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Ethical review of physiotherapy research.
In this article, we discuss a number of ethical issues for physiotherapists conducting research. Compliance with ethical standards expected of all health care professionals involved in research--including the requirement to submit research for independent ethical scrutiny--can usefully be supplemented by examination of the ethical reasons for these standards, and also reflection upon the reality of conducting physiotherapy physiotherapy: see physical therapy. research, often in the midst Adv. 1. in the midst - the middle or central part or point; "in the midst of the forest"; "could he walk out in the midst of his piece?"
midmost of clinical practice. This article seeks to explore these issues.
Discussion of the ethics of research focussed explicitly on physiotherapists is timely. Currently in physiotherapy, as in other professional health activities, there are demands for more research on the one hand, and for greater ethical awareness and compliance on the other. In a recent article, Henley and Frank (2006) recognise the drive for more and better evidence of the effectiveness of clinical practice, and the current pressure for compliance with ethical standards being led by publishers of journals. They recommended that 'Physical therapy journals should standardize ethical protections and make documentation of compliance a prerequisite of publication' (Henley and Frank 2006: p.499). The insistence that research should have been conducted in an ethical manner before it can be published gives researchers a strong reason for ensuring that their research does comply with standard ethical protections for as Henley and Frank describe, it is 'a powerful mechanism for encouraging ethical research' (p.504). They suggest that published research comply with three such protections, these are: seeking research ethics Research ethics involves the application of fundamental ethical principles to a variety of topics involving scientific research. These include the design and implementation of research involving human participants (human experimentation); animal experimentation; various aspects of committee approval prior to carrying out research; getting informed consent from participants, and keeping information gathered about participants confidential (Henley and Frank 2006).
Physiotherapists not explicitly involved in research may consider a discussion about research ethics is irrelevant to them. However many physiotherapy treatments have evolved greatly from their original form and/or have been applied to new patient (and perhaps more vulnerable) groups in which this treatment has not previously been used. Questions must be asked about whether such treatment should proceed without supporting research that is able to assess the appropriateness of such treatment. This article is designed for physiotherapists engaged in research and those involved in the creation of innovative therapies.
Research ethics committee approval: The importance of independent ethical review
We know from history that research participants have not always fared well and concern for their welfare has, at times, been lacking (Beecher 1966, Paul 1988). There has been recognition worldwide in the light of this history that safeguards are required to ensure that the welfare of research participants is protected (Evans and Evans 1996). Central among these safeguards is that the proposed research should be reviewed by an independent ethics committee ethics committee A multidisciplinary hospital body composed of a broad spectrum of personnel–eg, physicians, nurses, social workers, priests, and others, which addresses the moral and ethical issues within the hospital. See DNR, Institutional review board. (World Medical Association 2000, Nuremberg Code The Nuremberg Code is a set of principles for human experimentation set as a result of the Subsequent Nuremberg Trials at the end of the Second World War. Specifically, they were in response to the inhumane Nazi human experimentation carried out during the war by individuals such 1946-49). The establishment of independent ethics committees in New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. (NZ) was in direct response to events at National Women's Hospital Women's Hospital of Greensboro (part of Moses Cone Health System)
As the state's first free-standing hospital dedicated to women, the Women's Hospital of Greensboro is a 134-bed hospital is dedicated to providing state-of-the-art, compassionate and personalized care to women where research into the natural course of carcinoma in situ carcinoma in situ
A neoplasm whose cells are localized in the epithelium and show no tendency to invade or metastasize to other tissues.
Carcinoma in situ of the cervix cervix /cer·vix/ (ser´viks) pl. cer´vices [L.]
1. neck.
2. the front portion of the neck.
3. cervix uteri. was carried out from 1966 until 1987 (Cartwright 1988). The research was brought to the attention of the public by two journalists (Coney coney or cony (both: kō`nē), name used for the rabbit (Oryctolagus) and for its fur; more often, for the pika, a small rodent found at high altitudes in both hemispheres; and for the hyrax, a small herbivorous, and Bunkle 1986), leading to a government-appointed inquiry chaired by Judge Silvia Cartwright Dame Silvia Rose Cartwright, PCNZM, DBE, QSO (née Poulter) (born November 7 1943) was New Zealand's second female Governor-General.
She is a graduate of the University of Otago, where she gained her LL.B in 1967 and a former student at Otago Girls High School. . The Inquiry found that a research trial had been undertaken in which many women did not know that they were participants in research and that some women had died due to a failure to supply standard treatment (Cartwright 1988).
The primary researcher had taken his research to a hospital ethics committee (Paul 1988), but this committee had failed to recognise the potential harms and other ethical issues the research raised. Part of the explanation for this might be that it was not sufficiently independent or empowered to question and reject research. The committee was made up of many of the researcher's peers, and was supportive of the concept of professional freedom for clinicians (Paul 1988). As such, it lacked the objectivity required to identify the flaws in Green's research and also the perspective required to protect the study participants (Paul 1988).
The current system of ethical review in New Zealand is to a major degree the child of this experience (Nie & Anderson 2003). Where health-related research on patients is concerned, there are currently 6 regional committees (3 on the North Island and 3 on the South Island) and a multi-region committee (which reviews research going on simultaneously in more than one region) charged with the task of ethical review of research. These committees have a membership appointed by the Ministry of Health. Some human research--that which does not involve patients for example--may be reviewed by committees established within tertiary educational institutions (universities and polytechnics). Their membership is a mixture of community and institutional appointments.
Ethics committees are guided by a number of recognised and widely accepted ethical standards (for an account of these, see next section) and by the system of accreditation by the Health Research Council (HRC HRC Human Rights Campaign
HRC Human Rights Council (UN)
HRC Human Rights Commission
HRC Hard Rock Cafe
HRC Hillary Rodham Clinton (democratic senator/presidential candidate; former first lady) ) Ethics Committee. The HRC Ethics Committee accredits ethical review committees on the basis of the Operational Standard (Ministry of Health, 2006). To achieve accreditation, committees must, for example, have the appropriate mix of community (e.g. non-health professional, or non-institutional) and expert representation to make effective ethical judgements. They also must have sufficient Maori representation, and an acceptable gender balance. Their processes and principles must be consistent with thorough and efficient review; e.g. they need to guarantee that each protocol receives sufficient consideration, and that mechanisms are in place to inform researchers of the committee's decisions. All of the Ministry of Health (regional and multi-centre) committees are currently accredited accredited
recognition by an appropriate authority that the performance of a particular institution has satisfied a prestated set of criteria.
accredited herds
cattle herds which have achieved a low level of reactors to, e.g. , as are a number of the major institutional committees.
In New Zealand, the ethical review system has two other elements: firstly Maori consultation is regarded as an important element of much research (Sporle and Koea 2004). This consultation is in addition to the review carried out by the committees, including their Maori members. Secondly, as far as health research goes, there is also what is called a locality assessment--which is, at least, a declaration signed by the relevant local health institutions that the research is practical in the locality and site planned (e.g. that the researcher has time to do the research, or that the local hospital has the facilities to enable to research to take place).
However, important though it is to get independent ethical review, approval of a research proposal by a research ethics committee should not be viewed by physiotherapists as the end of their ethical obligations nor a substitute for their own ethical awareness. Attention to ethical concerns should be a primary concern of all researchers throughout the time period of the research, and researchers must be alert to these.
Values informing ethical review
As was mentioned in the previous section, there are some widely accepted ethical principles which are understood to apply to research. In addition, there are a number of guidelines which express these values, which have been promulgated prom·ul·gate
tr.v. prom·ul·gat·ed, prom·ul·gat·ing, prom·ul·gates
1. To make known (a decree, for example) by public declaration; announce officially. See Synonyms at announce.
2. over the years by different organisations and committees: some of these will be mentioned briefly below after the consideration of the values themselves.
A well accepted framework of such values is that of Beauchamp and Childress (2001). Among the values they list which are most obviously applicable to research are: respect for autonomy; beneficence beneficence (b·neˑ·fi·s ; and non-maleficence.
Autonomy refers to the idea that each individual should be in control of their own destiny and their own person (Beauchamp and Childress 2001, 57). Respecting this value, in the general context, means protecting people from those things, such as coercion and manipulation, which might threaten to undermine this control, and ensuring people are empowered to exercise this control, for example by making sure they have relevant information. In the research context in New Zealand, autonomy is realised most obviously in the right to informed consent--the right to decide upon the basis of good information whether or not to participate in research (Health & Disability Commissioner 1996). It may also be realised in respect of confidentiality of health information, since control over oneself may be perceived to extend to control over certain information about oneself (Ministry of Health 1994).
Beneficence refers to the aim to make things better for people in general. In the health research context this relates to the fundamental moral justification for health research, which is to ensure the development of effective and safe treatments for human ills, including of course physical treatments.
Non-maleficence refers to the avoidance of doing harm, and is often seen as rooted in the Hippocratic tradition (Campbell et al 2005). In the health research context, it is often argued that there needs to be some balancing of beneficence and non-maleficence: for the term research implies trying something out that has not been tried out previously, which implies that the potential to do good or harm is not yet understood. So, the people on whom the treatment is being tried out are, to some extent, 'guinea pigs'--albeit in most cases informed and consenting guinea pigs--who take on the risk of harm on behalf of and for the benefit of a wider group.
Amongst the guidelines which reflect these values, and apply to research and researchers in a general way, are those of the Health Research Council of New Zealand (e.g. Guidelines for Health Research With Children, HRC 2007; Guidelines for Researchers on Health Research Involving Maori, HRC 2008) and of the National Ethics Advisory Committee (NEAC NEAC North Eastern Athletic Conference
NEAC National Economic Action Council
NEAC National Ethics Advisory Committee (New Zealand)
NEAC National Environmental Appraisal Committee (Belize) ) which has developed guidelines on conducting observational studies, audits, and related activities (NEAC, Dec. 2006) and is developing a parallel set of guidelines for intervention studies intervention studies,
n.pl the epidemiologic investigations designed to test a hypothesized cause and effect relation by modifying the supposed causal factor(s) in the study population. and innovative practice (NEAC, Work Programme). There are also international guidelines which apply in New Zealand, for example the World Medical Association Declaration of Helsinki For the political accords, see .
. There is also another Declaration of Helsinki, dealing with the Information Society.[1] Introduction
The Declaration of Helsinki,[2] was developed by the World Medical Association[3] (WMA (Windows Media Audio) An audio compression method from Microsoft. Known originally as MSAudio, this proprietary format competes with the MP3 and AAC methods. WMA encodes rapidly and is known to be especially effective at low bit rates. , 2000).
The values of autonomy, beneficence and non-maleficence, and their general applicability to health research (including physiotherapy research), are well established. But in any actual circumstance in which physiotherapy research is conducted, all kinds of more or less hidden ethical dangers lurk To view the interaction in a chat room or online forum without participating by typing in any comments. See de-lurk.
lurk - lurking . These may undermine the application of the accepted bioethical values. The aim of the remaining sections of this paper is to bring some of these hidden dangers to light.
Autonomy: some hidden dangers to informed consent
As stated earlier, obtaining the consent of a person to participate in research is plainly important. It may not be a requirement in all cases, as we discuss below. Consent, where it is required, as in the vast majority of cases, functions as a protection for participants, ensuring that they are not subject to any experimental or innovative treatment or other intervention which they do not want. Typically, in fulfilment of consent, potential participants must be adequately informed about what is proposed. This means writing an information sheet for participants which is clear, fully states the purpose of the research, any attendant risks, costs and compensations, as well as what the data to be collected are to be used for. Other information may include how data are to be stored, and for how long. Furthermore, participants are generally assured that they can withdraw their consent at any point in the research, without the need to give any reason, and without any penalty or come back.
What if consent can't be obtained?
Physiotherapists will from time to time want to carry out research on people who are not competent to consent. Where there is a choice, research should always be carried out in groups that are competent to consent. But this might restrict the ability of physiotherapists to develop properly evidenced therapies for some groups of clients, for example for those with severe brain injury associated with increased muscle tone, where the clients' inability to consent and special physical needs may be related. One possible way forward in a case like this is to ask would this person, when competent, have been willing to take part in research. A client's family may be a good source of information for answering this question. A highly detailed application to an ethics committee would be necessary and advice should be sought on proper practice.
While it is the case that there are some people who are incompetent to consent, care needs to be taken not to assume this. For example disabled people may be thought to be unable to give consent when in fact many may be perfectly competent. It may just mean that they need more time and more effort put in to explaining the research rather than just assuming that they lack the competence to consent. A rule of thumb in this area is that there should be a presumption of competence in all cases. Incompetence must be proved, never assumed.
Consent and relationships between physiotherapists and participants
A hidden danger in seeking someone's consent to take part in research lies in the surrounding context of physiotherapy practice and the relationship the physiotherapist physiotherapist /phys·io·ther·a·pist/ (-ther´ah-pist) physical therapist.
physical therapist. has with participants. The context and the relationship have the potential to threaten autonomy even when other aspects of obtaining consent are in place (Tolich and Baldwin 2005). Many practicing physiotherapists, like other practicing health professionals, appear to have a readymade 'pool' of potential participants in their own clients. This is not to say that recruitment is limited to this pool. But in many cases the physiotherapist's own client base will be easy to contact, easier to introduce the subject of possible research participation to, and may well be easier to recruit since they may place a good deal of trust in the physiotherapist, and believe that the research must be worthwhile being part of just because he or she is conducting it.
But select ion of participants from a physiotherapists own client base should sound ethical alarm bells. One question might be how easy individuals in this client pool would find it to say 'no'? How far is their capacity to formulate and express doubts about the research and/or their participation in it undermined by their existing relationship with the physiotherapist? For example, a physiotherapist helping with rehabilitation rehabilitation: see physical therapy. during long-term care after an accident or illness may enter a long-term and intense relationship with a patient, through frequent, lengthy sessions. Moreover, the role of the physiotherapist in trying to return the patient to optimal function may mean that he/she has a particularly important actual and symbolic role in the patient's life. These factors, in a situation where the physiotherapist makes a request of the patient, may undermine the patient's ability to make a considered and independent decision.
An ethically problematic context such as this is not, however, necessarily a red-light to doing research. One possible way around this problem is for the physiotherapist to ask someone else to take on the role of obtaining consent to participate where the potential participants are clients. Where this is not possible, the physiotherapist might advise clients to think very carefully about whether they really want to participate, suggest they consult with family members before deciding, and make certain that they are aware that participation is by no means expected of them, and that if they say 'no' their care will not in any way be affected. Just allowing time for the decision ('I'll see how you feel about it again next week') may help the client reflect upon things in a truly independent way.
There are some populations whose ability to refuse consent to take part in research (or judgement) may be undermined by wider social attitudes and their reliance on others. This group may include prisoners, elderly people in long stay care and children. For example an elderly person in long term care may feel unable to refuse to participate if he/she believes the care will be affected by a refusal. Particular care needs to be taken with these groups that information is given appropriately and full opportunity given to refuse consent without any detrimental effect on care provision or treatment.
Confidentiality: promise and practice
Confidentiality is a protection for research participants in that it restricts access to knowledge gained about them as part of or simply during the research. The participant is usually assured that only those actually collecting data will get to know who the data came from, that the data will be kept hidden away from others, and that there won't be any way for a third party (such as a statistician or the reader of a journal) to be able to connect the data with an individual participant. These guarantees of confidentiality usually extend for the whole period of research and beyond. This can be understood to include the period of data collection and analysis, presentation and final storage (Ethics committees may demand a storage period of raw data of a number of years.) Where these safeguards of confidentiality cannot be offered, the participants should at least be told, so they can decide whether or not they are happy with whatever level of confidentiality can be offered.
Confidentiality is generally regarded as an important right for research participants, but it may be argued that some physiotherapy research is unlikely to threaten it. For example, quantitative physiotherapy research often involves objective measurements of variables, and efforts to generalise v. 1. same as generalize.
Verb 1. generalise - speak or write in generalities
mouth, speak, talk, verbalise, verbalize, utter - express in speech; "She talks a lot of nonsense"; "This depressed patient does not verbalize" from the sample in the research to its wider population, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. statistical norms. This might include, for example, measuring the range of motion of a particular joint. This data would most often be useless for identification purposes on its own: if someone who was not intended to see it did, they'd be none the wiser about the person from whom it came, and because it is unlikely to be sensitive material, most participants would be less concerned about it being kept confidential. However, this doesn't negate ne·gate
tr.v. ne·gat·ed, ne·gat·ing, ne·gates
1. To make ineffective or invalid; nullify.
2. To rule out; deny. See Synonyms at deny.
3. the need for care: data sets may contain or be easily linked to names and other personal details if they are not effectively anonymised or if the personal details of participants and the data are kept in too close a proximity to one another--in the same file or folder for example. And it shouldn't be assumed that data the researcher considers altogether non-sensitive is non-sensitive from all the participants' points of view.
Moreover, physiotherapists may well carry out qualitative research Qualitative research
Traditional analysis of firm-specific prospects for future earnings. It may be based on data collected by the analysts, there is no formal quantitative framework used to generate projections. . In qualitative research, identifying details may well be an integral part of the data--for example, names, places, dates in a taped interview narrative. Anyone who happens to have access to this data may be able to identify the participant or others in the narrative. Those who have such access may include people other than the researcher--for example a person who transcribes the interview. Confidentiality may also be breached through dissemination of results. Although information such as name, age and location will be expected to be removed prior to publication, there is always potential for participants to be recognised through other identifying information. This is a particular concern in a small country such as New Zealand where including data in a published article about a participant such as a diagnosis, the number of children, and that the participant lives in a small town may be sufficient to result in identification of a participant. This problem may be avoided by changing personal and other details.
In responding to concerns about confidentiality and privacy, researchers generally make certain promises. Typically promises about confidentiality include guarantees to keep data gathered for research purposes in a locked filing cabinet in a locked cupboard or office, or on a password-protected computer. However, these promises may presuppose pre·sup·pose
tr.v. pre·sup·posed, pre·sup·pos·ing, pre·sup·pos·es
1. To believe or suppose in advance.
2. To require or involve necessarily as an antecedent condition. See Synonyms at presume. ideal conditions, rather than the reality of practice. One can easily imagine circumstances in which a busy physiotherapist comes into his/her office, putting things down momentarily on a desk, only to be called away to take a phone call or see a client who is in a hurry. Anyone who happens to enter the office may see the things dumped on the desk, including photos of someone known to him/her, and suddenly good intentions about confidentiality fall down.
These realities of practice aren't unique to physiotherapists: however, they remind physiotherapy researchers that confidentiality in practice is achieved only with constant vigilance; that it involves many practicalities, and that the real contexts in which people exist often need to be carefully monitored to fulfil the promise of confidentiality.
Non-maleficence and beneficence: Ensuring the well-being of participants
As stated earlier, there is a need to consider the harms and benefits that might eventuate e·ven·tu·ate
intr.v. e·ven·tu·at·ed, e·ven·tu·at·ing, e·ven·tu·ates
To result ultimately: The epidemic eventuated in the deaths of thousands.
Verb 1. from research. As far as doing harm goes, it may be considered that physiotherapy is unlikely to be ethically troubling. It is fairly clear what sorts of harms may arise from taking substances into the body in the form of drugs or from new surgical techniques: both are in their different ways physically quite invasive. But it might be argued that physiotherapy is not anywhere near so physically invasive, and doesn't have the toxic potential of the drug or the serious injury potential of the scalpel. This is potentially a problematic attitude, and there are at least three strong reasons for taking the potential for harms eventuating from physiotherapeutic interventions being researched very seriously.
The first reason is that some physiotherapy interventions do contain serious potential for physical harm. Electrotherapy electrotherapy /elec·tro·ther·a·py/ (-ther´ah-pe) treatment of disease by means of electricity.
Medical therapy using electric currents. modalities Modalities
The factors and circumstances that cause a patient's symptoms to improve or worsen, including weather, time of day, effects of food, and similar factors. , acupuncture acupuncture (ăk`ypŭng'chər), technique of traditional Chinese medicine, in which a number of very fine metal needles are inserted into the skin at specially designated points. spinal manipulation For detail of manipulation in individual synovial joints, see .
Spinal manipulation is manipulation of synovial joints in the spinal column. The most commonly cited of these are the zygapophysial joints. and even some forms of mobilization can all result in undesirable outcomes. Therefore we need to consider any potential for physical harm when involving patients in research even on well accepted procedures.
The second reason is that potential for harm may result from the adoption of new treatments, or the adaptation of old treatments on populations in which such treatments have not previously been used. In 1998, the Journal of Pediatrics published an article written by Harding, Miles, Becroft, Allen and Knight. The article concluded that encephaloclastic porencephaly--a characteristic form of brain damage, sometimes with fatal or severely disabling outcomes--might be a previously unrecognized complication of chest physiotherapy The examples and perspective in this article or section may not represent a worldwide view of the subject.
Please [ improve this article] or discuss the issue on the talk page. in vulnerable extremely preterm preterm /pre·term/ (-term´) before completion of the full term; said of pregnancy or of an infant.
adj. infants. The article centred on a series of cases in Auckland. The outcomes in Auckland were reminiscent of those in an earlier article, written by Cross et al (1992), which reported on a case series in Birmingham, in the UK. In both cases, the physiotherapy that was being given was an established treatment; however it had not been tried before on very premature babies. It was extended to their care presumably pre·sum·a·ble
That can be presumed or taken for granted; reasonable as a supposition: presumable causes of the disaster. because it seemed to have advantages in other age groups, but in retrospect physiotherapy emerged as a possible cause of serious, sometimes mortal, outcomes.
The Birmingham and Auckland case series alert us to a number of important things about physiotherapy research. First, that research needs to be done--innovative extensions of normal treatments require careful monitoring and checking not only retrospectively, but prospectively. Second, that innovative physiotherapy is potentially extremely harmful. This may be particularly the case where the patient group which it is thought might benefit from the physiotherapy is itself physically vulnerable.
The third reason is because other sorts of harm can arise from the non-physical research carried out by physiotherapists, which might be perceived as very low-risk methods such as interviewing. For example, the recollection of emotionally difficult experiences in the course of an interview can cause harm in participants. It is important that this possibility is identified. Recognising the possibility of such emotional and/or psychological harm is the first step to putting in place safeguards to prevent such harm. If physiotherapy researchers themselves do not recognise the potential for this form of harm, they may not recognise that ethical review of their study is required through an ethics committee.
Further responsibilities to participants
There are times during research when a researcher may come across information that has significant implications for the health or wellbeing of the participant. For example, a physiotherapist may carry out research on elderly people, and while screening participants for research into falls may find out a participant has very high blood pressure. A question arises about what physiotherapists should do with this kind of information. Should they report this concern, or keep such findings confidential? If the participant is not a patient of the physiotherapist, the physiotherapist may feel that he or she has no obligation to respond at all. However a duty of care to participants may indeed extend further than the described limits of the research. To some extent these concerns should have been predicted prior to commencement of the study and appropriate steps put in place of which the participant is made aware as a part of the consent process. Such steps might include ...
A further example is when undertaking research on dependent people, a researcher may be told during an interview or simply in passing that a participant is suffering abuse at the hands of a caregiver. In this example, a researcher may be unsure about exactly how to respond. They might be fearful that they may make the situation worse if they respond inappropriately. There is also a possibility that such information is not true and in passing it on, the physiotherapist risks impugning the name of the caregiver. A physiotherapist may need to access other health care services in order to respond in a sensitive manner. Appropriate mechanisms for responding to such possibilities should be provided when submitting an application for ethical committee approval.
Our primary aim has been to emphasise three things with respect to ethical conduct of physiotherapy research. First, that independent ethical review of research is vital, but that it is not a substitute for the researcher's own ethical sensitivity and awareness. Second, that the ethical ideas which underlie the traditional foci of research ethics (for example the idea of autonomy which underlies informed consent and confidentiality) need to be supplemented by taking into account the implications of other ethical ideas, such as the avoidance of harm and doing good. And third, that ethical conduct of physiotherapy research requires a focus on the realities of the research context, and on the details of what can happen, on the part of the researcher.
Key Points
* Where possible, physiotherapy treatment should be based on research conducted under the widely accepted values of bioethics bioethics, in philosophy, a branch of ethics concerned with issues surrounding health care and the biological sciences. These issues include the morality of abortion, euthanasia, in vitro fertilization, and organ transplants (see transplantation, medical).
* In practical situations there are many hidden threats to the effective application of these values
* Physiotherapists in New Zealand are expected to seek independent ethical review of any proposed research
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New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Oxford University Press Beecher H (1966). Ethics in Clinical Research. New England Journal of Medicine The New England Journal of Medicine (New Engl J Med or NEJM) is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It is one of the most popular and widely-read peer-reviewed general medical journals in the world. 274(2); 1354-1360.
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Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. at National Women's Hospital and into other related matters. Auckland: Government Printing Office.
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Of or occurring after birth, especially in the period immediately after birth. encephaloclastic porencephaly--a new lesion? Archives of Disease in Childhood. 67: 307-311.
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- John Wiley & Sons, publishing company
- John C. Wiley, American ambassador
- John D. Wiley, Chancellor of the University of Wisconsin-Madison
- John M. Wiley (1846–1912), U.S.
Harding J, Miles D, Becroft D, Allen B, Knight D (1998); Chest physiotherapy may be associated with brain damage in extremely premature infants. Journal of Pediatrics 132(3): 440-444.
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Lynley Anderson, DipPhysio, MHealSc, PhD
Neil Pickering, BA(Hons), MA, PhD
Senior Lecturers, Bioethics Centre, Medical and Surgical Sciences, Dunedin School of Medicine
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EBC Ultimax Brake Pads UD835
- Our Price: $44.92
- Shipping:FREE SHIPPING
- Part Number: UD835
Purchase this item by Tuesday, Dec 15th for Delivery by Dec 24th
$44.92Free Shipping
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Ultimax Brake Pads
- Part #: UD835
- Rear Pair
EBC UD835 fits:
- 2000-2001 Lexus ES300
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Friday, July 6, 2012
Some early Pac-12 bowl projections
By Kevin Gemmell
Phil Steele released hisĀlatest poll projections yesterday and there are some interesting postseason destinations for Pac-12 teams.
First, here's
a lookĀat his projections
(Pac-12 No. 7) vs. Air Force (MWC No. 4) in the New Mexico Bowl
(Pac-12 No. 5) vs. Boise State (MWC No. 1) in the Maaco Bowl
(Pac-12 No. 3) vs. Kansas State (Big 12 No. 5) in the Holiday Bowl
(Pac-12 No. 6) vs. Navy in the Kraft Fight Hunger Bowl
(Pac-12 No. 2) vs. West Virginia (Big 12 No. 3) in the Alamo Bowl
Oregon State
(Pac-12 No. 4) vs. NC State (ACC No. 4) in the Sun Bowl
(BCS Pac-12 No. 1) vs. Wisconsin (BCS Big 10 No. 1) in the Rose Bowl
(BCS at-large) vs. USF (BCS ACC No. 1) in the Orange Bowl
Some quick thoughts:
I agree that Oregon and USC will both be in BCS games -- though I think one of them is going to end up in the national championship game. I don't know which one, butĀI'm pretty confident one of them will be there.
SomeĀpretty lofty projections for Oregon State and UCLA. I don't have any issue with projecting either them to the postseason, but I think their predicted finishes are too high. The Beavers still have significant holes on the offensive line. And though there is promise of an improved running game, I'm going to have to see it beforeĀeven considering them in the same class asĀUtah, Cal and Washington. Likewise for the Bruins -- who need to figure out who is going to be their quarterback before we anoint them to a mid-level bowl game.
Washington, Stanford, Cal and Utah are tough to predict because they could all land anywhere between the two and five hole. Washington to the New Mexico Bowl though is a head-scratcher. I'd likely reserve that spot for Oregon State, UCLA or even Washington State -- who I would say is probably more bowl ready than either the Bruins or the Beavers.
Guessing USF (a Big East team) ends up in the Orange Bowl since Florida State (an ACC team) is tabbed for the national championship?ĀHowever that math worked out, ifĀit actually comes to fruition thatĀOregon plays USF, the Ducks will make last year's Orange Bowl (West Virginia 70, Clemson 33) look like a nail biter.


text:
Dr. Fitzgerald Alcindor, MD
General Practice, Fitzgerald Alcindor MD
- 22 W Columbia St
Hempstead, NY 11550
- 1 Office Location
- (516) 489-9440
Dr. Fitzgerald Alcindor has been practicing medicine for 23 years. Dr. Alcindor graduated from the SUNY Downstate Medical Center College of Medicine in 1991. He practices medicine in Hempstead, NY and specializes in General Practice. Dr. Alcindor is affiliated with Nassau University Medical Center, Mercy Medical Center and Winthrop University Hospital. He speaks English, French and Spanish.
Gender: Male
Years in Practice: 23 Years
Languages Spoken: English, French, Spanish
Medical School: SUNY Downstate Medical Center College of Medicine
Graduation Date: 1991
Hospital Affiliations: Nassau University Medical Center, Mercy Medical Center, Winthrop University Hospital
Specialties: General Practice


text:
For new questions please post at magento.stackexchange.com, the community-run support site for the Magento community. We will be providing updates on the new forum solution soon. For questions or concerns please email email@example.com.
Any help will be forever appreciated…
I've followed the guide, created a copy of the default interface and renamed it to a custom name.
------------- app/design/frontend/newInterface/newTheme
I've then replicated that over in the skin directory
------------- skin/frontend/newInterface/newtheme
Edited a few files in this directory
------------- app/design/frontend/newInterface/newTheme/template
The files edited where in page, basically changing the 3 column template to be that of my own template, which gets other elements from within the directory like this
<?php echo $this->getChildHtml('header');?>
<?php echo $this->getChildHtml('footer');?>
However when I load the interface from the Magento admin, the theme changes (i think) but the output on the screen is just blank in the front end.... No source at all.
Any ideas guys?
Make sure you've selected the right column layout in admin. You should at least see your header and footer on frontend. For content display, include the content-call in your template files. Use the same code as above but replace 'header' with 'content'. For reference, please follow Magento's default template files.
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Date: 1939-09-10
Description: View down railroad tracks towards the Central Avenue depot and the railroad crossing.
Date: date unknown
Description: A man stands in front of huge blocks of ice at the American Shipbuilding Company. The ship War Otter is in the background.
Date: 1935 ca.
Description: Elevated view of the Brule River in northern Wisconsin, flowing between a road and landscaped stone wall under a bridge and pedestrian walkway.
Date: 1943 ca.
Description: Elvated view of war hero Richard Ira Bong (center, in flight jacket) on leave in Poplar, with friends, relatives, and admirers. The group is walking down a...
Date: 1933-09-21
Description: Employees of Anderson & Sons, a Minneapolis construction company, surfacing and curing USH 53 in Douglas County.
Date: 1929
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Date: 1930 ca.
Description: View of the Davidson Feed Mill near the Amnicon River.
Date: 1947-08
Description: Exterior view of the Tyomies Publishing Company building. The 6th Street Cafe is visible next door.
Date: 1945 ca.
Description: View of Tower Avenue, looking north. A drugstore can be seen on the corner (right), as can an auto parts store.
Date: 1934-08
Description: Building at the Tri-State Fair, outside of which a white pine tree dying from white pine blister rust is displayed.
Description: Customers standing in front of the Cooperative Marketing Store.
Date: 1932 ca.
Description: "Mexican Room" at the Bellwood. The room has many chairs, tables and lamps, and a brick fireplace is on the left. Three plants in a holder stand in front o...
Date: 1962-04
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Date: 1890 ca.
Description: Stereoview of Big Manitou Falls on the Black River. This waterfall reportedly was called "Gitchee Monido" by the Ojibwa, which means "Falls of the Great Sp...
Date: 1961
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Wireless Networks Market Research Reports
Wireless Networks Market Research Reports
Asia Mobile Operators
By Paul Budde Communication
"......; some information on financial performance; market position. It is noted that the information provided varies from market to market and operator to operator, depending very much on the availability of statistics and corporate reports. In some......"
Global LMR Systems Market 2014-2018
By Infiniti Research Limited
"...... gas companies, airport operators, and for the mobile workforce in the transportation companies. Communication in tactical situations is all about conveying the right information to the right person at the right time to ensure reliable operations. An......"
The SDN, NFV & Network Virtualization Bible: 2015 – 2020 – Opportunities, Challenges, Strategies & Forecasts
By Signals and Systems Telecom
"......help address the explosive capacity demand of mobile traffic, but they can also reduce the CapEx and OpEx burden faced by service providers to handle this demand by diminishing reliance on expensive proprietary hardware platforms. SDN and network ......"
Voice over LTE
By iDate Research
"...... of embracing it. We shall thus discern the challenges that operators face in choosing this solution as well as the opportunities that it represents. List of players reviewed The VoLTE-focused activities of the following companies and organi......"
2014 Deep Research Report on Global and China Mobile Phone Antenna Industry
By QYResearch Group
"......, China domestic market analysis. Global Regional (such as US Europe Asia China Japan etc regions) Global Leading Suppliers, different type products, different applications etc Mobile Phone Antenna production and market share, Mobile Phone Antenna in......"
Connected Devices in LTE
By Global Wireless Research
"......of LTE Advanced (LTE-A) represents an especially important landmark for the industry as data speeds will increase dramatically. This report evaluates the market opportunities and outlook across several industry verticals for connected devices in a......"
Mobile Satellite Services Market by Services (Video, Voice, Data, Tracking and Monitoring Services), by Access Type (Land Mobile, Maritime, Aeronautical) – Worldwide Market Forecasts and Analysis (2014 – 2019)
By MarketsandMarkets
"...... systems that can be accessed through land mobile, maritime, and aeronautical. The emerging advancements in digital technology and rising integration demands of satellite and terrestrial mobile technology are visibly driving the market for MSS. In......"
Mobile Unified Communications and Collaboration Market by Solutions (Conferencing, Unified Messaging, Voice, Collaboration), & by Deployment Type (Cloud & On-Premise) – Global Forecast to 2019
By MarketsandMarkets
"...... various communication solutions. This is evident from the latest advancements,of the integration of mobile into existing UC&C technology. The emergence of mobile UC&C is the outcome of the growing usage of mobile devices among businessesfor ......"
The 2G, 3G and 4G Wireless Network Infrastructure Market: 2014 – 2020 – with an Evaluation of WiFi and WiMAX
By Signals and Systems Telecom
"...... global 2G, 3G and 4G wireless infrastructure revenues stood at $52 Billion. SNS Research estimates that these revenues, from macrocell RAN (Radio Access Network) and core network investments have largely remained flat in 2014. However, the market is......"
Mobile Data Pricing: Innovative Practices to Drive Adoption and Traffic
By Pyramid Research
"......s an in-depth assessment of mobile service provider pricing plans worldwide, identifying effective data plans and best practices to grow mobile data usage and revenue. The report incorporates detailed country case analyses for China, France, India, J......"


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SMART Storage Systems Extends CloudSpeed Product Line With the Introduction of Two New SSDs
SMART Storage Systems, an innovative enterprise solid-state drive (SSD) technology provider, today announced that the company has extended its CloudSpeed product line with the introduction of two new drives, the CloudSpeed 1000 and CloudSpeed 1000E. While leveraging cost-effective 19nm consumer-grade multi-level cell (MLC) Flash and enhancing its base endurance with SMART Storage Systems award winning Guardian Technology Platform, the new CloudSpeed SSDs deliver up to 5x better endurance than competing MLC-based SSDs, resulting in the lowest cost per terabyte written (TBW) in the industry. This enables enterprise customers to better control their storage total cost of ownership (TCO).
"By 2017, SSD prices will fall 35 percent annually, but the reliability of the Flash used will decline nearly 30 percent1," according to a recent Gartner conference presentation. The anticipated drop in Flash reliability poses as a significant challenge in the enterprise market as SSD manufacturers further leverage MLC Flash to meet cost reduction goals, while real-time applications and cloud computing services increase the amount of data being written to drives. Until today, data center managers frequently deployed SSDs leveraging consumer-grade MLC Flash to provide the performance required at a low price-per-gigabyte. However, SSDs that leverage standard, non-endurance enhanced consumer-grade MLC Flash wear-out quickly in enterprise environments. This results in storage TCO skyrocketing as organizations need to replace SSDs multiple times during the warranty period.
"Our CloudSpeed product line gives OEMs and enterprise organizations the best of both worlds; a low acquisition cost and high endurance. This combination results in the absolute lowest TCO over a five year period," stated John Scaramuzzo, president at SMART Storage Systems.
|Related Links
|OCZ Storage Solutions Introduces the Saber 1000 Series -- a New Class of Enterprise SATA SSDs Designed for Hyperscale Applications
November 20, 2014
|Toshiba Introduces New ESD Protection Diode
November 19, 2014
|A Majority of Americans Can't Go Two Hours without Checking Technology Devices
November 19, 2014
|Cray Adds Cloudera Enterprise to Cray Urika-XA System
November 19, 2014
|Nimble Storage Advances Adaptive Flash Platform: Releases Fibre Channel Storage Arrays
November 18, 2014
About Author
- VIDEO: Watch Music Video for ONE DIRECTIONS's 'Night Changes'
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- Photo Flash: First Look at THE FLASH & ARROW's Crossover Episode
- FOX Sets January Premiere Dates New Drama EMPIRE & AMERICAN IDOL
- Time Warner Cable Brings Your Favorite 'Musicals' to On Demand


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Battle of the Crickets, October 14
Posted Oct 14th 2013, 12:57pm
... which is the more aggressive. Before the fight starts, a cricket's handler prods the insect with a piece of hay or a small stick to irritate it. A judge then removes a divider between the two crickets to allow them to fight. The judge follows a set of strict guidelines, most dating back to the 13th century, to determine match points. The highlight of the season is the two-day ...http://www.scmp.com/photos/today-photos/gallery/1331395/battle-crickets-october-14
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November 27, 2014
LAS VEGAS (AP) - A federal judge in Nevada is ordering one of
two companies providing Las Vegas airport wheelchair services to
implement policies to prevent employee sexual harassment.
The U.S. Equal Employment Opportunity Commission said Friday
that it asked the judge to act because Prospect Airport Services
Inc. failed to protect employees even after a $75,000 settlement in
the case of a man receiving unwanted sexual advances by a female
Company lawyer Tom Murphy says that Prospect had already agreed
to do most of the things the judge ordered.
U.S. District Judge Kent Dawson in Las Vegas issued the
injunction Wednesday.
Acting EEOC Las Vegas office chief Adriana Lopez says 16 percent
of all sexual harassment charges at the EEOC last year were filed
by men.
Copyright 2014 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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text:
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Baseball Bat Bottle Openers
$95.00 - 125.00
Intersection of Love - Photo Print
$75.00 - 125.00
Reclaimed Wood Cookbook Stand
Stone Drink Dispenser
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Nesting Stoneware Mixing Bowls - Set of 3
You Are Loved Always Inspiral
Kaleidoscope Necklace
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Imperial Tea Gift Set
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Field Guide to North American Bird Feathers
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text:
1 person found this helpful
"Good Place To Work! "
- Comp & Benefits
- Work/Life Balance
- Senior Management
- Career Opportunities
I have been working at Mars
+ Great development opportunities
+ Lots of freedom in work and responsibilities
+ Opportunities for advancement
+ Competitive Salary
+ Long Hours
+ Politics involved in upwards advancement.
+ Canadian site staffed extremely lean, can be a waiting game for advancement
Good job on development of people and running a well-tuned business. Provide more opportunities for growth at the analyst level.
299 Other Employee Reviews for Mars (View Most Recent)Sort: Rating Date
1 person found this helpful
I have been working at MarsPros
Very open and friendly culture, flat hierarchy, great relationships between all levels (management and non-management), the Mars 5 principles, friendly and helpful colleagues, a lot of freedom, a fun place to work!Cons
Very decentralised, sometimes too much of freedom and little structure, not always easy to get the job done. Communication and knowledge transfer is not the best. Either you love it and can work for, or you don't.Advice to ManagementAdvice
Keep the freedom, but add more structure.RecommendsNo opinion of CEO
2 people found this helpful
"Good privately owned company. "
- Comp & Benefits
- Work/Life Balance
- Senior Management
- Career Opportunities
I worked at MarsPros
The company has good benefits along with promoting a good work / life balance. The base salary is pretty competitive. There are some great people that you will work with. Company has a solid cash flow and has a strong market share in many of the divisions.Cons
Most positions have group or division bonus plans which means that your individual performance doesn't affect your total compensation fairly. The company is slow to change at times with somewhat vague communication from senior managment. There is a little too much corporate red tape when it comes to sometimes the smallest tasks being completed.Advice to ManagementAdvice
More concise communication especially when it comes to major changes. Less bureaucratic red tape when it comes to basic changes or implementation of changes.RecommendsApproves of CEO


text:
Edinburgh Instruments Ltd
based in Livingston, UNITED KINGDOM
Edinburgh Sensors are proud to be global providers of high quality Gas Sensor solutions. Our diverse range of gas sensors use the latest technology to enable reliable, accurate and continuous gas detection. Established for over 20 years, Edinburgh Sensors use proven technology to deliver OEM Gas Sensors and Gas Monitors / Indoor Air Quality Monitors that are smart, ...
Petersen Products Company
based in Fredonia, WISCONSIN (USA)
Manufacturer of custom and standard Pipe Plugs for blocking almost any size, pressure, temperature, and chemical requirement. Systems for installing a plug in a pressurized pipeline through a small hot tap. Annular seals to seal between an inner and larger outer pipe for bypass or repair. Contact Petersen for your specific requirements. Call 262-92-2416 (1-800-926-1926).
Eigenbrodt GmbH & Co. KG
based in Königsmoor, GERMANY
Meteorological and Environmental measurement, offering equipment for Meteorological and Environmental sciences. Precipitation collectors / acid rain collectors - Acid rain analysers / precipitation monitors - Fog sampler - Precipitation sensors and rain gauges - Temperature and humidity probes - Radiation shelters for temperature/humidity probes - Radiation sensors / ...
based in Vireux Molhain, FRANCE
AnHydre is a distributor of instruments for water monitoring (surface water, groundwater, coastal water, oceans). Sampling devices, instruments (handheld, on line) and analyzers.
Banner Engineering Corp.
based in Minneapolis, MINNESOTA (USA)
Banner is a global leader in process and factory automation. In addition to its traditionnal product lines, Banner Engineering provides innovative Wireless I/O solutions to the environmental industry helping gater data from virtually any sensor, detector or analyser in the field, and controlling equipment (pumps, valves, PLCs...) without costly wire runs.
Delta OHM S.r.L.
based in Caselle di Selvazzano, ITALY
Delta Ohm develops and manufactures instruments for measuring:Temperature, humidity, dew point, pressure, BAR, mBar, Pascal, mmH2O, InchHG, psi, air speed, light, Phot, UVA, UVB, UVC, Solar Radiation, PAR, Acoustic, Sound meter, Vibration, Noise, CO, CO2, Air Quality, pH, ORP, Redox, Dissolved Oxygen, Turbidity, Data loggers, WBGT microclimate, PPV, PMV, Heat stress, ...
RS Hydro Ltd
based in Bromsgrove, UNITED KINGDOM
RS Hydro are a total solutions provider for the water & wastewater, environmental, food & beverage, mining & aggregates, petrochemical, power generation and research industries for the UK and worldwide. We are specialists in flow meters, water quality monitoring instruments, water sampling equipment, groundwater monitoring, water level loggers, weather stations and ...
Van Walt Limited
based in Haslemere, UNITED KINGDOM
Van Walt Ltd has been providing soil, water and groundwater monitoring equipment to the environmental, educational, agricultural and mineral exploration business communities for more than 30 years. We supply a wide range of innovative equipment to buy or rent including: hand & manual augers; window samplers; penetrometers; soil & sediment samplers; water quality meters; ...
Harris Miller Miller & Hanson Inc. (HMMH)
based in Burlington, MASSACHUSETTS (USA)
Harris Miller Miller & Hanson Inc. (HMMH) was founded in 1981 to provide the highest quality noise consulting services to airports. Today, HMMH is an international leader in environmental noise and vibration control, air quality analysis, airport and airspace planning, and climate and energy solutions. With three offices throughout the country, we serve government and ...
based in Chesterland, OHIO (USA)
CAS is your BEST source for Data Loggers and Monitoring Systems for environmental applications. Whether you require only a single input, dedicated logger or a multiple input, intelligent logger, CAS has a solution for you. We have provided data logging and monitoring equipment for a number of different projects including smokestack emissions monitoring, diesel engine ...


text:
Magnolia Condos For Sale, Central Seattle
The Magnolia neighborhood is located in Central Seattle. Condos for sale in Magnolia include foreclosures (bank-owned condos), short sales, and traditional resale and new construction condos.
Search Magnolia condos for sale:
Looking for more options?
Search by building name, floor, HOA dues, and more in the Detailed Condo Search.
Magnolia, Central Seattle
Magnolia is located on a peninsula west of some of Seattle's busiest neighborhoods. It retains a small-town atmosphere, set off from the rest of the city by three bridges. Though famous for its expensive homes with sweeping Puget Sound views, it also boasts many more affordable homes in the interior of the peninsula. Magnolia has its own small retail core, and enjoys 360 degree views of the Seattle area from its many hillside homes.
More information about:
Back to: All Central Seattle Neighborhoods
Today's Newest Magnolia Condo Listing
2500 W Manor Place Unit 217, Seattle
Stunning Magnolia remodel! This west facing corner unit has been tastefully updated throughout including quartz counters, hardwood floors, custom cabinets with soft close...
- Beds 1
- Baths 1.0
- Bldg. Quarterdeck
The database information herein is provided from and copyrighted by the Northwest Multiple Listing Service (NWMLS). NWMLS data may not be reproduced or redistributed and is only for people viewing this site. All information provided is deemed reliable but is not guaranteed and should be independently verified. All properties are subject to prior sale or withdrawal. All rights are reserved by copyright. DMCA information
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text:
Adam Jones
Tillman Dominates White Sox In 6-0 Shutout
Chris Tillman was terrific in the Orioles 6-0 shutout victory over the Chicago White Sox.
Late Homer By McLouth Brings O's 4-3 Win
The Orioles picked up another dramatic victory with help from home runs off the bats' of Lew Ford and Nate McLouth.
Johnson Pitches O's Past Jays
Steve Johnson pitched the Orioles past the Jays in game two of the series.
Clutch Pitching Leads O's Past Rangers
Chris Tillman led the way in the Orioles 5-3 victory over the Rangers
Offense Falls Flat in 5-1 O's Loss to Texas
The Orioles managed only one run against Ryan Dempster and the Texas Rangers.
For O's, a Huge Detroit Comeback
The Orioles bounced back after a 5-0 first inning deficit to win 7-5 and two out of three from the Detroit Tigers.
Britton And Davis Lead The Way As O's Topple Tigers
Zach Britton returned to the big leagues Saturday night, pitching the Orioles past the Detroit Tigers 3-2.
Sox Top O's In Series Finale
Wednesday night, the Orioles stole one away from the Boston Red Sox when, after being no-hit for five innings, they put together a big inning out of nowhere. Thursday, an inning that SHOULD HAVE been big evaporated on the Orioles out of nowhere, and it led to a come from behind win for the Sox. […]
Big Inning Lifts Birds Past Sox, 5-3
Being no-hit by Red Sox right hander Aaron Cook, the Orioles turned on a dime in the sixth of Wednesday night and put together the big inning the propelled them to a 5-3 win.
Reynolds Leads O's Past Sox
Mark Reynolds slugged two home runs in the Orioles 7-1 victory over the Red Sox


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- Barts Cancer Institute Queen Mary University of London (2 courses) BCP Certis (0 courses) Boston University (1 course) Cardiff University (0 courses) New Scientist Jobs (0 courses) Visit our sister site, New Scientist Jobs, the dedicated job site for science, technology and engineering roles. Search the latest jobs from top organisations within the commercial, academic and public sectors.
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Ask Leo Episode Five: Renewing Reserves
Leo is back with his friend Theo, who has some advice regarding reserve items.
Ask Leo Episode Five: Renewing Reserves from Tufts HHSL on Vimeo.
From our turkeys to yours, we hope you have a relaxing Thanksgiving break next week! And to aid in that relaxing, Hirsh Health Sciences Library will be closing Wednesday the 26th at 5 pm, and will re-open on Sunday, November 30th at 10 am. We will be closed in between, so make sure to get in some of that sleep you've been skipping out on, and we'll see you once you're refreshed and full of food!
Thanksgiving Food for Thought!
In honor of Thanksgiving, the following is a re-post of last year's description of the 'evidence-based' Thanksgiving meal. Enjoy!
Cranberry Sauce
Cranberries for preventing urinary tract infections.
Jepson RG, Williams G, Craig JC.
Cochrane Database Systematic Reviews. 2012 Oct 17
Findings:"…cranberry juice cannot currently be recommended for the prevention of UTIs"
Bottom line: Well, cranberries are still pretty tasty…
Stuffing and Mashed Potatoes
Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies.
Noto H, Goto A, Tsujimoto T, Noda M.
PLoS One. 2013;8(1):e55030. Epub 2013 Jan 25.
Findings: "Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence."
Bottom line: Eat the stuffing!!!!
Sweet Potatoes
Sweet potato for type 2 diabetes mellitus.
Ooi CP, Loke SC.
Cochrane Database Systematic Reviews. 2012 Feb 15
Findings: "There is insufficient evidence to recommend sweet potato [as a therapy] for type 2 diabetes mellitus."
Bottom line: Sweet potatoes are still very good for you if you have type 2 diabetes (but leave out the marshmallows, capesh!).
and, of course…
Does Turkey Make you Sleepy?
Ballantyne, C.
Scientific American. November 21, 2007
Findings: Goble, goble, zzzzzzzzzzz…..
Bottom line: Have a wonderful Thanksgiving!
School Affiliation: October
This past October, from the 19th to the 25th, we ran our semi-annual School Affiliation statistics again. This time around, we were able to keep it away from a major exam block, and we also grabbed the circulation data for that time to make sure we got the best picture of the week. Since it was shorter than last time, this post will be relatively quick. But hopefully you'll still find it interesting!
First thing is first: how many people were in the library that week? Well, we counted a total of 3,230 people that week, 695 of which were here on Wednesday alone. You can see the breakdown below.
Now, what you're probably really wondering is how that breaks down by school, right? The answer is rather interesting. Namely, it breaks down (by floor, even!) thus:
You may notice that everyone loves the 7th floor, and that the Dental school in particular loves the ever-loving-fillings out of it. It's worth noting that they had some exams that week, which helps explains their numbers. But what's interesting in that graph is that you can see what kind of exams they were – the kind that required solo study (notice that the quiet floors had the majority of them). In fact, this survey seems skewed toward quieter studying. I look forward to finding out what differences there are come Spring – does April encourage more group study than October? Or was it pure chance that these number shook out this way?
Of course, what's most fascinating is when you compare the above graph with the circulation one below, and see the full picture:
It can be a little tricky to tell due to scale there, but Medical actually checked out the most that week, followed by Nutrition, and then Dental. It seems that the Dental students were really here for the studying, not the circulation. And the Medical students were most likely checking things out and then going back to the individual study rooms or learning commons – essentially showing up on one set of statistics but not the other. Although Nutrition really made the interesting difference – the circulation number is actually higher than what we counted!
This is why the middle and bottom graphs are uneven when compared to one another – people just simply move around. The library supplies space and materials, but they don't always get used at the same time.
That wraps it up for this time. We could, of course, look at these numbers from a dozen different directions, but maybe we can save that for the next time. After all – it's only November.
New Books at Hirsh
We've recently added several new titles to our collection and we hope you'll stop by to check them out! If you need a break from your textbook, take a look at our new book section across from the 4th floor library service desk. We have a wide variety of books to choose from. Here are a few of our recent additions:
- Dr. Mütter's marvels: a true tale of intrigue and innovation at the dawn of modern medicine by Cristin O'Keefe Aptowicz
- The monkey's voyage: how improbable journeys shaped the history of life by Alan de Queiroz
- The body keeps the score: brain, mind, and body in the healing of trauma by Bessel A. van der Kolk, M.D.
- Wild: from lost to found on the Pacific Crest Trail by Cheryl Strayed
- Resident on call: a doctor's reflections on his first years at Mass General by Scott A. Rivkees
- Infinitesimal: how a dangerous mathematical theory shaped the modern world by Amir Alexander
Is there something out there that you'd like to see on our shelves? We're always looking for suggestions, so please feel free to recommend a purchase.
Please note the library service desk will have limited hours on Tuesday, November 11th for Veteran's Day.
Unwind with some games and crafts at the Circ desk this Friday 11/7 @ 2:30pm.
Need a Friday afternoon break? This Friday from 2:30-4:00PM you'll find a number of games, puzzles, and decks of cards to borrow near the service desk on the 4th floor of Sackler. Please feel free grab an empty table and play away!
And due to the popularity of our pumpkin-painting a few weeks ago, we'll also have a November-themed craft project. Hand turkeys anyone?
Have fun!
Happy Halloween from HHSL!
We'd like to officially announce the re-opening of the sixth floor in Sackler! Everything has passed inspection and can be fully utilized. Thank you all for your patience while the construction was going on. We'd also like to thank everyone who was involved with the transformation. We hope you enjoy the new classroom as well as the continued use of study space.
Ebola News Via Our Licensed Resources
Keep abreast of new guidelines and evidence emerging on many diseases with DynaMed, which is available to the Tufts community via the Library website and as a mobile app.
For background reading and a glimpse of the future, try Richard Preston's "The Ebola Wars" in The New Yorker.
Below are DynaMed's most recent updates on Ebola and its summary of the changes in the CDC guideline. Select its E-Newsletter tab to sign up for its email alerts, view the archive of EBM Focus, or register for CME credit for reading it.
Ebola Virus Disease
- Updated 2014 Oct 24 01:59:00 PM: case description of care for an Ebola patient in a biocontainment unit in Germany (N Engl J Med 2014 Oct 22)
- Updated 2014 Oct 22 10:57:00 AM: Government of Canada providing experimental vesiculars-stomatitis-virus based vaccine (VSV-EBOV) to the World Health Organization (Public Health Agency of Canada Fact Sheet)
- clinical features associated with 2014 West Africa outbreak of Ebola virus (N Engl J Med 2014 Oct 16)
Ebola: Updated CDC Guidelines
The world is presently experiencing the largest outbreak of Ebola virus disease (Ebola) in history. Over 9,000 persons have been infected in West Africa, resulting in over 4,500 deaths. Three cases have been diagnosed in the United States, two among nurses caring for the first patient.
Following the transmission of Ebola to healthcare workers, Centers for Disease Control and Prevention (CDC) have revised their guidelines on the use of personal protective equipment (PPE). New CDC guidance emphasizes:
- Rigorous and repeated training in performing all infection control procedures, specifically the donning and doffing of PPE, with demonstration of competency for all healthcare workers involved in the care of Ebola patients.
- No skin exposure when PPE is worn. New step-by-step instructions require full-body coverage, including use of a surgical hood with single use face shield, fluid-resistant gowns supplemented by waterproof aprons and boot covers, double gloves and either N95 respirator or powered air purifying respirator (PPAR). Use of facemasks and goggles are no longer considered adequate.
- Supervision by a trained observer to ensure that there is no breach in protocol when healthcare workers don or doff PPE.
Special thanks to Research & Instruction librarian Elizabeth Richardson for compiling this post!
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text: My boyfriend and I stayed in the Serenity Suite after a long weekend of cycling in the mountains. Diane and Chris were very accommodating and even had a safe place to store our bikes. The breakfast is served in suite and is all prepared the night you arrive, so you can get up and eat whenever you want. This also... More


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Grand Marnier
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Find records of Enrique Arguilez
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Enrique I Arguilez's last known residence is at Campo, San Diego County, California.
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These links will allow you to view related information about the current location. this information has been stored under tabs.
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Find yourself nestled in the pristine environs of a national park. Get up close to the nature and wildlife of Darwin and the surrounding areas.
$350 to $550
Stunning Private Oasis. A beautiful tropical elevated 3 bedroom house plus free car with pool and garden for your exclusive use during your stay in ...
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Amazing views from this stylish and spacious 3 bedroom 2 bathroom top floor apartment located just minutes from Darwin's CBD.You'll be amazed from the ...
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Step back into the wild era of buffalo and crocodile hunting at this historic property, now offering deluxe cabins, fishermen's cabins or campsites.
$16 to $250
Take advantage of some of the region's best tour operators and set off from your cabin or campsite into the wonders of Litchfield Park.
$29.5 to $160
Put your Top End holiday into safe hands, and let the Boomerang crew take you to the Mindil Markets and the casino and point you towards other sights.
$31 to $326
Escape to the resort's sprawling tropical gardens after a day soaking up the excitement of Darwin and let the kids run free while you relax poolside.
$30 to $250
Settle in for lazy breakfasts or post-sightseeing swims in the tranquil oasis of shady trees, featuring self-contained cabins, villas or campsites.
$8 to $75
Get away to Dundee Downs, 90 minutes from Darwin, where the cabins are comfortable, the fishing spots are secret and the hospitality is old-fashioned.
$160 to $270
Quiet and peaceful 1 bedroom apartment in Nightcliff, pet-friendly, plus free car.Modern, spacious and quiet tropical 1 bedroom ground level apartment ...
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Gardenia Holiday House is a ground level, 3 bedroom property in Nighcliff and includes a FREE car hire and is a great getaway for families and others ...
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Go a little bit country, setting up camp or living it up in the colonial homestead to explore every inch of the fascinating Litchfield National Park.
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Explore this wilderness area from deluxe accommodation, enjoying river tours, lazy sunset cruises, wetland safaris, fishing, and bird watching tours.
$11 to $950
Discover the place where the tropics and Outback meet at a working cattle station, offering horse treks, four-wheel drive tours, and a range of rooms.
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Vintage Twist - Darwin & Surrounds
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Traditional secretarial typing jobs have evolved to PC-based word processing and data entry and today most typing jobs will involve some other elements of office administration. There are also specialist typing roles. For instance transcription is a kind of data entry that turns recorded speech into written transcript. Transcriptionists are normally provided with specialist software packages to complete this work or Microsoft Word can be used. Specialist fields of transcription include legal transcription, medical transcription and corporate transcription. Audio typing is used extensively in certain workplaces so there are audio typing jobs in architect firms, GPs offices, TV production companies and legal departments among others.
Administrative Assistant 7 days ago
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Fugitive lip biter arrested in California
Nov 6, 2014
Jonathan E. Benedict
Oct 30, 2014
Darrell W. Cook
Oct 2, 2014
Michael Polchies
Sep 25, 2014
Home » News » Crime
Footprints in snow lead to Merrimack man's arrest
At 1:12 a.m. Sunday, a 1996 Dodge pickup truck crashed into a PSNH utility pole on Daniel Webster Highway, near Reeds Ferry Lumber. No one was found near the wreckage, but police followed a set of footprints in the snow from the truck to the parking lot of the London Count Apartments.
Soon after, Alexander Mavrogeorge, 25, of 21 London Court, the registered owner of the truck, arrived at the accident scene. Police said he denied driving the truck, but the sneakers he was wearing were consistent with the footprints in the snow that officers tracked from the damaged truck to his address. Mavrogeorge was arrested at the scene and charged with OUIL and conduct after an accident.
What's next: Mavrogeorge is free on $2,500 personal recognizance bail and is to be arraigned in 9th Circuit Court, Merrimack District Division, on March 7.
- Police say woman stole pocketbook at Hudson Market Basket - 0
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Pipes and plans: A chance to show up Mass.
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- Whom do you think bears the brunt of the blame for the mayhem this weekend in Keene?
- KSC students
- 37%
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Photograph by Brad Goldpaint
Published October 19, 2012
Our annual sky show from Halley's comet, the Orionid meteor shower, will peak overnight Saturday, with as many as 20 shooting stars an hour expected to be visible from dark locations away from city lights.
(See Perseid pictures: "Meteor Shower Dazzles Every August.")
"The peak of the shower starts at about 11:30 p.m. local time on October 20th, just as the moon is setting, and should be strongest just before dawn," said Anthony Cook, astronomer at Griffith Observatory in Los Angeles, California.
Sky-watchers should also be on the lookout for fireballs—baseball- to basketball-size space rocks that create especially brilliant meteors as they burn up in Earth's atmosphere.
"These can be bright enough to cast shadows and create luminous trails that remain visible for many seconds after the meteor has disappeared," Cook said. "Even if you must make do with less-than-ideal sky conditions, the view of a swift Orionid or a bright fireball will make the watch worthwhile."
(Read about 2011's Orionid meteor shower.)
Orionids Are Reminders of Distant Comet
Just like all other meteor showers, the Orionids gets its name from the constellation from which its shooting stars appear to radiate—what astronomers call the shower's radiant.
In this case observers can trace back the streaks of light to the area in the sky occupied by the mythical hunter Orion—all radiating out from a spot just above its bright orange star Betelgeuse.
The Orionid shower is caused when Earth slams into a debris field left behind by Halley's comet, which won't return to our neck of the woods for another five decades. (Find out why Halley's comet has been hailed as an omen of doom.)
"Seeing Orionids is a little like getting a postcard from the comet, which only makes a local appearance every 76 years," Cook said.
"While the Orionids are mostly caused by sand-grain-size pebbles shed by the famous comet in past centuries, it's amazing to think that Halley's itself will not be seen by eye until July of 2061, just less than 49 years from now."
Also see "New Meteor Shower Discovered; May Uncover New Comet" >>
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