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How global fintech trends will impact your banking
Robert Barba @Barbawire
April 12, 2018 in Banking
@LittleIvan/Twenty20
Fintech startups around the world are changing the way people manage their money.
Apps are reshaping entire payment systems, people are learning to live with chatbots, and innovative interfaces are challenging the way banking gets done.
Much is happening abroad, but the impact of these trends on the U.S. market is very hard to predict. Our financial system is far more complex and well entrenched than systems in other countries, with thousands of institutions and a complex regulatory environment featuring countless state-level authorities and multiple federal agencies.
U.S. banks tend to be slower to adopt technology, in part because of the gargantuan task of updating old, siloed systems. As a consumer, you've experienced this if you've ever been transferred from a rep who only handles checking accounts to someone who can answer a question about your credit card.
The following is a look at how global fintech trends could eventually show up in the U.S.
Banking futurists often talk about a not-so-distant future where banks will be able to deliver highly personalized and consistent services to customers via chatbots. These assistants could be integrated into bank apps or embedded in third-party products like Apple's Siri, Amazon's Alexa or Facebook Messenger. They would help you with easy stuff like reading your last five transactions back to you, as well as more complex things like helping you come up with a plan to boost your savings.
"We're in a transition phase out of 'AI hype' and into big banks 'empowering AI' and rolling out AI-powered consumer experiences."
When we talk to the big players — some of which are based in U.S. — they often tout how their technology is the heart of a new digital bank in India or the Facebook Messenger integration they did in Central America or Canada.
They are having lots of conversations with banks in the U.S., they say, but can't announce anything quite yet. Institutions in the U.S. are certainly interested, but they are being cautious given the regulatory environment.
"Banks in North America are more aware of the regulatory environment we find ourselves in today, but realize the benefits of AI-powered consumer-facing applications and are compelled to move forward with technology to better serve their customer base," says Zor Gorelov, CEO and co-founder of Kasisto, a startup in New York that is working with global banks like Standard Chartered and TD Bank.
One reason the rest of the world has begun adopting virtual assistants more rapidly than the U.S. is different patterns of mobile technology adoption. Virtual assistants make a lot more sense in mobile devices than desktop devices. Americans may love their smartphones, too, but for large parts of the world, "mobile is the internet," says Jake Tyler, co-founder and CEO of Finn.ai, a Canadian firm that counts the Bank of Montreal among its clients.
To put it another way, Americans do their banking on both mobile and desktop devices. In other parts of the world, everyone uses mobile devices for banking.
There are some large banks in the U.S. with chatbots. Capital One has Eno, Ally has Ally Assist and Bank of America is slowly rolling out Erica, its much anticipated virtual assistant.
AI companies are closely watching Erica's rollout. Given Bank of America's size, if Erica is a hit, other banks will quickly look to introduce their own banking chatbots, Gorelov says.
"We're in a transition phase out of 'AI hype' and into big banks 'empowering AI' and rolling out AI-powered consumer experiences," Gorelov says. "As these large banks deploy, learn and iterate, the pace of adoption will continue to pick up as more banks are likely to follow suit."
The neobank challengers
In the last few years, the U.S. has seen the launch of a whole crop of neobanks, consumer-friendly startups that are trying to change the way we manage our money. A bunch of neobanks have appeared in Europe, too (they are called challenger banks across the pond), and it seems like they are all eyeing the U.S. market.
Last year, French firm Revolut, which includes a crypto wallet and free international transfers among its features, announced its plans to expand into the U.S. Germany's N26 recently raised $160 million from venture capital investors to fuel a U.S. expansion. Meanwhile, British startup Cleo, which is more of an AI-powered budgeting tool than a challenger bank, recently began offering its product in the U.S.
These firms clearly believe the opportunity to connect with potential customers outweighs the headaches involved in finding partner banks to offer their services.
It remains to be seen how much traction they will be able to find, however. A recent Cornerstone Advisors study asked people where they would be most likely to open a new checking account. Digital banks got a single-digit percentage in each of the generational buckets, for instance only six percent of those born between 1980 and 1987 said they'd be mostly likely to pick a digital bank. By contrast, nearly half of those older millennials said they'd open a checking account at Bank of America. s
China's fintech darling: WeChat
Perhaps you've heard of WeChat, the wildly popular messaging and payments app in China. If you haven't, you should take a closer look. The app has basically reshaped the way people communicate and pay for stuff in China. Users upload their banking credentials and then utilize QR codes to pay for everything.
If your wondering whether WeChat or an app with a similar reach, like Facebook, could take over our banking system in the U.S., don't worry, that would be very unlikely. WeChat filled a void in communications and payments that was unique to China. Until rather recently, the Chinese banking system was not really intended for consumers at all.
WeChat dominates its market because it solved several problems at once and gained scale quickly. Americans already have countless ways to communicate digitally and very well-established banking relationships.
There is one aspect of the WeChat system that might show up here: Tech companies pushing banks into the background. Perhaps you've noticed the payments features in Facebook Messenger or in iMessage. Or you've heard that banks like Capital One and Chase are in talks with Amazon to feature a checking product.
In each of these scenarios, banks are relegated to providing the plumbing for tech firms. That makes some banks worry about brand recognition. Other players see it as an evolution of the business and want to make sure they are making it easy for their customers to transact on their terms.
5 questions to ask before trying a neobank
What is a neobank, and why does SoFi want to be one?
Banks are learning how to text with customers
What's next for neobank Chime
Community banks are going national
The true cost of free checking


Public Relations Global Network (PRGN), the international network of leading independent public relations agencies, today announced the election of Patricia Pérez of VPE Public Relations in Los Angeles, CA as president. Pérez will lead the worldwide network of 40 independently-owned public relations agencies on six continents. She takes over from José Luiz Schiavoni of São Paulo, Brazil-based PR firm S2 Comunicação Integrada.
VPE has been part of PRGN since the organization's second meeting in 1993. As Principal at VPE, Pérez oversees the agency´s social marketing efforts which include social engagement, public education, and community outreach campaigns. The agency is one of the United States´ largest Latino-owned public relations firms and serves the needs of corporate, governmental and VPE´s clients include McDonald´s, Disneyland, Nestlé, First 5 LA, and The California Wellness Foundation.
PRGN has also named Francine Robbens, Partner and Consultant at Brussels-based PRP / Public Relations Partners (www.prp.be), as president-elect. Robbens has extensive expertise in media relations and crisis communications for telecom, health and lifestyle clients, and has coordinated several pan-European programs and implemented international strategies in the Belgian and Benelux markets. She is currently part of the Executive Committee of PRGN.


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Metasia punctimarginalis is a moth in the family Crambidae. It was described by George Hampson in 1913. It is found on Borneo.

References

Moths described in 1913
Metasia

redpajama_set_name: RedPajamaWikipedia


text:
Sigle
 Libera Università del Web

Codici
 LUW – codice aeroportuale IATA dell'aeroporto civile di Luwuk (Indonesia)


Read reports from Exodus staff who have recently travelled to various parts of the world which are featured within our Episodes eNewsletter archive. Or you can view the past issues of our specialist enewsletters if your interest is in Walking & Trekking, or Cycling: 'One World, Two Wheels'.
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Superficial Thrombophlebitis
Author: Khanjan H Nagarsheth, MD, MBA; Chief Editor: Vincent Lopez Rowe, MD
Superficial thrombophlebitis is a common inflammatory-thrombotic disorder in which a thrombus develops in a vein located near the surface of the skin. Most superficial veins that develop thrombosis also have phlebitis, in contrast to deep venous thrombosis (DVT), a sometimes asymptomatic condition in which phlebitis may be absent. (See Etiology and Workup.)
Although superficial thrombophlebitis usually occurs in the lower extremities, it also has been described in the penis and the breast (Mondor disease). Superficial thrombophlebitis can also develop anywhere that medical interventions occur, such as in the arm or neck (external jugular vein) when intravenous (IV) catheters are used. (See Etiology, Presentation, and Workup.)
Thrombosis and thrombophlebitis of the superficial venous system receive little attention in medical and surgical textbooks. However, thrombophlebitis is encountered frequently, and although it is usually a benign, self-limiting disease, it can be recurrent and tenaciously persistent, at times causing significant incapacitation. (See Epidemiology and Prognosis.)
When affecting the great saphenous vein (GSV; also referred to as the greater or long saphenous vein), thrombophlebitis will sometimes progress into the deep venous system. Damage to deep venous valves leads to chronic deep venous insufficiency (often referred to as postphlebitic syndrome), as well as to recurrent pulmonary embolism (PE) and an increased risk of death.[1]
Causes and sites of development
Superficial thrombophlebitis can occur spontaneously, especially in the lower extremities in the GSV, or as a complication of medical or surgical interventions. Although the etiology is frequently obscure, superficial venous thrombosis is most often associated with one of the components of the Virchow triad; ie, intimal damage (which can result from trauma, infection, or inflammation), stasis or turbulent flow, or changes in blood constituents (presumably causing increased coagulability). (See Etiology.)
In each type of superficial thrombophlebitis, the condition presents as redness and tenderness along the course of the vein, usually accompanied by swelling. Bleeding also can occur at the site of a varicose vein. (See Presentation.)
Although unusual, superficial thrombophlebitis may occur in the small saphenous vein (SSV; also referred to as the lesser saphenous vein), which empties into the popliteal vein.
Superficial thrombophlebitis can also occur in the external jugular vein, if it has been used for an infusion site. Superficial thrombophlebitis of the upper extremities usually occurs at infusion sites or sites of trauma.
Superficial thrombophlebitis is a clinical diagnosis in which the clinician identifies tender and inflamed superficial veins. However, ruling out DVT in the clinical setting is difficult; further testing is often required to evaluate for this condition. (See Presentation and Workup.)
Treatment for superficial thrombophlebitis is aimed at patient comfort and at preventing superficial phlebitis from involving the deep veins. (See Treatment and Medication.)
Superficial phlebitis with infection, such as phlebitis originating at an IV catheter site, is referred to as septic thrombophlebitis, a clinical entity requiring diagnostic and therapeutic approaches that are different from those applied to sterile phlebitis.
Microscopic thrombosis is a normal part of the dynamic balance of hemostasis. In 1846, the German pathologist Virchow recognized that if this dynamic balance were altered by venous stasis or turbulence, abnormal coagulability, or vessel wall injuries, then microthrombi could propagate to form macroscopic thrombi.
In the absence of a triggering event, neither venous stasis nor abnormal coagulability alone causes clinically important thrombosis, but vascular endothelial injury does reliably result in thrombus formation. The initiating injury triggers an inflammatory response that results in immediate platelet adhesion at the injury site. Further platelet aggregation is mediated by thromboxane A2 (TxA2) and by thrombin. A more detailed visual of the coagulation pathway can be seen in the image below.
Blood coagulation (thrombin) and protein C pathways. Courtesy of Wikimedia Commons ©John H Griffin, PhD.
Platelet aggregation due to TxA2 is inhibited irreversibly by aspirin and reversibly by other nonsteroidal anti-inflammatory drugs (NSAIDs); thrombin-mediated platelet aggregation, on the other hand, is not affected by NSAIDs, including aspirin. This is why aspirin and other NSAIDs are somewhat effective in preventing arterial thrombosis, where platelet aggregation is mediated via TxA2, as seen in patients with stroke and myocardial infarction (MI), but are not very effective in preventing venous thrombophlebitis, where it is believed that clot formation is more of a result of thrombin activation.
The most important clinically identifiable risk factors for thrombophlebitis are a prior history of superficial phlebitis, DVT, and PE. Some common risk markers include recent surgery or pregnancy, prolonged immobilization, and underlying malignancy.
Phlebitis also occurs in diseases associated with vasculitis, such as polyarteritis nodosa (periarteritis nodosa) and Buerger disease (thromboangiitis obliterans). Buerger noted phlebitis in 8 of 19 patients, and Shionoya reported it in 43% of the 255 patients he followed.[2, 3] After 2010, a medically emergent cutaneous thombophlebitis began to be noted more frequently, after an increase in use of levamisole (an antihelminth) for bulking cocaine in the US. In a review of the literature by Pearson et al, cutaneous thrombosis was noted in 84% of patients presenting with levamisole-induced vasculopathy.[4, 5]
The increased likelihood of developing thrombophlebitis occurs through most of pregnancy and for approximately 6 weeks after delivery. This is partly due to increased platelet stickiness and partly due to reduced fibrinolytic activity.
The association between pregnancy and thrombophlebitis is of particular concern to women who carry the factor V Leiden or prothrombin C-20210-a gene, because they already have a predisposition to clotting, which would also be exacerbated by pregnancy.[6]
Estrogen therapy
High-dose estrogen therapy is another risk factor. Case-controlled and cohort studies based on clinical signs and symptoms of thrombosis suggest that by taking high-estrogen oral contraceptives, a woman may increase her risk of thrombosis by a factor of 3-12 times, though the absolute risk remains low. Newer low-dose oral contraceptives are associated with a much lower risk of thrombophlebitis, though the absolute risk has not been well quantified.[7]
Additional risk factors
Other recognized markers of risk for venous thromboembolic disease include the following:
Age older than 60 years (however, there are fewer complications in this age group)
Cigarette smoking
IV drug abuse
Hypercoagulable states (eg, factor V Leiden mutation, prothrombin gene mutation, and protein S deficiency)
Systemic lupus erythematosus
Acquired immunodeficiency syndrome (AIDS) - Lupus anticoagulant
Drug-induced lupus anticoagulant
Antithrombin III deficiency
Behçet disease
Blood type A
Catheters (indwelling venous infusion catheters)
Estrogen replacements (high dose only)
Fibrinogen abnormality
Hemolytic anemias
Heparin-associated thrombocytopenia
Homocysteinemia
Homocystinuria
Hyperlipidemias
Phenothiazines
Plasminogen abnormality
Plasminogen activator abnormality
Polycythemia
Postoperative
Resistance to activated protein C
Thrombocytosis
Venography
Venous pacemakers
Warfarin - First few days of therapy
Caustic materials, such as lighter fluid, injected intravenously [8]
Traumatic thrombophlebitis
Superficial venous thrombosis following an injury usually occurs in an extremity, manifesting as a tender cord along the course of a vein juxtaposing the area of trauma. Ecchymosis may be present early in the disease, indicating extravasation of blood associated with injury to the vein; this may turn to brownish pigmentation over the vein as the inflammation resolves.
Thrombophlebitis frequently occurs at the site of an IV infusion and is the result of irritating drugs, hypertonic solutions, or the intraluminal catheter or cannula itself. This is by far the most common type of thrombophlebitis encountered. Usually, redness and pain signal its presence while the infusion is being given, but thrombosis may manifest as a small lump days or weeks after the infusion apparatus has been removed. It may take months to completely resolve.
The features of iatrogenic form of traumatic (chemical) phlebitis may be deliberately produced by sclerotherapy during the treatment of varicose veins.
Thrombophlebitis in varicose vein
Superficial thrombophlebitis frequently occurs in varicose veins. It may extend up and down the saphenous vein or may remain confined to a cluster of tributary varicosities away from the main saphenous vein.
Although thrombophlebitis may follow trauma to a varix, it often occurs in varicose veins without an antecedent cause.
Thrombophlebitis in a varicose vein develops as a tender, hard knot and is frequently surrounded by erythema. At times, bleeding may occur as the reaction extends through the vein wall. It frequently is observed in varicose veins surrounding venous stasis ulcers.
Superficial thrombophlebitis along the course of the GSV is observed more often to progress to the deep system.
Infection-related thrombophlebitis
Infection-related thrombophlebitis is associated with several different conditions, including a serious complication of intravascular cannulation and can be suspected in patients who have persistent bacteremia in the setting of appropriate antibiotic therapy.[9] It is characterized by perivascular inflammation with or without evidence of purulence within the venous lumen. It also frequently is associated with bloodstream infection.
In 1932, DeTakats suggested that dormant infection in varicose veins was a factor in the development of thrombophlebitis occurring following operations or after injection treatments, trauma, or exposure to radiation therapy.[10]
Altemeier et al suggested that the presence of L-forms and other atypical bacterial forms in the blood may play an important etiologic role in the disease and recommended administration of tetracycline.[11]
Migratory thrombophlebitis
Jadioux described migratory thrombophlebitis in 1845, determining it to be an entity characterized by repeated thromboses developing in superficial veins at varying sites but occurring most commonly in the lower extremity. Although numerous etiologic factors have been proposed for this condition, none have been confirmed.
The association of carcinoma with migratory thrombophlebitis was first reported by Trousseau, in 1856. Sproul noted migratory thrombophlebitis to be especially prevalent with carcinoma of the tail of the pancreas.[12]
Thrombophlebitis of superficial veins of breast and anterior chest wall (Mondor disease)
Mondor disease is a rare condition. Thrombophlebitis is usually located in the anterolateral aspect of the upper portion of the breast or in the region extending from the lower portion of the breast across the submammary fold toward the costal margin and the epigastrium.
A characteristic finding is a tender, cordlike structure that may be best demonstrated by tensing the skin via elevation of the arm.
The cause of Mondor disease is unknown, but a search for malignancy is indicated. Mondor disease is more likely to occur after breast surgery, with the use of oral contraceptives, and with protein C deficiency.
Thrombophlebitis of the dorsal vein of the penis, generally caused by trauma or repetitive injury, is also referred to as Mondor disease.[13, 14]
Superficial thrombophlebitis is a common condition worldwide.
In the author's experience, superficial thrombophlebitis most frequently occurs in the age group ranging from young adulthood to middle age. However, Markovic et al reported that a common risk factor is age older than 60 years, though fewer complications occur in this age group.[15]
As previously mentioned, pregnancy, puerperium, and high-dose estrogen therapy are recognized risk factors for phlebitis. However, there are no intrinsic, sex-linked risks for the disease.
The prognosis in superficial thrombophlebitis is usually good. Superficial phlebitis is rarely associated with PE, though it can occur, particularly if the process extends into a deep vein. However, individuals with superficial venous thrombosis do not seem to have a great tendency to develop DVT. In contrast, patients with DVT are frequently found to have superficial venous thrombosis.
The patient should be told to expect the disease process to persist for 3-4 weeks or longer. If it occurs in the lower extremity in association with varicose veins, it has a high likelihood of recurrence unless excision is performed.
Because thrombophlebitis tends to recur if the vein has not been excised, instructing the patient in ways to prevent stasis in the vein is usually advisable. The use of elastic stockings may be indicated, especially if the patient plans to stand in an upright position for long periods. Slight elevation of the foot of the bed, avoidance of long periods of standing in an upright position, and avoidance of prolonged inactivity is recommended.
For patient education information, see Varicose Veins, Deep Vein Thrombosis (Blood Clot in the Leg, DVT), and Phlebitis.
Patients with superficial thrombophlebitis often give a history of a gradual onset of localized tenderness, followed by the appearance of an area of erythema along the path of a superficial vein. Patients may also have a history of the following:
Local trauma
Similar prior episodes
Prolonged travel
Hormone use
Family history of blood coagulopathies
Enforced stasis
Although patients should be asked about these risk factors for hypercoagulability, the absence of identifiable risk factors has no prognostic value.
Ask about trauma, needlesticks, indwelling intravenous (IV) catheters, drug (eg, phenytoin) or hypertonic solution (10% calcium chloride) infusion, and sclerotherapy.
Thrombosed varicose veins
Ask about history of varicose veins, previous history of thrombosed varices, and any injury to the leg that has the varices. One should ascertain whether there was a thrombosed vein and should determine the timing of erythema and pain.
Thrombosed hemorrhoids
The history should focus on previous occurrences of thromboses and surgical intervention, as well as on the timing of symptoms.
Also known as Trousseau's sign of malignancy, migratory thrombophlebitis is described as thrombophlebitis that travels, often from one leg to the other. It has a strong association with adenocarcinoma of the pancreas and lung; therefore, the history should be directed toward finding malignancy.
Visual appearance is not a reliable guide to a peripheral venous condition, because the clinical findings of venous disease (erythema, edema, and pain) are common to many other entities. Swelling may result from acute venous obstruction (as in deep venous thrombosis [DVT]) or from deep or superficial venous reflux, or it may be caused by an unrelated disease condition, such as hepatic insufficiency, renal failure, cardiac decompensation, infection, trauma, or environmental effects. Lymphedema may be primary or it may be secondary to overproduction of lymph due to severe venous hypertension.
Normal veins are distended visibly at the foot, the ankle, and, occasionally, the popliteal fossa, but not in the rest of the leg. Normal veins may be visible as a blue, subdermal, reticular pattern, but dilated superficial leg veins above the ankle usually are evidence of venous pathology.
Darkened, discolored, stained skin or nonhealing ulcers are typical signs of chronic venous stasis, particularly along the medial ankle and the medial lower leg. Chronic varicosities or telangiectasias also may be observed.
Palpation of a painful or tender area may reveal a firm, thickened, thrombosed vein. Palpable thrombosed vessels are virtually always superficial.
Complications in superficial thrombophlebitis include the following:
Extension into the deep venous system
Hyperpigmentation over the affected vein
Persistent, firm nodule in subcutaneous tissues at the site of the affected vein
Conversion to suppurative thrombophlebitis
Complications of suppurative phlebitis include the following:
Metastatic abscess formation
Bloodstream infection
Septic emboli
Death from superficial thrombophlebitis without complication is unusual; however, if superficial thrombophlebitis extends into the deep venous system, it can be a source of pulmonary emboli.[16]
Complications can also result if the recanalization of thrombosed veins results in a valveless channel from destruction of the fragile valves by the inflammatory process. The lack of valves in the vein can lead to a prolonged venous circulation time and often to chronically elevated ambulatory venous pressure within the legs. This often results in a clinical postphlebitic syndrome of chronic pain, edema, hyperpigmentation, ulceration, and an increased risk of recurrent thrombophlebitis.
Diagnostic Considerations
Conditions to consider in the differential diagnosis of superficial thrombophlebitis include the following:
Deep venous thrombosis (DVT)
Neuritis
Ruptured medial head of the gastrocnemius
Baker cyst
Lipodermatosclerosis
Postphlebitic syndrome
Septic thrombophlebitis
Varicosities
Patients who lack deep system involvement may rarely progress to develop DVT over time. Also, patients who present with clinical evidence of superficial phlebitis may rarely have deep system involvement that is clinically occult. The incidence of fatal pulmonary embolism (PE) in these patients is not insignificant. Any chest symptoms, no matter how minor, should be considered extremely worrisome in a patient with superficial thrombophlebitis, as PE is not uncommon and can be difficult to diagnose.
Phlebitis that has progressed to involve any other deep veins (anterior or posterior tibial veins, proximal peroneal vein, popliteal vein, or femoral vein at any level) is a life-threatening condition that must not be confused with superficial venous thrombophlebitis.
The principal deep vein of the thigh, the femoral vein, often is referred to incorrectly as the "superficial femoral vein." Do not be misled by this nomenclature. A thrombus in this vein is the most serious type of DVT.
Key questions in cases of superficial thrombophlebitis concern the location and extent of the thrombosis, as well as its proximity to the deep venous system at the saphenofemoral or saphenopopliteal junction.
Patients who present with spontaneous thrombophlebitis without a previous indwelling intravenous (IV) catheter or other precipitating cause should be considered for evaluation for a hypercoagulable state. Certainly, all patients with a past history of another thromboembolic event should undergo a workup as well.
Migratory thrombophlebitis, especially without good cause, may be an indication for a more detailed evaluation of the patient to determine whether a malignant lesion exists. This evaluation should include selective application of serum carcinoembryonic antigen (CEA) testing, prostate-specific antigen (PSA) testing, colonoscopy, computed tomography (CT), and mammography.
A combination of functional and semianatomic or anatomic techniques allows a complete understanding of most venous system pathology. Functional tests are extremely useful as measures of whole-leg or regional venous function, but they can detect only regionally significant reflux or a significant impediment to venous outflow, which would predispose to the development of a thrombus.
Anatomic imaging of the venous system can detect small amounts of local and regional reflux, as well as the presence of an obstructing or nonobstructing thrombus. Unfortunately, anatomic imaging often fails to identify important functional deficits.
Histologic findings include inflammatory reaction in the vein wall and thrombus in the lumen of the vein.
Blood tests rarely are helpful in the diagnosis of thrombophlebitis, except in those patients at risk for an underlying hypercoagulable state. Several common hypercoagulable states, including the following, can be identified through laboratory studies:
Resistance to activated protein C (most often due to factor V Leiden)
Antiphospholipid antibodies
Prothrombin gene 2010-a mutation (factor II mutation)
Schönauer et al reported a high factor VIII concentration to be an independent risk factor for superficial thrombophlebitis.[17] In another study, de Godoy and Braile reported that 5.5% of patients with repetitive superficial thrombophlebitis were positive for protein S deficiency.[18] Other authors have reported that factor V Leiden and the prothrombin gene mutation significantly increase the risk of superficial thrombophlebitis.
The prothrombin time (PT) and activated partial thromboplastin time (aPTT) are not useful in the diagnostic evaluation of patients with suspected superficial or deep thrombophlebitis. Most patients with thrombophlebitis have a normal PT and aPTT, and active thrombophlebitis is not uncommon in patients with a therapeutically elevated international normalized ratio (INR) due to warfarin therapy.
A low white blood cell (WBC) count lowers the likelihood of an infectious process and raises the likelihood of phlebitis. An elevated WBC count is not specific, because normal and elevated WBC counts are common in patients with thrombophlebitis. Chronic venous insufficiency (venous congestion due to reflux) and superficial thrombophlebitis or deep venous thrombosis (DVT) can mimic leg cellulitis very closely, and true cellulitis (with an elevated WBC count) is a frequent complication of both diseases.
D-dimer is a unique degradation product produced by plasmin-mediated proteolysis of cross-linked fibrin that is often measured in the evaluation for DVT and pulmonary embolism (PE). However, it is of little clinical use for detecting thrombophlebitis.[19]
Venography is rarely required to diagnose superficial thrombophlebitis. The modality is also not necessary to exclude the diagnosis of DVT, which can be excluded with duplex scanning.
Invasive contrast venography, once the criterion standard for evaluation of the venous system, has fallen out of favor because of its invasiveness, as well as its use of ionizing radiation and IV contrast. In addition, it can lead to venous scarring and thrombophlebitis. If information on the pelvic veins or iliac venous outflow tract is required, CT venography, if available, is usually preferable.
Magnetic resonance venography (MRV) is a noninvasive test that probably is more sensitive and more specific than ultrasonography (US) in the detection of deep venous thrombophlebitis; however, this is not readily available and is not practical at most institutions.
Duplex US evaluation is the diagnostic study of choice for venous thrombosis. Thrombosed veins may appear thickened or inflamed on US, but the most accurate diagnostic finding is a lack of compressibility of the vein using the scan head (see the image below). An experienced sonographer should be able to diagnose superficial thrombophlebitis with a high sensitivity and specificity.[20]
Thrombosis of great saphenous vein and tributaries. Note lack of full compressibility of vein secondary to intraluminal thrombus. Courtesy of Wikimedia Commons ©Nevit Dilmen.
All patients with superficial thrombophlebitis above the knee should undergo duplex US as the initial diagnostic modality of choice to rule out DVT. When the patient has superficial thrombophlebitis below the knee, duplex US is only indicated for signs and symptoms consistent with DVT (eg, asymmetrical swelling, erythema, pain). Superficial thrombophlebitis in lower-extremity varicose veins has an extremely low incidence of DVT.[21]
After an initial diagnosis of superficial thrombophlebitis, especially in the thigh region, a follow-up duplex US examination in 48-72 hours should be performed to look for progression of disease after treatment is initiated. A finding of no clot extension indicates successful therapy. Thrombus extension or encroachment toward the deep venous system should prompt more aggressive treatment.
Results from a study by Quéré et al indicated that in patients with symptomatic superficial venous thrombosis, compression US of an affected limb's entire venous system provides valuable treatment information.[22] The investigation involved 844 patients from the Prospective Observational Superficial Thrombophlebitis (POST) study, all of whom had symptomatic superficial venous thrombosis. A complete lower limb scan of both legs using compression US was performed on all of the patients, with imaging of the superficial and deep venous systems.
Among the report's findings were that concomitant DVT was present in 198 patients (23.5%) and that 41.8% of those individuals had proximal DVT.[22] Superficial venous thrombosis was not contiguous with DVT in 83 (41.9%) of the 198 patients.
Diagnosis in Pregnancy
Venous thrombophlebitis and PE are common during all trimesters of pregnancy and for 6-12 weeks after delivery.
Superficial varicosities and superficial phlebitis, along with associated DVT, are also common during pregnancy because of a pregnancy-related reduction in intrinsic plasminogen activator activity. Failure to treat the mother properly is the most common cause of fetal demise.
The diagnostic approach, as follows, should be exactly the same in a pregnant patient as in a nonpregnant one:
Duplex US is safe in pregnancy
If indicated, a nuclear perfusion lung scan may be performed safely in pregnancy
If indicated, heparin may be used in pregnancy
If indicated, fibrinolytics may be used in pregnancy
The treatment of superficial venous thrombosis depends on the condition's etiology, extent, and symptoms. Duplex ultrasonography (US) gives an accurate appraisal of the extent of disease and thus allows the administration of a more rational therapy.
For the superficial, localized, mildly tender area of thrombophlebitis that occurs in a varicose vein, treatment with mild analgesics, such as aspirin, and the use of some type of elastic support usually are sufficient. Patients are encouraged to continue their usual daily activities. If extensive varicosities are present or if symptoms persist, phlebectomy of the involved segment may be indicated.
More severe thrombophlebitis, as indicated by the degree of pain, redness, and the extent of the abnormality, should be treated with elevation of the extremity and the application of massive, hot, wet compresses. The latter measure seems to be more effective when a large, bulky dressing, including a blanket and plastic sheeting followed by hot water bottles, is used, taking care to avoid burning the patient.
Anticoagulants are usually not indicated in superficial thrombophlebitis unless the process extends into the deep venous system[23] or persistent inflammation is present in an affected area.[24]
In the case of thrombosis of a hemorrhoid, evacuation of the thrombus, though very painful, usually provides rapid relief. Magnesium sulfate compresses may also be used to alleviate swelling and pain, though surgery is sometimes necessary to remove the clot from the hemorrhoid.
Long-leg, heavy-gauge elastic stockings or multiple elastic (Ace) bandages are indicated when the patient becomes ambulatory.
Gradient compression stockings are an often-overlooked adjunctive therapy that is both benign and effective. These highly elastic stockings provide a gradient of compression that is highest at the toes (at least 30-40 mm Hg) and gradually decreases to the level of the thigh. This amount of compression reduces capacitive venous volume by approximately 70% and increases the measured velocity of blood flow in the deep veins by a factor of 5 or more. Gradient compression hose also have been shown to increase local and regional intrinsic fibrinolytic activity.
In the early phases of superficial thrombophlebitis in the leg, dangling the extremity without external support from stockings or elastic bandages leads to leg swelling and increased pain.
Pharmacologic Therapy
Current treatment options are aimed at resolving symptoms, preventing recurrence and most importantly, and preventing extension to the deep venous system, which may potentially result in a thromboembolism. Previous treatment options were based on a Cochrane review published in 2007 that showed that nonsteroidal anti-inflammatory drugs (NSAIDs) and low-molecular-weight heparin (LMWH) are the first options.[25]
A second Cochrane review published in 2013 added, among others, a large randomized control study that included more than 3000 patients with superficial thrombophlebitis and compared fondaparinux with placebo. The investigators found fondaparinux to be a good option for treatment of superficial thrombophlebitis and prevention of some of its associated complications.[26]
Fondaparinux
Fondaparinux is a newer anticoagulant that was derived from the binding region of heparin and antithrombin. It is an inhibitor of factor Xa, and its main uses are the same as those of heparin—more specifically, prevention and treatment of venous thrombosis and pulmonary embolism (PE). Fondaparinux is not shown to interact with platelets and platelet factor 4 and thus theoretically should not cause heparin-induced thrombocytopenia (HIT). Its main advantage over heparin or LMWH is that its bioavailability and half-life (15-17 hours) allow once-daily dosing.
As noted (see above), fondaparinux has been shown to achieve significant reductions in the extension of superficial thrombophlebitis into the deeper venous systems and the rate of recurrence in general, as well as to reduce the symptoms of venous thromboembolism when compared to placebo[26] ; however, there was no difference with respect to the rates of major bleeding. To date, no studies have been done to compare the efficacy of fondaparinux with that of heparin or LMWH in superficial thrombophlebitis.
Use of the lowest dosage of fondaparinux (2.5 mg/day subcutaneously) for 45 days was shown by Decousus et al to suffice for prevention of extension, recurrence, and embolization of superficial venous thrombosis.[27] Another advantage to this anticoagulant medication is that the dosage studied for superficial venous thrombosis does not have to be monitored. At this dosage, fondaparinux has not been shown to affect activated partial thromboplastin time (aPTT), prothrombin time (PT), or bleeding time.[28]
Fondaparinux should be avoided in patients with kidney function compromise, active bleeding, bacterial endocarditis, and body weight below 50 kg. One downside to the use of fondaparinux is that there is currently no antidote, especially for the low dosage used for superficial thrombophlebitis treatment. Also, because this agent is cleared by the renal system, prolonged administration warrants renal function monitoring and should be discontinued if creatinine clearance is less than 30 mL/min.
Low-molecular-weight heparin
The 2007 Cochrane review cited above suggested that anticoagulation with LMWH is better in reducing local signs and symptoms, along with reducing propagation to deep venous thrombosis (DVT).[25] In addition, LMWH is useful in preventing the progression of thrombosis and is recommended when there is evidence of DVT.
Patients with contraindications to anticoagulation or those receiving adequate anticoagulation treatment who have progression of thrombosis should be considered for saphenous ligation at the junction with the deep venous system.
Nonsteroidal anti-inflammatory drugs
The efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) is similar to that of LMWH in reducing the risk of extension of superficial thrombophlebitis into the deep venous system along with decreasing recurrence. In addition, NSAIDs are often more practical and more easily administered than LMWH. No NSAID has not been shown to be superior to others in the treatment of superficial thrombophlebitis.
Antibiotics are not routinely indicated for treatment of superficial thrombophlebitis, in that the erythema and tenderness are local inflammatory reactions, not allergic reactions. However, if suppurative thrombophlebitis may be present, then antibiotics should cover skin flora and anaerobic organisms, especially if an abscess is present. One should also consider coverage with vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) if the local population warrants this.
Local thrombolytics
No adequate studies have been performed on the use of local thrombolytics, and they were excluded from the Cochrane Database of Systematic Reviews article. Therefore, at this time, their use is not recommended.
Patients who present with thrombosis of the great saphenous vein (GSV) or the small saphenous vein (SSV) should be considered for anticoagulation or ligation of the vein, given that a high incidence (6-44%) of concurrence or progression to DVT has been reported in such patients. In a study, Ascher et al reported that 65.6% of patients who presented with GSV thrombosis were found to have associated DVT.[29]
A meta-analysis of the prevalence of DVT and PE in patients with superficial vein thrombosis found a weighted mean prevalence of 18.1% for DVT and 6.9% for PE in patient with superficial thrombophlebitis. The authors concluded that in selected patients with superficial thrombophlebitis, screening for DVT or PE may be warranted.[30]
Optimal treatment of saphenous vein thrombosis remains controversial. As noted by Wichers et al in a systematic review, a lack of randomized trials has prevented evidence-based recommendations in this area.[16]
In a small, randomized trial of 60 patients with GSV thrombosis, Lozano et al compared treatment using LMWH with surgical saphenous ligation.[31] Patients in the LMWH group experienced no episodes of DVT or PE but had a 10% incidence of recurrent superficial venous thrombosis. Among the patients treated surgically, two pulmonary emboli (6.7%) were found, and one episode of recurrent superficial venous thrombosis (3.3%) occurred.
In a larger randomized trial (Stenox study), no statistical difference in the incidence of DVT or PE was found between patients with superficial venous thrombosis who were treated with placebo, with NSAIDs, or with two doses of LMWH. In the study, 436 patients were randomized to one of the three groups; all patients wore compression stockings.
The study's placebo group had a higher incidence of recurrent superficial venous thrombosis than did the other patients. Interestingly, the results in the group treated with NSAIDs were the same as those in the patients treated with LMWH.
Similar to the outcome of the above study, Wichers et al concluded, after a systematic review of the literature, that LMWH or NSAID therapy appears to reduce the incidence of superficial venous thrombosis extension or recurrence.[16] Larger trials are likely required to demonstrate differences in the incidence of DVT.
Treating patients with some form of low- or intermediate-dose anticoagulation appears reasonable at this time; this should be followed by repeat duplex ultrasonography to look for progression at regular intervals for a few weeks to a month. In patients with stable nonprogressing thrombus, anticoagulation therapy can probably be discontinued in the absence of other risk factors.
SURPRISE trial
The SURPRISE trial was a randomized, open-label, blinded outcome event adjudication trial that compared rivaroxaban 10 mg once daily with fondaparinux 2.5 mg once daily in 472 patients with superficial vein thrombosis who were at risk for venous thromboembolism (VTE) and complications.[32] Both groups were treated for 45 + 5 days and had an observational period of 90 + 10 days.
The investigators looked at primary efficacy outcome as a composite endpoint of deep venous thrombosis (DVT), pulmonary embolism (PE), progression of superficial vein thrombosis towards the saphenofemoral junction, recurrence of superficial venous thrombosis and all-cause mortality at day 45.[32] The trial was designed to show noninferiority of rivaroraxaban compared to fondaparinux in terms of primary endpoints and risk of major bleeding.
The investigators found that the primary efficacy outcome occurred in 3.3% of patients receiving rivaroxaban and 1.8% of patients receiving fondaparinux.[32] On the basis of this finding, the absolute difference between rivaroxaban and fondaparinux was 1.53% (P = .025 for noninferiority). Rivaroxaban 10 mg once daily was shown to be noninferior to fondaparinux 2.5 mg once daily for treatment of superficial venous thrombosis. The incidence of clinically significant nonmajor bleeding was 2.5% at 45 days and 2.5% at 90 days for rivaroxaban versus 0.4% at 45 days and 0.9% at 90 days for fondaparinux.
Noninferiority was shown for rivaroxaban with no statisically significantly increased rate of major bleeding as compared with fondaparinux.[32] No data were collected on comparative quality of life between the two medication regimens. This is an important consideration, in that rivaroxaban is given orally once daily and fondaparinux as a subcutaneous injection once daily. The authors state that this consideration will have to be addressed in further studies.
Excision and Ligation
With persistence or spread of the process, the thrombophlebitic vein may be excised.[33] Patients who demonstrate signs and symptoms of septic thrombophlebitis require urgent venous excision to control the septic focus. This is usually performed through a direct incision over the vein, allowing removal of the infected thrombosed segment along with wide debridement of any surrounding infected or necrotic tissue. Cultures are sent to guide antibiotic therapy.
Surgical treatment may also be considered for patients with saphenous thrombophlebitis. This is most often considered if the process extends upward toward the femoral or popliteal vein despite anticoagulation or in a patient with a contraindication to systemic anticoagulation.
Whether surgical ligation or anticoagulation is the best initial treatment for saphenous vein thrombosis without deep venous involvement remains controversial. If saphenous ligation is chosen, high ligation at the saphenofemoral or saphenopopliteal junction is recommended, with ligation of any branches near the junction. For saphenopopliteal procedures, US mapping for guidance is recommended because of the variability in location of the saphenopopliteal anatomy.
Puncture and Evacuation
A painful section of a superficial vein containing a palpable intravascular coagulum may be treated by puncture incision with an 18-gauge needle and evacuation of the clot after local anesthesia. This procedure often produces marked rapid relief and rapid resolution of the inflammation.
Puncture and evacuation is less effective in the first week after the onset of symptoms, because the vessel wall is thickened and the coagulum itself is more cohesive during the early phase of phlebitis.
Treatment of Septic and Suppurative Thrombophlebitis
If thrombophlebitis is associated with a cannula or a catheter, the device should be immediately removed and cultured. If the patient is in a septic state, appropriate antibiotics should be given. If suppurative thrombophlebitis is suspected, immediate and complete excision of all of the involved veins is indicated. The wound may be left packed open for secondary closure or skin grafting at a later date. The use of appropriate systemic antibiotics is always indicated.
If the suppurative process involves one of the deep veins, aggressive antimicrobial and anticoagulant therapy are necessary.
If a venous segment involved in superficial thrombophlebitis is suspected to be a source of bacteremia but does not require excision, it can be aspirated in order to culture the contents of the venous lumen. This may be helpful in immunocompromised patients with phlebothrombosis and positive blood cultures.
Follow-up should be performed 2-3 days after treatment for superficial thrombophlebitis, either with an office visit or by telephone, to be sure that the patient is progressing in a satisfactory manner.
Some anti-inflammatory drugs may be of benefit in the treatment of superficial thrombophlebitis. Salicylates, indomethacin, and ibuprofen have been reported to be effective. In addition, salicylates, ibuprofen, and dipyridamole have been used as antithrombotic agents, but their effectiveness has not been documented in this setting.[34]
Because thrombophlebitis is primarily due to inflammation and fibrin clot, antithrombotic or antiplatelet-aggregating agents would seem to have little value. Anticoagulants are usually not indicated unless the process extends into the deep venous system.[23]
Additionally, in rare cases in which persistent inflammation is present in an area of superficial thrombophlebitis, a brief course of low-molecular-weight heparin (LMWH) can be used as an alternative to excision of the vein in order to bring the inflammation under control. This treatment alternative may be necessary for management of superficial thrombophlebitis associated with pregnancy.
Antibiotics are usually not necessary in superficial thrombophlebitis unless the process is suppurative. In persistent cases or even as early definitive therapy, excision of the inflammatory process is effective. The wounds usually heal well with primary closure; the inflammatory process, except in suppurative phlebitis, is usually nonbacterial and localized and is removed completely.
Along with LMWHs, nonsteroidal anti-inflammatory drugs (NSAIDs) are considered first options to resolve symptoms and prevent extension of thromboembolism.
Ibuprofen (Ibu, Advil, Motrin)
Ibuprofen is the drug of choice for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Indomethacin (Indocin)
Indomethacin, which inhibits prostaglandin synthesis, is rapidly absorbed. Metabolism of the drug occurs in the liver by demethylation, deacetylation, and glucuronide conjugation.
Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
Naproxen inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in decrease of prostaglandin synthesis.
Anticoagulants, Hematologic
Heparin is essential for patients with superficial thrombophlebitis that is progressive and for those with particular risk factors for progression or recurrence. Heparin should always be used when thrombophlebitis involves the great saphenous vein. Heparin is the mainstay of treatment when deep system involvement is suggested, but anticoagulation alone does not guarantee a successful outcome. The disease may progress despite full and effective heparin anticoagulation.
Heparin works by activating antithrombin III to slow or prevent the progression of venous thrombosis. Heparin does not dissolve existing clots.
Fractionated LMWHs have largely replaced unfractionated heparin in the treatment of superficial phlebitis. LMWHs offer several distinct advantages over unfractionated heparin, including the following:
- They may be used in the outpatient setting
- They do not require measurement of the activated partial thromboplasting time (aPTT)
- They produce more reliable anticoagulation
- They are associated with a lower risk of bleeding
When unfractionated heparin is used, an aPTT of at least 1.5 times the control value is necessary for a therapeutic effect. To achieve this, unfractionated heparin must be given intravenously in adequate doses. Low-dose, subcutaneous unfractionated heparin should not be used, as it is not an effective therapy for thrombophlebitis and does not provide effective prophylaxis against progression of the disease.
Warfarin should not be used in the acute treatment of superficial phlebitis, because the early risk of increased thrombogenesis outweighs any convenience of oral therapy.
Enoxaparin (Lovenox)
Enoxaparin was the first LMWH released in the United States and is the only LMWH now approved by the US Food and Drug Administration (FDA) for both treatment and prophylaxis of deep venous thrombosis (DVT).
It is widely used in pregnancy, although clinical trials are not yet available to demonstrate that it is as safe as unfractionated heparin.
When enoxaparin is used, there is no utility in checking the aPTT (the drug has a wide therapeutic window, and aPTT does not correlate with the anticoagulant effect).
Dalteparin (Fragmin)
Dalteparin is indicated for the prevention of DVT, which may lead to pulmonary embolism (PE). It enhances the inhibition of factor Xa and thrombin by increasing antithrombin III activity. In addition, dalteparin preferentially increases the inhibition of factor Xa. The average duration of treatment is 7-14 days.
The initial bolus used for inflammatory or septic thrombosis is lower than that needed for spontaneous DVT and PE, because most patients with inflammatory or septic thrombophlebitis do not have underlying hypercoagulability.
Patients withDVT and PE require more aggressive therapy because DVT is a manifestation of an active hypercoagulable state.
Do not check aPTT until 6 hours after the initial bolus, as an extremely high or low value during this time should not provoke any action.
These agents are not routinely useful in nonseptic superficial phlebitis. Antibiotics are indicated whenever infection is suspected to play a role and whenever phlebitis of the great saphenous vein above the knee threatens to approach the saphenofemoral junction. The choice of antibiotics should be guided by blood culture results whenever possible, but empiric therapy should at a minimum provide coverage for group A streptococci and for Staphylococcus aureus.
Superficial phlebitis must not be confused with septic phlebitis, which can be life threatening. If septic phlebitis is suspected, the selection of antibiotics is critically important and depends upon the clinical setting.
Ceftriaxone (Rocephin)
Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity. It has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. This agent arrests bacterial growth by binding to 1 or more penicillin-binding proteins. When used for the treatment of phlebitis, ceftriaxone should be administered intravenously rather than intramuscularly.
Ceftriaxone is effective in the treatment of superficial phlebitis and bacterial septicemia caused by Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, viridans group streptococci, Escherichia coli, Enterobacter cloacae, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Morganella morganii, Serratia marcescens, Acinetobacter calcoaceticus, Bacteroides fragilis, and various Peptostreptococcus species.
Cephalexin (Keflex)
Cephalexin is a first-generation cephalosporin that may be used as adjunctive therapy in superficial phlebitis if infection is possible but unlikely, and if the only likely organisms would be skin flora, including staphylococci and streptococci.
What is superficial thrombophlebitis?
Where does superficial thrombophlebitis usually occur?
What is the prognosis of superficial thrombophlebitis?
What causes superficial thrombophlebitis?
What is the presentation of superficial thrombophlebitis?
Where are the sites of development in superficial thrombophlebitis?
How is superficial thrombophlebitis diagnosed?
What are the goals of treatment for superficial thrombophlebitis?
What is septic thrombophlebitis?
What is the pathophysiology of superficial thrombophlebitis?
What are the risk factors for superficial thrombophlebitis?
Does pregnancy increase the risk for developing superficial thrombophlebitis?
Is estrogen therapy a risk factor for superficial thrombophlebitis?
What are the risk factors for venous thromboembolic disease?
How can injury cause superficial thrombophlebitis?
What is the most common cause of superficial thrombophlebitis?
Can sclerotherapy for varicose veins cause superficial thrombophlebitis?
Where does superficial thrombophlebitis frequently occur?
How does superficial thrombophlebitis develop in a varicose vein?
What is infection-related thrombophlebitis?
Can infection cause superficial thrombophlebitis?
What is migratory thrombophlebitis (thrombophlebitis migrans)?
What is Mondor disease?
What is the etiology of Mondor disease and when is it more likely to occur?
What is the epidemiology of superficial thrombophlebitis?
What education should be given to patients with superficial thrombophlebitis?
What history findings suggest superficial thrombophlebitis?
What history should be obtained for suspected traumatic thrombophlebitis?
What varicose vein history should be obtained when superficial thrombophlebitis is suspected?
What hemorrhoid history should be obtained when superficial thrombophlebitis is suspected?
What are the signs and symptoms of migratory thrombophlebitis (thrombophlebitis migrans)?
What are physical findings suggestive of superficial thrombophlebitis?
What are the signs of chronic venous stasis in superficial thrombophlebitis?
What are palpation findings suggestive of superficial thrombophlebitis?
What are possible complications of superficial thrombophlebitis?
What are complications of suppurative phlebitis?
What is the risk for mortality from superficial thrombophlebitis?
How do complications arise in superficial thrombophlebitis?
What conditions should be included in the differential diagnoses of superficial thrombophlebitis?
Why are chest symptoms in patients with superficial thrombophlebitis cause for concern?
Which life-threatening condition must be differentiated from superficial thrombophlebitis?
What is a superficial femoral vein?
What are the differential diagnoses for Superficial Thrombophlebitis?
What are the key factors evaluated in superficial thrombophlebitis?
When should patients with superficial thrombophlebitis be evaluated for a hypercoagulable state?
What further evaluation is indicated for migratory thrombophlebitis (thrombophlebitis migrans)?
What is the role of imaging studies in the evaluation of superficial thrombophlebitis?
What is the role of anatomic imaging in the evaluation of superficial thrombophlebitis?
Which histologic findings suggest superficial thrombophlebitis?
Which risk factors for superficial thrombophlebitis can be identified with lab testing?
Which lab studies help identify hypercoagulable states in superficial thrombophlebitis?
What is the role of prothrombin time (PT) and activated partial thromboplastin time (aPTT) in the evaluation of superficial thrombophlebitis?
What do low or elevated WBC count or chronic venous insufficiency suggest in the evaluation of superficial thrombophlebitis?
What is the role of D-dimer in the evaluation of superficial thrombophlebitis?
What is the role of venography in the evaluation of superficial thrombophlebitis?
What is the role of invasive contrast venography in the evaluation of superficial thrombophlebitis?
What is the role of magnetic resonance venography (MRV) in the evaluation of superficial thrombophlebitis?
What is role of ultrasonography in the evaluation of superficial thrombophlebitis?
When is duplex ultrasonography indicated for the evaluation and management of superficial thrombophlebitis?
What is the role of compression ultrasonography in patients with symptomatic superficial thrombophlebitis?
Are women at increased risk for superficial thrombophlebitis during pregnancy?
What is the diagnostic approach for pregnant patients with suspected superficial thrombophlebitis?
What is the basis for treatment selection in superficial venous thrombosis?
When are analgesics sufficient for the treatment of superficial thrombophlebitis?
How should more severe superficial thrombophlebitis be treated?
When are anticoagulants indicated for the treatment of superficial thrombophlebitis?
How is thrombosis of a hemorrhoid treated?
When are compression stockings indicated in the treatment of superficial thrombophlebitis?
What is the efficacy of gradient compression stockings for the treatment of superficial thrombophlebitis?
What is the aim of treatment for superficial thrombophlebitis?
Is fondaparinux effective for treatment of superficial thrombophlebitis and prevention of complications?
What are the benefits of fondaparinux for treatment of superficial thrombophlebitis?
What is the dosage of fondaparinux for treatment of superficial thrombophlebitis?
When is fondaparinux contraindicated for treatment of superficial thrombophlebitis?
Is low-molecular-weight heparin (LMWH) effective for the treatment of superficial thrombophlebitis?
Are NSAIDs effective for the treatment of superficial thrombophlebitis?
When are antibiotics indicated for treatment of superficial thrombophlebitis?
What is the role of local thrombolytics in the treatment of superficial thrombophlebitis?
What is the treatment for thrombosis of the great or small saphenous veins?
What is the prevalence of deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients with superficial vein thrombosis?
What is the optimal treatment of saphenous vein thrombosis?
Which treatments are effective in reducing the risk of recurrent superficial venous thrombosis?
How does rivaroxaban compare to fondaparinux in the treatment of superficial venous thrombosis in patients at risk for venous thromboembolism (VTE)?
When is venous excision indicated for the treatment of superficial thrombophlebitis?
When is surgical treatment indicated for superficial thrombophlebitis?
What is the role of surgical ligation in the treatment of superficial thrombophlebitis?
What is the role of puncture incision in the treatment for superficial thrombophlebitis?
What is the treatment for septic and suppurative thrombophlebitis?
What monitoring is needed after treatment for superficial thrombophlebitis?
Which anti-inflammatory drugs may be beneficial in the treatment of superficial thrombophlebitis?
Are antithrombotic or antiplatelet-aggregating agents indicated in the treatment of superficial thrombophlebitis?
Are antibiotics indicated in the treatment of superficial thrombophlebitis?
Which medications in the drug class Antibiotics are used in the treatment of Superficial Thrombophlebitis?
Which medications in the drug class Anticoagulants, Hematologic are used in the treatment of Superficial Thrombophlebitis?
Which medications in the drug class Nonsteroidal Anti-inflammatory Drugs are used in the treatment of Superficial Thrombophlebitis?
Khanjan H Nagarsheth, MD, MBA Assistant Professor of Surgery, Department of Vascular Surgery, University of Maryland Medical System
Khanjan H Nagarsheth, MD, MBA is a member of the following medical societies: Academic Surgical Congress, American College of Surgeons, American Venous Forum, Association of Trauma and Military Surgery, Eastern Association for the Surgery of Trauma, Eastern Vascular Society, Knoxville Academy of Medicine, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Critical Care Medicine, Southeastern Surgical Congress, Tennessee Medical Association, Vascular Society of New Jersey
Adam J Rosh, MD Assistant Professor, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine
Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine
Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society
David FM Brown, MD Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Ryan Doss, MD Resident Physician, Department of Emergency Medicine, Detroit Medical Center, Wayne State University School of Medicine
Ryan Doss, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, Michigan College of Emergency Physicians, and Michigan State Medical Society
Craig F Feied, MD, FACEP, FAAEM, FACPh, Professor of Emergency Medicine, Georgetown University School of Medicine; General Manager, Microsoft Enterprise Health Solutions Group
Craig F Feied, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Phlebology, American College of Physicians, American Medical Association, American Medical Informatics Association, American Venous Forum, Medical Society of the District of Columbia, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society
Jonathan A Handler, MD, HSG Chief Deployment Architect, Microsoft Corporation, Adjunct Associate Professor, Department of Emergency Medicine, Northwestern University, Feinberg School of Medine
Jonathan A Handler, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Jeffrey Lawrence Kaufman, MD Associate Professor, Department of Surgery, Division of Vascular Surgery, Tufts University School of Medicine
Jeffrey Lawrence Kaufman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society for Artificial Internal Organs, Association for Academic Surgery, Association for Surgical Education, Massachusetts Medical Society, Phi Beta Kappa, and Society for Vascular Surgery
Samuel M Keim, MD Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine
Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine
Robert G Klever Jr, MD Resident Physician, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine
Robert G Klever Jr, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Eddy S Lang, MDCM, CCFP(EM), CSPQ Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada
Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose
William A Marston, MD, Associate Professor, Department of Surgery, Division of Vascular Surgery, University of North Carolina School of Medicine
William A. Marston, MD is a member of the following medical societies: American College of Surgeons, American Venous Forum, North Carolina Medical Society, Peripheral Vascular Surgery Society, and Southern Association for Vascular Surgery
Nelson S Menezes, MD, FRCS(Edin), FACS Assistant Professor of Surgery, Weill Cornell Medical College; Chief of Vascular Surgery, Department of Surgery, Brooklyn Hospital Center
Nelson S Menezes, MD, FRCS(Edin), FACS is a member of the following medical societies: American College of Surgeons, International Society of Endovascular Specialists, Medical Society of the State of New York, and Society for Vascular Surgery
Travis J Phifer, MD Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport
Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine
Disclosure: Medscape Salary Employment
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Schönauer V, Kyrle PA, Weltermann A, Minar E, Bialonczyk C, Hirschl M, et al. Superficial thrombophlebitis and risk for recurrent venous thromboembolism. J Vasc Surg. 2003 Apr. 37 (4):834-8. [Medline].
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Stevens SM. Review: Fondaparinux reduces VTE and recurrence in superficial thrombophlebitis of the leg. Ann Intern Med. 2012 Aug 21. 157(4):JC2-4. [Medline].
Prandoni P, Tormene D, Pesavento R, Vesalio Investigators Group. High vs. low doses of low-molecular-weight heparin for the treatment of superficial vein thrombosis of the legs: a double-blind, randomized trial. J Thromb Haemost. 2005 Jun. 3 (6):1152-7. [Medline].
Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev. 2007 Apr 18. CD004982. [Medline].
Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev. 2013 Apr 30. 4:CD004982. [Medline].
Decousus H, Prandoni P, Mismetti P, et al. Fondaparinux for the treatment of superficial-vein thrombosis in the legs. N Engl J Med. 2010 Sep 23. 363(13):1222-32. [Medline].
Bijsterveld NR, Moons AH, Boekholdt SM, van Aken BE, Fennema H, Peters RJ, et al. Ability of recombinant factor VIIa to reverse the anticoagulant effect of the pentasaccharide fondaparinux in healthy volunteers. Circulation. 2002 Nov 12. 106 (20):2550-4. [Medline].
Ascher E, Hanson JN, Salles-Cunha S, Hingorani A. Lesser saphenous vein thrombophlebitis: its natural history and implications for management. Vasc Endovascular Surg. 2003 Nov-Dec. 37 (6):421-7. [Medline].
Di Minno MN, Ambrosino P, Ambrosini F, Tremoli E, Di Minno G, Dentali F. Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis. J Thromb Haemost. 2016 May. 14 (5):964-72. [Medline].
Lozano FS, Almazan A. Low-molecular-weight heparin versus saphenofemoral disconnection for the treatment of above-knee greater saphenous thrombophlebitis: a prospective study. Vasc Endovascular Surg. 2003 Nov-Dec. 37 (6):415-20. [Medline].
Beyer-Westendorf J, Schellong SM, Gerlach H, Rabe E, Weitz JI, Jersemann K, et al. Prevention of thromboembolic complications in patients with superficial-vein thrombosis given rivaroxaban or fondaparinux: the open-label, randomised, non-inferiority SURPRISE phase 3b trial. Lancet Haematol. 2017 Mar. 4 (3):e105-e113. [Medline].
Quenet S, Laporte S, Décousus H, Leizorovicz A, Epinat M, Mismetti P, et al. Factors predictive of venous thrombotic complications in patients with isolated superficial vein thrombosis. J Vasc Surg. 2003 Nov. 38 (5):944-9. [Medline].
Rathbun SW, Aston CE, Whitsett TL. A randomized trial of dalteparin compared with ibuprofen for the treatment of superficial thrombophlebitis. J Thromb Haemost. 2012 May. 10 (5):833-9. [Medline].

redpajama_set_name: RedPajamaCommonCrawl


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Elon GOAT Token brings giant Musk statue to Tesla factory in Austin
People recently driving around in Austin might have seen Elon Musk.
But not the real person. Instead, they may have seen a sculpture of Musk's head atop the body of a goat riding a rocket, all attached to a trailer.
Complete with what appear to be flames that shoot from the rocket, the statue was commissioned by the cryptocurrency company Elon GOAT Token. The company was delivering it to Tesla's Gigafactory in Austin on Saturday, during what it dubbed "Goatsgiving." The Elon GOAT Token ($EGT) sculpture was created to honor Musk's "many accomplishments and commitment to Cryptocurrency," the company said on its website. Musk is the owner of electric car manufacturer Tesla.
Over the past year, $EGT hasn't seen much growth, according to data from tracker CoinMarketCap, but its founders hoped the Musk statue would inspire the entrepreneur to tweet about the company and bring new exposure to the token.
Elon GOAT Token's efforts to deliver the statue landed the company on Twitter's U.S. trending page. Musk purchased the social network last month, causing an upheaval with mass layoffs, departed advertisers and potential changes to the process of obtaining a Twitter Blue check mark.
Costing a total of $600,000, according to Elon GOAT Token, the Musk sculpture is a nod to the billionaire's fame — a rocket representing SpaceX, the spacecraft company Musk founded; and the literal goat, a word that is also used as an acronym for the phrase "Greatest Of All Time."
Despite exponential growth in recent years, cryptocurrency has had a rough 2022. FTX, the cryptocurrency exchange that was estimated to be worth $32 billion in January, collapsed this month. Its CEO resigned, and the company filed for bankruptcy, prompting an investigation into how the business came undone.
In the past year, millions of dollars in cryptocurrency have been stolen in scams targeting users of exchange operator Coinbase.
Why the FTX collapse has plunged the crypto world into upheaval
Although for Elon GOAT Token "times have not been good," co-founder Ashley Sansalone said Saturday in a Twitter audio stream, the company had earmarked enough money to complete the statue project.
"We believe that Elon's potential acceptance of this biblical sized gift could catapult $EGT into the limelight and accelerate its various initiatives," the company said on its website.
Elon GOAT Token did not respond to The Washington Post's request for comment Saturday.
After months of construction and travel across the country, the statue arrived at the Austin building, Elon GOAT Token confirmed in a tweet Saturday after live-streaming the event. Musk, who has 119 million followers on Twitter, had not publicly acknowledged the project as of Saturday evening. Tesla did not respond to The Post's request for comment Saturday.
Kevin Stone, a sculptor based in Canada, said he received a call about the project last year from its designer, Danny Wang, who didn't disclose the identity of whoever had commissioned the statue until after the contract was signed.
Crypto scam victims seek to hold Coinbase responsible for losses
At first, Stone thought the mystery client was Musk himself. He didn't think anyone else would have commissioned such a "crazy project."
The sculptor began work on the head of the piece in January and finished it nearly six months later, after about 600 hours of work. The sculpture of Musk's head itself ended up six feet tall and four feet wide, weighing 250 pounds.
For Stone, who is known for his sculptures of birds and dragons, the project was the chance to do something he'd never done.
"It was so crazy I couldn't turn it down," he said. "I just wanted to be a part of it just because it was such a unique opportunity to do something that was really, really different."
Spectacle, a U.S. design and fabrication company, designed the goat and rockets on the statue.
On Saturday evening, Sansalone started a Twitter audio stream, saying he and those who had accompanied him for the journey were sitting about 150 feet away from the Gigafactory, where security had asked them to relocate for safety reasons.
Sansalone said that the Elon GOAT Token statue was always "supposed to be fun," intended to make Musk laugh, and that the crypto company was trying to do the same thing as the Tesla CEO, despite being "small in comparison."
As the sun began to set in Austin on Saturday, it was unclear whether Musk would allow the statue to stay.
"We're not leaving," Sansalone said near the end of the stream. "We're going to see how this goes. We're going to wait here."
In the background of the Twitter audio stream, people could be heard yelling: "Elon Musk, let's go! Elon Musk, let's go!"
Read More: Elon GOAT Token brings giant Musk statue to Tesla factory in Austin
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2 edition of campus at Chapel Hill found in the catalog.
campus at Chapel Hill
John V. Allcott
two hundred years of architecture
by John V. Allcott
Published 1986 by Chapel Hill Historical Society in Chapel Hill, N.C .
University of North Carolina at Chapel Hill -- Buildings -- History.
Statement John V. Allcott ; illustrated with maps, photographs, architectural drawings, and sketches by the author.
LC Classifications LD3944.6 .A44 1986
Pagination xii, 108 p., [2] p. of plates :
Postponed: Sue Monk Kidd imagines the wife of Jesus in THE BOOK OF LONGINGS, in conversation with Therese Anne Fowler. 05/15/ - pm. Flyleaf Books | Martin Luther King Jr. Blvd., Chapel Hill, NC | Chapel Hill, NC | Many UNC students are attracted to off-campus housing because of its affordability and convenience to Chapel Hill's many amenities. The market is competitive, particularly for apartments within walking distance to campus. Signing a lease at least a year in advance is highly recommended. From Commuter Resources to "Friday Nights on the Front Porch," Carolina provides resources to help make getting around campus, both day and night, easier for you. Carolina Club The Carolina Club is a member-supported dining club created for alumni, faculty, staff and friends of the University of North Carolina at Chapel Hill. Saunders, Manning and Murphey Halls, University of North Carolina, Chapel Hill, N.C., North Carolina Postcards Collection, UNC-Chapel Hill Our work is the latest chapter in a longstanding campus conversation about equity and the legacies of our history that extends back at least into the s.
The statue had been a part of campus life in Chapel Hill for over a century. The United Daughters of the Confederacy proposed the monument, which the .
The Scouts of Stonewall (Large Print Edition)
The guiding hand, or, Some phases of the religious life of the day
Next to die
The 2007 Report on Wood Window Units
Monteagle Limestone of South-Central Kentucky.
Appropriation Des Langues Au Centre de La Recherche Spracherwerb ALS Forschungsgegenstand
Janet-Viscount project in Islington
The adventures of Harry Revel
Be fertile and increase, fill the earth and master it
The Life and Times of the Thunderbolt Kid
Tapestries and textiles
Hales pond and other poems
Debt Conversion Programme: Another window for investment in Nigeria
Women of North Africa
Encyclopedia of American Gospel Music
evolution of the Edinburgh townscape
Updated Rept. On The Emigration Laws & Policies Of Mongolia... Message... 105-108... Comm. On Ways & Means... The Pres. Of The U.S... 105th Cong., 1st Sess., 07/21/97.
Duo!
campus at Chapel Hill by John V. Allcott Download PDF EPUB FB2
Please join us to celebrate the updated and expanded edition of John V. Allcott's The Campus at Chapel Hill: Years of Architecture with a brief book talk and reception at the John and June Allcott Gallery in Hanes Art Center. ABOUT THE BOOK: The Campus at Chapel Hill: Years of Architecture: The only book exclusively on the architecture of the University of North Carolina, the.
Please join us for a fun ramble on the campus at UNC-Chapel Hill for an architecture tour highlighting many of the interesting stories built into its history and written about in The Campus at Chapel Hill: Years of tour will be led by JJ Bauer (Faculty, Department of Art and Art History) and include the participation of John V.
Allcott's family members. Red Book includes current and historical pricing data and product information for ,+ prescription and over-the-counter drugs, nutraceuticals, and bulk chemicals.
Note:When switching between Micromedex and Red Book, be sure to logout (top right hand corner of the screen.)Author: Rebecca Carlson, Mls, Ahip.
Visit us on Twitter. Visit us on Instagram. Heel Print Housing Excellence Program. Click here to learn more about this initiative, supported by Off-Campus Student Life in partnership with the Town of Chapel Hill Fire Dept.
Off-Campus Student Life. Check out the UNC-CH Off-Campus Student Life page to find off-campus resources such as tips for moving off-campus, roommates, safety and security.
Campus at Chapel Hill book photography from around the world in this exhibition featuring work by University of North Carolina at Chapel Hill alumni, faculty, staff and students. The exhibition will open January 8 and run through J at the FedEx Global Education Center.
In an original poem about her experiences in Chapel Hill, Sakari Singleton says that the University has always loved her for her.
Carolina, she says, helped her become stronger, better and wiser by opening doors to new friendships and relationships. 14 reasons to love Carolina.
Sophomore Taylor Coffey wanted to make a list of all of the things. © University of North Carolina at Chapel Hill. The Campus at Chapel Hill: Years of Architecture: The only book exclusively on the campus at Chapel Hill book of the University of North Carolina, the country's first state university Explore the architectural history and significance of iconic buildings on the UNC campus: the ideas and architects involved,End date: A large citation and abstracting database providing comprehensive coverage of the peer-reviewed journal and conference literature, with links to full-text where available through the library; includes scientific, technical, medical, social science and arts and humanities disciplines and indexes o titles from more than 5, international publishers including over book : Rebecca Carlson, Mls, Ahip.
It's where you'll read the first book that really made an impact in your life. Your first apartment is responsible for the memories you'll look back on fondly for years to come.
Union Chapel Hill doesn't take that responsibility lightly. We provide expertly designed floor plans that fit your off campus lifestyle.
Kendall Addison Account Book, #z, Southern Historical Collection, The Wilson Library, University of North Carolina at Chapel Hill @ Wilson Library +7 Old Line Plate added a new photo — at Wilson Library.5/5(2).
The Campus Y owes its origins to the YMCA and YWCA, which were established at UNC-Chapel Hill in and respectively. Their social gospel mission initiated campus services for UNC students, such as the Book Exchange and the intramural sports programs, and they challenged students to reach out to the community.
E-Book Collections. Find the latest information/resources on the Coronavirus (COVID) Need help accessing resources from off-campus or via UNC Hospitals. Columbia Street CB Chapel Hill, NC () Searchable campus map.
Our. Those North Carolinians who love Chapel Hill and others who want to begin to understand its influence and power should read this book.
It is a good basic reference and summary--and a timely reminder of the strength and value of the University of North Carolina at Chapel HillD. MartinCited by: One of the many community events in the Chapel Hill / series honoring the Town's history and its relationship to UNC was the book launch of "The Campus at Chapel Hill: Years of.
A message from Provost Bob Blouin and University Librarian Elaine Westbrooks. Dear members of the Carolina community, We are writing to let you know that, despite more than a year of sustained negotiations, the publisher Elsevier has failed to provide an affordable path for UNC-Chapel Hill to renew our bundled package of approximately 2, e-journal titles.
University of North Carolina at Chapel Hill, the The shortened form UNC-Chapel Hill may serve in first reference to the Chapel Hill campus in stories that make no reference to other UNC campuses. The full title of the university need not appear in the story. Raleigh Street CB #; Chapel Hill, NC ; A book I need is checked out.
Can I place a hold/recall on the book. I need a book from another campus library. Can I have it sent to HSL. A book I need is listed as "in transit" in the catalog. What does that mean. I need to reserve a DVD/video for a class. How do I do this. I need materials that UNC-Chapel Hill does not own.
If you have any questions about visiting Carolina, please contact us at Planning to explore campus on your own. Be sure to check out our self-guided tour. Until then, please enjoy this sneak peek of campus. Visit Carolina: UNC Chapel Hill Campus Tour from Udara Fernando. Chapel on the Hill - Abilene Christian University is a Reception Venue in Abilene, TX.
Read reviews, view photos, see special offers, and contact Chapel on the Hill - Abilene Christian University directly on The Knot.4/5(1). There are a number of hotels in Chapel Hill and Carrboro near campus.
For options in the Chapel Hill area, we recommend checking out the Visitors Center website. The only hotel available on campus is the Carolina Inn.
Click "Book Now" on the Carolina Inn's website and receive a 15% discount. The Campus at Chapel Hill discusses the history and significance of iconic buildings on the campus, the ideas and architects involved, the people who were prime movers for specific buildings, and how green design initiatives are being incorporated in new new edition updates Professor John V.
Allcott's original book with an. South Bldg Cb Chapel Hill,North Carolina USA () Home Learning will begin Monday, March Teachers are workin this week to prepare.
Paper copies of resources will be available from each campus later this week. School Shutdown Continues through the end of the School Year: A Message from the Texas Education Agency & Chapel Hill ISD on staying healthy and safe. The University of North Carolina at Chapel Hill (UNC, UNC-Chapel Hill, North Carolina, Chapel Hill, or simply Carolina) is a public research university in Chapel Hill, North flagship of the University of North Carolina system, it is considered a Public Ivy, or a public institution which offers an academic experience equivalent to an Ivy League : Lux libertas (Latin).
The Campus Y is a collaborative space that unites students, staff, faculty, and community partners in the pursuit of social justice.
Join a Committee. Home University of North Carolina at Chapel Hill CB # Chapel Hill NC 9 AM-5 PM | Weekdays T: Educational History: Graduated from Texas Tech University. Degrees and Certifications: B.S. Exercise & Sports Science. Professional Development: TABC Chalk Talk – Published Coaches Handbook – Author.
PUBLISHED BOOK -"THE ROAD TO AUSTIN". Report ID: SR UNC-Chapel Hill Page No. 1 of Semester Section Book For Spring Run Date: 01/26/ Campus: UNC Chapel Hill Run Time: College of Arts & Sciences - African, African American & Diaspora - Subject: AFRI, AFRI-AMER, DIASPORA STDS.
Switch To A Different Campus. Campus List. Chapel Hill High School; Chapel Hill Jr. High; Chapel Hill Elementary School Accelerated Reader Book Finder; BAD WEATHER INFORMATION; Enrollment; Faculty Directory Contact Us; CHAPEL HILL.
INDEPENDENT SCHOOL DISTRICT INDEPENDENT SCHOOL DISTRICT. Time Change this Weekend- Spring Forward. Welcome to Graduate Chapel Hill. Just a short walk from the scenic UNC-Chapel Hill campus, our hotel (formerly The Franklin) mixes classic style and campus spirit.
Feel at home in our Carolina retreat, located right on Franklin Street. Learn More. (Chapel Hill, N.C.— Ap ) – "Popular: Finding Happiness and Success in a World that Cares Too Much About the Wrong Kinds of Relationships" is the University of North Carolina at Chapel Hill's selection for the Carolina Summer Reading Program.
CHAPEL HILL Internationally known author John Grisham got permission from a Chapel Hill town board this week to close the book on four century-old cottages near the UNC : Tammy Grubb.
On Octo the Service Desk launched a pilot program to accept appointments at SASB North for students, faculty, staff, retirees and anyone else associated with UNC-Chapel Hill who needs tech support. The SASB North location offers all the same services as the Service Desk's Undergraduate Library location.
Chapel Hill is home to student housing, luxury apartments, modern townhomes, and cozy single-family homes. Rent Trends As of Maythe average apartment rent in Chapel Hill, NC is $1, for a studio, $1, for one bedroom, $1, for two bedrooms, and $1, for three on: W Rosemary St, Chapel Hill, NC The Carolina Inn is adjacent to the campus of the University of North Carolina at Chapel Hill.
This historic hotel features a flat-screen TV in each room and a fitness center on site. Free Wi-Fi and satellite channels are included in the classically decorated guest rooms of this Chapel Hill hotel/10(). Carolina Development, Chapel Hill, NC. 15K likes. Sharing the power of possibility at the University of North Carolina at Chapel Hill.
Chapel Hill Christian School South (then known as the Coventry Branch; now as the South Campus) was established for the school year in answer to the rising demand for quality Christian education. At that time, classes were held in a facility provided by the Brown Street Alliance Church and included pre-K through 2nd grade.
CHILDREN'S CAMPUS OF CHAPEL HILL CHAPEL HILL, NC OWNER Rucker Properties, LLC/ Childrens Campus at Southpoint ARCHITECT SZOSTAK DESIGN, INC 1/2 West Franklin Street Chapel Hill, NC () STRUCTURAL GARDNER & MCDANIEL, PA PO Box Durham, NC () CIVIL COULTER JEWELL THAMES, PA West Main Street.
His book, The Campus at Chapel Hill: Years of Architecture, provides an in-depth look at the architecture of historic campus and is and is filled with fascinating photos, rare documents and Allcott's colorful and whimsical sketches.
His daughter, Elinor Allcott Griffith, shared memories of growing up in Chapel Hill, exploring the campus. Apartments for Rent in Chapel Hill, NC. The proud home to the University of North Carolina at Chapel Hill, this serene suburb is considered one of the top college towns in the Hill embraces its reputation with an evident passion for live music, sports, nightlife, cuisine, and higher education.35+ miles from UNC-Chapel Hill • Book on personal credit card or.
Diners Club. card. Check with your department for direct billing whenever possible. • Guidance on allowable rates, including high-cost cities, can be found in. Policy • Save itemized receipt/"Folio" and submit when the trip is completed. LODGING | 3rd Party Vendors.Picture this: sleek, modern guestrooms with free WiFi, charging station, wide-screen TV, mini-fridge and spa-like bath plus local art, 24/7 fitness center, AC Lounge and patio with firepit – located near UNC and the social hub of Franklin on: West Rosemary Street.
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