This course is designed to give the candidate exposure to the various play therapies: play room, sand tray, art, movement and psychodrama. Through reading, lecture, class discussion, case presentations, and role play simulations, candidates will become familiar with various techniques used with children in therapy and counseling. Candidates will discuss the applicability of these theories in working with deaf and hard of hearing children and youth; as well as in working with children and youth with differing cultural and ethnic backgrounds.
This foundation course affirms the central focus of social work practice as the person or human group in interaction with the social environment. Its purpose -- to understand the problematic transactions between people and their environments; its goal -- to use this understanding to restore and enhance mutually beneficial transactions between people and society through reciprocal tasks and adaptations. Concepts of biopsychosocial development across the life span will be presented. The family will be considered as an open system with functions that shift at stages of transitions.
This course examines the behaviors, functions, and structure of groups, communities, and organizations. Students are introduced to theories that explain interactions within and between each of these larger systems. Students are also given an opportunity to apply many of the theoretical concepts used to explain the behaviors of individuals and families learned in the first semester Human behavior course, to behaviors exhibited by larger systems (groups, communities, and organizations). The course also addresses issues related to equitable distribution of goods and services that may be encountered by macro systems.
This second course examines the biological, social, and psychological aspects of aging, with special attention to the interrelationship between theoretical and practice-oriented knowledge. The course is organized around basic theories and processes of aging and considers developmental issues facing aging individuals as they move through maturity and old age. Examination of cross-cultural issues that shed light on the American experience will be introduced. Cultural/historical, class, gender, ethnic, and minority relationships to aging will be considered. Selected policy issues related to developmental changes and needs will be introduced where possible, as will earlier developmental processes that continue into advanced age.
This required course examines dysfunctional behavior in the context of developmental and environmental stresses. Ego psychology as a personality theory is considered as a means to understanding the development of adaptive and maladaptive ego functioning. This course surveys the varied manifestations of adult psychopathology including psychotic disorders, personality disorders, adjustment disorders, affective disorders, eating disorders and addiction.
This foundation course is an introduction to the understanding and appraisal of social services and social policies in the United States. The social values and economic and political factors which guide their development will be discussed. Attention is given to the role of social work in evaluating and changing policies.
This concentration course, taken in the second year, focuses on human behavior and the social environment of deaf and hard of hearing populations. The course looks at the complex interplay of psychosocial, system, and ecological forces in the life cycle development of individuals who experience deafness. The course explores forces of oppression and political and economic influences that impact the behavior, adaptation, and functioning of deaf and hard of hearing people.
Prerequisites: SWK 705, SWK 706, and passing the qualifying exams.
This course presents specialized content about social welfare policies affecting deaf and hard of hearing people and people with disabilities. These policies are discussed within the framework of analysis and evaluation to determine future directions for policy. The impact of the service delivery, funding, and organizational systems on the implementation of policy will be considered. The course will look at policies for people who are deaf-blind, developmentally disabled, and chronically mentally ill.
This course examines theories of cultural and ethnic identity, literature related to the cultures of women, deaf and hard of hearing people, gay and lesbian people, ethnic minorities of color, and people with disabilities. Because of the complexity of culturally competent social work practice, students are required to examine personal prejudices, stereotypes, and belief systems that negatively affect the provision of services to diverse populations. Readings on oppression, identity, and minority cultures are supplemented with presentations by experts from the community and dialogue with them. The course uses classroom exercises, written assignments, and objective measurements to increase self-awareness in the context of the student's personal identity and attitudes about difference based on ethnicity, gender, sexual orientation, and disability.
This course is the first Foundation Year practice course given during the first semester of the MSW program. The course focuses on knowledge, values and skill development in social work practice with individuals with an opportunity to develop interviewing skills. The generalist social work model of practice is introduced, which includes engagement, assessment, planning, intervention, evaluation, termination, and follow up. Particular attention is placed on social work ethics, diverse populations and populations at risk.
This is the second foundation course in the sequence of social work practice courses. It focuses on the knowledge, values, and skills required for effective intervention with larger systems of organizations and communities. It builds upon knowledge of interventions with individuals and groups to develop foundation skills such as advocating for clients within complex systems, building coalitions, negotiating with diverse groups, assessing community needs, program evaluation, development, management, proposal writing, understanding budgets, and supervision.
The focus of this course is on assessment and intervention with older people and their families. A primary, secondary, and tertiary intervention model is presented with emphasis on maintaining independence, using community-based services, and preventing institutionalization. The interdisciplinary aspects of gerontological social work, working with teams, and educating as well as learning from other professionals are addressed. Special attention is given to social work with older people with hearing loss; Alzheimer's and other organic disorders; alcohol abuse; medication problems; bereavement, death, and dying; neglect; abuse and victimization; and social work practice with racial, ethnic, and sexual minorities.
Prerequisites: SWK 707 and SWK 741.
This course is a foundation year social work practice course which focuses on the development of social work knowledge, values and skill in work with families and small groups. Students learn how to formulate assessments, develop goals and intervention strategies in work with families and small groups. This course introduces students to a variety of theoretical approaches that can be applied to diverse families and groups including those who are vulnerable or at risk.
This course is part of the required sequence for the aging and hearing loss concentration. Its focus is on social policy and community planning issues related to needs and services for aging people in the United States. Questions facing all aging individuals will be framed within two contexts: the cultural context of the aging deaf, and the special situation of deaf and hard of hearing elderly people. The course's perspective is to examine how national policy and service networks promote or interfere with successful aging and ways in which social work can contribute to improving relevant social policies and programs.
Prerequisites: SWK 707 and SWK 743.
This practice course is taken in the concentration (second year) of the Masters degree program focusing on advanced social work practice with deaf and hard of hearing individuals, couples and families. The course emphasizes the development of culturally sensitive application of strategies and interventions in social work practice. Theoretical models of practice such as family systems theory, ego psychology and brief solution therapy will be applied to deaf and hard of hearing populations. The course deepens and broadens the development of approaches to address ethical dilemmas in practice within Deaf communities.
This is the second concentration practice course with a focus on specialized knowledge and skills needed to work with organizations and communities of which deaf and hard of hearing people are a part. Building on the foundation year principles of intervention with organizations and communities, this course prepares students for macro practice with a diverse population of deaf and hard of hearing people in communities and organizations. Using an empowerment framework, this course focuses on the processes of empowerment of deaf and hard of hearing populations, and interventions that increase their access to political and social processes in communities and organizations. The course addresses ethical issues presented in practice with deaf communities, such as accessibility, communication and language choices, power, oppression and related cultural factors. Topics include grassroots organizing, planning, grant writing and fund raising, administration, social action, needs assessment methodology and program evaluation skills. Empowerment theory, group theory and the strengths perspective are applied in work with deaf and hard of hearing populations.
This three-credit course is a required part of the foundation curriculum that provides social work students with generalist skills needed in the social work profession. This course provides students with an understanding of qualitative research design and evaluation procedures, focusing on concepts and skills required to evaluate practice and program effectiveness. Students evaluate alternative designs or models for research and evaluation, including in-depth interviews, focus groups, visual media comparisons, observational studies, and archival/document designs. Students learn to analyze qualitative data by applying appropriate content coding techniques. In addition, they learn to interpret the results, critically analyze the strengths and weaknesses of the research designs, and reflect upon how the results can be used for future research or practice.
This three-credit course is a required part of the foundation curriculum that provides social work students with generalist skills needed in the social work profession. This course provides students with an understanding of quantitative research design and evaluation procedures, focusing on concepts and skills required to evaluate practice and program effectiveness. Students evaluate alternative designs or models for research and evaluation, including group and single-system designs. Students learn to analyze quantitative data by applying appropriate statistical tests. In addition, they learn to interpret the results, critically analyze the strengths and weaknesses of the research designs, and reflect upon how the results can be used for future research or practice.
This course exposes students to the specialized knowledge, skills and values needed for effective social work practice with deaf and hard of hearing children and their families within the complex ecosystem of their educational settings, and broader communities. Focus is on 1) assessment, intervention and prevention in the school setting; 2) collaboration and referral to outside agencies, 3) detection and reporting of child abuse and neglect; 4) interprofessional collaboration between social workers and educators to meet the complex needs of at risk students. Traditional school social work practice (family and group counseling, parent education, crisis intervention and advocacy) and emerging models of service delivery (play therapy modalities, and prevention activities such as psycho-educational approaches in conflict resolution, substance abuse prevention, etc.) in schools will be covered. School social work roles and functions ranging from formalized data collection procedures and assessment through contributing to and monitoring the ISP process to purely clinical interventions are covered. This class builds upon school social work policy, human behavior, and research courses. Societal, cultural, institutional, diversity and familial values will be explored in relation to practice and student success.
This course builds a base of knowledge, skills and values among graduate social work students which will prepare them for work with deaf and hard of hearing children, adolescents and their families, within the context of the educational setting. Students will develop an understanding of laws and policies which impact the ecosystem of the child which relates to school social work and mental health policies, educational placement and access, poverty, violence, child abuse and maltreatment, substance abuse, domestic violence, healthcare, social justice and accessibility. Skills in assessing policy needs, evaluating policy and policy implications for deaf and hard of hearing children, their families and the educational system will be developed. Students will also develop skills to effect change in policies and programs which impede the deaf child's success in school. this course is grounded in professional social work values and ethics and examines their implications for policy.
Prerequisites: SWK 705 and SWK 711.
Foundation Field Practicum I comprises a semester-long, 16 - 20 hour-per-week, supervised experience in a social service agency or school and a bi-weekly seminar class. Under the guidance of experienced MSW social work internship supervisors, students do initial and ongoing assessments, plan and implement interventions designed to bring about personal growth, empower clients and client systems, and promote social change. Additionally they are expected to understand organizational structure, the specifics of service delivery in their setting and community services available to their client populations. The bi-weekly class sessions are designed to help students integrate the field experience with theory application and practice interventions with peers in a small group environment. Students are required to complete 250 hours in the field practicum setting before the end of the semester.
This course follows successful completion of SWK 771. Students return to their agencies a week prior to the start of classes for 16-20 hours a week. Understanding of generalist social work theory and the development of intervention skills are expanded during this semester. Students refine and deepen the goals of their learning contract, as well as the skills of assessment and intervention with clients and client systems. Students are required to complete 250 hours in the field practicum setting before the end of the semester.
This course is designed to enhance students' abilities to integrate micro, mezzo, and macro levels of social work practice with deaf and hard of hearing populations. Seminar participants present their own work from field practicum and participants in discussion of the work of peers. Seminar participants and the instructor also identify and examine controversial issues and other issues of concern to the profession in general and to social work practice with deaf and hard of hearing populations in particular.
Students in advanced year have a full block placement in the spring semester while taking two additional online courses. During the semester, students are placed in internship settings that require advanced social work practice skills. Students work at their practicum sites for four eight hours days totaling thirty-two hours per week, or 512 hours for the semester. The field practicum is an agency or school carefully selected to promote learning in the concentration focus of deaf and hard of hearing populations. An experienced MSW field instructor supervises the student in practicum. The goal of the practicum is for students to deepen their knowledge and skills in social work practice, particularly with deaf and hard of hearing populations. The practicum serves as a vehicle for students to integrate knowledge, skills, ethical and professional values, culturally competent practice approaches, and ongoing assessment of the effectiveness of each social work intervention.
This course is the second semester of the advanced research sequence. Students continue their research project (thesis), collecting their data, and analyzing findings using computer technology where appropriate for quantitative and qualitative analysis. Special issues of analysis and interpretation for research related to deaf and hard of hearing populations are considered.


text:
Q: Horizontal scrollbar appears on ios devices when the position is fixed I did a mobile navigation, what appears on the left when the user opens it. The navigation is fixed and it pushes the content to the right. I added overflow:hidden for body, and it removes the scrollbar on desktop but not on ios.
Style:
body{
    padding:0;
    margin:0;
    overflow:hidden;
}

.opened-navigation#navigation {
    -webkit-transform: translate(0, 0);
    -moz-transform: translate(0, 0);
    transform: translate(0, 0);
}

#navigation {
    width:240px;
    position:fixed;
    left:0;
    top:0;
    height:100%;
    background:yellow;
    -webkit-transform: translate(-100%, 0);
    -moz-transform: translate(-100%, 0);
    transform: translate(-100%, 0);
}

.opened-navigation#content {
    -webkit-transform: translate(240px, 0);
    -moz-transform: translate(240px, 0);
    transform: translate(240px, 0);
}

#content {
    background:red;
}

HTML

Nav

Content
    Open Navigation

Javascript
$(document).ready(function(){
    $('#opennav').click(function(e){
        e.preventDefault();
        $('#navigation, #content').toggleClass('opened-navigation');
    });
});

When I add overflow:hidden for html it works, but on desktop it crops some of my elements. What is the solution?
Online version: http://psd-labs.com/demo/

A: I added position:relative; to body. I don't know why, but it fixed the problem.

redpajama_set_name: RedPajamaStackExchange


Overweight women were given two months to 250 ml of tomato juice daily and the result was an astonishing and lowered weight women. The interesting thing is that women were not to make changes in their daily eating habits in the use of this juice. Research at the beginning and at the end blood samples of women were also taken and it was confirmed that their cholesterol level and also low Laysufyn increase in blood and with a substance which boosts immunity against cancer. The researchers said the immune system has become also strong due to usage of tomato juice.
If you want this juice, it can make easily at home, after four kilos of tomatoes grinding them will add two tablespoons of salt and four teaspoons of sugar in the oven for ten minutes and bake at the stove. Keep stirring spoon juices during cooking and then cooling the melt will keep in the fridge and in the daily body fat to drink 250 ml juice.


The 2013 Pledges Are Upon Us!
If the bulk of the text looks familiar, it's because we posted an almost identical article before the lockout. We've changed the teams and dates, and some other details, but it did a decent job of explaining what we're after.
Unless you're new around these parts, you're familiar with the Pledge Games we've proudly hosted leading up to both H2H and H2H2. In two years' worth of fundraising, your pledges have accounted for $12,536.06 of the nearly $20,000 that the group has been fortunate to donate to Children's Hospital of Michigan Foundation.
Once again, you'll have the opportunity to pledge your donation dollars. In years past, we've gotten some magnificent pledges and we look forward to hearing yours this year. Whether it's $20 for a Red Wings win, $10 for a Pavel Datsyuk goal, $35 for a Jimmy Howard shutout, or anything in between, we're anxious to add your promise to our spreadsheet and collect a few bucks here and a few bucks there until the total is something we can all be proud of.
If at all possible, we respectfully request that your pledges are based on something quantifiable — and preferably quantifiable by the post-game statistics. Shots, goals, plus/minus, penalties… all of that is fair game. But when we get into the more bizarre pledges (how many times Larry Murphy mentions hot dogs [not that this is an option this time around], second-period shots if the team is losing, etc), it became insanely difficult to keep track of everything. We're going to enlist all of the help we can get in counting phenomena, but it would really help us out a great deal if your pledges were based on something easily countable.
Also, let's try to keep the pledges to things for which there will be no disputes. For example, we may count 4 "Datsyukian Dekes," but you only saw 3. No one has ever claimed we were trying to gauge them for more money (and I can't imagine anyone would, since it's going to a good cause), but the very last thing we want is for someone to feel as if their generosity has been taken advantage of. Some folks can give a dollar, some can give much, much more. But we're grateful for every last dime and have no interest in stretching you thin.
This year, we're proud to submit the following 11 games for your pledge consideration in hopes that we can double the amount we've been able to forward to the charity that's eventually selected (to be announced in the very near future). For any (or all) of the following games leading up to the Holidays and the Winter Classic, you may place your pledge.
We will NOT be handling donations this year. Once the pledge games are completed, you will receive an e-mail with detailed instructions on how to get your donations into the right hands. From that account, we will be delivering a (hopefully huge) check during the Winter Festival, so you'll have to pay promptly.
You may use the following form (we'll be pimping it all over the place) to submit your pledge.


text:
Q: MEAN Technology(mongodb,express js,angular js,node js) In MEAN Technology,I need to develop the payroll application,In this I have two fields code and name,But code and name should be unique,how to code this in mongodb?

A: Are you serious?
But still, do you mean code and name should be unique individually or do you mean the combination of code+name should be unique.
There is a difference, if code and name should be unique individually it means there cannot be same code in two different DB. if the combination should be unique means for one code there could be different names and vice versa.
I am going to provide a subjective answer as you haven't shown what you have tried or what you wish to try.
either you user _id as code+name making sure that it would be unique.
or you can have different key for code and name in document having a unique key indexing on both of them. or in second case having a compound unique indexing.


text:
Is NASCAR a Sport?
Sport or Not? Let's Find Out!
So, is NASCAR a sport? Numerous activities are debated worldwide as to whether or not you can classify them as sports. Golf, poker, and darts are a few examples. However, NASCAR racing is the most contentious when categorizing it as a sport.
NASCAR, by many definitions, is a sport since the athletes require physical training.
For a long time, participants raced to a series of regulations in a competitive context. For example, NASCAR pit crew members must be in high physical and psychological condition. There's certainly a lot of expertise involved.
Yet, while we go into why NASCAR would be a sport and what other sports standards it complies with, let's look at why several people don't think it is a sport. These are just a few top famous, and they're all arguable.
So without any further ado, let's jump right into it!
Is NASCAR Driving Considered a Sport?
Yes, NASCAR driving is, indeed, considered a sport. The reason behind this is that Wikipedia defines sport as "an athletic action involving skills or physical prowess frequently and has a competitive nature, such as sprinting, football, handball, golfing, bowling, boxing, wrestling, hunting finishing, and so on." Since the nature of NASCAR matches, most of the attributes above the discussion should end here.
Why Is NASCAR Racing Considered a Sport?
NASCAR racing is considered a competitive automobile racing sport since drivers suffer 2-5 G's every 15 seconds in just a length of 150 meters. Only 3 seconds on a roller coaster is sufficient to make someone throw up, not overlooking 15 seconds. When the drivers collide, they can suffer up to 70 Gs. Even though guys are sitting, they burn 2400 calories during the race. They also maintain a consistent heart rate of around 180 for nearly every race.
The pit workers must then:
Jump more than a wall
Jack up a 2.6-tonne car
Change two tires
Go to the opposite side
Jack up the 2.6-tonne NASCAR car again
Change two more tires
Fill it up with 22 gallons of gas
Add and remove tapes
Strip off a windshield strip
All this in 15 seconds. Finally, this sport requires as much strategy as baseball, cricket, volleyball, athletics, and hockey, all while running cars for 4-5 hour straight.
Are NASCAR Drivers Considered Athletes?
Yes, NARCAR drivers are considered professional athletes. A professional athlete is indeed an individual who performs a service for a professional athletic event for monetary or other rewards. In addition, NASCAR drivers compete in a car of a racing team in such a professional sports event for which the teams compensate them. Hence they fall within the definition of "Athletes."
Numerous activities are debated worldwide as to whether we can classify them as a sport. Golf, poker, and darts are a few examples, but NASCAR auto racing is definitely a sport and it mustn't be debated.
Why Do People Think NASCAR Isn't a Sport?
When most people think of sports, they think of football, volleyball, and any variety of ball sports. Instead, they might pursue sports, swimming, or cycling. Athletes often perform these sports globally, although they may also appear in tournaments such as the Olympics. NASCAR is not normally the first thing that springs to mind when people hear the word "sport."
However, only because NASCAR does not compete in the Olympics or other sports international association events should it not be dismissed as a sport. Squash and cricket, for example, are sports, yet they do not appear there in the Olympics during the time of writing. There are lots of NASCAR fans who think it is a sport.
Take, for example, ball sports. For example, a tennis player spends most of a match racing around the court, striking the ball across the net for all to see. The same thing is happening in football and basketball, except that teams are actively trying to attain a goal by physically moving onto a court or field.
In a NASCAR race, though, you rarely see the NASCAR driver. You see, the automobile, yes. However, the driver does appear to be performing much in any way of physical exertion. This is true for many Texas motor speedways. Hence, it is simple for most people to dismiss it by saying, "They're simply competitive driving the car around in rounds for just a couple of hours."
Not Very Popular
However, as we will discover in the next sections, this is not the case. NASCAR is among the highest seen texas motor speedways worldwide. Therefore it's only reasonable to examine it thoroughly to see if it truly qualifies as a sport in the classic sense.
The Competition Factor
Definition of a Sport
Suppose we try googling the meaning of a sport. In that case, we will receive many results from multiple dictionaries, all of which outline approximately the same thing. For example, must-have sports elements of a competition, a demand for ability rather than luck to be successful, involve physical activity, and frequently compete as just a job or merely for amusement.
The competition aspect necessitates that athletes play the sport according to a predetermined body of norms, with champions being individuals who achieve a specific goal while sticking to such restrictions. Mostly in the context of NASCAR, there is no debate about the presence of competition. There are three main NASCAR cup series, the Cup, Trucks, and NASCAR Xfinity series.
Clear Rules
There are clearly defined rules for each. With drivers and teams all aiming toward a goal in every race that is reaching the finishing line first and one overriding aim throughout the competition – being NASCAR Champion. So NASCAR has checked the first box of becoming eligible as a sport.
The Skills Required in NASCAR
Skill vs. Luck
The next aspect of becoming a sport is the requirement for ability rather than luck. Playing slot machines at the casinos for hours cannot be regarded as a sport because it depends entirely on chance, no matter how skillful the player believes they are. However, sports like soccer and tennis clearly demand a high level of ability to defeat your opponents.
Many individuals will not need convincing that NASCAR demands a great deal of skill. However, as we stated in the opening section, many more believe NASCAR needs none at all. They believe the drivers just drive in circles.
Lots Of Skills Needed
However, NASCAR racers are not simply going in circles; they are racing with a speed close to 200mph against 39 other nearly similarly skilled drivers. Instead, they must be able to time perfectly and understand where to go after an overtaking and when to hold back with quick critical reactions.
You can nearly forget all you learned as a driver at these speeds. For example, you must be able to spin a steering wheel with incredibly precise motions while keeping an eye on whoever is around you at all times. For example, you're driving so close to other cars to get a slipstream before perfectly planning the overtake to proceed through a pack of NASCAR racing cars.
More Than Just Turning Left
Even minor errors might lead to tragedy. For example, thousands of automobile accidents occur every year. But, just a portion of them occurs in NASCAR racing. So, it is easy to understand how skillful the drivers truly are as they go to the circuits. Never mind, there are also road courses on the NASCAR schedule that completely defy the concept of driving in a circle — more on that in this post.
Final Words – Is NASCAR a sport?
Despite what people believe when they see races, NASCAR is indeed a sport in which drivers must be physically strong to handle the hard circumstances of a race and be highly competent to win. The competition adheres to tight rules, and the entertainment provided by NASCAR cements its place as one of the world's most popular sports. NASCAR stands for National Association for Stock Car Auto Racing. NASCAR stock cars are very highly modified. We just cannot compare NASCAR with some other stock car racing.
Many people consider that NASCAR is not a sport, but if you're a NASCAR fan, you'll know that they are wrong and that NASCAR is indeed a sport. So if you look inside a Sprint Cup Series garage, you'll know that NASCAR cars are different from other ordinary cars.
This was a complete guide on whether NASCAR is a sport or not.

redpajama_set_name: RedPajamaCommonCrawl


Professor László Tabár is a visionary physician, researcher, and educator who has contributed significantly in the worldwide fight against breast cancer. In a career spanning over 40 years, he has worked tirelessly to reduce or eliminate suffering and death from the disease.
His pioneering research has laid the foundation for early detection through modern mammographic screening. As a clinician, he has applied his expertise to the interpretation of well over one million mammograms.
A consummate educator, Professor Tabár is responsible for the mentoring of tens of thousands of breast imagers, surgeons and pathologists worldwide. His influence is felt on every continent and there can be no doubt that his work as a researcher and educator has saved the lives of hundreds of thousands of women.
Dr O'Connor has been personally trained and mentored by Professor Tabár himself. This has contributed to Dr O'Connor's outstanding clinical acumen and reputation amongst his peers as an expert in breast imaging.
The László Tabár Breast Centre was opened in November 2009 by Professor Tabár and Dr Tom Stavros, one of the pioneers of breast ultrasound.
The Centre utilises the highly advanced GE Senographe DS Digital Mammography machine, which provides the lowest does mammography available.
In 2014, the unit was officially dedicated the LászlóTabár Breast Centre in honour of Professor Tabár as a Nobel Prize Nominee. During his visit to the Centre, he highlighted the 'excellent, high quality service' provided by the Coastal Medical Imaging and Specialist Women's Imaging Centre for women in the community.


It doesn't matter if it's your mighty PC or your humble Z88 one thing that you will eventually want more of is storage space for your files. For the Z88 there are a few options. You can buy yourself more ram in either the form of an internal upgrade or as a separate ram card. While extra ram is always welcome this is not the place to store the only copy of a valuable file you've been working on for the last week (so says the voice of experience). While the Z88 OS is definitely the most stable and reliable I've had the pleasure of using there is always room for error - even if it is a simple case of forgetting to replace your Z88's batteries. If you do this then kiss the contents of your ram goodbye. Option two is to buy a floppy drive for your Z88. If anyone knows where to buy these in the UK then please let me know. The last option is to buy an EPROM card. Available in several sizes ranging from 32K upwards these little beauties will allow you to save any files safe in the knowledge that no matter what happens to your Z88 that BAFTA award winning play you have just written will be completely safe. That's fine up to a point but once the EPROM card is full and all the files have been copied to your PC, printed out or finished with then you are left with the task of formatting the card. This as most Z88 users will know involves inserting the EPROM card into an eraser, a device that needs to be plugged into the mains and left to format your card - leaving you with the ideal opportunity to make yourself a cup of tea. While not the end of the world it can at times be frustrating as you impatiently wait for the EPROM to be erased, temporarily shackling what should be a completely independent and portable machine. This is where the Flash EPROM boldly steps in, a whole 1MB of storage space that can be formatted whilst still inside your Z88, negating the need for that EPROM eraser. At £59 it is not the cheapest EPROM in town but when compared to other EPROM's and what you get in storage space for your money then it starts to look a much more attractive offer.
While you may get more for your money in real terms this alone is not the reason for buying one. Saving files to a Flash EPROM instead of a standard EPROM is much quicker, apparently 48 times quicker, so saving that large file now takes seconds instead off minutes. And it's not just in saving files that the Flash EPROM is quicker at; formatting a full 1MB only takes 10 seconds while formatting my standard 128K EPROM took many minutes.
Yet the Flash EPROM cannot perform these small miracles by itself, it needs the software to do so - and this comes in the form of FlashStore. Rakewell, the UK suppliers of the Flash EPROM, supply the card with this software already installed, so all you have to do is go to the INDEX, lift up the flap, insert the Flash EPROM and then close the flap. It's as simple as that. As well as FlashStore the card also comes with Zetriz, the Z88 version of Tetris and Garry Lancaster's Z88 Forever compilation which includes essential utilities such as Unzip Lite and Installer. Selecting FlashStore from the INDEX first gives you the option of choosing which slot, handy if you have more than one Flash EPROM. Once the slot is chosen you are greeted with a screen that is separated into three boxes, the largest of the three been in the centre. The right box informs you of how large the EPROM is (depending on how many ROM images have been blown onto the card - this I'll explain in a while), the amount of free space available, the number of files saved and also the number of files deleted. In the left hand box are listed the options which if selected are carried out in the central box. These are CATALOGUE, SAVE, FETCH, RESTORE, DEVICE, FORMAT and QUIT. Catalogue lists all the names of the files on that EPROM and their corresponding size. Save allows any files in the selected Ram to be safely stored. Fetch copies a file from the Flash EPROM into Ram while Restore works the same but will copy all the files on the EPROM into the Ram. Device lets the user select any slots from 1-3 assuming a Flash EPROM is present. Format will erase everything on the card quickly and finally Quit does just what it says exiting you from FlashStore.
The great thing about the Flash EPROM is the amount of storage space available which can be put to good use if used with a utility called RomCombiner. What RomCombiner allows you to do is take several ROM images from different cards and sources and then put them onto just one. The amount of space available to Flash EPROM users means that Z88 users can now benefit by having a vast selection of utilities and games available at the press of a key - the choice of the selection is up to the individual. For example on a Flash Eprom of mine I have the Spellmaster cartridge, PC-LINK II, WhatNow?, FlashStore, the Z88 Forever compilation and Garry Lancaster's Zip utilities ROM. Not only does this remove any cartridge swapping (Spellmaster and PC-LINK II) it also frees up a spare slot or two which can be put to good use with a ram card. Once these files are "blown" onto the Flash Eprom the files are safe and undeletable (unless you use RomCombiner to format the whole EPROM) and the remaining space is formatted into a save area which can be formatted quickly and easily at any time using FlashStore.
But what are the bad points I here you cry? Other than only been able to save files to slot 3 (a bind if you have also have a Flash EPROM in slot 1 or 2) there is nothing else I can think of. In fact so impressed was I that I bought the company. Okay so I lied a little but I was pleased enough with the Flash EPROM's performance to buy another. So in slot 2 I have all my favourite utilities and games whilst the card in slot 3 is used for saving my text files and other bits and pieces. Anyone in need of some extra storage space should seriously consider buying one of these devices - it's like putting fuel injection into your Z88.
A worthy addition to any Z88 and once purchased you'll wonder how you ever lived without it.


The DStv Smart LNB with 2 x Universal Ports (Used on Explora Decoder and Newer Single View Multichoice Decoders) is designed and manufactured for DStv installations where customers make use of their own satellite dish. It is not generally suitable for multiple unit dwellings (complexes/apartments) or commercial/retail environments. The DStv Smart LNB combines the features of a DStv Switch into the LNB and is recommended for all DStv Explora and most XtraView installations.


text:
Celebs and NFTs: who's offering what?
The world of NFT art has attracted a lot of attention from the celebrity community over the past few years.
For example, Mark Cuban has a current portfolio worth upwards of half a billion US dollars which includes avatars from CryptoPunk, Bored Ape/Mutant Ape Yacht Club, Gucci and dozens more. Gary Vaynerchuk's portfolio tops just over $100 million USD which includes a CryptoPunk he purchased in 2021 for USD$3.7 million and his own NFT collection: VeeFriends.
Which is the topic for this article; celebrities who have created their own collections of NFTs. Who's created one, and what's on offer?
Hmmm, yes… Of course… NFTs
If this has been your reaction up to here, it's ok. There are so many different acronyms and initialisms floating around these days that it can be easy to get lost amongst them all.
We won't bog you down with too much detail, but the brief summary is that NFTs (Non-Fungible Tokens) are one-of-a-kind digital assets stored on the blockchain, similar to cryptocurrency.
People can make NFTs from almost any digital file including music, digital art, domain names, memes and even social media posts. The process of converting the digital file to an NFT is referred to as minting, and done via certain marketplaces (think eBay but for NFTs).
Provided there's a good marketing strategy behind them and/or a famous NFT artist creates them, they can sell for amazing prices. The most expensive NFT ever sold (to date) was 'The Merge' from renowned NFT artist Pak, which went for an incredible USD$91.8 million.
These celeb NFT projects will blow your mind
There may have been a little bit of a mixed reception when NFTs finally hit the mainstream, but in recent years many have seen nothing but overwhelming increases in value.
So it's no surprise that some of the more adventurous and innovative celebs hopped onto the fast-moving bandwagon. Here are the stand-out celeb NFT projects that have dropped so far.
Image source: crypto snoop dog
An avid NFT buyer and owner for some time, Mr. Dogg launched his very own NFT collection in April 2021. Called 'A Journey with the Dogg', this included 8 digital art pieces, each with a specific number of editions, and are based on memories from Snoop's early years.
One such piece in the collection was sold for a very tidy USD$108,000.
Image source: Starly/ David Bowie
Although he's sadly gone, David Bowie is anything but forgotten. Starly, in collaboration with Melos Studio as well as Denis O'Regan (Bowie's photographer) and of course Davie Bowie's estate has created a collection of 12,000 NFTs which officially dropped on 27 January this year.
These collector cards come in packs and are split up into Common, Rare and Legendary cards.
Image source: Paris Hilton
Having been investing in cryptocurrency from way back in 2016, it was no real surprise when Paris Hilton got involved in NFTs (she now owns more than 150 herself). Hilton created her first NFT in 2019, going on to sell it in 2020 for charity.
Since then, he has collaborated with Blake Kathryn to create the Planet Paris NFT collection, a series of short animated videos with a musical backdrop which was released in 2021.
Hilton has also worked with Superplastic to develop the 'Paris: Past Lives, New Beginnings' NFT collection. This included 4 pieces of digital art, each representing her journey through the public domain and an expression of herself reclaiming her life for herself.
Image source: Opensea/ Shaq
To support his charity, man-mountain Shaquille O'Neal launched his 'Shaq Gives Back NFT collection.
Comprising a total of 10,000 NFTs, each of the man himself dressed in a variety of different outfits, 100% of the proceeds from sales are going directly to The Shaquille O'Neal Foundation, which provides toys, clothing and meals for underprivileged youth and also creates pathways for underserved youth.
To date, this collection has raised over USD$2 million.
Image source: Opensea/ Shawn Mendes
In a collab with Genies, musician Shawn Mendes launched an NFT collection to complement the release of his album Wonder, with proceeds going towards a grants program for digital artists.
This collection included a range of different digital 'wearables' like a guitar, t-shirt and vest, as well as little rendered Shawn Mendeses playing piano, singing in the rain and holding up a guitar.
Image source: Mike Tyson
Iron Mike is another huge fan and avid collector of NFTs including within the iconic Bored Ape Yacht Club.
Now, he's teamed up with up-and-coming artist Cory Van Lew to create his very own collection. Included in this project are several pieces of digital art, some 1-of-1 and others with a very limited edition count, and are being released over 4 drops.
Successfully win the auction for the major 'Ultimate Mike Tyson NFT' and you'll unlock an otherwise series of 'unlockable' features which involve an all-expenses paid trip to Mike's ranch including a first-class airfare, training, battling and relaxing with Mike.
Image source: Nifty gateway/ Steve Aoki
Celeb DJ Steve Aoki is very much a proponent of the NFT space, admitting that he made more money with NFT drops in a year than he did over a decade of making music.
He owns a number of Bored Ape Yacht Club NFTs and several others, and has even launched 'Aokiverse', an exclusive club based on NFTs.
Aoki has had two NFT drops so far, the first in March 2021 in collaboration with Antoni Tudisco and the second a month later where he worked with Maciej Kuciara.
Connect with Mooning for comprehensive NFT solutions
Need some help finding a talented artist to create a groundbreaking NFT collection? Struggling to navigate your way through the minting, listing and selling process? Want to know you're selling at a sky-high price due to a first-class marketing campaign execution?
At Mooning, our expertise when it comes to NFTs knows no bounds. We like to think of ourselves as the Club Med of NFTs; an all-inclusive solution for you to take advantage of that allows you to put your feet up and relax while we do all the heavy lifting.
Only unlike Club Med, you leave with a fat stack of cash once your NFTs drop! So get on board the Mooning train and take it all the way to domination station – you'll be more than glad you did.
Interested? Call us on 1300 818 435 or send us an online enquiry today.
How Much Does it Cost to Mint an NFT 5 creative ways to use NFTs in your marketing mix What does an NFT do for marketers?
Top 10 NFT artists right now (Part 2)
How your brand can utilise NFTs


Fabulous opportunity for an updated home in Zionsville for great price. No covenants/restrictions and a lake view out the front windows. All new kitchen with white cabinetry, quartz countertops, backsplash, and all new black stainless appliances (sharp looking!). Large family room and separate dining room. Three large bedrooms and 2.5 baths. Fenced back yard. New updates: roof, water heater, water softener, all appliances, exterior paint, interior paint, carpet, tile bathroom floors & shower surrounds, windows and patio door. Large yard with rear fence.
MLS/BLC # 21593692 is a 3 -bedroom, 3-bath property located at 8902 Oak Street, Zionsville, IN 46077, in Boone County. This Residential/Condo was built in 1962 and offers 1536 square feet of total space. The current listing status of 8902 Oak Street Zionsville IN 46077 is "Sold." 8902 Oak Street Zionsville IN 46077 is in the Lake View Subdivision. See More Zionsville homes for sale.
8902 Oak Street, Zionsville, IN 46077 Property displayed on MSWOODS.COM and listed by F.C. Tucker Company. The BLC® listing information is provided by the Metropolitan Indianapolis Board of REALTORS® from a copyrighted compilation of listings. The compilation of listings and each individual listing are © 2019 Metropolitan Indianapolis Board of REALTORS® All Rights Reserved. The information provided is for consumers' personal, non-commercial use and may not be used for any purpose other than to identify prospective properties consumers may be interested in purchasing. All properties are subject to prior sale or withdrawal. All information provided on 8902 Oak Street, Zionsville, IN 46077 (and all other homes for sale in Zionsville) is deemed reliable but is not guaranteed accurate, and should be independently verified.
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Friedrich Air Conditioning Co. has named Maria Downes as its newest HVAC systems national account manager.
Downes will manage several of Friedrich's top HVAC market distributor accounts and develop new business opportunities.
Prior to joining Friedrich, Downes spent more than five years working for Whirlwind Corp., where she held a variety of sales and management positions.


text:
Figure.
Center-Level Median STS PROM by Reported TAVR Case Volume (n=182 Centers)
STS indicates Society of Thoracic Surgeons; PROM, predicted risk of operative mortality; TAVR, transcatheter aortic valve replacement. In the box-and-whisker plots, the middle line is the median, the top and bottom of the box indicate the interquartile range, and the error bars are minimum and maximum values excluding outliers.
Patient Characteristicsa
Operative Characteristicsa
In-Hospital Clinical Outcomesa
30-Day Clinical Outcomesa
In-Hospital and 30-Day Mortality in the STS/ACC TVT Registry Compared With Previous Studies
Audio Interview: Outcomes Following Transcatheter Aortic Valve Replacement in the United States
Video Interview: Outcomes Following Transcatheter Aortic Valve Replacement in the United States
Supplement.
eTable 1. List of Current TVT Registry Participants (as of October 11, 2013)
eTable 2. Baseline Characteristics and In-Hospital Outcomes Among Patients With vs Without 30-Day Follow-up Data
eTable 3. Baseline Characteristics and In-Hospital Outcomes Among Patients Excluded From the Primary Analysis
Department of Health and Human Services. Correspondence regarding premarket approval application for Edwards Sapien transcatheter heart valve. November 2, 2011. http://www.accessdata.fda.gov/cdrh_docs/pdf10/p100041a.pdf. Accessed October 28, 2013.
US Food and Drug Administration. FDA expands approved use of Sapien artificial heart valve. October 19, 2012. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm323478.htm. Accessed October 28, 2013.
Centers for Medicare & Medicaid Services. National Coverage Determination (NCD) for transcatheter aortic valve replacement. http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=355&ncdver=1&NCAId=257&ver=4&NcaName=Transcatheter+Aortic+Valve+Replacement+%28TAVR%29&bc=ACAAAAAACAAAAA%3D%3D&. Accessed November 1, 2013.
Carroll JD, Edwards FH, Marinac-Dabic D, et al. The STS-ACC transcatheter valve therapy national registry: a new partnership and infrastructure for the introduction and surveillance of medical devices and therapies. J Am Coll Cardiol. 2013;62(11):1026-1034. PubMedGoogle ScholarCrossref
Leon MB, Smith CR, Mack M, et al; PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597-1607.PubMedGoogle ScholarCrossref
Smith CR, Leon MB, Mack MJ, et al; PARTNER Trial Investigators. Transcatheter vs surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187-2198.PubMedGoogle ScholarCrossref
American College of Cardiology; Society of Thoracic Surgeons. ACC/STS TVT Registry home page. https://www.ncdr.com/TVT/Home/Default.aspx. Accessed October 28, 2013.
American College of Cardiology; Society of Thoracic Surgeons. ACC/STS TVT Registry: data collection. https://www.ncdr.com/tvt/Home/DataCollection.aspx. Accessed October 28, 2013.
American College of Cardiology; Society of Thoracic Surgeons. ACC/STS TVT Registry: NCDR participants/site manager contact. https://www.ncdr.com/TVT/Private/Resources/ParticipantDirectory.aspx. Accessed October 28, 2013.
Society of Thoracic Surgeons. Online STS risk calculator. http://riskcalc.sts.org/STSWebRiskCalc273/. Accessed October 28, 2013.
Wilson CM, Kostsuca SR, Boura JA. Utilization of a 5-meter walk test in evaluating self-selected gait speed during preoperative screening of patients scheduled for cardiac surgery. Cardiopulm Phys Ther J. 2013;24(3):36-43.PubMedGoogle Scholar
Garin O, Herdman M, Vilaqut G, et al. Assessing health-related quality of life in patients with heart failure: a systematic, standardized comparison of available measures [published online May 17, 2013]. Heart Fail Rev. doi:10.1007/s10741-013-9394-7. PubMedGoogle Scholar
Leon MB, Piazza N, Nikolsky E, et al. Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium. J Am Coll Cardiol. 2011;57(3):253-269.PubMedGoogle ScholarCrossref
Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol. 2012;60(15):1438-1454.PubMedGoogle ScholarCrossref
US Food and Drug Administration. Strengthening Our National System for Medical Device Postmarket Surveillance. September 2012. http://www.fda.gov/downloads/AboutFDA/CentersOffices/CDRH/CDRHReports/UCM301924.pdf. Accessed October 28, 2013.
Resnic FS, Normand SL. Postmarketing surveillance of medical devices—filling in the gaps. N Engl J Med. 2012;366(10):875-877.PubMedGoogle ScholarCrossref
Hauser RG. Here we go again—failure of postmarketing device surveillance. N Engl J Med. 2012;366(10):873-875.PubMedGoogle ScholarCrossref
Rumsfeld JS, Peterson ED. Achieving meaningful device surveillance: from reaction to proaction. JAMA. 2010;304(18):2065-2066.PubMedGoogle ScholarCrossref
Gilard M, Eltchaninoff H, Iung B, et al; FRANCE 2 Investigators. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med. 2012;366(18):1705-1715.PubMedGoogle ScholarCrossref
Thomas M, Schymik G, Walther T, et al. Thirty-day results of the Sapien Aortic Bioprosthesis European Outcome (SOURCE) Registry: a European registry of transcatheter aortic valve implantation using the Edwards Sapien valve. Circulation. 2010;122(1):62-69.PubMedGoogle ScholarCrossref
Hamm CW, Möllmann H, Holzhey D, et al; GARY Executive Board. The German Aortic Valve Registry (GARY): in-hospital outcome. Eur Heart J. 2013. doi:10.1093/eurheart/eht381.PubMedGoogle Scholar
Moat NE, Ludman P, de Belder MA, et al. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the UK TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol. 2011;58(20):2130-2138.PubMedGoogle ScholarCrossref
Cardiac Interventions Today. FDA approves revised labeling to allow alternative access sites for Edwards Sapien TAVR device. September 23, 2013. http://www.bmctoday.net/citoday/2013/08/article.asp?f=fda-approves-revised-labeling-to-allow-alternative-access-sites-for-edwards-sapien-tavr-device. Accessed October 28, 2013.
Outlook for Elderly Patients With Aortic Stenosis
Robert O. Bonow, MD, MS
Antithrombotic Therapy After Transcatheter Aortic Valve Replacement
Comment & Response
Augustus Hough, PharmD; Daniel Woods, MD
Antithrombotic Therapy After Transcatheter Aortic Valve Replacement—Reply
Michael Mack, MD
Valvular Heart Disease Cardiology Cardiothoracic Surgery Health Care Safety Surgery
Citations 299
Mack MJ, Brennan JM, Brindis R, et al. Outcomes Following Transcatheter Aortic Valve Replacement in the United States. JAMA. 2013;310(19):2069–2077. doi:10.1001/jama.2013.282043
Outcomes Following Transcatheter Aortic Valve Replacement in the United States
Michael J. Mack, MD1; J. Matthew Brennan, MD, MPH2; Ralph Brindis, MD, MPH3; et al John Carroll, MD4; Fred Edwards, MD5; Fred Grover, MD4; David Shahian, MD6; E. Murat Tuzcu, MD7; Eric D. Peterson, MD, MPH2; John S. Rumsfeld, MD, PhD4; Kathleen Hewitt, MSN8; Cynthia Shewan, PhD9; Joan Michaels, RN8; Barb Christensen, RN8; Alexander Christian2; Sean O'Brien, PhD2; David Holmes, MD10; for the STS/ACC TVT Registry
1Heart Hospital Baylor Plano, Baylor Healthcare System, Plano, Texas
2Duke Clinical Research Institute, Durham, North Carolina
3University of California, San Francisco
4University of Colorado, Denver
5University of Florida, Jacksonville
6Massachusetts General Hospital, Boston
7Cleveland Clinic, Cleveland, Ohio
8American College of Cardiology, Washington, DC
9Society of Thoracic Surgeons, Chicago, Illinois
10Mayo Clinic, Rochester, Minnesota
JAMA. 2013;310(19):2069-2077. doi:10.1001/jama.2013.282043
Audio Interview (04:34)
Video Interview (04:56)
Importance Transcatheter aortic valve replacement (TAVR) was approved by the US Food and Drug Administration for the treatment of severe, symptomatic aortic stenosis and inoperable status (in 2011) and high-risk but operable status (starting in 2012). A national registry (the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy [STS/ACC TVT] Registry) was initiated to meet a condition for Medicare coverage and also facilitates outcome assessment and comparison with other trials and international registries.
Objective To report the initial US commercial experience with TAVR.
Design, Setting, and Participants We obtained results from all eligible US TAVR cases (n=7710) from 224 participating registry hospitals following the Edwards Sapien device commercialization (November 2011–May 2013).
Main Outcomes and Measures Primary outcomes included all-cause in-hospital mortality and stroke following TAVR. Secondary analyses included procedural complications and outcomes by clinical indication and access site. Device implantation success was defined as successful vascular access, deployment of a single device in the proper anatomic position, appropriate valve function without either moderate or severe AR, and successful retrieval of the delivery system. Thirty-day outcomes are presented for a representative 3133 cases (40.6%) at 114 centers with at least 80% complete follow-up reporting.
Results The 7710 patients who underwent TAVR included 1559 (20%) cases that were inoperable and 6151 (80%) cases that were high-risk but operable. The median age was 84 years (interquartile range [IQR], 78-88 years); 3783 patients (49%) were women and the median STS predicted risk of mortality was 7% (IQR, 5%-11%). At baseline, 2176 patients (75%) were either not at all satisfied (1297 patients [45%]) or mostly dissatisfied (879 patients [30%]) with their symptom status; 2198 (72%) had a 5-m walk time longer than 6 seconds (slow gait speed). The most common vascular access approach was transfemoral (4972 patients [64%]), followed by transapical (2197 patients [29%]) and other alternative approaches (536 patients [7%]); successful device implantation occurred in 7069 patients (92%; 95% CI, 91%-92%). The observed incidence of in-hospital mortality was 5.5% (95% CI, 5.0%-6.1%). Other major complications included stroke (2.0%; 95% CI, 1.7%-2.4%), dialysis-dependent renal failure (1.9%; 95% CI, 1.6%-2.2%), and major vascular injury (6.4%; 95% CI, 5.8%-6.9%). Median hospital stay was 6 days (IQR, 4-10 days), with 4613 (63%) discharged home. Among patients with available follow-up at 30 days (n=3133), the incidence of mortality was 7.6% (95% CI, 6.7%-8.6%) (noncardiovascular cause, 52%); a stroke had occurred in 2.8% (95% CI, 2.3%-3.5%), new dialysis in 2.5% (95% CI, 2.0%-3.1%), and reintervention in 0.5% (95% CI, 0.3%-0.8%).
Conclusions and Relevance Among patients undergoing TAVR at US centers in the STS/ACC TVT Registry, device implantation success was achieved in 92% of cases, the overall in-hospital mortality rate was 5.5%, and the stroke rate was 2.0%. Although these postmarket US approval findings are comparable with prior published trial data and international experience, long-term follow-up is essential to assess continued efficacy and safety.
Trial Registration clinicaltrials.gov Identifier: NCT01737528
In November 2011, the US Food and Drug Administration (FDA) approved use of a device for transcatheter aortic valve replacement (TAVR) using the transfemoral approach for the treatment of severe, symptomatic aortic stenosis in patients with inoperable status.1 The label for the device was expanded in September 2012 to include patients with high-risk but operable status by either a transfemoral or transapical approach.2 Since commercial approval, this first-to-US-market TAVR device has been introduced to nearly 250 US clinical sites. To meet Medicare insurance coverage requirements, facilities must comply with coverage criteria outlined by the Centers for Medicare & Medicaid Services (CMS) National Coverage Determination,3 including participation in a national procedural registry designed to answer outstanding evidentiary questions. To satisfy this requirement, the Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC) developed the STS/ACC Transcatheter Valve Therapy (TVT) Registry.4
Although the pivotal PARTNER trials demonstrated efficacy of TAVR within a select cohort of patients and hospital centers, there are no data on dissemination and utilization patterns of this technology in routine clinical practice in the United States.5,6 Additionally, concerns persist regarding the safety and effectiveness of this novel technology as it moves beyond protocolized trial care and highly experienced centers and operators.
In this analysis, we describe the initial US TAVR experience, including patient selection, procedural details, and in-hospital and 30-day outcomes following TAVR among patients enrolled in the TVT Registry.
The TVT Registry
The STS/ACC TVT Registry was launched in December 2011 following FDA approval of the Sapien Transcatheter Heart Valve.7 The TVT Registry is a joint initiative of the STS and ACC including participation of more than 250 clinical sites (eTable 1 in the Supplement), with multistakeholder involvement on the steering and stakeholder advisory committees. The TVT Registry is responsive to the CMS National Coverage Determination (May 2012) requirement for national registry participation of all TAVR centers and is intended to serve as a platform for (1) device and procedural surveillance; (2) quality assurance and improvement initiatives; and (3) efficient conduct of device-labeling studies that will speed US access to new devices and support expansion of device labeling with evidence development. Registry activities have been approved by a central institutional review board, and the Duke University School of Medicine institutional review board granted a waiver of informed consent and authorization for this study.
Participating TVT Registry centers collect information on patient demographics, comorbidities, functional status, patient-reported quality of life, hemodynamics, procedural details, and postoperative, 30-day, and 1-year outcomes.8 Data quality checks are implemented both at the National Cardiovascular Data Registry data warehouse and the Duke Clinical Research Institute Analysis Center, including data quality feedback reports and data range and consistency checks. Additionally, site training is conducted by the National Cardiovascular Data Registry through frequent informational webinars. In the case of missing data, sites have been contacted to encourage complete reporting.
Data Element Definitions
Data elements were collected using standardized definitions,9 which have been harmonized with the STS National Database wherever possible. The following represent several definitions of interest. The clinical indication for TAVR (inoperable or high-risk status) was based on determination by 2 experienced local cardiac surgeons using risk calculations from the STS predicted risk of operative mortality (PROM) from isolated surgical aortic valve replacement (AVR)10 and clinical judgment. The STS PROM estimates expected risk of operative mortality, with a range of 0% to 100% risk.
For the purposes of this analysis, patients were considered to have high-risk but operable status if the procedure was chosen based on extreme risk (due to comorbid conditions or technical reasons) or patient preference. A hybrid operating room was defined by the registry as a procedure room with standard fluoroscopic catheterization laboratory imaging situated in an operative suite. Porcelain aorta was defined as extensive circumferential calcification of the ascending aorta precluding safe surgical entry. "Hostile chest" included medical conditions that preclude open chest procedures, including abnormal chest wall anatomy (congenital or acquired), extensive mediastinal radiation, complete absence of sternal reconstructive options based on plastic surgery consultation, or other anatomical reasons to consider repeat sternotomy or right anterior thoracotomy prohibitively hazardous. Gait speed was defined as slow if the reported 5-m walk time was longer than 6 seconds.11 The 12-question Kansas City Cardiomyopathy Questionnaire (KCCQ-12) has been validated12 and is available online through the TVT Registry data coders dictionary.
Study End Points
Both in-hospital and 30-day outcomes were site-reported to the TVT Registry using standardized definitions, including harmonization with Valve Academic Research Consortium (VARC) and VARC-2 definitions for stroke, transient ischemic attack, aortic valve reintervention, major bleeding, and major vascular complications.13,14 All site-reported stroke, transient ischemic attack, and valve reintervention events were adjudicated by a board-certified cardiologist using a combination of site-reported clinical information and targeted chart reviews.
Device implantation success was defined as successful vascular access, delivery and deployment of a single device in the proper anatomic location, appropriate performance of the prosthetic heart valve (aortic valve area >1.2 cm2 and mean aortic valve gradient <20 mm Hg or peak velocity <3 m/s, without moderate or severe prosthetic valve aortic regurgitation), and successful retrieval of the delivery system. Aborted procedures were defined as those that were cancelled or terminated after the patient entered the procedure room. Incident renal failure included a new post-TAVR requirement for hemodialysis or increase in serum creatinine level to 3.0 mg/dL or higher.
Thirty-day outcomes are reported among patients with a known 30-day status among the hospitals with 80% or higher 30-day follow-up for each of the primary and secondary outcomes of interest (death, stroke, incident dialysis-dependent renal failure, and aortic valve reintervention), beginning with prospective TVT Registry data collection on May 1, 2012. Thirty-day follow-up status was considered to be known for cases that involved in-hospital death, death within 30 days of the index procedure, or no death within 30 days of the index procedure but affirmation that the patient was alive (with or without an adverse event) within the 30-day follow-up window (25-75 days following the index procedure). Baseline characteristics and in-hospital outcomes for patients with vs without 30-day follow-up are presented in eTable 2 in the Supplement.
Patient- and case-specific results were summarized and reported as medians and interquartile ranges (IQRs). Confidence intervals were calculated using exact 95% binomial confidence limits for key in-hospital and 30-day outcomes. Descriptive statistics are stratified by risk status (inoperable/high risk) and access site; however, statistical comparisons were not performed because of a lack of adequate comparator groups.
The median STS PROM was calculated for each hospital center using the STS isolated surgical AVR risk algorithm and variables reported to the TVT Registry and shown as a function of center-level TAVR volume (Figure) evaluating the relationship between observed center-level variation in patient selection and procedural volume, with the hypothesis that a larger proportion of low-volume centers would select lower-risk TAVR cases. In the Figure, each dot represents an individual center and the median PROM is the median predicted risk for patients at each center. Although the STS PROM for surgical isolated AVR may not be an accurate predictor of TAVR risk, it does provide a uniform summary statistic for assessing baseline case complexity.
SAS statistical software version 9.1 (SAS Institute Inc) was used for all calculations, and analyses were performed at the TVT Registry Analysis Center at the Duke Clinical Research Institute.
Patient Cohort
There were 8075 TAVR cases entered into the TVT Registry between November 1, 2011, and May 31, 2013, allowing 60 days for data entry. Among these patients, 292 cases had missing data for in-hospital events, discharge status, or valve sheath access site; in addition, in 73 cases the operator assessment of procedural risk (either inoperable or high risk) was unknown. The baseline characteristics and in-hospital outcomes of these 365 patients are documented in eTable 3 in the Supplement. These patients were excluded from the primary analysis, leaving 7710 TAVR procedures from 224 hospitals. There were 2911 patients in whom KCCQ-12 data were available and 3065 for whom 5-m walk times were available. These patients were included in a secondary analysis. Characteristics of patients with vs without complete data for the KCCQ-12 and 5-m walk test are also presented in eTable 3.
Among the 7710 patients undergoing TAVR, the median age was 84 years (IQR, 78-88 years) and 51% % were male (Table 1). The median calculated STS PROM was 7% (IQR, 5%-11%), with considerable site-level variation (median site-level PROM ranged from 1.2% to 17.4%, including all centers; the Figure shows results for centers with 10 or more cases).
Documentation of preoperative evaluation of a patient's suitability for surgical AVR by at least 2 cardiac surgeons was reported in 91% of cases (n = 7020). A total of 1559 patients (20%) were considered to have an inoperable status and 6151 patients (80%) were considered at high operative risk (multiple comorbidities, 59%; severe deconditioning/debilitation, 17%; other, 4%). Markers of increased risk with surgical AVR were common: 7% with a left ventricular ejection fraction of 30% or less (n = 540), 13% with a previous stroke (n = 1004), 5% with dialysis-dependent renal failure (n = 350), 28% with moderate/severe chronic obstructive pulmonary disease (n = 2145), and 15% with oxygen-dependent lung disease (n = 1135) (Table 1). "Hostile chest" was reported in 10% (n = 742), 1 or more prior cardiac surgeries in 32% (n = 2445), and a porcelain aorta in 8% (n = 587).
Patients in this cohort had a high burden of advanced heart failure, with severe functional limitations. Prior to the TAVR procedure, more than 81.3% had New York Heart Association class III/IV heart failure symptoms (n = 6272). Among the 3065 patients for whom a 5-m walk test results was reported, a slow gait speed was present in 2198 patients (72%) (median time, 8 seconds; IQR, 6-11 seconds). Among the 2911 patients for whom KCCQ-12 results were available at baseline, 763 (26%) were "quite a bit" or "extremely" limited in their ability to shower or bathe, 1524 (52%) had similar limitations with walking on level ground, and 2042 (70%) had similar limitations with hurried activities. A majority said that they would be mostly dissatisfied (1297 patients [30%]) or not at all satisfied (879 patients [45%]) if their remaining life were spent with a similar degree of symptoms.
Transcatheter AVR was performed for degenerative aortic stenosis in 7090 patients (92%), with a median aortic valve area of 0.6 cm2 (IQR, 0.5-0.8 cm2). Among those with reported pre-TAVR mitral valve function data (n=6528), mitral valve insufficiency was none/trace in 1015 (16%), mild in 3129 (48%), moderate in 2037 (31%), and severe in 347 (5%).
Procedural Characteristics
A total of 4391 procedures (57%) were performed in hybrid operating rooms, 2165 (28%) in hybrid catheterization laboratories, and 1050 (14%) in standard catheterization laboratories; general anesthesia was used in 7565 cases (98%) (Table 2). The most common approach was transfemoral (4972 cases [64%]), followed by transapical (2197 cases [29%]) and other approaches (536 cases [7%]); percutaneous access was used in 1792 transfemoral cases (36%). In patients with inoperable status, 420 (27%) procedures were performed by a "nontransfemoral" approach, an off-label use of the TAVR device.
Device implantation success for the transcatheter valve was achieved in 7069 cases (92%; 95% CI, 91%-92%); among those without a prior transcatheter or surgical AVR, 2 or more valves were used in 2.9%. Intraprocedural death was uncommon (0.8%); however, conversion to open-heart surgery (94 cases [1% of total]) was associated with a 49% incidence of in-hospital mortality (46 deaths). The most common causes of open-heart conversion included dislodged valve (22 cases), ruptured annulus (13 cases), ruptured ventricle (11 cases), and aortic dissection (12 cases).
In-Hospital Outcomes
Overall, 94.5% of patients (n=7283) survived to hospital discharge (in-hospital mortality, 5.5%; 95% CI, 5.0%-6.1%) (Table 3). Major in-hospital complications included stroke (2.0%; 95% CI, 1.7%-2.4%), major vascular injury (6.4%; 95% CI, 5.8%-6.9%), acute renal insufficiency (5.5%; 95% CI, 5.0%-6.0%), and major bleeding (3.5%; 95% CI, 3.1%-3.9%). New-onset atrial fibrillation was observed in 6.0% (95% CI, 5.5%-6.5%) and need for new pacemaker or implantable cardioverter-defibrillator in 6.6% (95% CI, 6.1%-7.2%). Patients with inoperable status or who had a nontransfemoral procedure experienced a higher incidence of most adverse events compared with those with operable status and transfemoral procedures. Median intensive care unit stay was 46 hours (IQR, 25-77 hours), and median hospital stay was 6 days (IQR, 4-10 days). The majority of patients were discharged either to home (n=4613 [63%]) or to a rehabilitation facility (n=2134 [29%]).
Among the 5979 patients with an immediate pre–hospital discharge echocardiogram, moderate or severe aortic insufficiency was observed in 508 patients (8.5%); moderate in 481 (8%), and severe in 27 (0.5%). Among patients with available baseline and post-TAVR echocardiogram results (n = 4918), the degree of mitral regurgitation was reduced in 2402 (49%), unchanged in 1962 (40%), and worsened in 554 (11%).
30-Day Outcomes
Thirty-day outcomes data are reported from 114 hospitals (51% of the 224 hospitals in the registry) with 80% or higher 30-day follow-up for each of the primary and secondary outcomes of interest (death, stroke, incident dialysis-dependent renal failure, and aortic valve reintervention). These 114 hospitals enrolled 3528 patients, and follow-up data were not available for 395 patients (eTable 2 in the Supplement). Among the 3133 patients for whom 30-day outcome data were available, the incidence of death was 7.6% (95% CI, 6.7%-8.6%), including 52% with a noncardiovascular cause (Table 4). Stroke occurred in 2.8% (95% CI, 2.3%-3.5%), incident hemodialysis in 2.5% (95% CI, 2.0%-3.1%), and aortic valve reintervention in 0.5% (95% CI, 0.3%-0.8%). Among patients with available follow-up, the incidence of class III/IV heart failure during follow-up was 12% (compared with 81% at baseline). Overall, there were no major differences between patient characteristics and mortality outcome for patients enrolled at the 114 hospitals with 80% or higher follow-up and patients enrolled at the 110 hospitals with lower than 80% complete 30-day follow-up (eTable 2 in the Supplement).
This analysis represents the first public report from the US national STS/ACC TVT Registry and documents 2 major findings. First, postapproval commercial introduction of this new technology with an early-generation device has yielded success rates and complication patterns that are similar to those documented in carefully performed randomized trials. Second, the outcomes of procedures even with this early-generation approved device are similar to the global experience of TAVR, which now is based on second- and third-generation improved devices. These findings help address a lingering question of clinical outcomes with the first-generation TAVR device after controlled US dissemination to a relatively narrow group of treatment centers. As a part of the FDA Strategic Initiative,15 the TVT Registry has helped to address critiques of the adequacy of postmarket surveillance of high-risk medical device performance and safety.16-18
Whether outcomes of postapproval medical device use are comparable with those obtained in regulatory approval trials has been a long-standing point of concern. The commercial introduction of TAVR was unique in that the CMS and several professional societies collaborated to define requirements for certification of clinical sites and operators through the CMS National Coverage Determination, with an unprecedented level of site training and case supervision by the industry sponsor. This initial report provides early evidence that similar results from clinical trials can be achieved for complex medical devices in the postapproval experience when a controlled rollout is followed. Patients with inoperable status in the PARTNER trial had 30-day death and stroke rates of 5% and 6.7%, respectively.5 Although the in-hospital mortality and stroke rates of 5.8% and 2.3%, respectively, reported in TVT Registry for inoperable cases are less than the 30-day outcome rates (7.7% and 2.5%, respectively), they are consistent with the trial outcomes on which device approval was based. Likewise, the in-hospital mortality and stroke rates of 5.5% and 2.0% and 30-day rates of 6.6% and 2.5%, respectively, in the high-risk operable patient cohort of the TVT Registry are in a similar range as the 3.4% and 4.7% 30-day mortality and stroke rates in PARTNER "cohort A".6
In-hospital transfemoral mortality rates were 5.4% and 3.8% in the inoperable and high-risk groups (30-day rates, 6.7% and 5.0%), comparable with PARTNER trial as-treated 30-day mortality rates of 5% and 3.7% in the same cohorts, respectively. The observed in-hospital mortality rates in the nontransfemoral cohort of 7.1% and 8.2% (30-day rates, 12.6% and 10.8%) for inoperable and high-risk status were slightly higher than the mortality rate of 8.7% in the PARTNER Trial, which was studied only in the high-risk, operable population.
These US registry results also suggest comparability with those reported in international registries (Table 5). The FRANCE 2 Registry, which included not only the device evaluated in our study but also a later generation of the device as well as other TAVR devices, reported outcomes of 3195 patients treated in 34 French centers between January 2010 and October 2011.19 The 30-day mortality rate was 9.7%. The Sapien Aortic Bioprosthesis European Outcome (SOURCE) Registry, an industry-sponsored postapproval European study, reported a 30-day mortality of 6.3% after transfemoral and 10.3% after transapical procedures.20 The German Aortic Valve Registry (GARY) has reported results in 3866 patients undergoing TAVR in 2011.21 Two-thirds underwent the procedure by a transfemoral approach, with an in-hospital mortality of 5.1%, and the remaining one-third by a transapical approach, with a mortality of 7.7%, which approximate the results reported herein. Similar results are reported from the UK SATIRE Registry in the United Kingdom, in which 30-day mortality was 7.1% in 870 patients undergoing the procedure through 2010.22
Vascular and bleeding complications were relatively uncommon despite this early experience and the availability of only early-generation, larger-sheath-size delivery systems in this country. Based on experience outside of the United States, vascular and bleeding complications appear to decrease with smaller-caliber, next-generation delivery system availability.
A number of factors are related to the overall US outcomes reported in this analysis. First, there was already a broad experience with the device and procedure outside of the United States, which has been readily shared with US centers. Exploiting this global experience through international collaboration and common learning may well have shortened the US "learning curve." Second, at least 35 centers had significant experience with the procedure from participation in the PARTNER trial, which benefitted not only those centers but contributed to the shared learning that may have helped all centers. Third, the device manufacturer had an education program in place with mandated training in all aspects of patient selection, procedure performance, and postprocedure care. Company-employed clinical specialists were present during all procedures. Fourth, the presence of a national registry, with explicitly planned reporting of outcomes, may have resulted in a Hawthorne or observational effect, as has been seen with other registry experiences. Fifth, compared with immediate and broad introduction of medical devices on regulatory approval, the "rational dispersion" of this new technology may have been a factor in the outcomes achieved. Sixth, the risk profile of patients reported here is generally lower (inoperable, median, 7% [IQR, 4%-10%]; high-risk but operable, median, 7% [IQR, 5%-11%]) than that seen in randomized trials and in the reports from outside the United States. Patients with inoperable status in the PARTNER trial had a mean STS PROM of 11.2% (SD, 5.8%) and those with high-risk but operable status had a mean of 11.8% (SD, 3.3%). Although this may represent incomplete entry of variables into the risk calculator by US clinical sites, it could indicate "risk creep," meaning patients with lower surgical risk are being treated in the United States, leading to better outcomes with TAVR.
Several important and unexpected observations can be made from this initial report. There was wide variability based on center volume and selection of patients (Figure). This requires a future study examining the relationship of center volume to outcome, which could affect the CMS coverage criteria, which were based on a presumed relationship between volume and procedural outcome. In addition, 27% of patients with inoperable status received TAVR via an alternative access route, probably because of inability to use the FDA-approved and CMS-reimbursed femoral access route until after the recent FDA label expansion.23
However, several potential limitations should be considered in the interpretation of the results of this analysis. First, although there was an attempt to capture all TAVR procedures in the United States, not all cases have yet been entered into the TVT Registry since the issuance of the National Coverage Determination. By comparison with the Edwards Lifesciences record of procedures, it is estimated that this report represents approximately 88% of the procedures performed between the issuance of the National Coverage Determination (May 2012) and the end of the study interval (May 2013). It is likely that the early rolling enrollment of centers in the TVT Registry and an incomplete retrospective case capture has led to this discrepancy; however, it is unclear whether this underreporting is more prevalent among cases with poor outcomes. This could potentially limit generalizability of the results, although the vast majority of US TAVR cases are included in the current report, and other comparisons of missing vs complete case risk profiles and in-hospital outcomes do not suggest selective reporting of results (eTable 3 in the Supplement).
Second, the 30-day outcomes presented here are limited to a subset of centers and patients (eTable 2 in the Supplement). As analysis of missing vs complete cases does not suggest biased case reporting, similar outcomes were observed in those with and without 30-day data available, indicating that these outcomes most likely are generalizable. Subsequent reports from the TVT Registry will address more complete long-term (30-day and 1-year) outcomes, including survival and patient health status, to have a more comprehensive assessment of the outcomes of patients undergoing TAVR in the United States.
Third, there has been limited capture of patient health status and functional status follow-up data in the TVT Registry to date. As this became apparent during the early stages of the registry rollout, a robust site education program addressed the collection of this data at both baseline and follow-up. Subsequent reports will focus on health status and quality-of-life outcomes.
Among the 7710 patients undergoing TAVR at 224 sites in the STS/ACC TVT Registry, device success was achieved in 92% of cases, with a 5.5% incidence of in-hospital mortality and a 2% incidence of stroke. Although procedural complication rates were relatively low, within the first 30 days most deaths remained noncardiovascular in nature. These findings are comparable with prior published randomized trial and international registry experience. Longer-term follow-up is essential to assess continued safety and efficacy as well as patient health status.
Corresponding Author: Michael J. Mack, MD, Baylor Health Care System, 1100 Allied Dr, Plano, TX 75093 (michael.mack@baylorhealth.edu).
Author Contributions: Dr Brennan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Mack, Brindis, Carroll, Edwards, Grover, Shahian, Tuzcu, Rumsfeld, Hewitt, Michaels, Christensen, Holmes.
Acquisition of data: Carroll, Edwards, Hewitt, Shewan, Michaels, Christensen, Holmes.
Analysis and interpretation of data: Brennan, Brindis, Carroll, Edwards, Grover, Shahian, Tuzcu, Peterson, Rumsfeld, Hewitt, Shewan, Christian, O'Brien, Holmes.
Drafting of the manuscript: Mack, Brennan, Brindis, Carroll, Edwards, Holmes.
Critical revision of the manuscript for important intellectual content: Mack, Brindis, Carroll, Grover, Shahian, Tuzcu, Peterson, Rumsfeld, Hewitt, Shewan, Michaels, Christensen, Christian, O'Brien, Holmes.
Statistical analysis: Carroll, Edwards, Peterson, Christian, O'Brien, Holmes.
Obtained funding: Carroll, Hewitt, Holmes.
Administrative, technical, or material support: Carroll, Hewitt, Shewan, Michaels, Christensen.
Study supervision: Mack, Grover, Shahian, Hewitt, Christensen, Holmes.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Grover reports support for travel to meetings from the ACC and STS. Dr Peterson reports consultancy for Janssen, Boehringer Ingelheim, and Sanofi. Dr Shahian reports support for travel to meetings from the STS. No other disclosures were reported.
Funding/Support: This study was funded by the American College of Cardiology Foundation and the Society of Thoracic Surgeons.
Role of the Sponsor: The study was designed and performed by the steering committee of the TVT Registry, which is a joint partnership of the STS and the ACC Foundation. Employees of both organizations sit on the steering committee. The budget was funded out of the general operating funds of the TVT Registry. The STS and ACC Foundation otherwise had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Disclaimer: Dr Peterson, an associate editor for JAMA, was not involved in the editorial review of or the decision to publish this article.
Correction: This article was corrected on November 19, 2013, to correct the name of the device in the abstract and an incorrectly indented row stub in Table 3.


Women in Animation (WIA) highlights the unconscious bias and gender gap in the animation industry.
With over 65% of animation programs being female there are a lot of talented people who can fill the positions. From the calculations it is evident that the annual increase needs to be only 3.5% every year, Dean added.
"In our industry, women don't seem to feel comfortable and supported in order to really push the boundaries of what they are capable of. We would like women to be far more daring," said Corinne Kouper and Eleanor Coleman at France's Les Femmes s'Animent.
As per the data by the Animation Guild, Local 839 IATSE to Variety, out of the 4,058 people were working in animation in Los Angeles as of April 2017, 24% of those employed were female which is an increase from 2012 when only 2,766 people were employed and 18% female.


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year over year, due primarily to online shopping (2015).


Toyota will soon be making way for more stylish version of Fortuner SUV named as Fortuner TRD Sportivo.
As you can estimate from the spy images, Fortuner TRD Sportivo will be blessed with additional bits like TRD-badged skirts for the rear and front bumpers and also a roof mounted spoiler. As we have already seen in the other TRD Sportivo special editions of the Etios and Liva, Toyota may add monor interior upgrades to this special edition Fortuner. Sources tells that changes may be simply cosmetic rather than mechanical.
What actually remains a mystery, are the versions that will be available with TRD Sportivo kit. At present Fortuner is available in three varients, 4×2 manual, 4×2 automatic and 4×4 manual.
The new Fortuner is expected to be priced slightly higher than the standard variants of the current version.


Stylish and classic, this monochrome desk globe is just wow. The colours are on point and so classy, this desk globe would look fantastic in both the office and home. Also being a desk globe it is the perfect size at 6", so won't overload any space. On an axis, it is easy to spin, look, plan your next adventure, or holiday, Or your travels or a gap year. Super pretty and educational too. This desk globe also comes gift boxed making it a lovely gift for both him or her.
Finished off in a classic matte black stand, this globe is a real show stopper.


Escrow 101: What Businesses Need to Know - American Deposit Management Co.
If you've bought or sold property at any point in your life, you've probably heard the term "escrow" thrown around. You also may know that it is also a vital component of many business-to-business (B2B) transactions. But, what exactly is "escrow"?
At its core, the concept is simple: Escrow is a neutral third party that holds money, titles, or anything of value to ensure the buyer and seller involved in a transaction meet their obligations for the transaction to take place.
Think of it like a referee — or a middle man who's a real stickler for the rules.
Why do people and businesses need escrow? Because most large transactions are complex, and with that complexity comes risk. Escrow is an attempt to hedge against that risk. Take for example the process of buying property. The buyer has some obligations to the seller, and vice versa. You need a system in place to ensure those obligations are met. So you put something — typically earnest money — into escrow to make sure both parties hold up their end of the bargain.
Given that, you can imagine how escrow could be useful in other large, lengthy transactions outside the world of real estate, especially in B2B transactions. Here, we breakdown the ins and outs — from types of escrow services to the fees associated with them.
How do businesses use escrow?
If you find yourself operating a business, it won't be long before you find yourself needing escrow services. These services are generally required when large sums of money are being transferred between businesses. This could be anything from a purchase of assets to an acquisition or merger. The details of these large transactions can take time to settle, so the funds for the transaction need to be kept in a safe place to ensure delivery when the transaction is complete.
These services can be used by business for many types of transactions, but they are most common on mortgages and other property transactions.
As you learn quickly when you buy a home or an office building, there's so much more to the cost than the actual cost of the property.
Most mortgages require the buyer to make a down payment and pay closing fees to complete the transaction. After that, the buyer is usually required to hold insurance on the property, as well as pay property taxes to local and state government. Often, those payments are assessed annually, and, equally as often, lenders need assurances that buyers will pay those costs when the time comes.
These are examples of situations where mortgage escrow comes into play. Funds are set aside in the mortgage escrow account to reduce the risk that they won't be available when the time comes. These services are critical for buyers and sellers to protect their interests while the transaction is being negotiated and finalized.
It's true; protection rarely comes for free.
When it comes to real estate transactions, costs vary by state, but generally you will pay an escrow agent a percentage of the cost of the property. The party responsible for those fees — the buyer, the seller or both — also varies by state.
At the end of the day, it's all about securing your investments — whether that be the purchase of a new home or software to build your business. And that's something we can get behind.
Want to learn more about how ADM can help you or your business with escrow services? Visit our Settlement & Escrow page or call us at 414-961-6600.


text:
Charley's Aunt
Posted by Victoria Weisfeld | Oct 30, 2018 | Reviews
Seamus Mulcahy as "Charley's Aunt" in an unguarded moment; photo: Jerry Dalia
By Vicki Weisfeld
Charley's Aunt, the 1892 farce that ran almost 1,500 performances in London's West End is remounted by The Shakespeare Theatre of New Jersey in a sparkling, fast-paced production directed by Joseph Discher that opened October 27 and runs through November 18. The author, actor Brandon Thomas, wrote several other plays, but this was his masterpiece.
As the play opens, St. Olde's College student Jack Chesney (played by Aaron McDaniel) is in his campus rooms, fretting over the draft of a letter to a young lady. He can't get the news of his attachment quite right, and her family is decamping to Scotland on the morrow. He's soon joined by his pal Charles Wykeham (Isaac Hickox-Young), suffering similar writer's block over his letter to another young lady in the soon-to-depart group.
Charley, an orphan, is further flustered by information that his wealthy aunt, Donna Lucia D'Alvadorez will be arriving mid-day to meet him. Though she's paid for his education from her home in far-off Brazil ("where the nuts come from"), they've never met. Jack soon concocts a plan to invite their lady-loves to luncheon in his rooms to meet Charley's aunt, who can provide a suitable chaperonage. But how to get rid of her when they want privacy? Jack hits on the stratagem of adding their amusing friend Lord Fancourt Babberly—"Babbs" (Seamus Mulcahy) to the party. He can entertain the old lady, surely.
Babbs arrives and mentions he's taken up amateur theatricals and is about to play an elderly lady in some production. (At this point, the direction of the plot is clear, which doesn't subtract a bit from the enjoyment!) The costume is produced, Babbs dons it, and almost simultaneous with the arrival of the young ladies is a note saying Donna Lucia's plans have changed and she cannot arrive for several days.
Poor Babbs is finagled into pretending to be the aunt and the fun is in full sway. More people join the luncheon party—Jack's father, Colonel Sir Frances Chesney (David Andrew MacDonald) and the father and guardian of the young ladies, Stephen Spettigue (John Ahlin), both of whom have an eye on the fetching (and wealthy) Donna Lucia.
Although the story starts a bit slowly, once the plot gets rolling, there's no stopping it. When Charley's aunt—the real Donna Lucia (Erika Rolfsrud)—arrives, sizes up the situation, and keeps her true identity secret in order to torment poor Babbs, the catastrophes and the laughs multiply.
The cast has a great deal of fun with the physical comedy and sight gags. (You'll love the after-dinner tea presided over by Babbs in Act Three.) All of those named above are up for the rapid pace of the shenanigans, including the three delightful ingenues: Emiley Kiser as Amy Spettigue (Charley's love), Erica Knight as Kitty Verdun (Jack's), and Sally Kingsford as Ela Delahay, Donna Lucia's companion. By maintaining his dignity regardless of the outrages he witnesses, Peter Simon Hilton's Butler is a perfect foil.
Ultimately, the real success of the production rests on the shoulders of Seamus Mulcahy. His Babbs—mugging, fleeing, angry, amorous—is a treat from beginning to end and well earned the enthusiastic standing ovation he and the cast received.
Brian Prather has designed three lovely sets that accommodate the antics; Natalie Loveland's costumes are charming; lighting design by Matthew Adelson, and dialect consultant, Julie Foh.
Shakespeare Theatre of New Jersey productions are hosted at Drew University in Madison, N.J. (easily reachable from NYC by train). For tickets, call the box office at 973-408-5600 or visit the Box Office online. Note that STNJ offers special ticket pricing of $30 for theatergoers under age 30!
Charley's Aunt
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Victoria Weisfeld
Vicki Weisfeld is an avid theater-goer and reviewer of stage, screen, and books at her website, vweisfeld.com. She lives in Princeton, New Jersey, and writes short stories, mysteries, and thrillers.
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