text:
Cardiac Magnetic Resonance Imaging Study for Quantification of Infarct Size Comparing Directly Serial Versus Single Time-Point Measurements of Cardiac Troponin T
Author + information
- Received March 23, 2007
- Revision received August 10, 2007
- Accepted September 7, 2007
- Published online January 22, 2008.
Author Information
- Evangelos Giannitsis, MD⁎,1,4,
- Henning Steen, MD⁎,4,
- Kerstin Kurz, MD⁎,
- Boris Ivandic, MD⁎,
- Anke C. Simon, MD⁎,
- Simon Futterer, MD⁎,
- Christian Schild, MD⁎,
- Peter Isfort, MD⁎,
- Allan S. Jaffe, MD, FACC†,3,⁎ (Jaffe.Allan{at}mayo.edu) and
- Hugo A. Katus, MD, FACC⁎,2
- ↵⁎Reprint requests and correspondence:
Dr. Allan S. Jaffe, Mayo Clinic and Mayo Medical School, CV Division, Gonda 5, 200 First Street SW, Rochester, Minnesota 55905.
Objectives We compared single-point cardiac troponin T (cTnT) measurements with parameters from serial sampling during 96 h after acute myocardial infarction with magnetic resonance imaging measured infarct mass.
Background Contrast-enhanced magnetic resonance imaging (CE-MRI) allows exact quantification of myocardial infarct size. Clinically, measurement of cardiac biomarkers is a more convenient alternative.
Methods The CE-MRI infarct mass was determined 4 days after primary percutaneous coronary intervention in 31 ST-segment elevation myocardial infarction (STEMI) and 30 non–ST-segment elevation myocardial infarction (NSTEMI) patients. All single-point, peak, and integrated area under the curve (AUC) cTnT values were plotted against CE-MRI infarct mass.
Results All single-point and serial cTnT values were significantly higher in STEMI than in NSTEMI (p < 0.01) patients. Except for the admission values, all single-point values on any of the first 4 days, peak cTnT and AUC cTnT were found to correlate comparably well with infarct mass. Among single-point measurements, cTnT on day 4 (cTnTD4) showed highest correlation and performed as well as peak cTnT or AUC cTnT (r = 0.66 vs. r = 0.65 vs. r = 0.69). Receiver-operator characteristic analysis demonstrated that cTnTD4 >0.84 μg/l predicted infarct mass above median as well as peak cTnT >1.57 μg/l or AUC cTnT (receiver-operator characteristic for AUC: 0.839 vs. 0.866 vs. 0.893). However, estimation of infarct mass with cTnTD4, peak cTnT, and AUC cTnT was worse in patients with NSTEMI (r = 0.36, r = 0.5, r = 0.36) than in STEMI (r = 0.75 vs. r = 0.65 vs. r = 0.76).
Conclusions All single-point cTnTs, except on admission, give a good estimation of infarct size and perform as well as peak cTnT or AUC cTnT. Infarct estimation by single-point measurements, particularly cTnTD4, may gain clinical acceptance because the measurement is easy and inexpensive.
Prognosis after acute myocardial infarction (AMI) is strongly determined by the extent of myocardial injury (1). Currently, several imaging techniques, including thallium sestamibi, positron emission tomography, and contrast-enhanced magnetic resonance imaging (CE-MRI), are used for quantification of infarct size (2). Among these techniques, some prefer cardiovascular magnetic resonance (CMR) imaging because it allows noninvasive assessment of myocardial function and viability with high spatial resolution and is superior to single-photon emission computed tomography (SPECT) for the identification of subendocardial AMI (3,4). Furthermore, the technique is highly sensitive and permits quantification of small areas of myocardial injury attributable to native coronary artery disease and/or percutaneous coronary interventions (5,6). However, the use of cardiac magnetic resonance (MR) imaging for quantification of infarct size is limited by availability and high cost. Therefore, estimating infarct size from concentrations or activities of cardiac proteins in peripheral blood, as has been done for years, is a convenient alternative (2).
Previous work depended on creatine kinase-MB fraction (CK-MB), but it is now clear that cardiac troponin T (cTnT) or cardiac troponin I (cTnI) possess better sensitivity and specificity and are, therefore, the preferred markers for diagnosis and risk stratification of patients with acute coronary syndrome and AMI (7,8). There is strong evidence to indicate that both serial and single-point measurements of cTnT correlate well with infarct size as measured at postmortem in animal experiments (9,10) and/or with various imaging techniques in clinical studies (11–13). However, MR imaging studies to determine the optimal timing for single-point measurements and compare such measurements to serial measurements are currently not available.
Accordingly, the present study sought to determine the best single-measurement time point and its performance as compared to peak and cumulative cTnT values (area under the curve [AUC]) values after AMI. Peak and AUC values were determined from daily serial sampling over 96 h, and all values were correlated to infarct size that was quantified using contrast-enhanced CE-MRI.
Only patients with first AMI were enrolled. Using 12-lead standard electrocardiogram, AMI patients were categorized into acute ST-segment elevation myocardial infarction (STEMI) and non–ST-segment elevation myocardial infarction (NSTEMI). We defined STEMI by the presence of ST segment elevation ≥0.1 mV in unipolar leads or elevation ≥0.2 mV in anterior wall leads and was retrospectively confirmed by elevated cTnT above 0.03 μg/l. Non–STEMI was defined using the diagnostic criteria of the European Society of Cardiology/American Heart Association Task Force on Myocardial Infarction and required an elevation of cTnT above 0.03 μg/l, which is the 10% coefficient of variation value for this assay used clinically at our institution on at least 1 occasion within 24 h after the ischemic index event, with a rise or fall during subsequent sampling (8). Patients with renal failure having a glomerular filtration rate below 60 ml/min/1.73 m2 were excluded because it might result in overestimation of infarct size and because of potential toxicity related to gadolinium use (14). Blood samples were taken on admissions and daily for 96 h. After collection, blood samples were centrifuged immediately and serum was stored at −20°C until analysis. We measured cTnT on the same Elecsys analyzer (Roche Diagnostics, Mannheim, Germany) using the third-generation assay (15). The detection limit of the assay is 0.01 μg/l. The decision limit used for diagnosis of AMI is 0.03 μg/l, with an imprecision of <10%. The laboratory staff responsible for measurements were blinded to the patient data.
We measured single-point cTnT at admission and after 24, 48, 72, and 96 h. Peak cTnT and cumulative cTnT over 96 h were determined retrospectively from serial samples. A value was defined as peak if it was the highest in the concentration time course and if there was at least 1 lower value before and after this maximum value.
All decisions regarding acute reperfusion therapy and clinical management of patients were left to the discretion of the attending cardiologist, who was not involved in the study. The study protocol was approved by the local ethical committee of the University of Heidelberg, and all patients gave informed consent before study enrollment.
Cardiac magnetic resonance imaging (MRI) was performed in all patients before discharge unless they had contraindications, withdrew their consent, experienced claustrophobia, or reported shortness of breath prohibiting adequate breath holding during the MRI examination.
Cardiac MRI was performed in a 1.5-T whole-body MRI scanner (Philips Achieva Intera, Philips, Best, the Netherlands). Assessment of resting left ventricular function was determined by cine images using a steady-state free precession sequence in continuous short-axes planes covering the whole left ventricle from base to apex, as well as 2- and 4-chamber views. Ten minutes after gadolinium contrast injection (Gd = 0.2 mmol/kg of gadopentetate dimeglumine [Schering, Berlin, Germany]), 3 volume stacks of delayed contrast-enhanced images covering the whole left ventricle were planned on previous short-, 2-, and 4-chamber axes. End-diastolic and -systolic volumes with resulting ejection fraction were generated manually using short-axes volumetry. Infarct size was visually defined as area of delayed hyperenhancement on short-axes views and determined manually by delineation of hyperenhanced versus normally saturated dark myocardium. Magnetic resonance imaging analysis included quantification of absolute infarct size (g) and left ventricular function in all patients.
Statistical analysis
Means with standard deviation or medians with 25th and 75th percentiles were calculated to describe continuous variables. Given that cTnT values and infarct size values were not normally distributed, correlations were calculated using Spearman rank correlation. Paired and unpaired correlations were analyzed for differences using z-statistics. Receiver-operator characteristic (ROC) curves were constructed to examine the relationship between biomarker estimates and CE-MRI infarct size. For ROC analysis, the patients were categorized into 2 data sets: those with CE-MRI infarct size above median and those below median. Finally, multivariate logistic regression analysis was performed to test for significant predictors of infarct size, including variables with a univariate p < 0.1. For all analyses, a p value <0.05 was regarded as statistically significant. All statistical analyses were performed using MedCalc Version 9.2 for Windows (MedCalc Software, Mariakerke, Belgium).
A total of 61 patients with AMI were included. Of these, 31 patients had a STEMI and 30 patients had a NSTEMI. Median time from onset of symptoms to reperfusion was 477 min (95% confidence interval [CI] 252.7 to 608.6 min) for the entire cohort, 224 min (95% CI 124.2 to 362.1 min) for STEMI, and 709.5 min (95% CI 516.9 to 1,332.75 min) for NSTEMI. Median door-to-balloon-times were 77.5 min (95% CI 49.95 to 124.6 min) for the entire cohort, 46.5 min (95% CI 35.4 to 70.4 min) for STEMI, and 221 min (95% CI 129.1 to 377.3 min) for NSTEMI.
On initial angiogram, patients with STEMI tended to more often have an occluded infarct-related artery (Thrombolysis In Myocardial Infarction flow grade 0 or 1) than patients with NSTEMI (61.3% vs. 43%, p = 0.08). Primary percutaneous coronary intervention (PCI) in STEMI or early PCI in NSTEMI patients was attempted in 60 of 61 patients and was successful in 58 of 61 patients (95.1%). Reperfusion success, defined as post-procedural Thrombolysis In Myocardial Infarction flow grade 2 or 3, was comparable in STEMI and NSTEMI (96.8% vs. 93.3%).
Baseline clinical characteristics of the entire study population are displayed in Table 1.
MRI results
We performed CE-MRI after a median of 4 days (range 3 to 4). Patients with a STEMI had a significantly higher mean infarct mass (mean [95% CI]: 34.24 g (23.19 to 45.29 g) vs. 12.61 g (7.79 to 17.44 g), p = 0.0009], relative infarct size (20.32% [15.24 to 25.40] vs. 8.05% [5.53 to 10.56], p = 0.0001), and a trend to lower LV ejection fraction (54.45% [50.53 to 58.37] vs. 60.21% [56.60 to 63.83], p = 0.089).
Biomarker results
A total of 280 samples were obtained from 61 patients, yielding a mean of 4.6 samples per patient. Median cTnT values with corresponding 95% CI for the median were 1.7 μg/l (1.09 to 2.5) on day 1, 1.64 μg/l (1.01 to 1.98) on day 2, 1.49 μ/l (0.93 to 1.89) on day 3, 1.27 μg/l (0.82 to 1.81) on day 4, and 23.0 μg/l (19 to 27.82) for peak cTnT value.
By infarct type, single-point cTnT values at 24 h (2.67 μg/l vs. 0.6 μg/l, p < 0.0001), 48 h (2.1 μg/l vs. 1.07 μg/l, p = 0.0019), 72 h (2.02 μg/l vs. 0.83 μg/l, p = 0.0017), and 96 h (1.86 μg/l vs. 0.76 μg/l, p = 0.027) were significantly higher in STEMI than in NSTEMI. Likewise, serial values, including AUC cTnT, (203.3 vs. 73.4, p = 0.0006), peak cTnT (3.08 μg/l vs. 1.08 μg/l, p = 0.0001), peakCKact (1,645 IU vs. 739 IU, p = 0.0008), and peak CK-MB mass (40.8 μg/l vs. 24.9 μg/l, p = 0.043), were significantly higher in STEMI than in NSTEMI. Consistently, time-to-peak cTnT values (20.5 h vs. 36.5 h, p = 0.0025) were shorter in STEMI than in NSTEMI.
Regression coefficients measured by Spearman rank correlation between biomarker estimates and absolute MRI infarct mass for the entire cohort are displayed in Figure 1.
Measurements of cTnT on any single point after admission correlated comparably well with infarct mass and were not different from peak cTnT or integration of the AUC from serial sampling.
The ROC analysis displays the performance of cTnT at 96 h, peak, and AUC values for prediction of infarct size above median, that is, 13.6 g (Fig. 2), demonstrating similar AUC values for cTnT at 96 h, peak cTnT, and AUC cTnT.
Impact of infarct size on performance of biomarker estimates
Three categories were formed to test the impact of infarct size on the performance of biomarker estimates. Spearman correlation coefficients between biomarker estimate and categories were compared (Table 2). Patients with NSTEMI or CE-MRI infarct size below the median (13.6 g) showed a substantially worse performance of cTnT than patients with STEMI, anterior MI, or non-anterior MI.
Multivariate analysis for prediction of infarct size
All significant univariate predictors were included in the multiple logistic regression model to examine their independent predictive value for estimation of infarct size above median (13.6 g). Keeping all other variables constant, all single-point and peak cTnT were tested to obtain the model with the highest chi-square value. In this final model, cTnT on Day 4 and presence of STEMI versus NSTEMI were the only independent significant predictors of larger infarct size (Table 3). A secondary analysis within STEMI or NSTEMI gave no meaningful results owing to the small number of patients.
Our data indicate that measurement of cTnT at a single point on any of the first 4 days or using the peak-value correlates well with infarct mass determined by CE-MRI. These data points perform as well as serial sampling estimates, including integration of AUC. We would suggest that the 96-h value would be convenient to use clinically, and it would be helpful for clinical trials to also use a similar value. However, correlations of all values are similar, although with a different slope, so clinicians can use any of the results if they so choose, and with time they should be able to develop a good estimate for infarct size.
Our results are not nearly as robust in patients with small infarcts, and that is likely the reason for the poorer correlations with NSTEMI, which were smaller by both cTnT measurements and by CE-MRI. This may be related to the variety of pathophysiologies that exist in patients with NSTEMI (16). In addition, however, microinfarcts associated with minor elevations of cTnT may escape visualization with CE-MRI or be difficult to quantify owing to insufficient visualization caused by inadequate spatial resolution or partial volume effects. Interestingly, Ricciardi et al. (5) found more promising results with visualization of a mean infarct size as low as 2.0 g. In that study, 5 of 9 patients with late hyperenhancement had suffered a side-branch occlusion during PCI, but none developed Q-wave infarction. Interestingly, new wall motion abnormalities were detected in only 1 patient with late hyperenhancement. The reason for this disparity is unclear but may involve the use of a single breath-hold 3-dimensional inversion recovery sequence with slightly lower spatial resolution in our study, and, conversely, a potential underestimation of infarct size because of incomplete coverage of the left ventricle coming from single-slice inversion recovery technique in the study of Ricciardi et al. (5).
Single versus serial cTnT for estimation of AMI
The most accurate methods for estimation of infarct size in the pre-reperfusion era were based on complete recovery of CK or its isoforms (17,18) or LD isoenzymes released from the infarcted myocardial tissue (19,20). Measurement of maximum enzyme values of CK or CK-MB proves convenient but has a propensity to overestimate infarct size, particularly when spontaneous reperfusion, PCI, or thrombolysis-induced reperfusion leads to an earlier and higher maximum CK level at identical amounts of left ventricular impairment (21–23). In addition, the peak value is influenced by release ratio, which is much higher after reperfusion (24); the plasma half-life of the cardiac constituent (25); and the magnitude of the AMI itself (26–28). In addition, CK and, to a lower extent, CK-MB mass lack absolute cardiospecificity, thus increasing the likelihood of overestimation of infarct size attributable to skeletal muscle damage. Other investigators have advocated for lactate dehydrogenase, which is cardio-unspecific, or the more cardiospecific derivative hydroxybutyrate dehydrogenase (HBDH) because these enzymes demonstrate a slower release from the myocyte and may manifest a more consistent release ratio despite successful reperfusion (19). By using HBDH at 72 h, others have found (20) minimal underestimation of infarct size compared to HBDH at 96 or 120 h. However, as noted by Sobel et al. (29), there is substantial HBDH in red cells, and hemorrhage can occur after reperfusion, confounding this measure of infarct size as well.
At present, the cardiac troponins are the preferred cardiac markers for the diagnosis of AMI owing to their superior sensitivity and specificity (8). In addition, unlike the small cytosolic cTnT fraction that may be prone to an accelerated release from the infarcted myocardium after successful reperfusion, the majority of the protein resides in the gradually released structurally bound fraction that manifests a more consistent release ratio (21,30). Experimental work has shown that the increases in serum troponin parallel the loss in tissue concentrations of troponin (31) and that blood values of cardiac troponin T correlate with histochemical infarct size in the non-reperfused experimental AMI (9,10). Interestingly, single-point measurements at 96 h after left anterior descending coronary artery ligation were as effective as measurement of cumulative release requiring tight serial sampling over 120 h or peak concentrations with retrospective location of the peaks, requiring at least 3 samples (9). Consistently, an increasing number of imaging studies have confirmed that the more convenient single-point cTnT or cTnI perform as well as cumulative release in humans (11–13). The SPECT or CE-MRI infarct size has been found to correlate well with single-point values of cTnT at approximately 72 h (12,13) and 96 h (11) and with single-point values of cTnI between 24 and 48 h (13,32). This is likely a reflection of the stability of the release ratio related to the structurally bound pool.
In the present study, the best single-point cTnT value was identified at 96 h and performed as effectively as peak cTnT and AUC cTnT over 96 h. For the latter, it is reasonable to speculate that performance of cumulative measurements could be improved by expansion of serial measurements beyond 96 h. However, prolongation of sampling is likely to reduce the attractiveness and acceptance of the method.
In the multivariate logistic regression analysis, high cTnT values and presence of STEMI emerged as significant independent predictors of larger infarct size. Interestingly, LV ejection fraction, which was preserved in most patients, failed to predict infarct size. This may be attributable to the fact that we could include only patients with first infarctions, and those who could not breath-hold because of respiratory difficulties could not be imaged.
Performance of single or serial cTnT in small AMI
In our study, prediction of infarct size with either single or serial cTnT was considerably better in patients with larger CE-MRI infarct size (i.e., mean infarct mass 34.24 g in STEMI) compared with smaller infarct size including NSTEMI, non-anterior infarct location, or CE-MRI infarct size below median (mean infarct mass 12.61 g, 18 g, and 13.6 g, respectively). A previous report had already alluded to the finding that correlation between infarct size and cTnT measured 72 to 96 h after infarct onset is inferior in NSTEMI than in STEMI (10). It has been speculated that the poorer correlation was due to suboptimal timing of sampling in NSTEMI and in part to inadequate visualization with current CE-MRI technology. Both likely play a role. Several additional reasons may also contribute. First, time-release curves of large STEMI differ markedly from small NSTEMI or microinfarcts and thus may have an impact on serial measurement algorithms, likely because of fluctuations in perfusion and thus variable release of marker. Thus, single-point measurements, for example, for peak, are less unequivocal and occur earlier for NSTEMI (48 or 72 h) than for STEMI (72 or 96 h). This latter finding is consistent with the prior report of earlier peaking of markers in patients with NSTEMI of Morrison et al (33). Second, NSTEMI comprises a heterogenous group of AMI, including strictly posterior AMI, owing to occlusion of the left circumflex artery as well as microinfarcts, which may hamper optimal timing even within the class of NSTEMI. Third, image resolution of MRI may be too low to allow visualization of very small infarcts or impair accurate quantification of small infarcts. Other possible reasons for incorrect quantification of small infarcts by CE-MRI include partial volume effects and higher intra- and interobserver variability at the low end of spatial resolution.
Although not addressed in the present study, as we had very few patients with prior AMI, it is likely that troponin and CMR will not correlate nearly as closely in patients with prior AMI than in those with first AMI because CE-MRI will measure both areas of damage. However, this would suggest synergism between the 2 methods, with 1 providing an estimate of the most recent insult and CMR integrating damage over time.
Single measurement of cTnT on any of the first 4 days, particularly on day 4 after onset of AMI, gives a good estimation of infarct size. Single-point measurements are convenient, easy, and inexpensive and may gain clinical acceptance because they are as effective as serial measurements. However, our findings may not be extrapolated to very small AMI unless imaging technologies have improved to allow exact visualization of small infarct areas. In addition, more efforts are required to refine sampling protocols in the heterogenous class of NSTEMI.
↵1 Dr. Giannitsis has received financial support for studies from Roche Diagnostics and is a consultant to Roche Diagnostics.
↵2 Dr. Katus developed the assay for cTnT and holds a patent jointly with Roche Diagnostics. He has received research support from Roche Diagnostics.
↵3 Dr. Jaffe is a consultant and has received research support from Dade-Behring and Beckman-Coulter. He is a consultant to Ortho Diagnostics and has consulted over time for most of the major diagnostic companies.
↵4 Drs. Giannitsis and Steen contributed equally to this article.
- Abbreviations and Acronyms
- acute myocardial infarction
- area under the curve
- contrast-enhanced magnetic resonance imaging
- confidence interval
- creatine kinase-MB fraction
- cardiovascular magnetic resonance
- cTnI/T
- cardiac troponin I or T
- magnetic resonance
- magnetic resonance imaging
- non–ST-segment elevation myocardial infarction
- percutaneous coronary intervention
- receiver-operator characteristic
- single-photon emission computed tomography
- ST-segment elevation myocardial infarction
- Received March 23, 2007.
- Revision received August 10, 2007.
- Accepted September 7, 2007.
- American College of Cardiology Foundation
- ↵
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text:
WFISD board agenda includes improvement plans
The Wichita Falls ISD Board of Trustees is scheduled to meet Monday starting at 6 p.m. in the Board Room at the Education Center, 1104 Broad St.
Prior to the meeting, the community will have a chance to comment on the targeted improvement plans presented by the principals of the four improvement-required rated campuses at the board's work session on Sept. 12. The public hearing is set for 5:30 p.m.
On Monday's consent agenda, trustees are expected to vote on several items, including entering into an interlocal agreement with the Education Service Center Region 10 out of Richardson, Texas, to provide a 457(b) FICA Alternative plan to employees who work less than 20 hours or are seasonally employed.
The school board had previously elected to keep the current FICA Alternative plan due to a surrender fee charged to the district of up to 5 percent, according to information presented at last week's work session.
As part of the agreement, TCG Administrators, the group who has partnered with Region 10, have agreed to absorb the surrender cost of changing providers for the district.
Other items set for board approval:
- A change order in the amount of $240,950 for rebuilding Brewster Street at the Career Education Center. The City of Wichita Falls has agreed to pay $128,000 upon completion of the project.
- Multiple contracts for the Fiscal Year 2017-18 between the Region 9 Service Center and Wichita Falls ISD for a total of $341,618.
- Four targeted improvement plans as submitted by the four improvement required campuses for the 2017-18 school year.
- Class-size exception waivers for 23 classes at seven campuses. Nine of the classes are expected to have 24 students and 13 with 23 students. Waivers must be requested for any class in kindergarten through fourth grade that exceeds 22 students per teacher.
- A WFISD-initiated localized policy update regarding approval of intradistrict transfers and classroom assignments.

subset: commoncrawl


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iPhone battery life rubbish after Apple launch and iOS 12 update? You're not going crazy
There really is a reason why your iPhone battery suddenly seems much less efficient
EVERY year, Apple releases new iPhones, and we all make the same complaint: "My iPhone is worse now."
Well you're not going crazy – your iPhone battery life probably has taken a hit recently, and there's a simple reason why.
Right now, Twitter is being flooded with people complaining that their iPhones are running out of charge too quickly.
It seems a damning coincidence, given that Apple recently revealed three new mobiles – the iPhone XS, iPhone XS Max and iPhone XR – in hopes you'll upgrade.
Frustrated iPhone users are claiming that these performance issues are a big software trick to get you to upgrade.
But there's no proof that Apple is operating a big conspiracy. The answer is much simpler.
As part of the new iPhone launch, Apple rolled out the latest iOS 12 software update on Monday, September 17.
Your phones files and apps are arranged in indexes, keeping all of your phone's information organised – and, importantly, quickly accessible.
When a major software update happens, lots of the code and systems that make up your phone get changed significantly.
This means your iPhone has to re-organise and re-index the apps and data on your phone, to make it more searchable.
This puts a heavy demand on your iPhone's processor, which inevitably creates additional drain on your battery.
The good news is that this process only lasts for around 24-48 hours, so your battery life should be back to normal two days after the iOS 12 update.
Of course, there are other reasons your battery life may be struggling too.
As iOS 12 lands, lots of developers suddenly start updating their apps to support the new system and features.
That's why you've probably been seeing many more app updates on your App Store lately.
If you have Automatic App Updates turned on, these updates will be happening in the background throughout the day.
This creates additional processor load and requires an internet connection, both of which will drain your battery more quickly.
Apple September event – all the biggest announcements revealed
Here's everything we saw unveiled on September 21...
- Apple revealed the pricey new iPhone XS, which starts from £999
- We also saw the iPhone XS Max, the most expensive Apple smartphone ever – at £1,449
- These new phones have a brand new feature called dual SIM support, which lets you have two phone numbers at once
- There's also the "cheap" £749 iPhone XR, which comes in six colour options
- Here's the UK iPhone price list for the new models
- Apple also confirmed the iOS 12 release date...finally!
- Meanwhile, Apple secretly killed three iPhones off completely
- And there's now an Apple Watch 4, which can detect when you've fallen over – and call 999 for you
- Most mysteriously, what happened to these missing Apple gadgets...?
Finally, major iPhone updates generally get us using our phones a bit more.
Keen users rush to try out new features, and inevitably spend more time on their handsets each day.
This is also a contributing factor to your phone's battery life.
So ignore the conspiracy theorists: Apple isn't ruining your iPhone experience to get you to upgrade to newer models.
Your battery life will almost certainly improve over the next few days.
Apple unveiled its new iPhone trio last Wednesday, showcasing the most expensive iPhones to date.
The cheapest model is the iPhone XR, which starts at £749 – a whole £50 higher than last year's cheapest model, the £699 iPhone 8.
There's also the smaller (but more powerful) iPhone XS, which costs £999, and the larger flagship iPhone XS Max model, which costs anywhere from £1,099 to £1,449.
Apple also used its event to unveil a new Apple Watch 4 smartwatch, which can tell when you've fallen over – and even dial 999 for you.
If you still haven't got the new iOS 12 upgrade, follow our simple guide on how to update your iPhone.
Have you experienced any issues with the new iOS 12 update? Let us know in the comments!
We pay for your stories! Do you have a story for The Sun Online news team? Email us at firstname.lastname@example.com or call 0207 782 4368 . We pay for videos too. Click here to upload yours.


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The Office of Government Ethics said in a letter to Democratic senators this week that the Trump administration's blanket ethics waiver applicable to White House chief strategist Steve Bannon is "problematic because it is unsigned and undated" and "purports to have 'retroactive' effect."
In late May, the White House released the ethics waivers it provided to at least 16 White House staffers to allow them to work with subjects they had in the private sector before joining the government.
One of those waivers was a blanket exemption provided to all Executive Office of the President appointees that appeared to cover Bannon. The exemption allows all appointees to "participate in communications and meetings with news organisations regarding broad policy matters." Before joining the White House, Bannon led Breitbart, the nationalist right-wing news site, and his level of involvement with the site after joining the administration has been the subject of some debate.
The waiver was also listed as having a "retroactive" effect, claiming to cover any possible ethics breaches that occurred before the waiver was issued.
In the OGE's letter to Democratic Sens. Elizabeth Warren and Ed Markey of Massachusetts, Sheldon Whitehouse of Rhode Island, and Mazie Hirono of Hawaii, OGE Director Walter Shaub wrote that the "deficiencies" he saw in the waiver "are inconsistent with the language of" President Donald Trump's executive order on ethics from his early days in office.
"As discussed earlier, the order expressly provides that a waiver is effective only after it has been signed," Shaub wrote. "More importantly, the putative retroactivity is inconsistent with the very concept of a waiver, which is to take decisions regarding the appropriateness of an employee's participation in covered matters out of the employee's hands. By engaging in a prohibited matter at a time when the appointee does not possess a waiver, the appointee violates the rule."
"Although the White House may later decide that such a violation does not warrant disciplinary action, the subsequent issuance of a waiver would not change the fact that a violation occurred," he continued in the letter.
Shaub said it was significant that the waiver only partially covers any communications Bannon engages in or has engaged in with Breitbart.
"It authorizes him to communicate with Breitbart and to participate in meetings with his former employer, but only if the subjects of discussion are limited to 'matters of broad policy and particular matters of general applicability,'" Shaub wrote. "Given the limited scope of this waiver, Mr. Bannon remains barred, under both" Trump's executive order and long-standing ethics guidelines "from participating in any 'particular matter involving specific parties' in which Breitbart is a party or represents a party."
Shaub said Bannon "remains barred" from "participating in any meeting, event, or other communication with Breitbart when the subject of discussion is" a specific party and not a policy matter, regardless of if Breitbart is one of the parties involved in the matter.
Read Shaub's full letter
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EiA GO!
What's it all about?
A week of fun, interactive English specifically designed for students in years 1-4 who want to boost their English with a week of activities designed to develop basic language through the completion of short tasks, activities and challenges. The programme has been produced in consultation with Austrian teachers and is perfect for students who want a week filled with creative challenges. The course is flexible and made up of five one-day modules. It is the perfect option for holiday courses as it is a bit lighter than our regular programmes and the focus is on the activities that encourage the use of language rather than more tradition 'lessons'.
Sample Programme
|Team Challenge
|Choose an option from the list below
|Choose an option from the list below
|Choose an option from the list below
|Show in a Day
Team Challenge
Core Module 1 - Monday
Work in teams to solve a variety of mental and creative challenges!
- Brain teasers
- Language challenges
- Impossible rescue
- Scavenger hunt
Dress To Impress
Option Module 1
Design and make outfits by recycling everyday materials and junk!
- Create designs for clothes and accessories
- Craft your designs
- Dress yourselves
- Produce scripts
- Get on the catwalk!
Music Maker
Option Module 2
Form bands with your friends to write and perform your own unique chart hit!
- Work on rhythm and lyrics
- Write a song
- Make simple musical instruments
- Put it all together
- Perform to the class!
Sporting Legend
Option Module 3
Play sports-related activities and games, and take part in a tournament with your friends.
- Sports, sports equipment and rules
- Physical warm-ups and stretching
- Become a commentator
- Inventing a sport
- Classroom Olympics
Million Dollar Pitch
Option Module 4
Work with your friends to create a new product or invention that will take the world by storm!
- Describe objects and their uses
- Find new uses for old objects
- Create a new invention
- Design your product
- Learn to present
- Pitch your product to your friends
Comic Book Hero
Option Module 5
Work towards creating a comic book story with your friends.
- Describe superheroes and their abilities
- Create a superhero card game
- Learn about comic book layout and conventions
- Learn to draw comic book characters
- Create your story and make your own comic book.
Choose Your Own Adventure
Option Module 6
Work with your classmates to create your own adventure storybook!
- Practise telling stories
- Imagine alternative twists to well-known stories
- Write your stories
- Design and put together your book
- Read your classmates stories!
TV News Report*
Option Module 7
Work to put together a series of TV news reports based on current or national news.
- Learn the language of the newsroom
- Invent a news story
- Prepare an interview
- Record or perform your news segment
The Great British Fayre**
Option Module 8
Work with your friends to put together a traditional British fayre for everyone to enjoy!
- Play a series of food-related vocabulary games
- Follow a recipe and give cooking instructions to others
- Try out some traditional British party games
- Plan and host a party for the other student
Can you Vlog?*
Option Module 9
Work with your friends to create and record your first group Vlog!
- Learn about the different types of vlog
- Record an interview
- Film a challenge vlog
- Film a 'how to' vlog
- Film a review vlog
Write Now!
Option Module 9
Become a writer and create some of your own original work in English!
- Learn about different writing styles
- Try writing different types of short poem
- Work with your friends on some group poetry
- Produce an original piece of 'flash fiction' and the opening to a short story
- Write and perform your own mini-dialogues
EiA Show In A Day
Core Module 2 – Friday
Work together with your classmates to prepare and perform a show in a single day!
- Play drama games
- Work on performance techniques
- Develop characters
- Rehearse
- Perform!
* Please note: If the students would like to record their news reports, the school must have facilities to upload videos from the students' smartphones and access to basic video editing software.
** Please bring: either sandwich ingredients or baking ingredients, tea, paper plates and napkins.


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We recently moved into our first home and while the size of the house and land was perfect for the price, I wasn't in love with everything about this house. In case you find yourself in a similar situation I am going to share our budget friendly house updates. The first I would like to share is out new master bathroom!
First we painted the kids rooms before we moved in so that they would feel at home when they got here. The first thing that had to go for my husband and I was our master bathroom. It was pink! Like salmon pink, with flower wallpaper! While I am all down for pink camo or pink in my daughter's room and wearing neon pink clothes and nail polish, the pink bathroom just wasn't us.
This post may contain affiliate links which means that the companies I recommend pay me a small percentage if you choose to purchase something from them (at no extra cost to you). I only recommend products that I use and love! For more information on this check out the full disclosure page
Here are the before photos.
. .
The wallpaper was peeling off and collecting mold. It had to go!
The light fixtures were rusting….and I'm not loving the gold.
And the fan was dirty and falling out of the ceiling.
A few more before pictures before we get started.
Now me being the frugalista that I am I wanted to update our bathroom for as little as possible. I was able to keep it under $100. Here is how I did it.
First thing to go was the wallpaper border. Many posts that I read about how to remove wallpaper suggested things like heating it with a hair dryer (that didn't work) and using a mixture of fabric softener and water. I didn't have any fabric softener so I tried spraying warm water on it. To my surprise it worked! I soaked it really good with the warm water until I could tell that the glued piece was wet. As I pulled it off I followed it along with a putty spatula and it came right off.
Next I had to get rid of that 90s Hollywood bulb style light fixture. I searched around Home Depot and some other stores but I wasn't able to find what I was looking for under $100. So I turned to Craigslist, restore stores and thrift stores. I searched for a while and was contemplating a few when my mother in law texted me saying that she found one at a second-hand store and asked If I wanted it. $25 Um, "Yes"! If you are thinking about updating your bathroom too tell your friends and family and tell them exactly what you are searching for. The more eyes on the lookout the better! Also check Craigslist, Facebook, restores, and second hand stores. Sometimes you can find a steal!
If you would still prefer new over used check Amazon. They have some great deals like these ones. Under $60!
Next I used some Rustoleum Metalic to update the old rusting gold light. In order to keep costs down I wanted to keep and reuse as much as possible. This stuff is amazing! It covered the rust and the ugly gold right up. It looks like a totally new light!
I also used it on the trim of the sliding mirrored doors. They were white and starting to rust as well. I First looked into buying new mirrors but they were around $200+ so I figured I would try the Rustoleum out on them since it worked so well in my light. They turned out just perfect too!
The mirrors were a little harder to spray paint because you can't take them apart like you can the light. To do these I unscrewed them from the wall and took them outside. First I covered the mirrors with plastic (make sure they are completely covered) then followed the instructions on the bottle of Rustoleum. This took about a bottle and a half maybe a little less. Hey $12 for new sliding mirrored doors is a lot better than $200+!
The next thing I did was the old mirrors, vanity and window. To fully replace these would have blown my budget with the new mirror alone so instead I got a can of Minwax Polyshades stain. Remember that I wanted a nature meets spa kinda thing so I wanted it all to look like wood still so I picked this kind over the gel stain (I love the DIY gel stain cabinets but it just wasn't what I was going for here). This is the espresso stain. I then took all the doors off, sanded them down and followed the directions on the can of Minwax Polyshades Stain.
While everything dried outside it was time to paint. It is AMAZING what a can of paint can do! Because I was painting the bathroom I went with a higher quality, mold resistant paint (it costs a little bit more but I want it to last). I ended up choosing Behr's Premium Plus Ultra stain blocking paint and primer on one (color= sounds of nature). I repainted the ceiling white with some paint we had leftover from another project.
The last step was to put everything back together and pray that what I had in the end matches what was in my head!
I finally have somewhere to hang the hunting pictures that we have gotten for the last few Christmas', my mother in law recently re-use her bathroom and have me her old shower curtain and the rest of the decore I picked up from the dollar store.
What do you guys think? I am pretty happy with it! I still need to do my floating shelves over the toilet but I have to wait for one of our camping trips to gather the drift wood (I will do a post on these later). There are some other things like the faucets and the shower tile that I would like to see go but for now I can live with them lol.
My husband is not really the decorating type and when I first began this project he told me he was just fine with it how it was…as I am writing this post I showed him the before pictures and asked him if he would like it back… To that he replied "Oh **** no!" I think he likes it too!
Total cost for this project
Light fixture $25
Rustoleum Metalic Spray Paint $5.77 x 2=11.54
Minwax Polyshades Stain $12.87
Paint $33.98
Decore $8.00
Total spent= $91.39
If you have been wanting to update some things in your house but just couldn't see pouring thousands of dollars into a remodel I hope that I have inspired you to try a budget friendly update! If you have any questions please leave me a comment or if you want to share your budget friendly remodeling tips I would love to hear from you.
Until next time!


text:
American right panics over lesbian farmers
After the US Department of Agriculture hosted a summit on rural LGBT people, right-wing talk radio host Rush Limbaugh decided the White House was trying to inundate rural America with lesbian farmers. Panic ensued, and you can now buy an "America Needs Lesbian Farmers" T-shirt.
Gilead Australia accused of price gouging
Australian HIV advocates and health officials say that Gilead, the makers of the PrEP drug Truvada, tried to protect their exorbitant profit margins on the drug at the expense of gay Australians. Activists say Gilead applied to restrict subsidized access to the drug, so that it could continue to charge most users over $700 a month.
Australian parliament showdown over plebiscite
The Australian Labour and Liberal parties are locked into a game of parliamentary chicken over a proposed plebiscite on same-sex marriage. Labour says the plebiscite is just an expensive delaying tactic, and has threatened to shoot it down in parliament. The ruling Liberals say doing so might delay an equal marriage vote by three years.
Study: Three world regions lag in gay acceptance
A sociologist at Ohio State University who looked at changes in acceptance of gay people over time has found that the world is surging forward with the exception of three regions: the Muslim world, the former Soviet-Union and Sub-Saharan Africa. Worryingly, the study also shows a widening gap in gay acceptance between world regions.
New anti-gay study falls flat
After the socially conservative sociological journal The New Atlantis published a paper arguing that homosexuality can be changed and transgender children don't exist, the internet helpfully piled on to demonstrate what the researchers got wrong and left out.


text:
Search the Community
Showing results for tags 'battery'.
Found 1 result
Computer Specs: Asus U56e laptop, Windows 7, Intel Centrino Wireless N 1030 adapter, ESET NOD32 antivirus, less than 2 years old I've been having a ridiculous amount of issues with my wireless adapter, and I was wondering what my options are.... All of my problems started about 6 months ago when I dropped my laptop (*cries*). A week later the hard drive went out. I got it replaced. A couple of weeks after that, my wireless adapter started getting disabled randomly, or not appearing at all. Eventually, it NEVER worked. I took it to Geek Squad and they said that nothing was wrong with my


text:
The New Haven (CT) Fire Department has recently released a Safety Bulletin to their members on the failure of fiberglass columns under fire conditions. The bulletin was a result of an incident that occurred at a recent fire involving a two story wood frame dwelling with a front porch, with it's roof supported by hollow fiberglass columns. Within minutes of the arrival of the NHFD units, the columns failed under fire exposure, bringing down the roof onto the front lawn.
No fire fighters were injured, however, based on this incident, the NHFD began to gather information on these columns. They conducted tests where the columns were loaded with barrels of water above and then exposed to a fire below. The columns failed in under 4 minutes. They have since found several of these building components throughout their city. While these columns have a rating for compression loads, it appears that fire has not been considered as a load.
Has anyone had any experience (good or bad) with these columns in the field?


text:
Added to Your Shopping Cart
LMG3410R070 daughter card
Features for the LMG3410-HB-EVM
- Input voltage operates up to 600V
- Simple open loop design to evaluate performance of LMG3410R070
- Single PWM input on board for PWM signal with 50 ns dead time
- Convenient probe points for logic and power stage measurements with oscilloscope probes that have short ground spring probes
Description for the LMG3410-HB-EVM
The LMG34XX-BB-EVM is an easy to use breakout board to configure any LMG34XX half bridge board, such as the LMG3410-HB-EVM, as a synchronous buck converter. By providing a power stage, bias power and logic circuitry this EVM allows for quick measurements of the GaN device switching. This EVM is capable of delivering up to 8 A of output current with adequate thermal management (forced air, low frequency operation, etc) to insure the maximum operating temperature is not exceeded. This EVM is not suitable for transient measurements since it is an open loop board.
Only a single pulse width modulated input is required, with complementary pulse width modulated signals and corresponding dead time generated on board. Probe points are provided to allow for key logic and power stage waveforms to be measured with oscilloscope probes that have short ground springs.
The LMG3410-HB-EVM configures two LMG3410R070 GaN FETs in a half bridge with all the necessary auxiliary peripheral circuitry. This EVM is designed to work in conjunction with larger systems, such as the LMG34XX-BB-EVM or a custom designed power stage. By providing the LMG3410R070 on a high performance layout with convenient connection points, operation and in circuit measurements can quickly and easily be achieved.
No level shifting or isolation is required since all necessary circuitry is included. The auxiliary bias can be generated in two ways, default with isolated power supplies that require only a single 5V input and configurable to operate in bootstrap mode off 12V. Exposed copper pads are provided for heatsink assembly to allow for higher power dissipation.


text:
Fortis Healthcare reports a Q4 net loss at Rs 37.52 crore, Check out details
The company had posted a net loss of Rs 87.60 crore for the corresponding period of previous fiscal, Fortis Healthcare said in a BSE filing.
Consolidated income from operations of the company stood at Rs 1,123.43 crore for the quarter under consideration. It was Rs 1,070.18 crore for the same period year ago.
Consolidated income from operations of the company stood at Rs 1,123.43 crore for the quarter under consideration. It was Rs 1,070.18 crore for the same period year ago.
For the fiscal year ended March 31, 2017, the net profit of the company stood at Rs 479.28 crore. It had posted a net profit of Rs 41.79 crore for the year-ago fiscal.
Income from operations of the company for the fiscal year ended March this year was at Rs 4,573.71 crore. It was Rs 4,198.89 crore for the previous fiscal year.
Following is the summary of the Q4 results for FORTIS
Consolidated Business - Key Financial Highlights for the year (FY17)
- Consolidated Revenues at Rs 4,574 Cr, up 8.7%. This is despite the impact of demonetization witnessed in H2FY17. Revenue growth in H1FY 17 (versus the corr. previous period) was at 9.7%, while in H2FY17 revenue growth stood at 7.6% largely as a result of demonetization.
- Consolidated Operating EBITDAC (EBITDA before net business trust costs) was at Rs 734 Cr, +10.5%, representing a margin of 16.1% versus 15.8% in the previous year. EBITDAC margins in H1FY 17 were at 17.2%, while in H2FY17 EBITDAC margins were at 14.8% largely as a result of demonetization.
- Consolidated Operating EBITDA was at Rs 362 Cr, up 75%, representing a margin of 7.9% versus a margin of 4.9% in the previous year.
- PBT before exceptional and foreign exchange gain/(loss) witnessed significant improvement at Rs 76.6 Cr versus Rs (52.5) Cr in the previous year
- PAT after Minority Interest and Share in Associates ( PATMI) was at Rs 426.1 Cr versus Rs 27.7 Cr in the previous year. PATMI includes a one-time gain in Share in Associates. This is the Company's share in the profits of RHT which includes the exceptional gain arising from the FHTL transaction recorded in Q3FY17.
- FY17 revenues for the India hospital business were at Rs 3,712 Cr, up 8.3%. Operating EBITDAC was at Rs 545 Cr, a growth of 7.9%. The EBITDAC for the India hospital business represents a margin of 14.7%, similar to previous year margins.
- Key operational parameters in the Company's hospital business continued to see a healthy uptrend. ARPOB (Average Revenue per Occupied Bed) grew to Rs 1.45 Cr compared to Rs 1.37 Cr in FY16, an increase of 6%. ALOS (Average length of stay) was at 3.56 days similar to previous year, while Occupancy improved to 75% versus 72% in FY16 respectively.
- FMRI, the Company's flagship facility recorded revenues of Rs 479 Cr in FY17, a healthy growth of 16% over the previous year. The flagship facility has become the highest ARPOB generating hospital in the Company's network of multi-specialty hospitals. The ARPOB at FMRI stood at Rs 2.58 Cr in FY17 (FY16: Rs 2.50 Cr). The hospital continues to record a strong improvement in operating profitability.
- Revenue at the Fortis Escorts facility, continued to ramp up. It recorded a revenue of Rs 402 Cr in FY17, an increase of 17% over the corresponding previous period and also continued to witness a steady improvement in its operating profitability.
- The India diagnostics business recorded revenues (net of inter company elimination) of Rs 795 Cr, up 10.6%. The operating profitability of the diagnostics business .i.e. EBITDA was at Rs 174.6 Cr, similar to the previous year. EBITDA margins stood at 21.9% against 24.3% in FY16.
*EBITDAC refers to EBITDA before net business trust costs
Consolidated Business - Key Financial Highlights for the quarter (Q4FY17)
- Consolidated Revenues were at Rs 1,123 Cr versus Rs 1,070 Cr in the corresponding previous quarter, up 5%.
- Consolidated Operating EBITDAC (EBITDA before net business trust costs) was at Rs 148 Cr, representing a 13.2% margin, comparable to the 14.9% margin in the corresponding previous quarter.
- Consolidated Operating EBITDA at Rs 84 Cr, up 79% and representing a margin of 7.5% versus a margin of 4.4% in the corresponding previous quarter.
- PBT before exceptional and foreign exchange gain / (loss) witnessed significant improvement at Rs 17 Cr versus Rs (29) Cr in the corresponding quarter.
- PAT after Minority Interest and Share in Associates (PATMI) was at Rs (63.8) Cr versus Rs (90.7) Cr in the previous quarter.
- India hospital business revenues were at Rs 913 Cr versus Rs 871 Cr in Q4FY16. Operating EBITDAC in the quarter stood at Rs 110 Cr, representing a margin of 12.0% versus 14.8% in the corresponding previous quarter. This compares to 14.3% in the trailing quarter.
- ARPOB (Average Revenue per Occupied Bed) in the quarter stood at Rs 1.50 Cr as compared to Rs 1.43 Cr in Q4FY16, a growth of 5%. ALOS (Average length of stay) was at 3.50 days versus 3.59 days in the previous corresponding quarter, while Occupancy stood at 70% versus 71% in Q4 FY16.
- The India diagnostics business recorded net revenues of Rs 203 Cr compared to Rs 181 Cr in Q4FY16, up 12.3%. The operating EBITDA was at Rs 40 Cr, representing an EBITDA margin of 19.9% compared to 22.6% in Q4FY16.
Commenting on the results, Mr Bhavdeep Singh, CEO, Fortis Healthcare Ltd, said, "For Fortis Healthcare, our driving force continues to be the vision of creating a world-class integrated healthcare delivery system focusing on clinical excellence, superior patient care and services. We have made substantial headway, in both these critical areas despite the impact of demonetizationwith our consolidated FY17 revenues up by 8.7%, our hospital business revenues up by 8.3%. Our diagnostic business revenues are also up by 10.6%. Overall, the key operational parameters in the company's hospital business continue to see a healthy uptrend. In the coming quarters, we will drive additional substantive gains as we further accelerate our efforts across all focus areas."
Other Business Highlights – FY17
- The Company in August 2016 announced the demerger of its diagnostics business and has since received a number of regulatory clearances as required. It filed a Composite Scheme of Arrangement and Amalgamation (demerger of diagnostics business) with the National Company Law Tribunal (NCLT), Chandigarh and has subsequently got approval from the all shareholders and creditors of Fortis Healthcare, SRL Limited and Fortis Malar. The next hearing by NCLT is scheduled for June end.
- In October 2016, the Company completed the acquisition of 51% economic interest in Fortis Hospotel Limited (FHTL) from RHT; witnessing a significant reduction in net BT costs – down 19% during the year. Since the deal was completed in October, the full impact of the reduction in the net BT costs would be significantly higher in FY18, further improving the Company's operating EBITDA.
- The Company during the year also issued shares in lieu of the conversion notice received by it from the FCCB holders for its USD 85 Mn equivalent bonds .i.e USD 30 Mn bonds listed on the SGX and USD 55 Mn bonds held by International Finance Corporation (IFC). The resulting capital post this conversion stands at approx. 51.7 Crore equity shares (excluding outstanding ESOPs). Post the above conversions, there are no further outstanding FCCBs / other convertible instruments.
- The Company continued to maintain a healthy Balance Sheet with a net debt to equity ratio of 0.20 times. Net debt stood at Rs 1281 Cr as on 31st March 2017. This compares to a net debt of 0.16 times in the previous financial year and a net debt to equity ratio of 0.30 times as on December 31, 2016.
Key Highlights FY 17 - Hospital Business
- In FY17, the top 10 facilities contributed approx. 77% of the hospital business revenue versus 76% in the previous year. Most facilities, including the larger ones at FMRI, Mohali, FEHI, Mulund, Noida, Shalimar Bagh, Anandpur and Ludhiana continued to exhibit growth momentum both in terms of revenues and operating margins.
- The contribution of International sales to the overall revenue of the Hospital business stood at 10.6% (Rs 395 Cr), a growth of 10% over the previous year. The retail business witnessed significant traction which was driven by a heightened level of on-ground activities, medical and surgical camps. The Company further strengthened these initiatives with the opening of 4 new Information Centres in FY17 in the Middle East and Myanmar.
- The Company continued to see healthy growth in the procedures performed across its facilities. Joint replacement surgeries (Knee and Hip) witnessed a strong growth of 28% with 10335 surgeries being performed during the year across the network. Transplant surgeries (Liver and Kidney) also witnessed a robust growth of 19%. The company also successfully performed close to 100 heart transplants during the year.
- In order to further strengthen its clinical programs and have the best available talent for treating its patients, the Company during FY17 witnessed the joining of a number of senior consultants in the urology, nephrology and orthopaedics specialties. These eminent doctors have brought on board their immense knowledge and vast experience thus enabling the Company to gain a sharper focus on enhancing patient care and clinical outcomes.
- As a part of its focus on growth through the O&M model, the Company during the year began operations in Rajasthan and Bangladesh. It also further strengthened its presence in Mauritius by taking over the operations and management of an existing hospital; adding to the existing hospital that it has been successfully managing for the past many years. The Company's philosophy under the O&M model works on minimum guarantee basis with nil investments; in return for providing its robust systems and processes, high calibre clinical and administrative acumen and a well-established 'Fortis' Brand name.
- In Q4FY17, the Company introduced and expanded its clinical programs and service offerings in several facilities in its network. These included :
- A state-of-the-art Bone Marrow Transplant (BMT) unit inaugurated at FMRI. The 14-bed BMT ICU has 12 beds for adults and 2 paediatric beds.
- To address the growing need for liver transplants and the treatment of liver related diseases, Fortis Hospital, Bannerghatta Road, launched a dedicated Centre for Hepatobiliary Sciences and Liver Transplant.
- As part of International Women's Day, Fortis Malar Hospital, Chennai launched an All Women's Clinic. The multi-speciality clinic aims at providing a one-stop solution for women and is run by an all women team of clinicians and staff.
- After publishing FEHI's Cardiac Clinical outcomes data and Fortis Vasant Kunj's Kidney Transplant (1 year Survival) clinical outcomes data, five other Fortis hospitals joined this initiative. Fortis Mohali, Fortis Mulund, Fortis BG Road, Fortis CG Road and FMRI published cardiac clinical outcome data for CABG and PTCA procedures.
Key Highlights FY 17 - Diagnostics Business
- The lab medicine i.e. the pathology business contributed 86% to total revenues and grew 9% over the previous year. The contribution of the imaging business to total revenues declined to 6.9% from 8.2% in the corresponding previous period, mainly due to network rationalization. Clinical Trials, Wellness and the International segment contributed 7% to the overall revenues of the Diagnostics business.
- SRL performed over 15.3 million accessions during the year, a 5.5% growth over last year. Through these accessions it undertook 35 million tests, up 7% as compared to 32.7 million tests in FY16. For the quarter, 3.8 million accessions were performed, a 5.6% growth over the corresponding quarter.
- The business continued to have a well -diversified geographical mix with no over dependence on any region, allowing it to optimally capitalize on its pan India network. The business witnessed 31% revenues from the north, 27% from the west, 19% from the south, 20% from East and Central India and 3% from International for the period ended March 31, 2017.
- SRL continued to grow its laboratory and collection centre network; adding 13 new laboratories and 31 collection centers while rationalising its portfolio with the closure of 4 laboratories and 34 collection centers in the quarter.
- As of March 31, 2017, SRL had a network of 356 labs and approx. 5245 collection points.
Clinical Excellence - Q4FY17
- A team led by Dr K. R. Balakrishnan, Director – Cardiac Sciences and Dr Suresh Rao, Head of Cardiac Anaesthesia & Critical Care, performed a lifesaving heart transplant on a 78-year-old patient, making him possibly the oldest person to receive a heart transplant in the country.
- On January 19, 2017, Mumbai city witnessed its 40th Heart Transplant at Fortis Hospital, Mulund. The donor's heart was harvested at Fortis S.L. Raheja Hospital, Mahim and was transported to Fortis Mulund, covering a distance of 23 kms in 17 mins.
- A team led by Dr Vivek Vij, Director – Liver Transplant, Fortis Memorial Research Institute, Gurgaon, conducted a novel surgery to save the life of a 21-year-old Iraqi woman. The patient suffered from Budd Chiari Syndrome, a rare genetic disorder that causes blood clots in liver vessels.
- A team led by Dr Randeep Wadhawan, Director, Minimal Access Surgery, Bariatric & Gastrointestinal Surgery at Fortis Flt Lt Rajan Dhall Hospital, Vasant Kunj, New Delhi created history by removing the world's largest adrenal tumour, weighing 11.5 kgs, from a 55-year-old patient's stomach.
- A team of doctors at Fortis Hospital, Shalimar Bagh, New Delhi performed a meticulous two-hour laparoscopic procedure to remove 838 stones from the gall bladder of a patient. This is reportedly the highest number of gallstones ever extracted from a patient in India.
- A multi-speciality team of doctors at Fortis Hospital, Bannerghatta Road, Bengaluru, successfully treated a 2-month-old Iraqi baby suffering from a rare congenital condition wherein the urinary bladder is exposed and the urinary tract organs are malformed.
- A team of doctors at Fortis Hospital & Kidney Institute, Kolkata successfully performed a minimally invasive surgery to remove a 3 cm kidney stone in a 4-year-old boy from Lucknow.
- Dr Rama Joshi, Director - Gynae Oncology, FMRI, Gurgaon, became the first Gynae Onco Surgeon in Northern India to complete 50 robotic surgeries in record time using the Da Vinci Robot. Dr Joshi performed these surgeries on patients ranging from 9 years to 81 years in age.
Awards & Accolades - Q4 FY17
- Fortis Hospital, Bannerghatta Road, Bengaluru won a Gold at the Asian Hospital Management Awards (AHMA) for its 'Mission AAA' (Avoid Antibiotic Abuse) in the Physician Leadership Programme category. The award was presented at an event at Ho Chi Minh City, Vietnam.
- Fortis Hospital, Mohali was feted with the coveted Asia Pacific Hand Hygiene Award for 2016. Dr Anita Sharma, Head - Infection Control Committee, received the honour on behalf of Fortis Mohali at a ceremony in Bangkok.
- La Femme, New Delhi was ranked No. 2 in North India, 5th in the country in All India Critical Care Hospital Ranking Survey 2017.
- Fortis Escorts Hospital, Jaipur, became the first hospital in Rajasthan to receive the prestigious NABH Nursing Excellence accreditation, a testimony of the high nursing standard, unmatched expertise and relentless commitment towards patient welfare.
- Dr Ashok Seth, Chairman - Fortis Escorts Heart Institute, New Delhi was conferred with the prestigious 'Life Time Achievement Award in Interventional Cardiology' by the Chien Foundation, Singapore at the premier annual meeting of the Asian Pacific Interventional Cardiology – AsiaPCR SingLIVE 2017.
- Prof Dr Upendra Kaul, Dean and Executive Director, Clinical Research, Fortis Healthcare was appointed as the Co-Chairman of the "Expert Group for CV Diseases", under the Grant-in-Aid (GIA) scheme of Inter-Sectoral Convergence & Coordination for Promotion and Guidance on Health Research, by the Ministry of Health and Family Welfare, Government of India.
- Dr Vivek Jawali, Chairman - Cardiac Sciences, Fortis Hospitals, Bengaluru was selected as a member of Medical Council of India's special five-member committee formed to draw up an action plan to stimulate the growth of medical specialities and super specialities in India.
Disclaimer: This site is primarily intended for healthcare professionals. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription. Use of this site is subject to our terms of use, privacy policy, advertisement policy. © 2020 Minerva Medical Treatment Pvt Ltd


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Companies signed IT and business process outsourcing deals worth a record $ 9.5 billion in annual contract value, according to the quarterly outsourcing index produced Information Services Group (ISG). Traditional outsourcing contracts were up 5 percent to $ 5.8 billion, while the fast-growing as-a-service segment leapt 20 percent to $ 3.7 billion, according to ISG.
"Most conversations we're having with clients are cloud-led," says John Keppel, ISG president, for Europe, Middle East and Africa. "Enterprise customers are first seeking to be more cost efficient so that they can redeploy funds into digital and cloud activities. But we're also seeing them pivot quickly to broader digital transformation initiatives that are focused on creating a customer-first environment that is intelligent and mobile. This is a very long game and we are in the early stages at this point."
To read this article in full or to leave a comment, please click here


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This winter I'm going to offer two weekend photo workshops in the beautiful Anza-Borrego Desert in Southern California. You can read about all the details here: Anza-Borrego Photo Tour / Workshop.
The timing of the announcement is perfect because over the last two days Borrego Springs has received almost an inch of rain, with more forecasted for the rest of this week. An inch of rain my not sound like much, but that is a huge amount for this area. This, coupled with some earlier storms all but assures us that there will be some wildflowers. Even without wildflowers this is a wonderful area, but wildflowers can completely transform the desert.
Right after uploading the page, and before I had a chance to announce this workshop, someone spotted it on our website and has already signed up. I only have permits for two weekends, and only for 5 people at a time, so these could fill quickly – and when they do, that will be it. So check out the page and let me know if you have any questions!
In addition to this workshop, we also offer a number of Alaska photo tours.


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abstract class %CSP.Page extends %Library.Base
The %CSP.Page object serves as an event handler for CSP requests. All .csp pages by default derive from %CSP.Page, although you can override this using the <CSP:CLASS> tag. CSP Servlets can be created by deriving a class from %CSP.Page, see %CSP.StreamServer as an example.
Specifies the default character set for the page. This can be overriden using the <CSP:CONTENT CHARSET=> tag, or by setting the %response.CharSet property in the OnPreHTTP method. If this parameter is not specified, then for the default charset is utf-8.parameter CONTENTTYPE;
Specifies the default content type for the page. This can be overriden using the <CSP:CONTENT TYPE=> tag, or by setting the %response.ContentType property in the OnPreHTTP method. The default value if this parameter is not set is text/html.parameter CONVERTINPUTSTREAM = 0;
Specifies if input %request.Content or %request.MimeData values are converted from their original character set on input. By default (0) we do not modify these and receive them as a binary stream which may need to be converted manually later. If 1 then if there is a 'charset' value in the request Content-Type or mime section we will convert from this charset when the input data is text based. For either json or xml data with no charset this will convert from utf-8 or honor the BOM if one is present.parameter CSPFILE;
If this page was compiled from a .csp file, then this parameter contains the filename used for compilation.parameter CSPSTRICT;
The CSPSTRICT parameter is set to 1, if the DOCTYPE indicates that this is a strict or frameset XHTML or HTML 4 page.parameter CSPURL;
This parameter is used to make sure that if multiple CSP applications are mapped to the same namespace that the CSP engine can correctly identify which class corresponds with which URL. If 'LockCSPName' is true (the default, defined in the CSP application) then you can only access this page if the url exactly matches this 'CSPURL'. You can set this parameter to "" if you wish to disable this check for this class. This check is applied for all CSP urls (cls/csp/zen).parameter CSPXHTML;
If this page was compiled from a .csp file, then this parameter is automatically set to contain the url of this file used for compilation.
The CSPXHTML parameter is set to 1, if the DOCTYPE indicates that this is an XHTML page.parameter DOMAIN;
The default domain for csp:text, span and div tags. This parameter is used to specify the subset of localized messages to be used on this page.parameter ENCODED = 0;
Controls how the query parameters for this page are passed, it can be set to one of the following:parameter ERRORPAGE;
- ENCODED=0 - Query parameters are not encrypted
- ENCODED=1 - Query parameters are encrypted and passed within CSPToken
- ENCODED=2 - Same as '1' except any unencrypted parameters are removed from the %request object before calling the Page method. This ensures that only encrypted parameter are available in the %CSP.Request object.
Specify a custom error page to call if there are any problems with generating this page. If this is not specified it will use the default error page specified for this CSP application, and if this is not specified it will use the system default error page. For example this could be set to '/csp/samples/error.csp' to display the sample error page.parameter EXPIRES = -1;
Specified the default value for the %response.Expires.parameter NOCHARSETCONVERT;
It can be set to one of the following values:
Note that setting this header also effects the 'Cache-Control' and 'Pragma' headers. If the page is set to expire immediately then it will send a 'Cache-Control: no-cache' and 'Pragma: no-cache' to prevent any caches from storing the page. If the page is set to never expires then it will not send any 'Cache-Control' or 'Pragma' headers. If you set an expires date then it will not modify the 'Cache-Control' or 'Pragma' headers so if they are set they will be sent as specified and if you did not set them then nothing will be sent for these headers.
- -1: Expire immediately, this is the default for a CSP page
- "": Never expire (no HTTP Expires header is sent)
- nnnnn: Number of seconds from now when the object should expire
- Thu, 29 Oct 1998 17:04:19 GMT: Absolute time at which the object should expire
- ddddd,sssss: Absolute time the object should expire in $ZTimeStamp format. Note that this must be specified in the GMT timezone
Specifies if we wish to turn off charset conversion for this page. Normally CSP uses the tables built into Cache to convert between different charset's, however if you do not have a charset available you may wish to turn this off to avoid getting the error page saying that this charset is not installed. Then the data will be output and read in using RAW mode. This can be overridden using the <CSP:CONTENT NOCHARSETCONVERT=1> tag, or by setting the %response.NoCharSetConvert property in the OnPreHTTP method.parameter PAGETIMING = 0;
If this parameter is true then we automatically record timing statistics of how long it takes to produce this page. It is off by default.parameter PRIVATE = 0;
Controls the access to the page, it can be set to one of the following:parameter SECURITYRESOURCE;
The user needs initially to enter the site through a PUBLIC page.
- PRIVATE=0 - Page can be linked to/bookmarked
- PRIVATE=1 - Can only be referenced from another CSP page
This is a comma-delimited list of system Resources and associated permissions. A user must hold the specified permissions on all of the specified resources in order to view this page.parameter TIMINGSLOTS = 48;
The format of each item in the list should be as follows:
Permission is optional, and defaults to USE if not supplied. If it is supplied, it should be one of USE, READ or WRITE. You can also specify or grouping using the '|' character, so 'R1,R2|R3,R3|R4' means you must have resource R1 and one of R2 or R3 and one of R3 or R4. So if you have R1,R3 it will pass, if you have R1,R4 it will not as it does not meet the R2|R3 condition. So the '|' or condition takes precedence over the ',' and condition.
Used by the timing to decide how many slots a day should be divided up into. The default is to record the timings over half an hour (48 slots per day). If you need more detail you can modify this value in the superclass.parameter UseSession = 1;
This parameter controls the CSP session support. By default CSP will use a persistent session which holds a license until the session is ended or times out. If you override this then this CSP page will use a transient session which is never persisted.
You pass this the url of the page you are going to and a name and value parameter and it will return the name and value encrypted if the target page is encoded.classmethod Decrypt(data As %String) as %Binary
Decrypts the input string using the %session.Key value that is unique to this user session. The input string is the string provided by the Encrypt method, the output is the decoded string.classmethod Encrypt(data As %Binary) as %String
Encrypts the input string using the %session.Key value that is unique to this user session. The output string is a string that can be included in HTML and in URLs as it does not contain any characters that need to be escaped in these environments. It can be decrypted with the Decrypt.classmethod EscapeHTML(in) as %String
Note that the data must not contain any unicode characters as the encryption function just takes a byte stream. If you wish to encrypt unicode data then the simplest way is to form a $listbuild of the string first to convert it into a byte stream.
This method converts input HTML text into Escaped HTML text.classmethod EscapeURL(in As %String, charset As %String) as %String
This method converts the in input URL string into Escaped URL string. Note that '/' is not escaped which is consistent with rfc3986. The conversion first encodes the string using the current devices charset and then url encodes the result. If you pass in charset then we will use this rather than the current devices charset for the encoding.classmethod HyperEventCall(methodName As %String, args As %String, type As %Integer = 0, mobile As %Boolean = 0) as %String
This method returns the string that needs to be written to the current device in order to insert a HyperEvent into a CSP page that is defined via a class. This method is the hand written class equivalent of using #call(...)#, #server(...)# or #vbserver(...)# in a CSP page.classmethod HyperEventHead(iframeOnly As %Boolean, strict As %Boolean = 0, optionalBroker As %Boolean) as %String
The methodName argument defines the method to call in the same format as #server: either ..method or package.class.method.
The args argument defines the runtime JavaScript arguments to be passed to the Cache method as a comma separated string.
In order to use this method, HyperEventHead must be used in the  section and if you are using the #server style hyperevent then you also need HyperEventBody be used in the  section.
An example of an OnPage method for your page using a #call(...)# style HyperEvent:Write "",! Write "",! Write ..HyperEventHead(),! Write "",! Write "",! Write "My New CSP Page!",! Write "<form name=""f"">",! Write "<input type=""text"" name=""f1"" value=""fieldabc"">",! Write "<input type=""text"" name=""f2"" value=""fielddef"">",! Write "<input type=""button"" value=""Go"" onclick='" Write ..HyperEventCall("..MyMethod","self.document.f.f1.value,self.document.f.f2.value",1) Write ";'>",! Write "</form>",! Write ..HyperEventFrame(),! Write "",! Write "",! Quit $$$OK
Include another csp page or file in the output at this point. If the url ends in either 'csp' or 'cls' then it will call the csp or cls class to generate output skipping the output of the HTML headers. If the url is a file then it uses the stream server to output this file. This url can be a relative path in which case it will be resolved based on the current page url first. This is called by the <csp:include Page="page.csp"> tag.classmethod InsertHiddenField(url As %String, name As %String, value As %String, extra As %String = "") as %String
You can pass additional parameters to the included page by adding them to the url to call. These parameters will only exist for the included page and the %request object is restored when it returns to the calling page. For example:
<csp:include Page="page.csp?PARAM=VALUE">
Inserts a '<input type="hidden" name="Name" value="Value">' tag into the current document. If the target url you are submitting to (url) is encoded then this will encrypt the data in this hidden link. In this way it is similar to the Link. The extra are any extra attributes to add to the tag.classmethod InsertHiddenFields(url As %String, ByRef query As %String) as %String
For example:<form action="target.csp"> #(..InsertHiddenField("target.csp","Name","Value"))# <input type=submit name=Submit> </form>
Return the string containing the hidden form tags. You pass it the url URL of the target page that this form is submitted to (the action=xxx attribute).classmethod IsPrivate() as %Boolean
The array, query, contains an optional set of name-value pairs which are also output as hidden input fields. This is normally called automatically directly after the <FORM> tag to insert any hidden input tags that are required. However if you generate a form programatically then you may need to call this function just after you output the <FORM> tag.
Returns 1 if this page is in fact a private page (see PRIVATE).classmethod Link(link As %String, ByRef query As %String, addQ As %Boolean = 0) as %String
Tranforms the link specified by link into a URL and returns it as a string.abstract classmethod OnHTTPHeader(ByRef OutputBody As %Boolean) as %Status
The URL may be encrypted.
The array, query, contains an optional set of name-value pairs which are added to the URL. For example 'Set query("name")="data"'
If the optional argument addQ is true, then a ? or &, as appropriate, is added to end of the URL
Event handler for PAGE event: this is invoked in order to send HTTP headers. The default action is to invoke the WriteHTTPHeader() of the %CSP.Response which generates HTTP 1.0 standard headers. Set OutputBody to 0 to prevent prevent OnPage from being called, leave it unchanged otherwise. Returns a %Status code.classmethod OnPage() as %Status
Event handler for PAGE event: this is invoked in order to generate the content of a csp page.abstract classmethod OnPageError(ByRef sc As %Status)
Event handler for any error that occurs on the page. If an error occurs and this method is defined it calls this method passing it the error code by reference. You may change the error code if wished, if you set it to $$$OK then it will cancel the error and the CSP error page will not be displayed.abstract classmethod OnPostHTTP()
Event handler for POSTPAGE event: this is invoked after the data for the CSP page has been sent to the browser from the Cache server.classmethod OnPostHyperEvent(class As %String, method As %String) as %Status
Event handler which is invoked after a hyperevent method is called on this page.abstract classmethod OnPreHTTP() as %Boolean
Event handler for PreHTTP event: this is invoked before the HTTP headers for a CSP page have been sent. All changes to the %CSP.Response class, such as adding cookies, HTTP headers, setting the content type etc. must be made from within the OnPreHTTP() method. Also changes to the state of the CSP application such as changing %session.EndSession or %session.AppTimeout must be made within the OnPreHTTP() method. It is prefered that changes to %session.Preserve are also made in the OnPreHTTP() method as this is more efficient, although it is supported in any section of the page. Return 0 to prevent OnPage from being called.classmethod OnPreHyperEvent(class As %String, method As %String) as %Status
Event handler which is invoked before a hyperevent method is called on this page. This gives you a chance to modify the behavior of every hyperevent call within this page. Return an error code to prevent the hyperevent from being called.classmethod Page(skipheader As %Boolean = 1) as %Status
Process a request to serve a CSPPage. This method is invoked by the Caché CSP Server. In turn, this method invokes:classmethod QuoteJS(in) as %String
Note that OnPostHTTP() always gets run, even if there was an error.
- OnPreHTTP()
- OnPage()
- OnPostHTTP()
skipheader will skip the running of the OnPreHTTP() method.
This method converts input string into quoted JavaScript literalclassmethod RewriteURL(url As %String) as %String
This method will rewrite a URL to use #url()# if neededclassmethod ShowError(sc As %Status)
Display a %Status error code to the CSP Page.classmethod StartTimer(name As %String)
Used to get performance information on your CSP pages. This is called to start the timing of a block of code. The name specifies the type of component we are timing, for example we automatically call this with 'Page' at the start and end of the rendering of the CSP page. The idea is that you can call this at the start and end of any block of code to log information on how long this is taking.classmethod StopTimer(name As %String)
This is a default implementation of what sort of information to log, however you can subclass this and StopTimer to enhance the information that is logged.
Used to time performance information on your CSP pages. This is called to stop the timing of a block of code. The name specifies the type of component to time. See StartTimer for more information on this.classmethod ThrowError(sc As %Status)
Passed a %Status code this goes to the error page passing this status codeclassmethod UnescapeHTML(in) as %String
This method converts Escaped HTML text into normal HTML textclassmethod UnescapeURL(in As %String, charset As %String) as %String
This method converts the in Escaped URL string back to its original form. The conversion first unescapes the URL then decodes the string using the current devices charset. If you pass in charset then we will use this rather than the current devices charset for the decoding.


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LSV is pleased to be able to facilitate its first dedicated workshop aimed at assisting pool owners / operators in understanding best practice examples of how to implement the new supervision requirements of the updated GSPO.
Industry thought leaders in aquatic risk and pool safety will be presenting and facilitating discussions throughout the workshop.
Date: Friday 17th May 2019
Time: 12.00pm – 4.00pm (includes lunch)
Venue: Life Saving Victoria, State Centre, 200 The Boulevard, Port Melbourne
Cost: $50 per person
To secure your place simply:
- Visit www.lsv.com.au/training and either register a new account or log in using your existing username and password.
The portal is best viewed using Google Chrome as the web browser.
- On the 'Find a new course' page, enter 905632 into the Course ID search field, and click "search". Please ensure that you have provided your Unique Student Identifier (USI) to ensure we can issue your qualifications. To obtain a USI visit http://www.usi.gov.au/students/create-your-usi. Should you need further assistance creating or retrieving your USI please contact the USI Office on 1300 857 536.
- Click the 'Enrol' button next to your course and provide your details.
The event is limited to 60 persons and is offered on a first come, first serve basis, so don't delay in getting your registration in.
How the Day Will Run
12.00pm: Workshop Briefing
12.10pm: Overview of updates to Aquatic Supervision in the GSPO
12.30pm: Lunch
1.00pm: Best Practice Application Examples from Industry
2.00pm: Workshop Activity – Supervision Assessment – Assess the effectiveness of a supervision program and identify risks
3.00pm: Workshop Activity – Supervision Planning – Design an effective Supervision Plan under guidance from an expert
4.00pm: End of Workshop
Presentations: A selection of industry representatives have been chosen to present based on their facility's implementation of best practice examples of applying the new GSPO Supervision requirements. These presentations are informational and designed to plant seeds as to how facility owners / operators might address the requirements in their facility and will assist facility owners / operators in benchmarking against industry.
Workshop Activities: The workshop activities are designed to be interactive group activities that give participants the opportunity to interact and test theories / methodologies in a safe and supportive environment where input from industry experts can assist them in formulating their own aquatic supervision strategy.
What You Need to Know
The workshop is aimed at professionals that are responsible for the Management of Lifeguards (GSPO SV8) and / or are the owner or operator of a public pool.
The workshop will outline what your responsibilities are in relation to the new requirements of the Aquatic Supervision section of the GSPO and give information and practical resources on how to fulfill your responsibilities and implement a best practice approach to pool supervision.


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NAI Hallmark has been named by CoStar Group, Inc. (NASDAQ:CSGP) the leading provider of commercial real estate information, analytics and online marketplaces, to receive the following Power Broker Awards:
Every year CoStar Power Broker Awards celebrates the top CRE firms and brokers in the United States and Canada. Over the past 18 years, CoStar has recognized the industry leaders for their success in the commercial real estate market.
Every day, CoStar's 1,750 researchers find and verify information on commercial real estate sales, leases and listings. At the end of each year, CoStar tallies the commercial real estate sales and lease transactions that closed during the previous year to determine the winners of the CoStar Power Broker Awards in each market. These awards are presented to both the firms and individuals who closed the highest transaction volume in commercial property sales and leases in their respective markets throughout the year.


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Give your home a new look that is attractive and appealing.
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5 Household Items that You Can Use as Organizers
Maintain order at home with the help of these essentials
Photography: Jun Pinzon (Main Photo)
When organizing the home, we can be very creative when it comes to keeping things in place. Some homeowners opt to have built-in shelves and other secret nooks, while there are those who prefer to work with DIY organizers!
There's no need to buy new bins, boxes, and containers! You can turn everyday items into instant storage must-haves. Make sure you have these five items at home:
Recommended Videos
More on Realliving.com.ph


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Teva Partners With REI and Dave Matthews Band On National Sweepstakes
Goleta, Calif. – Teva® (a division of Deckers Outdoor Corporation NASDAQ: DECK) received the support of REI, a national outdoor specialty retailer, to launch a summer sweepstakes in partnership with Dave Matthews Band.
"We worked with Dave Matthews Band to create the ultimate sweepstakes prize for REI customers: great live music, top notch camping gear and cool new kicks to wear to the show.†said Liz Ferrin, Teva Global Promotions Manager.
Starting June 11th, details on the "Win a Trip to See Dave Matthews Band Live at the Gorge†sweepstakes became available at all REI locations nationwide. Visit www.teva.com to enter.
The grand prize winner will receive two VIP tickets to enjoy Dave Matthews Band live at the Gorge amphitheatre in George, WA on the nights of: August 29, 30, and 31st, 2008. Additional prizes in the grand prize package include: two pair of Teva's new Omnium footwear, $1000 USD, a camping pass for the Gorge, REI camping gear and other special gifts from Teva, Dave Matthews Band and REI.
"There was a natural synergy between all three partners from the beginning. The chance to win tickets to see Dave Matthews Band in one of the nation's premier outdoor venues is a big draw for our fans.†Says Bruce Flohr, Red Light Management/Dave Matthews Band
The grand prize winner will be contacted by phone on August 1st, 2008.
About Teva
Teva is an authentic icon in the Outdoor Industry. Founded in the early 1980's by a Colorado River guide, Teva pioneered the sport sandal category. For over 20 years on the river, in the canyons, and across the trails of the great outdoors, athletes and enthusiasts have traveled the globe comfortably and confidently in Teva footwear. Providing a positive contribution to the world in which they play is at the core of everything Teva stands for. The Teva name itself is a Hebrew word meaning "nature" and the hand logo is the Hopi symbol for "Friendship" and "Water".