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True success is achieving what you want in a way that aligns with your Core Values
Boost Your Resilience
Learn to develop an empowering "inner coach" who focuses on the best for you and within you. Shift your mindset for your advantage and the benefit of those you impact. Motivate yourself to thrive for the long term by knowing your value and knowing what you value.
A Mindset of Commitment and Passion
Portrait: US Army (USA) Brigadier General (BGEN) John H. StanfordWhat happens when we decide to be "all in"? Why does it feel good and why is it good for us? Recently, I had the good fortune to facilitate a board of directors retreat for a local chapter of a national charity. I was once again … Continue reading A Mindset of Commitment and Passion
How to Be the Best Version of You
Genuinely successful people measure themselves by what they can do – not what they have. Mindset is a set of attitudes and beliefs that govern all of our perceptions and behaviors. If we are not consciously shaping and molding our mindset, events and other people influence it without our discrimination. Are you willing to trust … Continue reading How to Be the Best Version of You
Fall is the Time to Take Charge
With summer behind us, fall is a good time to renew our commitment to our best selves at work and at home. Because most of our childhoods were conditioned around the school year, this last quarter can feel like a time for getting serious again. If summer is for fun and daydreaming, then fall is … Continue reading Fall is the Time to Take Charge
Never Let Stress Get in the Way of Your Success
Stress has been a part of everyday life since the dawn of humankind. Successful people know how to use stress to their advantage instead of letting stress use them. They cultivate a sense of balance by taking a big-picture view of stress. They learn to focus and take action on the internal changes needed to … Continue reading Never Let Stress Get in the Way of Your Success
Finding Your Extraordinary.
Living an extraordinary life seems like something only rockstars in business, sports or entertainment get to do. But is that really true? Doesn't extraordinary depend on how you define it and the context of how you're living? For someone who is super successful in their career but lacks a depth of real meaning at the … Continue reading Finding Your Extraordinary.
How to Stay Flexible at Work
In the fast-paced and dynamic nature of business, it can be a real challenge to stay focused and keep up. Our schedule and priorities are constantly changing as we scramble to stay nimble and ahead of the curve. How do our emotional struggles, which can range from a nagging fear of rejection or failure, anxiousness … Continue reading How to Stay Flexible at Work
Would You High Five A Setback?
So what this comes down to is this: Did we get disappointed with ourselves in any way this week? Good. Did we learn something new or remember something we forgot as a result? Great.
What's Your Mindset?
Carol Dweck is a Stanford psychologist and author of Mindset, a book about her research in the area of achievement and success. She discovered there are two types of mindsets, or established set of attitudes, from which people engage with the world and with themselves.


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Chicago's Best Ideas with Todd Henderson
Add to Calendar 2020-01-27 12:15:00 2020-07-05 09:27:13 Chicago's Best Ideas with Todd Henderson Event details: https://www.law.uchicago.edu/events/chicagos-best-ideas-todd-henderson-0 - University of Chicago Law School firstname.lastname@example.com America/Chicago public
Room II
1111 East 60th Street, Chicago, Illinois 60637
Room II
1111 East 60th Street, Chicago, Illinois 60637
Open to the public
The Trust Revolution: How the Digitization of Trust Will Revolutionize Business & Government
In this CBI, Professor Henderson will examine how Internet platforms--eBay, Uber, AirBnB--relate to the Code of Hammurabi, Medieval guilds, the New York Stock Exchange, and corporate brands. All of these institutions, along with religions and governments and families, are in large part about providing trust to enable human cooperation. By undertaking a genealogy of trust, we can illuminate modern debates about the role and scope of government in regulating the daily lives of citizens.
Lunch will be provided.

subset: commoncrawl


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Harlequins have announced their team to head north and face Sale Sharks on Friday night and Alex Dombrandt's absence has raised some questions.
The rampant loose forward has been on the bench for Quins' past two matches, and this has caused some concern given the uncertainty over his future. While there are reports that the 22-year-old has signed a new deal at the Stoop, there are those that are still sceptical anything has happened, and his omission only fuels the suspicions of those on social media that his future lies elsewhere.
Tellingly, he also not listed as absent due to injury.
Why is Dombrant constantly being left out? Can't be a good sign with the rumours he's leaving ??
— Jack Gammans (@jgam89) January 2, 2020
Given his age and the reputation he has already got after a barnstorming debut season in 2018/19, there is likely to be a host of clubs that would want his signature.
Need to start 2020 with a win and start a good run in the league. Good to see @KyleSinckler back, hope the rumours about leaving are wrong, where is @Alex_dombrandt on the team sheet, and also hope the rumours about him leaving are wrong as well #COYQ
— Darren Over (@DarrenOver) January 2, 2020
However, some have simply put this down to squad rotation, which is an issue in the season after a Rugby World Cup. While Dombrandt did not make Eddie Jones' squad to travel to Japan, he was in the training squads prior to the tournament, and played in the match against the Barbarians in May.
This would have compromised the mandatory five-week rest period players needed to be given, and as a result, players are going to be used sparingly throughout the season. After all, he started at No8 in both contests against Ulster in the Champions Cup, which were arguably Harlequins' two biggest games this season to date.
With a call-up for the Six Nations looking very likely, Paul Gustard will also want to manage his players to ensure they are still firing on all cylinders come the end of the season. However, until something concrete is revealed about Dombrandt's future, there will always be concerns amongst fans that they could be losing one of their most promising players.
Harlequins Starting XV:
1 Joe Marler (198)
2 Elia Elia (49)
3 Kyle Sinckler (143)
4 Stephan Lewies (11)
5 Matt Symons (35)
6 James Chisholm (80) (VC)
7 Chris Robshaw (286) (Captain)
8 Tom Lawday (11)
9 Danny Care (268) (VC)
10 Marcus Smith (71)
11 Vereniki Goneva (4)
12 Paul Lasike (14)
13 Cadan Murley (25)
14 Gabriel Ibitoye (31)
15 Ross Chisholm (114)
16 Jack Musk (6)
17 Santiago Garcia Botta (9)
18 Will Collier (162)
19 Tevita Cavubati (8)
20 Semi Kunatani (16)
21 Martin Landajo (10)
22 Brett Herron (4)
23 Aaron Morris (36)
Not available due to injury: Forwards
Rob Buchanan
Scott Baldwin
George Head
Phil Swainston
Glen Young
Jack Clifford
Archie White
Will Evans
James Lang
Ben Tapuai
Francis Saili
Michele Campagnaro
Nathan Earle
Mike Brown
One of Welsh Rugby's biggest characters on and off the pitch, RugbyPass travelled to Brecon to see how life after rugby is treating Andy Powell.
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Special Offers on Treasure Trails
If you've recently seen us at a Christmas show but couldn't decide which Trails to buy, don't worry, you can still take advantage of our special show offers on any Treasure Trail across the UK.
2019 Yorkshire Trails Christmas Offers: (RRP £9.99)
Buy 1 Trails for £9.99* (free P&P)
Buy 2 Trails for £18* (free P&P)
Buy 3 Trails for £24 each* (free P&P)
(3 or more Trails = £8 per Trail with free P&P)
*These offers are only available when buying your printed Trails directly from us at Yorkshire Trails.
Gift Vouchers also available - contact us for details.
1. Choose your Treasure Trails. If you haven't already decided, full details of each Trail can be found on the Treasure Trails website: www.treasuretrails.co.uk
2. Email us at with your name, delivery address and which Trails you would like.
3. We'll send you an online payment request and confirm your order. Once payment is received, we'll order your Trails for you ASAP. Trails will be posted out via First Class post within 3 working days.
If you have any questions, please email or get in touch via our contact page.
If you need your Trails in a hurry - you can purchase a download version for £9.99 to print at home via the Treasure Trails Website.
Need extra copies of the same Trail for your group?
Treasure Trails are a great activity for youth groups, walking groups, social groups, larger family groups and all sorts of group excursions.
One Trail booklet is ideal for 4-5 people so for larger groups you will need additional copies and a little help with organising your activity.
Click here for details of our group packs and prices.


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text: Boneo Primary School HomeProductsSafety SurfacingLoose Undersurfacing Back Boneo Primary School Proudly displaying their school name across the eye-catching shade sails, Boneo Primary School have created a fabulous play area catering to their students' every need. They look great, offer protection from the elements and a sense of fun and play. Enquire Boneo Primary School $0.00 QTY: Order now for immediate delivery when stock arrives. Share Tweet Equipment Junior School Shade Enquiry Manufactured by Australia's largest Playground Company, FORPARK AUSTRALIA, our equipment is designed to comply with Australian Standards and is built to last using powder coated uprights, platforms, and components. The fittings are manufactured from various materials including powder coated galvanised steel, roto-moulded plastics, and rope items which are wrapped in a fire-resistant nylon braid.Made in Australia. Junior School Playgrounds have an important role in a student's development. The playground is a place where friendships are made, skills are developed, and challenges are met. By providing a balanced array of physical, social, creative, and cognitive play opportunities, we give children all the "tools" they need, to develop and hone their skills. Shade structures provide year-round protection from the elements, especially in the summer months. SafePlay offer a wide range of manufactured shade systems providing up to 99% UV protection. We can supply steel-framed structures and tensioned sails and provide custom design service.Shade structures provide year-round protection from the elements. Shade is important to the safety of children, especially in the summer months. SafePlay offer a wide range of manufactured shade systems providing up to 99% UV protection. We can supply steel-framed structures and tensioned sails and provide custom design service.Shade post and sail colours can be specifically chosen to compliment the colour scheme of the buildings or play equipment.Child Care Centres, Pre-Schools and Kindergartens can benefit from the addition of Shade Sails and Fixed Shade Structures by protecting young skin, and extending outdoor play time. Product Enquiry Boneo Primary School First Name: * Last Name: * Telephone: Email: * Enquiry: *


text: ▸▾ Claim This Listing Please login in order to be able to claim this listing. Username*: Email*: Password*: Log in | Lost your password? Servpak Corp Rating (average): (0) Business Name: Servpak Corp Business Genre: Manufacturing, Paper plastic Business Website Address: serv-pak.com Business Address, City: 5844 Dawson St, Hollywood ZIP Code: 33023 Business Phone Number: 9549624262 Business Fax: 9549625776 Ratings There are no reviews yet. Please login to rate this listing.


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Bristol City FC take on Sheffield Wednesday in the latest Sky Bet Championship match.
Kick Off:
Go VIP - Upgrade to the St Patrick's Day Party Hospitality Package in the Heineken Lounge and receive:
- Pint of Guiness on arrival
- Selection of small plates
- Half-time refreshments
- Padded seat in the South West corner
- Guest speaker Q&A session
Founded in 1894, and reformed in 1982, Bristol City FC have played their home games at Ashton Gate Stadium since 1904.
The team finished 8th in the league table, after a rollercoaster 2018/19 season, and were part of the battle for the last playoff spot; which ultimately went to Derby County.
The club's home colours are red and white, and their nickname is The Robins. The bird will feature on the club's badge during the 2019/2020 season for the first time in 25 years. Their main rivals are Bristol Rovers, with whom they contest the Bristol derby, and Cardiff City, with whom they contest the Severnside derby.
Date of Event
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When you look at us right now, though we've just moved into a new home with a homeschool room, you'll see unschooling. We've flipped the May switch. Fewer languages to study and more projects. Less sitting in one place or formal structure, but still lots of learning. At the end of April, I have them write … Continue reading
Tag Archives: project based learning
two seasons in our home: formal studies and project-based learning (unschooling)
I cannot call myself a true unschooler because there is a season where I pull out the workbooks, insist on essay writing, exponents and French verb conjugations. True unschoolers don't insist on anything prescribed. I'm sure I'll change my approach again, but I think I've found myself a tried and true balance. One that provides a lot of … Continue reading


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It is silly to suggest that ILO Maritime Labour Convention, 2006, has not advanced seamen's rights. The constant dribble of news about ship detentions shows that something is being done. But it is equally silly to think that the Convention has ushered in a new age in which seamen's rights are universally upheld.
The violations continue. So must the war on the violators, which has to be fought on multiple fronts. The following bold proposals, some of them previously raised in Marine Café Blog, should plug some of the holes that allow shipowners and other parties to disadvantage and exploit mariners.
1. Expand ILO Maritime Labour Convention, 2006, to include onshore violations of seamen's rights. Delaying seamen's dollar remittances and cheating on the conversion of their US dollars to the local currency are amongst the many common malpractices on land.
2. Subject ships covered by a Maritime Labour Certificate (MLC) to random inspection. The MLC is really a waiver system that shields countless vessels from Port State Control inspection.
3. Impose fines on shipowners who commit serious and repeated breaches of the Convention. There should a table of fines corresponding to every violation, and copies of it should circulated by shipping associations amongst their members. The fines can be collected by national Port State Control authorities with a portion to be donated to local seamen's charities.
4. Offer cash rewards to seamen who blow the whistle on violations of ILO Maritime Labour Convention, 2006.
5. Impose heavy fines on ship captains involved in double-bookkeeping. This egregious practice would not be possible without the active participation of the ship's master.
6. Establish a centralised online register of rogue shipowners. The database should name the companies known to have abandoned their crews; had their ships detained more than once; and committed serious malpractices, including double-bookkeeping.
7. Ban the maritime flunkey system in Manila under which cadets are made to work as unpaid office or domestic help, sometimes for months on end. The practice is disgraceful. It demeans not only the individual but the merchant marine profession itself.
8. Stop overburdening seamen with training requirements. Doctors and other medical professionals are not required to undergo re-training for procedures which they have already learned and performed countless times before. Why should seamen? It's all about making the fat cats fatter.
For all that has been said and done, seamen remain at the bottom of the maritime food chain, constantly preyed on by those at the top. Oftentimes, the predators include their own brothers in the profession. The day when seamen are generally respected and treated with dignity is still far, far away. ~Barista Uno


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Production Estimator - Residential Developer/Builder
|Job Title:
|Production Estimator - Residential Developer/Builder
|Contract Type:
|$80,000 - $100,000 + Super
|Job Published:
|December 21, 2019 05:46
Job Description
My client are a busy developer/builder building both their own estates comprised of turnkey homes and townhouse developments, as well as joint ventures with other large developers. They are a boutique builder with big growth plans in place to accelerate your career progression. Due to a strong pipeline of site starts, they are seeking a motivated production estimator to join their team based in the CBD working across a variety of projects.
This is a unique opportunity to work for a company without any "red tape" – they will welcome your ideas for improvement and have a non-hierarchical structure. You can expect to enjoy a relaxed work environment with a structured training and development program, hands on management and regular social events. They place a real emphasis on fostering a positive office culture so are looking for just the right person to fit into their team.
The Job
Reporting to the General Manager, your responsibilities will include:
- BOQs, purchase orders, pricing, estimating of new homes and variations
- Compiling preliminary pricing and preparing accurate base cost for projects
- Complete set tasks and achieve job targets within designated time frames
- Liaising with internal stakeholders and the external suppliers/subcontractors
To be successful in this role, you will have:
- First and foremost a positive attitude and willingness to learn
- 2+ years' experience of working as a production estimator for a residential builder (medium density experience a bonus)
- A tertiary qualification relevant to the construction industry
- Excellent time management skills and ability to maintain accurate documentation
- Experience with Databuild, Framework or Timberline software would be advantageous
You can expect to be rewarded with a competitive starting salary of up to $100k + Super, as well as a great team of people to work with and genuine job satisfaction and work/life balance. If this sound like the job for you please contact Lauren Rogers today on 85353100 or apply directly through the advert.
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Friendswood Estate Homes for Sale - Friendswood
Search Friendswood Estate homes for sale & real estate in Friendswood, Texas. Friendswood is a small community nestled close to Clear Lake, just off of 45 South, on the way to Galveston Bay. What was once a small farming community brimming with fig orchards has become one of America's Best Places to Live. For information about Friendswood Estate & neighborhood properties for sale or to schedule a private home showing, contact your Friendswood real estate experts today!
Friendswood Estate Homes for Sale - Friendwood, TX
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See all Neighborhoods: Friendswood Subdivision Directory
Friendswood Home Searches
Selling or buying a home in Friendswood Estate soon? Call VIP Realty at (281) 456-2475. Our community of Friendswood Estate REALTORS will help you navigate the Friendswood housing market near Houston, TX.
Friendswood Estate Homes for Sale
Tucked away from the busy stream of vehicular traffic, Friendswood Estate offers single-family residential housing in pleasant park-like settings. Choices abound with resale homes in a variety of architectural styles. When you stand in front of the gorgeous Friendswood Estate homes for sale, you will be amazed at how well-designed these extraordinary homes have been crafted. Pause for a moment and appreciate the attention to details and finishing your potential new dwelling offers.
Impressive architecture and dramatic windows will grip you from the moment your eyes greet these charming residences. Friendswood Estate homes for sale feature Olde Worlde styling, stone and brick facades and all the modern amenities a typical buyer could desire. Lush landscaping sets off the homes that often include pools, study and media rooms.
Friendswood Attractions & Things to Do
There's no shortage of outdoor things to do in Friendswood. With ample recreational green spaces, you can get in a workout and let the kids roam. Kids love playing in Lynn Gripon Park or catch a glimpse at original rocket ships at Rocket Park near the Space Center. Located near the town's firehouse is Stevenson Park which has tons of amenities from a splash pad to basketball courts. Centennial Park is home to walking trails, open fields and an amphitheater that holds events and free concerts.
Spanning 80 acres of natural habitat, see and feed animals from all over the world at Bayou Wildlife Zoo. What's more, you can make an appointment with Nightsong Petting Zoo and get to see their sheep, goats, rabbits, barn cats, horses, and more. For a day on the greens, Timber Creek Golf Club provides an experience for golf enthusiasts of all ability levels.
For theater and cinema, Friendswood is home to The Purple Box Theatre, winner of the Excellence in Dance award from the Junior Theater Festival. For the price of admission, residents enjoy both dinner and a movie at Star Cinema Grill.
Users may not reproduce or redistribute the data found on this site. The data is for viewing purposes only. Data is deemed reliable, but is not guaranteed accurate by the MLS or NTREIS.
Listing information last updated on July 12th, 2020 at 9:00pm CDT.
Copyright © 2020, Houston Realtors Information Service, Inc. All information provided is deemed reliable but is not guaranteed and should be independently verified.
The IDX information is provided exclusively for consumers' personal, non-commercial use, it may not be used for any purpose other than to identify prospective properties consumers may be interested in purchasing. All information provided is deemed reliable but is not guaranteed accurate by the MLS and should be independently verified.
Listing information last updated on July 12th, 2020 at 9:10pm CDT.


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DALLAS (AP) - Texas' governor has declared a state of disaster as the coronavirus pandemic spreads to all of the state's biggest cities.
The declaration Friday came as the number of COVID-19 cases is climbing and reaching into San Antonio and Austin. Illnesses were reported in those cities for the first time Friday. San Antonio is banning large public gatherings. Its giant Fiesta celebration will be postponed until November. That follows Dallas Mayor Eric Johnson issuing a proclamation late Thursday declaring a local state of disaster for the city of 1.3 million people.
(Copyright 2020 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.)


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PET Metalized film
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PET Metalized film is highly glossy,smooth and clear in surface with the Aluminum layer, it has the metalized and plastic characteristics, when applied on paper, will shows a metallic gold or silver effect. It is sun-proof and prevents UV irradiance, which help
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In Penang – Ali Nasi Lemak Daun Pisang, Lebuh Pantai
Somewhere along Lebuh Pantai (Beach Road), there is a food court named Sri Weld Food Court which houses various hawker food stalls. It is pretty tidy and surprisingly airy, cooling even when the weather is scorching. I couldn't exactly remember how I found this food court but I'm glad that I did. In the...
By: yoononn
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WW2 German Repro Heer Field Gray Gabardine Visor Cap All Sizes
Made of field gray gabardine as the original. Available Sizes: 55, 56, 57, 58, 59, 60, 61, 62. The item "WW2 German Repro Heer Field Gray Gabardine Visor Cap All Sizes" is in sale since Monday, January 13, 2020. This item is in the category "Collectibles\Militaria\WW II (1939-45)\Reproductions\Germany". The seller is "militaria_lee" and is located in Qingdao,Shandong.
This item can be shipped worldwide.
Country/Region of Manufacture: China
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Excerpt: This issue of JCCP includes a series of case reports spanning the neonate to the active teenager, as well as a commentary on nutritional factors affecting women and the very important issue of postpartum depression.
The excerpt is reproduced with the permission of the publisher. Click on the above link for free full text.


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Word instantly makes a link when a user pastes a complete URL on a page. It is possible to tell Word your proofing language differs. Another reason that you need to purchase Microsoft Word 2016 may be the big improvements to browse mechanisms.
Question Paper Template in LaTeX?
Source : i.stack.imgur.com
It is one of the most popular programs in the Microsoft Workplace toolbox. It is the most commonly used application by trainees and staff members alike, because it is easy to utilize. It is one of the best document processing tools offered today that enables you to create many kinds of files for personal or professional usage.
30+ Free Printable Graph Paper Templates (Word, PDF ...
Source : templatelab.com
You might attempt to fix the file or find a backup you didn't understand you had. From here, you will need to browse to the file you're trying to open. You are going to be reanimating your Word files quickly.
Question Paper Template in LaTeX?
Source : i.stack.imgur.com
If you want to make a new document, then you're able to pick from a completely arranged new list, which likewise has pre-made design templates for the sort of text you're composing. With Microsoft Word's brand-new functions and semi-new layout, you are able to easily navigate along and make a terrific document even when you use a touchscreen. It is possible to also read a document without diversions utilizing the Read Mode. When you're working on a file with different individuals in real time, each individual receives a cursor with their own unusual color.
For your references, there is another 37 Similar photos of exam paper template word that Jude Cormier Jr. uploaded you can see below :
This 30+ Free Printable Graph Paper Templates (Word, PDF ... uploaded by Jude Cormier Jr. from public domain that can find it from google or other search engine and it's posted under topic exam paper template word. If you have any complain about this image, make sure to contact us from the contact page and bring your proof about your copyright image. All trademarks referenced here in are properties of their respective owners and most of the sources material is posted on this website after the "Fair use" doctrine of copyright released for non-commercial News reporting, education and discussion purposes. We will comply with all takedown requests.


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3 bedroom house7 Catherine StreetThis home is in a great location, close to shops, the University and it has straight bus routes into town. Ground floor consists of a big lounge and kitchen with the bathroom also being there. The property also has a decent sized garden. Viewings are now available!Mr Sales and Lettings are members of the Property Ombudsman Scheme.Mr Sales and Lettings are members of the Client Money Protection Scheme.NoticePlease note we have not tested any apparatus, fixtures, fittings, or services. Interested parties must undertake their own investigation into the working order of these items. All measurements are approximate and photographs provided for guidance only.
Property ID: 1164


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Texas Resources for Writers
Here you'll find a collection of resources for writers in Texas, from conferences to local critique groups to literary magazines. If you live in Texas, these are some organizations you might want to check out:
Did you know WriteByNight called Austin home for nearly five years? For more than a decade, WriteByNight has helped writers in Texas and beyond achieve their literary goals. And we want you to be next! Claim your free consultation to learn about WBN's customizable one-on-one writers' services, including:
Not ready to chat? That's cool. Until you are, why not sign up for our weekly message full of education and inspiration for writers and aspiring writers. You'll also receive a free diagnostic tool, "Common problems and SOLUTIONS for the struggling writer."
American Literary Translators Association
Bridges cultural communication among countries and languages through the art and craft of literary translation. ALTA is the only organization in the United States dedicated solely to literary translation.
Formed in 1949, the society holds numerous contests, publishes anthologies and chapbooks, and offers public meetings that have featured some of the most influential poets and artists from Austin and beyond.
Weekly discussion-based meetings, where writers bring examples of their current writing for sharing (read silently) and to spark discussion.
Writers of all ages and skill levels are invited to examine the techniques of literary artists and experiment with language to communicate experience and meaning. Workshops for kids and adults.
Under the auspices of the University of Texas, a literary magazine "bringing together the best voices in contemporary short fiction and poetry."
A journalists' social club and occasional journalism discussion series based in Austin.
An annual conference in the Dallas-Fort Worth metroplex, it offers the chance for attendees to meet literary agents and editors, published authors, and other industry professionals.
Dobie Paisano Fellowship Program
Provides solitude, time and a comfortable place for writers who have written significantly about Texas—as well as a four-figure monthly stipend.
A nonprofit, independent literary center in San Antonio, Gemini provides university and master-level classes, as well as readings, seminars and discussions.
A publisher and distributor that specializes in the development of independent authors and the growth of small presses.
The literary magazine of the University of Houston. One of the finest journals in the nation, it publishes new fiction, poetry, nonfiction and reviews.
Acquires original cultural material for the purposes of scholarship, education and delight. Hosts many public events, including readings and discussions of contemporary and classic literature.
Katherine Anne Porter Literary Center
A National Literary Landmark in Kyle offering frequent readings by authors of note.
At each regular meeting, business is transacted and a program presented by a writer or critic of distinction. Poems by PST members are awarded cash prizes by a selected judge.
A free workshop-like site for aspiring fiction writers to receive feedback and ratings on their work. Prolitfic was created by a team of UT-Austin students, but writers can post stories from anywhere.
An independent press based in Austin, dedicated to publishing surprising, heartbreaking fiction alongside thoughtful ephemera.
An annual festival bringing many dozens of writers from far and wide for readings, panel discussions, signings and much more.
A nonprofit organization whose purpose is to stimulate interest in Texas letters and to recognize distinctive literary achievement. Induction into the TIL is based on literary achievement. TIL also annually gives awards for published work.
A nonprofit literary organization that supports literature in North Texas through author readings, workshops, concerts and salons.
A nonprofit literary center in Dallas, offering workshops, seminars, readings and discussions for adult and youth writers.
A writing center in Houston offering workshops, readings, and more.
WOTA is a weekly radio show featuring interviews with writers and those connected with the writing life.
Offers writing workshops, seminars, and one-on-one consultations for writers of fiction, nonfiction, poetry, and screenplays. In-person courses meet at the Drawing Board in Richardson; others are online.
Help us add to this list, Texans! Do you know of a local writing group or a lit journal we should be aware of? Let us know here
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[Epub] ➝ 5,000 Words Per Hour: Write Faster, Write Smarter, Volume 1 ➢ Chris Fox – Tactical-player.co.uk
Not sure if I should give this book 5 or 3 stars I must confess I haven t finished reading or listening to it, why When I was told to complete the 5 minute writing task in the very first chapter I couldn t stop writing I normally only muster up 500 words a day, but today still 4pm I managed 2,800 I started at 11.30am and finished at 3pm Now I did not take the authors advice don t write in bed, don t edit, switch off internet, don t xyz Nevertheless, I am going to associate writing in bed only when the headlight is on, and sleep and do other activities with no or low lighting.It s been a productive day, not only have I started writing again, but I actually loved it And to top things off I began to add structure my book.Nevertheless, I m not sure if it was him or I was due a writing bust I guess it doesn t matter because the author is very motivational I will revisit the rest of the book in a few days weeks If I do slip up I might have to follow his advice to the T.Lastly, what am not sold on is the idea to write anything Lets get one thing clear, editing is the longest and most difficult part of the writing process Am not falling into the trap of just writing any old gibberish just for the sake of it there will be a harder mountain to climb I ve learnt my lesson from university. The Fastest Way To Succeed As An Author Is To Write Books How Do You Do That With A Day Job, Family, School, Or All Your Other Time Commitments The Secret Is Efficiency , Words Per Hour Will Help You Maximize Your Writing Time By Building Effective Habits That Both Measure And Increase Your Writing Speed Create An Effective Writing Habit Track And Improve Your WPH Stop The Endless Editing And Tinkering So You Can Finish Your Draft Use Voice Dictation Software To Dramatically Increase Words Per Hour It S Time To Shift Your Writing Into High Gear I got this book back in September I m terrible about remembering to review but I got the sequel Lifelong Writing Habit and it reminded me This book s title sounds intimidating 5000 words an hour How can that even be possible Well I can t prove that it s possible for me, my best pace so far has been 2000 words an hour However, the book really truly is aimed at everyone, whatever pace you are at It s about the tools to improve your personal best Maybe one day that will lead to 5k, maybe it won t but it s not about a specific number, it s just about improvement.I ve read several alright than several writing self help books over the years I have to say that this book is one of the best I have read because I could identify with what was being said I found the explanations understandable, the exercises straightforward I could relate to it and it really struck a chord with me.I would definitely recommend it to any writer. I really like Chris Fox s obvious enthusiasm and he has a strong voice The book is short, to the point and I really related to many of the points he made about mindset at the back of the book The tools Fox offers here in the form of the book, its exercises and the accompanying app and or spreadsheet is truly good value for money for writers Many of my own writing clients worry about finishing their novels or screenplays, yet Fox lays out HOW to do this in simple, actionable steps that are bound to appeal, especially to newbie writers Whilst I don t think the system suits my tastes overall I am allergic to spreadsheets and timing and hate apps, which kind of counts me out I will certainly recommend this book to my newbie novelists and screenwriters, especially those interested in NanoWrimo and its scriptwriting equivalent I have also found myself curious about his own novels, so as soon as I ve made it through my Kindle backlog I will be looking up his fiction Nice work. There is a short review and the slightly longer review, depending on how much I want to say into my new recording device that I m using right now I mentioned the recording device because that to me is what this book is about, instead of writing faster, writing smarter I m not saying that it is deceptive, because it delivers, but could have delivered that in half the size of the size and half of the of the price Effective yes because I went out and bought an affordable microphone, and downloaded some affordable recording software, and bought Dragon NaturallySpeaking, and I m generating a few thousand words per hour than my type speed of 1000 By planning your work a little bit in advance or making notes is to be the structure of what you want to say, then dictating is effective than because you still probably need to make the same amount of edits I mention Dragon NaturallySpeaking instead of Dragon Anywhere because dragon anywhere requires you to be connected to the Internet in order to dictate to your iPhone, and if you want to dictate to your phone, then something like GBoard from Google gives you much the same capability. I ve been a serious author since 2013, and have written novels since 2003 I picked up a copy of 5000 Words because I want to improve my word count per day.The exercises in this book are a great starting point for anyone wanting to improve their word count per day by making small changes to their existing writing rituals and tracking.Before reading this book, a good day of writing took six hours to write between 6000 8000 words a day With the exercises inside, I am working on improving my output speed so I can give my readers stories to enjoy per year.


text: Hellcat 10 Report post Posted May 4, 2018 Really digging the airsoft and looking to get back into it again. Had many years of fun playing with CSG and SA down in Canterbury. Are there any airsoft groups around Blenheim? Cheers Hellcat Quote Share this post Link to post Share on other sites


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Expertek Featured in CIO Applications Magazine
August 2019 - Expertek Systems was featured in a special edition of CIO Applications magazine highlighting our ongoing partnership with Infor to deliver world-class solutions and services to distributors that reduce costs, enhance operational efficiencies and optimize inventory.
Read full article
July 24, 2017 — Marlborough, MA
Expertek Announces New Version of Its FieldOffice Distribution Solution with VMI Functionality
Expertek Systems, a leading provider of cloud software solutions and services for distributors, today announced the latest version of FieldOffice, a mobile distribution solution featuring new automated vendor managed inventory (VMI) functionality that allows distributors to drive more sales and improve the customer experience.
Designed specifically for the unique requirements of distributors, FieldOffice streamlines the selling process by allowing salespeople to use iPad™ devices to capture customer quotes and submit orders, check inventory availability, pricing and credit status, edit and check customer notes and contacts, look up past order history and access and email product material on demand, at customer sites or virtually any
remote location.
See Expertek VMI featured in Supply and Demand Chain Executive
June 12, 2017 — Marlborough, MA
Expertek Introduces Cloud Migration Offering for Distributors
Expertek Systems, a leading provider of cloud software solutions and services for distributors, today announced Expertek Cloud Migration, a comprehensive solutions and services packaged offering for distributors migrating to the cloud.
Designed specifically for the unique requirements of distributors, Expertek Cloud Migration includes: Infor™ CloudSuite Distribution™ a complete enterprise solution specifically developed for the wholesale distribution industry, cloud managed services, comprehensive IT services delivered via the cloud from Expertek's data centers, and strategic business and technology consulting services."
April 19, 2017 — Marlborough, MA
Expertek Named a Top 100 Logistics IT Provider by Inbound Logistics Magazine
Expertek Systems, a leading provider of cloud software solutions and services for distributors, today announced it was named to the Inbound Logistics list of the Top 100 Logistics IT providers for 2017.
"To remain competitive in the rapidly evolving distribution business, companies are faced with adopting new strategies such as adding manufacturing, omnichannel, and third-party logistics capabilities, while optimizing inventory and productivity within its supply chain," said Felecia Stratton, editor of Inbound Logistics magazine. "Expertek offers advanced cloud solutions and services that not only meet current customer demands, but also anticipate their ever-evolving business requirements, and that's why Inbound Logistics editors have recognized Expertek as one of 2017's Top 100 Logistics IT Providers."
March 20, 2017 — Marlborough, MA
Expertek Celebrates its 25th Anniversary of Delivering Innovative Software Solutions and Services to Distributors
Expertek Systems, a leading provider of cloud software solutions and services for distributors, today announced the celebration of its 25th anniversary this year.
"It's quite an accomplishment to thrive for a quarter of a century in the highly competitive IT software and services business," said Ken Mostello, Co-founder and CEO, Expertek. Mostello attributed Expertek's longevity to "providing businesses with a competitive advantage through innovative technology and the company's deep expertise in the distribution market.


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Brookvale: 02 9907 3339
St Leonards: 02 9439 3333
2017 October
Is recurrent thrush affecting your ability to fall pregnant?
- October 31, 2017
- Posted by: paula
- Category: Blog
As unpleasant and unwanted as they are, vaginal yeast infections (also known as thrush) are extremely common, with around 3 out of 4 women experiencing a yeast infection at some stage in their lifetime. Vaginal yeast infections are caused by an overgrowth of Candida albicans – a common type of yeast that normally lives in


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Hi everyone, I have been fortunate enough to have received an invite to try a full version of the Pearl Mountain Image Converter.
As I am sure many of you know by now I love creating artwork on my computer, like you see in the current header "Celebrating Women" and the lacy background to the blog right now. I have found out that for some reason, while looking through sites that show you information on your site and what you can do to improve it, I found that I needed to work with more Lossless Compression on the blog. And being that I have also tried to speed things up on the blog, I've been so busy in the background here going through all the pictures and resizing them by hand myself, on posts by the other half owner of this blog… teee hee hee… I don't blame Joan for this, she has been sick, had her daughters college graduation just happened and her husband has not been doing too well. But this has been a tedious task copying her pictures from the posts and working on them one by one.
Now thank God for Pearl Mountain Image Converter, as it has saved me a lot of time and I was able to send out several registration codes over to Joan and her Daughter (I even shared one with my husband). And having gone through the program with such ease right away, I am sure that Joan can even understand how it works in no time at all. You can ask that sweet lady, Joan, about it all and I am sure that without hesitation she will admit that sometimes these things on the computer are difficult for her to understand. If she does hesitate, please tell me and I will owe her an apology.
What do I love about this program? You can add watermarks to your images, mass convert all of them to a lossless compression, resize them, crop your pictures and even adjust colors in your pictures etc. I love how quick and easy they have made this program, and the GUI is so well done that everything is self explanatory. As a result of this program and their sharing some extra codes with me, I should now use the program on my own posts, forget the rest and get back to serious work on the front end of the blog. I can do so many tasks now such great ease that I should be able to save myself the wear and tear on my family time, my hands (and neck, I have that chronic pain as many of you know) and perhaps even get some time for some personal posts around social media sites! Yay! More time to get to know you all a little better, I enjoy that most of all!
Here is what Pearl Mountain has to say about their Image Converter:
PearlMountain Image Converter is a photo converter as well as batch image converter, which helps you convert images to other formats, resize, rotate, crop, add watermark, apply effects and add border to thousands of images at a time. Some of the highlighted features include:
• Convert thousands of files at once in batch mode.
• Supports the most popular image formats: BMP, JPEG, TIFF, RAW, PNG, GIF, TGA, and PSD, and almost all image formats.
• Save operations that you usually use as profiles and bring convenience with you in the future.
• Convert between many different image file formats.
• Resizing image for any different use, such as for web, e-mail, photo printing, Facebook, MySpace, mobile phone, ipod/ipad/iphone, etc.
• Add image and text watermark for Image Copyright Protection
• Adjust image brightness, contrast and saturation in batch to make your images look more special.
• Apply border to images.
• Crop photos, removing unwanted areas.
I wish to thank Pearl Mountain sharing their wonderful product with me. Thanks to you I am looking forward to more time doing my favorite things, like posting reviews & giveaways, and spending less time in the background correcting the picture sizes and making sure we are using lossless compression on the pictures. Thank you so much!
So if you have a blog, a family or just love posting pictures, this program is indeed for you! I have 17 license codes to giveaway so we will have a total of 17 lucky winners. How about that? I am so happy that Pearl Mountain gave me so many codes, allowing me to share with others, (after sharing 3 codes, I've said enough… I want to giveaway the rest)! So get your friends, family and co-workers (hey, get on your bosses good side and send him/her over here to enter too!) This is practically a sure winner for you all folks so enter now!
Good Luck and have fun!
a Rafflecopter giveaway
Mariah Lockwood personally reviewed this product. I did not receive any monetary compensation for my review, Pearl Mountain provided me with a free sample of this product to test. I was under no obligation to review it if I so chose. Nor was I under any obligation to write a positive review or sponsor a product giveaway in return for the free product.. All opinions are mine and belong to me solely. My thoughts and opinions may differ from yours. I am disclosing this in accordance with the Federal Trade Commissions 16 CFR, Part 255 Guides Concerning the Use of Endorsements and Testimonials in Advertising. The photo's used in this review were provided by Pearl Mountain and myself.
I received one or more of the products mentioned above for free using Tomoson.com. Regardless, I only recommend products or services I use personally and believe will be good for my readers.


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Plattform durchsuchen (Search our Platform)
Climate change adaptation for rural communities dependent on agriculture and tourism in marginal farming areas of the Hwange District, Zimbabwe (Nhemachena, Charles / Mano, Reneth / Shakespear, Mudombi / Muwanigwa, Virginia)
Rural communities in northwest Zimbabwe derive their livelihoods from rainfed agriculture and from tourism associated with Victoria Falls and the adjacent Hwange National Park. The region's climate is characterised by high temperatures and low and highly variable rainfall. Current climate and future climate change thus pose significant risks to maize-based food production in this region. Given future projections of climate change for this region, and for southern Africa more generally, farming systems are expected to undergo profound changes in order to adapt. The project will consider adaptation in marginal farming areas that are co-dependent on agriculture and the tourism industry, and how these two key livelihood resources could interact under future climate change. Potential adaptation strategies will be considered as a means to strengthen and supplement local livelihoods based on production of both food crops and sales of non-farm forest products to tourists and the tourist support industry in the areas near Victoria Falls and Hwange National Park.
Weblinks: https://academicjournals.org/journal/AJAR/article-authors/05190DE45750
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Less than worthless: Real-estate appraisal deems Winnipeg HBC building worth $0
WINNIPEG – The Hudson's Bay Company's 93-year-old flagship Winnipeg store is worth absolutely nothing, according to an appraisal from a real-estate evaluator.
The building is worth a whopping $0, and it would actually cost millions to sell the building, an appraisal report from Cushman & Wakefield ULC shows of the historic property.
CTV News has obtained a copy of the report, which suggests the department store, currently owned by the Hudson's Bay Company, would actually cost less than that, as the report shows the building has a current tax liability of $302,298.
The report said the building received an extensive $4 million update to the first, second, and third floors in 1986 and 1987. Another $900,000 was used to repair the sixth and fourth floors, as well as the basement
The building, more than 600,000 sq. feet, has had a tough go of it in its recent history.
In 2010, the basement was converted to a Zellers store, which closed down three years later in March 2013.
Earlier that same year, the iconic Paddlewheel restaurant on the sixth floor, was closed down after nearly 60 years in business.
Currently three floors are permanently closed.
In March, the City of Winnipeg voted to give the department store a heritage designation — which means any buyer would be unable to demolish it.


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This week's episode is a live show which sees the Empire Podteam - Chris Hewitt, Helen O'Hara, James Dyer, and Terri White - embark upon their first-ever tour, starting in the far-flung city of... London. Kings Place, to be precise, just around the corner from the Empire office. Not exactly clocking up the air miles, huh.
Recorded as part of the London Podcast Festival, this typically raucous live show sees the quartet review Downton Abbey, For Sama, and Hustlers (complete with eye-watering tale of real live strip clubs), then discuss the week's movie news, before being joined by a brand-new member of the team: director Colin Trevorrow. There might be talk of his brand-new Jurassic World short film, Battle At Big Rock. And he might even stick around for the audience Q&A. We couldn't possibly say either way.
Please accept our apologies in advance. Enjoy.


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Make and receive secure and convenient electronic payments using a solution trusted by 425,000+ member businesses.
Learn how Greystone Healthcare Management transformed their AP department from a cost center into a revenue generator, converted paper checks into ACH and streamlined their complex vendor payment process.
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Bioresorbable Scaffold for Treatment of Coronary Artery LesionsIntravascular Ultrasound Results From the ABSORB Japan Trial
Author + information
- Received July 19, 2017
- Revision received November 26, 2017
- Accepted November 28, 2017
- Published online April 2, 2018.
Author Information
- Kozo Okada, MDa,
- Yasuhiro Honda, MDa,∗ (yshonda{at}stanford.edu),
- Hideki Kitahara, MDa,
- Kyuhachi Otagiri, MDa,
- Shigemitsu Tanaka, MDa,
- M. Brooke Hollak, RNa,
- Paul G. Yock, MDa,
- Jeffrey J. Popma, MDb,
- Hajime Kusano, PhDc,
- Wai-Fung Cheong, PhDc,
- Krishnankutty Sudhir, MD, PhDa,c,
- Peter J. Fitzgerald, MD, PhDa,
- Takeshi Kimura, MDd,
- on behalf of the ABSORB Japan Investigators
- aDivision of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
- bDepartment of Internal Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- cClinical Science and Medical Affairs, Abbott Vascular, Santa Clara, California
- dDepartment of Cardiovascular Medicine, Kyoto University Hospital, Kyoto, Japan
- ↵∗Address for correspondence:
Dr. Yasuhiro Honda, Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H3554, Stanford, California 94305-5637.
Graphical abstract
Objectives The aim of this study was to characterize post-procedural intravascular ultrasound (IVUS) findings in the ABSORB Japan trial, specifically stratified by the size of target coronary arteries.
Background Despite overall noninferiority confirmed in recent randomized trials comparing bioresorbable vascular scaffolds (BVS) (Absorb BVS) and cobalt-chromium everolimus-eluting metallic stents (CoCr-EES), higher event rates of Absorb BVS have been reported with suboptimal deployment, especially in small coronary arteries.
Methods In the ABSORB Japan trial, 150 patients (2:1 randomization) were scheduled in the IVUS cohort. Small vessel was defined as mean reference lumen diameter <2.75 mm. Tapered-vessel lesions were defined as tapering index (proximal/distal reference lumen diameter) ≥1.2.
Results Overall, IVUS revealed that the Absorb BVS arm had smaller device expansion than the CoCr-EES arm did, which was particularly prominent in small- and tapered-vessel lesions. Higher tapering index was also associated with higher rates of incomplete strut apposition in Absorb BVS, but not in CoCr-EES. With respect to procedural techniques, small-vessel lesions were treated more frequently with noncompliant balloons at post-dilatation but using significantly lower pressure in the Absorb BVS arm. In contrast, tapered-vessel lesions were post-dilated at equivalent pressure but with significantly smaller balloon catheters in the Absorb BVS arm, compared with the CoCr-EES arm.
Conclusions The significantly smaller device expansion especially in small vessels may account for the poorer outcomes of Absorb BVS in this lesion type. Appropriate optimization strategy, possibly different between polymeric and metallic devices, needs to be established for bioresorbable scaffold technology. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 Absorb™ BVS) in Japanese Population [ABSORB JAPAN]; NCT01844284)
Recent randomized controlled trials have shown equivalent safety and efficacy outcomes at the midterm between everolimus-eluting bioresorbable vascular scaffold (BVS) (Absorb BVS) and cobalt-chromium everolimus-eluting stent (CoCr-EES) (both Abbott Vascular, Santa Clara, California) (1–4). However, a higher rate of scaffold thrombosis and its association with inadequate scaffold expansion have been reported in multicenter observational studies and recent meta-analyses (5–8). Previous studies have also reported that post-procedural nonuniform scaffold expansion, device-vessel mismatch, and the use of Absorb BVS in small vessels were associated with adverse clinical events (2,9,10). These data suggest that knowledge of acute device performance and deployment characteristics may be important to ensure favorable clinical outcomes and reduce adverse events.
The ABSORB Japan (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 [AbsorbTM BVS] in Japanese Population) trial was a randomized, controlled trial comparing the Absorb BVS with the control CoCr-EES, designed to support regulatory approval of the Absorb BVS in Japan. It included an intravascular ultrasound (IVUS) cohort study (1), providing a unique opportunity to compare the acute results of polymeric scaffold and metallic stent implantation. In addition, there may be potential differences in angiographic measures between thicker radiolucent polymeric scaffold and thinner, more radiodense metallic stents. Therefore, the primary aim of this study was to systematically characterize post-procedural IVUS findings in the ABSORB Japan trial, focusing especially on acute device performance related to procedural factors and lesion characteristics. Additionally, the secondary aim was to compare differences between quantitative coronary angiography (QCA) and IVUS measurements, understanding of which is considered essential for image-guided BVS implantation and post-deployment optimization.
Study design
The design of the ABSORB Japan trial has been described previously (1). In brief, the ABSORB Japan trial was a prospective, multicenter, randomized, single-blind, active-controlled clinical trial in which 400 patients undergoing percutaneous coronary intervention from 38 investigational sites in Japan were randomized in a 2:1 ratio to treatment with Absorb BVS or the XIENCE CoCr-EES. Among the study cohorts, 150 patients were scheduled in the IVUS cohort. The Institutional Review Board at each investigational site approved the clinical trial protocol. All patients provided written informed consent before enrollment.
Study population
Patients were eligible for enrollment if they were ≥20 years of age and had evidence of myocardial ischemia (stable angina, unstable angina, or silent ischemia). Patients with left ventricular ejection fraction <30%, estimated glomerular filtration rate <30 ml/min/1.73 m2, recent myocardial infarction, and those at high bleeding risk were excluded. Key angiographic inclusion criteria were lesions with no more than 24 mm in length, reference lumen diameter (RLD) of ≥2.5 to ≤3.75 mm, and diameter stenosis (DS) of ≥50 to <100% on visual assessment. Key angiographic exclusion criteria were left main or ostial location; excessive vessel tortuosity; heavy calcification proximal to or within the target lesion; restenotic lesion; and bifurcation lesion with side branch ≥2 mm in diameter, requiring protection guidewire or dilation.
Study procedure
The study allowed treatment of up to 2 de novo lesions in separate epicardial coronary arteries. Successful pre-dilation of the target lesion was mandatory. Device sizes available in the study were: 2.5, 3.0, and 3.5 mm in diameter and 8, 12, 18, and 28 mm in length. The target lesion had to be treated with a single study device and planned overlapping was not allowed. Post-dilatation of Absorb BVS was not mandatory but was allowed, using a low-profile, high-pressure, noncompliant balloon with diameter ≤0.5 mm larger than the nominal size. Post-dilatation of CoCr-EES was per standard of care.
Quantitative coronary angiography
QCA was performed at baseline and post-procedure, using MEDIS QAngio XA 7.3 (Medis Medical Imaging Systems, Leiden, the Netherlands) at Beth Israel Deaconess Medical Center. Quantitative measurements included lesion length; minimum lumen diameter (MLD); proximal, distal, and mean (average of proximal and distal) RLD; DS; acute gain (in-device MLD at post-procedure minus MLD at baseline); and tapering index (proximal/distal RLD). MLD and RLD were obtained by the average values of 2 different projections. Smaller MLD was used for comparison with IVUS-determined MLD at minimum lumen area (MLA) site. Procedure success was defined as residual in-device DS ≤30%. Device sizing was evaluated by nominal device diameter minus mean RLD and classified as undersized (≤−0.25 mm), properly sized (−0.25 to 0.25 mm), and oversized (>0.25 mm), respectively. Very small vessels were defined as vessels with mean RLD <2.25 mm (2). Angulated lesions were defined as lesions with bend angle ≥30°. To compare mean RLD with mean reference lumen and vessel diameters by IVUS, mean RLD was divided into 4 subgroups (<2.50, 2.50 to 3.00, 3.00 to 3.50, and >3.50 mm).
Intravascular ultrasound
IVUS was performed in a standard manner using an automated transducer pullback at 0.5 mm/s with a commercially available imaging system (40-MHz IVUS [Boston Scientific Corporation, Marlborough, Massachusetts or Terumo Corporation, Kanagawa, Japan]; 45-MHz or 20-MHz IVUS [Volcano Corporation, San Diego, California]). IVUS-guided PCI was not recommended by the study protocol, but operators were allowed to use IVUS information to optimize device deployment. Final IVUS images obtained at the end of procedure were submitted for independent IVUS analysis at Stanford Cardiovascular Core Analysis Laboratory, blinded to clinical and angiographic information. Using a validated quantitative IVUS analysis system (echoPlaque, Indec Systems, Santa Clara, California), vessel, lumen, device (scaffold or stent), and peridevice plaque (vessel minus device) areas were manually traced at the leading edge of boundaries at 1-mm intervals from proximal to distal 5-mm reference segments throughout the target segment with automated interpolated measurements of the remaining frames. Each volume calculated using Simpson's method was standardized as volume index (volume/analyzed length [mm3/mm]). In the present study, acute device performance was evaluated by 3 indexes: 1) percent device expansion was calculated as a ratio of device volume index (percent volume expansion) or minimum device area (percent area expansion) to reference lumen volume index (average of proximal and distal references); 2) uniformity index of device expansion (minimum device area/maximum device area) and coefficient of variation of device cross-sectional areas (SD of device area/mean device area) were evaluated as indexes of uniform expansion; and 3) incomplete strut apposition (ISA) was defined as separation of at least 1 strut from the intimal surface, with evidence of blood flow behind the strut(s) in a vessel segment not associated with any side branches. Similar to QCA analysis, device sizing was also evaluated and classified by nominal device diameter minus mean RLD. Small-vessel lesions were defined as lesions with mean RLD <2.75 mm, which corresponded to mean RLD by QCA <2.5 mm (key exclusion criteria) in this population (Figure 1). Tapered-vessel lesions were defined as tapering index (proximal/distal RLD) ≥1.2. Maximum, minimum, and average lumen diameters at MLA site were also measured, and lumen eccentricity at MLA site was calculated as (maximum lumen diameter minus MLD)/maximum lumen dimeter.
Statistical analysis
Sample size calculation for the IVUS cohort of ABSORB Japan trial was performed to assess the in-device mean lumen area change from post-procedure to 3 years as the secondary-powered endpoint of the trial. Statistical calculations were performed with JMP 10 software (SAS Institute Inc., Cary, North Carolina). Data are expressed as frequencies and percentages for categorical variables and as mean ± SD for continuous variables. Categorical comparisons were performed using chi-square test or Fisher exact test. Continuous values were compared using unpaired or paired Student t test, Wilcoxon rank sum test, nonparametric Mann-Whitney U test, or 1-way analysis of variance, as appropriate. Correlations between continuous variables were investigated using linear regression analysis. Logistic regression analysis was performed to find the relationship of the presence of ISA to the following factors: proximal lesions, calcified lesions, tortuous lesions, angulated lesions, eccentric lesions, lesion type B2/C, and IVUS indexes (mean reference lumen diameter, tapering index, and device volume expansion). A p value <0.05 was considered statistically significant.
Patient, lesion, and procedural characteristics
Between April 2013 and January 2014, 154 lesions from 149 patients were officially enrolled in this IVUS cohort of the ABSORB Japan trial (Figure 2). One lesion was assigned to Absorb BVS but received CoCr-EES because the Absorb BVS could not be delivered in the target lesion. Ten lesions were excluded from quantitative analysis because of overlapping of 2 different devices, missing IVUS images, inconsistent pullback (qualitative assessment was still available in 2 lesions), or partial scanning of the device segment. As a result, quantitative analysis included 144 lesions; qualitative analysis included 146 lesions.
Baseline patient and lesion characteristics were comparable between the 2 device arms, except for a tendency toward lower prevalence of prior myocardial infarction in the Absorb BVS arm (Table 1). Overall, patient age was 67 ± 9 years, and diabetes was present in 28.4% of the patients. Stable coronary artery disease was present in 87.2% of the patients and 96.5% of the patients had treatment of 1 study target lesion only.
No statistically significant difference was seen in procedural characteristics between the 2 device arms (Table 2). Pre-dilation was performed using slightly undersized balloons with moderate pressure in both arms. Total device length was similar between the arms, whereas nominal device diameter and device-deployment pressure tended to be smaller in the Absorb BVS arm compared with the CoCr-EES arm. Post-dilation was performed in a similar proportion, whereas there was a tendency toward greater use of noncompliant balloons in the Absorb BVS arm. Nominal post-balloon diameter and dilation pressure did not differ significantly between the arms.
QCA results
At baseline, QCA indexes were comparable in the 2 device arms (Table 3). Also, the percentage of very small vessels, tapering index, and device sizing did not differ significantly between the arms. At post-procedure, the Absorb BVS arm showed significantly smaller MLD and acute gain with greater residual DS, compared with the CoCr-EES arm at in-device segments, whereas these indexes did not differ significantly between the arms at in-segments. Overall, higher tapering index significantly correlated with smaller in-device MLD (r = −0.21, p = 0.012), which was also observed within the Absorb BVS arm (r = −0.24, p = 0.017). In contrast, this relationship was not seen within the CoCr-EES arm (r = −0.11, p = 0.48).
IVUS results
Post-procedural IVUS results are summarized in Table 4. At reference segments, IVUS indexes were similar between the 2 device arms. No significant residual dissection was seen at reference segments in either arm. Target lesion length, vessel and peri-device volumes, and device sizing were also comparable between the arms. In contrast, at in-device segments, lumen and device volumes, minimum lumen and device areas, and MLD at MLA site were significantly smaller in the Absorb BVS arm than in the CoCr-EES arm. The Absorb BVS also showed more nonuniform expansion (i.e., smaller uniformity index, greater coefficient of variation of device areas, and greater lumen eccentricity at MLA site) compared with the CoCr-EES. On the other hand, the incidence of prolapse was lower in the Absorb BVS arm compared with the CoCr-EES arm.
Percent device expansion in relation to the reference segment dimension was analyzed in 117 lesions because neither proximal nor distal reference was available due to the involvement of major branches (including ostial lesions) in 27 lesions. Overall, smaller percent volume expansion was seen in the Absorb BVS arm compared with the CoCr-EES arm, which was particularly prominent in small-vessel lesions (Figure 3). Similar results were also seen in percent area expansion. On the other hand, greater nonuniform expansion in the Absorb BVS was observed regardless of vessel size (Figure 4).
Tapered-vessel lesions were seen in a similar proportion in small- and large-vessel lesions (26.1% vs. 23.9%; p = 0.79). In the Absorb BVS arm, higher tapering index tended to correlate with smaller device expansion (device volume, minimum device area, and percent expansion), which was not observed in the CoCr-EES arm (Table 5). As a result, smaller device volume and percent volume expansion, seen in the Absorb BVS arm compared with the CoCr-EES arm, were more prominent in tapered-vessel lesions (Figure 5). Combined together, the difference between the arms for device expansion was most accentuated in tapered lesions in small vessels (percent volume expansion: 0.89 ± 0.12% vs. 1.14 ± 0.17%; p = 0.02).
The overall incidence of ISA tended to be lower in the Absorb BVS arm compared with the CoCr-EES arm (Table 4). Among several lesion characteristics, only higher tapering index was associated with occurrence of ISA (logistic regression: p = 0.01) in the Absorb BVS arm, whereas this relationship was not observed in the CoCr-EES arm. Accordingly, in the Absorb BVS arm, lesions with ISA had a significantly higher tapering index than lesions without ISA (1.26 ± 0.19 vs. 1.11 ± 0.14; p = 0.009), whereas no difference was found in tapering index in the CoCr-EES arm (1.13 ± 0.15 vs. 1.11 ± 0.20; p = 0.85). On the other hand, lesion type (B2 or C) (p = 0.01), greater mean reference lumen area (p = 0.048) and smaller percent area expansion (p = 0.03) were associated with occurrence of ISA in the CoCr-EES arm.
Procedural differences
Overall, procedure profiles did not differ significantly between the arms, except for several differences in pre-dilation and post-dilation strategies found in complex lesion subsets. Specifically, small-vessel lesions were treated more frequently with noncompliant balloons at post-dilatation but using significantly lower pressure in the Absorb BVS arm compared with the CoCr-EES arm (Table 6). In contrast, tapered-vessel lesions were post-dilated at equivalent pressure, but with significantly smaller balloons in the Absorb BVS arm than in the CoCr-EES arm (Table 7).
Comparison of IVUS and QCA
At reference segments, mean RLD at post-procedure by QCA was significantly smaller than mean RLD measured by IVUS (p < 0.0001) (Tables 3 and 4). The difference between the 2 modalities was −0.19 ± 0.26 mm (−0.84 to 0.43 mm), which did not differ significantly between the Absorb BVS and CoCr-EES arms (−0.20 ± 0.25 mm vs. −0.17 ± 0.28 mm; p = 0.64). Mean RLD at post-procedure by QCA positively correlated with both mean RLD and reference vessel diameter (RVD) by IVUS, but their scatter plots were relatively widespread because of various residual stenosis at reference segments (Figure 1). When the analyses were performed in the subgroups classified based on vessel size by QCA, mean RLD and RVD measured by IVUS were widely distributed in each subgroup (Figure 6). As a result, 20.8% of the "properly sized" devices by QCA were considered as "undersized" by IVUS. There was also positive correlation of tapering index between QCA and IVUS but its correlation coefficient was moderate (r = 0.65, p < 0.0001).
At in-device segments, smaller MLD by QCA was also significantly smaller than IVUS-determined MLD (p = 0.004). However, the percent difference in MLD between the 2 imaging modalities was not significantly different between the 2 device arms (Absorb BVS: 2.9 ± 13.2% vs. CoCr-EES: 3.2 ± 10.9%; p = 0.91). In contrast, the percent difference between MLD by QCA and IVUS-determined average lumen diameter at MLA site was significantly greater in the Absorb BVS arm compared with the CoCr-EES arm (8.9 ± 10.8% vs. 4.7 ± 9.3%; p = 0.02), likely attributable to greater lumen eccentricity in the Absorb BVS arm than in the CoCr-EES arm.
The main findings of this study are: 1) overall, the Absorb BVS arm showed smaller device expansion and greater nonuniformity of expansion compared with the CoCr-EES arm; 2) smaller device expansion seen in the Absorb BVS arm compared with the CoCr-EES arm was more prominent in complex lesion subsets, such as small-vessel lesions and tapered-vessels; 3) in these lesion subsets, operator's post-dilation procedures were significantly different between the 2 devices, with respect to the use of noncompliant balloons, dilation pressures, and balloon diameters; 4) higher tapering index was associated with higher rates of ISA in the Absorb BVS arm, but not in the CoCr-EES arm; and 5) QCA underestimated both RLD and reference device diameter as compared with IVUS, but with no apparent device specific difference.
Device expansion
In the present study, the Absorb BVS arm had smaller device expansion compared with the CoCr-EES arm, which was more prominent in complex lesions. Possible explanation for this observation may involve several factors, including device-related and procedure-related differences between the polymeric scaffold and conventional metallic stents. A recent experimental study of metallic stents has revealed that both stent materials/designs and post-dilatation strategies can significantly impact initial stent expansion and subsequent acute recoil, thereby affecting final stent expansion (11). The Absorb BVS is similar in design to the CoCr-EES, but is made of a lactic acid-based polymer, which can result in even greater intrinsic differences in mechanical device properties. In fact, despite the similar radial strength reported in bench studies, the Absorb BVS can show greater acute recoil than metallic stents in vivo, particularly in complex lesions (12,13). With respect to operators' device deployment and optimization strategy in the present study, whereas device sizing and initial deployment procedures were similar in the 2 device arms, significant differences were observed in post-deployment optimization, particularly in small or tapered-vessel lesions. The more conservative post-dilation strategy observed in the Absorb BVS arm appears attributable to early concern of scaffold disruption resulting in focal loss of mechanical support which can occur with overexpansion of the device beyond its expansion limit (14). However, as clinical experience has been accumulated since the start of this trial, it has been learned that the scaffold disruption could be avoided if the post-dilation balloon is not sized >0.5 mm (nominal expansion limit of BVS) larger than the nominal BVS diameter, regardless of dilation pressure (15). Recent investigations have also demonstrated that appropriate balloon size and high-pressure post-dilation with noncompliant balloons are feasible and crucial for optimal BVS expansion (6,16–20). The present study supports this conclusion, whereas more detailed optimization strategies specific to the polymeric scaffold, if any (for instance, single long vs. multiple short inflations), are yet to be investigated.
The use of Absorb BVS in small vessels, particularly in vessels <2.25 mm, has been reported to be associated with an increased risk of scaffold thrombosis (2,6). Although reasons for this observation are likely multifactorial, combined with the results of a previous report (6), the present study suggests that inadequate scaffold expansion, more frequently occurring in small vessels than in larger vessels, may, in part, contribute to the higher risk of the adverse events in this lesion subset. As current Absorb BVS has relatively thick and wide struts, underexpansion of the scaffold leads to the crowding of multiple thick struts, which decreases the vessel lumen and results in a larger footprint, causing disruption of laminar flow and platelet activation due to high shear stress and ultimately promoting thrombotic events (21). Therefore, it may be important, especially for the treatment of small-vessel lesions, that the scaffold has to be fully post-dilated, thus embedding the struts deeply in the vessel wall to reduce the footprint and favoring rapid endothelialization. Additionally, meticulous lesion preparation, optimal vessel-device sizing (including avoiding very small vessels), and intravascular imaging guidance may also help reduce underexpansion and thereby improve the outcomes in small vessels (6,17).
The present study also demonstrated significantly greater nonuniform expansion in the Absorb BVS arm than in the CoCr-EES arm. To date, compared with minimum stent area or the degree of stent expansion, there has been less attention dedicated to uniformity of device expansion. In polymeric scaffolds, however, a recent study reported that nonuniform scaffold expansion was associated with adverse clinical events (9). Multiple investigations have also suggested that aggressive lesion preparation, in combination with a high pressure post-dilation, may contribute to achieving uniform scaffold expansion (9,19,20). The exact clinical significance of uniform expansion in BVS implantation, which may differ between polymeric and conventional metallic devices, may warrant further investigation.
Incomplete strut apposition
Despite smaller device expansion, the Absorb BVS arm tended to show lower rates of ISA compared with the CoCr-EES arm, both in complex and noncomplex lesions. There may be 2 possible explanations for this observation. First, despite the lower tensile properties mentioned previously, polymeric scaffolds may have greater conformability and flexibility compared with metallic stents (22), which may contribute to good strut apposition. Second, the image resolution of IVUS can affect accurate detection of ISA. Compared with optical coherence tomography (OCT), IVUS is technically limited in detailed strut assessment, which appears to be accentuated in the evaluation of polymeric scaffolds due to greater image artifacts caused by polymeric struts than by conventional metallic struts (i.e., larger blooming effects, significant side-lobe artifacts, and strong ultrasound spokes behind the struts), potentially leading to lower detection of ISA in the Absorb BVS arm. Of note, although the definitive answer would require combined use of IVUS and OCT in the same patient population, the OCT cohort of this trial also reported lower rates of ISA in the Absorb BVS arm, indirectly suggesting the first hypothesis mentioned previously as the leading explanation for the current finding (23).
Interestingly, higher tapering index was associated with higher ISA rates in the Absorb BVS arm but not in the CoCr-EES arm, which may be explained by smaller balloon diameters for post-dilation used in the Absorb BVS arm for the treatment of tapered-vessel lesions. The current Absorb BVS comes in 3 sizes and can only be expanded up to 0.5 mm over the nominal device size, beyond which there is an increasing risk of device disruption. Thus, accurate vessel sizing is considered important to avoid significant device-vessel mismatch, select the proper size of post-dilation balloon, and reduce the ISA rates particularly in tapered-vessel lesions. Sequential implantation of scaffolds with different diameters may also help to accommodate different vessel diameters in this lesion subset. Of note, similar to the uniformity of device expansion discussed previously, clinical relevance of post-procedure ISA in bioresorbable scaffolds can be different from what we have learned from metallic platforms. In addition, it remains to be investigated whether different device-sizing strategies need to be established for Absorb BVS (e.g., on the basis of the proximal reference, rather than the average of the proximal and distal references, in tapered-vessel lesions).
IVUS versus QCA
Accurate vessel size assessment is essential for appropriate device sizing of Absorb BVS. Compared with visual estimation, QCA generally provides more objective lumen diameters but with no information on the true vessel size, particularly when reference vessel segments are also diseased. In contrast, intravascular imaging can offer detailed morphometry of both reference and lesion segments for determining exact vessel diameter and lesion length (18). Indeed, as compared with IVUS, mean RLDs were underestimated by QCA by up to −0.84 mm in the present study, and 20.8% of the "properly sized" devices by QCA were considered as "undersized" by IVUS. In addition, nearly one-half of proximal references and one-third of distal references had significant residual plaque burden (plaque volume >50%) uncovered by the device.
Theoretical concerns have also existed for the QCA assessment of in-device diameters within scaffold segments, because of possibly different angiographic projections between polymeric scaffolds and conventional metallic stents. Specifically, the thicker radiolucent struts of Absorb BVS, compared with the thinner, more radiodense struts of CoCr-EES, may cause weakening of vessel-contour contrast in angiography, which may lead to the discrepancy that in-device MLD misleadingly appears smaller despite adequate scaffold expansion. In the present study, however, QCA and IVUS showed no device-specific discrepancy in in-device MLD, with slight but statistically significant underestimation by QCA regardless of the device type. On the other hand, when comparing QCA-determined MLD with IVUS-determined average lumen diameter at MLA site, a significantly larger discrepancy was observed in Absorb BVS than in CoCr-EES, presumably due to greater nonuniform (or eccentric) expansion of Absorb BVS. Although intravascular imaging has clear advantages for precise reference, lesion, and device assessments to achieve optimal acute results, further studies are warranted to investigate if intravascular imaging guidance would be advisable to ultimately improve long-term clinical outcomes of fully bioresorbable scaffold technologies.
Study limitations
First, the IVUS cohort of the ABSORB Japan trial was not designed for detailed analyses of specific lesion subsets; therefore, the clinical impact of our findings needs to be determined in larger studies. Second, the sample size of the IVUS cohort was pre-determined to test the secondary powered endpoint of the original trial (i.e., serial lumen area change from post-procedure to 3 years), although most of the observed differences between the 2 device arms in small and tapered vessels reached statistical significance despite the limited sample sizes in the subanalyses of the current study. Third, the ABSORB Japan trial enrolled a selected patient population with primarily stable coronary artery disease and single de novo relatively simple target lesions. Thus, the study results may not be generalizable to truly complex lesions or patients with acute coronary syndromes. Fourth, because pre-interventional IVUS was not mandated by the protocol, influence of underlying plaque types on scaffold expansion could not be evaluated in detail. Last, for device area measurements, image resolution of the current IVUS technology primarily allows assessment of internal device dimensions. Although it offers comparative methodology for the assessment of BVS versus metallic stents, it remains to be clarified in subsequent OCT studies whether additional evaluation of external device dimensions as well as the effective flow area within lumen could provide incremental benefits to BVS research or clinical guidance.
In the ABSORB Japan trial, smaller device expansion seen in the Absorb BVS arm compared with the CoCr-EES arm was more prominent in small-vessel lesions, which may account for the poorer outcomes of Absorb BVS in this lesion type. In addition, significant vessel tapering appears to affect the strut apposition of Absorb BVS. Appropriate deployment and optimization strategies, possibly different between polymer and metallic devices, need to be established for bioresorbable scaffold technology, especially for the treatment of complex lesions.
WHAT IS KNOWN? A higher rate of scaffold thrombosis and its association with inadequate scaffold expansion have been reported in multicenter observational studies and recent meta-analyses.
WHAT IS NEW? Smaller device expansion seen in the Absorb BVS arm than in the CoCr-EES arm was more prominent in small-vessel lesions, which may be partially explained by relatively conservative post-dilation strategies in the Absorb BVS arm.
WHAT IS NEXT? Further studies will need to confirm the clinical relevance of our IVUS findings and whether intravascular imaging guidance will improve acute device performance and long-term outcomes of Absorb BVS.
The authors appreciate Heidi N. Bonneau, RN, MS, CCA, for her editorial review of the manuscript.
The ABSORB Japan trial was funded by Abbott Vascular, Santa Clara, California. Drs. Yock, Fitzgerald, and Kimura have received institutional research grant support from Abbott Vascular. Drs. Kusano, Cheong, and Sudhir are employees of Abbott Vascular. Dr. Popma has received institutional grant support from Boston Scientific, Medtronic, and Abbott Vascular; and has served on the advisory board for Boston Scientific and Abbott Vascular. Dr. Kimura has served on the advisory board for Abbott Vascular and Abbott Vascular Japan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Abbreviations and Acronyms
- bioresorbable vascular scaffold
- CoCr-EES
- cobalt-chromium everolimus-eluting stent(s)
- diameter stenosis
- incomplete strut apposition
- intravascular ultrasound
- minimum lumen area
- minimum lumen diameter
- optical coherence tomography
- quantitative coronary angiography
- reference lumen diameter
- reference vessel diameter
- Received July 19, 2017.
- Revision received November 26, 2017.
- Accepted November 28, 2017.
- 2018 American College of Cardiology Foundation
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Nuoret dokumenttiteatterin tekijät kanssatutkijoina
The perspective of young people as co-researchers has recently increased as a participatory framework of study in several fields of inquiry. The focus has mostly been on empowering the youth instead of methodological perspective which is the focus in this arts-based pedagogical study on youth documentary theatre as an action research. The objective of the text is to describe how the integrated practices of research and documentary theatre support youth as co-researchers.
The article is based on a youth documentary theatre implemented in 2016 as a case example. Seven 17–28-year-old youngsters were invited to make theatre as co-researchers and as informants of their own life course, especially in-between the stages of schooling. The research material consists of multiple data, for example, research diary of the director, interviews, the verbatim theatre piece and the documented five live performances including audience feedback.
Results show that documentary theatre can function as a research team, following the collective praxis method in which the youth co-research is supported by director's choices implementing equal partnerships. Director's role is a facilitator giving freedom and space to the youth's decisions on the narrative and play. This is the way for more robust insider knowledge as well.
How cultural policies and research are taking into account youth agency? Dignifiying youth is offered as a conclusion. In institutions like theatre, inclusive youth pedagogies and forms of directing are suggested, taking youth as co-artists together with professional adults. This applies to youth research as well.
Key words: young people, documentary theatre, co-researching, action research, artistic research