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Sartori S, Postorivo S, Vece FD, Ermili F, Tassinari D, Tombesi P. Contrast-enhanced ultrasonography in peripheral lung consolidations: What's its actual role? World J Radiol 2013; 5(10): 372-380
Sergio Sartori, MD, Section of Interventional Ultrasound, Department of Medicine, St Anna Hospital, Corso Giovecca 203, I-44100 Ferrara, Italy. srs@unife.it
Radiology, Nuclear Medicine and Medical Imaging
Brief Article
Contrast-enhanced ultrasonography in peripheral lung consolidations: What's its actual role?
Oct 28, 2013 (publication date) through Jan 22, 2021
World Journal of Radiology
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Radiol. Oct 28, 2013; 5(10): 372-380
Published online Oct 28, 2013. doi: 10.4329/wjr.v5.i10.372
Contrast-enhanced ultrasonography in peripheral lung consolidations: What's its actual role?
Sergio Sartori, Simona Postorivo, Francesca Di Vece, Francesca Ermili, Davide Tassinari, Paola Tombesi
Sergio Sartori, Simona Postorivo, Francesca Di Vece, Francesca Ermili, Paola Tombesi, Section of Interventional Ultrasound, Department of Medicine, St Anna Hospital, I-44100 Ferrara, Italy
Davide Tassinari, Oncology Unit, City Hospital, 47900 Rimini, Italy
Author contributions: Sartori S, Tombesi P, Di Vece F, Postorivo S designed the research; Sartori S, Tombesi P, Postorivo S performed the research; Tassinari D, Ermili F, Di Vece F collected and analysed the data; Postorivo S, Di Vece F, Ermili F wrote the paper; Sartori S, Tombesi P, Tassinari D revised it; Sartori S, Tombesi P, Di Vece F, Postorivo S, Tassinari D, Ermili F approved its final version.
Correspondence to: Sergio Sartori, MD, Section of Interventional Ultrasound, Department of Medicine, St Anna Hospital, Corso Giovecca 203, I-44100 Ferrara, Italy. srs@unife.it
Telephone: +39-532-236551 Fax: +39-532-239613
Revised: August 29, 2013
Accepted: September 18, 2013
AIM: To evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis between neoplastic and non-neoplastic peripheral pleuro-pulmonary lesions.
METHODS: One hundred patients with pleural or peripheral pulmonary lesions underwent thoracic CEUS. An 8 microliters/mL solution of sulfur hexafluoride microbubbles stabilized by a phospholipid shell (SonoVue®) was used as US contrast agent. The clips were stored and independently reviewed by two readers, who recorded the following parameters: presence/absence of arterial enhancement, time to enhancement (TE), extent of enhancement (EE), pattern of enhancement (PE), presence/absence of wash-out, time to wash-out, and extent of wash-out. After the final diagnosis (based on histopathologic findings or follow-up of at least 15 mo) was reached, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) of each CEUS parameter in the differential diagnosis between neoplastic and non-neoplastic lesions were calculated. Furthermore, an arbitrary score based on the ratio between the PPVs of each CEUS parameter was calculated, to evaluate if some relationship could exist between overall CEUS behaviour and neoplastic or non-neoplastic nature of the lesions.
RESULTS: Five patients were lost at follow-up before a conclusive diagnosis was reached, 53 lesions resulted neoplastic and 42 non-neoplastic. Enhancement in the arterial phase was observed in 53/53 neoplastic lesions and 30/42 non-neoplastic lesions. On the whole, 40/42 non-neoplastic lesions showed absence of enhancement or early enhancement (95.2%) vs 3/53 neoplastic lesions (5.7%). EE was marked in 29/53 (54.7%) neoplastic lesions and 25/30 (83.3%) non-neoplastic lesions, moderate in 24/53 (45.5%) and 5/30 (16.7%), respectively. PE was homogeneous in 6/53 (11.3%) neoplastic lesions and 18/30 (60%) non-neoplastic lesions, inhomogeneous in 47/53 (88.7%) and 12/30 (40%), respectively. 19/30 (63.3%) non-neoplastic lesions enhancing in the arterial phase had no wash-out in the venous phase, 11/30 (36.7%) had late and mild wash-out. Wash-out was early in 26/53 (49%) neoplastic lesions, late in 26/53 (49%), absent in 1 (2%); marked in 16/53 (30.2%), and moderate in 36/53 (67.9%). The delayed enhancement in the arterial phase showed a sensitivity of 94.32%, specificity of 95.2%, PPV of 96.2%, NPV of 93%, PLR of 19.81, and NLR of 0.06 in identifying the neoplastic lesions. All other parameters individually considered showed unsatisfactory values of sensitivity, or specificity, or both, in differentiating neoplastic from non-neoplastic lesions. The median of the overall arbitrary score was 3 (range 0-14) in non-neoplastic lesions, and 16.5 (range 7.0-17.5) in neoplastic lesions (P < 0.001). The correlation between the diagnosis of neoplastic vs non-neoplastic lesion and the score value was statistically significant (r = 0.858, P < 0.001). Based on the score distribution, a cut-off of 7.5 enabled to reach a sensitivity of 98.1%, specificity of 95.1%, PPV 96.3%, NPV 97.5%, PVR 20.1 and NVR 0.02 in differentiating neoplastic from non-neoplastic lesions.
CONCLUSION: CEUS could be useful in the diagnostic workup of pleuropulmonary lesions. A delayed TE or a score ≥ 7.5 suggest the neoplastic nature of a lesion.
Key Words: Thoracic ultrasonography, Contrast-enhanced ultrasonography, Pleuropulmonary diseases, Neoplastic lesion, Diagnostic accuracy
Core tip: Contrast-enhanced ultrasonography (CEUS) is widely used to characterize focal liver lesions. The lung has dual blood supply (pulmonary arteries and systemic bronchial arteries), and theoretically it should be suitable for CEUS evaluation of arterial vascularity. This study suggests that a delayed time to arterial enhancement or an arbitrary score based on the overall CEUS behaviour ≥ 7.5 have high sensitivity and specificity in suggesting the neoplastic nature of pleural or peripheral pulmonary lesions. CEUS could allow for discriminating between lesions which need invasive diagnostic procedures, and those which can be monitored with clinical and instrumental follow-up.
Citation: Sartori S, Postorivo S, Vece FD, Ermili F, Tassinari D, Tombesi P. Contrast-enhanced ultrasonography in peripheral lung consolidations: What's its actual role? World J Radiol 2013; 5(10): 372-380
URL: https://www.wjgnet.com/1949-8470/full/v5/i10/372.htm
DOI: https://dx.doi.org/10.4329/wjr.v5.i10.372
Despite the limits caused by the sound reflection at the aerated lung surface, in the last years transthoracic ultrasonography (US) has gained increasing interest in the evaluation of peripheral pulmonary lesions abutting the pleura[1,2]. However, the correlation between the US pattern of lung consolidations and their specific pathology is quite poor, and transthoracic US is mainly used as an alternative to computed tomography (CT) to guide percutaneous needle biopsy of the lesions, when endoscopic biopsy fails in yielding adequate tissue specimens[3,4,5].
Contrast-enhanced ultrasonography (CEUS) with second generation US contrast agents is increasingly used in the diagnostic imaging of abdominal organs. In particular, in Europe, Eastern Countries, and Canada it is recommended as the first-line technique for the characterization of focal liver lesions[6-8]. The lung has dual blood supply (pulmonary arteries and systemic bronchial arteries), and this peculiarity could theoretically be exploited by CEUS to characterize and differentiate lesions with different arterial supply. However, at present only few preliminary studies on the role of CEUS in the characterization of peripheral lung masses have been reported in literature, and most of them were mainly descriptive and gave conflicting results[9-14]. This prospective pilot study was planned to evaluate the possible role and diagnostic accuracy of CEUS in the differential diagnosis between neoplastic and non-neoplastic pleural and peripheral pulmonary lesions.
From October 2009 to October 2011, 100 consecutive patients (56 males and 44 females, mean age 61 years, range 24-89 years) with pleural lesions or peripheral pulmonary consolidations abutting the pleura were enrolled into this prospective study. The study was approved by Ethics Committee of our hospital and informed consent was obtained from each patient. The inclusion criteria were the following: age > 18 years; presence of a pulmonary peripheral mass depicted by chest Rx or CT, and visible at transthoracic US; diagnostic course still running; absence of known hypersensitivity to sulfur hexafluoride, pulmonary hypertension, class IV New York Heart Association heart failure[15], unstable angina, acute or recent myocardial infarction, or adult respiratory distress syndrome.
A preliminary US evaluation of the lesions was performed using a real-time sonography system equipped with a 3.5 to 5.0 MHz convex transducer and a 5.0 to 7.5 MHz linear transducer (Mylab 70 XVG Gold, Esaote, Genova, Italy) to identify the optimal acoustic window for CEUS examination, according to the lesion location and patient's body size[16-18]. CEUS was performed with a low mechanical index contrast-specific nonlinear technique (CnTI, Esaote, Genova, Italy) and an 8 microliters/mL solution of sulfur hexafluoride microbubbles stabilized by a phospholipid shell (SonoVue®, Bracco, Milan, Italy) was used as US contrast agent. Acoustic power was set at 40 kilo pascal for both high-frequency linear transducer and low-frequency convex transducer. All US and CEUS examinations were performed by one of two physicians (PT and SP) with at least 5 years of experience in CEUS examination of abdominal organs, and well experienced with US of the lung.
After iv administration of a bolus of 2.4 mL of Sonovue, the lesions were continuously examined for at least 180 s taking care to include a portion of normal surrounding parenchyma in the same US scan, in order to examine contemporaneously both the lesion and normal lung. If normal parenchyma could not be included in the same scan, or the mass was located at the basis of the lung, the surrounding chest wall, or the liver or spleen, were examined contemporaneously to the lesion. All CEUS examinations were recorded, stored and independently reviewed by the two operators.
First, each lesion was assessed for the presence or the absence (Figure 1) of enhancement in the arterial phase, defined as the twenty s period following the appearance of the first microbubbles in the lesion or the surrounding parenchyma (or the chest wall, the liver, or spleen). If the lesion showed arterial enhancement, the following parameters were then recorded: time to enhancement (TE), extent of enhancement (EE), pattern of enhancement (PE), time to wash-out (TW), and extent of wash-out (EW). TE was defined as early if it was observed contemporaneously to the normal lung, or before the enhancement of the chest wall, liver or spleen (Figure 2); and as delayed if it was observed at least 2 s after the enhancement of the normal lung, or contemporaneously to the enhancement of the chest wall, liver or spleen (Figure 3). EE was defined marked (Figure 4) or moderate (Figure 3B) with respect to the EE of the normal lung, the chest wall, the liver or spleen. PE was classified as homogeneous (Figure 4) or inhomogeneous (Figure 3B). TW was defined as early if it occurred within 60 s after the injection of Sonovue, as late if it occurred later, and as absent if it was not observed within 180 s after the bolus. EW was classified as marked or mild according to its entity with respect to the entity of the arterial enhancement. The parameters examined are reported in Table 1. If some discordance in the evaluation of the CEUS parameters occurred between the two readers, the clip was reviewed and discussed with a third reader (SS) and the final decision was reached by consensus.
Table 1 Contrast-enhanced ultrasonography parameters.
TE EE PE TW EW
Enhancement present Early (0-1 s with respect to normal lung) Late (≥ 2 s later than normal lung) Marked Moderate Homogeneous - - - - -
Enhancement absent Stop assessing CEUS parameters - - - - -
Wash-out Early ( < 60 s) Late (≥ 60 s) Marked Mild Absent
TE: Time to enhancement; EE: Extent of enhancement; PE: Pattern of enhancement; TW: Time to wash-out; EW: Extent of wash-out; CEUS: Contrast-enhanced ultrasonography.
Figure 1 Absence of arterial enhancement. A: transverse sonogram of the right chest wall in the sixth posterior intercostal space showing an inhomogeneous mass in the pleural space; B: transverse contrast-enhanced sonogram of the mass showing complete absence of enhancement in the arterial phase. Final diagnosis was haemothorax with a large clot.
Figure 2 Early arterial enhancement. A: Transverse sonogram showing parenchymal consolidation of the lower lobe of the right lung (arrow); B: Transverse contrast-enhanced sonogram in the arterial phase showing clear enhancement of the lung consolidation (large arrow); the enhancement of the liver is still starting (thin arrow). Final diagnosis was slow resolution pneumonia.
Figure 3 Delayed arterial enhancement. A: Tranverse sonogram of the left chest wall in the seventh intercostal space along the mid-axillary line showing an isoechoic pleural nodule, pleural effusion (thin arrows), and spleen (large arrow); B: Transverse contrast-enhanced sonogram in the arterial phase showing inhomogeneous enhancement of the nodule (thin arrow) that occurs contemporaneously to the enhancement of the spleen (large arrow) (left side of the split-screen); the enhancement of the nodule is less marked than that of the spleen. Final diagnosis was pleural metastasis from colon cancer.
Figure 4 Marked and homogeneous arterial enhancement. Left side of the split-screen: transverse sonogram of the left chest wall in the sixth intercostal space showing loculated pleural effusion (thin arrow) and pulmonary consolidation. Right side of the split screen: contrast-enhanced sonogram showing homogeneous and marked enhanced of the pulmonary consolidation with respect to the chest wall (large arrow). Final diagnosis was compressive atelectasis.
The final diagnosis was based on histopathologic findings (by endoscopic or percutaneous imaging-guided biopsy, or surgical exploration), or clinical follow-up. Clinical proof of malignant lesion was accepted if the patient was treated for malignancy and the clinical course and response to therapy were appropriate. Clinical proof of benign lesion was accepted if the lesion disappeared spontaneously or after treatment other than antineoplastic chemotherapy, or no change in size was observed for more than 15 mo.
After the final diagnosis was reached, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative PLR of each CEUS parameter in the differential diagnosis between neoplastic and non-neoplastic lesions were calculated. First, the presence vs the absence of arterial enhancement was evaluated. If the lesion showed arterial enhancement, each distinctive feature of TE (i.e., early or delayed) was compared to the other one plus the absence of enhancement. The other parameters of arterial enhancement were analyzed as well (marked vs moderate enhancement, and homogeneous vs inhomogeneous enhancement). Finally, wash-out features were evaluated (presence vs absence, early vs late, and marked vs mild or absent) for the lesions that had enhancement in the arterial phase.
Furthermore, an arbitrary score based on the features of all CEUS parameters examined was conceived, in order to evaluate if some relationship could be found between the overall CEUS behaviour and the neoplastic or non-neoplastic nature of the lesions. The absence of arterial enhancement or wash-out (when arterial enhancement was present) was scored 0. For each parameter of enhancement or wash-out, the feature with lower PPV was scored 1 and the other one was scored according to the ratio between the two PPVs (for instance, homogeneous enhancement: PPV 25%, score 1; inhomogeneous enhancement: PPV 79.7%, score 3.2). The sum of the scores assigned to each CEUS parameter yielded the overall score, and the median values of the overall scores of neoplastic and non-neoplastic lesions were compared by using the non-parametric Mann Whitney test. Finally, the relationship between neoplastic or non-neoplastic nature of the lesions and overall CEUS score was analysed by using the non-parametric Spearman test. An alfa error < 5% was assumed as statistically significant in both analyses. All statistical analyses were performed with a statistical software program (Stata 11.0 for Windows, Stata Corp., College Station, TX, United States).
The quality of CEUS examination was good in all patients and no adverse reaction to Sonovue was observed. Both high-frequency linear transducer and low-frequency convex transducer yielded the same quality of CEUS examinations. There was no concordance between the readers in TE and EW evaluation in 5/100 cases and 4/100 cases, respectively (r = 0.899, and r = 0.9, respectively). In all these cases final consensus was reached after collegial review and discussion of the CEUS clips.
Mean diameter of the lesions was 3.5 cm (range 1-12 cm). Five patients were lost at follow-up before a conclusive diagnosis was reached. The final diagnosis was based on a median clinical follow-up of 17 mo (range 7-26 mo) in 23/95 cases (3 neoplastic and 20 non-neoplastic lesions), and histopathological findings (63 endoscopic or percutaneous biopsies, and 9 surgical explorations) in 72/95 cases (50 neoplastic and 22 non-neoplastic lesions). On the whole, fifty-three lesions resulted neoplastic (40 primary tumors, 13 metastatic tumors), and 42 resulted non-neoplastic. All the 22 biopsy diagnoses of non-neoplastic lesion were confirmed by the clinical follow-up. The final diagnoses are reported in detail in Table 2.
Table 2 Final diagnoses.
Non-neoplastic lesions n Neoplastic lesions
Lost at follow-up (n)
Primary tumors n Metastatic tumors (origin) n
Slow resolution pneumonia 19 Adenocarcinoma 18 Colon 5 5
BOOP 5 Squamous carcinoma 5 Stomach 2
Abscess 4 Small-cell lung cancer 3 Testis (seminoma) 2
Pulmonary infarction 3 Indifferentiate carcinoma 6 Liver (HCC) 1
Organized pleural effusion 4 Sarcomatoid carcinoma 2 Breast 1
Post-surgical fibrosis 4 Mesothelioma 2 Indeterminate 2
Obstruction atelectasys 2 Schwannoma 2
Fibrotic plaque of the pleura 1 Plasmacytoma 1
Total 42 53 5
BOOP: Bronchiolitis obliterans organizing pneumonia; HCC: Hepatocellular carcinoma.
Enhancement in the arterial phase was observed in 53/53 neoplastic lesions and 30/42 non-neoplastic lesions. Arterial enhancement resulted absent in four organized pleural effusions, 1 abscess, 3 pulmonary infarctions, 3 post-surgical fibroses, and 1 fibrotic plaque of the pleura. TE was delayed in 50/53 neoplastic lesions (94.3%), and early in 28/30 non-neoplastic lesions (93.3%). On the whole, 40/42 non-neoplastic lesions showed absence of enhancement or early enhancement (95.2%) vs 3/53 neoplastic lesions (5.7%). EE was marked in 29/53 (54.7%) neoplastic lesions and 25/30 (83.3%) non-neoplastic lesions, moderate in 24/53 (45.5%) and 5/30 (16.7%), respectively. PE was homogeneous in 6/53 (11.3%) neoplastic lesions and 18/30 (60%) non-neoplastic lesions, inhomogeneous in 47/53 (88.7%) and 12/30 (40%), respectively. 19/30 (63.3%) non-neoplastic lesions with enhancement in the arterial phase had no wash-out in the venous phase, 11/30 (36.7%) had late and mild wash-out. Wash-out was early in 26/53 (49%) neoplastic lesions, late in 26/53 (49%), absent in 1 (2.0%); marked in 16/53 (30.2%), and moderate in 36/53 (67.9%). The results are summarized in Table 3.
Table 3 Enhancement and wash-out findings in non-neoplastic and neoplastic lesions n (%).
Wash-out
Early Delayed Absent Marked Moderate Homogeneous Inhomogeneous Marked Mild Absent Early Late
Non-neoplastic lesions 28/42 2/42 12/42 25/30 5/30 18/30 12/30 0/30 11/30 19/30 0/30 11/30
(66.7) (4.8) (28.6) (83.3) (16.7) (60) (40) (0) (36.7) (63.3) (0) (36.7)
Neoplastic lesions 3/53 50/53 0/53 29/53 24/53 6/53 47/53 16/53 36/53 1/53 26/53 26/53
(5.7) (94.3) (0) (54.7) (4.3) (11.3) (88.7) (30.2) (67.9) (1.9) (49) (49)
The delayed enhancement in the arterial phase showed a sensitivity of 94.32%, specificity of 95.2%, PPV of 96.2%, NPV of 93%, PLR of 19.81, and NLR of 0.06 in identifying the neoplastic lesions. All the other parameters individually considered showed unsatisfactory values of sensitivity, or specificity, or both, in differentiating neoplastic from non-neoplastic lesions. All analyses are reported in detail in Table 4.
Table 4 Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio of enhnacement and wash-out parameters.
Sensitivity Specificity PPV NPV PLR NLR
95%CI 95%CI 95%CI 95%CI 95%CI 95%CI
Present 100 28.6 63.9 100 1.4 0
100-100 14.9-42.2 53.5-74.2 100-100 1.21-1.59 --
Early 5.7 6.7 9.7 3.8 0.06 14.15
-0.719 -17.9 -20.8 -10.5 -2.24 12.8-15.5
Delayed 94.3 95.2 96.2 93 19.81 0.06
Enhancement 88.1-100.6 88.8-101.7 90.9-101 85.4-100.6 18.4-21.2 -2.2
Marked 54.7 16.7 53.7 17.2 0.66 2.72
41.3-68.1 3.3-30 40.4-67 3.5-31 0.36-0.95 1.86-3.57
Moderate 45.3 83.3 82.8 46.3 2.72 0.66
31.9-58.7 70-96.7 69-96.5 33-59.6 1.86-3.57 0.36-0.95
Homogeneous 11.3 40 25 20.3 0.19 2.22
2.8-19.9 22.5-57.5 7.7-42.3 10.1-30.6 -1.62 1.77-2.67
Inhomogeneous 88.7 60 79.7 75 2.22 0.19
80.1-97.2 42.5-77.5 69.4-89.9 57.7-92.3 1.77-2.67 -1.62
Marked 30.8 100 100 23.4 -- 0.69
18.2-43.3 100-100 100-100 11.3-35.5 0.5-0.87
Wash-out Mild 69.2 0 76.6 0 0.69 --
56.7-81.8 64.5-88.7 0.5-0.87
Absent 98.1 63.3 82.5 95 2.68 0.03
94.5-101.8 46.1-80.6 73.2-91.9 85-104.6 2.2-3.15 -3.92
Early 50 100 100 29.7 -- 0.5
36.4-63.6 100-100 100-100 15-44.5 0.23-0.77
Late 50 0 70.3 0 0.5 --
36.4-63.6 55.5-85 0.23-0.8
PPV: Positive predictive value; NPV: Negative predictive value; PLR: Positive likelihood ratio; NLR: Negative likelihood ratio.
The correlation data between PPV and values of the arbitrary score are reported in Table 5. The risk score was calculated in all the patients, with overall median value of 15 (range 0-17.5). In non-neoplastic lesions the median score was 3 (range 0-14), in neoplastic lesions it was 16.5 (range 7.0-17.5) (P < 0.001). The correlation between the diagnosis of neoplastic vs non-neoplastic lesion and the score value was statistically significant (r = 0.858, P < 0.001). Based on the score distribution, we found that a cut-off of 7.5 enabled to reach a sensitivity of 98.1%, specificity of 95.1%, PPV 96.3%, NPV 97.5%, PVR 20.1 and NVR 0.02 in differentiating neoplastic from non-neoplastic lesions.
Table 5 Arbitrary score based on the ratio between the positive predictive value calculated for each contrast-enhanced ultrasonography parameter.
PPV Score
Enhancement Absent 63.9 0
Early 9.7 1
Delayed 96.2 9.9
Marked 53.7 1
Moderate 82.8 1.5
Homogeneous 25 1
Inhomogeneous 79.7 3.2
Wash-out Marked 100 1.3
Mild 76.7 1
Absent 69.3 0
Early 100 1.4
Late 70.3 1
Absent enhancement or wash-out = 0; lower positive predictive value (PPV) = 1.
Thoracic US has become a well-established method to guide percutaneous biopsy of peripheral pulmonary lesions abutting the pleura, and is considered as effective as CT-guidance in terms of sample accuracy, with the advantages of lower cost, lack of exposition to ionizing radiation, shorter procedure time, and lower rates of post-procedural pneumothorax[19]. Despite the increasing applications of CEUS in the characterization of focal lesions of the liver and other abdominal organs[6-8,20], to date the use of second generation US contrast media in pleuropulmonary diseases is limited to improve the diagnostic yield of percutaneous biopsy[21,22]. The role of CEUS in the characterization of peripheral pulmonary lesions has been scarcely investigated, and the few preliminary studies published in literature were mainly descriptive and gave inconclusive and disappointing results[9-14,23]. The lung is characterized by dual blood supply: the bronchial arterial system, which provides nutrition for the bronchi, pulmonary vessels, alveoli, interstitial tissue, and visceral pleura; and the pulmonary arterial system, which is responsible for gas exchange[10]. Such a peculiarity could theoretically be exploited to differentiate pleural-based non-neoplastic lesions from neoplastic lesions, as the formers are supplied by both arterial systems, whereas tumor angiogenesis usually rises from bronchial arteries[12]. Therefore, a different TE should be seen in real time imaging, as the tissue enhancement resulting from the pulmonary arteries starts before the tissue enhancement resulting from the bronchial arteries. Moreover, a regular, dominant pulmonary arterial supply should lead to a more marked tissue enhancement than that observed in tissues only supplied by the bronchial arteries. CEUS represents the best imaging method to evaluate both the vascularity and transit time within an organ, as it enables the assessment of any time of enhancement during the arterial phase. Conversely, contrast-enhanced CT is an instant scanning modality, and can assess the vascularity only at a certain point in time during the arterial phase[24]
Although CEUS was shown to be as effective as CT in detecting peripheral lung cancer vascularisation[25] a prior study on 137 patients with pleural based lesions reported that CEUS did not allow to distinguish benign from malignant pulmonary consolidations[9]. However, 62% of malignant lesions had delayed TE, whereas 62% of inflammatory consolidations had early TE, and this observation was subsequently confirmed on larger and more recent series[10,11,26]. In our pilot study, delayed TE was observed in 94.3% of neoplastic lesions and in 4.8% of non-neoplastic lesions. A methodological defect could have biased the results of the above-mentioned studies. An arbitrary cut-off of six s after the iv bolus of the US contrast agent was used to define TE as early or delayed, because the time windows of pulmonary arterial vascularity and systemic bronchial arterial vascularity usually range from 1 to 5 s, and from 8 to 11 s, respectively[10,11]. However, a lot of physiological and pathological conditions, such as sitting or supine position of the patient, antiarrhythmic drugs, tachycardia, bradycardia, chronic heart failure, chronic pulmonary disease, hyperthyroidism and hypothyroidism, and so on, can modify the standard time window of both pulmonary and systemic bronchial arterial vascularities. Indeed, a wide variability in hepatic artery arrival time, ranging from 8 to 16 s, was observed even in healthy volunteers in a study investigating the hepatic transit time in healthy subjects and patients with liver metastases[27]. It follows that a cut-off based on the standard time windows of the pulmonary and systemic bronchial arteries can be misleading in the assessment of early or delayed TE. In our study, this potential bias was avoided defining TE as early if the enhancement in the lesion was contemporaneous to that of the normal lung, and as delayed if it appeared after the enhancement of the normal lung, or contemporaneously to that of the chest wall, liver, or spleen. In this way, a true early enhancement was observed in just three neoplastic lesions, probably due to a concomitant supply from pulmonary arteries, as described in some bronchioloalveolar carcinomas and adenocarcinomas[28]. Likewise, non-neoplastic lesions showed absence of arterial enhancement or early enhancement in all cases but two, in which the delayed enhancement was likely determined by a widespread vasoconstriction caused by hypoxia[10].
Conversely, and despite the theoretical rationale in favour of a more marked arterial enhancement in non-neoplastic lesions due to the dual blood supply, EE did not result useful to distinguish neoplastic from non-neoplastic lesions, as well as all the other CEUS parameters. The presence of enhancement and the absence of wash-out (when arterial enhancement was present) showed very good sensitivity in suggesting the neoplastic and the non-neoplastic nature of the lesions, respectively, but specificity of both parameters was quite poor; and the presence of early wash-out had a 100% specificity in predicting the neoplastic nature of the lesions, but an unacceptably low sensitivity. However, we analysed also the overall CEUS behaviour including all the CEUS parameters into an arbitrary score, either to limit the possible bias consequent to the subjective evaluation of a single parameter, or to explore the possibility of further improving the good performance yielded by the delayed TE. Indeed, the score was proven to be a reliable tool to differentiate the two populations, and the cut-off of 7.5 enabled to improve the sensitivity of the single CEUS parameter "delayed TE" in discriminating between neoplastic and non-neoplastic lesions.
Our study has several limits. First, US and even more CEUS are strictly operator-dependent techniques. However, an adequate learning curve can minimize the risk of high interobserver variability; indeed, in our study it resulted fairly low and limited to two CEUS parameters. Second, because of the low number of patients enrolled into this pilot study, benign neoplastic lesions were just 2/53, and both of them showed a CEUS behaviour comparable to that of malignant lesions. Consequently, our results suggest that CEUS can discriminate between neoplastic and non-neoplastic lesions, but it does not enable to distinguish benign from malignant neoplastic lesions. Finally, US and CEUS may represent useful tools to evaluate peripheral pulmonary masses, but they can not investigate central lung lesions.
Despite these limits, this prospective pilot study suggests that CEUS could play some role in the diagnostic work-up of peripheral lung lesions. If the results will be confirmed by wider series, a lesion with a CEUS score < 7.5 could undergo clinical and instrumental follow-up, whereas invasive diagnostic procedures could be reserved to lesions with delayed TE, or a score ≥ 7.5 if TE is not delayed.
The lung has dual blood supply (pulmonary arteries and systemic bronchial arteries), and this peculiarity could theoretically be exploited by contrast-enhanced ultrasonography (CEUS) to differentiate non-neoplastic from neoplastic lesions, as the formers are supplied by both arterial systems, whereas tumor angiogenesis usually rises from bronchial arteries.
Research frontiers
CEUS represents the best imaging method to evaluate both the vascularity and transit time within an organ, as it enables the assessment of any time of enhancement during the arterial phase. Conversely, contrast-enhanced computed tomography is an instant scanning modality, and can assess the vascularity only at a certain point in time during the arterial phase
Innovations and breakthroughs
A different time to arterial enhancement (TE) should be seen in neoplastic and non-neoplastic lesions, as the enhancement resulting from the pulmonary arteries starts before that resulting from the bronchial arteries. However, the few preliminary studies investigating the role of CEUS in the characterization of lung consolidations gave inconclusive and disappointing results. In all these studies, an arbitrary cut-off of six s after the bolus of the US contrast agent was used to define TE as early or delayed, because the time windows of pulmonary arterial vascularity and bronchial arterial vascularity usually range from 1 to 5 s, and from 8 to 11 s, respectively. However, a lot of physiological and pathological conditions can modify the standard time window of both pulmonary and bronchial arterial vascularities. Authors avoided this potential bias defining TE as early if the enhancement in the lesion was contemporaneous to that of the normal lung, and as delayed if it appeared after the enhancement of the normal lung, or contemporaneously to that of the chest wall, liver, or spleen. In this way, a true early enhancement was observed in just 3/53 neoplastic lesions, and the delayed TE showed a very high diagnostic accuracy in identifying neoplastic lesions. Moreover, a cut-off value of 7.5 obtained by a cumulative arbitrary score based on the ratio between the positive predictive values of all CEUS parameters investigated, was shown to further improve the diagnostic performance of TE.
The study results suggest that CEUS could play some role in the diagnostic work-up of peripheral lung lesions. Lesions with a CEUS score < 7.5 could undergo clinical and instrumental follow-up, whereas invasive diagnostic procedures could be reserved to lesions with delayed TE, or a score ≥ 7.5 if TE is not delayed.
Low mechanical index CEUS with second generation ultrasonography contrast agents is a technique that allows for real-time depiction of tissue micro- and microvascularity, and in the last years it is increasingly used worldwide in abdominal imaging; in particular it is recommended as the first-line technique for the characterization of focal liver lesions in most western and eastern countries.
This is an interesting and somewhat unique study to identify neoplastic lesions in the lung using contrast-enhanced ultrasound.
P- Reviewers Alicioglu B, Maruyama H, Martins WP S- Editor Gou SX L- Editor A E- Editor Liu XM
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3. Scisca C, Rizzo M, Maisano R, Monaco M, Ferrari M, Munaò S, Zavettieri M, Bonaffini O, Mare M, Rossi RT. The role of ultrasound-guided aspiration biopsy of peripheral pulmonary nodules: our experience. Anticancer Res. 2002;22:2521-2523. [PubMed] [DOI]
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5. Tombesi P, Nielsen I, Tassinari D, Trevisani L, Abbasciano V, Sartori S. Transthoracic ultrasonography-guided core needle biopsy of pleural-based lung lesions: prospective randomized comparison between a Tru-cut-type needle and a modified Menghini-type needle. Ultraschall Med. 2009;30:390-395. [PubMed] [DOI]
6. Claudon M, Cosgrove D, Albrecht T, Bolondi L, Bosio M, Calliada F, Correas JM, Darge K, Dietrich C, D'Onofrio M. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) - update 2008. Ultraschall Med. 2008;29:28-44. [PubMed] [DOI]
7. Wilson SR, Burns PN. Microbubble-enhanced US in body imaging: what role? Radiology. 2010;257:24-39. [PubMed] [DOI]
8. Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, Piscaglia F, Wilson SR, Barr RG, Chammas MC. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med. 2013;34:11-29. [PubMed] [DOI]
9. Görg C, Bert T, Kring R, Dempfle A. Transcutaneous contrast enhanced sonography of the chest for evaluation of pleural based pulmonary lesions: experience in 137 patients. Ultraschall Med. 2006;27:437-444. [PubMed] [DOI]
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14. Sperandeo M, Sperandeo G, Varriale A, Filabozzi P, Decuzzi M, Dimitri L, Vendemiale G. Contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions: a preliminary study. Ultrasound Med Biol. 2006;32:1467-1472. [PubMed] [DOI]
15. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston: Little, Brown & Co 1994; 253–256. [PubMed] [DOI]
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18. Stević R, Jaković R, Masulović D, Nagorni-Obradović L, Mujović N, Jovanović D. [Ultrasonography in diagnosis of thoracic diseases]. Med Pregl. 2010;63:86-90. [PubMed] [DOI]
19. Sconfienza LM, Mauri G, Grossi F, Truini M, Serafini G, Sardanelli F, Murolo C. Pleural and peripheral lung lesions: comparison of US- and CT-guided biopsy. Radiology. 2013;266:930-935. [PubMed] [DOI]
20. Piscaglia F, Nolsøe C, Dietrich CF, Cosgrove DO, Gilja OH, Bachmann Nielsen M, Albrecht T, Barozzi L, Bertolotto M, Catalano O. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med. 2012;33:33-59. [PubMed] [DOI]
21. Sartori S, Nielsen I, Trevisani L, Tombesi P, Ceccotti P, Abbasciano V. Contrast-enhanced sonography as guidance for transthoracic biopsy of a peripheral lung lesion with large necrotic areas. J Ultrasound Med. 2004;23:133-136. [PubMed] [DOI]
22. Cao BS, Wu JH, Li XL, Deng J, Liao GQ. Sonographically guided transthoracic biopsy of peripheral lung and mediastinal lesions: role of contrast-enhanced sonography. J Ultrasound Med. 2011;30:1479-1490. [PubMed] [DOI]
23. Caremani M, Benci A, Lapini L, Tacconi D, Caremani A, Ciccotosto C, Magnolfi AL. Contrast enhanced ultrasonography (CEUS) in peripheral lung lesions: A study of 60 cases. J Ultrasound. 2008;11:89-96. [PubMed] [DOI]
24. Zheng YL, Yin XY, Xie XY, Xu HX, Xu ZF, Liu GJ, Liang JY, Lu MD. Value of contrast-enhanced ultrasonography in assessing the vascularity of liver metastases: comparison with contrast-enhanced computed tomography. J Ultrasound Med. 2010;29:1403-1410. [PubMed] [DOI]
25. Wen Q, Liu XM, Luo ZY, Chen JJ, Hong YR. [Enhancement pattern of peripheral lung carcinoma: comparison between contrast-enhanced ultrasonography and contrast-enhanced computed tomography]. Zhonghua Yixue Zazhi. 2008;88:2779-2782. [PubMed] [DOI]
26. Linde HN, Holland A, Greene BH, Görg C. Contrast-enhancend sonography (CEUS) in pneumonia: typical patterns and clinical value-a retrospective study on n = 50 patients. Ultraschall Med. 2012;33:146-151. [PubMed] [DOI]
27. Zhang H, He Y, Du L, Wu Y. Shorter hepatic transit time can suggest coming metastases: through-monitoring by contrast-enhanced ultrasonography? J Ultrasound Med. 2010;29:719-726. [PubMed] [DOI]
28. Pezzella F, Pastorino U, Tagliabue E, Andreola S, Sozzi G, Gasparini G, Menard S, Gatter KC, Harris AL, Fox S. Non-small-cell lung carcinoma tumor growth without morphological evidence of neo-angiogenesis. Am J Pathol. 1997;151:1417-1423. [PubMed] [DOI]


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text:
Færder National Park covers 340 square kilometres of mainland, islands, skerries and sea bed in Færder municipality. It stretches from Ormøy in the north to Færder lighthouse in the south. The national park also encompasses the islands south of Hvasser, as well as Verdens Ende and Moutmarka.
Nearby national parks
In the middle of Oslofjorden, Færder National Park shares a border with Ytre Hvaler National Park.
Ytre Hvaler
Ytre Hvaler in turn borders Kosterhavet National Park in Sweden
Kosterhavet
Visiting the national park
Færder National Park lies close to major population centres and is one of Norway's most widely used national parks. The park's management plan recommends providing facilities for large numbers of visitors at Verdens Ende, in the Bolærne area and in the port of Tønsberg, which are all very close to the national park itself. These places should also provide visitors with useful information about the park and what it has to offer.
There are no plans to build new infrastructure within the national park itself. The main emphasis will be on simple, low-impact outdoor recreation. With that in mind, simple landing places, toilets and rubbish bins have been installed on the most popular islands. The idea is to make the park accessible to large numbers of visitors without harming it in the process, so that we don't "kill the goose that lays the golden egg".
Moutmarka and the large, polished rocks at Verdens Ende are an easily accessible but unique habitat. The fringes of the national park also offer lots of outdoor recreation such as walking, kayaking, swimming, fishing, etc. This includes the marked coastal paths around the north of Hvasser and on the west of Nøtterøy.
Færder National Park is managed by an executive board, made up of elected politicians from Færder Municipality and Vestfold County Council. The board has executive authority within the constraints of the rules on conservation.
Members of the Færder National Park Board
Roar Jonstang (Chair)
Bente Kleppe Bjerke (Vice Chair)
Rune Hogsnes
Karen Lie
Pål Syse
Deputy: Unni Hanson
Deputy: Carl-Erik Grimstad
Deputy: Nell Gaalaas-Hansen
Deputy: Arne Magnus Berge
Deputy: Monica Hofer Hagen
A national park manager acts as the secretariat for the Board. The manager is employed by the County Governor. The national park manager has a duty to ensure that the park's management is based on scientific principles, and that it complies with international obligations, national guidelines, the Norwegian Biodiversity Act and the Nature Conservation Regulations.
The Norwegian Nature Inspectorate (SNO) is responsible for the government's environmental field work, which includes monitoring environmental conditions. The SNO makes sure that visitors comply with laws and regulations, boats keep to speed limits, fishers do not break any laws and birds are not disturbed during the nesting season. The SNO also provides visitors to the national park with information about the countryside.
The coastal service often carries performs activities in Færder National Park. These include removing rubbish, cutting the grass, maintaining quays, buoys to mark swimming areas and sea stairs, and encouraging visitors to behave in a way that minimises the impact on the environment. The coastal service is jointly operated by the municipalities of Færder, Stokke and Tønsberg.
Read more about the coastal service
National Park Manager:
Bjørn Strandli
Mobile phone: 997 44 225
Email: fmvebvs@fylkesmannen.no


text:
Chinese video gamer survives being stabbed through the head after cheating row
By Mail Foreign Service
An astonishing picture has emerged that shows a teenage boy with what appears to be a 10-inch knife embedded in his skull after a row over a computer game.
Chinese media have reported that the boy was playing the online game Counter-Strike with his friends at an internet cafe when the attack occurred.
Xiao Wei, 16, of Mishazi town, in north-east China's Jilin province, even walked to the 2nd Affiliated Hospital of Jilin University with the help of his friends.
Lucky escape: The teen had the knife plunged through his head after fellow gamers accused him of cheating
The cleaver was stabbed into Wei's left temple, leaving only the handle protruding, and exited 1cm from his right temple.
'His face was covered in blood, but he was still conscious,' said Professor Yan Shijun, deputy director of neurosurgery department of the hospital.
Wei and his friend Huang were playing Counter-Strike and defeated most of the 'enemies' in the virtual world.
Alive: Wei lies on the operating table as doctors prepare to remove the blade from his head
'When we were playing games, a group of people from the same cafe came to us, saying we must install some software to win the game. Then we had an argument with them,' said 18-year-old Huang.
Wei and Huang were allegedly pulled out of the cafe and beaten to the ground outside.
Huang said: 'My left arm was stabbed through by them, and when they had gone, I found Xiao Wei was lying on the ground with a knife in his head.'
Gaming website Gamer Crave reported that the attackers had accused Wei of using a cheat code that allowed his character in the game to see through walls - making it easier to locate opponents.
Dr Yan said it was the first time during 23 years of medical practice that he'd seen a patient remain conscious after being stabbed through the head.
X-rays and CAT scans confirmed that the cleaver luckily didn't hit any main arteries or nerves. However, the patient may have post-surgery complications like infections, brain damage, epilepsy fits, and tetanus.
Doctors operated for more than two hours to take out the knife, which has a blade measuring 14cm.
Wei's father said his son quit school last year as an 8th grader: 'He then worked from time to time, and spent most of the time at the internet cafe. We would never expect he would have such injuries at a cafe.'
Doctor Yan said last Wednesday that Xiao Wei had woken up from the surgery, and his condition was stable.
Police have obtained CCTV footage from the cafe and are continuing their investigation.
Chinese video gamer survives being stabbed through the head after cheating accusation


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The architecture of future homes will evolve on an entirely different basis from today's houses. The structural elements would be flexible and coherently arranged to best serve individual preferences.
Houses would be prefabricated using a new type of pre-stressed, reinforced concrete with a flexible ceramic external coating that would be relatively maintenance free, fireproof, and impervious to bad weather. The construction of their thin shells can be mass-produced in a matter of hours. Furthermore, with this type of construction, there would be minimal damage to homes from natural disasters.
The interior of smart homes would have no source of light in the form of lamps and hanging fixtures. Instead, all the walls would evenly illuminate — either the entire inner surface or particular areas. One would also be able to specify the colour and intensity of the illumination.
Thermopanes would be used to tint out bright sunlight by variable patterns of shading. All these features could be selected by the occupants to supply more than enough of the energy required to operate the entire household.
The buildings would be designed as self-contained residences with their own thermal generators and heat concentrators. Photovoltaic arrays would be built into the skin of the building and into the windows themselves.
A considerable amount of water can be saved by designing bathroom installations into one system. A shower, sink and toilet moulded into one system would be the simplest type of bathroom that would only use one sixtieth the amount of the water used in today's more common bathrooms. Waste water from the shower and sink would automatically fill the toilet; so instead of telling people to save water, there would be a system built in.
Cleanliness and hygiene will become major features of future homes. By building in several sensory devices, homes would be able to detect fire, toxic materials — anything that may threaten the life of a human being. With these nervous systems built in, future homes would be smart homes.
When you leave the building the entire building is clean. With a slight increase in air pressure in the building, no dust would be able to come in from outside. If there are any contaminants in the air it would increase the electrostatic charge, which removes contaminants.
For apartment buildings and other large structures, Fresco has devised a cybernated construction system. The idea is that computer-controlled robots would handle 90% of the movement and placement of prefabricated components. Special advanced materials are to be developed, eliminating waste and minimising the need for manual labour. Guided by satellite, and using a sophisticated form of artificial intelligence, the buildings will actually construct themselves — a technique Fresco has named "self-erecting structures".
One of the most interesting aspects of tomorrow's civilisation is that people's homes will change as the people living within them change. As people's needs and dimensions of knowledge grow, so will the environment in which they live.
IMAGINE living in a house that is permanently dust free, driving a car that automatically repairs itself, traveling at two thousand miles an hour in absolute comfort, and having the chances of getting ill significantly reduced by living in a city that self regulates it's air and water by design. These idealistic-sounding goals are more possible than you might imagine.
Future by Design is quite honestly the most inspiring documentary I have ever seen that illustrates just how possible and practical such things are. There is, however, a bittersweet quality to the film: on the one hand it shows how technologically advanced and capable we are – illustrating how the world could be today rather than tomorrow or in the future. On the other hand, it describes how behind we are politically and how future progress is painfully halted due to certain systems set in place.
Thomas Edison had to actually make an electric light bulb before anyone took him seriously and backed him up. The same scenario can be said of Jacque Fresco – the man behind Future by Design. Fresco has been a social and industrial engineer and inventor all his life. Now in his 90s, he still invents and implements his ideas for a new, re-designed society – focusing his attention on The Venus Project – a small 25 acre 'futuristic' society located in Venus, Central Florida.
Developed since the late 1970s, The Venus Project is a living model of how hi-tech and nature can co-exist. The small society consists of a scattering of dome shaped homes co-existing in a lush, natural environment. You cannot see one house when you're in another and the entire project represents how sustainable communities could be created worldwide.
And it isn't necessary for one to have studied science or design in order to understand Fresco and his working concepts. I found my jaw on the floor as he presented designs (in all fields) that simply made so much practical sense.
Even more appealing was the social philosophy behind each idea – that being to improve the standard of living for all people while simultaneously saving the planet. As an engineer, Fresco's ideas are not part of his own view of how the world should be, but rather how the world could be today and what it takes to start progressing towards it.
A dome-shaped home requires the least amount of material to build and offers the maximum protection against the elements due to its shape.
By increasing the air pressure slightly inside the home, dust will not be able to enter it. Cleanliness will be a major factor in the future home environment.
There is a type of memory alloy that reshapes itself when heated. Cars made from this material will straighten out any dents when heated (assuming that accidents will even happen in the future).
Sensors installed in the front of vehicles can detect how far away other objects are and keep a constant distance between them.
Travelling underwater is likely to become the future of sea travel as it is far more economical than travelling on the surface of the ocean where one is confronted by wind and waves.
A long, thin boat that breaks the surface tension of the water by rapidly releasing air bubbles at the front while simultaneously drawing water towards the rear (propelling it forward) will be able to travel very economically at remarkable speeds.
Having computers and machines continuously regulate the air and water supplies of cities and eliminating contaminants will significantly reduce viruses and disease.
The real appeal of Future by Design is the idea of creating harmony between people and nature. The Earth is far more abundant that what we are made to believe and there are even ways of making the planet more abundant by improving nature and applying design technology intelligently.
It is a sad reality that we live in an age where more time and technology is devoted to destroying humanity rather than advancing it; where global equality is greater than it has ever been; where more resources are invested in making a bigger, better bomb rather than providing clean drinking water where it's needed.
The standard of living proposed by Fresco and films such as Future by Design is by no means perfect; it is just significantly better. After all, the blunt truth is that no one knows what the future might bring, only that we can do a lot better with regards to the intelligent management of the Earth's resources for the benefit of all the world's people and protection of the environment.
What can be accurately predicted is that the future of communication lies in 3D imaging, and I would therefore urge everyone to give Future by Design a watch. It should appeal to anyone who has an interest in technology, ecology, people, design and society, and the possible future of our civilization.
MANY people maintain the belief that nothing is free in today's world. While this may be true in the physical world, there is plenty of free stuff on the web (if you know where to look). This is particularly true with regard to creating and developing your very own website.
Several web developers simply coin it by creating sites for individuals who don't know any better. Granted there are several brilliant website designers who deserve to be paid well for their expertise. However, there are others who will charge a hand and a foot to create something that you could quite easily create yourself for free.
Blogging is the most free form of beginning a journey in website design and development. One is able to choose a ready-made design from a large library of templates, publish posts to your heart's content and make use of a variety of free-to-use tools. Taking things to the next level, however, is a different story and often involves having to spend something.
There are several website builders that label themselves as "free" yet there is always a catch. Basically the beginning stages are free, but the hidden agenda becomes apparent once you become excited about website building and want to take things a little further.
Nevertheless, I have come across two website-building sites that I would like to share with anyone interested in self-taught web design. After all, teaching oneself a new skill, whatever that may be, should always result in the warm and fuzzy feelings of self-satisfaction.
Doodlekit is a fully hosted free website builder and content management system that claims to be the quickest and most advanced website tool available. That is a mighty claim which is surely shared with several other website builders.
However, I would agree that Doodlekit is at least easy to use. First-timers may not be able to design a website "within minutes" yet can at least doodle with designing for as long as they please without any charge.
What's also great is that the site doesn't require the installation of any software – all aspects of it are done online via the Doodlekit website.
350 pages markets itself as the "quick and easy website builder" that is "fun and flexible". They're also convinced that us 'ordinary' folk can produce a professional-looking website in minutes, if not "seconds!".
The site does have some great features though, despite being a little over-appealing (a typical tactic used to rope one in). It is a bit more professional than Doodlekit in the sense that it allows one to fully customise each heading, button bar, logo, divider, image and photo gallery, and even goes as far as allowing the customisation of fonts, styles and colours. Such stylistic changes are often deep in the realm of professional web design.
What's also great about both these design tools/websites above is they don't require you to do any coding whatsoever. Specifically with 350 pages, layout is as simple as dragging and dropping content using your mouse.
It may be a sad reality for web developers who slogged away for years learning HTML, but a warm welcome to those who don't know an "<a href>" from an "<align-left>" code.
A particularly pleasant feature of 350 pages is that it offers a library of video tutorials to get you started. The only catch (as the title suggests) is that you can only design up to 350 pages for free before having to pay anything.
Yet this isn't really a catch, because if you get as far as 350 pages you should have built up enough confidence and web design skills to take things into your own hands. I wish you many hours of happy doodling.
IT must be good to be Google. Bringing joy and information to millions around the world every day, while earning billions in the process must feel really fulfulling. Getting the opportunity to work for Google is the dream job of many Internet junkies.
I've always imagined that the job of creating customised versions of the Google logo is one of the most coveted in the company. Imagine being asked what you do for a living and being able to repspond with, "oh I'm just doing a little graphic design work at the moment creating logos. Have you ever heard of Google?" You'd have Internet geeks polishing your shoes and bringing you freshly-squeezed orange juice.
However, it seems that this is not the case. There is no single Google King-God who is the master behind every customised logo. That is why it is usually just the standard blue, red, yellow and green logo.
But, every little now and then we are pleasantly greeted by a customised logo — creatively crafted to commemorate a significant event in history or to celebrate an important person's birthday. I've been excited to see these appearing more often than usual, which is largely due to a new annual Doodle 4 Google competition, and 2009 has seen some of the best designs yet.
It's really worth doing the above for you may be missing out on these visually-pleasing bits of knowledge. When a customised logo appears hover your mouse over it to get a description of what it's all about. If intrigued enough, click on the logo to be presented with a wealth of information on the event.
So, without any further ado I present you with some of the top logos and best designs for 2009.
Google displayed this logo on July 22, 2009 on Google China and Google India homepages to commemorate the longest solar eclipse in both countries for at least a century. The solar eclipse lasted as long as six minutes and 39 seconds in some places. This eclipse is also considered as one of the most watched eclipses of all time because of the path it takes, it is clearly visible from some of the most densely populated places on earth.
400 years ago (on August 25, 1609), the Italian astronomer and philosopher Galileo Galilei showed Venetian merchants his new creation — the telescope. The instrument was to bring him both scientific immortality and, more immediately, a whole lot of trouble. Galileo's discoveries were, perhaps predictably, not best welcomed by the Catholic Church, and he spent the final decade of his life under house arrest.
Google pays tribute to comics by displaying this logo (on July 23, 2009) with the launch of a new super Google logo by DC artists Jim Lee, Scott Williams and Alex Sinclair. The logo marked the start of Comic-Con festivities.
On May 17, 2009, Google celebrated the birth anniversary of Igor Fyodorovich Stravinsky by displaying this logo on all its homepages. Igor Fyodorovich Stravinsky (June 17, 1882 to April 6, 1971) was a Russian composer, pianist, and conductor, who was considered by many to be one of the most important and influential composers of 20th century music. He was a quintessentially cosmopolitan Russian who was named by Time magazine as one of the 100 most influential people of the century. In addition to the recognition he received for his compositions, he also achieved fame as a pianist and conductor<!–, often at the premieres of his works.
On July 10, 2009 the Google logo was transformed into a Tesla Coil to celebrate the birthday of Nikola Tesla. Tesla (July 10 1856 to January 7, 1943) was an inventor and a mechanical and electrical engineer. Tesla is often described as an important scientist and inventor of the modern age, a man who "shed light over the face of Earth". He is best known for many revolutionary contributions in the field of electricity and magnetism in the late 19th and early 20th centuries. Tesla's patents and theoretical work formed the basis of modern alternating current (AC) electric power systems, including the polyphase power distribution systems and the AC motor, with which he helped usher in the Second Industrial Revolution.
Google celebrates the anniversary of first manned spacecraft (The Eagle – Apollo 11), which landed on the moon on July 20 in 1969.
Google celebrates the birth anniversary of Mary Cassatt (May 22, 1844 to June 14, 1926). Mary Cassatt was an American painter and printmaker. She lived much of her adult life in France, where she befriended Edgar Degas and later exhibited among the Impressionists. Cassatt often created images of the social and private lives of women, with particular emphasis on the intimate bonds between mothers and children.
The Perseids are a prolific meteor shower associated with the comet Swift-Tuttle. Meteor showers occur when the Earth moves through a meteor stream. The stream in this case is called the "Perseid cloud" and it stretches along the orbit of the Comet Swift-Tuttle. The cloud consists of particles ejected by the comet as it passes by the Sun. Most of the dust in the cloud today is approximately 1 000 years old. The shower is visible from mid-July each year with the greatest activity between August 8 and 14, peaking on August 12. During the peak, the rate of meteors reaches 60 or more per hour. They can be seen all across the sky, but because of the path of Swift-Tuttle's orbit, Perseids are primarily visible in the northern hemisphere.
AOL.com (the web portal of America Online), was a powerful player in the early days of the Internet, but has lost ground since then due to stiff competition. However, it is currently refashioning itself as a popular one-stop portal.
The web portal rolled out a redesigned homepage yesterday which it hopes will become a central station of sorts for Internet travelers by letting people coordinate social networks, email accounts and more without switching from site to site.
The move comes a month after AOL.com, the number four gateway to the web after Google, MSN and Yahoo, revamped its homepage to allow users to preview outside email accounts without having to navigate away from the homepage.
The new RSS feed browser allows users to receive news from other websites and display it in scrollable window at the bottom of the page. Entering the name of a US city or zip code provides a feed of local news and weather.
Another feature labeled "Themes" gives users the possibility of personalizing the homepage by choosing a color or backdrop of their own design. The functionality of the new site is allowing users to create their own personalised one-stop portals.


Learn with Play at Home: Doc-tober on Disney Junior. Promoting health and wellbeing for children with technology.
Disney Junior is the #1 Preschool Subscription TV channel that brings Magical Storytelling into the homes of young children, through engaging stories and endearing characters. The thing that I love the most about the Disney Junior characters is the way that they have been designed to deliver stories of generosity, teamwork and kindness to others. They are written and delivered in a way that promotes health and wellbeing for younger children.
I have found, as a teacher and a parent, that it is often when children see and hear the same messages and lessons they've heard from their parents/caregivers, delivered by others (ie. teachers, relatives, friends, television shows, games), that really reinforces and drives the message home. And, as children can be very influenced by what they see on television, it's important we're choosing shows that include the same values that we aim for and share the same messages we are teaching.
For the month of October, Disney Junior are running Doc-Tober where they are showcasing the loveable Doc McStuffins character and all her toy friends through new episodes on the Disney Junior TV channel (including the introduction of Doc's new mobile clinic, the Doc-Mobile) as well as new Doc games and activities on DisneyJunior.com.au.
Doc McStuffins is a 6 year-old girl who wants to be a doctor just like her Mother. She has a magical stethoscope that brings toys to life and she treats and cares for toys out of her backyard clinic and the new Doc-Mobile.
My kids really enjoy watching the show and I love that as well as each episode being full of good advice for children, they each have their own overlying message that is woven into each episode. Themes covered include important reminders for children's health and wellbeing such as always wearing your seatbelt or why it's important to get enough sleep. The series has also inspired a lot of role play in our house.
Maddie (aged 5) and I checked out the Disney Junior website and she enjoyed a turn playing the new Doc Mobile games available for this month. To see them in full and have access to all the features, be sure to view via your laptop or desktop computer.
"It's important to exercise everyday to stay strong and flexible"
"Staying hydrated will help you be healthy and feel great"
"Remember to get plenty of rest so that you can recharge your energy"
These were delivered in a fun and engaging way for children and in context that they could understand and relate to their own life. This is how children learn best. It is great to play games that challenge children but also allow them to feel success.
In addition to the games there are also partial episodes available for you to watch online as well as a range of colouring sheets and activities such as the Well-being Chart shown above.
The shows are all accessible via Foxtel and Fetch (neither of which we currently have at our house) with Disney Junior's core TV Shows, Sofia the First, (we made princess cone hats and hosted a princess tea party while learning all about good manners thanks to Sofia the First), Jake and the Never Land Pirates and Doc McStuffins shown on free-to-air TV in Australia on Ch 7 (Sunday mornings 6-7am) and 7mate (Tues-Fri morning 7-9am).
You can also purchase DVDs of the shows, access via itunes and check out the Disney Junior website.
Do your children watch any of the Disney Junior shows? Which are their favourites?
It is definitely nice to see strong, smart female characters.
My four year old loves to watch Disney Junior when he's at his Grandparents (we don't have pay TV at home) and he always comes home singing all the songs. I must see about recording Jake and the Neverland Pirates as I think he'd love that but we don't do morning TV.
We don't have pay TV but I like the online games. I appreciate the educational thought that is underneath these programs for kids.
Oh wow, we have Fetch TV but we've never watched this. We'll definitely check it out. The website looks great too. Thanks!
We're really careful about which shows we let our kids watch, and record ones we like so I know what they are watching and when. We watch playschool, wiggles, octonauts, charlie and lola, angelina ballarina and guess how much I love you. I haven't seen Doc McStuffins yet and it sounds great, thanks for the tip, I'll look out for it!
It's important, as you say, to monitor the amount of screen time children are getting but it's great such things as this now exist. We were so limited in what we could watch as children because aside from maybe Sesame Street, there wasn't anything educational. Thanks for sharing.
This show hasn't come across my radar but maybe my kids are moving out of this age group - I like the idea of a main character who is a female Dr.
My big girl loves Doc McStuffins and Jake & the Neverland Pirates. I love that I know they are both age appropriate in a world full of plenty of content that is most definitely not.
Kids tv has certainly changed since my kids were little!
My twins just love the Doc and I really like the message it sounds out to young girls too. Maddie looks like she is having such fun with those games and goodness she is growing up isn't she?!! Thanks for sharing those links, will check them out!
What a cool looking show, we haven't seen it yet, will have to look out for it. That chart is awesome.
We also love Disney Jr. in our home. I'm a particular fan of the Jake and the Neverland Pirates series. Thanks for this post showcasing another of their great shows.


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See Zac Efron Fight Taron Egerton to Replace Hugh Jackman as Wolverine in Fan Art
Shubam Koundel
While Hugh Jackman Has played as Xmen's Wolverine for the longest period before retiring a few years back and said he won't be playing the role of Wolverine anymore. That means the role is up for grabs and fans believe that Zac Efron would be the best fit to play the role of Wolverine. But some Other fans believe Taron Egerton Should play the part and why not Zac Efron. Let's see how fans imagine their favorite starts playing the role of Wolverine.
First up is Zac Elfron
Now in this fan art, we can see how Zan Efron is converted in almost like Wolverine. The fans believe that Zac Efron has the face and well body to play the role.
Know that shooting is going on For Guardians of Galaxy: volume 3 and Marvel is about to drop some news characters like Adam Warlock and a Twitter page confirmed that the Movie is looking for some on to play the role of wolverine or someone like Zac Efron.
There is no casting underway for Vol. 3. And in what world would I only cast a "Caucasian" if the character has gold skin? And if I wanted a Zac Efron type wouldn't I go to Zac Efron? Where do you get this nonsense? https://t.co/dxZJUMvtVs
— James Gunn (@JamesGunn) March 10, 2021
But the rumor was almost shot down by the director of the movie James Gunn and replied instead of posting this nonsense why he wants someone like Zac Efron when he can just get him only. But he told me There has no such casting going on for any kind of part too.
Let's Talk About how Taron Egerton could be the one playing Wolverine?
Taron Egerton is Famous for their role in the Kingsman franchise and he is also been in the most action scenes and fans believe he would be the best fit for the role of Wolverine. He is also looking like a wolverine and imagined by some fans in this fan art that he could be the next wolverine. While Taron Egerton has been giving huge hits in the Kingman universe he could have been already approached for the role of Wolverine.
Why are fans so hyped about the next Wolverine?
The fact is Wolverine is one of the strongest characters in the Marvel universe and since marvel and sony have acquired rights from Disney there is the possibility that we could be seeing the Wolverine in the Marvel universe now and many other characters. The Future of wolverine and the mantle has to be handled by some in the future and the talks are already around the town for who possibly be the next Wolverine.
Why is it so important?
Not only Marvel but also Xmen's future also depends on the new wolverine and wolverine is just a huge character to play with after Hugh Jackman when the bar was set high by the legend himself. A new Wolverine will just not be enough, it will open the possibilities of him entering with and being seen with other characters such as Deadpool too. We hope only the best one is selected and this score is settled once and for all by the Directors and announce who is there as the next Wolverine.
Tom Hardy BATTLING Henry Cavill To Become the Next 007 After Daniel Craig's Exit
SPOILERS: Major CHARACTER DEATH in Stranger Things Season 4 Has Fans Worried


Hans Asperger, a leader in autism research study whose name is utilized to explain high-functioning individuals with the condition, had a formerly unidentified dark past that consisted of sending out kids with specials needs to a "euthanasia" program run by the Nazi routine, inning accordance with brand-new examinations into his long-lost files.
The brand-new findings expose that Asperger was far from a bold protector of his clients versus" euthanasia" by the Nazis, as many individuals believed. Rather, he gained from his cooperation with the routine and "openly legitimized race health policies, consisting of required sanitations," inning accordance with a research study released online the other day (April 19) in the journal Molecular Autism.
Hans Asperger (1906-1980) discussed autismin the late 1930 s and early 1940 s, however it was Leo Kanner's well-known 1943 paper that prepared for explaining the condition, which is now specified as a neurodevelopmental condition that impacts an individual's capability to interact, communicate and act normally with others in social circumstances.
Regardless of Asperger's early deal with autism, he was forgotten by history up until 1981, when researchers discovered and advertised his work. His research study ended up being so popular that the term "Asperger's syndrome" was utilized to describe individuals on the high-functioning end of the autism spectrum, who in some cases call themselves Aspies.
However over the last few years, scientists began discovering worrying ideas about Asperger's behaviorduring the Nazi duration in Austria, where he lived. These ideas stimulated the research study of Czech, along with Edith Sheffer, a senior fellow at the Institute of European Research Studies at the University of California, Berkeley, whose book "Asperger's Kid: The Origins of Autism in Nazi Vienna" (W. W. Norton & & Co., 2018) is due out Might 1.
The brand-new discoveries are mainly based upon proof that was long believed to have actually been ruined throughout The second world war: Asperger's individual files, political evaluations by Nazi authorities and medical records from various organizations, consisting of the well-known kid "euthanasia" center Am Spiegelgrund, Czech stated.
While Asperger never ever signed up with the Nazi celebration outright, he belonged to a number of groups associated with the routine, and was rewarded for his commitment with profession chances, Czech discovered. Furthermore, case records from his Jewish clients expose that "Asperger had a severe sense of their spiritual and 'racial' otherness which anti-Semitic stereotypes in some cases discovered their method into his diagnostic reports," Czech composed in the research study.
Nevertheless, Asperger's darkest actions focus on his deal with Am Spiegelgrund, where numerous kids with specials needs were explored on or killed, Czech stated.
For example, in 1941 Asperger referred the "helpless cases" of 3-year-old Herta Schreiber and 5-year-old Elisabeth Schreiber (no obvious relation to Herta) to Am Spiegelgrund, records reveal. Both little ladies had psychological specials needs and passed away of pneumonia not long after getting to the center. In specific, Herta Schreiber was most likely offered barbiturates that eventually caused her death, Czech discovered.
Asperger was likewise part of a committee that examined the cases of 200 kids in a psychiatric healthcare facility, calling 35 of them "uneducable" and "unemployable," words that marked the kids for "euthanasia," Czech discovered. It's challenging to understand exactly what took place to these kids due to the fact that the report does not note their names, however a lot of them most likely passed away as an outcome of these harmful medical diagnoses, Czech stated.
In spite of these discoveries, Czech stated that individuals should not think about Asperger's contributions to the field of autism to be polluted, nor must he be purged from the medical lexicon. "Rather, it must be viewed as a chance to cultivate awareness" about the unpleasant conditions where autism researchand Asperger's contributions to it emerged, she stated.
However Sheffer, the author of the brand-new book, busily disagrees.
On the other hand, the term Asperger's syndrome is being phased out– not due to the fact that of Asperger's past, however due to the fact that psychiatrists state that it falls under the umbrella of autism spectrum disordersand ought to simply be described as autism.
The Diagnostic and Analytical Handbook of Mental Illness (DSM), the American Psychiatric Association's guide for medical diagnosis, stopped consisting of Asperger's syndrome in the DSM-5, which came out in 2013.
Exactly what's more, the International Category of Illness (ICD), which is utilized by the World Health Company, will likely drop Asperger's syndrome in the ICD-11, which is due out in 2019, Adam McCrimmon, an associate teacher of instructional research studies at the University of Calgary, composed in The Discussion.


The Aircircle has all the controls you need to start recording videos, capturing screenshots, or accessing your Mobizen videos and settings. However, sometimes it can be distracting during a recording. You can choose whether or not you would like the Aircircle.
Navigate through your Mobizen Settings to the Aircircle options.
Here, toggle ON/OFF the aircircle.
Clean mode not only takes away the aircircle, it gives you an absolutely clean screen by disabling touch points, watermark, recording time, and facecam features.
Navigate to Clean Recording mode by accessing the Mobizen Settings tab.
Here, toggle ON/OFF Clean Recording Mode.
Allows you to record with a clean screen by disabling the Aircircle, Watermark, Recording time, Front Camera (Facecam, PiP) features all at once.
Allows you to record while only disabling the Air Circle and you can manually choose which other features(Watermark, Recording time, Front Camera) you would like to disable.


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Check back for our 2020 Speaker Announcement & Date!
The YWCA Inspire Luncheon has earned its reputation as the most powerful non-profit event in the Silicon Valley.
The Inspire Luncheon attracts over 1,800 attendees, including corporate and community leaders, elected officials and Silicon Valley professionals. Funds raised support the agency's community programs and services that annually serve more than 18,000 women and families.
Each year, we host an influential keynote speaker whose aim is to inspire the Silicon Valley community. Past speakers have included Gloria Steinem, Jane Goodall, Helen Hunt, Geena Davis, Jackie Joyner-Kersee, Billie Jean King, Alfre Woodard, Janet Reno, Benazir Bhutto, Elizabeth Smart and Anita Hill.
The Luncheon also features the presentation of the YWCA Empowerment Award, which celebrates and honors women in our community who are advocates and ambassadors for change. These women are champions – strong, resilient and dedicated to sharing their journey so that other women will become empowered to do the same.
Your generosity and support at this event ensures that YWCA programs and services continue to change the lives of women and families in our community. Can't wait to see you at next year's luncheon.
adminInspire Luncheon 10.27.2018


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Today, Marvel Studios and Sony announced the end of their search for a new Spider-Man for the character's Marvel Cinematic Universe debut. Earlier this year, a deal was struck between Marvel and Sony to bring the web-head into the well established MCU as well as create a brand new series of solo adventures for Spidey. This deal will allow Sony to utilize characters and actors from the MCU in their own set of new Spider-Man solo films, the first of which has a release date scheduled for 2017 after the new Spider-Man makes his debut in Captain America: Civil War (2016).
Replacing Andrew Garfield from the Amazing Spider-Man series is 19 year old Tom Holland whose most famous movie listed on IMDB as of today is Untitled Spider-Man Reboot. Sony and Marvel were reported to have been interested heavily in Ender's Game star Asa Butterfield, but he had dropped out of the running officially last week.
Needs more 'nerd'
Today's announcement of Holland taking over as the web-slinger ends several months of speculation as to who would fill the spandex of Marvel's most popular and lucrative hero. The announcement also puts to rest any potential of Marvel Studios taking the opportunity to bring Miles Morales to the big screen rather than cast a third actor to play Peter Parker in less than a decade. While choosing Peter Parker as the MCU's Spider-Man over Miles Morales may be disappointing to some fans (myself included), it will no doubt allow Spidey the smoothest transition into the MCU versus what we can only assume would be the more jarring appearance of the unfamiliar Morales to the casual movie goer. After two different failures to capitalize on the character's potential on screen resulting in what will be a 2nd reboot of the character, it's no wonder Marvel and Sony want to minimize risk with the next effort.
The announcement of Holland's casting as Peter Parker does seem to overshadow Marvel's announcement from yesterday. Marvel revealed that Miles Morales would, indeed, be the new Spider-Man in their upcoming universe reboot replacing the Peter Parker character permanently. Morales has gained quite a bit of popularity since his debut in the Ultimate Spider-Man (2011) comics after the death of that universe's Peter Parker. The new version of Morales as Spider-Man will NOT be an alternate reality or continuity but rather the new status quo for the series going forward marking a new milestone of progress in comics.
With actors and actresses not having the longevity of their comic book counterparts, the future of Miles Morales being Spider-Man on the big screen is not as grim as it may seem. The Morales character (whose original introduction in the comics was after the death of Peter Parker) actually gives Marvel Studios and Sony a pretty convenient contingency plan in the event that Holland decides to leave the franchise as he can easily be written off and another young actor can replace him as Morales. While this is highly speculative, it seems a fairly plausible route for Sony/Marvel to take in the event those circumstances arise.
Look for Holland to make his debut in Captain America: Civil War in 2016.
Amazing Spider-ManAndrew GarfieldCaptain America: Civil WarMarvelMarvel Cinematic UniverseMCUMiles MoralesPeter ParkerSonySpider-ManTom Holland
Geek in the desert with a huge heart who loves his wife and his dogs. An avid movie watcher, game player, toy collector, music listener, and overall pop-culture geek-writer.
SleezyMcBeezy
I want Childish Gambino aka Donald Glover for this role.. tired of boring nerdy … what's this guy going to do? look scared and weak? … ok maybe he will be cool
Shane Murphy
Oh, we're going to make Spider-Man black now, we're just going to make Spider-Man black now? That's what we're going to do, we're just going to make Spider-Man black now? Well, why don't we just have Michael Cera play Shaft?
God dammit, Shane…
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New Delhi: Excelity Global, India's largest provider of payroll administration, benefits and human capital management, announced its collaboration with Fortis Healthcare, on Monday.
"We take pride that Fortis has chosen Excelity as its partner of choice to manage their payroll and benefits operations. Organisations today are looking to streamline their payroll and benefits administration process while gaining process efficiencies and Excelity has been instrumental in doing this on a continuous basis," said Sumit Sabharwal, CEO (Managed Services), Excelity Global.
As part of this strategic engagement, Excelity will leverage its HR outsourcing experience to manage payroll and benefits for over 22,000 colleagues within Fortis Healthcare and other group companies.
"Excelity has demonstrated expertise in handing large payroll and benefits administration engagement in the past and we hope they will be leverage their expertise to deliver a world-class experience to our employees," stated Ranjan Pandey, VP-HR Operations, Fortis Healthcare.
"Our focus continues to be transforming our client's HR operations, incorporating smart technology, and improving their employee experience. At Excelity, we continue to strengthen our presence and capabilities in key markets across Asia Pacific," added Sabharwal.


We supply graphics to all types of media ie direct to media printing on either Foamex substrate or large scale fabric banners. Ink jets mounted to Foamex and vinyl cut graphics.
Fabric graphics can be continuous & uninterrupted with our Pila display system - up to 6m wide, an excellent branding opportunity using the latest techniques of direct to media high res printing.
Your artwork & logo's can be uploaded to our secure FTP site for printing. We can also create artwork for your approval. Working with our graphics partners we control all items to ensure a continuous and smooth running event.


Mechanical Engineering finds application in all fields of technology. It is one of the oldest branches of Engineering which have always remained in demand and will continue to be in the future. Mechanical engineers have always been needed as an essential staff in various industries of both public and private sector. Mechanical engineers are required to design, test, manufacture, install, operate and maintain a wide array of machines and mechanical systems that are used in countless industries.
The department has the state of the art laboratories to provide hands on experience to the budding diploma engineers in the field of mechanical engineering. This course is widely in demand and will yield a lot of skills and knowledge to the students which will provide excellent job prospects in the market.
Every manufacturing and production industry needs mechanical engineers to carry out jobs efficiently and flawlessly for their companies. There is huge potential for job in core companies associated with manufacturing, design, maintenance and production related companies dealing with mechanical engineering.


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Q: Python built-in base-256 to base-10 conversion and vice versa? I want to store large numbers (200-300 digits +) in a text file, so I want to know if there is either a built-in function that converts base-10 numbers to base-256 equivalents and vice versa in Python, or whether there is a module that supports this (much like the default hex() function).

A: Integers have the to_bytes-method:
base256 = number.to_bytes((number.bit_length()+7)//8, 'big')

number =int.from_bytes(base256, 'big')

A: 'Base256' is essentially binary bytes.  While one can interpret the result as latin-1 encoded text, that does not seem as much use.  So I would not suffix the resulting file as .txt.
That aside, the struct module us used to convert data to and from bytes. A relatively simple example:
>>> import struct
>>> b = struct.pack('HhL', 33333, -33, 3333333333)
>>> b
b'5\x82\xdf\xffU\xa1\xae\xc6'
>>> struct.unpack('HhL', b)
(33333, -33, 3333333333)

When writing to or reading from a file, remember to open in binary mode.

redpajama_set_name: RedPajamaStackExchange


how to create an adobe acrobat form and collect responses youtube maxresde creator update for everyone app online... 11/08/2011 · The Adobe Acrobat User Community is a global resource for users of Acrobat and PDF, with free eseminars, tips, tutorials, videos and discussion forums.
Email, download, or simply view your Results PDFs in Adobe Acrobat, Reader, or any PDF viewer you choose. Viewable on all platforms and devices. Produce portable and professional results reports with our PDF …... Illustrator 9 and PDF 1.4 – Acrobat will have to wait. Mid 2000, Adobe did something weird: they released Illustrator 9. Although launching a new version of a drawing application is not that bizarre, Illustrator 9 did have one amazing feature: it was the first application to support PDF 1.4 and its transparency feature.
Illustrator 9 and PDF 1.4 – Acrobat will have to wait. Mid 2000, Adobe did something weird: they released Illustrator 9. Although launching a new version of a drawing application is not that bizarre, Illustrator 9 did have one amazing feature: it was the first application to support PDF 1.4 and its transparency feature. free financial accounting books pdf This video will show you how to create an Adobe Acrobat fillable Form and connect responses started in a matter of minutes – from creating the form to distribution and response collection.
15/01/2014 · NEW Collect form responses with FormsCentral - Easily collect responses by moving your PDF or web forms online with the Adobe FormsCentral online service.* IMPROVED Approve with electronic signatures - Keep projects moving. new insight into ielts students book with answers pdf If you wish to print or save pdf versions of the forms, look for the Acrobat icon in the top right corner of the form window. Click on it to save and print the form in pdf format.
If you have Adobe Acrobat, you can use one of two mechanism: You can "Distribute" your form via Tools>Forms>Distribute. In this case, Acrobat will add an email submission mechanism to the form, and will also create a response file to collect all returned form data.
- Create the form fields in your PDF using Acrobat. - Apply the Extended Reader Rights so that the users (who I'm assuming will have Reader) can save the filled-in data. - Distribute the file to the users and collect the responses.
Illustrator 9 and PDF 1.4 – Acrobat will have to wait. Mid 2000, Adobe did something weird: they released Illustrator 9. Although launching a new version of a drawing application is not that bizarre, Illustrator 9 did have one amazing feature: it was the first application to support PDF 1.4 and its transparency feature.
Easily collect responses by moving your PDF or web forms online with the Adobe FormsCentral online service.* Convert existing forms to fillable PDFs Type less, gather more.


Ban Xia: The principal drug, being pungent in flavor and warm in nature, dispersing accumulation of pathogens, letting the adverse flow of the stomach-Qi go downwards to arrest vomiting.
Harmonize the stomach and calm the adverse-rising energy, eliminate phlegm and dispel retained fluid.
Vomit without thirst, phlegm and retained fluid accumulation, vomit due to stomach cold, phlegm and retained fluid with cough.


Pseudonym of Robert Malcolm Ward Dixon, an academic who has lectured in many parts of the world. He was born in Gloucester, England. He was educated at the University of Oxford and the University of Edinburgh. Dixon is Professor of Linguistics at The Cairns Institute, James Cook University, Queensland, and formerly Director of the Research Centre for Linguistic Typology at La Trobe University, Melbourne, Australia. He is the creator of 'Frank le Roux', a female investigator.