Often overlooked, these unassuming devices play a crucial role in preventing chaos beneath the kitchen surface. Without a proper preventative maintenance plan in place, the insidious accumulation of grease trap waste can transform into a plumbing nightmare. The consequence? A dreaded backup that not only disrupts kitchen operations but also opens the door to costly fines and extensive cleanup expenses. It’s clear: the humble grease trap demands attention to keep the kitchen flowing smoothly.
A commercial kitchen hydro jet plumbing service plays a crucial role in minimizing the risk of overflows and slow drains. By utilizing a high-pressure jetter equipped with a specifically designed head, this service can effectively and thoroughly restore the condition of your pipes. The high-pressure jetter, when employed correctly, helps eliminate blockages caused by grease, debris, and other buildup within the plumbing system, thereby reducing the likelihood of grease trap overflows and addressing slow drains.
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Enriching the lives of young people with significant disabilities.
Fighting Chance believes no Australian should be prevented from pursuing their ambitions and fulfilling their potential because of disability. The organisation adopts innovative training programs and social businesses that provide meaningful participation, employment and skill development to address this issue.
Funds raised: $56,965
Fighting Chance pitched at TFN Sydney on 12 March 2014 to fund individual placements within its Work Experience Program and secured $56,965 (including $25,000 in matched funding from the Macquarie Group Foundation), plus another $2,000 in post-event donations.
The pathway to life beyond school is an intimidating prospect for any young person – but when faced in conjunction with the challenge of disability, it can be overwhelming. Within a year, Fighting Chance has used the funding and credibility achieved through TFN to smooth that path for as many young Australians as possible while embarking on significant growth in its operations and impact.
Armed with a sharpened self-confidence, FC capitalized on the pitch coaching and mentoring advice received before the March event and went on to achieve significant funding success in other arenas, including more than $6,000 raised at 10x10 shortly after the TFN event and a staggering $400,000 raised by its Tour de Chance cycle challenge in 2015.
Measuring philanthropic outcome by reference to the number of lives impacted, the resources and support achieved over the past year has already been a game-changer. FC has been able to innovate and expand its social enterprises, relocating to larger and more suitable premises back in April 2014 and significantly increasing in the number of student places available. FC now offers transition programs to school groups as well as individuals and has used the funds raised through TFN to meet the cost of 17 placements for young people living with disability.
Read their Impact Report

domain: sociology


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BURNT-OUT physically, mentally demoralised and presiding a train wreck of historic proportions.
Anyone with an ounce of logical thought, or any capacity for mercy, must feel that Joe Root should leave the England captaincy now for his own good.
When Australia retain the urn this weekend, perhaps as early as today, Root will officially be England’s worst Ashes captain — with six losses, two draws and two crushing series defeats against the old enemy.
Root is gone at all levels. He was dismissed for a second-ball duck in glorious batting conditions at his Headingley home — albeit to a jaffa from Josh Hazlewood — after a first-baller at Lord’s last week.
The 28-year-old Yorkshireman has played in every one of England’s official internationals this summer.
That is a staggering 17 one-dayers, four Tests and one Twenty20.
He admitted to being knackered before this series and that fatigue has become increasingly obvious.
Never more so than when his feeble team were obliterated for just 67, their lowest Ashes total for 71 years, as the Aussies closed in on an unassailable 2-0 lead yesterday.
The shambolic nature of this England batting order is not Root’s fault.
Such has been the marginalising of red-ball Championship cricket that Root is now the only genuine established specialist Test-class batsman England possess.
That crushing responsibility has seen Root again elevated, against his better instincts, to No 3 — where he averages 38, compared to 48 at his favoured No 4.
And while Root still averages a decent 40.4 as skipper, he managed 52.8 without the burden of captaincy.
The Yorkshire royalty of Geoffrey Boycott and Michael Vaughan are calling for him to move down the order, Boycott insisting he must resign as captain.
However logical or merciful England’s director of cricket Ashley Giles might feel, however keen he might be to send Root back to the ranks, the glaring question remains: ‘What the hell is Plan B?’
Could England elevate vice-captain Ben Stokes, already overworked as an all-rounder batting at No 5 and only recently rehabilitated following his infamous street brawl in Bristol?
And how can they turn to his predecessor as vice-captain, Jos Buttler, whose modest Test batting record is heading sharply south?
Opener Rory Burns, who captains Surrey and has made a century and a 50 this series, is surely too green to step up after just ten Tests.
Jimmy Anderson and Stuart Broad are surely too long in the tooth, while bowlers are rarely made captain anyway.
Root will likely remain lumbered with the captaincy and England will remain saddled with a skipper of little obvious tactical acumen and few leadership qualities.
Root’s captaincy record is patchy, not dreadful. There were decent victories at home to India and South Africa and in Sri Lanka.
But England Test captains are judged largely on Ashes records — and Root’s is lamentable.
The 4-0 defeat Down Under in 2017-18 saw an ill-disciplined England humiliated on and off the field, with Root ending up hospitalised by gastroenteritis on the final day in Sydney.
While the sickness may have been metaphorical yesterday, it must have felt just as crippling.
England have tossed away promising positions in all three Tests against an Aussie side whose batting, minus Steve Smith, is almost as weak as their own.
Too much emphasis has been put on one-day cricket under England’s departing coach Trevor Bayliss, a limited-overs specialist who presided over their World Cup triumph.
But their Test form has suffered with too many of those world champions playing in these Ashes.
Jason Roy has looked horribly ill-suited to the five-day game and it was his wild drive that started England’s capitulation here.
Roy and Joe Denly will likely be axed for the Fourth Test at Old Trafford, with Ollie Pope returning to the middle order, and openers Zak Crawley or Dominic Sibley considered for debuts.
But no English batsman has made 1,000 runs after 11 rounds of First Division Championship matches this summer.
Giles, the King of Spain, and chairman of selectors Ed “The Man With Two Brains” Smith, are stuck in Old Mother Hubbard mode.
The Ashes are gone and there may be even worse to come.
A root and branch review is needed — starting with Root.

domain: sports


The Federal Road Safety Corps (FRSC) on Tuesday, urged motorists and other road users to avoid reckless driving during the Eid-El-Maluud celebration.
The FRSC made the appeal in a statement by the Corps Public Education Officer (CPEO), Mr Bisi Kazeem, in Abuja.
Kazeem called on motorists to exhibit more patience and resist the temptation to violate stipulated speed limits on all roads in the country.
He said that the call came as part of sensitisation programmes targeted at reinforcing and consolidating existing efforts and strategies of the Corps.
This, he said, was to ensure a safer motoring environment during El Maluud celebration.
He said that a crash free mobility was a possibility in the nation and the principal road use attribute that could lead to zero crashes on our roads was discipline and absolute compliance with established traffic rules and regulations.
According to him, a disciplined driver saves lives.
“When pedestrians comply with the use of walkways and pedestrian bridges where provided, when drivers desist from taking intoxicating substances before mounting the wheels.
“When they observe and obey the traffic lights and all speed limits, when they regularly maintain their vehicles, avoid overloading, dangerous and reckless driving.
“And becoming more tolerant with other road users; the carnages on our roads would have been reduced drastically, ” he added.
Kazeem admonished the motoring public to imbibe safe road use attributes as they commute across the country, noting that the Corps would as usual ensure enhanced visibility of personnel around all corridors.
He noted that the celebration was taking place during the ember months where the roads tend to be busier by the day.
Kazeem said that the Corps had observed that a key characteristics of the ember period over the years was an upsurge in traffic volume, as road users become impatient.
He, however, wished the entire Muslim community a hitch free celebration calling on the motoring public to utilise all FRSC social media handles.
“Facebook.com//frscnigeria,Instagram.com//frscnigeria, twitter.com//frscnigeria, for necessary updates and in case of emergency, call the 122 toll free number.
“The National Traffic Radio live lines: 08052998090, 09067000015, and 08052998012 which are available means to reach FRSC to report Traffic situations anywhere in the Country.


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BISMARCK (AP) - North Dakota's Supreme Court says a deputy state prison warden who was fired for sexual harassment must get his job back.
The court's ruling says Robert Heier (HY-ur) was improperly disciplined twice for the same wrongdoing. The court says he's entitled to reinstatement and almost three years' back pay.
Heier got into trouble in April 2009. He grabbed the backside of a female prison employee at a music show and said he would have her fired if she told anyone.
Heier was suspended from his job for a day.
The employee said later the punishment wasn't strong enough. The case was reopened and Heier was fired.
The Supreme Court's ruling says North Dakota law doesn't allow for a state employee to be punished more than once for the same misconduct.
301 4th St SE , Minot, ND 58703 | 701-857-1900

domain: news


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Manchester Psych Fest has received Arts Council England funding to commission two local female artists to create a unique visual experience at the heart of the event.
Manchester-based designers and illustrators Louise Rivett and Jane Bowyer will collaborate and create digital and physical artworks across Psych Fest, including animation pieces, exhibitions and installations.
The funding has been granted to assist the festival in welcoming and engaging more female participants to a predominantly male-dominated genre. In addition to Rivett and Bowyer’s visual experience at Manchester Psych Fest, 44% of the acts performing at the festival feature women – something the festival organisers have actively worked on improving.
“The psychedelic scene has become a cult in the past decade, however it has always been male dominated. I made it an imperative to make the festival more open to women as part of a wider plan to bring positivity and togetherness to the event. Showcasing more female artists is definitely a step forward and the ACE funding greatly assists in making this step. Hopefully a female artist will headline the festival in the very near future.” – Festival Creator, Gareth Butterworth
Louise Rivett worked on both Cosmosis Festival and Manchester Psych Fest in 2016 and her collages, which will be exhibited at the festival, have previously been commissioned by Night & Day Café. Jane Bowyer’s practice balances playfulness with purpose to deliver work that is both beautifully crafted and leaves a lasting impression. She is renowned for her work on the ‘Women In Print’ project, a current exhibition that celebrates the life and achievements of 22 iconic female figures who have made a significant contribution to the city of Manchester, such as Emmeline Pankhurst and Ethel ‘Sunny’ Lowry. Both artists are active in creating new platforms for female-led art to engage new audiences.
Psych Fest comes to Band on the Wall on Saturday 2nd September and final release tickets are available here.


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Channing Crowder - Last year's true freshman earned first team All-SEC honors, not as a freshman but on the regular team. He finished with over 100 tackles and missed two full games. He had surgery on his knee in mid-season and only missed one game. He sports a B average in class and he is the first guy to tutor the freshmen linebackers at the voluntary workouts. Put a cape on him and watch him fly. Alas, his Achilles heel is the fact that he enjoys life a little too much and gets into trouble away from the field. Although the current situation is a little overblown, he needs to know when to take the cape off. Let's talk about him on the field -- he is the absolute leader of the defense. He plays with reckless abandon and will surely be the human highlight film on defense during the first part of the season. I have seen him jump on the stairmaster during workouts with other players and continue through three different players taking their turn on the one next to him. All the meanwhile yelling at the players next to him to catch up. I think if you plugged an I.V. into him he could go on forever. This guy is certainly more than any Gator fan bargained for in recruiting. He was a 4 star recruit as a FB/LB, but I am not sure anyone knew what the Gators were getting when they landed this guy.
Earl Everett - Absolutely one of my favorite players on the team. Channing may be the best player on the entire team right now but I have told several people that Earl may be the best, maybe by the end of this season. He is a great kid that never gets into trouble. He is quiet and listens. He has instincts that you can't teach, and he can absolutely lower the boom at any time. The little gleam in the eyes of coaches comes after they describe that little moment of time when Earl gets a bead on the opposing ball carrier. Picture them talking about Earl with their hands up and one over the other as they clap and the top hand slides forward in a motion that leads the listener straight ahead. The word "Boom" comes out as they try and convey the cannon that Earl just shot out of to level his opponent. Also know that Earl will play a lot of nickel in situations - yes, folks, he is that fast. I say he will be better at the end of the season because in fact he was a Freshman All-SEC last year, and he still has much to learn. When he learns it all, watch out.
Travis Harris - Moved from defensive end last year, where he was a necessity, Travis is another guy that has the motor that never stops. He is a good student and the ultimate of team players. A team leader for sure, he has great size and will line up sometimes head up on the tight end at the Sam linebacker position. Just looking at him in this off-season he looks like he has trimmed down a little. If he can get down enough weight, he may have a future at the next level. He is another that likes to ride his teammates to make them better. I look for Harris to have a solid year and if defense focus too much on Crowder and Everett, he can have a breakout year.
Todd McCullough - A guy that was missed more than anyone can know when he had to have surgery on his shoulder. Todd was a solid force out there last year that was dearly missed. He is a heady player and is actually, along with Crowder, able to play any of the linebacker spots on the field. As a matter of fact, I look for him to be the top backup at all three spots. He has the size to play in the middle, and the relative speed to play either of the outside spots. More than any of that, he has the brain to do it. If Channing is suspended for any length of time due to the off the field issues, look for Todd to plug the middle in his absence. While he may not start most games, I believe his ability to play any spot will lend him to being in as many plays as the starters.
Taurean Charles - It seems like most Gator fans want this guy to be the breakthrough guy that hasn't really done anything yet. He has all the physical tools. He's big, probably 6-2 and 240 lbs. He's fast, relative to someone his height and weight. When Taurean takes the time to settle down and study and work his butt off to learn the defense, that'll be when fan's hopes will come true. We see glimpses as he flies down the field on kick coverage; we just need to see it all the time.
Richard Brown - A lot of talk on this guy. He is a relatively unknown walk-on that spent 8 years playing minor league baseball with the Yankees. He originally signed with Florida State as a safety in 1085, but due to maturity he has developed into a small linebacker's body. He did have ACL surgery last year, but seems to be running pretty well in the off-season workouts. I look for him to contribute this year, mainly due to his maturity. He will be limited on positions he can play due to size. He is more in the Will linebacker / safety mode.
Javier Estopinan - He is a bright kid that should start out at the middle linebacker spot on defense. Due to depth problems, he should start as Crowder's immediate backup. The ex-all state wrestler is aggressive and should prove to be a valuable and needed asset to the depth chart in his first season. He should play a large part of special teams.
Brandon Siler - He seems to be everyone's favorite poster child for an impact freshman linebacker due to the workout photos He has broad shoulders and a huge chest and sports some speed. He has to be at least 230lbs right now and he graduated high school with a B+ average. His smarts and physical ability combined with the lack of depth means he plays a lot this year.
Alik Scott - The local guy out of Gainesville's PK Yonge school has been an asset on special teams for two years. He could see time in the linebacker corps with significant injuries due to the fact that he has been around and is a smart player.
Bryan Royal - Another walk-on that showed a little in the Orange and Blue game in the spring, when the already depleted linebacker corps was split amongst the two teams. Bryan has played some on special teams and has participated in most of the summer workouts.
Alvin Butler - A red-shirt freshman that shows the want and desire to play as a walk-on. He definitely has the smarts to play the position as his nickname "1600" dictates. That would be the score he got on the SAT college entrance exam.


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A new coffee shop is opening in Midtown today and that means free coffee for YOU!!! The Bay Area-favorite, Philz Coffee is holding its soft opening from 11 a.m. to 3 p.m. in midtown Sacramento at 1725 R St. If you can go, you’ll get free coffee and baked goods. Philz Coffee officially opens tomorrow morning at 6 a.m.
The coffee chain opened their original business in San Francisco back in 2002, and have since expanded to over 30 locations around California.

domain: food


Records Fall at Viking Invite
Monday, March 29, 2010
Posted by: Regents Sports Information
ROCK ISLAND, Ill. – The Rockford College track team opened the outdoor portion of their 2010 season with a record breaking effort at the Augustana College Viking Invitational on Saturday. The Regents broke or set five records during the meet.
Junior Matt Lindgren (Oak Forest, Ill./ Oak Forest) set a new record in the 1500 meters, winning the race in a time of 4:01.93, shaving over three seconds off the previous record. Freshman Jerry Lewis (Bloomington, Ill./ NWC) now owns both Rockford’s indoor and outdoor speed records after Saturday’s 10th place finish in the 100M with a time of 11.46 seconds. Sophomore Bobby Tassone (Sandwich, Ill./ Sandwich) established a men’s long jump record with a distance of 5.24 meters.
Two Regents’ ladies also got into the act. Juniors Heather Goodrich (Tinley Park, Ill./ Victor J. Andrew) and Maribel Guerrero (St. Elmo, Ill./ St. Elmo) also broke records. Goodrich established an outdoor triple jump record of 9.21 meters and now holds both the indoor and outdoor records in the event. Guerrero established a new 100 meter record with a time of 15.92 seconds.
The Regents will travel to the University of Chicago on Saturday to run in the Ted Haydon Invitational.


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A new trailer has been shared ahead of the upcoming 3 March UK release of Marie Lidén’s acclaimed, BAFTA-nominated documentary Electric Malady and ahead of this Sunday’s BAFTA Awards where it is nominated for Outstanding British Debut. After receiving its World Premiere at CPH:DOX this year and UK premiere at Sheffield DocFest 2022, the film was also nominated for the BIFA Raindance Discovery Award. Watch it exclusively on CineVue below.
Produced by Aimara Reques and Aconite Productions, artist and filmmaker Marie Lidén invites audiences into the isolated world of William, a young man who’s spent a decade reluctantly retreating from modern life. A one-time master’s student and aspiring musician, his adverse reaction to the electrical radiation from our interconnected digital age has led him to a remote cabin in the Swedish wilderness where he’s cut himself off from most forms of technology. But how do you get off the grid when the grid is now everywhere?
Hidden in a foil-encased bedroom, beneath layers of copper-lined fabric, William speaks openly to Lidén about suffering from the condition known as electrosensitivity. Shot partly with a hand-cranked Bolex camera, what emerges is a lyrical and empathetic portrait of loneliness and isolation — and a loving family’s efforts to save their son’s life.
Here’s Lidén on her new film: ”Electric Malady is so important to me because of the voice I hope it will give to those suffering with electrosensitivity. In many cases these people’s stories are marginalised, because they cannot communicate the way we do through Internet or even using phones. I’m also very aware of the boundaries exposed within the film, the questions raised about the differences between mental and physical symptoms, how we apply rules of diagnosis. I am excited by issues that straddle definition, where mainstream society wants to draw neat lines between the conscious and un-conscious, the psychological and the physiological, the real experience of people can be much more complex. I believe we have to explore these boundaries and continually challenge them, to ensure we do give a voice to the marginalised.”
Electric Malady is released by Conic in UK/Irish cinemas on 3 March 2023. A Q&A tour with the director will visit selected cinemas nationwide.

domain: artistic


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Rick Ross, Flo Rida take over Miami club scene
Ross and Diddy perform at Mansion; Flo Rida kicks it at LIV
Homegrown hip-hop stars Rick Ross and Flo Rida went head-to-head this past Friday at Mansion and LIV nightclubs.
Ross, who released his fourth album Teflon Don this summer, performed a mix of his old and new hits in front of a packed crowd. He was later joined onstage by his bff, Diddy, who helped sing along to Ross’ hits – “Hustlin’” and “Just Push It”.
The duo recently formed their own group, Bugatti Boyz, and filmed the video for their new single, Another One. (Hmm, it seems like Diddy, the chubby chaser, has found another “Big” friend, right?)
Across the beach, Ross’ other buddy, Flo Rida celebrated his birthday with a more swanky crowd. It may seem strange to celebrate your birthday a month later, but the rapper had a good excuse for not partying with his Miami peeps: he was on tour.
The “Club Can’t Handle Me” singer, who arrived around 1 a.m., hung out upstairs in VIP with his entourage and a few sexy ladies. Although no cake was included in this fiesta, there was plenty of Moet champagne passed around to which Flo Rida drank straight from the bottle. After all, he has an image to maintain.
On Our Radar
- Paris Hilton on the red carpet
- Kathie Lee Gifford at Boca Bachannal
- Ex Real Housewives of Miami star arrested
- Local chef a contestant on 'Hell's Kitchen'
- Big Bang Theory star Jim Parsons in Miami
- Dan Aykroyd making stops in Broward
- Scott Disick set to appear at Crazy Horse in Pompano Beach
- Toni Braxton meets up with the Wades at benefit
- Sir Richard Branson takes in Formula E
- Nick Zano talks being a Florida guy


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Fresh ground, just like Starbucks but less costly. It's in the middle of a new strip mall with a couple of other snack places which is just as well as the food menu is little light in comparison to its nemesis. Could be a bit more comfortable in the seating department but other than that, the coffee is good and the baristas are friendly.
Own or manage this property? Claim your listing for free to respond to reviews, update your profile and much more.


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full build #1
full buid #2 ( hyper carry)
Not Updated For Current Season
The masteries shown here are not yet updated for the current season, the guide author needs to set up the new masteries. As such, they will be different than the masteries you see in-game.
Threats to Nidalee with this build
In your first clear you can do the whole jungle. Start at gromp and go to blue, wolfs, birds (with w e w you can clear the little birds), red and golems. After you made the golems and took all of your potions you are nearly full hp.Now you can start ganing or counterjungling.
Nidalle is not a gaining Jungler ( you can but if you are junst jngling you will outfarm the enemy jungler hard),so if you see the enemy jungler go in his jungle and place wards everywhere with your trackers kniefe or before your first back with your trinket.
Pros / cons
Pros: Best clearspeed in game, much presure, good iteam synergie, high damage output, fun to play, carry potential, able to get vision controll,
Cons: need winning lanes, you need some skill, you have to hit your skillshots, many teams need ganks

domain: hobby


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Dear Community Lending Partner:
The Federal Home Loan Bank of San Francisco has revised the Affordable Housing Program (AHP) income qualification guidelines for the competitive program and the two set-aside programs—the Individual Development and Empowerment Account (IDEA) Program and the Workforce Initiative Subsidy for Homeownership (WISH) Program. We have also consolidated all previous income qualification forms into a single Excel workbook—the AHP Household Income Qualification Workbook—which members and sponsors will find easier to use.
The revised guidelines will go into effect immediately. Any household that is enrolled in the IDEA or WISH program or that is income-qualified for the competitive AHP on or after September 1, 2007, must be qualified according to the revised income qualification guidelines included in the AHP Household Income Qualification Workbook.
Changes to Income Qualification Guidelines
We have made the following changes to the Income Qualification Guidelines – Affordable Housing Program – Competitive and Set-Asides (IDEA and WISH) (FC 2258):
- All forms of educational assistance paid directly to a student, educational institute, or a veteran are not considered to constitute annual income.
- HUD Section 8 Vouchers are not considered to constitute annual income.
Changes to Acceptable Forms of Income Verification
The Bank has made the following changes to the Acceptable Forms of Verification for Household Income Qualification (FC 2259):
- Regular employment must be verified with a verification of employment (VOE) form completed by employers and/or the most recent, consecutive pay stubs for at least 3 pay periods.
- Seasonal employment must be verified with a VOE form for the current year from all employers, signed federal tax returns for the 2 most recent years, and a completed Unemployment Benefits Verification Request for the current year.
- Commission-based employment must be verified with a VOE form for the current year from all employers and signed federal tax returns for the 2 most recent years.
- Self-employment must be verified with signed federal tax returns (with Schedule C) for the 2 most recent years and either the most recent profit and loss (P&L) statement showing 3 months of earnings or a notarized self-affidavit of earnings anticipated over the next 12 months.
- Any income-earning assets (interest, dividends, and other investments) that are greater than $5,000 must be verified with the most recent account statement or other holding documentation from the financial institution indicating the cash value and interest rate or income generated by the assets.
- Income verification tips have been expanded to include specific calculation practices to be applied to employment situations including overtime, seasonal employment, and unemployment benefits.
AHP Household Income Qualification Workbook
We have consolidated all previous income qualification forms into a single Excel workbook—the AHP Household Income Qualification Workbook. This new workbook contains the following worksheets:
- AHP Income Qualification Guidelines (FC 2258)
- Acceptable Forms of Verification for Household Income Qualification (FC 2259)
- Instructions for using the AHP Household Income Qualification Worksheet
- AHP Household Income Qualification Worksheet, which is designed with built-in formulas that calculate not only annual projected income, but also details such as the household member’s age (based on date of birth) and the household’s Area Median Income (AMI) as a percentage for their specific Metropolitan Statistical Area (MSA), as determined by current HUD Income Limit Statistics
The revised workbook is available on our website. If you have any questions about these changes, please call the Community Investment Department at (415) 616‑2542.
James E. Yacenda
Vice President and Community Investment Officer

domain: finance


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AMARILLO, TX – A challenge facing DME suppliers relates to commercial plans that have “closed panels.” For example, ABC Medical Equipment applies to be added to the provider panel for an Insurance Company. However, the Insurance Company informs ABC Medical that the Insurance Company has a sufficient number of DME suppliers on its provider panel.
Unless a solution can be found, this places ABC Medical in the unenviable position of having to (i) decline to serve patients covered by the Insurance Company or (ii) serve the patients on an out-of-network basis.
To address this challenge, a number of DME suppliers are turning to the subcontract model. In its most simplistic form, here is how it works: Assume that XYZ Medical Equipment is on the Insurance Company’s provider panel. Assume that Mrs. Smith is covered by the Insurance Company.
Under the subcontract model, XYZ Medical will subcontract out to ABC Medical specific responsibilities to take care of Mrs. Smith. XYZ Medical will bill and collect from the Insurance Company and XYZ Medical will, in turn, pay ABC Medical for its subcontract services. On the surface, this looks like a straight-forward arrangement. However, as is often the case, the “devil is in the details” and if the subcontract arrangement is set up incorrectly, then ABC Medical and XYZ Medical are exposed to potential liability. Let me explain.
All of us know that a Medicare Part B supplier number cannot be sold, transferred, or “rented.” Doing so can violate the Medicare anti-kickback statute, the federal False Claims act, and the supplier standards.
There are similar legal concerns in the commercial insurance space. A commercial insurance contract cannot be “rented.” In other words, XYZ Medical cannot simply allow ABC Medical to “use” the contract that XYZ Medical has with the Insurance Company. If ABC Medical and XYZ Medical want to enter into a bona fide subcontract arrangement, then the issues they need to address are the following:
• Does the provider contract between XYZ Medical and the Insurance Company address whether or not XYZ Medical can subcontract out its services? If so, what does the contract say? Does it simply give the right, without any restrictions, to XYZ Medical to subcontract out its services? Or does the contract allow subcontracting…..but only if certain conditions are met?
• If the provider contract says nothing about subcontracting, then do the Insurance Company’s provider guidelines address subcontracting? If the contract and the provider guidelines are silent regarding subcontracting, then it is likely permissible for ABC Medical and XYZ Medical to enter into a subcontract arrangement. However, out of an abundance of caution, it would be wise for XYZ Medical to call the Insurance Company and inquire about subcontracting.
• Assume that ABC Medical and XYZ Medical conclude that subcontracting is allowed. Does XYZ Medical have operational responsibilities and financial risk? Said another way, does XYZ Medical have “skin in the game?” When XYZ Medical submits a claim to the Insurance Company, then XYZ Medical is representing that it is the supplier. As the supplier, XYZ Medical needs to have at least a minimal level of operational responsibilities and financial risk. If ABC Medical completely takes care of Mrs. Smith, and if all that XYZ Medical does is bill and collect from the Insurance Company, then XYZ Medical is not really the supplier; rather, ABC Medical is the supplier. Hence, there is a risk that the Insurance Company will assert that XYZ Medical submitted a fraudulent claim, and that ABC Medical collaborated in the submission of the fraudulent claim. Additionally, if ABC Medical is generating the patient and is doing all the work, and if XYZ Medical is pocketing a percentage of the payment by the Insurance Company, then there is a risk that the arrangement violates a state anti-kickback statute. Almost all states have an anti-kickback statute that is similar to the Medicare anti-kickback statute. Some state anti-kickback statutes apply only if the payer is the state Medicaid program. Other state anti-kickback statutes apply even if the payer is commercial insurance or is an individual patient paying cash.
The “take-away” is this: Just because a subcontract arrangement does not involve patients covered by government health care programs does not mean that the parties can set up a “sham” subcontract arrangement. A subcontract arrangement requires two parties: a contractor (XYZ Medical) and a subcontractor (ABC Medical). The contactor needs to have the minimum operational responsibilities and financial risk necessary for it to credibly hold itself out as the “supplier.”
Jeffrey S. Baird, JD, is chairman of the Health Care Group at Brown & Fortunato PC, a law firm based in Amarillo, Tex. He represents pharmacies, HME companies, and other health care providers throughout the United States. Baird is Board Certified in Health Law by the Texas Board of Legal Specialization. He can be reached at (806) 345-6320 or firstname.lastname@example.org.
Jeff Baird and Louis Feuer will be co-presenting a webinar for AAHomecare on Thursday, August 14. See details below:
AAHOMECARE’S EDUCATIONAL WEBINAR
Innovative Marketing While Remaining Within Legal Parameters
Jeffrey S. Baird, Esq., Brown & Fortunato, P.C.
Louis Feuer, Dynamic Seminars & Consulting, Inc.
Thursday, August 14, 2014
2:30-4:00 p.m. EASTERN TIME
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domain: medical


This paper presents a hybrid centralized control scheme for a nonsquare multivariable process. The proposed approach combines the Smith predictor, gain-scheduling methodology, and Davison method with the Particle Swarm Optimization (PSO) algorithm, all of which are combined to solve a nonsquare control-system problem that compensates for the multiple and different time delays and process nonlinearities. We call this fusion a hybrid control scheme. The Davison method does not provide a fine-tuning methodology for the centralized controller; therefore, the PSO method is added. This optimization method yields the best values for δand ϵ, improving the process response with a smoother controller action, with a trade-off between the performance and robustness of the proposed controller. This method is applied to a reactor-separator-recycle (R-S-R) plant. These process types are characterized as being subjected to strong interactions among its variables and present strong nonlinearities. The R-S-R plant is modeled using the identification method based on the reaction curve, from which its equivalent transfer function (ETF) is determined. ETF represents a multivariable system with multiple time delays. In the current proposal, the nonlinearities that are present in the R-S-R system are compensated using the gain-scheduling strategy. The simulation tests verify the performance of the proposed controller, which is performed in MatLab. This controller is compared with a proportional integral (PI)-centralized controller and Smith delay compensator. All controllers are tuned using PSO.


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- 1 How does gene manipulation work?
- 2 Which is the method for genetic manipulation?
- 3 What is the purpose of genetic manipulation?
- 4 What is genetic manipulation and what is its importance?
- 5 Is genetic manipulation?
- 6 What is another term for transgenic manipulation?
- 7 What are the 3 types of genetic engineering?
- 8 What are genetic techniques?
- 9 What are the pros and cons of GMO?
- 10 Is genetic manipulation safe?
- 11 What behavioral traits are genetic?
- 12 What is genetic manipulation in humans?
- 13 What is the importance of genetic?
- 14 Why genetic engineering is bad?
How does gene manipulation work?
Genetic manipulation may mean changing one base pair (A-T or C-G), removing a whole region of DNA, or bringing in an additional copy of a gene. Gene modification could also be extracting DNA from one organism’s genome and joining it with the DNA of another.
Which is the method for genetic manipulation?
Transduction. Transduction is the process by which foreign DNA is introduced into a cell by a virus or viral vector. Genetically modified viruses can be used as viral vectors to transfer target genes to another organism in gene therapy.
What is the purpose of genetic manipulation?
To recap, genetic manipulation is a process done to manipulate the genome of an organism in order to produce desired traits. In the past, this was done through selective breeding, which is when a desired trait is witnessed in an organism, and humans then breed that organism in hopes of that trait being passed down.
What is genetic manipulation and what is its importance?
Genetic engineering is an important tool for natural scientists. Genes and other genetic information from a wide range of organisms are transformed into bacteria for storage and modification, creating genetically modified bacteria in the process.
Is genetic manipulation?
Genetic engineering, also called genetic modification or genetic manipulation, is the direct manipulation of an organism’s genes using biotechnology.
What is another term for transgenic manipulation?
Genetically modified organism ( GMO ) is commonly used to describe any of these terms and vice versa: genetic modification (GM), GM seeds, biotechnology, biotech seeds, genetic engineering (GE) and transgenic crops.
What are the 3 types of genetic engineering?
Commonly used methods include:
- microinjection of DNA into the nucleus of anchored cells;
- electroporation, where DNA is introduced through cell membrane pores by pulsed electrical charges;
- polycationic neutralization of the cell membrane and the DNA to be introduced to improve passive uptake;
What are genetic techniques?
Definition. Genetic techniques include all methods used to study genetic phenomena such as heredity, variation and DNA structure and function.
What are the pros and cons of GMO?
The pros of GMO crops are that they may contain more nutrients, are grown with fewer pesticides, and are usually cheaper than their non- GMO counterparts. The cons of GMO foods are that they may cause allergic reactions because of their altered DNA and they may increase antibiotic resistance.
Is genetic manipulation safe?
There are no reports of illness, injury, or environmental harm due to GE foods. Genetically engineered foods are just as safe as conventional foods.
What behavioral traits are genetic?
Much behavioral genetic research today focuses on identifying specific genes that affect behavioral dimensions, such as personality and intelligence, and disorders, such as autism, hyperactivity, depression, and schizophrenia.
What is genetic manipulation in humans?
Traditionally, humans have manipulated genomes indirectly by controlling breeding and selecting offspring with desired traits. Genetic engineering involves the direct manipulation of one or more genes. Most often, a gene from another species is added to an organism’s genome to give it a desired phenotype.
What is the importance of genetic?
A gene is a basic unit of heredity in a living organism. Genes come from our parents. We may inherit our physical traits and the likelihood of getting certain diseases and conditions from a parent. Genes contain the data needed to build and maintain cells and pass genetic information to offspring.
Why genetic engineering is bad?
ABSTRACT: There are many risks involved in genetic engineering. The release of genetically altered organisms in the environment can increase human suffering, decrease animal welfare, and lead to ecological disasters. Economic risks are acceptable, if they are condoned by the corporations and governments who take them.


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Spring weather this week
Tonight will be clear and chilly but not as cold as last night. Lows will drop into the 40s. We are going to see lovely spring weather this week in South Mississippi.
Tuesday will be mostly sunny and a little warmer with highs climbing into the 70s. Winds will be southeasterly at 5-10 mph. Winds pick up a little on Wednesday to southeasterly 10-15 mph. Highs in Wednesday will be warm, as well with highs in the low 70s.
We will see very low chances for rain for the rest of the week. This weekend, we spring forward, so don’t forget to set your clocks forward one hour before going to bed on Saturday night.
Next week, it looks like higher rain chances on Monday and Tuesday.


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How to select furniture for small living room? Living room is the place where we spend most of our time. It is also the place that your guests see the most too. Setting up a small room could be a little tricky. However, here are some tips on Small Living Room Furniture Ideas to make it look more appealing.
How to select furniture for small living room?
Wallpaper and mirror can work wonders:
Small living room could look pretty crammed and crowded. But wallpaper and mirror can add the depth and make it look bigger. Placing the mirror on the wall across the window will reflect the outdoors and create the illusion of larger space in the room. Few excellent Ideas on Wallpaper are here Wallpaper ideas and selection & creative-ways-of-using-wallpapers-in-your-home
Pick small furniture:
If your living room is small, it would not be a good idea to pick the giant sized sofas and huge chairs. Remember that living room is not just about big furniture items. Buy the items that can fit well in your living room.
Furniture with storage:
Small space could get pretty cluttered. In order to avoid that, it would be a wonderful idea to buy the furniture items that have built-in storage. For instance, if you are buying the side table, pick the one that has multiple drawers.
Fill the corners:
small living rooms have small corners. Using the largest furniture in the room to fill the corners will leave more space for other items. In this way, the room will appear bigger and will also be able to accommodate more furniture. It will also make sure that the room doesn’t look overstuffed.
You don’t really need to buy a 3-piece sofa set for your small living room. It ends up consuming too much space. Instead, a single piece, 3-seater sofa is perfect for such areas. Also, do not buy a big sofa. Instead, a slim one would be better.
The back of the sofa does consume space; especially it is angling away from the base. By using the backless sofa you can save some space. You can place the cushions by the wall for back support. You can also place the backless sofa in the middle of the room.
Plants and flower pots are a great supplement to your furniture. At the same time, they also add the depth to the room, giving the feeling of larger space than is. Pick the plants that have lots of green leaves. If you want to explore more for indoor plants, then you can find something useful in following links, green-interiors-six-reasons-to-use-indoor-plants-and-how, indoor-gardening-decorative-planters & planting-the-indoor-greens
Furniture items that are multifunctional:
The furniture items that can perform multiple functions are perfect for a small living room. For instance, you can buy ottoman that can be used for seating as well as coffee tables. For more ideas on multipurpose furnitures tips-for-homeowners-how-to-save-space-with-multipurpose-furniture
Wall mounted racks:
Wall mounted racks can be used to keep things and they can also enhance the appearance of your living room. They do not use any space on the floor and hence you can buy additional furniture items. To find innovative ideas for wall mounted racks, see here 18-innovative-shelves-to-decorate-your-storage-space
What if you need to accommodate more people in your living room any given day? Buy the furniture items that can be folded and then put aside when you don’t need them. This way you will be able to spare a lot of space in the room.

domain: design


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Jean Georges Steakhouse
Aria at CityCenter - 3730 S. Las Vegas Blvd
Las Vegas, NV, 89109
Steaks, Steak House-Fine
$35 or more
Payment types accepted:
AMEX, VISA, MASTERCARD, DISCOVER, CASH
Monday: 5:00 PM to 10:30 PM
Tuesday: 5:00 PM to 10:30 PM
Wednesday: 5:00 PM to 10:30 PM
Thursday: 5:00 PM to 10:30 PM
Friday: 5:00 PM to 10:30 PM
Saturday: 5:00 PM to 10:30 PM
Sunday: 5:00 PM to 10:30 PM
Reservations: Reservations Suggested
Jean Georges Steakhouse Review:
Chef Jean-Georges Vongerichten will stimulate your steakhouse senses with bold flavors, quality meats and inventive side dishes.
Start out with a large selection of raw appetizers including tuna tartare, oysters on the half shell or a chilled seafood platter.
Entrees include a choice of fish or meat dishes. The JG cheeseburger is topped with truffle mayonnaise, brie, yuzu pickles and served with truffle fries. Other options include Colorado lamb chops, wood grilled whole snapper and Maine lobster. Mouthwatering sides include black truffle mac and cheese, broiled bone marrow and roasted Brussels sprouts with pecans and avocado.
Of course steak is the highlight here and guests can choose from a variety of cuts including a 36-ounce porterhouse, Wagyu filet mignon and more. Sauces, such as homemade hot sauce, soy-miso butter and bearnaise, accompany the steaks
The chef also offers a signature tasting menu available with a wine pairing.
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Trinity Services, Inc
Trinity Services Inc., a nonprofit, non-sectarian organization, was founded in 1950 as the Trinity School in Joliet, Illinois, by a group of parents of children with developmental disabilities. Until 1987 Trinity remained a school for children and adults with mental retardation. Since then, Trinity has grown to include a wide range of programs, supports, and services for children and adults with developmental disabilities and/or behavioral health needs. In addition to the school, Trinity Services now provides residential services, adult learning programs, Behavioral Health Programs, supportive employment, and a host of support businesses . Trinity serves more than 1,500 people in the south and northwest suburban regions of Chicago, Illinois. For over 50 years Trinity Services board of directors, leadership, and staff of has been helping people with disabilities live full and abundant lives. Guided by our philosophy of “servant leadership” – the notion of helping others before helping yourself – Trinity strives to be a role model, leading by example in the area of social responsibility. It is through the support of people such as yourselves that we are able to assist people with disabilities to become successful in their own personal goals. Whether it is learning to dress or cook independently, or to become employed within the community, each person's goals are as important to us as they are to the people who want to achieve them.


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I have loved the thought of growing food for a long time.
I have romantic visions and memories of a massive garden as a child. My parents even grew corn when we lived in the country. I remember planting tiny seeds through suburban rows after we moved closer to the city. It all seemed to easy when someone else did it.
I have tried different rounds of growing since moving to the city – most ended up with a premature demise of the flavor of the day. Forgetting to water was the most common culprit though the odd experiment failed due to lack of sun or raccoons deciding I had built them a salad bar. Other than sprouts, I`ve been struggling to find any success in our urban `farming`adventures (I was also comforted that I really had no other choice since our backyard is actually completely covered in cement being that we share it with a coffee shop).
This year has been different. We`ve still failed way more than we`ve succeeded; some ambitious early seeding was lost almost in entirety and I have managed to grow 2 beans (not plants, beans). But a drastic change occurred about 2 weeks ago. I suddenly began to enjoy pruning and staking and watering. Not just the idea of these things but the actual task.
Since my enjoyment has gone up, my small gardens have also began to flourish (including the fore mentioned monster crop of beans). We have oregano, parsley, 2 types of basil, some late cucumbers are coming along and all 8 different heirloom tomatoes are coming to the party. We`ve also learned a lot about the extreme heat of our fire escape, relative shade of our back yard and the fact that my parking spot gets way less direct sunlight than I assumed.
Regardless of our success, it’s the routine that’s becoming fun. It’s a whole lot less romance and a whole lot more committment than I thought but it really is fantastic, although we had our first salad featuring our own tomatoes last night to top it off. Perhaps there is some romance in here yet…

domain: agronomy


Techno was created and developed far away from the mainstream. The underground sound got its deserved popularity in the past few years but there is a lot of movement in sound with sub-genres and a lot of talent you may not hear about.
We believe underground producers and labels deserve special recognition, so we will be dedicating our new feature series to this cause.
This week we will have a look into a rising name on the underground scene, Anahit Vardanyan.
Born in Armenia, Anahit Vardanyan was hooked to the piano since her very early days. Anahit moves to Germany in 2016, pumped with passion for music. Being constantly in the studio to work on her dark and melodic compostions.
As a perfectionist, she spends as much time as possible in the studio. During the weekends Anahit Vardanyan presents herself on stage.
Speaking of her music, Anahit released her debut EP ‘Free Fall’ on Kitchen Recordings back in 2019. Her breakthrough release that caught the ears of techno fans worldwide was ‘Tatev’ EP, released on Hydrozoa.
In 2022 Anahit released three singles on Alaula Music, the latest being ‘Simplicity’ released on October 28th.


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Memorable Manitobans: Henry Fitzgibbon “Harry” Maley (1869-?)
Born in Ontario on 7 January 1869, son of John Edward Maley (1827-1905) and Wilhelmina Maley (1834-1921), he worked as an expressman before coming to Brandon where he helped to organize the Brandon Brewing and Bottling Company in 1902, in partnership with his brother Edward McKenzie Maley (1851-1940) and Alexander Ferguson. Later shareholders in the company included T. H. Taylor, R. A. Clement, and brewmaster William Schwartz. It operated until after Prohibition was repealed in 1923, when it was sold to a Winnipeg syndicate and became the Premier Brewing Company.
On 7 November 1894, he married to Emily Jane Clement (?-?) at Brandon. They had four children: John Ashley Maley (1896-?), Eleanor Abigail Maley (1900-?), Wilhelmina McKenzie Maley (1902-?), and Stephen Clement Maley (1909-?). In 1912, the family moved into Maley House, at the corner of Victoria Avenue and 16th Street, losing it four years later with the onset of Prohibition.
Maley was living in Brandon in 1923 but his later whereabouts are unknown.
Marriage and birth registrations, Manitoba Vital Statistics.
1901 and 1911 Canada censes, Automated Genealogy.
“New companies,” Manitoba Free Press, 6 March 1911, page 9.
“Valued Brandon church worker dies suddenly,” Manitoba Free Press, 16 July 1921, page 11.
Henderson’s Directory for Brandon, Peel Bibliography, University of Alberta.
We thank Dave Craig for providing information used here.
This page was prepared by Gordon Goldsborough.
Page revised: 15 October 2019
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domain: history


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I still haven't heard from them, which means I don't have any update. I suspect they are having as good a sleep as possible in the hospital, with Adam hooked up to fluids again after a dose of IV antibiotics. I'll keep posting news here as I have it...for now we rest and wait.
My prayer tonight is for a sense of calm and peace, for rest for Adam and Brian, for clear results from the blood cultures so that the docs can treat Adam quickly and effectively, and for strength for Adam's little body, already going through so much.
It may well be a full week, but I'll try to update again soon.


The state run media is singing the praises of Obama and his handling of the Libya situation. Yet, this praise doesn’t pass the smell or see test.
First of all we have found out the Egyptian Military and the Muslim Brotherhood were in cahoots to kick Mubarak outta office. They brokered a deal to get him outta of the way in exchange to set up the election so that the Muslim Brotherhood would have the inside track.
Egypt is one of the lynch pins in Iran’s, Al Qaeda, and the Muslim Brotherhood’s attempt to seal off Israel.
Libya is the next key in this plan of attack. Al Qaeda backs the Libyan rebels. The arms are supplied by Russia.
The next to fall will be Yemen.
In the end the United States and Al Qaeda are on the same side fighting to kick Qaddafi outta of Libya.
Yes, Qaddafi is a bad man.
He is evil.
Yet, the USA is on the side of terrorists who want to wipe off the face of the earth the Jews.
One more piece of the puzzle is this Israel is now being bombarded with rockets from Gaza.
The attacks on Israel will increase.
The real object of all of this fighting is to surround Israel.
When this happens all the nations in the Middle East and the world will attack Israel.
You can make book on it.
Libya, Egypt, Tunisia, Yemen, and Syria have gotten away from Sharia Law and the Caliphate.
The truth hurts.
The truth shall set you free.
The Jews are on the top every Communist, Fascist, Leftist, Liberal, Environmentalist’s, Socialist’s, and anti- semantic hit list.
All the evil forces of the world will always join forces to wipe my people out.


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(Adds analyst comment)
May 8 (Reuters) - Dish Network Corp reported first-quarter revenue that missed Wall Street estimates on Tuesday as subscriber additions to its cheaper online streaming service Sling TV failed to offset a drop in its legacy pay-TV subscriptions.
The U.S. satellite TV provider lost another 94,000 subscribers for its pay-TV service in the quarter, while it added 91,000 subscribers for Sling TV.
Shares of Dish dipped 0.5 percent to $33.72 in morning trading.
Dish has been trying to lure young viewers to the $20-per-month online streaming service Sling as it battles cord cutting in its satellite-TV services, with viewers moving to competitors like Netflix Inc and Amazon.com Inc's Prime Video.
Average revenue per user in the company's pay-TV business fell to $84.50 from $86.55.
MoffettNathanson analyst Craig Moffett said in a research note that Dish's average revenue per user could experience even more pressure in the future, as so-called skinny bundles, including its own Sling TV, cap Dish's ability to raise prices.
Average revenue per Sling TV user is $25, Moffett estimated, much lower than Dish's traditional TV customers.
Net income attributable to the company fell to $368 million, or 70 cents per share, for the quarter ended March 31, from $376 million, or 76 cents per share, a year earlier.
Revenue fell to $3.46 billion from $3.68 billion last year.
Analysts on an average were expecting a revenue of $3.5 billion, according to Thomson Reuters I/B/E/S. (Reporting by Arjun Panchadar in Bengaluru and Sheila Dang in New York; Editing by Arun Koyyur and David Gregorio)


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1. Thomas J, Kostousov V, Teruya J. Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation. Semin Thromb Hemost. 2018 Feb; 44(1): 20–29.
2. Paniccia R, Priora R, Liotta AA, Abbate R. Platelet function tests: a comparative review. Vasc Health Risk Manag. 2015 Feb 18; 11: 133–148.
3. Hayward CP, Harrison P, Cattaneo M, Ortel TL, Rao AK; Platelet Physiology Subcommittee of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Platelet function analyzer (PFA)-100 closure time in the evaluation of platelet disorders and platelet function. J Thromb Haemost. 2006 Feb; 4(2): 312–319.
4. Favaloro EJ. Clinical utility of closure times using the platelet function analyzer-100/200. Am J Hematol. 2017 Apr; 92(4): 398–404.
5. Raman S, Silverman NA. Clinical utility of the platelet function analyzer (PFA-100) in cardiothoracic procedures involving extracorporeal circulation. J Thorac Cardiovasc Surg. 2001 Jul; 122(1): 190–191.
6. Kottke-Marchant K, Powers JB, Brooks L, Kundu S, Christie DJ. The effect of antiplatelet drugs, heparin, and preanalytical variables on platelet function detected by the platelet function analyzer (PFA-100). Clin Appl Thromb Hemost. 1999 Apr; 5(2): 122–130.
7. Slaughter TF, Sreeram G, Sharma AD, El-Moalem H, East CJ, Greenberg CS. Reversible shear-mediated platelet dysfunction during cardiac surgery as assessed by the PFA-100 platelet function analyzer. Blood Coagul Fibrinolysis. 2001 Mar; 12(2): 85–93.
8. Williams MS, Ng’alla LS. Heparin therapy leads to platelet activation and prolongation of PFA-100 closure time. J Cardiovasc Pharmacol Ther. 2005 Dec; 10(4): 273–280.
9. Sobel M, McNeill PM, Carlson PL, Kermode JC, Adelman B, Conroy R, et al. Heparin inhibition of von Willebrand factor-dependent platelet function in vitro and in vivo. J Clin Invest. 1991; 87(5): 1787–1793.
10. Kroner PA, Frey AB. Analysis of the structure and function of the von Willebrand factor A1 domain using targeted deletions and alanine-scanning mutagenesis. Biochemistry. 1996 Oct 15; 35(41): 13460–13468.
11. Griffin MJ, Rinder HM, Smith BR, Tracey JB, Kriz NS, Li CK, et al. The effects of heparin, protamine, and heparin/protamine reversal on platelet function under conditions of arterial shear stress. Anesth Analg. 2001 Jul; 93(1): 20–27.
12. Mikhailidis DP, Fonseca VA, Barradas MA, Jeremy JY, Dandona P. Platelet activation following intravenous injection of a conventional heparin: absence of effect with a low molecular weight heparinoid (Org 10172). Br J Clin Pharmacol. 1987 Oct; 24(4): 415–424.
13. Barradas MA, Mikhailidis DP, Dandona P. The effect of non-esterified fatty acids on vascular ADP-degrading enzyme activity. Diabetes Res Clin Pract. 1987 Jan-Feb; 3(1): 9–19.
14. Mikhailidis DP, Mikhailidis AM, Dandona P. Effect of human plasma proteins on stabilisation of platelet anti-aggregatory activity of prostacyclin. Ann Clin Biochem. 1982 Jul; 19(Pt 4): 241–244.
15. Jagroop IA, Mikhailidis DP. Heparin therapy leads to platelet activation and prolongation of platelet function analyser-100 closure time. J Cardiovasc Pharmacol Ther. 2006 Jun; 11(2): 156–157.
16. Durila M, Vajter J, Garaj M, Smetak T, Hedvicak P, Berousek J, et al. Acquired primary hemostasis pathology detected by platelet function analyzer 200 seen during extracorporeal membrane oxygenation is sufficient to prevent circuit thrombosis: A pilot study. J Heart Lung Transplant. 2020; 39(9): 980–982.

domain: literature


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Two Missouri-based companies made a recent ranking of the fastest growing retailers: Bass Pro Shops and O'Reilly Automotive, both based in Springfield, came in at numbers 48 and 53, respectively. The nation's fastest growing retailer? Grocery store chain Albertsons with 432.7 percent sales growth between 2012 and 2013.
Missouri's battle over the right-to-farm amendment gained the attention of the New York Times over the weekend, which noted that while Missourians already have constitutional rights to religion speech and guns, the proposed amendment could "make a novel addition to the State Constitution."
And more controversy down on the farm: The growing popularity of barn weddings is raising the ire of some rural residents, who say the events disrupt their typically quiet lifestyles. According to a New York Times piece, a St. Louis County judge last summer ruled that a local historic barn was a potential fire hazard, leaving a bride and groom scrambling to find a new location to host their upcoming wedding reception.
Food for thought: The price of butter hit $2.62 a pound July 23, just 19 cents shy of its all-time record and about $1 a pound more than what it was last summer. Meanwhile, butter consumption in the U.S. has hit its highest point in more than 40 years.
And in other shocking dairy news, an exploding vat of eggnog damaged a pharmaceutical plant and injured two workers in New Jersey over the weekend.
Angela Mueller covers health care.


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Follow the steps to find out everything you can do on your account or watch a youtube video.
1. Go to the library catalog
2. Log on to your account with your library card number and phone number.
3. Click on "My Account"
4. You can see account info. Under "Account Info" you can see your address, phone, and email.
5. Next is notifications. Here you can see where you get notifications about items overdue and reserves.
6. Under "Items Out/Renewals" you can see all the items out and you can renew them all or invidually.
7. When you go to "Reserves and Requests" you can see what you have on reserve.
8. Under "Reserves and Requests" you can also choose authors that you like and you will automatically be put on reserve for their new books. You can choose to defer a reserve; here you can put dates you will be gone and the book will be on reserve after those dates.
9. The bookmark tab lets you bookmark books you want to read.
10. Search the catalog to place reserves and bookmark items.

domain: library


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How To Control Your Cholesterol With Food
High cholesterol is the most common root cause of heart disease. The avoidance of cardiovascular disease is vital to minimizing the threat of cardiac arrest as well as strokes. The treatments for high cholesterol include medications as well as healthy and balanced way of living enhancements. The healthy and balanced way of living enhancements include a well balanced diet plan, normal exercise, and weight control. How To Control Your Cholesterol With Food
Diet is the cornerstone of cholesterol control. There are several crucial foods to consider. Vegetables and fruits are abundant in nutrients and also fiber. Lean meats, chicken, fish, egg whites, and also dairy products are all wonderful choices. Additionally, vegetables and fruits have virtually two-thirds of their calories, so a healthy and balanced diet plan can help maintain triglycerides in check. How To Control Your Cholesterol With Food
How To Control Your Cholesterol With Food
Diet regimens that are reduced in hydrogenated fat and cholesterol, high in fiber, as well as low in salt are the best choices for a healthy and balanced diet plan. Decreasing cholesterol with diet regimen alone can lower the danger of cardiovascular disease such as coronary artery illness (CAD) and stroke. Individuals with hypertension ought to additionally make an initiative to maintain their high blood pressure low. High blood pressure enhances the danger of creating cholesterol-related conditions, so it must be managed too. How To Control Your Cholesterol With Food
Smoking cigarettes or utilizing other tobacco items has been shown in various studies to increase LDL cholesterol levels as well as lower HDL cholesterol levels. This is why giving up smoking is so important. Various other factors to cholesterol consist of excessive weight, physical inactivity, alcohol consumption, and also the presence of various other risk aspects, such as diabetes, heart disease, and cancer cells. On top of that, some drugs, consisting of anabolic steroids, have actually been revealed to trigger cholesterol. Every one of these factors to cholesterol are preventable.
It is not always easy to judge nourishment tags. Nourishment labels need to note the amount of hydrogenated fat, cholesterol, and also fiber in the product. Many foods that taste great may actually have high amounts of hydrogenated fat and cholesterol, even if they identify their food as “fat cost-free”. This is because of the fact that lots of trans fats, generally used as a chemical in numerous foods, increase cholesterol degrees in the body. Fiber is not just helpful for you, but it decreases the absorption of fat. A diet plan high in fiber can substantially lower the risk of developing cardiovascular disease.
Omega 3 fats are plentiful in fish, nuts, and seeds. Taking fish oils, consisting of oily fish such as tuna, salmon, as well as exactly how, can aid lower LDL cholesterol. They can likewise aid lower hypertension and also may help to stop type 2 diabetes as well as cancer. Various other nuts, seeds, and also oils that can help reduced cholesterol are walnuts, canola, sunflower seeds, as well as flax seed oil.
If you smoke, decreasing your cigarette usage is an essential step towards lowering your blood pressure as well as taking control of your cholesterol levels. Cigarette smoking is one of the major risk variables for cardiovascular disease. If you integrate cigarette usage with low physical activity, you are setting on your own up for future wellness problems. Physical activity reduces your blood pressure and routine workout is an integral part of a healthy and balanced lifestyle. Even a percentage of regular exercise can make a big difference in your general health and wellness.
Eating much more fruits, vegetables, entire grains, beans, fish, fowl, and also lean meats will certainly keep your heart healthy and balanced and also minimize cholesterol while improving your total health and wellness. Reduced cholesterol is a required part of a healthy and balanced lifestyle. By making just a couple of way of living modifications, you can lower your cholesterol as well as decrease your risk for cardiac disease and various other heart problems. If you are concerned regarding your cholesterol, consult your physician today and also make some straightforward modifications in your daily diet plan that will certainly have a positive impact on your heart and your total health.


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The Pet Food Association of Canada (PFAC) is the national voice of the pet food industry in Canada. PFAC represents pet food manufacturers who supply most of the pet food sold in this country and who export to almost 90 countries around the world. PFAC also represents members who supply the pet food industry with ingredients, products and services. The association provides members with regulatory support, government relations, export and market access support and other services.
Learn About Pet Food
Pet Food Trade
PFAC members follow robust food safety and nutrition criteria
PFAC members take the safety and quality of your pet’s food seriously. All follow a recognized food safety program, such as a Global Food Safety Initiative scheme, a HACCP based program, or similar. PFAC members also follow AAFCO nutritional guidelines to ensure a complete and balanced diet of appropriate nutrition for both cats and dogs.

domain: pet


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Barking is a extremely normal habits of pets as it is their method of communicating withtheir human buddy and other animals. Pet dog frequently bark to express their sensations to their human buddy. So, sometimes even a properly acted pet dog can startbarking ceaselessly. There are a great deal of factors that could trigger a dog to bark and theirbarking can be really bothersome. Canines often bark to alerttheir human companion of a suspicious activity or a suspicious person. Pets may also bark due to the fact that they do not trust odd peopleor they are uneasy with the existence of unusual people in their house. Some pets are used by their human companion to alertthem of trespassers and any other type of risks. But often perpetual barking can be extremely frustrating and disturbing dueto the fact that if your canine is barking all through the night, itcan have an adverse result on the people living in the exact same house as the pet and their next-door neighbors. A dog that is barking ceaselessly can trigger a significant boost in the stress levels of the people in the dog's environment,this can lead to loss of sleep.
One of the most popular methods of controlling barking issues in pets is using barkcollars. Bark collars is one of the most tender methods of controlling relentless barking in canines. It is also an effective way of managing barking problems in dogs. A bark collar is likewise an effective method of training a canine, although it is not as widely utilized aspositive support.
TYPES OF BARK COLLARS
There are numerous types of dog collars in the market today, however the three most typical types of dog collars consist of;
1. ELECTRIC SHOCK BARK COLLARS COLLARS
The electric shock bark collars are one of the earliesttype of bark collars on the marketplace. They work by giving the pet dog a mild fixedelectricity once the vibrations from its singing cords and barking noises are spotted by the sensing units of the bark collars. The electric shock dog collars sends out electric existing to pet's muscles whenever he barks. The inbuilt prongs is normally utilized to provide the mild electric shock which can adjusted inintensity inning accordance with the size of the petdog and the training requirements. However the exact approach that each specific electrical shock bark collars works depends upon the design and the producer of the electrical shock bark collar. The majority of type of electric shock barkcollars give off a moderate electricalcurrent when it senses that the dog is barking.Some people say that the electric shock bark collarsare terrible because of the mild electricalcurrent that is sent to the pet's body but it isnot most likely damage your canine in any way. The electrical shock bark collars is often utilizedto teach a dog to only bark when it is essential and not just barking ceaselessly. People that are utilizing the electric shock bark collar for the first time ought to begin with a low level setting and increase it slowly as the circumstance needs.
The use of electric shock bark collars is questionable, but it is extremely efficient for controlling constant dog barking as long as the user has adequate understanding about it. And also prevent setting the strength of the electric shocks expensive but rather set it to an strength that is simplyunpleasant sufficient to prevent the canine from barking. Likewise some electrical shockbark collars make use microphone to sense when the pet dog isbarking. Some collars nevertheless make use of both vibrationsensors and microphones to pick up when the dog is barking.
2. ULTRASONIC BARK COLLARS
The ultrasonic bark collars are one of the most popular bark collars in themarket today. This kind of bark collars are used to dissuade pets from barking by usingan irritating yet entirelyharmless sound. Ultrasonic More Bonuses bark collars frequently workby launching a high pitched ultrasonic sound that is said tobe annoying to prevent the dogfrom barking. They are also one of the most effective method of controlling a pet's incessant barking. The bark collar gives off a sound when its microphone senses the pet'sbarking that startles the canine withoutresulting see it here in any kind of physical harm. Themicrophones in the ultrasonic bark collars are established to pick up unique barking, which stops the high pitched ultrasonicsound from unintentionally going off as aresult of other sounds. The high pitched ultrasonic noise emitted by the ultrasonic bark collars can not be heard byhumans but they can be heard by pet dogs, and it only lasts for a few seconds. Recent research studies have actually revealed that this type of barkcollars does not have any kind of negative effect on the pet dog due to the fact thatthe duration of the high pitched ultrasonic sound is controlled. A number of brand names of ultrasonic bark collarshave a favorable tone function that functions asa favorable support when the pet stopsbarking.
3. CITRONELLA SPRAY BARK COLLARS
The citronella spray bark collars work by spraying out citronella unto thedog's snout whenever the dog startsbarking. The citronella spray frequently go for the pet dog's sense for quick outcomes. The citronella spray barkcollar are created to make the dog link the smell of citronella with barking, so the dog will stopbarking since he does not want smell thecitronella that is frequently launched as a consequence forbarking. This is often effective since the fragrance of citronella is extremely disappointing to pet dogs howeverit is likewise absolutely safe. Citronella is generally utilized as an bug sprayby humans but it does not bother people.
he said When the pet dog begins barking, themicrophone will sense the barking and the citronella spray bark collarwill release the harmless citronella scent. It does notrequire any human intervention to function and it has no adverse effects on the health of the pet dog, rather it has a relaxing result on the pet. It likewise make the mostof pets severe hatred of organic options. The quantity of citronella launched ought to just be enough to stop the canine from barking.
The only disadvantages of using the citronella spray bark collars isthat the scent of the citronella might stick to the dog's body for many minutes or hours insome celebrations.


text: The electronic version of the dexterity board game Sorry! Sliders. This game is available on the Xbox Marketplace and also as part of one of Hasbro's board game collections. It includes several variants not available in the analog version, as well as unlockable items, leaderboards and achievements. This game requires the Xbox 360 hard drive or the 512MB Memory Unit for storage.

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The Good Sister by Sally Hepworth (Kindle): A multi-layered story about a quirky librarian struggling with social functioning, in the vein of Eleanor Oliphant is Completely Fine. Fern and Rose are twins, but they couldn’t be more different. Fern has sensory processing disorder, but she thrives at the library where order reigns supreme. Ever the sensible one, Rose assumes a caretaker role with her sister. Feeling indebted to her sister, Fern makes a grand gesture to repay Rose—and it changes the relationship between the sisters forever. When this complicated family story takes a turn into psychological drama you’ll be left wondering, who is the good sister?
This was recommended to by the lovely Deb. I thoroughly enjoyed it and devoured it pretty much over the course of an afternoon and evening. 🙂
Life’s Too Short by Abby Jimenez: The story deals with real life problems and difficulties, particularly surrounding disability. There are so many parts of the book that make you pause and think about how you’re living your own life.
The connection between Adrian and Vanessa is so well written and there are frequent laugh out loud moments … and some tears too. I also enjoyed Kristen and Josh, and Sloan and Jason making a cameo appearance.
I’ve also seen that The Happy Ever After Playlist is going to made into a film and I can’t wait to see who’ll be cast as Jason!
You and Me on Vacation by Emily Henry (Kindle): This story is told in the present day, with flashbacks to different times over a span of twelve years. Poppy and Alex are likeable characters and I was invested in their story – I really enjoyed reading this. You could say that this is a perfect vacation read. 🙂
Love at First by Kate Clayborn: With winning characters, a multigenerational family-of-her-choosing, and a fun Chicago setting, this romance is going to make readers happy. Will and Nora live two floors apart from each other, where late night balcony chats bring them closer together—and their clashing plans for the building spark a surprising rivalry. I expected an absorbing plot and engaging characters; I did not expect it to get me right in the feels. Heads up for a steamy scene.
As Monday, 31 May is a UK Bank Holiday, the next scheduled post will appear on Tuesday, 1June. I do, however, have a guest post appearing on Melissa’s blog, Daily Life – Bits and Pieces, on Monday. 🙂


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The main reason behind such an extreme pace of home worth appreciation is the basic financial seesaw of supply and demand. The nation wants way more models to meet demand but there has been a large and protracted shortfall lately. On top of that, the pandemic has actually knocked down homebuilders’ capability to fill the housing supply as they’re operating out of land.
REITs of all kinds collectively personal more than $3 trillion in gross real estate assets throughout the united states, with stock-exchange listed REITs owning roughly $2 trillion in property. U.S. listed REITs have an fairness market capitalization of greater than $1 trillion. For a cool $6.9 million, this five-acre horse property just south of Boulder boasts Flatirons views and direct entry to riding trails within straightforward attain of town. The average worth of attached properties also exceeded $395,000 for the primary time.
Turn Into Licensed
Although the foreclosures moratorium on government-backed loans has put a halt on foreclosure activity the mortgage servicers have been able to begin foreclosures actions on vacant and abandoned properties. The National Association of Realtors expects rates to common 3.1% and the Mortgage Bankers Association says mortgage rates will common 3.3% in 2021. These fee estimates are both up from the 3.0% mortgage rate average in 2020 but decrease than 2019’s average charges. Many experts say it could be years before mortgage charges return to their pre-pandemic levels.
Education FoundationGrants for California REALTORS® and residents pursuing real estate schooling. Surveys & ReportsCalifornians are surveyed yearly to realize insights on the housing market from their persepective.
In Housing Markets Like Cape Cod And The Jersey Shore, Homes For Sale Disappeared During Covid
Here you’ll find instructional materials, marketing tools, coaching movies, and extra to keep you on top of your game. C.A.R. is a statewide commerce Real Estate association dedicated to the development of professionalism in real estate. Scholarships for California students planning to pursue a profession in real estate.
Beautiful and modern 4 Bed villa in Rawai Phuket: Very beautiful and modern 4 Bed villa in Rawai. A superbly presented four bedroom pool villa in the heart of Rawai built far enough from the village, surrounded by Rubber… https://t.co/FBmiVUpbiZ #realestate #property #properties pic.twitter.com/W1WcHcktxK
— @phuketlastupdates (@phuketupdates) May 17, 2021
Being in a place to see that there’s a rest room off of a bedroom, or that the kitchen is open to the lounge, and so forth, is extraordinarily important. Home layouts could be deal-breakers for folks, and if the structure isn’t shown nicely within the itemizing images, they may not even take the time to look additional. When solely shooting squared up to walls you miss the chance to indicate the full structure of the home or will on the very least need to take more photographs to do so. We have restricted time to seize the attention of viewers, so getting extra info in fewer pictures is essential. Real Estate Investment Our real estate property management asset professionals directly evaluate the challenges and opportunities of every particular person constructing’s technique.
Yes America Still Has Reasonably Priced Properties (gasp!). Heres The Place They Are
Pre-MLS marketing, together with “Coming Soon” signs as nicely as digital marketing outreach to broker neighborhood. A new Urban Land Institute report states industry leaders are hoping for a “consumer-spending-led economic recovery” from the COVID-19 pandemic. ETFs are topic to market fluctuation and the dangers of their underlying investments. Unlike mutual funds, ETF shares are purchased and bought at market value, which can be larger or lower than their NAV, and usually are not individually redeemed from the fund. Brokers and homeowners from CORFAC International’s member corporations seemed back on 2020 for the network’s first member outlook survey. The survey revealed that – after a year marked by the tumult of the pandemic, related financial downturn and political and social unrest – CORFAC brokers responded with resiliency and creativity. They shared how they adapted their business practices, recognized new areas of opportunity and started off 2021 with measured optimism in regards to the yr forward.
- The 1.1-acre lot is situated three metropolis blocks east of Candlestick Park, the television station reported.
- It prepares college students for a real estate career by exploring the link between real estate and capital markets, growing real estate decision-making abilities, and analyzing real estate opportunities.
A downward angle is the extra frequent concern of the 2 angle problems, and the result is very like having your tripod too high. Important options on the ceiling get cropped out, which then misses a possibility to level out potential patrons or renters why they should choose this specific property. There isn’t essentially one peak that works for each property and even each room within one property, so it is one thing that you want to regulate as you go. Kitchens and loos will profit from the slightly higher finish of that spectrum, whereas bedrooms and dwelling rooms will be on the lower end. The key is looking at your pictures when you shoot and adjusting if you’re cropping out or hiding essential components. Second, and more importantly, having your tripod too high or too low can reduce off necessary options that must be shown. If your tripod is simply too close to the ground, you could cut off ceiling followers, recessed lighting, high ceilings, or another features that might be in course of the top of the room.


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Kitchen Knit and Crochet Patterns
Here’s a recipe for kitchen-ready needle-art projects, both knitted and crocheted. Whip up accent pieces (check out our tasseled placemats!) or create something with more functionality, like dishtowels, trivets and more. Click below for the inspiration and the free patterns.
Items You Will Need
Quantities shown below are recommended


For 19-year-old Danielle Frank, California’s Trinity River is a cultural lifeline.
“We are water people. We are river people,” she says. “And we believe that when our river drains and there is no more water left, we will no longer be here.”
Frank is a Hoopa tribal member and Yurok descendant. The Trinity River runs through her homeland.
“Our river has been declining in health for decades,” she says.
The river has been dammed, and water from the Trinity is often diverted to the Central Valley. Frank says those diversions — combined with droughts and global warming — are causing fish kills.
“The water levels are dropping so low that the water temperatures are skyrocketing to temperatures that salmon, not only can they not thrive, can they not spawn, they cannot survive in these areas,” she says.
So Frank is pushing for change. As the youth coordinator for the nonprofit Save California Salmon, Frank helps young people maintain their connection to the river and learn how to influence water policy.
“We only get to continue living the way that we’re meant to if our rivers are running freely, if our salmon are still there in our communities, and if we understand the way that these decisions are made and we can influence them,” she says.
Reporting credit: ChavoBart Digital Media


Thanks for following! I am looking forward to a great year! I am Coach Smathers this is my first year here at WOISD. I am coaching football and track. I am a 2015 graduate of Tarleton State University. I started teaching and coaching in August 2016.
We will be using google classroom for most things however I can post things on the blog if it is needed just let me know. My email is email@example.com
Below is the Policies and Procedures file
Monday: History of Motion discussion,
Tuesday: Inertia Lab
Wednesday: Newtons First law discussion and practice.
Thursday: New Classroom arrangement
Friday: New classroom arrangement
TEKS: P.04A-F, P.05A-H
Monday: Begin kinematics Lab
Tuesday:Finish Kinematics Lab
Wednesday: Kinematics Test Review
Thursday: Kinematics Test
Friday: History of motion discussion.
TEKS: P.05b-c P.04c
Monday: kinematics Practice
Tuesday: Kinematics practice
Wednesday: Kinematics Practice
Thursday: Formative Assessment Kinematics.
Friday: Kinematics Quiz
TEKS: P.05b-c P.04c
Monday: Introduction into gravity
Tuesday: Free fall problem introduction
Wednesday: Practice free fall problems
Thursday: Free fall Lab
Friday: Free fall lab continued.
Monday: Test Review
Tuesday: Check Test Review
Thursday: Gravity Discussion.
Friday: Student Holiday.
Monday: Finish merrily we go lab.
Tuesday: Complete lab and report.
Wednesday: Acceleration discussion
Thursday: Acceleration practice
Friday: Test Review (Test Tuesday)
Monday: Velocity Practice
Tuesday: Distance time Graphs
Wednesday: Graphing activity
Thursday: Velocity Lab
Friday: Velocity Lab
TEKS: P.04A, P.04B, P.04C
Monday: Making things Faster Video.
Tuesday: Domino Lab
Wednesday:Domino Lab continued
Thursday: Review of speed finish the domino if necessary.
Friday: lab speed assignment.
TEKS: P.04A, P.04B, P.04C, P.04D, P.05A
Monday: Introduction into forces.
Tuesday: Forces, Introduction into mechanical equilibrium.
Wednesday: Mechanical Equilibrium discussion and practice.
Thursday: Scalars and vectors discussion.
Friday: Velocity and speed discussion.
TEKS: P.02H, P.02L, P.03F, P.01A, P.01B
Monday: Dimensional analysis practice.
Tuesday: Accuracy vs precision, significant figure activity.
Wednesday: Significant figures notes and practice.
Thursday: Test review.
Friday: Test over scientific notation, significant figures, and dimensional analysis.


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Rise Radiant is the album we’ve been working towards for almost a decade. It represents everything we love about Caligula’s Horse” – Sam Vallen
Caligula’s Horse have announced their fifth studio album Rise Radiant will be released on May 22nd.
Rise Radiant was produced by the Caligula Horse’s Sam Vallen, and mixed by Jens Bogren (Opeth, Devin Townsend Project, Leprous).
Lead guitarist Sam Vallen said, “Rise Radiant is the album we’ve been working towards for almost a decade. It represents everything we love about Caligula’s Horse – the colour, the ferocity, the introspection, the extremes – all tied up together in a way we could never have managed until now. As a band, we’ve never felt tighter, more inspired, or more driven than in the creation of this record. We’re tremendously proud of ‘Rise Radiant’, and we can’t wait for you to hear it!”
> PRE-ORDER – https://caligulashorse.lnk.to/RiseRadiant <
The band says about the album – Rise Radiant is an uncompromising exploration of the human experience dressed in vivid musical colour and virtuosic performances. It is an anthem for the regeneration of self-belief, an exploration of the themes of legacy, and a rallying cry for survival.
Comprised of 8 tracks, Rise Radiant will be available as a limited CD Digipak, Gatefold 2LP + CD & as a digital download. The formats also include 2 bonus tracks, covers of the Split Enz track “Message To My Girl” & Peter Gabriel’s “Don’t Give Up”, which also features a guest appearance by Lynsey Ward of Exploring Birdsong.

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Human chorionic gonadotropin (hCG) is a chemical created by trophoblast tissue, tissue typically found in early embryos and which will eventually be part of the placenta. Measuring hCG levels can be helpful in identifying a normal pregnancy, pathologic pregnancy, and can also be useful following an aborted pregnancy. There is also a benefit in measuring hCG in a variety of cancers including choriocarcinoma and extra-uterine malignancies.
Human chorionic gonadotropin is a hormone produced primarily by syncytiotrophoblastic cells of the placenta during pregnancy. The hormone stimulates the corpus luteum to produce progesterone to maintain the pregnancy. Smaller amounts of hCG are also produced in the pituitary gland, the liver, and the colon. As previously mentioned, certain malignancies can also produce either hCG or hCG-related hormone. Trophoblastic cancers (hydatidiform mole, choriocarcinoma, and germ cell tumors) are associated with high serum levels of hCG-related molecules.
The hormone itself is a glycoprotein composed of two subunits, the alpha and beta subunits. There are multiple forms found in the serum and urine during pregnancy including the intact hormone and each of the free subunits. HCG is primarily catabolized by the liver, although about 20% is excreted in the urine. The beta subunit is degraded in the kidney to make a core fragment which is measured by urine hCG tests.
Serum tests for hCG are immunometric assays. This means that they use 2two antibodies that bind to the hCG molecule, a fixed antibody and a radiolabeled antibody which adhere to different sites on the molecule, sandwiching and immobilize the molecule to make it detectable. Assays involve washing away the excess serum components and measuring the amount of remaining labeled hCG to give a quantitative result. There are more than 100 different assays commercially available which results in significant variability in reported values.
Urine assays are similar, although many detect total hCG levels greater than 20 mIU/mL. Many over-the-counter urine pregnancy tests do not detect hyperglycosylated hCG, which accounts for most of the hCG in early pregnancy, resulting in a wide range of sensitivities of these tests.
Serum testing is much more sensitive and specific than urine testing. Urine testing, however, is more convenient, affordable, comfortable for patients, has a fast turnaround (5 to 10 minutes), and does not require a medical prescription.
There are multiple reasons why an hCG test (serum or urine) may have a false report. While uncommon, false positive hCG tests can result in unnecessary medical care and/or irreversible surgical procedures. False negatives may be equally concerning and result in a delay in care or diagnostic evaluation. Potential causes of false results are listed and briefly discussed.
Serum False Positives (1/1000 to 1/10,000)
Serum False Negatives
Urine False Positives
Urine False Negatives
HCG levels are reported in milli-international units of hCG hormone per milliliter of blood, or mIU/mL. International unit per liter (IU/L) may also be used.
Urine hCG testing is qualitative, reporting a positive or negative result. The assays detect hCG levels typically starting at 20 to 50 (reportedly as low as 6.3 to 12.5) mIU/mL, corresponding to levels at approximately 4 weeks post-conception.
Serum assays can measure beta-hCG as low as 1 to 2 mIU/mL.
HCG is an important hormone in pregnancy, and its clinical utility is primarily centered around its detection in early pregnancy, along with serial measurement during pregnancy and pregnancy-related complications.
Levels of hCG can vary widely between women with normal pregnancies. Typically, serum and urine concentrations of hCG rise exponentially in the first trimester of pregnancy, doubling about every 24 hours during the first 8 weeks. The peak is usually around 10 weeks of gestation and then levels decrease until about the 16th week of gestation where they remain fairly constant until term.
Patients who have hCG levels that plateau prior to 8 weeks or that fail to double commonly have a nonviable pregnancy, whether intra-uterine or extra-uterine. Extra-uterine (ectopic) pregnancies usually have a rate-of-rise that is low without the typical doubling. However, given the large range of normal hCG levels and inconsistent rates-of-rise of this hormone, checking serum levels is typically paired with ultrasound evaluation to improve sensitivity and specificity.
Return of hCG to zero following delivery or termination of pregnancy ranges from 7 to 60 days. Trending the fall of hCG levels can be important in termination of molar pregnancies and also following the termination of normal or ectopic pregnancies to be assured that the therapy has been successful.
It notable that there are many different combinations of antibodies used in commercial assays. This results in heterogeneous results with as much as a 50-fold difference in immunoassay results. This is clinically relevant, particularly when comparing results from different laboratories in different facilities/hospitals when examining low values following pregnancy termination or trophoblastic disease.
Gestational Trophoblastic Disease
Detection of hCG is also useful in the evaluation of trophoblastic disease, including complete and partial hydatidiform mole, postmolar tumor, gestational choriocarcinoma, testicular choriocarcinoma, and placental site trophoblastic disease. All of these entities produce hCG, varying levels of which are reported on commercial assays. A total hCG level of greater than 100,000 mIU/mL in early pregnancy, for example, is highly suggestive of a complete hydatidiform mole, although many normal pregnancies may reach this level at their peak around weeks 8 to 11 of gestation. Precise hCG measurements are important to assess the tumor mass, the successful treatment of malignancy, and to test for recurrence or persistence of disease.
HCG in the serum increases with age in nonpregnant women. A cut off of 14 mIU/mL has been suggested for use in interpreting results in women over the age of 55. In all nonpregnant patients, testicular cancer, ovarian cancer, bladder cancer, or other malignancy should be evaluated as a source of persistently positive hCG testing.
Knowing the utility and variability of different hCG assays is clinically relevant to a wide range of medical providers. False positive and false negative testing has a large impact on patient care. All providers in a patient care team should be aware of common limitations in testing, for example, urine assay false positives with hematuria, false negatives with dilute urine, along with more obscure but still very relevant causes of inaccurate testing. Interpreting results that may be false should be undergone with care to help prevent unnecessary testing and treatment. (Level V) Collaboration, shared decision making, and communication are critical elements in good patient care.