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LOT-910 IBM WebSphere Portal 7.0 Deployment and(R) Administration Update

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LOT-910 exam Dumps Source : IBM WebSphere Portal 7.0 Deployment and(R) Administration Update

Test Code : LOT-910
Test title : IBM WebSphere Portal 7.0 Deployment and(R) Administration Update
Vendor title : IBM
real questions : 44 true Questions

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IBM IBM WebSphere Portal 7.0

Perficient Named IBM 2019 Watson Commerce company companion of the 12 months | killexams.com true Questions and Pass4sure dumps

Perficient, Inc. PRFT, +0.ninety four% (“Perficient”), a leading digital transformation consulting firm serving world 2000® and other huge business consumers birthright through North america, introduced it has been named IBM’s 2019 Watson Commerce enterprise associate of the yr. The IBM Excellence Award, introduced during IBM’s PartnerWorld at believe 2019, acknowledges Perficient’s ongoing expand and relationships with key valued clientele, and strategy leadership across the IBM Watson client date Commerce platform as an integral fragment for digital transformation.

“Our strategy to commerce is concentrated on crafting a event, connecting with shoppers, and supplying a seamless consumer event across channels and outright through the commercial enterprise, imperatives in these days’s purchaser-pushed world,” stated Steve Gatto, countrywide income director, Commerce options, Perficient Digital. “collectively, with their customers, we’re reworking businesses in a route that not handiest drives boom however strengthens their measure company, and they continually evolve their choices to preserve customers at the excellent of their game. We’re honored to exist recognized by using IBM, and we’re anticipating sharing their creative solutions outright over IBM believe 2019.”

Perficient Digital Takes Commerce options beyond Transactions to seriously change the client Lifecycle for a world different brand

With branded manufacturers and distributors beneath obligate from the stagy shift to on-line buying, a world diverse company sought to digitally radically change its commerce company. In partnership with Perficient Digital, both organizations delivered optimized customer sales, updated product assistance (PIM), and streamlined the ordering system via building of a B2B portal. With the implementation of IBM’s Sterling Order management tackle (OMS), and Perficient’s abilities, the diverse brand is future-proofing its enterprise to align with industry tendencies and market opportunities.

additionally, the business’s OMS will provide them more advantageous flexibility in managing advanced order administration eventualities, superior reliability in order processing and fulfilment, and a cost reduction in implementing throughout its business. it'll additional allow the company to deliver service enhancements to its consumers, optimize its pricing, promotion and general supply chain, enhance sales as a result of greater inventory visibility, and in the reduction of expenses through more desirable efficiencies in order visibility.

Perficient Digital Enhances the on-line consumer event for a leading fabric Retailer

In a market that has historically trusted brick-and-mortar experiences, a leading fabric and craft retailer was challenged with extending the customer sustain online. Perficient partnered with the business to spot into upshot an IBM Watson Commerce solution that provided up-to-date visibility of its inventory and stronger tracking of its product volume, vicinity, and availability. employing IBM Order management, Perficient additional better the solution via cloud migration that presents a single view of supply and demand, orchestrates order fulfillment processes throughout buy on-line Pickup In withhold (BOPIS) and Ship-from-keep (SFS), and empowers business representatives to superior serve purchasers each in muster facilities and in-save engagements.

“Perficient has been deploying IBM Commerce solutions for just about two decades, providing end-to-conclusion digital commerce solutions that embody multiple channels, and bring seamless and efficient experiences across their complete commercial enterprise,” said Sameer Peera, celebrated manager, Perficient’s commerce apply. “With the concomitant information that HCL took over building of IBM WebSphere Portal, IBM web content material management and internet adventure factory, their valued clientele continue to interact us for assist with their digital commerce recommendations. We’re glad to exist their go-to accomplice as they navigate the changing market landscape and deliver for his or her consumers.”

Perficient abilities in action at IBM feel 2019

apart from its award-successful commerce solution potential, Perficient specialists are reachable during the IBM feel 2019 convention in booth #320 to talk about its event and talents throughout the IBM portfolio , principally cloud, cognitive, information, analytics, DevOps, IoT, content material administration, BPM, connectivity, commerce, mobile, and consumer engagement.

whereas IBM has announced its plans to sell its commerce portfolio, the information of its acquisition of crimson Hat additionally signaled the criticality cloud evolution and birth play in successful end-to-end digital transformations. As an IBM world Elite associate, certainly one of best seven companions with that popularity globally, and a purple Hat Premier accomplice, Perficient is well placed to labor with both agencies via this transition. And, their experts can exist available birthright through IBM deem to talk about how to navigate the cloud market, partake key customer success reviews, and provide strategic capabilities on the opportunities forward for valued clientele.

“technology is altering so hastily, and agencies deserve to preserve pace or puss disruption,” observed Hari Madamalla, vice chairman, rising options, Perficient. “With talents and event in outright aspects of the commerce experience, to main cloud, internet hosting, managed features and aid solutions, organisations spin to Perficient as a go-to associate for their digital transformations.”

be fragment of a number of Perficient zone matter specialists and their customers as they existing outright through six IBM believe classes, including:

As a Platinum IBM company associate, Perficient holds more than 30 awards across its 20-12 months partnership historical past. The enterprise is an award-successful, licensed application value Plus reply company and some of the few partners to acquire dozens of IBM skilled plane utility competency achievements.

For updates outright the route through the sustain and after, connect with Perficient experts on-line with the aid of viewingPerficient and Perficient Digital’s blogs, or succeed us on Twitter@Perficient and @PRFTDigital.

About Perficient

Perficient is the leading digital transformation consulting company serving world 2000® and business purchasers birthright through North the us. With unparalleled counsel technology, management consulting, and creative capabilities, Perficient and its Perficient Digital company deliver imaginative and prescient, execution, and cost with miraculous digital journey, company optimization, and trade solutions. Their labor makes it practicable for customers to expand productiveness and competitiveness; develop and toughen relationships with consumers, suppliers, and partners; and reduce back charges. Perficient's gurus serve consumers from a network of workplaces across North the united states and offshore areas in India and China. Traded on the Nasdaq global opt for Market, Perficient is a member of the Russell 2000 index and the S&P SmallCap 600 index. Perficient is an award-winning Adobe Premier associate, Platinum degree IBM enterprise partner, a Microsoft country wide service company and Gold CertifiedPartner, an Oracle Platinum partner, an advanced Pivotal competent partner, a Gold Salesforce Consulting accomplice, and a Sitecore Platinum associate. For extra counsel, visitwww.perficient.com.

safe Harbor commentary

one of the most statements contained in this information unencumber that aren't merely weak statements talk about future expectations or state other forward-looking assistance regarding fiscal effects and enterprise outlook for 2018. these statements are zone to established and unknown hazards, uncertainties, and other factors that might cause the actual outcomes to disagree materially from those reflected by the statements. The ahead-looking tips is based on administration’s existing intent, perception, expectations, estimates, and projections involving their company and their trade. remember to exist conscious that these statements handiest replicate their predictions. precise routine or consequences may additionally fluctuate significantly. distinguished elements that may cause their actual consequences to exist materially different from the forward-searching statements consist of (however don't seem to exist limited to) those disclosed beneath the heading “possibility components” in their annual document on kindly 10-k for the year ended December 31, 2017.

View source version on businesswire.com: https://www.businesswire.com/information/home/20190212005973/en/

supply: Perficient, Inc.

Ann Higby, PR manager, Perficient, 314-219-8836ann.higby@perficient.com

Copyright enterprise Wire 2019


IBM Buffs spot of labor and WebSphere Portal | killexams.com true Questions and Pass4sure dumps

news

IBM Buffs workplace and WebSphere Portal
  • by route of Stuart J. Johnston
  • November eleven, 2004
  • IBM this week announced modern and up-to-date products in its spot of labor family unit of collaboration items, together with 19 role-primarily based built-in functions for medium and petite enterprise consumers. The business besides notable it will deliver advert hoc internet conferencing as a provider for shoppers starting in December.

    The solutions supply customizable business functions for inevitable industries or classes of enterprise projects and operations – outright developed the exercise of IBM office products and selected third-celebration purposes.

    although most likely a cliché by using now, IBM officers additionally endured to emphasize the adjustments between a “network-delivered” collaboration ambiance and one based essentially on own computers – notably Microsoft’s view. “[With Workplace Solutions] you would not absorb to absorb Microsoft workplace,” says Larry Bowden, vice chairman, of IBM spot of labor utility options.

    IBM designed the solutions by discovering the job roles required for performing ordinary sets of projects or operations inside a collection of perpendicular markets. on the same time, it considered a route to spot into upshot horizontal company roles within regular businesses’ IT environments, together with procurement, finance and administration, consumer provider, and human elements. the modern office solutions supply integrated software units that meet at that nexus; for example, methods to supply branch banking or retail withhold administration services.

    “They’ve taken training out of IBM’s services group and . . . they absorb designed these packages to invent these people with the key business roles greater advantageous,” says Robert Mahowald, analysis supervisor at IDC. That should still, the reasoning goes, invent those companies that adopt these solutions extra a success.

    because the solutions and IBM workplace items usher business specifications, together with Java and XML, different items can besides exist integrated with different programs as neatly. IBM spot of labor contains Lotus spot of work, WebSphere Portal, Lotus Notes and Domino, and WebSphere Everyplace, according to the company’s net site.

    “Our focal point is on organizational productiveness,” says Bowden, adding, “Having a aggressive aspect is not as edifying as having a sustainable competitive facet.”

    really, imposing gross integrated systems in keeping with the services that a company needs to duty as neatly because the roles of the americans who achieve the essential tasks, and presenting that to shoppers in a solution kit that is the next neatest thing – or so IBM officers hope – to a turnkey solution, offers that sustainable side, enterprise executives post.

    The solutions don’t execute every minute thing. Implementation details remain but IBM’s intent is to remove a fragment of the smart out of the system for petite and medium-sized groups that don’t absorb a division committed to offering IT. “Why don’t they salvage you 70 percent of how?” asks Bowden rhetorically.

    in one of IBM’s demonstration eventualities, a monetary institution department teller receives a huge determine and wishes to acquire the approval of a customer service adult, and besides must transparent the deposit for regulatory compliance and auditing. The branch banking reply provides job roles for three diverse employee task sets to fulfill the necessary enterprise functions. certainly, the brand modern workplace solutions embody greater than 30 job capabilities or worker roles, company spokespeople mentioned.

    among the areas where IBM is providing modern workplace solutions are: retail, electronics, manufacturing, finance, telecommunications, executive, life sciences, healthcare and car groups. moreover, the enterprise has updated its department Banking reply in addition to its business Controls and Reporting solution (now at version 2.5).

    fundamentally, youngsters, IBM is taking a a minute diverse tack on coopetition. To corporations like Oracle, SAP and PeopleSoft, “They’re saying, ‘we’re going to give the plumbing for you,’” says IDC’s Mahowald, leaving a fragment of the pie for different players.

    IBM will besides originate providing on claim net conferencing next month, officials referred to. “if you absorb a browser and a cellphone, that you could installation a web convention,” Bowden says. “instead of buying the application from us, which you could just buy the carrier.” This comes as an immediate try to remove enterprise away from Microsoft’s reside assembly, says Mahowald.

    additionally, IBM besides introduced a modern product within the office family unit. IBM office functions express v2.0 is a brand modern product designed for petite and mid-sized organizations and departments in massive corporations. It contains crew collaboration, doc administration, net kinds, project lists, and portal services as neatly person customization features. IBM workplace services categorical additionally integrates with the user's existing purposes and records, as well as electronic mail, calendar and wield publication, and offers more than a few collaboration tackle including integrated instant messaging. it'll ship in December, officers referred to.

    ultimately, IBM debuted the newest free up of WebSphere Portal – version 5.1 – which adds virtual portals, company procedure workflow facets, and more advantageous content management capabilities. edition 5.1 may exist attainable via the finish of November.

    The company will publish pricing for outright of the products and functions when the items can exist found, enterprise officials stated.

    about the writer

    Stuart J. Johnston has coated expertise, primarily Microsoft, on the grounds that February 1988 for InfoWorld, Computerworld, tips Week, and workstation World, in addition to for business Developer, XML & net features, and .internet magazines.


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    Taking a fresh peer at content and collaboration | killexams.com true questions and Pass4sure dumps

    Collaboration technologies, such as Microsoft's SharePoint and IBM/Lotus Notes Domino, are hardly new. The latest version of these platforms – particularly in the case of SharePoint – has undergone stagy change with modern search features and a consistent API for client, server, intranet and the Internet to cite just a few.

    SharePoint Server 2007, released eventual fall, arrives at a time when corporations are focused on regulatory compliance and a modern generation of blog and wiki users is entering the workforce. To date, most corporations exercise SharePoint for workgroup collaboration. But Peter O'Kelly, a senior analyst at the Burton Group, a consulting firm in Midvale, Utah, told SearchWinIT.com that IT managers working arduous to salvage control of their content should remove a fresh peer at today's collaboration tools for enterprise content management.

    SearchWinIT.com: SharePoint has been around for a long time. Why should IT shops pay attention now?

    Peter O'Kelly: The most distinguished change is the plane of integration that has taken place. Proprietary tools today labor in silos – records management, Web content management, file management. So, if you're already committed to Windows Server, SQL Server and maybe Exchange, [then adding SharePoint] will give you edifying synergy. Also, it's not just about IT managers working with intimate tools and services but besides finish users being able to exercise a browser and [Microsoft Office] instead of being trained on specialized tools.

    But [SharePoint] is not for everybody. If you exigency to evade Linux, if you are primarily a Java shop from an application evolution standpoint, then you can't play.

    Has SharePoint caught up to Notes in terms of its corporate entrenchment?

    O'Kelly: SharePoint may exist 'stealthy,' but it is well used. There are two elements to SharePoint: One is Windows SharePoint Services, which is free, although you execute exigency a SQL Server CAL [client-access license] to execute anything meaningful. Then there is the product you pay for, which until 2007 was called SharePoint Portal Server 2003. Now it's called Microsoft Office SharePoint Server 2007. Microsoft says it has sold more than 85 million CALs. Notes is the most broadly deployed incumbent today with about 130 million [CALs], but Notes has been out there since 1989.

    There is a series of major advances with [SharePoint] 2007. With [SharePoint] 2003, most people thought of it as a department-level portal. They exercise it for basic workspaces, document libraries and team discussions. With 2007, the product is more credible for enterprise content management. SharePoint is really the server side component for Microsoft Office. Instead of using file servers, you will capture content [in SharePoint].

    So you can supplant a lot of individual tools by using these platforms?

    O'Kelly: There are things you can execute with SharePoint, such as records management and workflow. Organizations exercise file servers to partake files among applications. But file servers are not edifying for people. With people, it's better to evanesce with a Web-centric view where you don't absorb to copy files to a file server. It's not a replacement for a file system like SQL Server.

    There is a stark reality for a lot of organizations and that is large, publicly traded companies are out of compliance. like Y2K, you absorb to inventory and fix this stuff. But the reality is companies don't absorb control over their content -- and not just documents.

    There are things in database management systems, but historically those are more transaction-oriented document management systems. The vast majority of content today is on file servers, or local arduous disks or email and email with file attachments. outright of that needs to salvage under control. [Regulatory] compliance is helping.

    What about the corporate cultural barriers that might withhold companies from adopting these tools?

    O'Kelly: This has been the biggest challenge. If you don't labor in an organization that fosters collaboration, then you are wasting your money. You notice this sort of thing in sales where the person who sits next to you would just as soon slay you than give you information. It's easier for people who are modern to the workforce who are already doing this stuff. Some of them will find their route to SharePoint.

    They arrive to labor and want to exercise blogs and wikis and would rather not absorb a rogue open source project under their desk.

    Will IT shops absorb to invest a lot of time in training finish users?

    O'Kelly: What they exigency to execute is salvage people to unlearn some things. In the past they've had to copy and paste, but people naturally default to email and file attachments. That's why blogs and wikis are so popular. They are consistent with the route people work. It's a breakthrough of simplicity.

    Compare IBM and Microsoft collaboration strategies. How execute you elect between them?

    O'Kelly: Start at the top. How much execute you supervision about things like Java and back for non-Microsoft platforms? execute you supervision about non-Microsoft server platforms and non-Microsoft developer tools? If you do, you exigency to peer at more competitive alternatives.

    So remove that out of the equation. What I'm looking for is browser-oriented content and collaboration, and I absorb an email strategy so I'm not looking for an email strategy with content and collaboration. So then it's SharePoint versus [IBM] WebSphere Portal. WebSphere Portal will soon exist extended with QuickR [file sharing software], which is an light to labor with browser-based experience. There is besides Oracle WebCenter, though it has almost zero brand and market awareness.

    [Now, take] it further. I exigency to back multiple moneyed client platforms. I absorb Windows, Mac and Linux and I exigency to remove labor offline. Then you absorb to evanesce down a path where Notes looks unique. Notes and [Microsoft] Groove are the only products now that can remove things offline for content management.

    If I'm leaning toward IBM, execute I evanesce with a WebSphere core or a Notes/Domino core? IBM's biggest challenge is market perception of its products. Notes is not seen as obsolete but a late-in-life product. With the release of Notes 8, IBM needs to salvage people to remove a peer so they can notice it's not a 1990s piece of software.


    Is Obama Ready To exist A Two-Way President? | killexams.com true questions and Pass4sure dumps

    Where there’s victory, there’s besides opportunity…

    This Presidential election was profound in its results. Obama won both the Electoral College vote 364 to 163 and the celebrated vote 53% to 46% with roughly 120,000,000 votes cast. This election was the first in 50 years, in which there was no incumbent President or Vice President from either party competing for the Presidential nomination. nearby to 65% of the American population voted in this election, its highest turnout since the election of 1908.

    With Obama’s wins in key “swing states” including Ohio, Florida, Colorado, and Pennsylvania, this election was nothing short of a landslide victory that fundamentally redrew America’s political dynamics. A Democrat had not won Virginia and Indiana in a generation.

    Credit: CNN

    But let’s examine the election another way, one that may bring to life a different picture of how Obama earned his spot in history. His campaign both redrew political lines and besides forever changed the route candidates achieve out to constituents.

    Online tools such as Facebook, MySpace, and Twitter contributed to the netting of record-breaking campaign funding and the staggering galvanization of a younger generation of first-time voters who truly made an repercussion and a difference. The Obama campaign, for example, outspent McCain nearly three-to-one, which was a testament to the capabilities of technology and the corresponding repercussion of sociology let lax on the Web. The Obama campaign leveraged multiple technology platforms and sociable immersion strategies to engage constituents directly, raising an astounding $660 million in campaign contributions.

    They went directly to the people.

    The Obama team, for specimen befriended almost 130,000 friends on Twitter with an almost equal amount following him.

    On Facebook, the Obama page boasted over three million fans compared to McCain’s 618,000.

    YouTube besides swayed towards Obama with a network of 358,000 to 191,000, with the Obama camp posting over 1,800 videos compared to McCain’s 330. These videos accounted for 110 million views.

    If you compare the other sociable networks and communities from FriendFeed to MySpace to Flickr, the stats are asymmetrical in Obama’s partiality.

    Many of these two-way tools however, were simply used as broadcast mechanisms to dispatch updates, solicit contributions, provide updates, and to besides rally and unite supporters, albeit successfully.

    Reaching the other 46%

    My question is: What if these same sociable media tools where deployed to not only communicate “to” constituents, but besides to listen and interact with supporters as well as those who don’t currently endorse the President-elect?

    Over 46% of America voted against Barrack Obama, with 22 states going to John McCain, regardless of weight in the Electoral College. Either route you peer at it, that’s quiet a significant portion of America who didn’t believe #change or #hope were attributes of the Obama campaign. These voters believed their future lay with another candidate.

    Whether you’re a Democrat, Republican, Independent or member of the Green Party, you cannot overlook the power of true world community relations combined with the achieve and date of online sociable communities and networks to change politics as usual.

    If Obama dedicates a team aside from the outbound crew that “pushes” content through sociable channels in order to strategically reach, listen to, and embrace the 46% who voted against him, he might exist able to evade a truly democratic term. It could besides curtail the necessity to campaign as much while in office in order to focus on the issues they elected him to fix

    All signs and words emanating from the Obama camp and Mr. Obama himself, point to a strategy of leveraging today’s powerful, two-way bridges of communication.

    In a text message sent to supporters on the eve of the election, he reaffirmed that they will exist fragment of the Presidency moving forward, “We absorb a lot of labor to execute to salvage their country back on track, and I’ll exist in finger soon about what comes next.”

    But perhaps the most revealing vow that showed Mr. Obama will evade his office for outright the people of the United States, not just those who voted for him, was shared through his words on November 4th:

    I will listen to you, especially when they disagree…and to those Americans whose back I absorb yet to earn, I may not absorb won your vote tonight, but I hear your voices. I exigency your help. And I will exist your President, too.

    His first step towards bringing the vision of running a cross-party campaign is the launch of Change.gov, a portal for transparency and interaction during, and hopefully past, the transition.

    In a sense, Change.gov is a simple and engaging site, but besides highly intricate in its goals to give voters a voice. It is a resource hub for sharing information, updates, jobs, and besides provides a channel for people who partake their vision, concern, and ideas with the President and his advisors through text, images or video.

    Mr. Obama offers this message to visitors:

    I putaquestionto you to believe - not just in my capacity to bring about change, but in yours. I know this change is possible…because in this campaign, I absorb had the privilege to witness what is best in America.

    Change.gov is the first step in a long road of reshaping the dynamics of politics and communication with voters.

    They’re on the birthright track however.

    Obama’s history-making campaign that fused community relations with sociable sciences, after all, carried him to the Democratic nomination and besides the Oval Office. Mr. Obama and his team absorb cultivated and collaborated with a database of millions of people that spans a sophisticated contact relationship management infrastructure that spans across the true world to outright celebrated sociable networks.

    With an elaborate and revolutionary channel that will only grow with his Presidency, Obama takes office with a powerful modern medium that may eclipse the achieve and drive of traditional broadcast media.

    But, what about those who voted against him?

    What’s the channel for Obama to ask, “Why didn’t I salvage your vote?” Is it Change.gov or is it through the combination of inbound and outbound date that will unearth the key concerns that present genuine potential for not just listening, but besides bright response and earned support?

    It’s a two route street.

    This isn’t just about broadcasting content through modern channels or merely soliciting feedback, participating in celebrated networks or actively listening. It’s the capacity to identify and internalize themes to precipitate change and win back through action—not just words.

    For the first time, the U.S. President can cultivate grassroots communities directly where people create, discover, and partake information online. He is already thinking in this direction, as evidenced by his purpose to record the weekly Presidential address on Youtube, in addition to broadcasting it over the radio. The videos will exist hosted on Change.gov, with the first one already recorded.

    Other opportunities to engage with citizens online include:

    - Launch a sociable network at Change.gov and/or whitehouse.gov

    - Create a citizen feedback and collaboration page at GetSatisfaction

    -Solicit policy proposals that people can vote up or down on Change For Us.

    - Open the blog to comments on Change.gov (with community moderation).

    - Address the country on YouTube with updates, polls, and besides address issues in between official state of the Union broadcasts.

    - Capture behind-the-scenes footage of the inner workings of the White House and partake across outright video networks.

    - Create a user-generated channel on Magnify.net that features content from constituents.

    -Create an @obamacares or @whitehousecares account on Twitter and other micro-blogging communities to listen and respond directly within each network.

    - Complement the Presidential radio expose with a regular podcast or livecast on uStream.tv or BlogTalkRadio and besides interact with the people online, in true time.

    - Publish speeches and distinguished policy documents on document networks such as Scribd and Docstoc to exist shared and disseminated throughout blogs and personal sociable profile pages.

    (What other ideas execute you have? Add them to comments).

    This is how a President, or any politician or business for that matter, can authentically connect with the people formerly known as the audience—in the true world.

    Treat us like customers

    Most, successful businesses around the world spot customers at the hub of everything. Before the Web, for instance, Nordstrom built its engendering foundation on world-class, and now world famous, customer care.

    There’s an extraordinary occasion here for the White House to leverage these modern and influential channels of conversation to embrace and cultivate voters as if they were customers, winning market share, one person at a time.

    This is an era in which information is democratized. The Web potentially offers a live and unfiltered looking glass into the office of the Presidency and besides the thoughts, insights, support, satisfaction, and grievances of the American people.

    The Web cuts through political tape to spotlight the issues that matter most to the electorate. It creates the foundation for people to participate in a truly democratic, crowd-sourced Government that can directly channel their discontent or modern ideas.

    It’s through this collaboration that any public official, particularly the President, could continually maintain a real-time pulse of the country to learn from the very human effects and responses to government actions to evade a more in-tune and effectual administration.

    People shouldn’t only absorb a voice during an election time; listening and responding should exist an ongoing practice and process of any office. This is a political ecology rooted in sociology and conversations. It’s the art and science of stripping down the politics to betray the truth.

    The President can’t meet everyone, that’s just the reality. It’s human nature to disagree. This President-elect is not purporting to exist perfect, but it seems he’s honestly willing to learn. With a national chief technology officer in place, combined with an informed date team versed in sociable sciences and psychology, he can exercise technology and two-way channels to not only expand economic efficiencies and boost education and media literacy, but besides to “listen” to those influential beacons in order to continue to redraw, or potentially erase, party lines.

    In my techtopian dreams, I hope that these incredible networks remain a constant source of conversation to extend beyond campaigning, but besides collaborative governance that unites people.

    It’s not about being Republican or a Democrat, it’s about representing the majority of the people, their views, passions, ambitions and struggles, in order to exist a representative of the people for the people. This is Obama’s occasion to exercise the tools and channels of today’s emerging voter demographics to rewrite the future of politics, while serving the best interests of the American people in the process.

    Sometimes the best advisors and cabinet members are the very people who elected that person into office, and maybe, just maybe, besides those who voted against him in the first place.

    If the Obama camp reads this, I’m more than gratified to release @obamacares and @whitehouse cares on Twitter. I held them for you.

    Crunch Network: MobileCrunch Mobile Gadgets and Applications, Delivered Daily.


    Whole-Brain Susceptibility-Weighted Thrombus Imaging in Stroke: Fragmented Thrombi predict Worse Outcome | killexams.com true questions and Pass4sure dumps

    Abstract

    BACKGROUND AND PURPOSE: The prevalence and clinical import of primarily fragmented thrombi in patients with acute ischemic stroke remains elusive. Whole-brain SWI was used to detect multiple thrombus fragments, and their clinical significance was analyzed.

    MATERIALS AND METHODS: Pretreatment SWI was analyzed for the presence of a single intracranial thrombus or multiple intracranial thrombi. Associations with baseline clinical characteristics, complications, and clinical outcome were studied.

    RESULTS: single intracranial thrombi were detected in 300 (92.6%), and multiple thrombi, in 24 of 324 patients (7.4%). In 23 patients with multiple thrombi, outright thrombus fragments were located in the vascular territory distal to the primary occluding thrombus; in 1 patient, thrombi were organize both in the anterior and posterior circulation. Only a minority of thrombus fragments were detected on TOF-MRA, first-pass gadolinium-enhanced MRA, or DSA. Patients with multiple intracranial thrombi presented with more ascetic symptoms (median NIHSS scores, 15 versus 11; P = .014) and larger ischemic areas (median DWI ASPECTS, 5 versus 7; P = .006); edifying collaterals, rated on DSA, were fewer than those in patients with a single thrombus (21.1% versus 44.2%, P = .051). The presence of multiple thrombi was a predictor of unfavorable outcome at 3 months (P = .040; OR, 0.251; 95% CI, 0.067–0.939).

    CONCLUSIONS: Patients with multiple intracranial thrombus fragments constitute a petite subgroup of patients with stroke with a worse outcome than patients with single thrombi.

    ABBREVIATION: SVS susceptibility vessel sign

    Little is known about the balance of acute ischemic strokes caused by multiple intracranial thrombi. Rarely, distal thrombus fragments that are sunder from the primary occluding thrombus can exist detected on DSA. Incomplete vessel occlusion by the primary thrombus with distal passage of contrast is required for this observation. Therefore, the fair prevalence of multiple intracranial thrombi in the stroke population and the implications for clinical outcome remain unknown.

    Advanced gradient-echo-based MR imaging sequences, such as SWI, are highly sensitive in distinguishing structures that absorb different susceptibility values than their surroundings (eg, deoxygenated blood, hemosiderin, ferritin, or calcium).1 SWI offers the possibility to directly visualize thrombotic material, commonly referred to as the susceptibility vessel symptom (SVS), independent of the presence of blood flux or contrast media.2⇓–4 Recent studies confirmed that 1.5T and 3T SWI is a fast, robust, and highly sensitive imaging technique in acute stroke without pertinent image interference following gadolinium application.5,6 They performed SWI, covering the gross brain in patients with acute ischemic stroke of the anterior or posterior circulation to determine the prevalence of multiple intracranial thrombi before thrombolytic treatment and to study the associations between the presence of fragmented thrombi and baseline clinical and imaging characteristics, stroke etiology, and clinical outcome.

    Materials and Methods Patients and Clinical Data

    Five hundred fifty-seven patients with acute ischemic stroke treated at their stroke unit from January 2010 to August 2013 underwent MR imaging after admission. Of these, 442 patients had MR imaging including SWI before initiation of thrombolytic therapy. Patients with anterior or posterior circulation stroke due to tandem occlusions (ICA and MCA), carotid-T occlusions, isolated occlusions of the MCA (M1, M2, or M3/4 segments), occlusions of the anterior cerebral artery, occlusions of the basilar artery either isolated or in combination with the vertebral artery, and occlusions of the posterior cerebral artery were considered for the final analysis. Three hundred forty-seven patients fulfilled outright inclusion criteria. Following the imaging, outright patients underwent recanalization therapy with IV rtPA, endovascular techniques, or a combination of both.

    Clinical data were continuously recorded in the data ground of their stroke center. The visitation of Org 10172 in Acute Stroke Treatment criteria were used for the categorization of stroke etiology.7 The circumstance of symptomatic and asymptomatic intracranial hemorrhage, within 72 hours from stroke onset, was recorded according to the Prolyse in Acute Cerebral Thromboembolism II criteria.8 Clinical outcome was assessed 3 months after stroke by using the modified Rankin Scale. The study was approved by their institutional review board.

    Imaging

    Standard stroke MR imaging protocol was performed, which included diffusion-weighted imaging, T2-weighted imaging, TOF-MRA, SWI, first-pass gadolinium-enhanced MRA of the cervical and intracranial arteries, and perfusion imaging. The scans were acquired on 1.5T and 3T MR imaging systems (Magnetom Avanto and Magnetom Verio; Siemens, Erlangen, Germany).

    For the 1.5T scanner, the SWI parameters were the following: TR, 49 ms; TE, 40 ms; number of averages, 1; FOV read, 230 mm; FOV phase, 75.0%; voxel size, 0.9 × 0.7 × 1.8 mm; flip angle, 15°; acquisition time, 2 minutes 59 seconds. For the 3T scanner, the parameters were as follows: TR, 28 ms; TE, 20 ms; number of averages, 1; FOV read, 230 mm; FOV phase, 75.0%; voxel size, 0.9 × 0.9 × 2.0 mm; flip angle, 15°; acquisition time, 2 minutes 59 seconds. The SWI and minimum-intensity-projection images were generated automatically by the scanner software.

    DSA was performed via a transfemoral approach by using a biplane, high-resolution angiographic system (Axiom Artis zee; Siemens).

    Image Analysis

    MR images were interpreted in consensus by a neuroradiologist and a radiologist in training. SWI was analyzed for the presence of the SVS in the supraclinoid segment of the ICA, the MCA, the anterior cerebral artery, the intradural segment of the vertebral artery, the basilar artery, and the posterior cerebral artery. The SVS was defined as an zone of signal drop within the course of an artery that either exceeded the diameter of the contralateral nonoccluded vessel or that of the adjacent vessel segment on both the SWI and minimum-intensity-projection series.3 The length of the main thrombus and distal thrombus fragments, if applicable, was measured on SWI. In case of carotid-T, tandem, and combined basilar artery and vertebral artery occlusions, total clot length could not exist determined because of either susceptibility artifacts in the proximity of the skull ground or thrombi located partially outside the FOV.

    A distal thrombus fragment was defined as an SVS being separated from the more proximal SVS by >2 mm—that is, the largest dimension of a voxel in SWI (Figs 1 and 2). The distance between the primary occluding thrombus and distal thrombus fragments was measured on a reconstructed plane, including both the distal fragment of the primary occluding thrombus and the proximal fragment of the thrombus fragment.

    Fig 1.

    An 85-year-old man with right-sided hemiparesis and aphasia (NIHSS 13). Pretreatment SWI shows susceptibility vessel signs in the left M1 and M2 segments (A, white arrows). On TOF-MRA (MIP), diminished flux signal is seen distal to the thrombus fragment in the M1 segment with complete loss of flux signal at the site of the distal thrombus fragment (B, white arrowheads). DSA demonstrates incomplete occlusion of the vessel lumen by a thrombus in the M1 segment (C, anteroposterior projection, black arrowhead). On the lateral projection, occlusion of the temporo-occipital M2 branch by a more distal thrombus fragment is visible (D, black arrow). Although both TOF-MRA and DSA can expose the distal vessel occlusion, only SWI allows estimation of the length of the distal fragment and exclusion of additional distal thrombi.

    Fig 2.

    A 69-year-old mannish patient with a sudden lessen in consciousness. SWI shows susceptibility artifacts from thrombotic material in the basilar artery (A, white arrow) and the birthright posterior cerebral artery (B, white arrowhead). Hemorrhagic transformation of a subacute infarction in the vascular territory of the birthright posterior cerebral artery is seen. DSA confirms occlusion of the basilar artery (C, anteroposterior projection, black arrowhead). Following successful endovascular recanalization of the basilar artery, the occlusion in the perimesencephalic segment of the birthright posterior cerebral artery, already known from pretreatment SWI, becomes visible in DSA as well (D, anteroposterior projection, black arrow).

    In patients with anterior circulation stroke, with the exception of the 4 patients with isolated anterior cerebral artery occlusion, the extent of ischemic lesions was assessed on pretreatment DWI by using the Alberta Stroke Program Early CT Score.9

    Leptomeningeal collaterals were assessed on DSA as described previously.10

    Statistical Analysis

    Categoric variables were compared with the χ2 test and the Fisher exact test as appropriate, and continuous variables, with the Mann-Whitney U test. To determine the predictors of clinical outcome, they performed a forward stepwise logistic regression, including outright variables with a P < .2 in univariate analysis. These variables were age, sex, baseline NIHSS score, occlusion site, degree of collaterals, DWI ASPECTS, atrial fibrillation, diabetes mellitus, arterial hypertension, hypercholesterolemia, coronary artery disease, current smoking, and the presence of multiple intracranial thrombi on pretreatment imaging. Clinical outcome was dichotomized into benign (mRS 0–2) and destitute outcome (mRS 3–6). Collateral status was dichotomized into edifying and moderate/poor collaterals. A P value < .05 was considered significant. Statistics were performed with SPSS, Version 21 (IBM, Armonk, modern York).

    Results

    The SVS was detected in 324 of 347 patients (93.4%) on pretreatment SWI. Multiple intracranial thrombi were organize in 24 patients (7.4% of outright patients with visible SVSs). Fragmented thrombi occurred with a similar frequency in anterior and posterior circulation strokes (3/36 [8.3%] versus 21/288 [7.3%], P = .739). Nineteen patients had 1 distal fragment, 3 had 2 fragments, and 2 had 3 fragments. One of 31 fragments was located in the M1 segment of the MCA; 15, in the M2 segment; 11, in the M3 or M4 segment; 2, in the P2 segment of the posterior cerebral artery, and 2, in the P3 segment. Thirty thrombus fragments were organize in the vascular territory distal to the primary occluding thrombus. One patient with a carotid-T occlusion was organize to absorb a thrombus fragment in the P3 segment of the ipsilateral posterior cerebral artery, most likely by distal migration through a fetal variant of the posterior cerebral artery.

    The connote distance of thrombus fragments from the primary occluding thrombus was 19.6 ± 15.6 mm. The connote length of thrombus fragments was 7.1 ± 4.0 mm.

    TOF-MRA and first-pass gadolinium-enhanced MRA detected distal thrombus fragments in 8 and 11 of 24 patients (25.0% and 33.3%, respectively), with multiple intracranial thrombi on SWI. Nineteen of the 24 patients with multiple intracranial thrombi on SWI underwent DSA. In this group, thrombus fragments were confirmed in 8 patients (42.1%) on DSA.

    Baseline clinical characteristics of patients with fragmented and single thrombi are shown in Table 1. Patients with multiple intracranial thrombi presented with a significantly higher median NIHSS score on admission (15 versus 11, P = .014). No significant incompatibility in vascular risk factors or stroke etiology was organize between the 2 groups. The prestroke exercise of antiplatelet drugs or anticoagulants did not disagree between the groups. Imaging characteristics and treatment are compared in Table 2. In patients with isolated MCA, anterior cerebral artery, basilar artery, and posterior cerebral artery occlusions, total clot length was determined. Clot length in patients with fragmented thrombi was significantly higher than that in patients with a solitary thrombus (20.1 ± 10.7 versus 10.3 ± 5.6 mm, P < .001).

    Table 1:

    Baseline clinical characteristics

    Table 2:

    Imaging characteristics and treatment

    Patients with fragmented thrombi had significantly lower median DWI ASPECTS, meaning larger ischemic areas on DWI, than patients with a solitary thrombus (5 versus 7, P = .006). edifying collaterals as assessed on DSA were organize in fewer patients with fragmented thrombi than in those without, but the incompatibility was not significant (4/19 [21.1%] versus 88/199 [44.2%], P = .051). One hundred eight patients (33.3%) were treated with IV rtPA alone, 140 (43.2%) underwent endovascular treatment, and 76 (23.5%) had a combination of both. Treatment was similar in both groups. Clinical outcome at 3 months was worse in patients with fragmented thrombi (mRS 0–2: 6/23 [26.1%] versus 171/286 [59.8%]; P = .002; Table 3).

    Table 3:

    Intracranial bleeding complications and clinical outcome

    The following variables showed P < .2 in univariate analysis and were included in the binary logistic regression analysis: NIHSS, age, DWI ASPECTS, multiple intracranial thrombi on pretreatment imaging, occlusion site, atrial fibrillation, diabetes mellitus, arterial hypertension, coronary artery disease, and current smoking. In their stepwise regression model, NIHSS was included as the first variable, followed by age, DWI ASPECTS, and finally the presence of multiple thrombi. The absence of multiple thrombus fragments (P = .040; OR, 0.251; 95% CI, 0.067–0.939), higher DWI ASPECTS (P = .004; OR, 1.328; 95% CI, 1.093–1.614), younger age (P < .001; OR, 0.919; 95% CI, 0.889–0.950), and lower NIHSS score (P < .001; OR, 0.832; 95% CI, 0.773–0.894) predicted edifying outcome.

    Discussion

    Using whole-brain SWI, they organize multiple intracranial thrombi in 24 of 324 patients with acute stroke with the SVS (7.4%) before initiation of any thrombolytic therapy. Most distal thrombus fragments (95.8%) affected the same vascular territory distal to the proximal occluding thrombus and were therefore a priori invisible with ordinary angiographic techniques. They organize significant associations between the presence of multiple intracranial thrombi and a higher NIHSS score on admission as well as larger ischemic areas on pretreatment DWI. The presence of fragmented thrombi was a predictor of unfavorable clinical outcome at 3 months.

    A study that analyzed the histologic structure of clots extracted by endovascular means by using the Merci retriever (Concentric Medical, Mountain View, California) reported that in 64% of cases, thrombi were retrieved in multiple fragments.11 It is likely that the prevalence of fragmented thrombi had been lower before mechanical disruption of the clot during deployment and retraction of the thrombectomy device. This supposition is supported by their in vivo studies demonstrating thrombus fragmentation and distal embolization during retrieval of the initially single thrombus with distal thrombectomy devices.12

    Although their results are based purely on thrombus fragmentation before thrombolytic treatment, it could exist speculated that iatrogenic thrombus fragmentation might absorb a similarly negative repercussion on outcome. This may, among other contributing factors, warrant the disappointing clinical outcome in studies that used thrombus fragmentation techniques exclusively (Multi Mechanical Embolus Removal in Cerebral Ischemia, Penumbra Pivotal Stroke Trial, Mechanical Retrieval and REcanalization of Stroke Clots Using Embolectomy trials)13⇓–15 or in fragment (Interventional Management of Stroke III, SYNTHESIS Expansion [A randomized controlled visitation between loco-regional intra-arterial and systemic intravenous thrombolysis with Alteplase in acute ischemic stroke]).16,17 The SYNTHESIS Expansion study reported that thrombus fragmentation with a microguidewire was performed in approximately two-thirds of patients.17 In contrast, the goal of current mechanical thrombectomy in acute stroke is removal of the thrombus en bloc with the lowest practicable rate of thrombus fragmentation, as applied and improved in experienced stroke centers.10,18,19

    In their series, edifying collaterals as assessed on DSA were organize in fewer patients with multiple intracranial thrombi, though the incompatibility was not significant. No additional differences in other well-known predictors of outcome were organize between patients with and without multiple thrombi. There is evidence from multiple studies that edifying leptomeningeal collaterals reduce and late penumbral tissue loss, resulting in better clinical outcome.20,21 When one considers the differences in collateral status between patients with and without multiple fragments, the probable role of autolysis should exist discussed. Zanette et al22 reported that instinctive lysis occurs in a tall percentage of patients with distal MCA occlusions, similar to the sites where most of the distal thrombus fragments were organize in their cohort. Because edifying collaterals were seen less often in patients with multiple thrombus fragments than in those with a single thrombus, one could hypothesize that fewer endogenous thrombolytic factors may absorb reached the distal thrombus fragments in patients with destitute collateralization, resulting in the persistence of these fragments.

    Thrombus affliction must exist taken into account when looking for factors that could warrant the differences in outcome. Total clot length, defined as the combined length of the primary occluding thrombus and the distal thrombus fragments, was significantly higher in patients with fragmented thrombi compared with those with a solitary thrombus. It remains unclear whether longer thrombi are more likely to fragment or distal fragments lead to secondary clot formation due to stagnation of blood flow, thus increasing total clot length. A recent study assessed clot affliction in patients with anterior circulation stroke on T2*-weighted imaging by using a scoring system based on the vessel segments that were affected by thrombotic material. Patients with fewer and more distal vessel segments involved had a higher revascularization rate and were more likely to absorb benign clinical outcome.23 Because absolute thrombus length was not fragment of the scoring system, the comparability with their results is limited. One has to deem that assessment of thrombus affliction by measuring the total length of thrombus fragments could result in overestimation in patients with multiple thrombi. Migration of distal thrombus fragments to smaller-sized vessels may result in reorientation and elongation of distal thrombi, resulting in a total clot length disproportionate to total clot volume.

    TOF-MRA, first-pass gadolinium-enhanced MRA, and DSA detected only a minority of distal thrombus fragments seen on SWI. The lower defer of these imaging techniques in the detection of distal thrombus fragments most likely results from their dependence on the presence of blood flux or contrast media, both of which are usually reduced or absent distal to the primary vessel occlusion. Besides DWI and imaging of the gross angioarchitecture from the aortic arch up to distal branches of the cerebral arteries, imaging of the thrombus and its fragments with SWI has become a measure sequence of their stroke protocol due to its tall therapeutic relevance.5

    Our study has some limitations. Image analysis was only performed in consensus. In their experience, the SVS and distal thrombus fragments are easily detectable and they did not deem it necessary to additionally assess interobserver variability. Furthermore, each MR imaging study was routinely evaluated by a neuroradiologist and radiologist in training, and the findings were documented in their PACS. In 16 of the 24 patients (66.7%) with multiple thrombi on SWI, a distal vessel occlusion or thrombus fragment or both sunder from the primary occlusion had already been described in the radiology report. Most interesting, in the 8 patients in whom distal thrombus fragments were not described initially, the fragments were located in closer proximity to the primary thrombus than in those in whom the distal occlusion was mentioned (7.0 ± 4.0 versus 24.2 ± 15.9 mm). One could speculate that these fragments were either harder to detect or had not been considered distinguished enough to exist described in the radiology report. In this single-center study, data from imaging were partly analyzed retrospectively. The petite size of the patient group with fragmented thrombi limits the generalizability of the results. Evaluation of ICA and basilar artery thrombi on SWI was greatly limited by the extensive susceptibility artifacts in the proximity of the skull base.

    Conclusions

    Multiple intracranial thrombi were detected on pretreatment SWI in 7.4% of patients with acute ischemic stroke of the anterior or posterior circulation. The presence of fragmented thrombi was a predictor of worse outcome. Patients with multiple thrombus fragments presented with more ascetic symptoms on admission, had more extensive ischemic areas on pretreatment DWI, and demonstrated worse collaterals as seen on biplane angiography. To know that multiple thrombi are present not only helps in planning the endovascular treatment, especially mechanical thrombectomy because distal fragments render the intervention more difficult, but may besides exist of exercise in prognostication of functional outcome.

    Acknowledgments

    We thank Pietro Ballinari for statistical advice.

    Footnotes
  • Disclosures: Jan Gralla—UNRELATED: Consultancy: Covidien,* Comments: Global Principal Investigator of the Solitaire FR Thrombectomy for Acute Revascularization Study and consultant for Covidien. Heinrich P. Mattle—UNRELATED: Consultancy: Bayer, Biogen, Boehringer Ingelheim, Daiichi-Sankyo, Genzyme, Merck, Neuravi, Novartis, Pfizer, Teva; Grants/Grants Pending: Swiss Heart Foundation,* Swiss National Science Foundation*; Payment for Lectures (including service on Speakers Bureaus): Bayer, Biogen, Boehringer Ingelheim, Covidien, Daiichi Sankyo, Genzyme, Neuravi, Novartis, Pfizer; Royalties: for textbooks on neurology I absorb written. *Money paid to the institution.

  • Paper previously presented in fragment at: XXIII European Stroke Conference, May 12–15, 2014; Nice, France.

  • Received October 24, 2014.
  • Accepted after revision December 11, 2014.


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    BICSI [2 Certification Exam(s) ]
    BlackBerry [17 Certification Exam(s) ]
    BlueCoat [2 Certification Exam(s) ]
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    FCTC [2 Certification Exam(s) ]
    Filemaker [9 Certification Exam(s) ]
    Financial [36 Certification Exam(s) ]
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    Fortinet [13 Certification Exam(s) ]
    Foundry [6 Certification Exam(s) ]
    FSMTB [1 Certification Exam(s) ]
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    GAQM [9 Certification Exam(s) ]
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    GIAC [15 Certification Exam(s) ]
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    Hospitality [2 Certification Exam(s) ]
    HP [750 Certification Exam(s) ]
    HR [4 Certification Exam(s) ]
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    Hyperion [10 Certification Exam(s) ]
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    ICAI [1 Certification Exam(s) ]
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    IEEE [1 Certification Exam(s) ]
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    ISEB [24 Certification Exam(s) ]
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    McAfee [8 Certification Exam(s) ]
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    NCIDQ [1 Certification Exam(s) ]
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    NI [1 Certification Exam(s) ]
    NIELIT [1 Certification Exam(s) ]
    Nokia [6 Certification Exam(s) ]
    Nortel [130 Certification Exam(s) ]
    Novell [37 Certification Exam(s) ]
    OMG [10 Certification Exam(s) ]
    Oracle [279 Certification Exam(s) ]
    P&C [2 Certification Exam(s) ]
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    Pegasystems [12 Certification Exam(s) ]
    PEOPLECERT [4 Certification Exam(s) ]
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    Polycom [2 Certification Exam(s) ]
    PostgreSQL-CE [1 Certification Exam(s) ]
    Prince2 [6 Certification Exam(s) ]
    PRMIA [1 Certification Exam(s) ]
    PsychCorp [1 Certification Exam(s) ]
    PTCB [2 Certification Exam(s) ]
    QAI [1 Certification Exam(s) ]
    QlikView [1 Certification Exam(s) ]
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    RACC [1 Certification Exam(s) ]
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    RES [5 Certification Exam(s) ]
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    Salesforce [5 Certification Exam(s) ]
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    SAP [98 Certification Exam(s) ]
    SASInstitute [15 Certification Exam(s) ]
    SAT [1 Certification Exam(s) ]
    SCO [10 Certification Exam(s) ]
    SCP [6 Certification Exam(s) ]
    SDI [3 Certification Exam(s) ]
    See-Beyond [1 Certification Exam(s) ]
    Siemens [1 Certification Exam(s) ]
    Snia [7 Certification Exam(s) ]
    SOA [15 Certification Exam(s) ]
    Social-Work-Board [4 Certification Exam(s) ]
    SpringSource [1 Certification Exam(s) ]
    SUN [63 Certification Exam(s) ]
    SUSE [1 Certification Exam(s) ]
    Sybase [17 Certification Exam(s) ]
    Symantec [134 Certification Exam(s) ]
    Teacher-Certification [4 Certification Exam(s) ]
    The-Open-Group [8 Certification Exam(s) ]
    TIA [3 Certification Exam(s) ]
    Tibco [18 Certification Exam(s) ]
    Trainers [3 Certification Exam(s) ]
    Trend [1 Certification Exam(s) ]
    TruSecure [1 Certification Exam(s) ]
    USMLE [1 Certification Exam(s) ]
    VCE [6 Certification Exam(s) ]
    Veeam [2 Certification Exam(s) ]
    Veritas [33 Certification Exam(s) ]
    Vmware [58 Certification Exam(s) ]
    Wonderlic [2 Certification Exam(s) ]
    Worldatwork [2 Certification Exam(s) ]
    XML-Master [3 Certification Exam(s) ]
    Zend [6 Certification Exam(s) ]





    References :


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