interested in meet new people. 29, male, Cianorte Likes: 34x Facebook profile Who s/he liked? Send message Favorite May she/he ask you for a date? Never Maybe Sure Relationship: ShowSexuality: ShowHeight: ShowWeight: ShowBody type: ShowEye color: ShowHair color: ShowLiving: ShowKids: ShowSmoking: ShowDrinking: Show Report photo Sign up to see all photos Facebook Twitter Google+ Pinterest Similar users Mike 28, Texas City Family Kelly 27, Sod Kevin 31, Charleston Nick 31, Laurel Bradlee 26, Sheridan Donovan 26, Omaha Justin 26, Portsmouth Edy 29, San Mateo Jacob 31, Washington MusicMovies


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How to avoid Penny Stock Scammers?
Penny Stock market is full of manipulations, frauds and scams, so you have to learn how to avoid being scammed by fraudulent penny stock dealers. Some suggestions are;
- There is difference between promotion and research. You can view more penny stock research tools on here. Promoters recruit newsletter writers to make reports on their stocks; many of them make appealing case for investing in unworthy stocks. You as penny stock investor should know difference between stock promotion and valid equity research. One must read the disclosures given at the end of such reports
- Success of the company depends on its management, same is the case with penny stock companies, and you need to find out company management track record like failures and success.
- Penny stocks generally don't provide detailed financial information, but it is necessary for you to check financial statements of the company. Analyze the complete balance sheet to find out is company has any outstanding debt or liabilities as well as to know the cash flow and liquidity.
- Focus on quality of disclosure, if company provides better disclosure, it will help you to judge companies position. Avoid investing in company with, low or no information. For example OTC market groups categorize its shares into three-tier market place OTCQX(the top one) OTCQB(Middle One) and OTC pink depending upon transparency of company's operations
- Investor should assess the company's business plan whether the given plan is achievable for particular company or not. Companies should have appropriate asset base to execute its plan.
Penny stocks are highly speculative investment options, and one should approach this type of stock with caution. Investor should follow proper trading and investment strategy. You can avoid scams by following these suggestions given above. Investing smartly and logically can increase the chances of success even in risky trading.


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Simple DirectMedia Layer
Version: | 1.2.15 |
Revision: | 2 |
Branch: | stable |
Dependencies [Show all dependencies]
- alsa-lib: Advanced Linux Sound Architecture library
- x11: Base X libs
- xext: X Extension library
Reverse Dependencies
- extremetuxracer: racing game featuring tux
- ffmpeg: multimedia system containing many audio/video codecs
- gstreamer-plugins-bad-1.0: audio/video codecs and other plugins for gstreamer
- libdv: software library for DV format digital video
- lincity-ng: LinCity-NG is a City Simulation Game.
- mplayer: The Movie Player
- openttd: open source simulation game
- qemu: FAST! CPU Emulator
- SDL_gfx: SDL graphics drawing primitives and other support functions.
- SDL_image: SDL image loading library
- SDL_mixer: SDL audio mixer library
- SDL_ttf: SDL truetype font library
- smpeg: SDL MPEG Player Library
- supertux: SuperTux is a jump'n run like game, with strong inspiration from the Super Mario Bros games for Nintendo.
- VirtualBox: general-purpose full virtualizer for x86 hardware
- VirtualBox-guest: Guest additions for paldo installations running in a VirtualBox VM
Build on x86_64 (glibc-2.25-gcc-6-1)
Installed Size: | 1128 KB |
Build Duration: | 0 min |
Build Date: | 2017-03-13 00:14:25 GMT |
Build Host: | buildd4.paldo.org |
File List
Build Log
Download Package


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- You are here:
- Home
- Government
- Departments
- Surveyor
- Plat Review
Plat Review
Plat Checking
- Subdivision and CIC Plat, or registered land survey (RLS): $300 per plat + $35 per lot
- Fee Calculator
- Plat Recheck Fee: $75
- Payment Methods: We accept cash or checks for the amount of the purchase. Make checks payable to:
Wright County Surveyor
3500 Braddock Ave NE
Buffalo, MN 55313
Title Opinion / Title Commitment
Wright County requires title opinions or title commitments to be submitted with every plat.
Other Requirements
- Please submit two paper copies of the final plat for checking
- We also need the correct fee paid when the plat is submitted before review will begin (see the Fee Schedule)
- Please submit an electronic point file (ASCII, CSV, or TXT etc.) and point plot drawing with the final plat
Wright County requires two mylar sets for recording. One set needs to be marked "Official Plat" and the other set "Copy." Please mark the mylars.
Plat Manuals
- Manual Of Guidelines For Platting In Minnesota - Adopted by Minnesota Society of Professional Surveyors (MSPS) and Minnesota Association of County Surveyors (MACS) in December 2009
- CIC Plat Manual of Minimum Guidelines - Adopted by Minnesota Society of Professional Surveyors (MSPS) and Minnesota Association of County Surveyors (MACS) in February 2015
- Note: Certificates and signatures for a CIC created after August 1, 2010, should be in accordance with Minnesota Statutes, Section 515B.2-1101 not 515B.2-110
Platting Adjacent to County Roads
The Wright County Highway Department requires a review of all plats adjacent to county roads. You can download the Preliminary Plat Review Form in PDF file format. The current Highway Department review fee is $250.
Contact Us
Eric Stennes
Plat Review
3500 Braddock Ave NE
Buffalo, MN 55313
Ph: 763-682-7889
Fx: 763-682-7313
Monday - Friday
8 a.m. - 4:30 p.m
Staff Directory


text: Born 1928. Living at 47 James Street, a family of 8 in two rooms. Opposite was Paddy's Market open on Saturdays lots of fun. We played "Hucky Duck", "Reely fo", "Kick the Can" and "Skiffies" at Mr. Geekie's sweet shop in Alexander Street and only a wee walk to the "Peek". Dundee will forever by in my heart...xxx.


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Tag Archives: financial planning
Oh Yes They Did! Millions Committing 'Financial Infidelity'
New survey finds many hiding money moves from significant others
Every relationship has different boundaries and expectations and the only way to find them is…
By Stacey Tisdale
[Study] Women Are Feeling Financially Empowered
More women trusting financial instincts
"In fact, American women and men have a lot to learn from one another, as…
By Stacey Tisdale
Soulful Sax Sensation Marcus Miller Shares Most Important Money Lessons
Series: The 3 most important lessons I've learned about money
"The richer you are as a person and the more competent you are as a…
By Stacey Tisdale
Creating a Financial Life Plan: Where to Begin
How to set financial goals
This story gives readers tools to connect with their highest ideals and priorities so that…
By Stacey Tisdale
Why Women Should Save Money Differently Than Men
Author Terrell Dinkins says 'mars/venus' rule should apply to finances
"Because of divorce, widowhood or remaining single, many of us will have to carry the…
By Stacey Tisdale
How Your Attitude About Race Affects Your Wallet
What happens when we fit our own stereotypes
Here we discuss 'inherit bias' – and how your attitude about race affects your wallet.
By Stacey Tisdale
Rising Home Prices Making Consumers Nervous
Conflicting reports show uncertainty about the economy
The mixed housing data and the recent uncertainty about the economy and financial markets have…
By Stacey Tisdale
America Saves Week: Train Your Brain to Save Money
Part 2 - Move past your natural tendency to avoid long-term planning
Behavioral finance experts say, however, before we start beating ourselves up, we need to take…
By Stacey Tisdale
[Watch] Get Rid of Student Loan Debt in 3 Years!
B.E. Senior Editor Stacey Tisdale discusses often overlooked ways to tackle student loans
As student loan debt becomes a defining economic issue of our time, it's more important…
By Stacey Tisdale
Striking a 'Rich' Balance Between Saving for Retirement and Their Children's Education
The Rich family finds the right balance between retirement savings and education costs
Parents feel a responsibility to help their kids get through college without an enormous debt…
By Stacey Tisdale
Is Your Student Loan Debt Affecting Your Child's Education Plans?
Survey finds parent's student loans hurting ability to help kids
For many, it's more than guilt and emotions, particularly when it comes to younger parents.…
By Stacey Tisdale
[WATCH] Millennials Resorting to Payday Loans to Help Make Ends Meet
Here are some better ways to manage day-to-day financial challenges
"Millennials confront greater difficulties – including economic uncertainty, student debt – than those who came…
By Stacey Tisdale
The 3 Things That 'Really' Make Goals a Reality
The scientifically proven formula for success
Psychology professor Gail Matthews from Dominican University in California, heard about an often cited study…
By Stacey Tisdale
Part 1: How to Make Financial Resolutions Stick
Getting clear on what really matters is the first step
Don't fall into the trap of getting so focused on the numbers that you forget…
By Stacey Tisdale
[Study] Better Finances Mean Fewer Money Resolutions For 2016
Fewer Americans are making New Year's resolutions about money
While results indicate feeling good about our 'personal economies' relieves a sense of urgency and…
By Stacey Tisdale
Part 2: How to Make Financial Resolutions Stick
There's a science to change
"Change is a process. The key to successfully changing behavior is knowing where you…
By Stacey Tisdale
[WATCH] BE's Stacey Tisdale Talks Keeping Spending and Emotions in Check on ABC's 'Here and Now'
Protecting your budget from the holiday urge to splurge
'Tis the season when even the best budgeters have a hard time staying on track,…
By Stacey Tisdale
3 Questions to Keep Your Emotions and Spending in Check this Holiday Season
Taking an honest look at why you feel pressured to spend
There's more to holiday overspending than just dollars and cents. This story looks at some…
By Stacey Tisdale
Ho Ho No! Parents Tapping Retirement to Buy Holiday Presents
Survey finds parents sacrificing short and long-term financial security
"Our long-term goals, such as retirement savings and having an emergency fund, should always take…


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No Capital Budget? Short-term Project? Systems are available from Compix for short term rentals. The minimum rental periods vary depending on the camera selected. Rentals may be extended on a week-to-week or month-to-month basis. Rental period begins two days after shipment via UPS second day air and ends upon date of receipt at Compix. If, during the first month, the decision is made to purchase the system then the first month's rental is credited against towards the purchase price.
Rental Prices
Rental does not include a computer, which is required for the Model 222. Rental rates do not include extra cost options or accessories.
Up to 2 weeks for unscheduled orders, depending on inventory on hand. Contact us for current availability or to schedule a rental start date.
Purchase Option
Try before buying. We offer 100% credit of your first month's rental when you convert to a purchase within the first 30 days. Rent to buy. For longer term rentals, 65% of payments are credited towards the purchase price.
Compix warrants the system during the rental period under the same terms as its standard product warranty. If the system is out of service during the rental period for reasons covered under the warranty, the rental period will be extended at no charge for a period equal to the time out of service. After the first month, a pro rata refund may be applied, or rental may be extended for the time out of service at customer's option.


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- lists
- blocks
Common words appear frequently in written and spoken language across many genres from radio to academic journals.
Informal words should be reserved for casual, colloquial communication.
Synonyms for grandiloquence
More words related to grandiloquence
noun. brag; source of pride
noun. skillful way with words
noun. nice way of saying something
noun. public speaking
noun. wordiness; long speech
Roget's 21st Century Thesaurus, Third Edition Copyright © 2013 by the Philip Lief Group.
Cite This Source


text:
A Victory Inn & Suites- Muskegon is located within a few miles (5 km) of Lakeshore Bike Trail and Hackley and Hume Historic Site. This 110-room hotel has an indoor pool, free in-room WiFi, and free self parking. It's also close to USS LST 393 and Lake Express Ferry Terminal.
All 110 air-conditioned rooms provide free local calls and ironing boards. Guests can expect to find free WiFi and cable TV.
Property features
Guests staying at A Victory Inn & Suites- Muskegon enjoy an indoor pool, a sauna, and free WiFi in public areas. If you decide to drive, there's free parking. The front desk is staffed 24/7 to help with dry cleaning or laundry, and answer any questions about the accommodations. Additional amenities include conference space, coffee/tea in a common area, and a TV in a common area.
- Free WiFi in rooms and public areas
- Free parking
- Indoor pool
- 24-hour front desk
A Victory Inn & Suites- Muskegon
Hotel Amenities
Hotel Amenities
A Victory Inn & Suites- Muskegon features an indoor pool and a sauna. High-speed wireless Internet access is complimentary. This Muskegon hotel also offers coffee/tea in a common area, dry cleaning/laundry services, and discounted use of a nearby fitness facility. Onsite self parking is complimentary.
- 24-hour front desk
- Coffee/tea in common areas
- Conference space
- Dry cleaning/laundry service
- Elevator/lift
- Number of floors - 4
- Total number of rooms - 110
- RV, bus, truck parking
- Pool sun loungers
- Free self parking
- Sauna
- Number of buildings/towers - 1
- Steam room
- Indoor pool
- Television in common areas
- Use of nearby fitness center (discount)
- Free WiFi
Family Friendly Amenities
- Family Hotel
- Indoor pool
- Free Wi-Fi
- Refrigerator (on request)
- Microwave (on request)
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Free self parking, RV, bus, truck parking
Room Amenities
A Victory Inn & Suites- Muskegon offers 110 air-conditioned accommodations with irons/ironing boards and blackout drapes/curtains. Cable television is provided. Rooms have partially open bathrooms. Bathrooms include shower/tub combinations.
This Muskegon hotel provides complimentary wireless high-speed Internet access. Business-friendly amenities include phones along with free local calls (restrictions may apply). Microwaves, refrigerators, and hair dryers can be requested. Housekeeping is provided daily.
- Air conditioning
- Phone
- Hair dryer (on request)
- Cable TV service
- In-room climate control (air conditioning)
- Free local calls
- Daily housekeeping
- Iron/ironing board
- Microwave (on request)
- Partially open bathroom
- Refrigerator (on request)
- Shower/tub combination
- Connecting/adjoining rooms available
- Free WiFi
- Blackout drapes/curtains
Nearby Things to Do
Recreational amenities at the hotel include an indoor pool and a sauna.
If you have requests for specific accessibility needs, please note them at check-out when you book your room.
- Accessible bathroom
- Roll-in shower
- In-room accessibility
Hotel Policies
Check-in time starts at 3 PM
Check-out time is 11 AM
Payment types
Children and extra beds
- Children are welcome.
- Pets not allowed
You need to know
Extra-person charges may apply and vary depending on property policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
No rollaway/extra beds available
No cribs (infant beds) available
Hotel Name
- Victory Inn Muskegon
- Victory Muskegon
We should mention
The property has connecting/adjoining rooms, which are subject to availability and can be requested by contacting the property using the number on the booking confirmation. Set meals are served in guestrooms only (no menus or public dining).


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Toko US with Ian Harvey has put together a series of tuning and waxing videos. Many of the videos include Willi Wiltz, the infamous WC ski tech.
This video shows how to apply cold powder wax along the ski edge to minimize excessive base burn which can occur in highly abrasive snows, such as man made or icy conditions.


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Sugar Cookies Every Way
Related To:
Classic Sugar Cookies
These are the familiar cookies, with crispy edges and a slightly soft middle. Superfine sugar gives them their crunchiness. The small amount of baking powder ensures that they puff just a little without spreading too much and losing their shape.
Get the Recipe: Classic Sugar Cookies
Brown Sugar Cookies
These cookies have a warm toffee note from the brown sugar. Add spices like cinnamon, ginger and nutmeg for another variation.
Get the Recipe: Brown Sugar Cookies
Chewy Sugar Cookies
This version of the sugar cookie has a slightly crispy edge and a super-chewy center, thanks to increasing the sugar and baking at a higher temperature. Roll the cookies in colored sugar instead of granulated for a sparkly upgrade.
Get the Recipe: Chewy Sugar Cookies
Soft Sugar Cookies
This is a soft and tender version of traditional roll-out sugar cookies — thanks to an extra egg. For a sparkly option, roll the dough in colored sanding sugar.
Get the Recipe: Soft Sugar Cookies
Chocolate Sugar Cookie Cut-Outs
These crisp-chewy cookies are a chocolatey alternative to traditional roll-and-cut sugar cookies, and great for decorating. If you prefer slightly thinner, crisper cookies, roll the dough 1/8 inch thick, and bake the cookies for about 8 minutes.
Get the Recipe: Chocolate Sugar Cookie Cut-Outs


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To choose between two equally bad alternatives in a serious dilemma.
When a person really wants to do something, he will find a way of doing it.
A burnt child dreads fire
A bad experience or a horrifying incident may scar one's attitude or thinking for a lifetime.
First come, first served
The first in line will be attended to first.
A friend in need is a friend indeed
A friend who helps when one is in trouble is a real friend.
A hungry man is an angry man
A person who does not get what he wants or needs is a frustrated person and will be easily provoked to rage.
Empty vessels make the most noise
Those people who have a little knowledge usually talk the most and make the greatest fuss.
An ounce of discretion is worth a pound of wit
It is better to be careful and discrete than to be clever.
A penny saved is a penny gained
By being thrifty one will be able to save up.
Barking dogs seldom bite
Those who make loud threats seldom carry them out.
Better late than never
To do something that is right, profitable, or good a little late is still better than not doing it at all.
A bird in hand is worth two in the bush
Something that one already has is better than going after something seemingly more worthwhile that one may not be able to get.
Birds of a feather flock together
People of the same sort of character or belief always go together.
Call a spade a spade
If you say that someone calls a spade a spade, you mean that they speak frankly and directly, often about embarrassing or unpleasant subjects; an informal expression.
Charity begins at home
A person's first obligation should be to help the member of his own family before he can begin thinking of talking about helping others.
Every cloud has a silver lining
If you say that every cloud has a silver lining, you mean that every sad or unpleasant situation has a positive side to it. If you talk about silver lining you are talking about something positive that comes out of a sad or unpleasant situation.
All that glitters is not gold
Do not be deceived by things or offers that appear to be attractive.
Don't put all your eggs in one basket
One should not risk everything he has in a single venture.
Every one can find fault, few can do better
It is easier to find fault in other people's actions or methods than to do it properly or correctly.
Fair exchange is no robbery
A contract is fair as long as both the parties understand and agree to the conditions willingly; after a deal is closed neither side can turn around and say that he was unfairly treated.


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Published byAustin York Modified about 1 year ago
Transcutaneous Aortic Valve Implantation (TAVI) Dr Sandeep Mohanan Senior Resident Government Medical College, Calicut 1
OVERVIEW BACKGROUND : AS-EPIDEMIOLOGY? BACKGROUND : AS-EPIDEMIOLOGY? MANAGEMENT OF AORTIC STENOSIS AND ROLE OF TAVI MANAGEMENT OF AORTIC STENOSIS AND ROLE OF TAVI THE ADVENT OF TAVI THE ADVENT OF TAVI CURRENT DATA AND EVIDENCE FOR TAVI CURRENT DATA AND EVIDENCE FOR TAVI TAVI- HARDWARE, PLANNING and PROCEDURE TAVI- HARDWARE, PLANNING and PROCEDURE PROS & CONS OF TAVI PROS & CONS OF TAVI ADVANCES IN TAVI ADVANCES IN TAVI THE FUTURE FOR TAVI THE FUTURE FOR TAVI
BACKGROUND - Progression and Natural history of AS Progression from moderate AS: - mean velocity increases by 0.3m/s/yr, -mean gradient increases by 7mmHg/yr, -AVA decreases by 0.1cm 2 /yr (depends on leaflet calcification, age, bicuspid valve etc) Once even mild symptoms develop prognosis drops Event free survival of severe asymptomatic AS: 30-50% at 2years (AHA 2014 guidelines) Mortality for symptomatic severe AS : 50% at 2years (Otto et al. AS. NEJM Aug2014)
Prevalence of severe AS among 50-59yrs : 0.2% among 60-69yrs :1.3% among >70-79yrs : 3.9% among octogenarians: 9.8% 1,2 With each decade risk of incident AS doubles 2 As age increases, disease acceleration also increases 1 BACKGROUND - Progression of AS with age 1.Eveborn et al. The evolving epidemiology of valvular aortic stenosis. Heart 2013 2.Stewart et al. Clinical Factors Associated With Calcific Aortic Valve Disease. JACC 1997
BACKGROUND: Population explosion and AS -Indian male ~ 67years Indian female ~ 70 years (Kerala: ~75 and ~79 yrs resp.) -India has ~100 Million in population >60 years 3 (9% of total) ~ 5 million AS !!! 1 ~ 5 million AS !!! 1 ->1/3 of severe AS not suitable for Sx 1)Aortic stenosis. Indian Heart Journal 2009. 2)UN data on world population 2013 3)Indian population statistics 2014
SURVIVAL in AS Cribier A. Development of transcatheter aortic valve implantation (TAVI): a 20-year odyssey. Arch Cardiovasc Dis. 2012;105(3):146–52
MANAGEMENT OF AORTIC STENOSIS Medical management has little to offer for severe AS patients Timing of AVR in AS patients (Valvular Heart Disease AHA guidelines 2014
Algorithm for AS management
AHA 2014 on SAVR vs TAVI for AS
NEED FOR TAVI IN AS Around 1/3 rd (27-41%) 2 of severe AS patients in the real world are deemed unsuitable for surgery ~50-70-% die by 2years 1 Acquired AS is increasing along with multiple comorbidities Elderly are scared & reluctant after SAVR risk counselling People prefer and demand minimally invasive techniques, local anaesthesia and quick discharge 1.Iung B. The EuroHeart Survey on Valvular heart disease. EHJ 2003 2.Bach DS et al. Unoperated patients with severe aortic stenosis. JACC 2007
ADVENT OF TAVI Henning Anderson (1992) : 1 st TAVI in a pig model Dr Alain Cribier (April 16, 2002): 1 st TAVI in human - A bail-out procedure in a very high risk dying patient "Few innovations in contemporary medicine has captured the imagination as thoroughly as the promise of percutaneous implantation of heart valves" 'TAVI pandemic': ~ 1,00,000 TAVI done in 1 st decade Several observational studies in inoperable patients from 2002 to 2008
Early data on TAVI
PARTNER trial Multicenter RCT (US + Europe) from 2007 to 2009 Severe calcific AS (0.8cm 2, 40mmHg, 4m/s ) with high or very high risk Cohort B : PROM >50% or serious irreversible condition Cohort A: STS ≥10% or surgeon PROM ≥ 15% based on coexisting morbidity EXCLUSION: Bicuspid AoV, non-calcified AS, severe CAD requireing revasc., a/c MI, TIA or stroke 25mm, severe MR/AR, advnaced CKD, TAVI with Edward Sapiens valve (23 or 26mm)
PARTNER Cohort B results -N=358 -Mean STS : 11.6 ± 6% -15% porcelain aorta, -13% chest deformity, -24% severe resp illness -23% Frailty -30 day mortality- 6.4% - ARR ~ 20% at 1 year (30.7% vs 50.7%, P<0.001)) -NYHA 3/4 symptoms at 1yr : 25% vs 58% - TAVI superior -AT 2 years TAVI –> Mortality was 43% for TAVI vs 85% for standard treatment (NNT <3!!!). -The high mortality is attributed to the significant co-morbidities. ( Makkar et al. Transcatheter Aortic-Valve Replacement for Inoperable Severe Aortic Stenosis. N Engl J Med 2012;366:1696-704.)
PARTNER Cohort A results N= 699 30 day mortality- 3.4% vs 6.5% 2years: - Mortality : 34% for TAVI vs 35% SAVR - no difference in MACCE Similar benefits in hemodynamics and NYHA No difference in stroke at 2years More paravalvular leak for TAVI leading to higher late mortality More vascular complications (11% vs 3%) Major bleeding and AF higher for SAVR Better quality of life for TAVI Females had mortality benefit in TAVI cohort (JACC April 2014)
PARTNER Cohort A echocardiography
PARTNER Cohort A symptom status
PARTNER Cohort A: Impact of AR Cause of AR: -Pattern of valve calcification - Undersizing of the valve - Valve placement Even mild AR increased mortality Moderate/severe AR occured in ~10%
US Core Valve investigators: TAVI vs SAVR in high risk (NEJM May 2014) 19 Medtronic Core valve (2011-2012) Heart team PROM> 15% N=795 mean STS of 7.4% More people declined SAVR 1 yr mortality— 14% vs 19% SAVR had higher major bleeding, stroke, AF and AKI TAVI had more PPIs and vascular complications Noninferior for NYHA, quality of life and echo-indicis All TAVI attributed complications decreased significantly from previous analysis TAVI is superior to SAVR
EDWARDS SAPIEN VALVE ( Edwards Lifesciences, Irvine, CA). SAPIEN THVS : model of the 1 st human TAVI Approved in Europe in 2007 and USA in Nov 2011 Balloon expandable stainless steel stent frame 3 bovine pericardial leaflets Inner polyethylene terephthalate fabric skirt in bottom portion to prevent leak The system is crimped onto a balloon catheter '23mm' : 18 -22mm annulus, 22F, MVD -7mm '26mm' : 21 -25mm annulus, 24F, MVD - 8mm
EDWARDS SAPIENS newer gen valves SAPIEN XT: - Cobalt chromium stent frame more radial strength -New leaflet geometry Better function, coaptation and lower profile -23mm (18F), 26mm (19F), 29mm - 16 F is esheath is used - Up to 27mm annulus size SAPIEN 3: -14 F -Additional outer PET fabric skirt -20mm, 23mm, 26mm, 29mm -Annulus size from 16mm to 28mm -No deaths, stroke, vascular compl or >2+PVL in a study on 15 patients (Binder et al. TAVR with Sapien 3. JACC Cardiovasc Interv 2013)
EDWARDS SAPIEN Delivery systems TRANSFEMORAL -Retroflex system: SAPIEN THV -Novaflex system: SAPIEN XT -Commander system: SAPIEN 3 TRANSAPICAL/ TRANSAORTIC -Ascendra/ Ascendra plus sytems: SAPIEN THV & XT -Certitude system : SAPIEN 3
COREVALVE RE-VALVING SYSTEM (Medtronic, Minneapolis) A trileaflet porcine pericardial bioprosthetic valve Mounted in a multilevel self-expanding Nitinol frame Upper third- low radial force - sits in the ascending aorta so as to orient the valve into the aortic root Middle third - high hoop strength (valve attached here) Lower third- high radial strength- sits in the LVOT --has a skirt of pericardium that seals the system
Core valve sizes and anatomic requirements 18 F sheath MAD- 6mm
TAVI selection criteria Patient and prosthesis selection are crucial in determining outcomes HEART TEAM: Cardiologist, CVTS, cardio-radiologists, cardiac- anaesthetists Patient selection: STS score >10% / Logistic Euroscore >20%/ severe risk factors not covered by risk-scores 2 TAVR is acceptable only in severe AS patients with 1) a life expectancy of >1 year, and 2) those with a chance of "survival with benefit" of >25% at 2 years 3) favourable anatomy for TAVI 1.Al-lamee et al. TAVI: Current principles of patient and technique selection and the future. Circulation 2011. 2. TAVI for patients with aortic stenosis: a position statement from EACTS and the ESC, in collaboration with the EAPCI. Eur Heart J. 2008;29:1463–147
Patient-selection considerations :TAVI vs SAVR Frailty : >1/4 th over 65 years and >1/3 rd over 80 years (Frailty in Elderly people. Indian journal of Gerontology, 2011) Co-morbid conditions : CAD, COPD, CKD, Cirrhosis, Stroke/TIA, Malignancy, Immunodeficiency, Severe MR/TR/AR/PAH Concomitant CAD : SVD/ TVD Surgical Risk : STS-PROM at 30days - Low : <4% - Intermediate: 4-8% - High: >8-15% - Prohibitive : >15%, >50% all-cause mortality risk at 1 year, porcelain aorta, prior radiation, post bypass surgery with adherent grafts to chest wall, ≥3 major organ dysfunction Patient preference
Surgical risk scores for TAVI Logistic Euroscore often overestimates mortality STS is more accurate but still has suboptimal predictive power Recent RCTs have used STS in stratifying patients Clinical risk assessment, anatomic characterisation and functional assessment are vital for optimal TAVI results 1.The Society of Thoracic Surgeons 2008cardiac surgery risk models: part 2—isolated valve surgery. Ann ThoracSurg. 2009;88:S23–S42. 2. Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving system—a Bern-Rotterdam Study.Am Heart J. 2010;159:323–329.
An exercise to remember :STS-PROM and its influence on decisions 70 year old male, HTN, mild MR, mild COPD, NYHA II, S.Cr-1.6 (most common AS patient) STS PROM ~ 4% (intermediate risk) Slightly increase his risk by S.Cr 2.0 / Diabetes add any 1 of advanced COPD/old MI/old CVA/ LV dysfunction /POAD / NYHA 3 STS PROM>8% (High risk!!) (This is excluding frailty, octogenerians and all anatomic factors!!) The real world is full of intermediate/high risk patients.... 29
Pre-TAVI work up Clinical assessment: Decompensated patients may require CCU care ± BAV before TAVI vs SAVR Coronary assessment: CAG, MSCT Annulus assessment: -Minimize paravalvular AR -Avoid device migration -Valve selection Valve size slightly greater than annulus size Other relevant cardiac anatomy: LV anatomy and function, mitral valve, LVOT,bicuspid valve, valve calcification, coronary ostia, angulation of ascending aorta, aortic wall anatomy/calcification Assessment of peripheral arterial system
Annulus assessment TTE/TEE – PLAX & 3C - Oval annulus precludes correct meurements MSCT – Min diameter in sagittal section Aortography - RAO & LAO 15 0 Rotational angiogram cMRI 3D TEE MSCT >TEE >TTE (Integrated approach) TTE TEE MSCT- Sagittal MSCT- Coronal
Other relevant cardiac anatomy LV : function, dimensions and thrombus Mitral valve: MR, s/p MVR LVOT: Diameter, stenosis, LVH, Sigmoid septum (apical approach) AoV anatomy: Bicuspid valve( elliptical, root dilation, PVL- relative C/I) : Large calcific nodules ( C/I) Aortic size & angulation: Horizontal aortic root & vertical annulus :Aortic root >45mm at STJ (C/I for Corevalve) Aortic calcification: porcelain aorta dissection, stroke, embolism Coronary ostial height: >10mm (If <10mm: coronary obstruction vs AV block) Al-lamee et al. TAVI: Current principles of patient and technique selection and the future. Circulation 2011.
Assessment of the peripheral arteries Device and access selection MLD, calcification and tortuosity of femorals, iliac and aorta Transfemoral has lower vascular complications and a survival benefit compared to transapical route 1 PAG, MSCT, MRA 1.Results of transfemoral or transapical aortic valve implantation following a uniform assessment in high-risk patients with aortic stenosis.J Am Coll Cardiol. 2009;54:303–311 Contraindications for access selection
Balloon aortic valvuloplasty Also pioneered by Cribier - 1986 1)Helps as a rehearsal: assessment of RVP 2)Cracks calcification and stretches aortic wall: Easier crossing and better deployment -Crucial for Edwards Sapien and less for low profile Core Valve device Disadvantages: Higher procedure time, costs, need for RVP, more complications, independent risk factor for PPI 1 * "Simplified TAVI" has been studied for CoreValve(18F) in 60 TAVI procedures with similar efficacy 1. Grube et al. Feasibility of transcatheter aortic valve implantation without balloon pre- dilation: a pilot study. J Am CollCardiol Intv 2011;4:751–7
Economic impact and quality of life? Quality of life is significantly more for femoral TAVR patients Femoral TAVR had better economic savings and QALYs compared to SAVR at 1 year 1 Initial costs are however very high!!! 39 1. Cost analysis of TAVR vs SAVR from Partner Cohort A, JACC 2012
HEMODYNAMICS 1.Coronary blood flow in patients with severe aortic stenosis before and after transcatheter aortic valve implantation. AJC 2014 2.Hahn et al. Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves).J Am Coll Cardiol.2013 Jun 25;61(25):2514-21. 3.Kim et al. A critical review of hemodynamic changes and left ventricular remodeling after surgical aortic valve replacement and percutaneous aortic valve replacement.Am Heart J. 2014 Aug;168(2):150-9.e1-7. Coronary blood flow: Significant increase in coronary flow associated mostly with a decrease in LVEDP 1 (TEE Doppler study in 90 patients after Edward Sapiens) TAVR patients had higher indexed EOA and lower prosthesis-patient mismatch. 2 Most paravalvular AR is mild and non-progressive Even >75% of moderate AR regress to trivial at 1 year (NEJM 2014)
PATIENT BENEFIT Females : PARTNER A found high-risk females who underwent TAVI had better survival compared to SAVR. ( Sex-related differences in outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis: Insights from the PARTNER Trial. J Am Coll Cardiol. 2014 Apr 22;63(15):1522-8.) Diabetics : Diabetics in PARTNER trial (N=275) had significant benefit compared to SAVR(18 % vs 27% at 2years) (Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Diabetes and Severe Aortic Stenosis at High Risk for SurgeryAn Analysis of the PARTNER Trial. JACC 2014) Renal dysfunction : Poor outcomes in SAVR, not TAVI (Impact of varying degrees of renal dysfunction on transcatheter and surgical aortic valve replacement.J ThoracCardiovasc Surg.2013 ) Major Bleeding : 13% in TAVI vs 35% in SAVR (Bleeding complications after surgical aortic valve replacement compared with transcatheter aortic valve replacement: insights from the PARTNER I Trial. J Am Coll Cardiol 2014 Mar 25;63(11):1100-9) O2 dependent COPD : Better outcomes with TAVI (Outcomes of patients with chronic lung disease and severe aortic stenosis treated with transcatheter versus surgical aortic valve replacement or standard therapy: insights from the PARTNER trialJ Am Coll Cardiol. 2014 Jan 28;63(3):269-79.) Mod-severe MR : Increased 2 year mortality for SAVR, not TAVI ( Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A.Circulation. 2013 Dec)
VARC definitions of complications
VARC definition on prosthetic valve >4 >35
STROKE after TAVI PARTNER-A : 8.3% TAVI vs 4.3% SAVR BERN-TAVI registry( Wenaweser et al EHJ 2013) 3.9% TAVI vs 3.2 % SAVR Wire, catheter, aortic anatomy, BAV, RVP, comorbidities, AF Silent infarcts No influence on neurocognitive performance Embolic protection devices and lower profile devices may help
Vascular complications after TAVI PARTNER A : 18% TAVI vs 4.8% SAVR Core Valve study : 11% VARC metanalysis(2012) – 6 to 11.9% Patient selection,imaging, sheath size, device profile Edwards esheath, vascular closure devices Transcatheter Aortic Valve Implantation: 10-year Anniversary. Part II. Eur Heart J. 2012;33(19):2399-2402
Paravalvular leak after TAVI PARTNER A: >2+ AR in 7% TAVI vs 1.9% SAVR (predictor of higher mortality) Core-Valve study(2014) : 6% had >2+ AR Atleast mild AR >50% 76% of those with mod/severe AR mild or no AR at 1 yr Mechanisms of AR: 1) Malposition, 2) Undersizing, 3) Underexpansion, 4) malapposition, 5) Aggressive BAV AR predictors: 1) "Cover index" <8% for Edward Sapiens (100* Prosthesis D- Annulus D(by TEE) / Prosthesis D) prosthesis-annulus discongruence) 2)Valve calcification degree and symmetry, 3) operator experience 4) LVOT angle and depth of implantation for CoreValve Determinants of significant paravalvular regurgitation after transcatheter aortic valve: implantation impact of device and annulus discongruence. JACC Cardiovasc Interv. 2009 Sep;2(9):821-7. PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med2012;366:1686 –1695
Pacing after TAVI The AV node and LBB lies close to the NCC Conventional SAVR in octogenarians 1 - 8.5% TAVI with Edwards SAPIEN - 5.4% pacing TAVI with CoreValve 2 -9.3% to 33% New LBBB occurred in 40% after CoreValve TAVI Continuous in-hospital rhythm monitoring for 48-72hrs with TPI back up. 1. Dawkins et al.Permanent pacemaker implantation after isolated aortic valve replacement:incidence, indications, and predictors. Ann Thorac Surg. 2008;85:108 –112. 2. Jilaihawi et al.Predictors for permanent pacemaker requirement after transcatheter aortic valve implantation with the CoreValve bioprosthesis. Am Heart J. 2009;157:860 – 866
Other complications DAPT after TAVI: Aspirin and clopidogrel for 3-6m SAPT has also been tried with no adverse effects No consensus Coronary obstruction and MI Bleeding complciation Acute kidney injury
Rare life-threatening complications
Valve-in-valve TAVI Bio-prosthetic aortic valve failure & post-TAVI failure Reoperation in patients with degenerated bioprostheses carries an mortality risk ranging from 1.5% to 23% depending on co- morbidities 1 1 st case : 82 yr female with degenerated Perimount- 2008 Valve-in Valve in ~134 patients (as of 2011) Transapical (70%) > transfemoral(25%) Preferably not for paravalvular leak Global success rates ~96% 1. Vogt et al.Reoperative surgery for failing aortic prosthesis: predictors of mortality. Eur J CardioThorac Surg 2000. 2. Transcatheter Heart Valves for Failing Bioprostheses State-of-the-Art Review of Valve-in-Valve Implantation. Circulation 2011
TAVI in Bicuspid aortic valve Exclusion criteria in RCTs Elliptical annulus, asymmetric calcium distribution, larger annulus In a recent analysis of 21 BAV patients who underwent TAVI No significant difference in device success (100% vs 92.8%; P=0.37), risk of annulus rupture or valve migration. Post-procedural mean gradient, aortic regurgitation ≥2 of 4, 30-day mortality were also similar in both group Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis Circ Cardiovasc Interv. 2013 Jun;6(3):284-91. ESC Congress 2013 N=32 bicuspid valve
Intermediate and low-risk cohort Wenaweser et al (Swiss registry): N=389 (2009-2011) : low(41) vs intermediate (254) vs high risk (94) Low risk fared the best (HR=0.38, P<0.01) 1 30 day mortality in low risk- 2.4% ( vs 5% and 15% respectively) ~40-50% of low/intermediate STS are actually high risk frailty ( >1/4 th over 65 years and>1/3 rd over 80 years ) (Frailty in Elderly people. Indian journal of Gerontology, 2011) Ongoing trials in intermediate risk : PARTNER 2 and SURTAVI trials 1. Wenaweser et al. Clinical outcomes of patients with estimated low or intermediate surgical risk undergoing transcatheter aortic valve implantation. Eur Heart J (2013) 34 (25): 1894-1905.
Difficult peripheral anatomy Transaortic approach - Corevalve Subclavian approach- Corevalve
PCI-TAVR or Hybrid-TAVR ~ 75% requiring AVR have CAD. Staged procedure Hybrid LIMA to LAD+ PCI to LCX & RCA + TAVR
TAVI for AR N=43 patients underwent TAVI with the CoreValve prosthesis mean age- 75.3 ± 8.8 years mean logistic EuroSCORE : 26.9 ± 17.9%; mean STS: 10.2 ± 5.3%. Implantation of a TAVI 42 patients (97.7%), 8 patients (18.6%) required a second valve during the index procedure for residual aortic regurgitation. Post-procedure AR grade I or lower 34 patients (79.1%). At 30 days, the major stroke incidence was 4.7%, 30-day all-cause mortality rate was 9.3% and at 12m was 24%. Feasible in very high risk with several technical challenges Roy et al.Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation. JACC2013 Apr
ADVANCES in TAVI
2 nd generation TAVI valves Easier deployment, better apposition and less complications Lower profile -14 F Retrievable valves Higher durability Dedicated bicuspid aortic valve Nanotechnology based- 10F
UCL-TAV valve - polymeric leaflets with high durability and minimal calcification Tissue-engineered valve- implanted b.m. Mononuclear cells self-repair
Advances in imaging 3mensio valve imaging with Phillips HeartNavigator sytem Dyna CT(Siemens) imaging
The Future for TAVR TAVR is being improved and improvised upon. The current lack of enough guideline-support urgent need for more evidence/guidelines SAVR TAVR has shown benefits TAVR>>SAVR TAVR (awaiting conquest) (PARTNER2 & SURTAVI) (NEJM2011) (NEJM 2010) eagerly awaited) (NEJM 2014) (JACC 2014) 64
Conclusion HEART-TEAM concept is supreme : Weigh evidence and choose the best in concordance to the wishes of our patient TAVI is now proven superior to SAVR in high-risk cohorts. Optimism is in the air: 1 st TAVR in India(Feb 2011) TAVI can be a true success once we identify people that may die due to AS from the group that may die with AS 65
66 THANK YOU Sometimes, "it is more important to know what sort of a person has a disease than to know what sort of a disease a person has." (Hippocrates)
1. TIA after TAVI?
2. Chest pain after TAVI?
3. Post TAVI complication?
5. Progressive dyspnoea after 1 year of TAVI?
6. 6months after aTAVI?
7. Cardiogenic shock immediately after TAVI?
8. Name this valve?
References Prog Cardiovasc Dis. 2014 May-Jun;56(6):619-24. doi: 10.1016/j.pcad.2014.02.004. Epub 2014 Mar 3.Outcomes of surgical aortic valve replacement: the benchmark for percutaneous therapies.Bajona P Prog Cardiovasc Dis.Bajona P JAMA. 2013 Nov 20;310(19):2069-77. doi: 10.1001/jama.2013.282043. Outcomes following transcatheter aortic valve replacement in the United States.Mack MJ 1, JAMA.Mack MJ Ann Thorac Surg. 2014 Jan;97(1):22-8. doi: 10.1016/j.athoracsur.2013.09.088. Epub 2013 Nov 19. Transapical versus transfemoral aortic valve implantation: a multicenter collaborative study.van der Boon RM 1 Ann Thorac Surg.van der Boon RM J Am Coll Cardiol. 2013 Feb 26;61(8):830-6. doi: 10.1016/j.jacc.2012.11.050. Epub 2013 Jan 16.Transcatheter aortic valve implantation with the Edwards SAPIEN versus the Medtronic CoreValve Revalving system devices: a multicenter collaborative study: the PRAGMATIC Plus Initiative (Pooled-RotterdAm-Milano-Toulouse In Collaboration).Chieffo A 1 J Am Coll Cardiol.Chieffo A J Am Coll Cardiol. 2014 Apr 22;63(15):1522-8.Sex-related differences in outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis: Insights from the PARTNER Trial (Placement of Aortic Transcatheter Valve).Williams M 1 J Am Coll Cardiol.Williams M J Thorac Cardiovasc Surg. 2013 Dec;146(6):1399-406; discussion 13406-7.Impact of varying degrees of renal dysfunction on transcatheter and surgical aortic valve replacement.Nguyen TC 1 J Thorac Cardiovasc Surg.Nguyen TC J Cardiovasc Med (Hagerstown). 2012 Apr;13(4):229-41. Transcatheter vs. surgical aortic valve replacement: a retrospective analysis assessing clinical effectiveness and safety.Fusari M 1 J Cardiovasc Med (Hagerstown).Fusari M J Thorac Cardiovasc Surg. 2013 Mar;145(3 Suppl):S11-6. doi: 10.1016/j.jtcvs.2012.11.051.A comprehensive review of the PARTNER trial.Svensson LG J Thorac Cardiovasc Surg.Svensson LG Catheter Cardiovasc Interv. 2013 Apr;81(5):871-81. doi: 10.1002/ccd.24623. Epub 2012 Sep 24.Clinical profile and outcome of patients with severe aortic stenosis at high surgical risk: single-center prospective evaluation according to treatment assignment.Dvir D Catheter Cardiovasc Interv.Dvir D Cardiovasc Revasc Med. 2011 Nov-Dec;12(6):345-9.Comparison between Society of Thoracic Surgeons score and logistic EuroSCORE for predicting mortality in patients referred for transcatheter aortic valve implantation.Ben-Dor I Cardiovasc Revasc Med.Ben-Dor I Catheter Cardiovasc Interv. 2012 Jul 1;80(1):128-38. Meta-analysis of complications in aortic valve replacement: comparison of Medtronic-Corevalve, Edwards-Sapien and surgical aortic valve replacement in 8,536 patients.Jilaihawi H 1 Catheter Cardiovasc Interv.Jilaihawi H J Am Coll Cardiol. 2014 Jan 28;63(3):269-79. Outcomes of patients with chronic lung disease and severe aortic stenosis treated with transcatheter versus surgical aortic valve replacement or standard therapy: insights from the PARTNER trial (placement of AoRTic TraNscathetER Valve).Dvir D J Am Coll Cardiol.Dvir D J Am Coll Cardiol. 2014 Mar 25;63(11):1100-9. Bleeding complications after surgical aortic valve replacement compared with transcatheter aortic valve replacement: insights from the PARTNER I Trial (Placement of Aortic Transcatheter Valve).Généreux P J Am Coll Cardiol.Généreux P
Circulation. 2013 Dec 24;128(25):2776-84.Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A.Barbanti M 1 Circulation.Barbanti M J Am Coll Cardiol. 2013 Jun 25;61(25):2514-21.Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves).Hahn RT J Am Coll Cardiol.Hahn RT Am Heart J. 2014 Aug;168(2):150-9.e1-7. A critical review of hemodynamic changes and left ventricular remodeling after surgical aortic valve replacement and percutaneous aortic valve replacement.Kim SJ Am Heart J.Kim SJ 76
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Afghan Biographies
Khuram, Abdul Karim Khorram Khurram
Name | Khuram, Abdul Karim Khorram Khurram |
Ethnic backgr. | Pashtun |
Date of birth | 1963 |
Function/Grade | Ex Government Official |
History and Biodata |
2. Previous Functions of Abdul Karim Khuram:
3. Biodata: Karim Khuram, the Chief of Staff of President Karzai's Office and Jawid Ludin, the Political Deputy Minister of Foreign Affairs, accused each other of spying for Pakistan and the US, Al Jazeera reported.(20120321) Khurram issued a warning to the president's press staff, ordering them not to allow US advisers in press conferences, one palace official said. The US embassy declined to comment for this story. But a US official based in Kabul confirmed the frustrations with the palace. "For the embassy, it is hard to get any access inside the palace since the chief of staff changed," the official said.(20120322) Khoram speaks Pashtu, Dari, French and English |
Last Modified | 2014-10-11 |
Established | 2009-10-09 |


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United States Department of Agriculture
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The National Germplasm Resources Lab facilitates the acquisition, exchange, and documentation of crop genetic resources important to world food security.•
The National Germplasm Resources Lab coordinates plant explorations to collect germplasm for the U.S. National Plant Germplasm System.
The National Germplasm Resources Lab supports the U.S. National Plant Germplasm System. The locations of our genebanks are shown on the USDA Plant Hardiness Zone Map. (Click the map image to display a larger image.)
NGRL conducts research on plant pathogens of quarantine significance and develops techniques to detect and eliminate them. This helps ensure safe global exchange and conservation of plants for food and agriculture.
NGRL develops and operates an information management system called GRIN (Germplasm Resources Information Network) that documents USDA•s genetic resource collections. GRIN was developed beginning in the early 1980s and is an indispensable tool for curators, plant breeders, and scientists worldwide.
Mission: The mission of the National Germplasm Resources Laboratory is to support the USDA-ARS National Genetic Resources program. Emphasis is on the U.S. National Plant Germplasm System (NPGS) that collects, conserves, documents, evaluates, enhances, and distributes plant genetic resources used by U.S. and world agriculture. Three units and four projects in NGRL support the NPGS. The Database Management Unit (DBMU) develops and operates the Germplasm Resources Information Network (GRIN). This database maintains electronic information on more than 570,000 unique accessions at twenty NPGS locations. Genebank staff use GRIN to manage the collections. Detailed information about NPGS accessions is also displayed in a public website that includes the capability for scientists to request material. DBMU also provides similar, but less comprehensive, support for ARS insect, microbial and animal germplasm programs by hosting online access to their databases. The Plant Exchange Office (PEO) arranges domestic and foreign plant explorations and exchanges that increase the quantity and quality of NPGS holdings. They help identify gaps in collections and support options for both ex situ and in situ conservation of crop plants and their progenitors. PEO is also responsible for GRIN-Taxonomy, widely regarded as the international standard for the nomenclature of agriculturally important plants. PEO arranges for required agricultural inspection of many NPGS distributions to foreign countries. The Plant Disease Research Unit (PDRU) conducts greenhouse and laboratory research on obligate parasite plant pathogens of quarantine significance. PDRU scientists study the biology of quarantine diseases and develop improved methods to detect and eliminate quarantine pathogens, primarily from clonally propagated plant germplasm. This directly benefits both the USDA Animal and Plant Health Inspection Service and the NPGS by facilitating the safe international movement of plant germplasm.


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Amongst cries of protest over the Trump administrations recent measures to stem the flow of terrorists entering the US, many moron liberals and mainstream media pundits are on an anti-Trump feeding frenzy, completely missing the fact that Trump's recent immigration ban should have been implemented months ago by the former Obama administration.
Unfortunately, the fact is that there are numerous terrorists living amongst the American public waiting on their opportunity to make a huge statement for their causes, which will undoubtedly leave more American's dead in the wake of their insane terror campaigns.
In 2016, the shooting incidents in Sanbernadino California and Orlando Florida harshly reminded the American public of the fact that there are terrorists living amongst us, which leaves no doubt that are our current immigration vetting and enforcement policies have failed to keep terrorists from entering our country. I.E., said policies are not working.
Despite numerous outcries from sane American's for immigration reform, the Obama administration chose to ignore the fact that our vetting polices / procedures are allowing terrorists to enter and live in our country. Now some leftover democratic morons, the mainstream media and some very stupid liberals are screaming for the impeachment of Trump because he wisely has chosen to do what is necessary to address a very serious and dangerous problem.
Yes President Trump has empathy for the innocent people who have been inconvenienced by his temporary immigration ban. The fact is that Donald John Trump does not like to see any American inconvenienced or treated unfairly. However, to implement harsh procedures to deal with a very dangerous crisis is much better than ignoring the same.
Unfortunately, there was no way for the Trump administration to address the issue without a few innocent people being temporarily inconvenienced in the process of fixing our immigration crisis.
Additionally President Trump is not prejudice against Muslims, however Trump is highly prejudice against any person and or persons who desire to murder people in our country. Trump's immigration policy is very simple to understand—if you hate America, than don't come here and if you are already here, get the hell out.
Of course, many of these violent and insane people don't want to be identified which leaves the problem of coming up with policies and procedures to identify them. Unfortunately, there are many idiots in this country who either choose to ignore that fact and or are too stupid to want to do anything about it.
For instance, on Saturday night an asinine federal judge in New York blocked part of President Donald Trump's long overdue executive order on immigration reform on, ruling that authorities could not remove individuals from seven Muslim-majority countries who had arrived in US airports after the order had been issued.
US Judge Ann M. Donnelly held that the petitioners had a "strong likelihood of success" in establishing that their removal "violates their rights to Due Process and Equal Protection guaranteed by the United States Constitution."
It should not be a shock to any sane person that Donnelly was appointed to the bench by President Barack Obama. The stupid bitch now sits on the US District Court for the Eastern District of New York.
Is it unfair to call Donnelly a stupid bitch? Consider the fact that Donnelly is for lack of better words, an asinine liberal democrat who made no bones about supporting crooked Hillary Clinton. Now she is risking the lives of innocent American citizens to help her anti-Trump cronies attempt to disrupt the great things that President Trump is doing for our nation. Stupid bitch? You be the judge.
Our nation faces numerous crisis situation problems; immigration enforcement and vetting is one of the top three crisis situations our nation is facing today. We should all thank God that we have a new commander in chief who chooses to take crisis situations head on verses ignoring them. May God bless Donald John Trump and America.
This is Brenda Corpian reporting for Get Off The Bs.


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As the local fundraising arm of the University of Illinois Foundation, UICOMP's Development department works closely with alumni, faculty, corporations, foundations, and other key supporters to create programs and opportunities that benefit the College and the community.
All gifts made to UICOMP are used exclusively to support local education, research, and service programs. An investment in UICOMP is an investment in the future of quality education and healthcare.
To learn more about our many giving opportunities, please call 309-671-8481.