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Publications (65)263.93 Total impact
Article: The association of asthma education centre characteristics on hospitalizations and emergency department visits in Ontario: a population-based study.[Show abstract] [Hide abstract]
ABSTRACT: Background International guidelines recommend patient education as an essential component of optimal asthma management. Since 1990 hospital-based asthma education centres (AECs) have been established in Ontario, Canada. It is unknown whether patient outcomes are related to the level of services provided.Methods Using linked, population-based health administrative and hospital survey data we analyzed a population of patients aged 2 to 55 years with a hospitalization for asthma (N¿=¿12 029) or a high acuity asthma emergency department (ED) visit (N¿=¿63 025) between April 2004 and March 2007 and followed for three years. Administrative data documenting individuals¿ attendance at AECs were not available. Poisson models were used to test the association of potential access to various AEC service models (outpatient service availability and in-hospital services) with asthma readmissions, ED visits or death within 6 to 36 months following the index admission or ED visit.ResultsFifty three of 163 acute care hospitals had an AEC (N¿=¿36) or had access by referral (N¿=¿17). All AECs documented use with guideline-based recommendations for AE programs. ED patients having access to an AEC that offered full-time, extended hours had reduced rates of adverse outcomes (adjusted relative rate [aRR] 0.78, 95% confidence interval [CI] 0.69, 0.90) compared to those with no AEC access. Hospitalized patients with access to asthma education during hospitalization had reduced rates of adverse events (aRR 0.87, 95% CI 0.75, 1.00) compared to those with no inhospital AEC access.Conclusion Although compliant with asthma guideline-based program elements, on a population basis access to asthma education centres is associated only with a modest benefit for some admitted and ED patients and depends on the level of access to services provided. Review of both services provided and strategies to address potential barriers to care are necessary.BMC Health Services Research 11/2014; 14(1):561. · 1.77 Impact Factor
Article: Socioeconomic status and event free survival in pediatric acute lymphoblastic leukemia: A population-based cohort study.[Show abstract] [Hide abstract]
ABSTRACT: The impact of socioeconomic status (SES) upon childhood cancer outcomes has not been extensively examined. Our objective was to determine the association between SES and event-free survival (EFS) among children with acute lymphoblastic leukemia (ALL) diagnosed in Ontario, Canada from 1995-2011 (N=1541) using Cox proportional hazards. Neither neighborhood-level median income quintile, distance from tertiary center, or rural residence significantly predicted EFS in the context of a universal healthcare system. Immigrant children experienced significantly superior EFS; confounding by ethnicity could not be ruled out. Confirmatory studies using additional individual-level SES variables are warranted.Leukemia Research 09/2014; · 2.76 Impact Factor
Article: Changing Age Demographics of Inflammatory Bowel Disease in Ontario, Canada: A Population-based Cohort Study of Epidemiology Trends.[Show abstract] [Hide abstract]
ABSTRACT: International cohort studies have reported increased incidence of inflammatory bowel disease (IBD) in recent years, and Canada has among the highest rates of IBD in the world. This study assessed incidence and prevalence of IBD in Ontario, the most populous province of Canada, to determine changing trends in age of onset.Inflammatory Bowel Diseases 08/2014; 20(10):1761-1769. · 5.12 Impact Factor
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ABSTRACT: The cause of rising asthma incidence over time remains unexplained. Examining trends in the age of diagnosis across successive birth cohorts may offer insights into asthma etiology.The Journal of allergy and clinical immunology. 06/2014;
Article: Validation of international algorithms to identify adults with inflammatory bowel disease in health administrative data from Ontario, Canada.[Show abstract] [Hide abstract]
ABSTRACT: Health administrative databases can be used to track disease incidence, outcomes, and care quality. Case validation is necessary to ensure accurate disease ascertainment using these databases. In this study, we aimed to validate adult-onset inflammatory bowel disease (IBD) identification algorithms. We used two large cohorts of incident patients from Ontario, Canada to validate algorithms. We linked information extracted from charts to health administrative data and compared the accuracy of various algorithms. In addition, we validated an algorithm to distinguish patients with Crohn's from those with ulcerative colitis and assessed the adequate look-back period to distinguish incident from prevalent cases. Over 5,000 algorithms were tested. The most accurate algorithm to identify patients 18 to 64 years at diagnosis was five physician contacts or hospitalizations within 4 years (sensitivity, 76.8%; specificity, 96.2%; positive predictive value (PPV), 81.4%; negative predictive value (NPV), 95.0%). In patients ≥65 years at diagnosis, adding a pharmacy claim for an IBD-related medication improved accuracy. Patients with adult-onset incident IBD can be accurately identified from within health administrative data. The validated algorithms will be applied to administrative data to expand the Ontario Crohn's and Colitis Cohort to all patients with IBD in the province of Ontario.Journal of clinical epidemiology 04/2014; 67(8):887-896. · 5.48 Impact Factor
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ABSTRACT: Cerebral palsy (CP) has a multifactorial etiology, and placental vascular disease may be one major risk factor. The risk of placental vascular disease may be lower among some immigrant groups. We studied the association between immigrant status and the risk of CP.PLoS ONE 01/2014; 9(7):e102275. · 3.53 Impact Factor
Article: Low socioeconomic status is associated with worse survival in children with cancer: a systematic review.[Show abstract] [Hide abstract]
ABSTRACT: While low socioeconomic status (SES) has been associated with inferior cancer outcome among adults, its impact in pediatric oncology is unclear. Our objective was therefore to conduct a systematic review to determine the impact of SES upon outcome in children with cancer. We searched Ovid Medline, EMBASE and CINAHL from inception to December 2012. Studies for which survival-related outcomes were reported by socioeconomic subgroups were eligible for inclusion. Two reviewers independently assessed articles and extracted data. Given anticipated heterogeneity, no quantitative meta-analyses were planned a priori. Of 7,737 publications, 527 in ten languages met criteria for full review; 36 studies met final inclusion criteria. In low- and middle-income countries (LMIC), lower SES was uniformly associated with inferior survival, regardless of the measure chosen. The majority of associations were statistically significant. Of 52 associations between socioeconomic variables and outcome among high-income country (HIC) children, 38 (73.1%) found low SES to be associated with worse survival, 15 of which were statistically significant. Of the remaining 14 (no association or high SES associated with worse survival), only one was statistically significant. Both HIC studies examining the effect of insurance found uninsured status to be statistically associated with inferior survival. Socioeconomic gradients in which low SES is associated with inferior childhood cancer survival are ubiquitous in LMIC and common in HIC. Future studies should elucidate mechanisms underlying these gradients, allowing the design of interventions mediating socioeconomic effects. Targeting the effect of low SES will allow for further improvements in childhood cancer survival.PLoS ONE 01/2014; 9(2):e89482. · 3.53 Impact Factor
Article: Evaluation of an Emergency Department Lean Process Improvement Program to Reduce Length of Stay[Show abstract] [Hide abstract]
ABSTRACT: Study objective In recent years, lean principles have been applied to improve wait times in the emergency department (ED). In 2009, an ED process improvement program based on lean methods was introduced in Ontario as part of a broad strategy to reduce ED length of stay and improve patient flow. This study seeks to determine the effect of this program on ED wait times and quality of care. Methods We conducted a retrospective cohort study of all ED visits at program and control sites during 3 program waves from April 1, 2007, to June 30, 2011, in Ontario, Canada. Time series analyses of outcomes before and after the program and difference-in-differences analyses comparing changes in program sites with control sites were conducted. Results In before-after models among program sites alone, 90th percentile ED length of stay did not change in wave 1 (–14 minutes [95% confidence interval {CI} –47 to 20]) but decreased after wave 2 (–87 [95% CI –108 to –66]) and wave 3 (–33 [95% CI –50 to –17]); median ED length of stay decreased after wave 1 (–18 [95% CI –24 to –12]), wave 2 (–23 [95% CI –27 to –19]), and wave 3 (–15 [95% CI –18 to –12]). In all waves, decreases were observed in time to physician assessment, left-without-being-seen rates, and 72-hour ED revisit rates. In the difference-in-difference models, in which changes in program sites were compared with controls, the program was associated with no change in 90th percentile ED length of stay in wave 2 (17 [95% CI –0.2 to 33]) and increases in wave 1 (23 [95% CI 0.9 to 45]) and wave 3 (31 [95% CI 10 to 51]), modest reductions in median ED length of stay in waves 2 and 3 alone, and a decrease in time to physician assessment in wave 3 alone. Conclusion Although the program reduced ED waiting times, it appeared that its benefits were diminished or disappeared when compared with that of control sites, which were exposed to system-wide initiatives such as public reporting and pay for performance. This study suggests that further evaluation of the effectiveness of lean methods in the ED is warranted before widespread implementation.BMC Health Services Research 01/2014; · 1.77 Impact Factor
Article: Residential movement patterns of families of young children with chronic conditions in Ontario, Canada: a population-based cohort study.[Show abstract] [Hide abstract]
ABSTRACT: Care giving for children with chronic diseases can lead to financial strain and compromised family well being. Little is known about whether these stresses lead to changes in residential movement patterns as they relate to income adequacy and proximity to care. We compared the residential movement patterns and associated changes in neighbourhood income of children with mild to severe chronic diseases compared with those that are healthy. A cohort of infants born from 2002--2007 in Ontario, Canada was followed for 5 years and divided into those with single- or multiple- body system complex chronic conditions (CCCs); low birth weight (LBW); asthma/recurrent wheeze (A/RW) and the control group of otherwise healthy children. Of 598,716 children studied, 15,207 had a single CCC, 3,600 multiple CCCs, 33,206 LBW, 57,137 A/RW and 489,566 were healthy. Lowest income quintile children were most likely to move residence. Compared with healthy controls, chronic disease cohorts, apart from those with asthma, were more likely to be born in the lowest income quintile neighbourhood and to move. Among children who moved, all chronic disease cohorts were significantly more likely to move to a low income quintile neighborhood (adjusted odds ratios for all chronic disease cohorts of 1.1-1.2). There were no differences across cohorts in residential movement close to a children's hospital. Young children with chronic conditions, particularly those born in low income neighbourhoods, are more likely to move residence than other healthy young children. However, it does not seem that proximity to specialized care is driving this movement. Further research is required to determine if these movement patterns impact the ability of children with chronic conditions to secure health services.International Journal for Equity in Health 08/2013; 12(1):62. · 1.71 Impact Factor
Article: Validation of a registry-derived risk algorithm based on treatment protocol as a proxy for disease risk in childhood acute lymphoblastic leukemia.[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND: Administrative databases and cancer registries are frequently used to conduct population-based research, but often lack clinical data necessary for risk stratification. Our objective was to determine the criterion validity of a risk-stratification algorithm based on treatment characteristics available from a pediatric cancer registry as a proxy for disease risk, by comparing it to traditional biology-based risk classifications. METHODS: We identified all children with acute lymphoblastic leukemia diagnosed at a single institution between January 2000 and June 2011, and linked them to a population-based cancer registry. Several risk algorithms were then constructed using disease risk variables collected through chart review by a pediatric oncologist, and compared to a risk algorithm based on treatment protocol name and age, available from the registry. RESULTS: Of 596 patients identified, 579 (97.1%) met inclusion criteria and were successfully linked. The registry-based algorithm showed almost perfect agreement with a biology-based algorithm based on age, initial white blood cell count, immunophenotype and cytogenetics (kappa=0.85, 95th confidence interval 0.81-0.90). Discrepant cases were often due to the presence of unusual high risk features not captured by standard disease-risk variables but reflected in clinicians' choices of higher intensity treatment protocols. CONCLUSIONS: Protocol name represents a valid proxy of disease risk, allowing for risk stratification while conducting comparative effectiveness research using cancer registries and health services data. Future studies should examine the validity of treatment-based risk algorithms in other malignancies and using other treatment characteristics commonly found in health services data, such as the receipt of specific chemotherapeutic agents.BMC Medical Research Methodology 05/2013; 13(1):68. · 2.21 Impact Factor
Article: Seasonal influenza vaccine effectiveness in pre- and full-term children aged 6-23 months over multiple seasons.[Show abstract] [Hide abstract]
ABSTRACT: INTRODUCTION: This study aimed to determine the effectiveness of seasonal influenza vaccine in pre- and full-term children aged 6-23 months. METHODS: We examined a cohort of 683,354 young children (7.7% preterm) over five influenza seasons (2004-2005 to 2008-2009) in Ontario, Canada. Vaccine effectiveness was estimated using influenza-coded ambulatory visits during virologically-confirmed influenza season periods as the outcome and multivariable Cox proportional hazards modeling. RESULTS: Full vaccination was associated with a 19% reduction in influenza-coded ambulatory visits (HR=0.81; 95% CI, 0.68-0.97) in all children, and an 18% reduction in full-term children (HR=0.82; 95% CI, 0.68-0.99). We did not find significant vaccine effectiveness for preterm children. No benefit was found for partial vaccination. CONCLUSIONS: In children younger than two years, only full influenza vaccination is associated with reduced influenza-coded ambulatory visits. Since the effectiveness of influenza vaccination in preterm children remains uncertain, further study of this highly vulnerable population is warranted.Vaccine 05/2013; · 3.77 Impact Factor
Article: Food fortification and decline in the prevalence of neural tube defects: does public intervention reduce the socioeconomic gap in prevalence?[Show abstract] [Hide abstract]
ABSTRACT: Objective: A significant decline in the prevalence of neural tube defects (NTD) through food fortification has been reported. Questions remain, however, about the effectiveness of this intervention in reducing the gap in prevalence across socioeconomic status (SES). Study Design: Using health number and through record linkage, children born in Ontario hospitals between 1994 and 2009 were followed for the diagnosis of congenital anomalies. SES quintiles were assigned to each child using census information at the time of birth. Adjusted rates and multivariate models were used to compare trends among children born in different SES groups. Results: Children born in low SES areas had significantly higher rates of NTDs (RR = 1.25, CI: 1.14-1.37). Prevalence of NTDs among children born in low and high SES areas declined since food fortification began in 1999 although has started rising again since 2006. While the crude decline was greater in low SES areas, after adjustment for maternal age, the slope of decline and SES gap in prevalence rates remained unchanged overtime. Conclusions: While food fortification is successful in reducing the prevalence of NTDs, it was not associated with removing the gap between high and low SES groups.International Journal of Environmental Research and Public Health 01/2013; 10(4):1312-23. · 2.00 Impact Factor
Article: Setting the RECORD straight: developing a guideline for the REporting of studies Conducted using Observational Routinely collected Data.Clinical Epidemiology 01/2013; 5:29-31.
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ABSTRACT: BACKGROUND AND OBJECTIVE:Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well understood. The objective of the study was to evaluate health care utilization and costs in a population-based sample of CMC in Ontario, Canada.METHODS:Hospital discharge data from 2005 through 2007 identified CMC. Complete health system use and costs were analyzed over the subsequent 2-year period.RESULTS:The study identified 15 771 hospitalized CMC (0.67% of children in Ontario); 10 340 (65.6%) had single-organ CCC, 1063 (6.7%) multiorgan CCC, 4368 (27.6%) neurologic impairment, and 1863 (11.8%) had TA. CMC saw a median of 13 outpatient physicians and 6 distinct subspecialists. Thirty-six percent received home care services. Thirty-day readmission varied from 12.6% (single CCC without TA) to 23.7% (multiple CCC with TA). CMC accounted for almost one-third of child health spending. Rehospitalization accounted for the largest proportion of subsequent costs (27.2%), followed by home care (11.3%) and physician services (6.0%). Home care costs were a much larger proportion of costs in children with TA. Children with multiple CCC with TA had costs 3.5 times higher than children with a single CCC without TA.CONCLUSIONS:Although a small proportion of the population, CMC account for a substantial proportion of health care costs. CMC make multiple transitions across providers and care settings and CMC with TA have higher costs and home care use. Initiatives to improve their health outcomes and decrease costs need to focus on the entire continuum of care.PEDIATRICS 11/2012; · 4.47 Impact Factor
Article: Call to RECORD: the need for complete reporting of research using routinely collected health data.Journal of clinical epidemiology 11/2012; · 5.48 Impact Factor
Article: Association between evidence-based standardized protocols in emergency departments with childhood asthma outcomes: a canadian population-based study.[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE To determine whether children treated in emergency departments (EDs) with evidence-based standardized protocols (EBSPs) containing evidence-based content and format had lower risk of hospital admission or ED return visit and greater follow-up than children treated in EDs with no standardized protocols in Ontario, Canada. DESIGN Retrospective population-based cohort study of children with asthma. We used multivariable logistic regression to estimate risk of outcomes. SETTING All EDs in Ontario (N = 146) treating childhood asthma from April 2006 to March 2009. PARTICIPANTS Thirty-one thousand one hundred thirty-eight children (aged 2 to 17 years) with asthma. MAIN EXPOSURE Type of standardized protocol (EBSPs, other standardized protocols, or none). MAIN OUTCOME MEASURES Hospital admission, high-acuity 7-day return visit to the ED, and 7-day outpatient follow-up visit. RESULTS The final cohort made 46 510 ED visits in 146 EDs. From the index ED visit, 4211 (9.1%) were admitted to the hospital. Of those discharged, 1778 (4.2%) and 7350 (17.4%) had ED return visits and outpatient follow-up visits, respectively. The EBSPs were not associated with hospitalizations, return visits, or follow-up (adjusted odds ratio, 1.17 [95% CI, 0.91-1.49]; adjusted odds ratio, 1.10 [95% CI, 0.86-1.41]; and adjusted odds ratio, 1.08 [95% CI, 0.87-1.35], respectively). CONCLUSIONS The EBSPs were not associated with improvements in rates of hospital admissions, return visits to the ED, or follow-up. Our findings suggest the need to address gaps linking improved processes of asthma care with outcomes.JAMA Pediatrics 07/2012; 166(9):834-40. · 4.28 Impact Factor
Article: Evaluating the effect of clinical decision units on patient flow in seven Canadian emergency departments.[Show abstract] [Hide abstract]
ABSTRACT: To evaluate the effect of emergency department (ED) clinical decision units (CDUs) on overall ED patient flow in a pilot project funded in 2008 by the Ontario Ministry of Health and Long-Term Care (MOHLTC). A retrospective analysis of unscheduled ED visits at seven CDU pilot and nine control sites was conducted using administrative data. The authors examined trends in CDU utilization and compared outcomes between pilot-CDU and control sites 1 year prior to implementation, with the first 18 months of CDU operation. Sites that were unsuccessful in their applications for CDU program funding served as controls. Outcomes included ED length of stay (LOS), admission rates, and ED revisit rates. At CDU sites, roughly 4% of ED patients were admitted to CDUs. The presence of a pilot-CDU was independently associated with a small reduction in ED LOS for all low-acuity patients (-0.14 hour, 95% confidence interval [CI]=-0.22 to -0.07) and nonadmitted patients (-0.11 hour, 95% CI=-0.16 to -0.07). A small independent effect on absolute hospital admission rate for all high-acuity patients (-0.8%, 95% CI=-1.5% to -0.03%) and moderate-acuity patients (-0.6%, 95% CI=-1.1% to -0.2%) was also observed. Pilot-CDUs were not associated with changes in ED revisit rates. With only 4% of ED patients admitted to CDUs, the potential for efficiency gains in these EDs was limited. Nonetheless, these findings suggest small improvements in the operation of the ED through CDU implementation. Although marginal, the observed effects of CDU operation were in the desired direction of reduced ED LOS, reduced admission rate, and no increase in ED revisit rate.Academic Emergency Medicine 07/2012; 19(7):828-36. · 2.20 Impact Factor
Article: Reduction in Clostridium difficile infection rates after mandatory hospital public reporting: findings from a longitudinal cohort study in Canada.[Show abstract] [Hide abstract]
ABSTRACT: The role of public reporting in improving hospital quality of care is controversial. Reporting of hospital-acquired infection rates has been introduced in multiple health care systems, but its relationship to infection rates has been understudied. Our objective was to determine whether mandatory public reporting by hospitals is associated with a reduction in hospital rates of Clostridium difficile infection. We conducted a longitudinal, population-based cohort study in Ontario (Canada's largest province) between April 1, 2002, and March 31, 2010. We included all patients (>1 y old) admitted to 180 acute care hospitals. Using Poisson regression, we developed a model to predict hospital- and age-specific monthly rates of C. difficile disease per 10,000 patient-days prior to introduction of public reporting on September 1, 2008. We then compared observed monthly rates of C. difficile infection in the post-intervention period with rates predicted by the pre-intervention predictive model. In the pre-intervention period there were 33,634 cases of C. difficile infection during 39,221,113 hospital days, with rates increasing from 7.01 per 10,000 patient-days in 2002 to 10.79 in 2007. In the first calendar year after the introduction of public reporting, there was a decline in observed rates of C. difficile colitis in Ontario to 8.92 cases per 10,000 patient-days, which was significantly lower than the predicted rate of 12.16 (95% CI 11.35-13.04) cases per 10,000 patient-days (p<0.001). Over this period, public reporting was associated with a 26.7% (95% CI 21.4%-31.6%) reduction in C. difficile cases, or a projected 1,970 cases averted per year (95% CI 1,476-2,500). The effect was specific to C. difficile, with rates of community-acquired gastrointestinal infections and urinary tract infections unchanged. A limitation of our study is that this observational study design cannot rule out the influence of unmeasured temporal confounders. Public reporting of hospital C. difficile rates was associated with a substantial reduction in the population burden of this infection. Future research will be required to discern the direct mechanism by which C. difficile infection rates may have been reduced in response to public reporting. Please see later in the article for the Editors' Summary.PLoS Medicine 07/2012; 9(7):e1001268. · 15.25 Impact Factor
Article: Low rates of influenza immunization in young children under Ontario's universal influenza immunization program.[Show abstract] [Hide abstract]
ABSTRACT: To determine physician-administered influenza vaccine coverage for children aged 6 to 23 months in a jurisdiction with a universal influenza immunization program during 2002-2009 and to describe predictors of vaccination. By using hospital records, we identified all infants born alive in Ontario hospitals from April 2002 through March 2008. Immunization status was ascertained by linkage to physician billing data. Children were categorized as fully, partially, or not immunized depending on the number and timing of vaccines administered. Generalized linear mixed models determined the association between immunization status and infant, physician, and maternal characteristics. Influenza immunization was low for the first influenza season of the study period (1% fully immunized during the 2002-2003 season), increased for the following 3 seasons (7% to 9%), but then declined (4% to 6% fully immunized during the 2006-2007 to 2008-2009 seasons). Children with chronic conditions or low birth weight were more likely to be immunized. Maternal influenza immunization (adjusted odds ratio 4.31; 95% confidence interval 4.21-4.40), having a pediatrician as the primary care practitioner (adjusted odds ratio 1.85; 95% confidence interval 1.68-2.04), high visit rates, and better continuity of care were all significantly associated with full immunization, whereas measures of social disadvantage were associated with nonimmunization. Low birth weight infants discharged from neonatal care in the winter were more likely to be immunized. Influenza vaccine coverage among children aged 6 to 23 months in Ontario is low, despite a universal vaccination program and high primary care visit rates. Interventions to improve coverage should target both physicians and families.PEDIATRICS 05/2012; 129(6):e1421-30. · 4.47 Impact Factor
Article: Follow-up care after an emergency department visit for asthma and subsequent healthcare utilization in a universal-access healthcare system.[Show abstract] [Hide abstract]
ABSTRACT: To describe the follow-up care within 28 days of an emergency department (ED) visit for asthma and to determine the association of follow-up visits within 28 days with ED re-visits and hospital admissions in the subsequent year. Population-based retrospective cohort study of children with asthma aged 2-17 years treated in an ED in Ontario, Canada between April 14, 2006 and February 28, 2009. Multiple linked health administrative datasets and Cox proportional hazard multivariable survival models were used to test the association of characteristics of 28-day follow-up visits with 1-year outcomes. The final cohort consisted of 29391 children, of whom 32.8% had follow-up, 6496 (22.1%) had an ED re-visit, and 801 (2.7%) had a hospital admission. Having a follow-up visit was not associated with ED re-visit or hospitalizations (hazard ratio 0.98; 95% CI 0.93, 1.03 and hazard ratio 1.06; 95% CI 0.92, 1.23, respectively). Younger children and those with indices of more severe acute or chronic asthma were more likely to have ED re-visits and hospitalizations. Other follow-up care characteristics (number of visits, type of physician providing care) were not associated with outcomes. Despite a universal healthcare setting, most children did not access follow-up care after an ED visit for asthma, and those that did had no associated benefit in terms of reduced ED re-visits and hospitalizations in the subsequent year.The Journal of pediatrics 04/2012; 161(2):208-13.e1. · 4.02 Impact Factor
Top Journals
Institute for Clinical Evaluative SciencesToronto, Ontario, Canada
SickKidsToronto, Ontario, Canada
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
- Department of Evaluative Clinical Sciences
University of OttawaOttawa, Ontario, Canada
McGill University
Montréal, Quebec, Canada
- Department of Pediatrics
Alberta Health Services
Calgary, Alberta, Canada
- Department of Pediatrics
University of Toronto
Toronto, Ontario, Canada
- • Hospital for Sick Children
- • Department of Paediatrics


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Special Reports
The European Commission is reviewing the European Union's rules on copyright. This timely special report discusses what is at stake, who stands to lose and to gain, and explains why.
- Copyrights and wrongs
- Who are copyright holders?
- A short history of EU copyright reform plans
Reform of the EU's copyright rules has been a hot topic for years, but with no effect. That may be about to change.
Copyright is big business for Europe, and its scope extends far beyond authors and performers.
Aborted reforms and bitter divisions over copyright are not new, nor is the need to update copyright law as technology changes.
- Copyright: old rules in a digital age Technological advances have put Europe's copyright laws to the test.
- Copyright: a cross-border conundrum Being able to gain access to content in one country but not another is frustrating for consumers and legislators alike.
- Copyright winners and losers An ongoing competition case could force member states to clarify their positions on copyright reform.
- Copyright – defending creativity Most stakeholders agree that authors and performers are under-remunerated under the current system, but there is disagreement over how to respond.
Featured ContentCreativity Works!
Europe's digital economy and cultural prowess depend on copyright to thrive in the long-term.
Featured ContentDon't miss the goal!
To unfold its full economic and social potential, sport needs a solid and enforceable copyright framework, not a weakened one.
Featured ContentEurope's copyright regime: aim to strengthen the creator-user bond
As technology advances, the traditional relationship between authors and users is changing.
Climate change
European Voice's special report examines how climate change policy is developing outside the confines of inter-governmental talks. Increasingly, the private sector is shaping climate-change thinking – and arguably to greater effect.
- Climate change: after the cold snap Combating climate change has slipped way down as a priority for many politicians and companies. A major climate summit could change that.
- Anatomy of a climate deal EU leaders have made a commitment to cut emissions, but the deal is riddled with compromises.
- Climate change: the long road to Paris Paris 2015 is the big international climate summit, but much of its success rests on a meeting in Peru later this year.
- Climate champion Connie Hedegaard moves on The first European commissioner dedicated to climate change, whose term ended on 1 November, says there have been victories and frustrations over her five years in office.
- Forests face the brunt of changes in the weather An increased likelihood of prolonged drought, extreme storms and flooding will pose a serious challenge for Europe's forests.
- Private sector picks up the pieces Many regional governments and businesses have played their part in tackling climate change.
Special report: Healthcare
Establishing a strategic healthcare policy for the European Union.
- Healthcare: old problems, new threats
- Paying the price for ill-health
- Advancing technology in healthcare
- The healthcare sector's budgetary breakdown
Healthcare systems across Europe were feeling the pressure long before the Ebola crisis imposed new strains.
How to get better value in healthcare – and to ease disparities between health systems in member states – is driving healthcare thinking in the EU.
Technology has brought a sudden wave of new routes to transforming healthcare, but can doctors and patients keep up with innovation?
The EU is taking a much greater role in making sure member states spend more wisely on healthcare, while also balancing the books.
- Teamwork helps improve healthcare treatment Failings in the EU's response to the 2011 avian flu pandemic have led to a greater level of co-operation among member states.
- The downward spiral of health inequality
- Resource inefficiency in healthcare
- Power to the patients Patients' groups are having more of a say over healthcare, but that may be only part of the answer.
- How much is too much when paying for healthcare? National health authorities take very different views on the price, availability and effectiveness of medicines.
- Cheap, but not cheerful drug-pricing
- Out with the old health policy
Sponsored ContentFrance calls for healthy lifestyles
This article is part of a series looking at challenges facing the health systems in six European countries.
Featured ContentHelping our immune system against cancer
Despite progress in our knowledge of the biological basis of cancer and therapeutic advances there remains a significant need for new treatment options.
Featured ContentTowards a European health union
Today EU public health policy is manifestly no longer in the closet.
Featured ContentTime for a 'new deal' for health promotion to accompany institutional renewal in the EU
How cost-effective disease prevention and health promotion can benefit societies and their economies.
EU studies
- Erasmus+ means more mobility The structure of the Erasmus programme has changed, giving students more opportunities to study abroad.
- Bologna looks to the future A review of the Bologna process for higher education reform is long overdue.
- Knowledge alliances roll out across Europe Commission searches for projects that bring together higher education and the workplace.
- Studying the EU at a distance Students as far afield as the United States and New Zealand are keeping a close eye on developments in the European Union.
Juncker's team
On 10 September, Jean-Claude Juncker unveiled the most significant shake-up of the European Commission's organisational structure in years. Here is European Voice's take on the new Commission college.
- A brave (though flawed) attempt at a shake-up
- Juncker deals out the pack
- Juncker's careful balancing act
Juncker has made a serious attempt at reform, but has taken several gambles.
Timmermans given significant powers as Juncker's right-hand man and changes made to Commission departments.
Juncker had to take many issues into consideration when assigning the Commission portfolios.
- Juncker's portfolio assignments: the reaction Jean-Claude Juncker unveiled his portfolio assignments today and announced a restructuring of the commission into teams. European Voice has been collecting the reactions.
- MEPs threaten to get tough Judging by early reactions there are some commissioner nominees who may face strong resistance in the Parliament.
- Juncker seeks greater control over foreign policy The high representative will move to the European Commission headquarters and half of her cabinet must be made up of Commission staff.
- Juncker's health plans drive a wedge between partners Commission reorganisation announcement prompts health NGO to pull out of plans to create a health intergroup in the European Parliament
- Juncker's plan would 'shut down environmental policy', campaigners warn Business groups have welcomed Juncker's new 'streamlined' Commission structure, but green campaigners have decried the loss of dedicated environment and climate commissioners.
- National media reaction to Juncker's allocation of portfolios While the division of some of the posts came as a surprise, the reaction from media in the member states has been largely positive.
Doing public affairs
Examining the world of public affairs in and around the EU.
- Public affairs is not an exact science
- A decade of change in EU public affairs
- Switching professions: politician to public affairs practitioner
Estimates put the number of lobbyists in Brussels at around 30,000 but calculations of their impact are still more vague.
Public affairs organisations have switched their focus to MEPs and changed their tactics to get the best results.
Do ex-MEPs become lobbyists because they are suited to the task, or because they are unsuitable for anything else?
- Cultural differences affect practices in the public affairs industry Lobbying in Brussels has developed into a unique practice incorporating the norms and regulations of other countries.
- Roman Catholic lobby Spurring the Roman Catholic lobby into action.
- Using social media in public affairs Creating grassroots momentum behind the reform of fisheries rules that was being proposed by the European Commission.
- Data protection and aggressive lobbying The moment that hard-nosed US lobbying arrived in Brussels.
- Making the public affairs sector more transparent The Joint Transparency Register has made the public affairs sector more open, but there are limits to what it can achieve.
- Public affairs: a small revolution, still turning Maros Sefcovic believes that there have been improvements to the conduct of public affairs around the EU.
Exploring EU migration, including what the statistics reveal, how member states are reacting to migration and the need for an EU model to manage it.
- Is the EU experiencing a great migration crisis?
Europeans are unhappy with their governments' migration policy, and many are blaming the EU.
- Is EU migration getting out of control? The figures on asylum and other forms of migration in the EU are dramatic, but are they still manageable?
- Tough immigration rules threaten economic growth Growing skill shortages and an ageing working force pose problems for growth within the European Union, while emerging economies will ramp up competition for talent and labour.
- Migration: what the polls are saying Opinion polls provide a snapshot of Europe's anti-immigration mood.
- Finding a way to manage migration Trends and policies are converging, but no European model of management has yet emerged.
- Why citizenship matters when it comes to migration Rainer Bauböck, professor of social and political theory at the European University Institute in Florence, tells Toby Vogel why citizenship is an important factor in immigrant integration and outlines some recent changes to the concept of EU citizenship.
Decarbonising road transport
Tackling climate change, car-makers concerns and the shift from road to rail.
- Decarbonising road transport: the road to cleaner fuel
- Burden-sharing: is road transport paying its fair share?
- Car CO2 limits – what is feasible?
How can the EU reduce emissions from transport while keeping the economy moving?
Defining the role of industrial sectors in tackling climate change has been a consistently hot topic in recent years.
Carmakers have cried foul about EU plans to limit carbon dioxide emissions from cars, but green groups say that such measures can have impressive results.
Publication of this report has been made possible by the CommentVisions debate series, in partnership with Shell. The sponsor has no control over the content, for which European Voice retains full editorial responsibility.
- In ranking fuel quality, can companies go it alone? The EU is trying to ensure that oil companies play their part in reducing the pollution emitted by transport.
- Stalled biofuel proposal is on the road again Disagreement over the environmental damage caused by certain types of biofuel is provoking warnings of damage to a promising industry.
- Shifting journeys from road to rail The Commission is pushing for a shift from road to rail, but not everyone agrees.
- Clean fuel infrastructure Consumers will not buy expensive electric vehicles if they fear that the distances they can travel will be limited by an absence of recharging or refuelling facilities.
Italy's presidency of the EU's Council of Ministers
A look at Italy's domestic politics, relationship with the EU and the agenda for the next six months at the helm of the Council of Ministers.
- Right place, right time for Italy?
- Grand ambitions for the Italian presidency
- Italy's agenda
- Italy's domestic politics
- Matteo Renzi – prime minister
Italy's government will want to show off its strengths during its six months at the helm of the Council, but may be distracted by the EU's institutional disputes.
According to the Italians, nothing is off-limits for discussion during the next six months, including treaty change.
Italy's priorities at home and at the EU level.
Great things are expected of Matteo Renzi, who has charm as well as a ruthless streak.
Italy's prime minister has momentum. How will he use it?
- Pier Carlo Padoan – Italy's finance minister Renzi plucked his minister of finance from the number two position at the OECD to do a job that few appear prepared to do.
- Federica Mogherini – Italy's foreign minister Italy's foreign minister comes to office with a strong interest in the Middle East and defence issues.
- Gian Luca Galletti – environment minister Italy's minister for the environment and protection of land and sea
- Federica Guidi – Italy's minister for economic development Guidi is an arrival from the private sector, where she was CEO of a global engineering firm and vice-president of Confindustria.
- Stefano Sannino – permanent representative to the EU Profile of Italy's permanent representative to the EU.
- Italy's environment policy The Italian government has a lot of work to do to improve its environmental record.
- Italy's economy under reform Doubts remain whether Renzi's reforms can stop two decades of decline in the the world's ninth largest economy and fourth largest borrower.
- Italy – a magnet for migrants With more arrivals in the first half of this year than in the entire last year, Italy is determined to discuss the fundamentals of the EU's migration policy.
- Italy: previous presidencies of the EU's Council of Ministers
European Parliament election results
In the aftermath of the elections to the European Parliament, this special report looks at how the 2014-19 term is shaping up, with country-by-country statistics, political party results and a list of the casualties.
- Grand coalition likely as gap between two main groups narrows
EPP and S&D are the two largest groups, with the other groups having varying degrees of success in the elections.
- How to make friends and influence people The composition of the next European Parliament is far from certain, with several national parties planning to change groups.
- Voter turnout shows negligible improvement on 2009 level The average turnout across Europe was almost exactly the same as in 2009. But rates varied greatly across the EU.
- The electoral fortunes of the EPP and the S&D How did the main centre-right and centre-left groups fare in the European Parliament elections?
- A good election for ALDE, GUE or the ECR? The election fortunes of three groups in the European Parliament.
- How the election went for the Greens, EFD and non-aligned Analysis of the European Parliament election results for two groups and the parties that have yet to find – or don't want to join – a group.
- Room at the top The leadership of the new Parliament will have many new faces.

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The relationships between heart failure (HF), sleep-disordered breathing (SDB), insomnia, depressive symptoms, and excessive daytime sleepiness (EDS), as well as their relationship to Global Perceived Health (GPH) in an elderly community-dwelling population, have not been explored. Data from 331 community-dwelling elderly (71-87 years old) were collected by echocardiography, polygraphy, and specific questionnaires. Factor analyses and structural equation modeling were used to explore the relationships between HF, SDB, sleep, psychosocial factors, and GPH. Exploratory and confirmatory factor analyses derived a 5-factor model representing SDB, insomnia, systolic function, breathlessness/physical function, and psychosocial function. Structural equation modeling analyses were used to explore the relationships between the 5 factors and to GPH. Sleep-disordered breathing had a weak effect on systolic function, but no effects on any of the other factors or GPH were found. Psychosocial function and breathlessness/physical function directly affected GPH. Indirect effects on GPH, mediated by psychosocial function, were found for breathlessness/physical function and insomnia. Systolic function also had an indirect effect on GPH. The fact that SDB in the elderly has no obvious negative associations to sleep complaints or GPH does not exclude them from being adequately treated for SDB. However, the present study has shown that SDB, by means of self-rated sleep complaints and health-related quality of life, can be problematic to detect. Psychosocial function was the most important factor for perceived GPH as it had a direct effect, as well as mediated the factors breathlessness/physical function and insomnia effects, on GPH. This study indicates that interventions in clinical practice targeting psychosocial dysfunction, such as depressive symptoms, could help to improve GPH in the elderly with or without HF.
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Build your own awesome backyard "rocket stove", which cooks food using only twigs and debris for fuel
Look! DIY Outdoor Stove
How to build a rocket stove! These are a backyard must- cook anything on this stovetop with a few handfuls of twigs! This blog is amazing and worth a look around!
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Day 10 - Scrap Windchimes. Post from chain link fence, grate from stove, broken hammer, and trophy parts. @createstuff #30daysofcreativity


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Rep. Charles Rangel (New York)
Check out what members of the Congressional Black Caucus had to say about honoring Martin Luther King Jr.'s legacy.
"Nearly five decades after marching 54 miles from Selma to Montgomery, I am proud to witness and celebrate the unveiling of the Dr. Martin Luther King Jr. memorial, which honors Dr. King's role in establishing the landmark Civil Rights Act of 1964 and his fight to make equality in America a reality for everyone. The memorial serves as an everlasting reminder to our nation to carry on Dr. King's legacy of striving for a better tomorrow and a better America."
(Photo: www.rangel.house.gov)
What's Happening in Ferguson, Missouri?11/21/2014
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Bring That Week Back: Alabama Pastor Banned From Church10/17/2014
Outrageous School Suspensions10/16/2014
Bring That Week Back: Inmate Dies After Threats from Guard10/09/2014
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Young and Ambitious: Kid Entrepreneurs10/03/2014
Bring That Week Back: College Selects Abu-Jamal as Speaker10/03/2014
Bring That Week Back: Reporter's 'I Quit' Video Goes Viral09/26/2014
Racism 101: Trouble on Campuses Around the Nation09/26/2014
Bring That Week Back: Darrien Hunt Shot 6 Times09/17/2014
Meet the Black MacArthur Fellows09/17/2014
Father Says 'My Son Did Not Kill Himself'09/12/2014
Sept. 11 Memorials Around the U.S.09/11/2014
10 Things We Learned From the Apple Live Event09/09/2014
10 Scholarships and Accelerators for Blacks in Tech09/04/2014
What You Need to Know About the Renisha McBride Case09/03/2014
Bring That Week Back: UN Calls Out US Over Profiling09/02/2014
Week in Review: Mom Regains Custody of Kids She Left in Car08/29/2014
Marches, Rallies Honor Eric Garner, Michael Brown08/25/2014
Bring That Week Back: Family of Renisha McBride Sues Killer08/21/2014
The Viral Epidemic of Police Brutality08/20/2014
Bring That Week Back: Man Shot Down by LAPD08/13/2014
Bring That Week Back: The Cutest Father-Daughter Rap Song08/08/2014
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Bring That Week Back: Daddy-Daughter Dance Video Goes Viral07/29/2014
Diversity in the Technology Workforce07/24/2014
Bring That Week Back: Shopping While Black Vine Goes Viral07/23/2014
Bring That Week Back: Barbershop Improves Youth Literacy07/18/2014


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Dog found after Vt. rollover crashThe Associated Press | January 02,2014ROCKINGHAM - Vermont State Police say a dog has been found and is doing fine after he became lost during a rollover crash on Interstate 91 in Rockingham.
Police say the crash happened Wednesday afternoon. The driver, 83-year-old David Andrews of Alpine, N.J., fell asleep at the wheel. His car went off the road, skidded into a patch of trees and flipped. He and passenger 81-year-old Nancy Andrews were taken to the hospital with minor injuries.
Police say their dog, Zorro, was in the car and went missing. Early Thursday, a trooper found Zorro walking on the snowy shoulder close to the crash scene. He said Zorro was a bit chilled, but has recovered and is in the care of friends of the owners.MORE IN This Just InBoard planning Full StoryNew offerings at the Rutland Free Library. Full StoryMan faces charge Full Story
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- RICHARD'S POOR ALMANACK: On this day in 1778, Capt. James Cook is first European to set eyes on Maui in Hawaiian Islands; 1922, Pharoah Tutankhamun found after 3000 years; 1909, Hollawood movie star Frances Dee born in Los Angeles.
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- RICHARD'S POOR ALMANACK: In 1944, U.S. begins B-29 bombing raids on Japanese main islands; in 1950, Great Appalachian Storm begins to form; 1963, Lee Oswald killed by Jack Ruby; 1974, D.B. Cooper hijacks Seattle-bound airliner; 1974, 'Lucy' found.
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- RICHARD'S POOR ALMANACK: On this day in 1863, President Abraham Lincoln delivers short speech in Gettysburg, Pa.; in 1984, a Pemex LNG facility destroyed by series of gas explosions, 600 people are killed; in 1998, Senate builds fire under Bill Clinton.


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EPIC Screenshot Thread is EPIC
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Lt. Commander
Join Date: Dec 2007
Posts: 120
# 5
Don't much care for the way Photobucket sizes these things down.
Attack Formation
25th century redesigned Miranda, making its ancestors proud.
Reminding Klingons we're classier than they since 2287.
U.S.S. Salah ad-Din [1]
A Bit of Wetwork [2]
Damage control is reporting... floodings on deck 5?
Why would Klingons want to destroy such beauty?
[Full]x3 and still no seatbelts!
A Dangerous Distraction
Emissary Inbound
NX in Orbit
Please don't be full of Borg!
Still 560 years till this show reaches Omicron Persei 8.
You worry about the enemy vessels. I'll worry about you.
I could really use a flashlight, guys. Or a drink.
Sorry, Resistance is... what?
qa'pla! What did you fire at that vessel!? And do we have more?
Bird of Prey breaking Orbit
For the new kids. Back when I was your age, Earth spacedock looked like this! And no one knew where to find Sulu!


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Newegg.com - A great place to buy computers, computer parts, electronics, software, accessories, and DVDs online. With great prices, fast shipping, and top-rated customer service - once you know, you Newegg.
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Vue™ life from a new perspective, one of comfort, performance and design. Vue™ chairs are the ultimate in task seating. Rated for 24/7 use, the mesh back has ample support and ergonomic shaping to provide all day comfort and prevent fatigue. The breathability of the mesh keeps you cool and comfortable throughout every workday - no matter how many hours you put in. 500 lb. weight capacity. Reinforced mechanism with back tilt. Also includes back height adjustment and optional T-pad height and width adjustable arms.
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BBTS Sponsor News: Transformers, Marvel, Batman, Metal Gear solid, Mezco Exclusives, Breaking Bad Figures & More!MP-11SW MASTERPIECE SKYWARP EXCLUSIVE Masterpiece Skywarp is now available for pre-order and is listed at $199.99. APS-03 DECEPTICON BARRICADE & SOUNDWAVE TWO-PACK The most popular Decepticons are back! Included in the two-pack are Barricade with Frenzy and Soundwave with Laserbeak and Mr. Gould. It is listed at $144.99. Q TRANSFORMERS SERIES – SETS, SINGLES These… Read More Read More Read More Read More
"RiffTrax Live: Santa Claus" Will Bring Belly Laughs to Naughty and Nice Nationwide this Holiday SeasonFathom Events, RiffTrax and IGN Present All-New Hilarious Commentary on This Holiday Title in Select U.S. Cinemas on December 4 DENVER – October 22, 2014 – Fathom Events, RiffTrax.com® and IGN are thrilled to bring Michael J. Nelson, Kevin Murphy and Bill Corbett (best known for the groundbreaking "Mystery Science Theater 3000") back… Read More Read More Read More
MEGA Brands announces new partnership with Universal Partnerships & Licensing to launch Despicable Me™ building sets this holiday season#MINIONMONTAGE CHALLENGE' RAMPS UP TO LAUNCH MONTREAL, Oct. 21, 2014 /PRNewswire/ – MEGA® Brands Inc., a member of the Mattel family of companies (NASDAQ: MAT), has announced today a multi-year global licensing partnership with Universal Partnerships & Licensing (UP&L) to develop a new kids construction line based on the phenomenally successful Despicable Me franchise from… Read More Read More Read More Read More Read More


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California Northern Chapter Resident/Fellow Member and Medical Student Electronic Abstract Form
Competition is open ONLY to members of the ACP Northern California Chapter. Note that each program is allotted a certain number of abstracts, so your program director must approve the submission.
Deadline Friday, October 17, 2014
WARNING: This form is programmed to reject all submission attempts after 11:59pm PDT, Friday, October 17, 2014
* indicates required fields.
If you have questions about the Abstract Competition, please contact Carmelina Raffetto at firstname.lastname@example.com.
Page updated: June 12, 2014
What's New
- Southern California Region I Chapter-Meet Our Governor-elect Designee, Mark S. Noah, MD, FACP
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25 Years in, the Urge Still Selling Out Venues
By Melinda Cooper
The 100 Greatest St. Louis Songs
By RFT Music
"Music You Know" Draws Inspiration from the Familiar
By Allison Babka
Pokey LaFarge Signs to Rounder Records
By Daniel Hill
Miami Dolphins Is Not a Football Team
By Drew Ailes
Combating a Rash of Tour Van Break-Ins
By Brian Heffernan
Grammophone to Close, Reopen As Restaurant
By Joseph Hess
Playing for the Cause Helps Out Those in Need
By Joseph Hess
Alberts recorded drummers from many communities and informal, polyphonic choruses singing in many tongues. These are signature sounds of African music, but perhaps more charming are the more Westernized ensembles. "All for You" is stripped-down high-life from Liberia with gruesomely comic lyrics -- "You took the razor, cut my throat/All for you" -- one could hear as a tortured feminist statement. And the acoustic rumba recorded in the Congo offers an irresistible snippet of village soukous: This is the music that shook the disco, unplugged and backstage, loping along as if there were no tomorrow.
-- Chris King


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Angelina Pivarnick WHOMPED on TNA Wrestlingby Free Britney at . Comments
Former Jersey Shore star and current Z-list celebrity annoyance Angelina Pivarnick got flat out CRUSHED this week in her debut on TNA IMPACT wrestling. Nice.
In North Carolina last week, Ange, who signed a deal to wrestle on the Spike TV program, decided to talk smack and deliver a kick to Miss Velvet Sky.
Big mistake. Big, hilariously awesome mistake ...
Good cause someone needed to put that nasty girl Angelina in her place. Love the Jersey Shore but man, that girl was just beyond. I bet she doesn't have any real friends cause she's selfish- just so full of herself !! Glad they kicked her out of the house. :)


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It's Raining Cats in South Jersey!
It may be hot and sunny outside but it's raining cats inside the AWA! The Animal Welfare Association needs your help finding homes for an influx of cats and kittens in South Jersey this month.
It may be hot and sunny outside but it's raining cats inside the AWA! The Animal Welfare Association needs your help finding homes for an influx of cats and kittens in South Jersey this month.
If the SoJO Dream Home was a competition, this $3.9 million dollar stunner would be the undisputed champion.
View Fourth of July NJ Fireworks Map for 2013 in a larger map
Independence Day is quickly approaching, and many New Jersey counties are ready to go with Fourth of July fireworks displays. Here is guide to firework displays across South Jersey.
The Atlantic City Air Show takes off Wednesday high above A.C., but if you can't make it out to the boardwalk, SoJO 104.9 has you covered.
Trust us, you're going to want to tell everyone you know about this.
Coming very soon, SoJO 104.9 and Townsquare Media will unveil a Seize the Deal auction with more than 35 items valued at over $92,000... and any one could be yours at more than half off!
After narrowly dropping our South Jersey Lip Dub Battle last year, Mainland is back again looking to get that win under its belt. However, Absegami came out of the gate strong with a lip dub that's hard to not sing along with.
SoJO 104.9 and the American Red Cross are teaming up on Monday, June 24th to collect blood.
Did you know that giving blood saves three lives?
Vote now for the SoJO listener you think rocks a suit and tie the best. The winner will be entered into our contest to see Justin Timberlake and Jay Z live in Chicago 104.9 times!
If you can't decided which you like better, the beach or the bay, this weekend's SoJO Dream Home is exactly what you need.
Who doesn't love a sequel?
If you're a member of Friends With Benefits, then you probably already know that we're giving one lucky listener the chance to see Justin Timberlake and Jay Z in Chicago this summer.
Barnegat's Michelle Lombardi could be the next big thing in music. So, if she makes it big, here's your chance to say you heard her first.


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Zebra Stripe Glass Beads Lampwork Oval 16x8mm Grey White 10pc
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- Home
- Ink Pads, Markers & Refills
- Combo Holder
Combo Holder
Product Description
Our Combo Ink Pad Holders are perfect for the paper crafter who has a collection of ink pads, markers and refill bottles, whether that collection is large or small. Instead of storing them in a drawer, tote or box you can display them beautifully in front of you in your work area. It brings your ink pads, markers and refill bottles together and organizes them by color so they are much easier to find and use.
The Combo Ink Pad Holders are compatible with a wide variety of different brands including Stampin' Up!, Memento, Color Box, Distress, etc, but check the dimensions listed below to make sure yours will fit. Your colors are displayed in of twelve, so you can keep each color family organized together in a column and never again forget which items you already have – you'll always be able to see them.
The finger slot cut into each divider makes removing the ink pads quick and easy. Dividers can be removed for storing larger accessories.
Dimensions are provided in the product images
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Product Reviews
Showing reviews 1-10 of 60 | Next
Love it
Posted by Karen on 11 18 2014
I love my combo ink holders. The new ones are improved on the old ones. The shelfs on the new one pull out for easy painting. The old ones do not. Thanks for great products! I have my eye on paper holders next.
Combo Holder - Love It!
Posted by Carole Corey on 11 17 2014
I was so anxious to get this Combo Holder and I know I am going to love it! Still trying to get my studio organized and this is such a great addition. I highly recommend it, especially if you have the Stampin' Up! inks, refills, and markers. Nice to have them all in one place.
I have a wide variety of Stamp 'n Storage products and every piece is well made, sturdy, and coordinates so nicely. I recommend this company without reservation.
Wonderful ink pad stroage
Posted by Karen Person on 11 04 2014
I have been impressed with my new stamp holder from beginning to end. I received it promptly and it was very well packaged. The Combo Holder is VERY well made. I am proud to have it on my table. Will order again.
Love this product
Posted by Amy on 10 30 2014
I love this product this is my 2nd purchase of the combo holder if I cold have fit the bigger one where I needed it to go I would have but instead I had to go with 2 of the smaller ones (48) everything is in one place now I don't have to search for anything the matching marker the pad the ink refill lover it!!! Thank you so much for a great product!!!
Posted by BECKY ELDER on 10 22 2014
I got the combo holder. love it!!! my stamp room 2 months ago got flooded so I am remodling. will send you a picture as soon is I have it going again. all my ink is right handy for me in this holder. it is the best!
Beautifully made!
Posted by Ingrid Wilson on 10 19 2014
It took awhile to receive my order but it was well worth the wait! The quality is wonderful. It will be a joy to have my pads and inks so readily available and handy!! I painted mine with spray paint to match my craft room- it was easy to do and dried quickly.
The COMBO 60 is A++.
Posted by Susan Hawke on 10 12 2014
My first concern for a remodel of my Stampin Up! "creativr building blocks" was higher density storage for my stamp sets, cardstock, designer papers, embossing folders, dies, framelits, embellishments and tools. Having a place for everything will enable efficient use of these elements, both in locating and easy clean up so I never have to enter clutter when I want to play. I addressed what wastes the most time finding: my original stamp pads, markers and re-inkers. My second concern was great storage for my new Blendabilities (TM). I wanted each color co-located, within color families, and a better than a plastic stack-able tray system for the Blendabilities(trays tumbled when I removed a color).
I drew out my ideal system, then hunted to see if anything would be available on line. Not only did Stamp-n-Storage accommodate my Brights, Subtles, Regals and Neutrals (10 of each), but also had an expanded system for the ten special In Colors active each catalog year, but also held my specialty pads: Encore Gold, Encore Silver, Memento Black, Pigment White, Pigment Vanilla, and a few black StazOn stamping pads. I have doubles of some colors besides black -- cherry cobbler, night of navy, and grass green; they also fit. I am tickled to have found the Combo 60 and the Blendabilities Tower. They both exceeded my expectations when they arrived. All surfaces are perfectly smooth, and there are no rough edges anywhere. Indeed, I got the quality and design I paid for!
combo holder
Posted by sandra on 10 09 2014
Love love it better than I could image. Great storage
Fastastic Product
Posted by Karen Campbell on 10 08 2014
Finally, I have my stamp pads, markers and refills all in one place! There are still several products I want and will order when finances allow.
Combo Holder
Posted by Unknown on 10 08 2014
Love it!!!! High quality, every thing fits well. Easy to see what you have and easy to get what you need
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i am the first son of your uncle karl. i have two sons
kenneth and karl, one grandson tyler. i live in wilmington
de. our uncle ken lives here also. please send me uncle
earls e-mail address.
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November 25, 2014
May 15, 2013
If you have a family history of cancer and are wondering what your chances are for getting the disease, there's a way to find out. In this week's Martha Jefferson Healthwise report, the hospital is now introducing a genetic testing program to help people find out that answer.
From breast cancer to colon cancer, if you have a family history of cancer, it could increase your risk.
Now Martha Jefferson Hospital is helping to determine your risk by offering genetic counseling.
"We would go through your family and your medical history really looking for any of those red flag indicators using computer programs and algorithms to help us figure out are you a good candidate for genetic testing," said Martha Thomas, Genetic Counselor, Martha Jefferson Hospital.
If you do need that testing, genetic counselor Martha Thomas says it's fairly easy. Everything you need is right inside of a prepackaged kit.
"You just draw a tube of blood and send it off to a lab. So, it's not complicated," said Thomas.
With the exception of breast cancer, most genetic testing kits will allow you to test and find out if you are predisposed to multiple types of cancer all at one time.
Thomas says it's important to go through genetic counseling if cancer runs in your family. She says it's also better to it early because your risk only increases as you get older.
"I think the genetic counseling portion is important to genetic testing because it really allows you to get informed about the testing that you're doing and it helps you answer some of those more complicated questions," said Thomas.
Having that knowledge can help you prepare for your future.
"Say you find out you're predisposed to breast cancer, there are lots of options that are available to you that can help reduce your risk for developing breast cancer," said Thomas.
Those options could end up saving your life.
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Reading Strategies Teacher Resources
Find Reading Strategies educational ideas and activities
Showing 1 - 20 of 4,183 resources
Blue Ribbon Readers: Making Connections
Model for young readers how to make the shift from passive to active reading by making text-to-self and text-to-text connections. After a series of activities that provide guided practice, the focus shifts to making text-to-words connections.
K - 5th English Language Arts CCSS: Designed
Children Making Text to Self Connections Through Reading and Their Environment
Students determine how to make connections between the stories they read to their community. In this text connection lesson, students take a mental walk through their own community before listening to Lisa Bullard's, My Neighborhood; Places and Faces.
Pre-K - K English Language Arts
Lesson Plan Aid for Book Punch- A Lion to Guard Us
Readers examine the book A Lion to Guard Us by Clyde Robert Bulla about a girl who undertakes a risky sea-journey to America to find her father in the 1600s. Writing prompts and questions guide character exploration, text-to-self connections, and vocabulary development from the text.
3rd English Language Arts
Lesson Plan Aid for Book Punch: Sarah, Plain and Tall
Lead your class through various literacy activities based on the text, Sarah, Plain and Tall. Vocabulary and characters are examined, and kids also make text-to-self connections. While the worksheets referenced in the lesson are only available from Book Punch, vocabulary lists, writing prompts, discussion questions, and reading checks are included in the lesson.
3rd English Language Arts
New Review Making Inferences
The ability to make inferences is an important skill. Provide your class with some practice. This resource includes several different passages with which learners are required to practice inferring. They read each passage and respond to the questions, noting down textual evidence when asked.
4th - 8th English Language Arts CCSS: Adaptable
Build a Connection
Learners discuss their personal connections with stories they've read in the past and identify techniques to connect with more stories. They create illustrations, construct task cards, and complete sentence stems based on books they read to develop a more intimate connection with the story.
2nd - 8th Visual & Performing Arts
Reading Strategies for Decoding Tricky Words
Help primary school pupils learn valuable reading strategies. As they choral read a poster or big book, they predict covered words and learn various reading strategies for figuring out an unknown word. This will help them gain an understanding of the alphabetic principle of associating sounds with letters in order to decode tricky words.
K - 2nd English Language Arts
Building Background Knowledge: Colonial Craftspeople
In the first lesson of this unit on colonial trade, fourth graders gain background knowledge of different jobs performed by early colonists. The class begins with a slide show presentation that includes a variety of great photographs depicting different trades in colonial America, during which learners work in small groups to take notes and make inferences about each occupation.
3rd - 5th English Language Arts CCSS: Designed
R.A.C.E. Writer's Checklist and Organizer
Young writers will surely remember this acronym while they are writing! Each letter prompts pupils to include a different aspect of a brief constructed response. The resource includes a checklist as well as a graphic organizer that learners can use to compose their responses while remembering each step of the acronym.
3rd - 8th English Language Arts
War Powers Act and the Constitution
The strength of this plan, which focuses on the War Powers Act, is in the included supplementary materials. Class members read several provided documents, take notes, and discuss their opinions and then deliberate within small groups or partnerships.
9th - 12th English Language Arts CCSS: Designed
Growing Minds: Garden Planning
School gardens are rich in cross-curricular learning opportunities! Excellent ideas put learners in charge of organizing and planning. Begin with a book about gardening (recommended titles provided), and discuss learners' prior knowledge and associations with gardening.
K - 5th Health CCSS: Designed
Text-to-Self Connections: Strengthening Reading Comprehension
You'll need to choose your own reading passages to use with this resource, but it clarifies the importance of text-to-self connections in strong reading comprehension. Anything you know that relates to a piece of writing can help illuminate it and make it relevant.
10th - 12th 21st Century Skills
A Research Toolkit of 12 Reading Strategies for the Foreign Language Classroom
Learning to read is not a simple task, but there are methods for assisting pupils as they develop literacy skills. The first four pages of this resource include information about language development and reading development, as well as various strategies with a focus on English language learners.
7 mins 1st - 12th English Language Arts
Student Opinion: How Impulsive Are You?
Sure to spark lively discussion in any Language Arts classroom, this article from The York Times asks the question, 'How much self-control do you have?'. Pupils begin by reading a short passage about a study on delayed gratification and then respond to several writing prompts designed to foster a text to self connection by asking about the reader's own experiences and opinions.
9th - 12th English Language Arts
Poems: What They Look and Sound Like
Explore the poetry genre through this two-part literature analysis. Learners focus on four forms of poetry: haiku, acrostic, rhyme, and shape. They learn defining features, make text-to-self connections, and find similar characteristics in song lyrics from Selena Gomez's "Gift of a Friend.
2nd - 3rd Visual & Performing Arts
Making Connections
Encourage your readers to make text-to-self, text-to-text, and text-to-world connections with a graphic organizer that also asks them to detail how they made these connections. Reproduce the template for each learner or project the template and ask class members to copy the organizer in their notebooks.
3rd - 10th English Language Arts


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* Win your first fight by\\
Shooting yourself in the head\\
And then it gets ''weird''.
* Fusion Accident\\
Using my top three monsters;\\
I hate you Igor!
* Death inside you, a\\
trigger to your persona.\\
Memento mori
* Social Links are the\\
worst thing to ever happen\\
Stupid dialogue
* Talk to everyone\\
Schoolwork twined with world-saving\\
Though you have one year
* Tartarus bosses\\
I have grinded for too long\\
Now die already


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Frielendorf House Rental Photos and Description
3 bedrooms, spacious living and dining area, fireplace, patio and balcony
The house offers 6 people to sleep and live, is comfortably furnished and only 80 m from the lake.
3 bedrooms (2 persons)
1 bedroom with an accrued separate toilet
Each bedroom has its own sink
Fitted kitchen with microwave and dishwasher
Spacious, comfortable living and dining area
Shower, toilet,
Terrace and balcony,
In the apartment there is a spacious living room with dining area, fireplace and TV and a well-equipped modern kitchen. Two bedrooms with double bed and a third bedroom with a single bed and washing facilities await you. Patio furniture and cluttered with the large green area for barbecues, badminton games or relaxed sunbathing.
Should they otherwise lack something - we live nearby and are happy there for them.
- Suitability:
- Events Allowed
- children welcome
- pets not allowed
- suitable for elderly or infirm
- wheelchair accessible


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SACRAMENTO . (AP) - Invoking the image of recent mass shootings, Democrats in the state Legislature on Wednesday passed a series of firearms bills designed to reduce the chances for widespread carnage even as opponents warned that the measures would not keep weapons from those intent on committing horrific crimes.
POLICE RECOMMEND MANSLAUGHTER AGAINST FATHER: PALO ALTO (AP) - Police are recommending vehicular manslaughter charges for a Northern California father whose two daughters died after he nodded off and crashed his SUV.
SAN FRANCISCO (AP) - An invasion of aggressive lice appears to be behind the balding of deer across California and may even be linked to deer deaths, according to state wildlife officials who are studying the hair loss.
ANAHEIM (AP) - Mickey Mouse is center stage again in Fantasyland.
NO INJURIES IN APPARENT DRY-ICE DISNEYLAND BLAST: ANAHEIM (AP) - Officials say what appears to be dry ice in a plastic bottle caused a small explosion at Disneyland, bringing evacuations but no reports of injuries.
FREEWAY SANDSTORM CAUSES MULTIPLE WRECKS, 6 HURT: LANCASTER (AP) - The California Highway Patrol has closed a freeway north of Los Angeles after a sandstorm in Lancaster led to several car wrecks that injured six people.
SACRAMENTO . (AP) - Women could go to a medical professional other than a doctor to end some pregnancies under a bill advancing through the state Legislature.
CALABASAS (AP) - Los Angeles County Sheriff's detectives are investigating Justin Bieber for reckless driving after witnesses, including former NFL star Keyshawn Johnson, complained.
PG&E SUED OVER NORTHERN CALIFORNIA CANAL BREAK: COLFAX, (AP) - Pacific Gas and Electric Co. has been hit by a pair of lawsuits over its handling of a canal failure two years ago that forced thousands of Placer County residents to ration water.
3 WOUNDED IN SAN FRANCISCO SHOOTING: SAN FRANCISCO (AP) - San Francisco police have arrested three people in connection with an early morning robbery attempt that left three others with gunshot wounds.
BODIES PULLED FROM WATERWAY WEST OF STOCKTON: STOCKTON (AP) - San Joaquin County Sheriff's officials are searching a waterway west of Stockton where an SUV crashed over the weekend.
SAN FRANCISCO (AP) - Wal-Mart Stores Inc. will pay $81.6 million after pleading guilty on Tuesday to criminal charges of improperly disposing of fertilizer, pesticides and other hazardous products that were pulled from stores in California and Missouri because of damaged packaging and other problems.
SANTA NELLA (AP) - American Indian veterans wearing tribal dress gathered to honor the sacrifice of their fighting men and women in an emotional ceremony at a Central California cemetery.
SANTA BARBARA (AP) - A surging wildfire forced thousands of people, most of them Memorial Day campers, to evacuate the mountains of California's Santa Barbara County, officials said.
NEWPORT BEACH (AP) - Police say five people from a single car were killed when it ran off an Orange County street, hit a tree and split into two pieces.
LOS ANGELES (AP) - A woman punched repeatedly by a California Highway Patrol officer on the side of a freeway in an incident caught on video will receive $1.5 million under a settlement, and the officer has agreed to resign.
MOUNTAIN VIEW (AP) - Authorities investigating a noxious odor that prompted evacuations in a San Francisco Bay Area city discovered two bodies inside a residence.
SACRAMENTO (AP) - The leader of the union representing state prison guards is retiring, leaving an organization that had sparred with then-governor Arnold Schwarzenegger before making peace with Gov. Jerry Brown.
SACRAMENTO (AP) - Gov. Jerry Brown has signed legislation prohibiting California state government agencies from selling or display items displaying the Confederate flag.


text:
Silverado Fire In Napa County 70% Contained, Evacuations Lifted
Evacuations due to the Silverado fire burning in Napa County have been lifted Friday evening and firefighters have the fire nearly contained, officials said.
Evacuation Lifted After Bomb Scare At Richmond Federal Building
An evacuation order at the Frank Hegel Federal Building in Richmond was lifted Friday afternoon after a suspicious package was determined to contain only flashlights and batteries, the city's fire chief said.
Richmond Tanker Crash, Gas Spill Forces Hotel Evacuation
A hotel in Richmond was evacuated Monday morning after a double tanker gas trailer overturned.
Bear Repellent Identified As Chemical That Forced SF Hotel Evacuation
Bear repellent was to blame for the evacuation of a hotel in Fisherman's Wharf and the hospitalization of three people on Monday, San Francisco police and fire officials said Tuesday.
Students Return To Residential Halls After UC Berkeley Explosion
Eleven buildings on the University of California at Berkeley campus that remained without power following an explosion Monday evening would not hold classes Tuesday, UC Berkeley officials said.
15 Sickened By Hazmat Exposure At San Francisco Wharf Hotel
A hazardous materials incident at a hotel in San Francisco's famed Fisherman's Wharf district sickened 15 people and prompted a brief evacuation Monday evening, fire officials said.
Mystery White Powder At Hayward Police Station Identified
Part of the Hayward police station has been evacuated after an employee opened an envelope that contained a mysterious white powder Wednesday morning, a Hayward fire captain said.
Cooler Weather Aids Firefight On Mt. Diablo; 45-Percent Contained
There was encouraging news for firefighting crews battling the Morgan fire Tuesday morning as there was no orange glow or plume of smoke visible on summit of Mt. Diablo.
Mount Diablo Wildfire Doubles In Size As Nearby Residents Flee
A wildfire burning in Mount Diablo State Park grew to six square miles Monday, more than doubling in size over the 24-hour period since it broke out, forcing more people to leave their homes and leading to a smoke advisory for area residents.
Rim Fire Burning In Yosemite 60 Percent Contained
The Rim Fire that has blackened more than 228,000 acres in Stanislaus National Forest is now 60 percent contained but about 4,500 residences remain threatened, Cal Fire officials reported Monday morning.


text:
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Nine weeks ago, a surprise offer persuaded Rachel Swan of Minneapolis to ignore the economic downturn and follow her heart.
She left her steady administrative gig at Capella University to become the manager at the new Pizzeria Lola in Minneapolis.
"That truly was a leap from the gut," said Swan, a restaurant lover who admits she moved to "what some consider a high-risk business. But I think there is a payoff. I really love my new job."
For the first time in three years, several national employment firms and search agencies are reporting that a rising number of employees, like Swan, are voluntarily bolting for the doors to test their fate with new employers who promise less stress, higher wages or at least a fresh start and a little fun.
After a long hibernation, employee turnover is creeping back.
"People are burned out. So they are apt to listen to new job opportunities. We have seen quite a bit of turnover lately where employers are losing their good people," said Jennifer Carlson, a division director who hires contractors for clients of the global staffing firm Robert Half International.
Workers stayed in jobs during the worst recession in 70 years, not trusting the stability of new job offers. The potential threat of being "last hired, first fired," was real.
But slowly, more accountants, managers, secretaries, software pros and financial analysts feel confident enough in the recovery to take a voluntary leap.
Many people laid off early during the recession quickly snapped up any replacement job that paid the bills.
"People took jobs that they were not thinking of as a career," said Kathy Carney, who manages the Minneapolis Workforce Center, a state-run service for job seekers. "They took it just to start working again, to feel better about themselves and to get money."
Now, more people are looking for careers -- often with a new employer.
"We have seen a dramatic increase in the number of people willing to look outside their company for jobs. In fact, March was our best month ever," said Sean Keating, founder of Oggi Professional Search, which finds accounting, finance and administrative workers for 3M, Starkey Labs, Pentair Co. and other companies in the Twin Cities area.
Each week, Keating approaches some 125 people about changing jobs. A year ago, two out of three were unreceptive. "They were just in a hunker-down mentality," he said. Today, two of three will consider a job change, and employed professionals are now calling him.
Finance and accounting workers are more receptive to phone calls about new job opportunities, said Steve Kenney, who oversees permanent placements for Robert Half. Before, turnover was frozen by workers' concerns about "the devil you know versus the devil you don't."
One survey of 1,400 workers by Right Management Inc., a recruiter based in Philadelphia, found that 84 percent planned to look for jobs in 2011, up from 60 percent last year. In a look at the reasons why workers apply for jobs elsewhere, a Robert Half survey last year found that four out of 10 workers said it was because of pay or benefit cuts.
Competition for workers is heating up. Of the 18,000 U.S. employers surveyed by Manpower Inc., 16 percent planned to add staff in the second quarter of 2011. Some 6 percent expect layoffs. In the Twin Cities, 13 percent plan to add staff while 6 percent expect layoffs.
About 13.5 million Americans remain unemployed, despite the U.S. jobless rate falling to 8.8 percent for the first time in 22 months.


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Credit Suisse to cut up to 30% of European investment banking jobs
26 June 2012
Credit Suisse is moving ahead with its plan to cut more than 3,500 jobs as it is set to shed up to 30% of senior jobs at its European investment banking department, people close to the bank said yesterday.
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jewelweedSyllabification: jew·el·weed
Definition of jewelweed in English:
Another term for touch-me-not.
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Word of the day jaunt
Pronunciation: jônt
a short excursion or journey for pleasure


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the starboard staff Come
Hello everyone, I need your help.I want to join Starboard All logos and.But I do not know how to interview for this company, tell me the e-mail address of the person in charge of Asia.There is an interview the video?
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Social media is a powerhouse of change for several areas of customer experience. In regards to marketing, the social web has provided a less expensive, more communicative alternative that's poised to replace traditional methods — billboards, TV spots, etc. — altogether. The following infographic from Voltier Digital highlights how things currently stand.
Inbound Marketing
First, a wee bit on this newer method of marketing communication. Voltier Digital says new marketing is any tactic that relies on earning people's interest instead of buying it. In other words, inbound marketing is about being "found" by the people who are already learning about and shopping in your industry, rather than marketing to the masses and hoping for the best.
"The best analogy I can come up with is that traditional marketers looking to garner interest from new potential customers are like lions hunting in the jungle for elephants," wrote Brian Halligan, founder and CEO of HubSpot. "The elephants used to be in the jungle in the '80s and '90s when they learned their trade, but they don't seem to be there anymore. They have all migrated to the watering holes on the savannah (the internet). So, rather than continuing to hunt in the jungle, I recommend setting up shop at the watering hole or turning your website into its own watering hole."
What's Not to Love?
The reason for an increase in inbound marketing is obvious: Why pay for outbound ads when consumers aren't even paying attention to them?
Here are some key stats from the infographic:
- 86% of people skip through television commercials.
- 44% of direct mail is never opened
- 84% of 25 to 34 year olds have clicked out of a website because of an "irrelevant or intrusive ad"
- 91% of e-mail users have unsubscribed from a company e-mail they previously opted to
- Inbound marketing costs 62% less per lead than traditional outbound
It's Not Easy
On the not-so-awesome side of the fence, inbound marketing takes a lot more effort to maintain. For instance, two way conversations on social platforms inevitably open the floodgates of criticism, which can be viewed publicly. Secondly, it takes a lot of time and attention. And third, the possibility of posting inappropriate content is much higher (hackers or disgruntled employees).
Still, there's no sign of slowing for inbound marketing. If you want to successfully move forward, it's time to consider increasing communication, filtering/review systems, and human resources.
Check out Voltier Digital's infographic in full below and let us know if you've got anything to add in the comments section below.
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