text:
This article will be permanently flagged as inappropriate and made unaccessible to everyone.
Are you certain this article is inappropriate?
Excessive Violence
Sexual Content
Political / Social
Email Address:
Article Id:
Reproduction Date:
Dengir Mir Mehmet Fırat (born 8 August 1943) is a Turkish politician of Kurdish origin who was one of the founders of the Justice and Development Party (AKP) in 2001. He served as a Member of Parliament for the Grand National Assembly from 1999 to 2011 and again since 2015 as a member of the Peoples' Democratic Party (HDP).
Fırat was born in the district of Kahta in Adyaman on 8 August 1943. His grandfather, Hacı Bedir Fırat, was an MP during the first, second and third Parliaments of the Turkish Republic, serving from Malatya for the first and second and from Kars for the third Parliament. His uncle Hüseyin Fehmi Fırat was a Democratic Party politician who also served as an MP for three terms. His cousin, Mehmet Sırrı Turanlı, was an MP for Adıyaman in the 11th Parliament and was later also a senator.
In Kurdish, the name 'Dengir' means "great voice" while the name 'Mîr' means bey (local leader). Mir Mehmet was the name of one of Fırat's forefathers.[1] From a Kurdish background, Fırat's grandfather was given a medal by Mustafa Kemal Atatürk.[2][3] Yusuf Halaçoğlu claims that Fırat is in fact of Turkish origin and not Kurdish as has been stated.[4][5]
After graduation, Fırat served as a freelance lawyer, a farmer and an export tradesman. He was a member of the Executive Board of the Mediterranean Exporters Association.
Fırat was elected as a Member of Parliament for Adyaman from the Islamist orientated Virtue Party (FP) in the 1999 general election. The party saw a split between traditionalist Islamists and moderate conservatives over the course of the Parliament, with a party leadership election contested by modernest Abdullah Gül and traditionalist incumbent Recai Kutan yielding a victory for Kutan. In the 2000 presidential election, Fırat put his name forward as a candidate, but withdrew and was defeated by cross-party candidate Ahmet Necdet Sezer.[6] The party was closed down in 2001 by the Constitutional Court for violating state secularism, after which traditionalist MPs formed the Felicity Party (SP) while moderate conservatives formed the Justice and Development Party (AKP). Fırat was one of the founding members of the AKP and joined the party after the FP's dissolution.
As one of the founders of the AKP, Fırat served as a Deputy leader of the party under Recep Tayyip Erdoğan. He was elected in the 2002 general election as a Member of Parliament for Mersin and re-elected in the 2007 general election as a Member of Parliament for Adana. He did not contest the 2011 general election. Despite the AKP forming a majority government in both 2002 and 2007, Fırat was not made a Minister despite being one of the AKP's founders. In an interview given to the New York Times in 2008, Fırat caused controversy after criticising Atatürk for his secular revolutions for causing a 'trauma' within society.[7]
Serving as the party's deputy leader, Fırat resigned from this role in November 2008 after accusations of corruption during a live debate with Kemal Kılıçdaroğlu, the parliamentary group leader of the Republican People's Party.[8][9] He resigned from the AKP completely on 27 July 2014, positing his decision on Facebook.[10]
Fırat defected from the AKP to the HDP in February 2015, with the intention of running for Parliament from Mersin as a HDP candidate.[11] He claimed that the HDP could become the main opposition party in future elections. His defection was one of the high-profile defections that the AKP had suffered to the HDP, which was perceived to be taking large portions of the AKP vote in the Kurdish south-east of Turkey.[12] He was elected to Parliament in the June 2015 general election after his party succeeded in surpassing the 10% election threshold needed to gain seats in Parliament. He was subsequently put forward by the HDP as their candidate for Parliamentary Speaker in the June–July 2015 speaker elections,[13] but was eliminated in the third round.[14]
İstanbul, Ankara, Barack Obama, European Union, Turkey
Recep Tayyip Erdoğan, Alliance of European Conservatives and Reformists, Turkish general election, June 2015, Ankara, Turkey
Turkey, Turkish general election, November 2015, Turkish general election, June 2015, Hung parliament
Turkey, Recep Tayyip Erdoğan, Justice and Development Party (Turkey), Turkish general election, 2011, Grand National Assembly of Turkey
Republican People's Party (Turkey), Justice and Development Party (Turkey), Recep Tayyip Erdoğan, Turkey, Grand National Assembly of Turkey
Abdullah Levent Tüzel, Abdurrahim Karslı, Abdurrahman Nafiz Gürman, Abdülhak Hâmid Tarhan, Adnan Boynukara


text:
Most Useful Asian Online Dating Sites: Top Website that is legitimate Reviews
Asia the most destinations that are popular dudes searching for non-western females. I would personally understand, i've traveled extensively all over Asia for decades and I also can state let me tell you so it's a great location to fulfill ladies.
Even if you're in a western country just like the United States, it is simpler to find Asian girls on a dating website for Asian ladies. I've tried a ton of these websites over my several years of travel. The truthful facts are that many of them had been disappointing SCAMS. The very good news is that there are a few run by one business which are quite good. I'm going https://www.mail-order-bride.net/jordanian-brides/ to split them straight straight down for you personally and present my strategies for what type is the better general and those that are great for certain nations.
AsianDating.com – Most Genuine Web Site
This is basically the king that is undisputed of internet dating sites for fulfilling Asian ladies. The primary reason is if you were planning a trip to Asia and wanted to visit a few different areas you could meet women from everywhere all on one site that it covers a few different countries, so.
Your website boasts over 2 million people by having great deal of this ladies based in non-Asian nations. If you're in america and seeking for the Asian woman online, then this is actually the website for you personally! I'm maybe perhaps not presently in the usa however when We visit I'm always in a position to find some women on anywhere i will be.
Your website is run by way of an ongoing business called Cupid Media and it is understood for top-notch quality. I could attest to this, I've probably used a lot more of their web web sites through the years than nearly anyone, when I have always been a world traveler that is avid.
Quality of females on Asiandating.com
Probably the most thing that is important every man requires in an online dating site is quality women. Read more "Most Useful Asian Online Dating Sites: Top Website that is legitimate Reviews"

subset: commoncrawl


text:
Plan huseemplois
...des soins palliatifs, j'ai donné 1 conference et bientot 2 sur "La mort, comment la vivre?" Depuis toute petite deja je disais vouloir faire "docteur pour les morts".. Pour le plan, ci joint le lien de ma conference!A suivre, le powerpoint qui est trop lourd.. environ 20000 mots, plagia free, avec quelques photos.. dans ce livre, je rajouterai mes experien...
I intend to build an SEO website for selling Hardware items like...Fastening & Joining Equipment, Pipes and Tubing, and other such around 35 categories, with each category containing around 20 products and then further categories. Initially, I plan to start selling only Fastening & joining. Request for website building and SEO consulting and support.
We want a 25'*50' Triplex House Plan , on the ground floor there should be a stilt parking in front and a office space at the back with a provision for lift as well as stairs. First floor should be spacious with 1 BHK with Puja room , Store room and stairs from inside as well as outside for the above floors. On the second floor there should be 3 Bedrooms
Hello everyone. I'm looking for a business plan writer. First, you need to write a draft copy so I can check it. I will share more details in the chat. Thanks
i need Business plan Almost ready just need of financial projection
I am good Home plan designer...
Hello, I am looking for someone to fill a long term position in my company as an illustrator. This is not on...your bid, so I know you are not auto-bidding, thanks! YOU MUST BE ABLE TO START RIGHT AWAY AND FOCUS ON THE DAILY PROJECTS I GIVE. THIS IS NECESSARY. PLEASE DO NOT BID IF YOU PLAN TO BE WORKING ON OTHER PROJECTS THIS IS A FULL TIME POSITION.
need Architectural plan and Structural Plan Plumbing Plan (blue in img) Sewer Plan (brown in img) Electrical Plan (Yallow in img) AutoCAD for this img or if you have better plan please let me know ,
Startup company trying to finish to-do list and website design along with the integration of social media platforms with a cohesive plan of attack. The founder has a great deal of marketing experience using finished website capabilities just not critical IT knowledge of how to bring all together and make it work. We have a clear vision of what messaging
... c) Target Market / Customers Segmentation d) Business Solution e) Competitors Analysis - SWOT Analysis - Marketing Plan & Strategy of Implementation a) Selling Proposition b) Pricing Strategy c) Awareness Plan d) Social Media Marketing Strategy & Media Buying e) Offers & Promotion Strategy f) Conversational Strategy - Sales KPI's
Hello, I am needing to building a two online consultation form for my shopify websites. I am in the cosmetic industry and I am needing to build a graphic flow plan to integrate into the website to pass on information to the Dr's who will be prescribing. Thank you
...presented, but the page weight is a concern and I would do with this additional feature if it would add lag to the process. The page itself will also need to be designed, but I do plan on keeping it very generic and not associated with the brand the user will be redirected to. More details will be provided in chat. ...
We are conducting LIVE coaching programs to enable certifications from CSI for career in Investment Finance. We are looking for sales and marketing professionals to cre...conducting LIVE coaching programs to enable certifications from CSI for career in Investment Finance. We are looking for sales and marketing professionals to create a marketing plan
...convocatorias/para-empresas/el-sena-y-colombia-productiva-abren-convocatoria-s. Actualmente el proyecto está formulado, en cuento al nombre, objetivo general, específicos, plan de actividades, presupuesto e indicadores. Falta: -Planteamiento del problema. (Esta desarrollado en un 70%) -Arbol de problemas -Justificación -Aspectos de propiedad intelectual
We're making a new community site that is focused on discussion. It is a WP MU (multi-site) that will include a free plan and three paid plans plus one 5-year membership option on Monthly subscription. The work is being done in components with a few Freelancers.
We're making a new community site that is focused on discussion. It is a WP MU ( multisite ) that will include a free plan and three paid plans plus one 5-year membership option on Monthly or annual subscription. The work is being done in components with a few Freelancers.
Floor plan and sketches of interior design for modern office. Walls can be removed, but should try keep changes to existing walls as little as possible. Some changes are however required to reach the goal. Requirements: - Office seating for 18 developers in open space. With possibility to reorganize space (without moving walls) to + 10 developers
I need to have a home floor plan illustration similar to the one I have uploaded in this project. It can't be exactly the same, but needs to have all of the same rooms and components, but in a different layout. The uploaded image is copyrighted, so I can't use it as is.
PLEASE ANSWER THE QUESTIONS WHEN APPLYING OTHERWISE YOU WILL BE IGNORED!!! We are a high en...Have you implement AWS Device farm for automated testing 3- Explain your experience in implementing automation of iOS App testing 4- Explain your process of developing test plan 5- Do you work for Agency? Can you work between 8am - 1pm PST (California time)?
[se connecter pour voir l'URL] your familiar protocol to imple...familiar protocol to implement it including login logout subscribe payment gateways(btc /eth / mastercard paypal / etc...) [se connecter pour voir l'URL] webpage can add user delete user change subscribe plan check traffic usage add server delete server access rules etc.. [se connecter pour voir l'URL] webpage f...
...imagination skills to provide design solutions for a portuguese / venetian bungalow [se connecter pour voir l'URL] roof plan (Plan is tricky), can make combination of different types of sloping roof, merging parts of the roof having different room heights, roofing for inclined walls in plan. All details in cad 2d, revit with all detailed section and elevations 2. Loft ...
...home-care products. To be considered for this job, please submit: 1) a proposal confirming a price including everything listed above and 2) a mock-up / template of what you plan to do (example of how it will look/general concept). NB: submissions that are missing any of the required details as per above will automatically be rejected. Thank you
...build front end of desktop Web app and Mobile. [se connecter pour voir l'URL] From this website i made a plan to make own desktop webapp and mobile only for me. Front end for web app and mobile was already built 30%,you need to complete until end. [se connecter pour voir l'URL]
Looking for logo for a sneaker company. Company name is-- TWill Loyal Sole...Company name is-- TWill Loyal Soles Open concept on design Incorporate shoes laces/ high top sneakers Would like colors to be red and black but open to other options If you plan on using sneaker image please use high top sneaker Please refrain from sending Mock Up Versions!
writing business application on follwing points 1. Founding/Leadership Team 2. Need or problem being addressed & its s...(Detailed document containing Need, Strategic Vision/Value Proposition, Product/Technology/IP Strategy, Management Team, GTM Strategy & Competitive Landscape, Financial Status & Plan, Milestones with Timelines, Current Status etc)
Investment plan : hourly or daily (earning monday to friday featured) can be created using admin panel Referral System: Matrix Infinite reference tree. (Matrix) But the upline only has 3 direct ones, nothing else. The direct room spills down where there is a locus. User can see his referral [se connecter pour voir l'URL] your tree you will only have 3 direct. the 4th
...company portal Channel, my website, my metaphysical conference, or my comic book series. I need help -- someone who KNOWS what they are doing and can come in with a plan and then execute that plan. Ideally you kind of direct me -- you tell me how much content I need to generate and when you need it, and then you do the posting and engage with followers. I
Investment plan : hourly or daily (earning monday to friday featured) can be created using admin panel Referral System: Matrix Infinite reference tree. (Matrix) But the upline only has 3 direct ones, nothing else. The direct room spills down where there is a locus. User can see his referral [se connecter pour voir l'URL] your tree you will only h...
Make a business plan for my [se connecter pour voir l'URL] details in the chat.
...alguien que pueda realizar mesualmente los diseños de las publicidades en distintos formatos, para cumplir con los ibejtivos de la empresa. Actualmente la empresa cuenta con un Plan de Marketing Digital definido y esta en busqueda del talento humano para desarrollar esta area de diseños del material publicitario para las redes y el sitio web. Anexo algunas
...-A list of required Materials and quantities (quantities of any required materials, lamps, plugs, furniture, devices...) The construction plan will be shared, files in PDF & Autocad Some changes on the plan will be shared by sizes and images to make it clearer ACs will be: -Concealed ACs in living room & master room -Other rooms will be split
...Settings Maintenance Settings Calendar function Room View Unit/Vent System View We have 3D designs of our product which we can provide and we would the animation to start from a plan diagram of a room. When the ventilation unit is selected we would like it to zoom in and rotate so that the fan operation can be seen and the individual sensor data is shown
3) Zimbra server & Setup Roles & Responsibilities • Understand company needs to define system specifications • Plan and design the structure of a technology solution • Evaluate and select appropriate software or hardware and suggest integration methods • Assist with solving technical problems when they arise • Address technical concerns, ideas and suggestion...
...database from highly targeted customer segments Present our products to retailers by offering to place them for sale in their stores. Sell prepaids plans or consignment plan to the targeted retailers Follow-up on existing clients to close pending offers The person who best fits this job is devoted to growing sales while delivering exceptional
business plan in different sectors of businesses
120m2, the ground floor of a 9floor condo, independent entrance from the street, children 3-7 y.o. at least 3 zones (classes). The plan and 3D Scatch UP model of the object with zone planning available in a week or so.
...Webserver framework: Apache, NginX 11. Proficient in DB managers: MySQL, MongoDB 12. Familiary in OS: Ubuntu 13. Technical and theoretical documentation ability 14. Ability to plan and follow kanban/scrum workflow methodology 15. Able to work independently 16. Knowledge in Git control with Bitbucket 17. Basic staging and production set-up, configuration
...the "Wallet Plugin" to act as a payment gateway for my users... Only the admin can add or deduct from the wallet. SAMPLE LINKS; [se connecter pour voir l'URL] [se connecter pour voir l'URL] So I just want the form to popup(will be using elementor page builder for that)... The user fills the form and clicks the submit button, the money
Start up company. A complete business plan about new born babies and mommy products. Sell online and offline.
"Opportunities don't happen. You create them." --Chris Grosser We are committed to your success Everything in our business plan is designed for your achievement. We provide world-class training, fabulous incentives, and frequent recognition meetings. We minimize your paperwork and product inventory so you can spend your time where it really matters—with
1 st plan 100 sms salary 5000 2 nd plan 200 sms salary 10000
Marketing Plan & Strategy of Implementation a) Selling Proposition b) Pricing Strategy c) Awareness Plan D) Offers & Promotion Strategy E) Conversational Strategy - Sales KPI's & Forecasting. - Referral Policy. - Retention Strategy - Management Summary: a) Executive Management Team. b) Forecasting Personnel Plan. - Financial Plan: a)
need a floor plan for resort , the resort is 3 acers,
I have a landscape plan and I need it brought to life. I have the finished drawings but need it done in 3D. I need a day version and then a night version with lights. I have attached the drawings and want someone to have this done by no later than Tuesday.
...Lab test and other data that we want the client to be exposed to without printing it on the package The site will manage users in several permissions and rules. According to plan and rule a QR will be created. Wireframe and spec will be sent to awarded provider Design Site will contain 8 Screens, need to be cut and ready to embed in a Wordpress theme
UPDATE You can use block letters plan font needs to be staggered (see below) Hello I need a vector background. 48 inches high by 168 inches wide. I want the words DownTown Wrecking Crew to be 1/2 inch high red in color. I want it on a red background. Staggard. See attached. I need it in the background so it can only be seen when close up. like
i need plans drawn up in autocad at imperial 1/4" = 1'-0" scale made from pdf's and an aut...at imperial 1/4" = 1'-0" scale made from pdf's and an autocad file that i will provide/. Plans are 1/2 done but need to be completed. floorplan, foundation plan (slab on grade) , roof framing plan, building section and 2d exterior elevations of all 4 s...
Hoping to find someone in this field and able to guide me to success. I have... I have some useful contacts and now like to schedule some phone call, email and ready to articulate how we can help during this pandemic situation. We will make an action plan based on your experience and understanding of this matter. Let's get in touch for more details.
...& already live on the iOS app store with thousands of people actively using it in just a few months. Next we are working on adding dating functionality to the platform, and plan to market the platform aggressively once REAL dating (filter & photoshop free dating) is live. [se connecter pour voir l'URL] Skills: Required 2+ years working with: - Python - NodeJS - AWS


text:
MINNEAPOLIS: Demonstrators clashed with police, looted stores and set fires as a man was fatally shot during a second night of protests in the US city of Minneapolis Wednesday over the killing of a black man by a police officer.
Police fired tear gas and formed a human barricade to keep protesters from climbing a fence surrounding the Third Precinct, where the officers accused of killing George Floyd worked before they were fired on Tuesday.
They pushed protesters back as the crowd grew, a day after firing rubber bullets and more tear gas on thousands of demonstrators angered by the latest death of an African-American at the hands of US law enforcement.
Minnesota state Governor Tim Walz urged people to leave the area around the precinct where several fires were burning, warning of the "extremely dangerous situation" in a tweet late Wednesday.
Outrage has grown across the country at Floyd's death on Monday, fueled in part by bystander cellphone video which shows him, handcuffed and in the custody of four white police officers, on the ground while one presses his knee into the victim's neck.
President Donald Trump in a tweet called Floyd's death "sad and tragic," and all four officers have been fired, as prosecutors said they had called in the FBI to help investigate the case.
Minneapolis police chief Medaria Arradondo cautioned protesters Wednesday to remain peaceful.
But by 10:00 p.m. (0300 GMT Thursday) an auto parts store across from the precinct had been set alight and a nearby Target was being looted, according to US media.
Police continued to hold the crowds back from scaling a fence into the precinct's parking lot, where their cruisers contain guns.
As the violence escalated, with more businesses looted, a man was shot near the protests and later died, police said. A person has been arrested.
Protesters remained peaceful at two other locations in the city.
At the place where Floyd was first taken into custody, people chanted and carried placards and sent out bouquets were set out as tributes to Floyd.
Calls for justice came from around the country.
"I would like those officers to be charged with murder, because that's exactly what they did," Bridgett Floyd, the victim's sister, said on NBC television.
"They murdered my brother.... They should be in jail for murder."
Protesters marched on downtown Los Angeles and briefly blocked the 101 Freeway.
Some demonstrators smashed the windows of two police highway patrol cruisers, clambering on the hood of one of the vehicles. One of the protesters was injured when they fell off the vehicle as it sped away.
Minneapolis mayor Jacob Frey said he could not understand why the officer who held his knee to Floyd's neck on a Minneapolis street until the 46-year-old restaurant worker went limp has not been arrested.
"Why is the man who killed George Floyd not in jail? If you had done it, or I had done it, we would be behind bars right now," Frey said.
The case was seen as the latest example of police brutality against African Americans, which gave rise six years ago to the Black Lives Matter movement.
Floyd had been detained on a minor charge of allegedly using a counterfeit $20 bill to make a purchase at a convenience store.
In the video, policemen hold him to the ground while one presses his knee to Floyd's neck.
"Your knee in my neck. I can't breathe.... Mama. Mama," Floyd pleaded.
He grew silent and motionless, unable to move even as the officers told him to "get up and get in the car."
He was taken to hospital where he was later declared dead.
Democratic presidential candidate Joe Biden said the FBI needs to thoroughly investigate the case.
"It's a tragic reminder that this was not an isolated incident, but part of an engrained systemic cycle of injustice that still exists in this country," Biden said.
"We have to ensure that the Floyd family receive the justice they are entitled to."
Democratic Senator Kamala Harris called the policeman's using his knee on Floyd's neck "torture."
"This is not new, it has been going on a long time... what our communities have known for generations, which is discriminatory implementation and enforcement of the laws," she said.
"He was begging to be able to breathe," she said. "It was a public execution."
The protests evoked memories of riots in Ferguson, Missouri in 2014 after a policeman shot dead an African American man suspected of robbery, and the case of New Yorker Eric Garner, who was detained by police for illegally selling cigarettes and filmed being held in an illegal chokehold that led to his death.
"How many more of these senseless excessive-force killings from the people who are supposed to protect us can we take in America?" said civil rights attorney Ben Crump, who was retained by Floyd's family
Crump pointed out that the arrest involved a minor, non-violent crime, and there was no sign, as police initially claimed, that Floyd resisted arrest.
"There is no reason to apply this excessive fatal force," Crump said.
"That has to be the tipping point. Everybody deserves justice ... We can't have two justice systems, one for blacks and one for whites."
Angry US protests for second night over police killing of black man
Angry US protests for second night over police killing of black man
- Outrage has grown across the country at George Floyd's death on Monday,
- 'I would like those officers to be charged with murder, because that's exactly what they did'
MINNEAPOLIS: Demonstrators clashed with police, looted stores and set fires as a man was fatally shot during a second night of protests in the US city of Minneapolis Wednesday over the killing of a black man by a police officer.
Civilians, soldiers clash leaving 127 dead in South Sudan
- The violence in Tonj began after several armed youths got into a disagreement with soldiers
- An initial armed confrontation was brought under control, but local youths subsequently mobilized for an attack on the army position
JUBA: Clashes between soldiers and civilians during a disarmament exercise in the central South Sudanese town of Tonj have left 127 dead, the army spokesman said Wednesday.
Major General Lul Ruai Koang told AFP that the fighting erupted on Saturday as security forces carried out an operation to disarm civilians in the area which has seen deadly inter-communal clashes.
More than six years after a civil war broke out in the country, and in the absence of a functioning government, many communities are flush with weapons, which they keep for protection or defense against cattle raids.
The violence in Tonj began after several armed youths got into a disagreement with soldiers. An initial armed confrontation was brought under control, but according to Koang the youths mobilized others for an attack on the army position.
"On the latest, the number of those killed, I can confirm to you that it rose to 127," Koang said, adding that 45 of those killed were security forces and 82 were youths from the area.
A further 32 soldiers were injured.
Koang said two military officers involved in "triggering the clashes" had been arrested, and that the situation in Tonj had calmed down.
South Sudan is emerging from a six-year civil war that left 380,000 dead and millions displaced, and disarmament is a major stumbling block.
Experts have warned against operations that coerce people to lay down their guns without proper planning, as some communities could find themselves unable to protect themselves after their weapons are removed.
"The clashes should be an opportunity to rethink the approach to disarmament. What is the point of removing guns without addressing what drives folks to arms themselves?" Geoffrey Duke, head of the South Sudan Action Network on Small Arms, said on Twitter.
"We can take guns away this week & they buy a new one next week (as) long as they still see the need to have (one)."
- Page 1
- ››


text:
Photos from Surfside Snow Carnival
Surfside Co-Owner Duke Edukas, Mike West of 686, and Sam Arellano of ABC
Industry brands and excited snow customers turned out Saturday for Surfside Sports' annual Snow Carnival.
Surfside is one of the few remaining major snow players in Orange County and has become a destination for snowboarders.
The demise of Sport Chalet has also meant skiers now buy outerwear and accessories at Surfside, even though the store does not actually sell skis.
We have photos from the day and of the industry folks we saw at the event in our slide show.
Related news
Burton's Dave Downing explaining the Step On boot and binding system to customers at the Surfside Snow Carnival Saturday - Photo by SES
Proof Lab operates several businesses in Marin and subleases space to others. Clockwise from top left: A coffee shop, Proof Lab Skate Shop; Proof Lab Surf Shop; Proof Lab Beer Garden. Photos courtesy of Proof Lab.


text:
Requesting a telephone channel (Voice channel) can quickly be arranged in Trengo! In addition, the wide choice of telephone numbers is a real plus. But where to start? Under Settings -> Voice (from the channel list) of course! With one click on the big green button, the first step in creating a Voice Channel is taken.
Choosing a country and a number
The nice thing about telephony within Trengo is that it's possible to choose from which country a generated phone number should come. Do you have many customers in the United States? Then create a US phone number and they can easily approach the company via a phone number that is familiar to them. Even when the office is located in the Netherlands!
Please note: it may be the case that some countries require an actual address in the country of establishment due to local legislation. Trengo will automatically display such information when such conditions apply.
In addition to choosing a country, a specific phone number can also be chosen (possibly a number with the company's own key ciphers of the city or region of the company). Would you like to use Voice with an existing phone number? Then we can port that phone number to Trengo!
Extra costs
Before a Voice channel can be created, a box must be ticked. This is for the monthly recurring costs of the selected number. These costs come on top of the costs of an extra channel and may vary per country.
Please note: since Trengo incurs costs for maintaining a phone number, telephony can only be tested if Trengo is used for at least one month. Only after this period has ended can the number be canceled!


text:
Services on Demand
- Cited by SciELO
- Access statistics
Related links
- Cited by Google
- Similars in SciELO
- Similars in Google
- uBio
Brazilian Journal of Medical and Biological Research
On-line version ISSN 1414-431X
Braz J Med Biol Res vol.43 no.6 Ribeirão Preto June 2010 Epub May 14, 2010
Braz J Med Biol Res, June 2010, Volume 43(6) 549-556
Use of the caffeine-halothane contracture test for the diagnosis of malignant hyperthermia in Brazil
R.T. Sudo1, L.B.P. Cunha2, P.L. Carmo1, A.R. Matos1, M.M. Trachez4, L.A.M. Cardoso3, M.I.S. Aguiar1, A.V. Abreu3 and G. Zapata-Sudo1
1Programa de Desenvolvimento de Fármacos, Instituto de Ciências Biomédicas, 2Serviço de Anestesiologia, 3Departamento de Ortopedia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
4Disciplina de Anestesiologia, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil
Subjects and Methods
Correspondence and Footnotes
Malignant hyperthermia (MH) is a pharmacogenetic disease triggered by volatile anesthetics and succinylcholine. Deaths due to MH have been reported in Brazil. The first Malignant Hyperthermia Diagnostic and Research Center in Latin America was inaugurated in 1993 at the Federal University of Rio de Janeiro, Brazil. The center followed the diagnostic protocols of the North American MH Group, in which the contractures of biopsies from the vastus lateralis muscle are analyzed after exposure to caffeine and halothane (CHCT). CHCT was performed in individuals who survived, their relatives and those with signs/symptoms somewhat related to MH susceptibility (MHS). Here, we report data from 194 patients collected over 16 years. The Southeast (N = 110) and South (N = 71) represented the majority of patients. Median age was 25 (4-70) years, with similar numbers of males (104) and females (90). MHS was found in 90 patients and 104 patients were normal. Abnormal responses to both caffeine and halothane were observed in 59 patients and to caffeine or halothane in 20 and 11 patients, respectively. The contracture of biopsies from MHS exposed to caffeine and halothane was 1.027 ± 0.075 g (N = 285) and 4.021 ± 0.255 g (N = 226), respectively. MHS was found in patients with either low or high blood creatine kinase and also with a low score on the clinical grading scale. Thus, these parameters cannot be used with certainty to predict MHS. We conclude that the CHCT protocol described by the North American MH Group contributed to identification of MHS in suspected individuals at an MH center in Brazil with 100% sensitivity and 65.7% specificity.
Key words: Malignant hyperthermia; Diagnosis; Skeletal muscle; Anesthesia
Malignant hyperthermia (MH) is an autosomal dominant pharmacogenetic disease, with crises triggered in susceptible individuals (MHS) by exposure to halogenated general anesthetics and/or succinylcholine, a depolarizing muscle relaxant (1). Hypermetabolic signs such as increased oxygen consumption and carbon dioxide production and tachycardia may be observed a few minutes after contact of MHS patient with these compounds, followed by severe muscle rigidity and rapid body temperature elevation, which can reach more than 44°C, rhabdomyolysis, bleeding, acute renal failure, and cardiac arrhythmias (1). Death occurs in approximately 75% of untreated patients (2).
The MH crisis enhances Ca2+ release from the sarcoplasmic reticulum (3) through the type 1 ryanodine receptor (RyR1). Mutations in the RyR1 gene are associated with 50-70% of the families affected by MH (4). RyR1 is one of the largest proteins in the body, is coded by a complex gene of 158 kb and 106 exons (5) and more than 100 different mutations associated with MH have been described (6). Mutations in sodium channels (7) and the alpha subunit of the dihydropyridine receptor (8,9) are associated with MH, but are very rare. Different mutations can produce different MH phenotypes. Recently, new mutations have been suggested to be associated with MH such as carnitine palmitoyltransferase II (CPT II) deficiency with heterozygous R506C mutation (10) and mutation in the calsequestrin 1 (CASQ-1) gene (11).
MH has a low incidence but a high mortality rate. The incidence of MH is 1:15,000 and 1:50,000-100,000 in children and adults receiving anesthetics, respectively (12). After the clinical introduction of dantrolene sodium to treat MH, mortality decreased from 75% to less than 5% (12). However, the mortality of MH is increasing in the United States (11.7%) (13), Japan (15%) (14) and Taiwan (28.7%) (15). No data regarding MH incidence or death have been reported in Brazil.
Early detection of susceptibility is valuable in preventing MH mortality. The gold standard method to diagnose MH susceptibility is based on measuring the intensity of muscle biopsy contracture in response to caffeine and halothane (caffeine and halothane contracture test, CHCT), compounds that activate Ca2+ release from the sarcoplasmic reticulum through RyR1 (16,17). There are two diagnostic protocols for MH from the North American MH Group (17) and the European MH Group (18). The North American protocol consists of exposing the muscle biopsy to incremental concentrations of caffeine (0.5-32 mM) and a single concentration of halothane (3%). The European protocol uses the same dose-response curve for caffeine, but increases halothane concentrations (0.5-3%). The North American protocol of CHCT has 97% sensitivity and 78% specificity (19).
Global MH centers can use genetic diagnostic methods for MH, which are less invasive for the patient than the CHCT. Once a causative mutation has been detected in the proband or index patient, it can be used to test relatives who have not yet been tested by CHCT. Mutation carriers should consequently be regarded as susceptible to MH. However, only 30 mutations have been shown to cause MH directly, with an increase of Ca2+ efflux trough RyR1 observed in in vitro studies. Family members who do not carry the mutation observed in the pedigree should still undergo CHCT investigation (20).
MH can also be predicted after the development of a hypermetabolic crisis during general anesthesia. Larach et al. (21) described a clinical grading scale based on clinical signs and symptoms associated with MH. This scale ranks the qualitative likelihood that an adverse anesthetic event indicates MH. Factors like MH family history and signs of MH crisis during anesthesia such as muscular rigidity, muscle breakdown, respiratory acidosis, increased temperature, and cardiac arrhythmias are used as indicators to diagnose MH. However, currently this scale cannot be used to determine the diagnosis or treatment during an MH-like episode because clinical symptoms of an MH crisis are nonspecific, and the diagnosis can be difficult to establish only with clinical signs (20). The final diagnosis is only confirmed by the CHCT.
Many case reports at the Brazilian National Society of Anesthesiologists meetings have reported lethal MH episodes. In 1993, the first Malignant Hyperthermia Diagnostic and Research Center in Latin America was created in Rio de Janeiro, Brazil. This MH Center has brought significant benefit to the families and anesthesiologists involved with patients who present unexplainable complications during general anesthesia. The purpose of this article is to present data from the Center for the past 16 years and compare them to international data.
The Institutional Ethics Committee of the Federal University of Rio de Janeiro, Brazil, approved the study.
Control CHCT was performed in 32 volunteers, and Drs. Thomas Nelson and Henry Rosenberg, members of the North American MH Group, evaluated and approved the viability of the Center in 1992. Since then, the Brazilian MH Center in Rio de Janeiro has performed 194 biopsies with an average of 11.6 biopsies per year.
The patient selection protocol for CHCT was based on that described by the Malignant Hyperthermia Association of the United States (MHAUS): people who survived an MH crisis or presented an incomplete MH episode during general anesthesia (i.e., muscular rigidity without hyperthermia), relatives of MHS individuals, including relatives who suffered unexplainable death during general anesthesia, and patients who had never undergone general anesthesia, but had signs/symptoms or laboratory exams indicative of MH (i.e., frequent cramps, congenital anomalies, or increased creatine kinase (CK) levels). Most of the patients were referred to the MH Brazilian Center by their doctors due to a suspected clinical episode of MH. Other patients were recommended by relatives when MH susceptibility was suspected due to family deaths, survival or susceptibility confirmed by the North American protocol of CHCT. Patients with muscle atrophy, weighing less than 20 kg, or less than 4 years old were excluded from the exam.
A written informed consent form to participate in the study was signed by all subjects in accordance with the North American protocol of CHCT. Patients submitted to the CHCT were admitted to the hospital one day before the biopsy was taken and their general health was evaluated during the pre-anesthesia visit. A blood sample for CK measurement was collected in the operating room before performing the biopsy.
Caffeine-halothane contracture test
A biopsy of the vastus lateralis muscle approximately 3.5 cm long, 2.0 cm wide and 1.5 cm deep was performed under local anesthesia of the femoral and femoral-cutaneous nerves with a mixture of lidocaine (1.5%) and epinephrine (1:200,000) in adults, and under general anesthesia with a combination of propofol (1.5 mg·kg-1·min-1 iv bolus followed by infusion of 100 µg·kg-1·min-1) and remifentanyl (2 µg/kg iv bolus) in children less than 14 years old. The muscle was immediately immersed in a temperature-controlled flask filled with Ringer-Krebs solution (118.1 mM NaCl, 3.4 mM KCl, 0.8 mM MgSO4.7H2O, 1.2 mM KH2PO4, 25 mM NaHCO3, 2.5 mM CaCl2.2H2O, 11.1 mM glucose), pH 7.4, oxygenated with a carbogen mixture (95% O2 plus 5% CO2). In the laboratory, 3-4 smaller fragments 1.5-2.0 cm long and 2.5-3.0 mm wide were dissected and positioned in vertical chambers (50 mL) in which one end of each muscle was attached to a fixed clamp and the other to an FT-03 force transducer (AstroMed Grass Instruments, USA) for isometric tension recording. The chambers were filled with oxygenated Ringer-Krebs solution maintained at 37 ± 0.1°C, pH 7.4 ± 0.02. Muscle twitches were elicited by electric field stimulation (50 V, 2-ms duration, 0.2 Hz). A Cyberamp (Axon Instruments, Inc., USA) conditioned the signals generated by the force transducer. These signals were digitalized (Digidata 1322, Axon Instruments, Inc., USA), displayed, and stored on a computer for further analysis using the Axoscope software (Axon Instruments, Inc., USA). The length-tension curve was constructed for each muscle fragment to obtain the maximal twitch response. After 30 min of adaptation, caffeine (Sigma-Aldrich, USA) was added to the solution in incremental concentrations (0.5, 1, 2, 4, 8, and 32 mM) at intervals of 4 min or after plateau contractions were reached. The stock solution of caffeine was freshly prepared in Ringer-Krebs solution. After the end of the caffeine contracture test, the chambers were carefully washed to eliminate contamination with caffeine and, using the same procedure, 3-4 additional muscle fragments were prepared for isometric tension recording. After a period of adaptation, a gas mixture containing 3% halothane (Cristália, Brazil) and carbogen was bubbled into the Ringer-Krebs solution for 10 min. A calibrated vaporizer (Fluovapor 1220, K. Takaoka, Brazil) was used to measure halothane concentration.
Muscle twitches (Pt; mean ± SEM = 2.928 ± 0.072 g, N = 1428) were used as a parameter of muscle viability but not for diagnostic purposes. Fragments with no twitches were discarded. The baseline tension for a diagnosis of MH was 0.2 and 0.7 g in response to caffeine (2 mM) and halothane (3%), respectively, measured in any muscle fragment independently of the type of protocol.
Clinical grading of patients
Patient information collected before biopsy included muscle rigidity, abnormal increase of CK, rhabdomyolysis-like signs, increased oxygen consumption and production of carbon dioxide by muscle metabolism, high temperature, tachycardia, arrhythmias, acidosis, response to dantrolene, and family history and was used to rank patients on a clinical scale to predict MH (21): 1 (almost never), 2 (unlikely), 3 (somewhat unlikely), 4 (somewhat likely), 5 (very likely), and 6 (almost certain). The MH susceptibility obtained from the North American protocol of CHCT was compared to that predicted by clinical grading.
Statistical analysis
Data are reported as means ± SEM. The average between two groups was compared by the Student t-test. Statistical significance was defined as P < 0.05. The GraphPad Prism version 4 software was used for statistical analysis.
Demographic data
From February 1993 to October 2009, 194 patients were eligible for diagnosis by CHCT. Table 1 shows that 110 patients came from the Southeast region of Brazil, 71 from the South, 8 from the Central West, and 3 from the Northeast. Rio de Janeiro (30.4%), Santa Catarina (28.9%), and São Paulo (11.3%) were the Brazilian states that more contributed to the total number of patients submitted to the CHCT. No patient came from the North region. CHCT was also performed in 1 patient from Argentina and 1 from Portugal.
Similar numbers of males (104) and females (90) were submitted to the test. Patients were predominantly young, with 55.7% of them being less than 29 years old (Table 2). The youngest patient was 4, the oldest 70, and the median age was 25 years.
Caffeine-halothane contracture test
A typical recording of a CHCT is shown in Figure 1. The tension response of the muscle was dependent on caffeine concentration and MH susceptibility. While twitches were increased at concentrations lower than 4 mM, no increases of baseline (contracture) was noted when non-MHS (MHN) muscle was exposed to caffeine (Figure 1A). The intensity of muscle contracture increased in a dose-dependent manner at concentrations above the threshold. MHS muscle showed baseline contraction of more than 0.2 g after 2 mM caffeine (Figure 1B). MHN muscle was also less sensitive to halothane (3%), with increased muscle twitches but no increase in baseline tension (Figure 1C). In contrast, halothane increased MHS muscle tension above 0.7 g (Figure 1D).
MHS was detected in 90 of 194 patients (46.4%) and not detected in 104 patients (53.6%) (Figure 2). Biopsies from 59 of 90 patients (65.6%) responded positively to caffeine and halothane, 20 only to caffeine, and 11 only to halothane. MHS patients were split between females (36) and males (54). The average baseline tension (contracture) of MHN muscle after 2 mM caffeine or 3% halothane was 0.007 ± 0.001 g (N = 432) and 0.050 ± 0.011 g (N = 485), respectively. The number of muscle specimens was higher than the number of patients because 3-4 specimens for each patient were used for the caffeine or halothane test. The average tension from MHS fragments was 1.027 ± 0.075 g (N = 285) and 4.021 ± 0.255 g (N = 226), respectively (P < 0.05 versus MHN; Table 3).
The CK levels measured in MHN (192.8 ± 65.3 U/L, N = 104) and MHS patients (216.3 ± 53.4 U/L, N = 90) were similar. Most MHN patients (91) had CK levels within the normal range (Figure 3). Surprisingly, 65 MHS patients (72.2%) showed normal CK levels (Figure 3), with only 25 patients (27.7%) showing above normal levels. Most MHS patients (67.8%) that positively responded to both caffeine and halothane had normal CK levels, with 19 patients (32.2%) showing above normal levels. Most MHS patients that responded to caffeine or halothane had normal CK levels (Figure 3).
Correlation between CHCT and clinical grading
We next correlated CHCT and the MH rank described by Larach et al. (21) (Table 4). Of 59 patients at low risk to develop MH (ranks 1 and 2), 40 (67.8%) were diagnosed as MHN and 19 (32.2%) as MHS. One hundred and twenty-five patients were distributed in the median rank (ranks 3 and 4), with a mix of MHN (N = 62, 49.6%) and MHS (N = 63; 50.4%). Twenty of 90 MHS patients (22.2%) and 41 of 104 MHN patients (39.4%) suffered a suspected MH crisis during general anesthesia. All grade 6 patients (N = 4) who survived a complete clinically detected MH crisis presented a positive response to CHCT. Eighty percent of grade 5 and 6 patients presented a positive response.
The sensitivity and specificity obtained from CHCT was calculated based on subjects ranked 6 from the scale ("almost certain" to be MHS), and from subjects ranked 1 (unlikely to be MHS). The calculated specificity and sensitivity from this center were 100% and 65.7%, respectively.
[View larger version of this image (164 K JPG file)]
[View larger version of this image (78 K JPG file)]
[View larger version of this image (67 K JPG file)]
Table 1. Distribution of 192 Brazilian patients submitted to the North American caffeine halothane contracture test (CHCT) for the diagnosis of malignant hyperthermia from 1993 to 2009.
[View larger version of this table (153 K JPG file)]
Table 2. Age distribution of 194 patients submitted to the North American caffeine halothane contracture test (CHCT) for the diagnosis of malignant hyperthermia.
[View larger version of this table (92 K JPG file)]
Table 3. Vastus lateralis muscle contracture in response to exposure to 2 mM caffeine and 3% halothane (CHCT).
[View larger version of this table (135 K JPG file)]
|Table 4. Distribution of patients according to the MH clinical grading scale (21).
[View larger version of this table (130 K JPG file)]
Malignant hyperthermia is a potentially lethal pharmacogenetic disorder of skeletal muscle induced by exposure to the inhalation of general anesthetics and/or succinylcholine (1). The high mortality of MH (ca. 75%) has been reduced by research on the disease, development of diagnostic protocols, and specific drug treatments for acute MH symptoms. The CHCT is still a reliable and highly sensitive test for detecting MH susceptibility. We present here data obtained for 16 years using the CHCT protocol approved by the North American MH Group at the MH Diagnostic Center of the Federal University of Rio de Janeiro.
The distribution of 194 patients submitted to the CHCT was not homogeneous from the 11 Brazilian states, probably because of the center's location. Most patients (N = 110, 56.7%) came from the Southeast, including the State of Rio de Janeiro, where the diagnostic center is located. However, 71 patients (36.6%) were from the South, which is located farther than the Southeast. Santa Catarina, with 56 patients, is more than twice as far as São Paulo from the diagnostic center, and São Paulo State is approximately 6.9 times larger than Santa Catarina. Thus, geographic localization is not the only factor that explains the high MH density. In fact, patients from Santa Catarina are related to three families of German origin, and the mutation could have resulted from European ancestors. This is in agreement with another large family of Italian heritage from São Paulo showing a severe MH crisis with death during general anesthesia. Additionally, an important explanation for the reduced number of patients from São Paulo in comparison to Santa Catarina is related to the development of an MH Diagnosic Center in that state at the Federal University of São Paulo (UNIFESP). Families from the Northeast, where colonization was from Holland, can show MH crises as well. No native Brazilian Indians received the test. Absence of an MH Diagnostic Center in Argentina brought one patient with family episodes of MH from that country, and relatives living in Brazil recommended another patient, also with a family history of MH, from Portugal. MH susceptibility was confirmed only in the Argentinian patient.
Most (75.3%) patients were less than 40 years old, with a median age of 25 years, indicating that MH is more prevalent in young individuals.
MH susceptibility was found in 46.4% of the patients (90/194), in agreement with rates from laboratories from Denmark and Toronto, 51.8 and 31.8% (22), respectively, where 1082/2214 patients were found to be susceptible to MH (48.9%) (23). MH susceptibility was lower (21.1%) in 10 laboratories from the North American MH Association (19). We detected muscle contracture to both caffeine and halothane in 59 of 90 MHS patients, and a selective response to caffeine or halothane in 20 and 11 patients, respectively. This apparent discrepancy in the reaction of the muscle to caffeine or halothane may occur because of the diversity of RyR1 mutations (24). According to the North American MH group (17), patients with abnormal reactions to caffeine or halothane are considered to be MHS. According to the European MH group (18), which has some differences in the protocol, one positive test means the individual is considered to be MH equivocal (MHE). Thus, 34.4% of the Brazilian MHS patients could be classified as MHE, similar to two Danish laboratories, with 34.8 and 34.5% (25) and to 22 centers of the European MH group, with 33.5% (26).
The hypermetabolism and breakdown of muscle membranes induced by increased Ca2+ concentration during an MH crisis may cause hyperkalemia, hyperphosphatemia, hypocalcemia, and increased serum levels of CK. Increased CK levels correlate with MHS incidence but are not sufficient as a screening test (27). Weglinski et al. (28) reported that 49% of 49 patients with high CK levels had a positive CHCT. However, Malandrini et al. (29) described only one MHS and one MHE patient of 37 with idiopathic hyperkalemia, or elevated serum CK levels without weaknesses or other neuromuscular symptoms. CK levels above normal (25-170 U/L) were observed in 13/104 (12.5%) and 25/90 (27.8%) of MHN and MHS patients, respectively, indicating a lack of correlation of CK levels with MH susceptibility.
We correlated the clinical signs and symptoms suggested by the North American MH Registry (21) to our in vitro test. A high correlation (>80%) was found in high-risk patients (rank 4-6), but a CHCT above the normal level was observed in 32.2% of rank 1-2 patients (low risk). We concluded that the clinically based score cannot predict that patients in the low probability rank are not susceptible to MH crises. MH clinical grading may therefore underestimate the likelihood of an MH event if an anesthetic was aborted early in the course of a reaction or in the absence of complete monitoring with capnography and arterial blood gas analysis (30). Recently, at the 3rd International Symposium on MH, Larach et al. (31) showed a similar lack of correlation between clinical grading and CHCT in North American patients. The clinical presentation of MH is highly variable and clinical data were frequently incomplete, making the MH risk difficult to measure using a clinical scale (32).
Genetic testing for detecting MH susceptibility (20) requires the consideration of mutations specific to a population, such as North America (33). However, not all mutations show a similar prevalence, and most of them are found in a single family. Our MH Center has already described a specific mutation in two Brazilian families (34).
In summary, the recommended CHCT described by the North American Malignant Hyperthermia Group was successfully applied at the Brazilian MH Center in Rio de Janeiro for the identification of MH susceptibility in 194 patients recommended for the test over 16 years of existence of the center.
1. Denborough M. Malignant hyperthermia. Lancet 1998; 352: 1131-1136. [ Links ]
2. Ellis FR, Halsall PJ, Christian AS. Clinical presentation of suspected malignant hyperthermia during anaesthesia in 402 probands. Anaesthesia 1990; 45: 838-841. [ Links ]
3. Britt BA, Kalow W. Malignant hyperthermia: a statistical review. Can Anaesth Soc J 1970; 17: 293-315. [ Links ]
4. Rueffert H, Olthoff D, Deutrich C, Meinecke CD, Froster UG. Mutation screening in the ryanodine receptor 1 gene (RYR1) in patients susceptible to malignant hyperthermia who show definite IVCT results: identification of three novel mutations. Acta Anaesthesiol Scand 2002; 46: 692-698. [ Links ]
5. Phillips MS, Fujii J, Khanna VK, DeLeon S, Yokobata K, de Jong PJ, et al. The structural organization of the human skeletal muscle ryanodine receptor (RYR1) gene. Genomics 1996; 34: 24-41. [ Links ]
6. Robinson R, Carpenter D, Shaw MA, Halsall J, Hopkins P. Mutations in RYR1 in malignant hyperthermia and central core disease. Hum Mutat 2006; 27: 977-989. [ Links ]
7. Vita GM, Olckers A, Jedlicka AE, George AL, Heiman-Patterson T, Rosenberg H, et al. Masseter muscle rigidity associated with glycine1306-to-alanine mutation in the adult muscle sodium channel alpha-subunit gene. Anesthesiology 1995; 82: 1097-1103. [ Links ]
8. Monnier N, Kozak-Ribbens G, Krivosic-Horber R, Nivoche Y, Qi D, Kraev N, et al. Correlations between genotype and pharmacological, histological, functional, and clinical phenotypes in malignant hyperthermia susceptibility. Hum Mutat 2005; 26: 413-425. [ Links ]
9. Brooks C, Robinson RL, Halsall PJ, Hopkins PM. No evidence of mutations in the CACNA1S gene in the UK malignant hyperthermia population. Br J Anaesth 2002; 88: 587-589. [ Links ]
10. Hogan KJ, Vladutiu GD. Malignant hyperthermia-like syndrome and carnitine palmitoyltransferase II deficiency with heterozygous R503C mutation. Anesth Analg 2009; 109: 1070-1072. [ Links ]
11. Protasi F, Paolini C, Dainese M. Calsequestrin-1: a new candidate gene for malignant hyperthermia and exertional/environmental heat stroke. J Physiol 2009; 587: 3095-3100. [ Links ]
12. Ording H. Investigation of malignant hyperthermia susceptibility in Denmark. Dan Med Bull 1996; 43: 111-125. [ Links ]
13. Rosero EB, Adesanya AO, Timaran CH, Joshi GP. Trends and outcomes of malignant hyperthermia in the United States, 2000 to 2005. Anesthesiology 2009; 110: 89-94. [ Links ]
14. Migita T, Mukaida K, Kawamoto M, Kobayashi M, Yuge O. Fulminant-type malignant hyperthermia in Japan: cumulative analysis of 383 cases. J Anesth 2007; 21: 285-288. [ Links ]
15. Yip WH, Mingi CL, Ooi SJ, Chen SC, Chiang YY. A survey for prevention and treatment of malignant hyperthermia in Taiwan. Acta Anaesthesiol Taiwan 2004; 42: 147-151. [ Links ]
16. Ellis FR, Harriman DG. A new screening test for susceptibility to malignant hyperpyrexia. Br J Anaesth 1973; 45: 638. [ Links ]
17. Larach MG. Standardization of the caffeine halothane muscle contracture test. North American Malignant Hyperthermia Group. Anesth Analg 1989; 69: 511-515. [ Links ]
18. European MH Group. A protocol for the investigation of malignant hyperpyrexia (MH) susceptibility. The European Malignant Hyperpyrexia Group. Br J Anaesth 1984; 56: 1267-1269. [ Links ]
19. Allen GC, Larach MG, Kunselman AR. The sensitivity and specificity of the caffeine-halothane contracture test: a report from the North American Malignant Hyperthermia Registry. The North American Malignant Hyperthermia Registry of MHAUS. Anesthesiology 1998; 88: 579-588. [ Links ]
20. Urwyler A, Deufel T, McCarthy T, West S. Guidelines for molecular genetic detection of susceptibility to malignant hyperthermia. Br J Anaesth 2001; 86: 283-287. [ Links ]
21. Larach MG, Localio AR, Allen GC, Denborough MA, Ellis FR, Gronert GA, et al. A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology 1994; 80: 771-779. [ Links ]
22. Islander G, Ording H, Bendixen D, Ranklev TE. Reproducibility of in vitro contracture test results in patients tested for malignant hyperthermia susceptibility. Acta Anaesthesiol Scand 2002; 46: 1144-1149. [ Links ]
23. Carr AS, Lerman J, Cunliffe M, McLeod ME, Britt BA. Incidence of malignant hyperthermia reactions in 2,214 patients undergoing muscle biopsy. Can J Anaesth 1995; 42: 281-286. [ Links ]
24. Fiege M, Wappler F, Weisshorn R, Ulrich GM, Steinfath M, Schulte Am Esch J. Results of contracture tests with halothane, caffeine, and ryanodine depend on different malignant hyperthermia-associated ryanodine receptor gene mutations. Anesthesiology 2002; 97: 345-350. [ Links ]
25. Urwyler A, Censier K, Seeberger MD, Drewe J, Rothenbuhler JM, Frei F. [Diagnosis of susceptibility for malignant hyperthermia using in-vitro muscle contraction testing in Switzerland]. Schweiz Med Wochenschr 1991; 121: 566-571. [ Links ]
26. Ording H, Brancadoro V, Cozzolino S, Ellis FR, Glauber V, Gonano EF, et al. In vitro contracture test for diagnosis of malignant hyperthermia following the protocol of the European MH Group: results of testing patients surviving fulminant MH and unrelated low-risk subjects. The European Malignant Hyperthermia Group. Acta Anaesthesiol Scand 1997; 41: 955-966. [ Links ]
27. McPherson E, Taylor CA Jr. The genetics of malignant hyperthermia: evidence for heterogeneity. Am J Med Genet 1982; 11: 273-285. [ Links ]
28. Weglinski MR, Wedel DJ, Engel AG. Malignant hyperthermia testing in patients with persistently increased serum creatine kinase levels. Anesth Analg 1997; 84: 1038-1041. [ Links ]
29. Malandrini A, Orrico A, Gaudiano C, Gambelli S, Galli L, Berti G, et al. Muscle biopsy and in vitro contracture test in subjects with idiopathic hyperCKemia. Anesthesiology 2008; 109: 625-628. [ Links ]
30. Larach MG. Should we reassess the susceptibility of MH patients? Can J Anaesth 1997; 44: 685-688. [ Links ]
31. Larach MG, Fuhrmann LJ, Allen GC. The epidemiology of malignant hyperthermia events in North America. In: Morio M, Kikuchi H, Yuge O (Editors), Malignant hyperthermia. Proceedings of 3rd International Symposium on Malignant Hyperthermia. Tokyo: Springer; 2010. p 39-41. [ Links ]
32. Girard T, Treves S, Voronkov E, Siegemund M, Urwyler A. Molecular genetic testing for malignant hyperthermia susceptibility. Anesthesiology 2004; 100: 1076-1080. [ Links ]
33. Sambuughin N, Nelson TE, Jankovic J, Xin C, Meissner G, Mullakandov M, et al. Identification and functional characterization of a novel ryanodine receptor mutation causing malignant hyperthermia in North American and South American families. Neuromuscul Disord 2001; 11: 530-537. [ Links ]
34. McWilliams S, Nelson T, Sudo RT, Zapata-Sudo G, Batti M, Sambuughin N. Novel skeletal muscle ryanodine receptor mutation in a large Brazilian family with malignant hyperthermia. Clin Genet 2002; 62: 80-83. [ Links ]
Research supported by CNPq, CAPES, Fundação Universitária José Bonifácio (FUJB), FAPERJ, and Sistema Único de Saúde (SUS).
Address for correspondence: R.T. Sudo, Programa de Desenvolvimento de Fármacos, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas, 373, Sala 14, Bloco J, CCS, 21941-902 Rio de Janeiro, RJ, Brasil. Fax: +55-21-2562-6505. E-mail: firstname.lastname@example.com
Received November 7, 2009. Accepted April 30, 2010. Available online May 14, 2010. Published June 11, 2010.
The Brazilian Journal of Medical and Biological Research is partially financed by


text:
have u ever felt like somehting, could set u free,so u could live ur life normally again. like a boost, a key?
Free e-mail watchdog
Answer this question
have u ever felt like somehting, could set u free,so u could live ur life normally again. like a boost, a key?
Answer for question:
Your name:
recent questions
recent answers
Protect critica informiton
which of the governmentwide commercial purchase card programs mandatory oversight procedures involves the Approving/Billing Official document findings and disciplinary category determinations?
Afere jaya Agdu 149 atrduta appa ayrsu ywsraj Nabjuga Ajadt Callgu jatd A402
what is notleahs roblox passwoed
$500,000.00vip exclusive
finpecia 1 mg robaxin price 500mg inderal 5 mg tablet how much is avodart cost advair diskus price in mexico augmentin 8...
free people v neck ruha tiger woods chapeau snapback phone sag with card holder iphone xr brooks ghost wszystko czarny o...
I just hope that I can win the $1,000,000.00 plus $100,000.00 with a twist . Thank you all
pittsburgh penguins nhl draft structured flex berretto nike air max 90 n艖i feh茅r b艖r long hoodie ruha plus size ch...
PCH win $1,000,000.00 plus $100,000.00 with a twist. Linda Truitt PCH Gwy No 13000 Dothan Al. Thank you all
Login to your account
Create new account
Discover Questions
Has a parent ever beaten you?
Who made the real world so hard to live in and why?
Which is the weekly holiday of OP department ?
Poll: Under 30 people: When is the last time you used a landline telephone to call a friend or relative?
People constantly mess with me. How to cope. Will ear phones work? Ignoring them doesnt work. I still get mad. :(?
Weknowtheanswer.com © 2014. All rights reserved.


text:
Welcome to BIORIMA's 3rd Press Release, which will give you an overview about the latest project advancements achieved during the last 12 months.Hope you enjoy reading it find the project news helpful for your own research and business!
This document provides an update of Biorima Project Partners' news and developments for the first quarter of 2020
Nanosafety Training School - From Basic Science to Risk Governance - REGISTRATION DEADLINE APPROACHINGInterprofessional Education Training School & Young Scientist Forum 202022 - 27 March 2020, Venice, ItalyThis year the Venice Nano Training School celebrates its 10th anniversary. The Training School, organised within the EU funded Horizon 2020 projects BIORIMA, GRACIOUS, NanoInformaTIX, PATROLS, NANORIGO, RiskGone and Go4Nano will take place in San Servolo (Venice, Italy) on 22th – 27th March 2020.Registration and Abstract Submission are open now! Please download the School Flyer here: https://www.biorima.eu/TrainingSchoolVen...=1576070231& .The school will feature keynote speeches, hands-on sessions and a dedicated Young Scientist Forum Day (23th March) during which early career researchers (PhD students, PhD candidates and Post-Docs) will have the opportunity to present their work. Abstract submissions opened on 10 Dec.The School week will include a variety of hands-on sessions aimed to transfer state-of-the-art knowledge on a variety of topics from key experts to the new generation of nano-environmental, health and safety, and biomedicine professionals, using interprofessional education.Variety of networking activities (a welcome cocktail and a social dinner) will enable plenty of time and opportunities for you to widen your network and foster academic exchange.Become part of an interactive, exciting week and enrich your knowledge by developing multidisciplinary expertise!Who should attend?Early-stage researchersPhD students and Post-DocsSenior researchersIndustryGovernmental AgenciesMedical PersonnelAnyone interested in Safe Nanotechnology, Risk Assessment and Nano-MedicineSchool TopicsHazard to Human Health & EnvironmentFate & Exposure AssessmentNanomedicine: from the lab to the marketModellingGrouping & Read Across ApproachesRisk GovernanceSchool LocationThe training school will take place in San Servolo (Venice, Italy). The School will start at 15.30 CET on 22 March will end on 27 March the School will end at 13.30 CET.DEADLINESAbstract submission closes on: 17th January 2020Notification of accepted abstracts: 30th January 2020Deadline for registrations: 20th February 2020School CertificatesEach participant will be given a certificate of attendance upon request.Contacts:Scientific enquiries:Danail Hristozov, GreenDecision (Italy) | firstname.lastname@example.com Stoycheva, Yordas Group (UK) | email@example.com Resch, BioNanoNet (Austria) | firstname.lastname@example.com, local support and administration:Chiara Mignani, GreenDecision (Italy) | email@example.com
"BIORIMA* activities are progressing successfully! The mid-term report on activities gives us full confidence in the project's ability to achieve the ambitious goal of providing an Integrated Risk Management framework for nano-biomaterials (NMB) used in advanced therapy medicinal products and medical devices." Essentially, this is a summary of the General Assembly meeting which took place in Rome on November 5-6th at the CNR premises (National Council of Research, a partner in BIORIMA and the local organizer of the meeting). All workpackages are progressing in line with timescales, including the development of tools for materials characterization, fate and exposure analysis, testing for human and environmental hazard, risk assessment and management, considering the whole life cycle of NBM: from production, to use, up to disposal. On November 7th, immediately after the General Assembly meeting, the first BIORIMA decision support system (DSS) prototype was shown to a group of stakeholders from industry and regulatory institutions during the second "BIORIMA Stakeholder Workshop" at the premises of Università Tor Vergata (in Rome) - a partner in BIORIMA. Fruitful discussions with stakeholders confirmed that BIORIMA is committed to delivering an integrated risk management framework which is tailored to industry users and their needs, as well as being in line with regulatory demands. The next key events and dates for the public are: the third BIORIMA training school, 2020. This will be organized together with other 6 EU-funded projects and take place during March 22-27th); and the General Assembly meeting with a public stakeholder workshop, which will take place later in the year in Venice. Stay tuned through our website, twitter and LinkedIn! www.biorima.eu


text:
It's been said that fear is the absence of faith and there is plenty of truth in that statement. Our fear, like Dru's, is out of a lack of faith in provision or protection. We may be fearful about many things in this life. We can easily be fearful about doctor's reports, losing our job, being alone, or the things our children are mixed up in. What we must do is not allow these fears to control us but rely on our faith in the One who controls all things. God didn't tell us "Do not be afraid" that many times just to be talking. He shares it with us for a reason. That reason is because He wants our faith in Him to rule over the fear that Satan tries to instill in us. So let your faith rule over your fear and take comfort in the words of Joshua 1:9. It says, "Have I not commanded you? Be strong and of good courage; do not be afraid, nor be dismayed, for the Lord your God is with you wherever you go." (NKJV)
*If you enjoyed today's post be sure to Share it on Facebook or on Twitter so others can be encouraged too!


text:
Haridra tablet for piles price daruharidra easy ayurveda
• Take a slow deep breath while you press the dose release button? Ahora vivo en UK y el aparato se ha averiado (según servicio técnico en Edimburgo, fallo de fabricación)? Lisinopril is supposed to slow kidney function down; that's how it protects your kidneys,
chiefly cymbalta price
by lightening the work load! For anxiety,
haridra tablet for piles
most people are now prescribed SSRIs with a "side" of a benzo for really bad days. Tetracycline is also used to treat plague and tuleramia (serious infections that may be spread on purpose as part of a bioterror attack). Imaging should be performed in all children in whom the diagnosis of appendicitis is uncertain,
haridra oil
particularly in those younger than three years? 265
cafergot costo comfortingly
mg/kg/dose PO twice daily on day 1, then 26 mg/kg/dose PO once daily. The material on this website is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. One 3 of trial ed set standart price nz to i course of size?
McDougal didn't seek "hush money" from Trump, but rather thought she was selling her story to the Enquirer for $100k and future appearances in the publication! Je
tobradex eye drops cost excellently
moet namelijk 2 weken voor peeling starten met tretinoine crème!
Daruharidra uses
Aucune étude en double aveugle et tout le tintouin, pour prouver, incontestablement les effets sur la récupération , donc effet placebo , 40 % comme les autres? By cooking and dropping the tuna and burnt fish,
feldene dor nas costas elementally
they can stay for much longer. • ^ Treating High Blood Pressure and Heart Disease: the ACE Inhibitors? Methotrexate is availa! Lungenvenenverschlusskrankheit), hohen oder niedrigen Blutdruck, Geschwüre, Blutungen, Herzprobleme (z. POINT: Should Small-Bore Pleural Catheter Placement Be the Preferred Initial Management for Malignant Pleural Effusions.
In addition, steady state levels of racemic citalopram were not significantly different in poor metabolizers and extensive CYP2D6 metabolizers after multiple-dose administration of citalopram, suggesting that coadministration, with escitalopram, of a drug that inhibits CYP2D6, is unlikely to have clinically significant effects on escitalopram metabolism. In this case, alcohol can make the side effects of Zoloft worse. Relatou-se que outros ocorreram horas ou dias após o uso de Viagra® e atividade sexual? • Start with a low dose of a single drug and monitor closely for side effects. Your order will arrive at your doorstep within 7-10 business days on average, after we receive your completed order and prescriptions? Cushing's is a bitch to diagnose and a bitch to treat! Airlines know this,
haridra himalaya product
so they pull away from the gate on time but let the plane sit on the runway as long as necessary before take off. •
anything tobradex eye drops price in egypt
The transformed bacterial colonies glow green when illuminated with the UV light. The term "ester" includes compounds and moieties which contain a carbon or a heteroatom bound to an oxygen atom which is bonded to the carbon of a carbonyl group? Michelle's unique blend of Scientific and Natural Health experience has helped empower others to understand and overcome Staph and MRSA infections! Such transcriptional silencer domains have been referred to in the art as "silencing domains" or "repressor domains" Although the precise mechanism by which many of these polypeptide domains inhibit transcription is not known (and the invention is not intended to be limited by mechanism),
haridra wadduwa
there are several possible means by which repressor domains may inhibit transcription, including: 1) competitive inhibition of binding of either activator proteins or the general transcriptional machinery, 2) prevention of the activity of a DNA bound activator and 3) negative interference with the assembly of a functional preinitiation complex of the general transcription machinery. • ^ ( EN) "Princess Diana gowns to be displayed to the public",
haridra face wash
ITV, 20 marzo 2013.
Trimethoprim-sulfonamide combination therapy in early pregnancy. Assessment of vitamin D requirements cannot address the level of sun exposure because of these public health concerns about skin cancer,
haridra resort & spa wadduwa
and there are no studies to determine whether UVB-induced synthesis of vitamin D can occur without increased risk of skin cancer [ 1]! However,
famvir tablets uk seaman
in non-equivalence trials the null hypothesis is the opposite, and states that the experimental treatment is inferior to the reference treatment! На сегодня есть возможность приобрести вещи в любой регион! Cientes con epilepsia, las concentraciones de gabapentina en el líquido cefalorraquídeo (LCR) son aproximadamente 20% de las concentraciones plasmáticas valle correspondientes en estado estable. I tolerated these dosages for approximately two months. Valeant circled the wagons,
haridra tablet for piles price
all but abandoning Addyi! Todos in assessore con comprare trial ed set extreme generico on line del baldieri promotore n? CMS design makes it easy to launch a Web site of any kind? Tell your doctor if,
fliban tablet price anaerobically
for any reason, you have not taken your medicine exactly as directed? Daily in divided doses, haridra tablet for piles price together with ampicillin 1 - 2 g iv? There is growing evidence that the other drugs are as effective. • de Campos JR, Vargas FS, de Campos Werebe E, et al. Anxiety is very treatable for those who seek professional help? I think,
haridra tablet for piles price
when it comes to side effects of medication, some people react to small doses? The clinical benefits of Mildronate stem from carnitine metabolism, haridra tablet for piles which plays an important role regulating cellular energy metabolism via a fatty acid beta-oxidation pathway and glycolysis; in the mitochondria carnitine is the main molecule in fatty acid metabolism (Gorgens et al, 2015)? Will I face a copyright issue if i directly copy paste the few points from other sites!
Haridra tablet for piles price
It is not known if Neurontin can harm your unborn baby.
Celelalte componente sunt: Nucleu Celuloza microcristalina Crospovidona Povidona Stearat de magneziu Dioxid de siliciu coloidal anhidru Film Hipromeloza Dioxid de titan Macrogol 400 Polisorbat 80 Ceara Carnauba Cum arata Valtrex si continutul ambalajului Comprimatele de Valtrex sunt ambalate in cutii cu blistere din clorura de polivinil/Al! My Rhuematologist told me to cut back and only to take at night!
Haridra plant
Pink pills affect the brain,
haridra family
while blue ones work with the body!
Haridra resort & spa
Secondary outcome measures were the use of life support (defined as the use of vasopressor or inotropic therapy, mechanical ventilation, or renal-replacement therapy) at days 5, 14, and 28 after randomization 19; the number of patients with serious adverse reactions while in the ICU (allergic reaction, hemolysis, transfusion-associated acute lung injury, or transfusion-associated circulatory overload) (see the Supplementary Appendix); the number of patients with ischemic events while in the ICU, which included cerebral ischemia (identified from the results of imaging), acute myocardial ischemia (defined by symptoms, electrocardiographic signs, or elevated biomarker levels resulting in an intervention), intestinal ischemia (as observed during endoscopic examination or surgery), or limb ischemia (defined as clinical signs resulting in an intervention) (for full definitions, see the Supplementary Appendix); the percentage of days alive without vasopressor or inotropic therapy, mechanical ventilation, or renal-replacement therapy in the 90 days after randomization; and the percentage of days alive and out of the hospital in the 90 days after randomization. Cialis Soft ; Cialis Super Active ; Erectalis ; Kamagra? The ITF made the announcement Wednesday,
haridra spa sri lanka
ending weeks of speculation about the future of the former world No. Can't-miss Conversations - John Paine Glenn spends the hour with John Paine and his family to talk about the true meaning of gratitude!


text:
Domestic Abuse Awareness Podcast
Peace Over Pieces Clara Baldwin
- Arts
Domestic Abuse Awareness Podcast
Ep. 9 - Clara's Story
Founder of Peace Over Pieces, Clara Baldwin, shares her personal story of what inspired her to start the organization.
Ep. 8 - Alexandra Barry
Alexandra Barry, founder of Siblings of Murdered Siblings Foundation - shares her story on becoming a survivor of losing her brother to homicide. She touches on her personal story, the court process, and her advice to those suffering from trauma.
Ep. 7 - Breana Kelsi
Fitness coach and Instagram influencer, Breana Kelsi, shares the story of how she met her abuser where she worked and how she discovered he was cheating on her through a DM on Instagram. She shares tips about trauma, escaping, and how manipulating a narcissist can be.
Ep. 6 - Tracey
Welcoming our first international guest Tracey dives into her story of how a manipulative 20-year marriage destroyed her mentally and emotionally. This is our first podcast that shows emotional abuse awareness is just as important as physical abuse.
Ep. 5 - Andre Lamont
Christian, college student, and motivational speaker Andre Lamont touches on the subjects of his experienced child abuse and how he recovered from rock bottom. (donate on peace-over-pieces.org)
Ep. 4 - Raelynn Henson
21-year-old Raelynn Henson shares her heart-wrenching story on sexual abuse and how to overcome trauma. Donate now on peace-over-pieces.org


text:
App.net Avatars United Bebo Bolt Capazoo eConozco Emojli eWorld Eyegroove FitFinder Formspring FriendFeed Friends Reunited Friendster Grono.net Google+ Google Buzz Heello Hyves iTunes Ping iWiW Jaiku LunarStorm Me2day Meerkat Mobli Mugshot Multiply Musical.ly Natter Social Network Netlog Orkut Pheed Piczo PlanetAll Posterous Pownce Qaiku SixDegrees.com So.cl Spring.me Surfbook tbh Tribe.net Tsū tvtag Vine Windows Live Spaces Wretch Yahoo! 360° Yahoo! Kickstart Yahoo! Mash Yahoo! Meme Yik Yak FACEBOOK ADS MANAGER Tutorial (2019) - Campaigns Vs. Ad Sets Vs. Ads
The basics we've gone over in this blog post are just the beginning. Keep creating great offers, CTAs, landing pages, and forms — and promote them in multi-channel environments. Be in close touch with your sales team to make sure you're handing off high-quality leads on a regular basis. Last but not least, never stop testing. The more you tweak and test every step of your inbound lead generation process, the more you'll improve lead quality and increase revenue.
But with such a massive and diverse collection of users, Facebook offers a unique opportunity for marketers to drive awareness for their brands — an opportunity that could also drive more leads for your business than any other paid channel. Below, we'll walk through the steps to get started with Facebook advertising, making sure you're producing the right ad at the right time. How To Successfully Appeal Facebook Ad Account Bans [2019 Method]
Once you have a good mix of high-value content, including visual content, start promoting it on social channels. The more engagement you get, the more Google considers your content to be of high value, which in turn boosts your SEO rankings. Search engines look for natural links, so the more informative your content is, the more likely people will link to it naturally. How do I track my UTM link?
Coupon: Unlike the job application, you probably know very little about someone who has stumbled upon one of your online coupons. But if they find the coupon valuable enough, they may be willing to provide their name and email address in exchange for it. Although it's not a lot of information, it's enough for a business to know that someone has interest in their company.
If there is something I have noticed about B2B leads is that you have to cast as wide a net as possible. You have so many avenues and options that just managing the funnel can be a challenging task. Every companies website should be the corner stone of their digital campaigns. Every visitor here should be considered a potential customer and Lucep uses instant response and artificial intelligence to make sure your sales team catch every opportunity that comes to your page.
Engagement in social media for the purpose of a social media strategy is divided into two parts. The first is proactive, regular posting of new online content. This can be seen through digital photos, digital videos, text, and conversations. It is also represented through sharing of content and information from others via weblinks. The second part is reactive conversations with social media users responding to those who reach out to your social media profiles through commenting or messaging.[22] Traditional media such as TV news shows are limited to one-way interaction with customers or 'push and tell' where only specific information is given to the customer with few or limited mechanisms to obtain customer feedback. Traditional media such as physical newspapers, do give readers the option of sending a letter to the editor. Though, this is a relatively slow process, as the editorial board has to review the letter and decide if it is appropriate for publication. On the other hand, social media is participative and open; Participants are able to instantly share their views on brands, products, and services. Traditional media gave control of message to the marketer, whereas social media shifts the balance to the consumer or citizen. Facebook Tracking Update! How To Setup Your Facebook Pixel & Custom Conversions. DIY Sales Funnel 7
Several customers are turning towards social media to express their appreciation or frustration with brands, product or services. Therefore, marketers can measure the frequency of which customers are discussing their brand and judge how effective their SMM strategies are. In recent studies, 72% of people surveyed expressed that they expected a response to their complaints on Twitter within an hour.[112] Facebook Ads Website Conversions Campaign Tutorial 2017 - Facebook Conversions Ads Tutorial
Twitter allows companies to promote their products in short messages known as tweets limited to 140 characters which appear on followers' Home timelines.[33] Tweets can contain text, Hashtag, photo, video, Animated GIF, Emoji, or links to the product's website and other social media profiles, etc.[34] Twitter is also used by companies to provide customer service.[35] Some companies make support available 24/7 and answer promptly, thus improving brand loyalty and appreciation.
On your smartphone, open up the Facebook app. Go to your Page and click on "Publish" as if you were going to write a new post, then select the "Live Video" option. Before you enter any information, go ahead and check the privacy settings. Under the description, you'll see a choice to broadcast to the public, just your friends, or only yourself. If you're testing out Facebook Live for the first time, we suggest using "only me" to ensure your live stream doesn't show up on your News Feed. 👀 Facebook Ads in 2019 | From Facebook Ads Beginner to EXPERT in One Video!
This mainly happens through digital channels, using inbound marketing techniques and a little bit of old-school outbound marketing (more on that in a minute). Buyers today do so much online information gathering on their own, they're not so keen on listening to traditional sales pitches. Instead, companies have to meet prospective buyers on their own turf: the internet.
Social media can be used not only as public relations and direct marketing tools but also as communication channels targeting very specific audiences with social media influencers and social media personalities and as effective customer engagement tools.[15] Technologies predating social media, such as broadcast TV and newspapers can also provide advertisers with a fairly targeted audience, given that an ad placed during a sports game broadcast or in the sports section of a newspaper is likely to be read by sports fans. However, social media websites can target niche markets even more precisely. Using digital tools such as Google Adsense, advertisers can target their ads to very specific demographics, such as people who are interested in social entrepreneurship, political activism associated with a particular political party, or video gaming. Google Adsense does this by looking for keywords in social media user's online posts and comments. It would be hard for a TV station or paper-based newspaper to provide ads that are this targeted (though not impossible, as can be seen with "special issue" sections on niche issues, which newspapers can use to sell targeted ads).
Instagram has proven itself a powerful platform for marketers to reach their customers and prospects through sharing pictures and brief messages. According to a study by Simply Measured, 71% of the world's largest brands are now using Instagram as a marketing channel.[58] For companies, Instagram can be used as a tool to connect and communicate with current and potential customers. The company can present a more personal picture of their brand, and by doing so the company conveys a better and true picture of itself. The idea of Instagram pictures lies on on-the-go, a sense that the event is happening right now, and that adds another layer to the personal and accurate picture of the company. In fact, Thomas Rankin, co-founder and CEO of the program Dash Hudson, stated that when he approves a blogger's Instagram post before it is posted on the behalf of a brand his company represents, his only negative feedback is if it looks too posed. "It's not an editorial photo," he explained, "We're not trying to be a magazine. We're trying to create a moment."[57] Another option Instagram provides the opportunity for companies to reflect a true picture of the brandfrom the perspective of the customers, for instance, using the user-generated contents thought the hashtags encouragement.[59] Other than the filters and hashtags functions, the Instagram's 15-second videos and the recently added ability to send private messages between users have opened new opportunities for brands to connect with customers in a new extent, further promoting effective marketing on Instagram.
ToFu: Leads at the top of the funnel need awareness. They know nothing about what you offer and what domain you operate in, so you'll need to create a conversation around both these focus points—without selling your product up front. If you sell CRMs, you attract ToFu leads by talking about how SDRs (sales development representatives) can do their job better using CRM software. Blogs, ebooks and guides are content types that work well at this stage.
For growing businesses like Monday.com, it's a smart idea to pivot off the brand awareness of household names. By filling the Monday logo with Apple's famous rainbow color-way, the ad above captures the attention of Mac users who'd recognize those vintage rainbow stripes anywhere (and could use a new task-management tool that works on their computer).
Over the years, businesses have used many tools for lead management, like the rolodex, contact management software and spreadsheets. But these tools function like a system of record. Sales reps just view their leads using these tools; they don't get context. And that's where CRM software (customer relationship management software) fills the void. In a CRM, every lead gets their own profile. This profile contains demographic details, a chronological list of every conversation the lead has had with your business, along with all the data/documents you've ever shared with them. And all this is just one part of what CRM software can do.
Thankfully, Facebook's tools cater to the marketer who wants to form an authentic relationship with their audience. With Facebook's impressive collection of analytics tools, you can understand your target audience before you post. You can stretch the limits of your creativity with Facebook's increasing number of multimedia content options. Then, with Page Insights, you can see which content people engage with and segment advertising to ensure you're helping more than annoying.
The project took up a lot of Ryan's time for that month, even though it was something he was doing on the side. He figured it would just be an interesting way to educate readers on how to validate their business ideas, and perhaps bring in some new audiences to his blog. But he was surprised by the number of leads he was able to generate as a result.
There's a lot of ad content on Facebook, and when Facebook users scroll through their News Feeds, that content start to blend together. Sometimes your best chance at sticking out on Facebook is by using subtle movements and details -- like Allbirds did, above. Let every other video on Facebook be quick and flashy, and yours will be a breath of fresh air to your audience. Are Facebook ads worth it?


text:
You need to be a member of REO Pro Network to add comments!
Nationwide REO Brokers (NREOB), allowed me to keep the assets that I listed through EAM. They are much more stringent then EAM was.
I know the listing I had with EAM I have already been contacted by 24 AMN letting me know how to proceed and task open in Equator.
Hi Monica,
Without revealing my source, I can tell you that Fannie is going to be purging many of their AMP's this year for lack of peformance. EAM may have been one of the first but, it won't be the last. In fact, the rumor is that Fannie Mae will be consolidating procedures to Dallas and closing the Irvine California office and in this process going from their current AMP list of about 15 to under 5 to 7.
What many of us agent don't know is that Fannie has even changed their payment profile with these AMPs. If you are not one of the top 3 AMPs, you don't even make a fraction on the file as you once did. For many AMPs, it's just not worth doing business with Fannie unless they are in the top 3 of performance so, many....are leaveing and many are being told to leave. What the specifics are for EAM, I can only speculate but, after talking with several of their employees who are no longer there, it's primarily because of not meeting metrics.
Any idea which AMPs are the strongest performers?
I noticed that the 4 Fannie Mae AMPs I work with all have had signifigant drop in assignments in the past 2-3 months. I am hoping at least one of them are the 'survivors' and can get more Fannie Mae business in the months to come. If not, I want to know which AMPs I should be targeting for future business. There is already another agent in my office who is Fannie Direct, so my only option is AMPs for Fannie Mae business.
That is a shame. I always had good luck with them and Owen REO and closed many deals in a short time frame for most. FNMA is undergoing some changes as I have received new forms and information.I made a lot of $$ with their properties last year but I am expanding my resources just in case. Thanks for your insight.I guess we will all find out as time moves on.
I am guessing that they are under enormous pressure to get Fannie Mae's assets sold within the time lines and that if too many assets go to auction, that may cause Fannie Mae to look elsewhere for out source companies.
I was wondering the same thing. I am in Florida. Owen REO stopped doing FNMA earlier this yearas they stated they lost the FNMA contract.. I got quite a few assignments from both. Starting to get concerned regarding the other Asset Companies.
I am not sure why but they were one of the best companies I worked for so far!
Super responsive and professional!