text: Current SurgeryCurrent Surgery RSS feed: Current Issue. http://www.journals.elsevierhealth.com/periodicals/cursur/?rss=yesElsevier Inc.en © 2006 Published by Elsevier Inc. All rights reserved. Current Surgery0149-7944636November 2006 © 2006 Published by Elsevier Inc. All rights reserved. email@example.com Boardhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00169-3/abstract?rss=yesEditorial Board10.1016/S0149-7944(06)00169-3Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2iiContentshttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00170-X/abstract?rss=yesContents10.1016/S0149-7944(06)00170-XCurrent Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2iiiiiPresidential Addresshttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00134-6/abstract?rss=yesBefore I begin, I would like to thank John Potts sincerely for that interesting introduction. But, more importantly, I thank all of the people that have helped me during my career. I would not be a surgeon if it was not for Dr. Phillip Burns, whom I first met in 1977. My grandfather was a surgeon, and when I got in to medical school, I thought I wanted to practice surgery, but like many young medical students, I was not sure. I believe that most medical students make their career decisions based on an interaction with one particular physician. The student's relationship with this mentor leads to an epiphany, and the medical student decides they want to be like "that person." For me, Phillip Burns was "that person."Presidential AddressJoseph B. Cofer10.1016/j.cursur.2006.08.006Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting361366Does Academic Intervention Impact ABS Qualifying Examination Results?http://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00087-0/abstract?rss=yesObjectives: To assess the impact of a focused academic support program on American Board of Surgery In-Training Examination (ABSITE) scores and Qualifying Examination (QE) outcomes.Methods: A mandatory intervention program was begun in April 2001 for residents with ABSITE Total Test (TT) percentiles <31. Program elements included: 1) individual faculty mentoring and personal learning plan 2) QE videotape review sessions 3) Surgical Education and Self-Assessment Program (SESAP) 4) monthly rotation evaluations, and 5) quarterly status feedback. A free medical evaluation was offered. Mock orals participation, educational psychologist consultation, and voluntary followup mentoring were added later. Study data were reviewed for 2003-2005 Chief Residents including ABSITE scores, QE results, conference attendance, rotation Overall Performance ratings, and resident surgeon case volumes. Results were compared for the academic intervention (AI) and no intervention (NI) groups.Results: Fifteen residents graduated during the study period. Eight residents completed nine interventions; seven returned to TT percentiles >30 (7/8, 88%). First post-intervention ABSITE gains were large compared to NI and national peer groups. Standard Score (SS) TT gains were maintained until residency completion by four AI residents. Median AI PGY-5 TT percentile was 32 and three scores were ≤25. Six AI residents (6/8, 75%) and all NI residents (7/7, 100%) passed the QE on their first attempts. AI and NI groups were similar for conference attendance, rotation evaluations, and operative log totals.Conclusions: A focused academic support intervention for residents with marginal ABSITE TT percentiles can produce immediate substantial gains. Gains are variably maintained through remaining residency years. PGY-5 TT percentiles ≤25, seen with three AI residents (3/8, 38%), are associated with a 40% first QE failure rate. Therefore, our 75% QE first-time pass rate for AI residents argues for intervention success.Does Academic Intervention Impact ABS Qualifying Examination Results?Karen R. Borman10.1016/j.cursur.2006.06.007Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting367372Forty Years in the Saddle: Lessons Learned as Program Director in One Program for Forty Yearshttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00078-X/abstract?rss=yesAbout 100 years ago, the well-known saying "If you don't know history, you are doomed to repeat it" was coined by George Santayana (1863-1952), Spanish-born American philosopher and poet. Also attributed to Santayana is the lesser known saying that the first sign of the downfall of a civilization is when people start calling things by different names. If this statement is really true, there may be cause for concern as doctors have become health-care providers, nurses have become full-time equivalents, and hospitals have become health-care institutions. In the context of Santayana's historical dictum, my experience during 4 decades as a Surgery Program Director might be interesting to my counterparts in the Association of Program Directors in Surgery (APDS).Forty Years in the Saddle: Lessons Learned as Program Director in One Program for Forty YearsAllen Silbergleit10.1016/j.cursur.2006.05.008Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting373384General Surgery Morning Report: A Competency-Based Conference that Enhances Patient Care and Resident Educationhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00084-5/abstract?rss=yesPurpose: After adopting a night float system, the residency program at the University of Virginia Health System Department of Surgery initiated a daily morning report (MR). The conference was originated to sign out new admissions and consults from the previous day to the services that would assume care. Although initially oriented toward transfer of patient information, MR is also hypothesized to serve as a competency-based resident education tool.Methods: An anonymous survey was distributed to on-service residents (n = 25). Questions were asked on a 5-point Likert scale. Respondents also ranked the weekly conferences, including MR, in terms of educational benefit derived.Results: Most residents agreed that MR is an efficient method to sign-out patient care [84% stongly agree (SA) or agree (A)] and that it provides an excellent educational experience (88% SA or A). They agreed that it is presented in an evidence-based format (88% SA or A). Regarding the core competencies, residents all asserted that MR addresses "patient care" (100% SA or A) and "medical knowledge" (100% SA or A). Most agreed that it addresses "professionalism" (60% SA or A), "interpersonal skills and communication" (76% SA or A), and "practice-based learning and improvement" (92% SA or A). The 4 most important components identified with respect to continuing to improve both patient care and resident education were the presence of the on-call attending, a review of relevant radiology, provision of follow-up on select cases, and critical review of the literature. On average, MR was seen as the most educational conference, with 52% of residents ranking it first.Conclusions: Although MR is ubiquitous in most primary care residency programs, such a conference has not typically been held on surgical services. The MR was developed at the University of Virginia Health System Department of Surgery as a necessity for patient sign-out. As this conference has continued to evolve, it has become an excellent tool for resident education. It now serves the purpose of enhancing patient care and medical education and of providing evidence of learning and assessment of the general competencies. The MR provides an example for program directors of how to tailor existing resident work sessions or conferences to meet Accreditation Council for Graduate Medical Education (ACGME) competency requirements.General Surgery Morning Report: A Competency-Based Conference that Enhances Patient Care and Resident EducationBrendon M. Stiles, T. Brett Reece, Traci L. Hedrick, Robert A. Garwood, Michael G. Hughes, Joseph J. Dubose, Reid B. Adams, Bruce D. Schirmer, Hilary A. Sanfey, Robert G. Sawyer10.1016/j.cursur.2006.06.005Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting385390Is it Appropriate to Use Core Clerkship Grades in the Selection of Residents?http://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00116-4/abstract?rss=yesObjective: This study challenges the appropriateness of using core clerkship grades for resident selection. The authors hypothesize that substantial variability occurred in the system of grading.Design: In this retrospective cross-sectional study, variability in the grading systems for third-year core clinical clerkships were examined. From the Medical Student Performance Evaluation of applicants from U.S. medical schools for residency training in the authors' department in 2004 and 2005, the authors gathered the following variables: medical school, third-year core clerkship grading systems, and percentage of students in each grade category. Descriptive analyses were conducted and within institution variability across clerkship scores was analyzed using repeated measure analysis of variance (ANOVA) and t-test.Setting: University teaching hospital.Participants: The survey covered 121 of 122 U.S. medical schools accredited by the AAMC/LCME.Results: Grading systems used included: variations of Honors/Pass/Fail (H,P,F) system in 76 schools, letter grade systems in 22 schools, and other variants (eg, Outstanding, Advanced, and Proficient in 6 schools and Pass/Fail in 4 schools). Thirteen schools (10%) provided either no grading system or no interpretable system. Grading systems included were further defined into 2 scores in 6 schools, 3 in 34 schools, 4 in 38 schools, 5 in 23 schools, and more than 6 in 6 schools. For schools using a grading system containing 3 or more scores, the percentage of students given the highest grade was significantly less in Surgery (28%) compared with Family Medicine (34%) and Psychiatry (35%) (p = 0.001).Conclusions: Core clerkship grading systems and the percentage to which institutions grade students as having achieved the highest performance level vary greatly among U.S. medical schools. Within institutions, significant variability exists among clerkships in the percentage of the highest grade given, which makes interpersonal comparison based on core clerkship grades difficult and suggests that this method may not be a reliable indicator of performance.Is it Appropriate to Use Core Clerkship Grades in the Selection of Residents?Hiroo Takayama, Rebecca Grinsell, Douglas Brock, Hugh Foy, Carlos Pellegrini, Karen Horvath10.1016/j.cursur.2006.06.012Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting391396Medical Student Entry into General Surgery Increases with Early Exposure to Surgery and to Surgeonshttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00081-X/abstract?rss=yesNationally, student interest in pursuit of a general surgery residency steadily dropped from the early 1980s through the first part of this decade. General surgery was the first-choice residency for 10.7% of U.S. senior medical students in 1984, but only 4.7% in 2002. This diminishing interest finally manifested itself in the National Resident Matching Program in 2001, when 68 (6.5%) general surgery residency positions went unfilled. In 2002, U.S. graduates comprised less than 80% of all matched applicants for the first time and 58 (5.5%) positions were unfilled. Analysis of these data led to projections of further declines in the number and quality of U.S. students matching to general surgery residencies, with serious implications for the nation. Published data suggest that, given an aging population, the United States will face an absolute shortage of general surgeons as soon as 2010, with difficulty in attracting and retaining surgeons in some regions of the country already apparent.Medical Student Entry into General Surgery Increases with Early Exposure to Surgery and to SurgeonsJohn C. Kirkham, Warren D. Widmann, Doris Leddy, Michael J. Goldstein, Benjamin Samstein, Mahmoud El-Tamer, Avital Harari, Tracey D. Arnell, Rena John, Mark A. Hardy10.1016/j.cursur.2006.05.005Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting397400Missed Opportunities: A Descriptive Assessment of Teaching and Attitudes Regarding Communication Skills in a Surgical Residencyhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00120-6/abstract?rss=yesBackground: The Accreditation Council for Graduate Medical Education (ACGME) requires that "residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients' families, and professional associates." The authors sought to assess current methods of teaching and attitudes regarding communication skills in their surgical residency.Methods: After obtaining Institutional Review Board (IRB) exemption, voluntary anonymous surveys were completed by a sample of convenience at the Vanderbilt University Medical Center: surgical residents at Grand Rounds and attending surgeons in a faculty meeting. Data were evaluated from 49 respondents (33 of 75 total surgical residents, 16 representative attending surgeons).Results: One hundred percent of respondents rated the importance of communication to the successful care of patients as "4" or "5" of 5. Direct attending observation of residents communicating with patients/families was confirmed by residents and faculty.Residents reported varying levels of comfort with different types of conversations. Residents were "comfortable" or "very comfortable" as follows: obtaining informed consent, 91%; reporting operative findings, 64%; delivering bad news, 61%; conducting a family conference, 40%; discussing do not resuscitate (DNR) orders, 36%; and discussing transition to comfort care, 24%.Resident receptiveness to communication skills education varied with proposed venues: 84% favored teaching in the course of routine clinical care, 52% via online resources, and 46% in workshops.Residents were asked how frequently they received feedback specific to their communication skills during the past 6 months: Most residents reported 0 (39%) or 1 (21%) feedback episode. Only 30% of resident respondents reported receiving feedback that they perceived helpful.Attending surgeons reported that they did provide residents feedback specific to their communication skills. When asked to estimate the number of feedback episodes in the last 6 months, 16 faculty members reported a total of 67 feedback episodes, whereas 33 residents reported a total of only 24 episodes.Most faculty members rated their comfort with providing feedback specific to communication skills as "very comfortable" (56%) or "comfortable" (19%). "Time constraints" was the most frequently cited barrier to teaching communication skills.Conclusions: Communication skills are valued as integral to patient care by both residents and faculty in this study. Residents are most receptive to teaching of communication skills in the clinical setting. Faculty members report they are providing feedback to residents. Although residents report direct observation by faculty, currently only a minority (30%) are receiving feedback regarding communication that they consider helpful. A need exists to facilitate the feedback process to resolve this discrepancy. The authors propose that an evaluation instrument regarding communication skills may strengthen the feedback process.Missed Opportunities: A Descriptive Assessment of Teaching and Attitudes Regarding Communication Skills in a Surgical ResidencyOlivia A. Hutul, Robert O. Carpenter, John L. Tarpley, Kimberly D. Lomis10.1016/j.cursur.2006.06.016Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting401409A PGY1 Curriculum—Meeting a Need for Changing Timeshttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00085-7/abstract?rss=yesA systematic process is described that produced a PGY1 curriculum for the surgical residents at Medical College of Wisconsin. The process involved faculty and residents. Topics were selected based on the six general competencies. Objectives were developed for all topics. The curriculum was delivered to the residents while they were off clinical duty. This Protected Block Curriculum approach was chosen to facilitate the learning structure of the curriculum. Feedback was positive, learning objectives appeared to be achieved and the plan is to continue to develop the PGY1 curriculum in the same format.A PGY1 Curriculum—Meeting a Need for Changing TimesJohn A. Weigelt, Deborah E. Simpson, Rebecca C. Anderson, Karen J. Brasel, Philip N. Redlich10.1016/j.cursur.2006.06.004Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting410417Patterns and Predictions of Resident Misbehavior—A 10-Year Retrospective Lookhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00068-7/abstract?rss=yesBackground: Surgical educators are charged with ensuring that their trainees conduct themselves in a professional manner. The authors retrospectively reviewed a 10-year experience of incident reports on surgical housestaff to determine patterns and predictors of behavior.Methods: A retrospective review of all letters, e-mails, and incident reports was conducted for general surgery residents from 1995 to 2005. Descriptive variables were selected for binary categorization (not mutually exclusive): poor professional conduct, protocol violation, administrative deficiency, verbal mistreatment, physical boundary issues, mistreatment of superiors, and deficient medical student interaction. Resident status was defined as current, graduate, and attrition.Results: Of 110 residents {90 [82%] categorical, 23 [21%] undesignated preliminary (3 overlapped both groups); 87 [79%] male, 23 [21%] female} who trained at the University of Pennsylvania during this period, 66 complaints were generated about 29 individuals. Overall, 50 of the 66 complaints (76%) were directed toward men and the remaining 16 (24%) toward women; 24% of all men and 35% of all women received 1 or more complaints. A total of 76% of complaints concerned categorical residents and 24% undesignated preliminary residents. And 26% of all categorical residents and 26% of all preliminary residents received at least 1 complaint. The most common complaints concerned professional conduct (83%), protocol violation (33%), verbal mistreatment (23%), deficiencies of administrative duties (8%), violations of physical boundaries (5%), deficient medical student interaction (5%), and mistreatment of attendings by residents (3%). Recipients of verbal mistreatment included staff nurses (27%), radiology technicians (13%), medical students (13%), environmental services employees (7%), security guards (7%), patients (7%), surgery attendings (7%), anesthesia attendings (7%), internal medicine chief residents (7%), and pharmacists (7%). A total of 31% of the complaints were regarding residents who involuntarily departed and 7% regarding residents who left voluntarily before completion. The mean PGY level at first complaint was 2.2 years. Of the 29 residents receiving complaints, 16 had recurrent offenses (range 2 to 7 total complaints, positive predictive value [PPV] 53%).Conclusion: Resident misbehavior manifests early and recurs often. Furthermore, it is frequently directed toward perceived subordinates. Nondesignated preliminary status, premature departure from the program, and the eventual selection of specific subspecialty fellowships seems to increase the risk for resident misbehavior. Identified residents require close surveillance and remediation.Patterns and Predictions of Resident Misbehavior—A 10-Year Retrospective LookAndrew S. Resnick, James L. Mullen, Larry R. Kaiser, Jon B. Morris10.1016/j.cursur.2006.05.004Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting418425Stimulating Resident Research in a General Surgery Residency Community Programhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00048-1/abstract?rss=yesObjective: Resident research teams were established at this community hospital in the 1997 academic year. Research productivity, including publications and presentations in the years before establishing research teams and the 8 years subsequent to establishment of research teams with faculty mentors, was reviewed.Methods: Each team is supported by a research specialist who provides assistance with project design, data evaluation, statistical analysis, manuscript editing, and preparation of research presentations. Every resident is assigned to a research team that meets monthly. The teams consist of a 4th- or 5th-year resident, 2nd- or 3rd-year resident, surgical intern, research team mentor, and research specialist. The resident is required to be an active contributing co-investigator on 1 team project per year, contributing to the development and performance of the study, participating in writing the manuscript, and must be able to defend the study. By the end of the third year, the resident is required to complete 1 individual project that is submitted to the postgraduate competition for residents. In addition, a completed manuscript must be ready to submit to a peer-reviewed journal. Promotion can be denied if the appropriate time has not been devoted to research. Minimum completion requirements include a case report and a presentation at a national or regional meeting. The research registry was reviewed for all presentations and publications given by the surgical residents during the 8 years before the teams were established and the 8 years after the teams were formed.Results: In the 8 years before the establishment of research teams, 60 papers were published. After the establishment of research teams, 77 papers were published. During the 8 years before research teams were being established, 69 presentations were given. During the subsequent 8 years with the use of mentoring and research teams, 92 presentations were given. The research teams resulted in a 33% increase in presentations and a 13% increase in publications.Conclusions: Establishment of research teams and mentoring can help stimulate research interest and activity. Continuity on research teams throughout the 5-year residency is also crucial for the progression and development, duration, and completion of projects. Continuity of the mentor and research specialists also helps facilitate productivity and completion of the task. This method has been highly successful in improving the research presentations and publications in a community-based hospital residency.Stimulating Resident Research in a General Surgery Residency Community ProgramJoann Lohr, J. Michael Smith, Richard Welling, Amy Engel, Kim Hasselfeld, Joy Rusche10.1016/j.cursur.2006.04.011Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting426434The 80-Hour Resident Workweek Does Not Adversely Affect Patient Outcomes or Resident Educationhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00037-7/abstract?rss=yesPurpose: To determine whether the 80-hour resident workweek adversely affects patient outcomes or resident education.Methods: To assess patient outcomes, the authors reviewed trauma patient morbidity and mortality at the second busiest level I trauma center in Los Angeles County before (July 1998-June 2003, Period 1) and after (July 2003-June 2005, Period 2) implementation of the duty hour limitation via a retrospective review of a prospective database. All patients were operated and managed by residents under faculty supervision. Patient characteristics included the injury severity score (ISS), mechanism of injury, complications, and death. To assess resident education, the authors compared ABSITE percentile scores, first-time pass rates on the American Board of Surgery Qualifying and Certifying Examinations, and total and chief resident operative case volumes. In addition, they estimated institutional costs incurred to comply with the new duty hour rules.Results: Patient outcomes. Over the entire 7-year study period, 11,518 trauma patients were transported to Harbor-UCLA Medical Center. Compared with Period 1, Period 2 experienced an increase in average yearly patient volume from 1510 to 1981 (p 0.01). The average ISS also increased, from 7.9 to 9.6 (p < 0.0001), as did the proportion of penetrating trauma from 14.8% to 17.6% (p < 0.0001). Morbidity and mortality rates remained unchanged. Resident education. Mean ABSITE scores and first-time Qualifying and Certifying Exam pass rates were unchanged. Mean resident total major case volumes increased significantly in Period 2 from 831 to 1156 (p < 0.0001), whereas chief resident year case volumes were unchanged. The estimated cost incurred by this institution to conform to the new work hour standards was approximately $359,000 per year.Conclusions: Despite concerns that the 80-hour workweek might threaten patient care and resident education, the morbidity and mortality rates at a busy level I trauma center remained unchanged. The quality of surgical resident education, as measured by operative volumes, ABSITE scores, and written and oral board examination pass rates were likewise unchanged. The reorganization of the authors' general surgery residency program to comply with the duty hour restrictions was achieved within reasonable cost.The 80-Hour Resident Workweek Does Not Adversely Affect Patient Outcomes or Resident EducationChristian de Virgilio, Arezou Yaghoubian, Roger J. Lewis, Bruce E. Stabile, Brant A. Putnam10.1016/j.cursur.2006.03.006Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting435439"What's So Special about an 80-Hour Work Week?"http://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00079-1/abstract?rss=yesde Virgilio and his colleagues from Harbor-UCLA Medical Center offer evidence that the impact of current duty hour restrictions is overall positive. Operative cases increased, ABSITE scores were unchanged, morbidity and mortality remained level, and the addition of physician extenders to handle the manpower reduction was accomplished at a nominal cost. The patients reviewed were trauma admissions and cases. I wonder if the same results would remain true if elective surgical cases were examined. This manuscript, however, raises basic questions regarding surgical training that cannot be addressed by a time clock."What's So Special about an 80-Hour Work Week?"Richard M. Bell10.1016/j.cursur.2006.05.007Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting440440The Electronic Journal Club: An Asynchronous Problem-Based Learning Technique Within Work-Hour Constraintshttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00128-0/abstract?rss=yesJournal clubs are a frequent component of a surgery residency's educational compendium. A survey of 278 members of the Association of Program Directors in Surgery, with an 81% response rate, published in 2001, identified 65% of programs as using this format. Most programs were held in the late afternoon or early evening on the central campus, with 3 to 6 articles reviewed, but without a formal format. Only 1 in 5 had some assessment or evaluation of the activity.The Electronic Journal Club: An Asynchronous Problem-Based Learning Technique Within Work-Hour ConstraintsJeffrey Hammond, Thomas Whalen10.1016/j.cursur.2006.07.003Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting441443The Surgical Learning and Instructional Portfolio (SLIP) as a Self-Assessment Educational Tool Demonstrating Practice-Based Learninghttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00040-7/abstract?rss=yesPurpose: Time constraints on the teaching and evaluation of residents continue to alter the way in which medical knowledge must be imparted and assessed. Lifelong learning is a component of the practice-based learning competency. A portfolio is one way to assess practice-based learning, but its use is unfamiliar to most surgical programs. The authors describe the evolution of the Surgical Learning and Instructional Portfolio (SLIP) into a worthwhile educational tool.Methods: In March 2001, the authors began a program to encourage residents to develop a case-based portfolio to document their experience and demonstrate acquisition of knowledge in caring for a variety of surgical diseases. The monthly case topic was chosen by the resident and reported using a template: case history, supporting diagnostic studies, differential diagnosis, final diagnosis with ICD-9 coding, management options, treatment used, 3 lessons learned, embellishment of 1 lesson, and 2 articles supporting the experience. Initially, cases were submitted to the program coordinator and reviewed every 6 months with a faculty advisor to provide feedback.Results: After the first 18 months of this program, resident compliance was less than 50%, satisfaction was low, and formal review did not occur. In July 2004, a single faculty member became responsible for evaluating and providing feedback on the monthly SLIPs. The assignments were handled electronically with feedback delivered within the month via e-mail. SLIP quality as measured by resident compliance and satisfaction improved.Conclusion: These SLIPs have matured into a valuable educational tool satisfying multiple ACGME competencies. This portfolio system required direct faculty feedback to become successful.The Surgical Learning and Instructional Portfolio (SLIP) as a Self-Assessment Educational Tool Demonstrating Practice-Based LearningTravis P. Webb, Charles Aprahamian, John A. Weigelt, Karen J. Brasel10.1016/j.cursur.2006.04.001Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting444447Work Hours Restrictions as an Ethical Dilemma for Residents: A Descriptive Survey of Violation Types and Frequencyhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00086-9/abstract?rss=yesBackground: The Accreditation Council for Graduate Medical Education (ACGME) implemented requirements regarding allowable duty hours for resident training in the United States in July 2003. In a previous pilot study at Vanderbilt University Medical Center, a significant number of residents reported violation of requirements. In addition, almost half of those individuals admitted under-reporting their hours worked. The authors' goal was to further delineate the type and frequency of violations and under-reporting.Methods: A survey tool was designed to assess specific types of violations as well as factors that influence the number of hours residents worked and reported. Approval was obtained from the Vanderbilt Institutional Review Board and Office of Graduate Medical Education before enrollment of subjects. The program directors of Pediatrics, Internal Medicine, Medicine-Pediatrics, and General Surgery supported the participation of their residents. A voluntary anonymous survey of these residents was conducted 1 year after the pilot study.Results: Of 263 eligible residents, 175 were surveyed. Of 175 residents, 125 (71%) residents responded. Eighty-five percent of residents reported violation of duty-hour requirements within the preceding 3 months. Residents reported violation of specific requirements as follows: 1 day off in 7, 28%; 80-hour weekly average, 65%; and "24+6" consecutive hours, 85%. Residents were asked to estimate the number of hours by which they exceeded requirements. Hours over the 80-hour weekly requirement were reported as follows: 1 hour, 12%; 2 hours, 15%; 3 hours, 21%; 4 hours, 5%; 5 hours, 14%; and 6 or more hours, 33%. Hours over the "24+6" requirement were reported as follows: 1 hour, 30%; 2 hours, 42%; 3 hours, 18%; 4 hours, 7%; 5 hours, 1%; and 6 or more hours, 2%.Forty-eight percent of respondents admitted under-reporting violations to their program director.Conclusions: Eighty-five percent of residents reported at least 1 violation, and 48% admitted under-reporting violations. These results support the previous findings of 80% and 49%, respectively. Of the various requirements, the "24+6" rule was most frequently violated. Of those in violation of the "24+6" requirement, the majority (90%) exceeded limits by no more than 3 hours. Of those in violation of the 80-hour weekly average requirement, the majority (57%) exceeded limits by no more than 5 hours. Per the ACGME website, "an RRC may grant exceptions for up to 10% of the 80-hour limit, to individual programs based on a sound educational rationale." Although the overall percent of residents reporting violation remains high, the number of excess hours worked is small relative to established standards (within 10%). The authors propose that systems adaptations could be developed to improve compliance. Special attention is warranted to investigate the activities of residents in the post-call period.Work Hours Restrictions as an Ethical Dilemma for Residents: A Descriptive Survey of Violation Types and FrequencyRobert O. Carpenter, John Spooner, Patrick G. Arbogast, John L. Tarpley, Marie R. Griffin, Kimberly D. Lomis10.1016/j.cursur.2006.06.003Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-22006 APDS Spring Meeting448455http://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00127-9/abstract?rss=yesGenomic Medicine is a text that explores the expansive topic of genomics and how it relates to clinical practice. It is a collection of key articles that were initially published in the New England Journal of Medicine as a series from November 2002 through September 2003. The intent of the series and subsequently the textbook is to demonstrate how the practice of medicine and the understanding of disease processes have advanced through the field of genetics and genomics.Daniel R. Baillie10.1016/j.cursur.2006.07.002Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2Book Reviews456456http://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00118-8/abstract?rss=yesAs a practicing adult cardiothoracic surgeon with over 25 years of experience in the operating room, I was eager to delve into this textbook of surgical anatomy. The stated goal of the authors is to meet the "need for more detailed understanding of the basic anatomy" of the heart. In this third edition, they have added a chapter on cardiac valvular anatomy and have expanded the treatment of abnormal coronary vascular anatomy, while adding more illustrations. Their work has paid dividends, making this a most complete text.Terrill E. Theman10.1016/j.cursur.2006.06.015Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2Book Reviews456457Electrosurgeryhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00119-X/abstract?rss=yesElectrosurgical units (ESUs) are the most common piece of electrical equipment in the operating room. The constant presence of the ESU in the operating room increases the potential for patient injury. However, positive patient outcomes can be successfully achieved through good medical and nursing practice. To prevent injuries related to the use of an ESU, the surgeon and perioperative nurse must understand the fundamentals of electricity, the types of ESUs available, their potential complications, and have a working knowledge of safe practices for the use of this technology in the perioperative setting. Informed surgeons, nurses, and staff are the patient's best advocate.ElectrosurgeryChristopher M. Jones, Ketsia B. Pierre, Ian B. Nicoud, Steven C. Stain, Willie V. Melvin10.1016/j.cursur.2006.06.017Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2Original Reports458463When Should We Order a CT Scan and When Should We Rely on the Results to Diagnose an Acute Appendicitis?http://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00115-2/abstract?rss=yesObjective: The objective of this study was to retrospectively analyze the last 100 consecutive emergency appendectomies performed in the authors' institution, which is a community-based teaching hospital, and look at the accuracy of the CT scan in the diagnosis of acute appendicitis.Design: Retrospective clinical study.Setting: A 600-bed community-based teaching hospital.Methods: The last 100 consecutive emergency appendectomies, which were performed at New York Methodist Hospital in 2004, were retrospectively analyzed. The collected data included the demographics of the patients, relevant history, physical examination, laboratory and radiological tests, and pathology results.The statistical analyses were performed using the JMP version 3.2 software (SAS Institute Inc., Cary, North Carolina). An alpha value of 0.05 was used in all statistical analyses, and p values were considered as being statistically significant at or below the alpha value of 0.05.Results: There was no statistically significant correlation between the acute appendicitis and some of the typical presenting symptoms and signs of acute appendicitis (rebound tenderness, low-grade fever, elevated white blood cell count, and anorexia).The sensitivity, specificity, positive predictive value, and negative predictive value of the CT scan in this retrospective analysis were 96%, 75%, 98.5%, and 50%, respectively, with an overall efficiency of 95%. However, the sensitivity, specificity, positive predictive value, and negative predictive value of the CT scan increased after reevaluation of the false-positive, false-negative, and inconclusive CT results by an experienced radiologist in a blind fashion (97%, 100%, 100%, and 71%, respectively). The correlation between the CT scan and the pathology result was statistically significant when the CT result was positive or negative (p = 0.0001).Conclusion: The CT scan is indicated when the clinical presentation is equivocal, and it will be helpful if the result is positive or interpreted as negative only by an experienced radiology attending.When Should We Order a CT Scan and When Should We Rely on the Results to Diagnose an Acute Appendicitis?Adil Ceydeli, Simon Lavotshkin, Jack Yu, Leslie Wise10.1016/j.cursur.2006.06.008Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2Original Reports464468Solid-Pseudopapillary Tumors of the Pancreas: Case Report and Literature Reviewhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00088-2/abstract?rss=yesSolid pseudopapillary tumors (SPT) of the pancreas are rare neoplasms of low malignant potential that mostly affect young women. These tumors are of unclear pathogenesis, are slow growing, and can become considerably large before causing symptoms. Complete resection is curative in most cases. This is the case of a 39-year-old African-American woman undergoing evaluation for Roux-en-Y gastric bypass, who was found to have a pancreatic mass. Image-guided biopsy revealed SPT. The patient underwent complete excision of the tumor and had an open Roux-en-Y gastric bypass performed concurrently. The patient had an uneventful postoperative course. A review of the literature is presented.Solid-Pseudopapillary Tumors of the Pancreas: Case Report and Literature ReviewWesley P. Francis, Etai Goldenberg, N. Volkan Adsay, Christopher P. Steffes, John D. Webber10.1016/j.cursur.2006.06.010Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2Case Reports469472General Surgery Resident Applicants Perception of Program Coordinatorshttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00161-9/abstract?rss=yesApplicants to general surgery residency programs have different perceptions regarding program coordinators and their role in the recruitment process. Although some applicants may know the surgery department chair or other faculty members because of their national/international standing, the first person the applicant usually interacts with is the program coordinator. As such, the program coordinator is the ambassador for the program, department, and institution and will be the one to make the first and lasting impression on the applicant.General Surgery Resident Applicants Perception of Program CoordinatorsRuth Nawotniak, Ellie Gray10.1016/j.cursur.2006.08.010Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2Program Coordinator's Corner473475The Legacy of Sir Henry Souttar: Pioneer of the First Mitral Valvulotomyhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00121-8/abstract?rss=yesSir Henry Souttar () was a versatile and daring British surgeon who made numerous surgical contributions. His distinguished career would have been legendary even if he had not performed one of the most inventive operations of his time: open mitral valvulotomy on a 15-year-old girl with tight mitral stenosis (MS) in 1925. It was the first transauricular approach to the valve, the first intracardiac manipulation of the living heart by the human hand, and the first successful intracardiac operation on record. It challenged the prevailing taboos and foreshadowed a new era of open-heart surgery. Yet for many years, the success remained shrouded with uncertainty. Questions surfaced. Did the patient actually improve clinically? Did the patient survive? Why did Souttar not repeat the surgery? Why did 3 decades elapse before the mitral valve surgery became routine?The Legacy of Sir Henry Souttar: Pioneer of the First Mitral ValvulotomyGeorge M. Comas, Warren D. Widmann, Mark A. Hardy10.1016/j.cursur.2006.07.001Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2History476481Deck of Cardshttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00126-7/abstract?rss=yes"Wanna watch me shuffle?" After registering our smiling anticipation, Jay performed an elaborate shuffle that culminated in a reunion of the 2 sets of cards high above his head.Deck of CardsRiley Bove10.1016/j.cursur.2006.07.004Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2Reflections482482Author indexhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00165-6/abstract?rss=yesAuthor index10.1016/S0149-7944(06)00165-6Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2Author and Subject Index for Volume 63, 2006483484Subject indexhttp://www.journals.elsevierhealth.com/periodicals/cursur/article/S0149-7944(06)00166-8/abstract?rss=yesSubject index10.1016/S0149-7944(06)00166-8Current Surgery 63, 6 (2006)2006-11-01Current Surgery2006-11-01636S0149-7944(06)X0061-2Author and Subject Index for Volume 63, 2006485489


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Before using antibodies to detect proteins that have been dotted or transferred to a membrane, the remaining binding surface must be blocked to prevent the nonspecific binding of the antibodies. Otherwise, the antibodies or other detection reagents will bind to any remaining sites that initially served to immobilize the proteins of interest. In principle, any protein that does not have binding affinity for the target or probe components in the assay can be used for blocking. In practice, however, certain proteins perform better than others because they bind to the membrane or other immobilization surface more consistently or because they somehow stabilize the function of other system components. In fact, no single protein or mixture of proteins works best for all Western blot experiments, and empirical testing is necessary to obtain the best possible results for a given combination of specific antibodies, membrane type and substrate system.
Learn more...
Overview of Western blotting
Before using antibodies to detect proteins that have been dotted or transferred to a membrane, the remaining binding surface must be blocked to prevent the nonspecific binding of the antibodies. Otherwise, the antibodies or other detection reagents will bind to any remaining sites that initially served to immobilize the proteins of interest.
The membrane supports used in Western blotting have a high affinity for proteins.
Therefore, after the transfer of the proteins from the gel, it is important to block the remaining
surface of the membrane to prevent nonspecific binding of the detection antibodies during subsequent steps. A variety of blocking buffers ranging from milk or normal serum to highly purified
proteins have been used to block free sites on a membrane. The blocking buffer should improve the
sensitivity of the assay by reducing background interference and improving the signal to noise ratio.
The ideal blocking buffer will bind to all potential sites of nonspecific interaction, eliminating
background altogether without altering or obscuring the epitope for antibody binding.
The proper
choice of blocker for a given blot depends on the antigen itself and on the type of detection label
used. For example, in applications where alkaline phosphatase conjugates are used, a blocking
buffer in TBS should be selected because PBS interferes with alkaline phosphatase. For true optimization of the blocking step for a particular immunoassay, empirical
testing is essential. Many factors, including various protein:protein interactions unique to a given
set of immunoassay reagents, can influence nonspecific binding. The most important parameter when
selecting a blocker is the signal:noise ratio, measured as the signal obtained with a sample containing
the target analyte, as compared to that obtained with a sample without the target analyte. Using
inadequate amounts of blocker will result in excessive background staining and a reduced signal:noise
ratio. Using excessive concentrations of blocker may mask antibody:antigen interactions or inhibit
the marker enzyme, again causing a reduction of the signal:noise ratio. When developing any new
immunoassay, it is important to test several different blockers for the highest signal:noise ratio
in the assay. No single blocking agent is ideal for every occasion since each antibody-antigen pair
has unique characteristics.
Download documents...
Tech Tip #22: Determine source of nonspecific background signal in chemiluminescent Western blots
Tech Tip #24: Optimize antigen and antibody concentrations for Western blots
Tech Tip #32: Guide to enzyme substrates for Western blotting
Tech Tip #67: Chemiluminescent Western blotting technical guide and protocols
The accompanying figure illustrates the value of testing different blocking buffers as part of a Western blotting optimization experiment. In this example experiment, in which all other conditions were equal, different blocking buffers quenched or enhanced the sensitivity and specificity of the Western blot for individual proteins. In other cases, one blocking buffer or another might cause speckling or high background.
Related literature...
Western Blot Handbook
View products...
Blocking Buffers for Protein Methods


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"My husband and I loved this! We eat a lot of Mexican food. I made 2 small changes-I used chuck instead of round (I just like the flavor better) and I substituted New Mexican red chiles for half the anchos. It was soupy but I served it on polenta which made the broth creamy goodness! I will definitely make this again.""


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After being committed for 17 years, Michael Myers, now a grown man and still very dangerous, escapes from the mental institution and returns to Haddonfield, where he wants to find his baby sister, Laurie. Anyone who crosses his path is in mortal danger.
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Getting two interceptions from Justin Sanchez '17 (#3, photo lower left), the final one with 1:07 left which he returned 18 yards to the Amherst 38-yard line, Wesleyan outlasted host Amherst, 20-14, to secure its first victory over its Little Three rival since 2002, and set up an opportunity for its first outright Little Three title since 1970 when Williams comes to Middletown Sat., Nov. 2. Before that, however, the Cardinals will look to stay undefeated when they travel to Bowdoin Sat., Oct. 26.
At Amherst, the Lord Jeffs drove 82 yards with the opening kickoff to go ahead, 7-0, at 11:02 of the first quarter, but the Wesleyan defense, with the help of Sanchez's first interception at 7:49 of the third period after Amherst reached the Wesleyan 34, along with a first-quarter Devon Carrillo '17 pickoff in the endzone to stiffle another Amherst drive and a blocked field goal by Donnie Cimino '15 in the second period, kept Amherst off the board for more than 50 minutes. In the meantime, the Cardinals racked up four scoring drives to move out to a 20-7 lead early in the fourth quarter, and got some outstanding defense along the way to come away with the victory. Sanchez, who also had a team-high seven tackles on the day, was named NESCAC Defensive Player of the Week.
Kevin Hughes '14 caught five of Jesse Warren's '15 14 completions on the day, including a key 42-yard TD at 13:47 of the fourth period, which proved to be the deciding points. Hughes caught the ball just inside the Amherst 20 along the right sideline and juked his way past some would-be Lord Jeff tacklers for the TD. On the day, Hughes had 81 receiving yards and Warren amassed 150 yards passing on 17 attempts.
Wesleyan trailed by a point at halftime, 7-6, behind a pair of Sebastian Aguirre '14 (#94, photo lower right) field goals, the first a chip shot from 25 yards out at 3:34 of the first period after Wesleyan failed to get a first down on a 3rd-and-1 run at the seven. His second, at 7:37 of the second period, cleared the crossbar from 41 yard out, a career best. Aguirre also upped his consecutive PAT mark to 24 and was honored by the NESCAC for the second time this season as Special Teams Player of the Week.
Wesleyan took the lead for good by getting its running game in gear during a five-play, 38-yard drive set up by good field position as Wesleyan punter Josh Hurwitz '15 hit a 52-yard punt and Amherst started at its own 10 following a holding penalty. Amherst was forced to punt on 4th-and 11 at the nine and a short kick gave the Cardinals outstanding field position. Five runs later, three by LaDarius Drew for 31 yards and the five-yard TD scamper, Wesleyan held a 13-7 margin at 9:45 of the third quarter.
When Amherst made it 20-14 at 5:16 of the fourth period, going 55 yards on eight plays, Wesleyan punted and Amherst began at its own 19. Hurwitz had eight boots for a solid 37.8-yards average with half his kicks nestling inside the 20. Amherst crossed midfield on the march before Sanchez grabbed an errant pass and gave Wesleyan the ball. Though Wesleyan failed to convert on 4th-and-1 at the Amherst 34, a final Amherst incompletion with :02 left ended the game.
Joining Sanchez with seven tackes in the game was Alex Davera-Russo '16. Nik Powers '15 had six tackles, two for a loss including the Cardinals' only sack in the contest.
Wesleyan was outgained in the contest, 355-310 as Amherst also had 19 first downs to Wesleyan's 14. Still, Wesleyan had a substantial edge in time of possession, 35:56 to 24:04 as the Cardinals picked up 160 yards on the ground, more than double Amherst's average amount allowed of 71 coming into the game, to 115 by the Lord Jeffs. Amherst threw the ball 44 times to Wesleyan's 17.
With the win at Amherst, Wesleyan has equaled its best start in 20 years at 5-0. The 1993 Cardinals also went on to defeat Bowdoin to open their year with six straight victories.


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Jazzy Blues Licks by Jody Worrell is a downloadable Quicktime video lesson that will teach you some blues guitar licks with a "jazzy" approach. We will cover each lick in detail and discuss the music theory and technique present. We've also included a .pdf of the tablature and a jam track so you can practice these new ideas.
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Code: BL32
Genre: Blues
Length: 20 minutes
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2003 Ford Truck Expedition Suspension – Air Suspension Height Sensor Linkage Loose Service Procedure
Filed Under (Ford Manuals) by admin on 10-01-2012
ISSUE Some 2003-2006 Expedition and Navigator vehicles equipped with an air suspension may exhibit an air suspension height sensor linkage arm disengaging from the suspension ball stud or height sensor rotating arm. This concern typically occurs with the rear sensor (Figure 1) but may occur with the front sensors as well. If this occurs, the symptom will typically be the vehicle leaning to one side, the vehicle sitting too low/high, a harsh ride, and/or an inoperative air suspension. In addition, this concern may result in diagnostic trouble code (DTC) C1725 (air suspension front pneumatic failure) or C1726 (air suspension rear pneumatic failure). ACTION When a linkage arm becomes disengaged, do not re-attach the arm and do not replace the sensor unless broken. Instead, install a revised linkage arm on all three (3) sensor assemblies, even if they have not detached from the ball stud. 1. Replace linkage arms on all three (3) sensor assemblies following Workshop Manual (WSM), Section 204-05. 2. Discard the old linkage arms. NOTE IF THE SENSOR ASSEMBLY NEEDS TO BE REPLACED FOR ANY DAMAGE/FAILURE OTHER THAN THE ONE DESCRIBED IN THIS TSB, THE REPLACEMENT ASSEMBLY IS SUPPLIED WITH A NEW STYLE LINKAGE ARM, SO THERE IS NO NEED TO ORDER ADDITIONAL LINKAGES FOR THE SERVICE REPAIR. WARRANTY STATUS: Eligible Under Provisions Of New Vehicle Limited Warranty Coverage OPERATION DESCRIPTION TIME 061510A 2003-2006 0.4 Hr. Expedition/Navigator: Replace The Three Linkage Arms, Includes Time To Check Diagnostic Trouble Codes (Do Not Use With 5300A, 5300A7, 5300A8) DEALER CODING CONDITION BASIC PART NO. CODE 5A967


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The Free Online 2014 HCPCS Code Lookup Website
2014 HCPCS Code L0112
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated
HCPCS L0112 was added on: Thursday, January 01, 2004
Type of Service Classification:
P = Lump sum purchase of DME, prosthetics, orthotics
Methodology for developing unique pricing amounts under Medicare Part B:
38 = Durable Medical Equipment, Prosthetics, Orthotics, Supplies And Surgical Dressings -> Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
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Did you know that HCPCS is an acronym for Healthcare Common Procedure Coding System? This coding system was developed in 1983 by the Centers for Medicare and Medicaid Services (CMS), (formerly Health Care Financing Administration) for the purpose of standardizing the medical billing and coding systems used to process Medicare claims. The HCPCS coding system is primarily used to bill Medicare for supplies, materials and injections and for certain services and procedures that are not defined in the Current Procedure Terminology (known as CPT). HCPCS codes must be used when billing Medicare carriers.


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Crown Baseball Bats to be a vendor at 2008 Perfect Game National Underclass Showcase – Main Event
Perfect Game Staff
Tuesday, December 23, 2008
CEDAR RAPIDS, IA. (December 23, 2008) – Crown Bats of Miami, FL.is proud to announce they will be a vendor at the annual National Underclass Showcase – Main Event December 28-30, 2008 at the Red Sox 5 Plex/ Terry Park in Ft Myers, FL. Crown Baseball bats are handcrafted and precisely personalized to your exact specifications.
The Perfect Game National Underclass Showcase – Main Event continues to be the largest individual showcase event that Perfect Game runs, which means it is the largest baseball showcase event in the world. Each year over 500 talented underclassmen from across the country show their skills for three days in front of the PG scouting staff and a huge gathering of professional scouts. In its history, the National Underclass Showcase has hosted players from all 50 states and 5 foreign countries including Aflac All Americans and 16 first round MLB draft choices.
Other vendors attending the National Underclass Showcase include Chilly-Billy ice compress, RBI Pro Swing and Aladame who will market Aladame as well as Perfect Game USA merchandise.
About Perfect Game USA
Celebrating its 16th Anniversary in 2008, Perfect Game USA is the world's largest baseball scouting report service, perennially reporting on thousands of high school baseball players to colleges and professional baseball. In 2008, through an extensive network of partners, coaches and scouts, Perfect Game will conduct over 140 events throughout the country including, some of the most heavily scouted events in all of baseball. These events include individual player showcases, highly competitive team tournaments and training camps. Over the past seven years 5,293 players who attended Perfect Game events have been selected/drafted by Major League clubs. Over two hundred of those players have already appeared in Major League games and that number is growing very fast. Perfect Game maintains the largest database of amateur prospects in baseball. Perfect Game stands alone as the leader in providing opportunities to young baseball players interested in college or professional baseball. For more information, please visit
About Crown Baseball Bats
Crown Baseball Bats are handcrafted and precisely personalized to your exact specifications. Choose the style, color and knob style of your bat. We can also personalize the bat with your name. All quality maple wood baseball bats from Crown Bats can have the barrel end cupped to reduce the weight of the baseball bat for added speed through the hitting zone. Take your game to new heights with Premium Crown Baseball Bats. For more information, please visit
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28 Gay Girl Covers Of Straight Songs Because Everything's Better When It's Queered
Some songs are just a lot better when queer people are singing them.
Some songs are just a lot better when queer people are singing them.
Quotes from a new Rolling Stone cover story just make explicit the themes she's been shredding about for years.
My libido / my libido / my libido / my libido / YEAH
It was a very musical week, ok.
New music videos from Robyn and Yeah Yeah Yeahs, the cure for RBF, and a web series guided by a 2-year-old's dialogue with her father.
Cara's Team Pick: "Women In Punk" offers dozens of hours of your favorite rock stars spliced together real nice on your computer. Wear your best headphones.
Because without Destiny's Child, there'd be no Beyoncé and how else would I have learned to crip walk? Also, something something Half Time show Destiny's Child.
Were these two women at your meetups? Probably.
"Let's get this party started, let's squeeze the lime."
Is this just a half-hearted excuse to talk about cute musicians? Isn't everything?
The Afghanistan re-make of Lady Gaga's "Telephone," courtesy of our U.S. Army soliders, has been making the rounds on the internet this week. And it turns out, they're not the only pop-loving, hip-shaking servicemen out there. Newsweek has compiled a few of their favorite military music videos on their blog, so check it out if […]


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48 people killed in the last 24hrs in Somalia
More than 48 people, mainly civilians have been killed and over 100 others injured in clashes that rocked in central and southern Somalia's capital Mogadishu within the last 24 hours.
The fighting continues into the second day on Friday after the clashes erupted again in Waradhumale in Galgudud region, central Somalia, between the pro-government moderate Islamic group Ahlu Sunna wal Jama'a and al Shabaab. Killed 25 people and injured 60 others.
Sheikh Abdirisaq Mahamed Ali, a senior official of Ahlu Sunnah in Galgadud region said that his planning is to remove the hard-line ideology from the region.
"We successfully carried out attacks to capture the positions against Al-Shabaab, we will continue seizing more other bases," he added.
Resident said heavy artillery shells have also landed in residential areas in the central of the restive capital.
In additional, fierce violence killed 23 people and injured 61 others in Bula Hawo, a strategic town in Southern Somalia, bordering Kenya and Ethiopia.
The fighting erupted Friday after pro-Somali government forces backed by Ethiopian forces tried to re-seize the region from the insurgent.
"The latest clashes erupted late Thursday and continue until Friday, the two sides are exchanging heavy artillery and machine gunfire," an eyewitness told Garowe Radio.
Meanwhile, hundreds of civilians have fled the town, crossing into neighbouring Kenya, according to United Nations refugee agency, UNHCR.
"Around 300 Somalis have crossed into Kenya over the past few days to escape the fighting, and we have received reports from them of many injuries," said the agency.
The war-battered seaside capital has been the scene of deadly civil strife since the collapse of the country's central government in 1991. Civilians bear the brunt of clashes between warring sides involved in armed struggle.
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Brisbane concert
i took my mrs to her first gangsta concert coz she likes bone thugz, snoop and yourself thanks to me. when you came on stage she didnt budge or blink, she was totally captivated by your love. you stole the night. i loved every minute of the performance. i saw you in sydney a couple years back and couldnt miss this one and you made our night. we both agreed that you know how to rock tha house and next time you come back to share love from the west, us ex western sydney siders will be there to return it!!!!!! one love from oz
Replies to This Posting
Re: Brisbane concert
I have been a massive Ice Cube fan for a long time and have never seen him live except on videos.so I was really pumped to see him in Brishane.The Tivoli went off-everyone there were awesome,and had mad love for you and the WC.My mates and I wore raiders jerseys,and even though it was hot as hell in the venue,we never took our jerseys off.I must admit I did video a bit of the concert-to show all that missed out what they were missing.I have always regarded you as the best rapper ever(not being a suck up either),always keeping it real and never selling out.Keep makin your albums and doin your shows down under as I am sure that not one person leaves your show dissatisfied.Raider fan fo life!!!
Re: Brisbane concert
Best concert I have ever been to. I was probably the oldest guy there but wtf I've followed Ice Cube's career since NWA when I was in LA in 1990.
How can I put this but usually when you go to see some more established acts sometimes it feels they are just going through the motions. With Ice cube it was like he was just starting. Didn't appear jaded at all. Great enthusiasm. Crowd was good though. Just wish I was 20 years younger and I would have been at the front going nuts.
Re: Brisbane concert
have seen cube twice now in 2 years back in 2008 for the raw footage tour but this year was amazing definately best concert iver ever been to cant wait for cube to come back to aus again!!!!!
keep it gangsta
Re: Brisbane concert
I was real excited to see cube.. i WAS listenen to his beats when i drive to work it was a good day, ghetto bird all that good stuff .but the concert was utter disappointment and i thinks he a sell out about the $$ which is all good. he only played lil bits of tracks and just bounced i though that was no good especially since his fans there are all old skool and payin 90 bux when U2 was sellin for 40. im glad i didnt pay 90 bux for a tix felt like he was just there to get paid and bounced, IT WAS NOT A GOOD DAY


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The Lakes Family PracticeBrownlow Health S.S.Centre1 Legahory Centre Craigavon, BT65 5BETel: 028 38 311410
E-mail scam reported
Beware opening an email circulating purporting to be from National Institute of Health & Care Excellence (NICE) regarding important blood analysis results. If you receive this do not open it. It is reported to contain malware which will damage your computer.
Copyright 2006 - 2014 My Surgery Website | Privacy & Usage | Edit | Staff Home | Site Map | Accessibility


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Studies demonstrate that Ashwagandha is an antioxidant that supports joint mobility and resistance to fatigue.
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Video: Rinse & Repeat at aMBUSH Gallery
This article was posted by Milk 2 years, 2 weeks, 2 days, 7 hours, 6 minutes ago. 12ozProphet, Art & Design, Events, Graffiti, Life & Culture
Featuring the work of Phibs, Teazer, Bridge Stehli, Shannon Crees, Teem, Fintan Magee, Guido van Helten, Adnate, Slicer, Deams, Cam Wall and Carl Steffan. Rinse & Repeat, presented by aMBUSH Gallery and Paper; plain., is an exhibition that seeks to articulate the significance of street and graffiti art to contemporary culture, and its belonging to the ranks of the most important art movements from throughout history. Rinse and Repeat launches at aMBUSH Gallery on Thursday 6 December from 6-10pm. The exhibition continues until Sunday 9 December 12-4pm.
- Tags:
- Street Art,
- Street Artist,
- Graffiti,
- Video,
- australia,
- Rinse & Repeat,
- Salvador Dali,
- 12ozProphet,
© Milk & 12ozProphet - Wednesday December 05, 2012 at 08:00 AM


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Seeds Farm is hiring for the 2014 Growing Season
Farm Description:
Seeds Farm (seedsfarmproject.com) is a small-scale, diversified vegetable and animal farm committed to farming ecologically. We grow vegetables and raise hens and pigs for a CSA and wholesale accounts. We are located one mile south of Northfield. Seeds Farm is part of the umbrella organization, SEEDS Project. We share land with other farmers with similar goals.
Farm Hand (part time)
This season we will hire 2-3 farm hands. This position is meant for the individual who is excited to explore farming as a vocation, likes to work hard, and wants to learn the ins and outs of growing food for yourself and community. Farm hands will assist in all aspects of vegetable farming/animal husbandry.
***This is a part time position, ~mid-May – September, though alternative schedules can be considered for the exceptional candidate. $7.5/hr, plus produce.
Experience and Skills:
- Ability to work in all sorts of weather conditions
- Honest
- Responsible, motivated and reliable
- Ability to repeatedly lift 50 lbs
- Flexible and adaptable with the changing nature of farm schedule
- Drama free
- Excellent communication skills
- Pleasant to be around
If interested in applying, please email your resume, application, and cover letter in pdf form to firstname.lastname@example.com (please include the position your are applying for in the subject line). Please include your favorite vegetable, favorite joke, and why you'd like to work on a farm in your cover letter. Applications will be reviewed as they come in, so don't wait!


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Calls and emails to the White House have topped on thousand.
We still need thousands more Peace Corps supporters this week to call President Obama at 202-456-1111, Monday - Friday (9 AM - 5 PM) and leave this message (or your own version). If you wish, you can also send your comments on-line via www.whitehouse.gov/contact. (The length of the message above totals under1,650 characters, well within the White House form's limit of 2,500 characters.)
Only if we can get thousands of calls/emails will this make an impact:
"President Obama, please urge Congress to provide $450 million to the Peace Corps in fiscal year 2010.
You promised during your campaign to double the Peace Corps to 16,000 Volunteers by 2011. But the budget you proposed to Congress for Fiscal Year 2010 requested only $374 million, an increase over FY09 of only $34 million – not enough after inflation and security costs to more than expand slightly its size now.
However, the House of Representatives voted an increase of $110 million, a historic increase that would bring the budget to $450 million; this would enable the new Peace Corps Director to improve operations, add many more Volunteers (from the 15,386 now applying to serve – an 18% increase over 2008) and open new programs (in many of the 20 countries now requesting Volunteers).
BUT because the Senate included your proposed increase of only $34 million, the difference between House and Senate versions must now be resolved in Conference.
So, I ask you to call Senator Patrick Leahy and Representative Nita Lowey, Chairs of the Senate and House State/Foreign Operations Subcommittees, and urge them, when they meet in Conference within a few days, to agree to the House total – $450 million.
To continue under-funding the Peace Corps would not only block needed reforms, but also signal tepid support for service programs."
- Your name, country, and years of service
Please forward this newsletter to at least 10 former volunteers and copy firstname.lastname@example.com on your forwards.
Please call and/or e-mail early this week!! (You can call only between 9 AM and 5 PM EST, Monday through Friday.)Also, you can call this White House hotline multiple times.
For this push to succeed, we need messages from thousands of RPCVs and Peace Corps supporters. So, please also forward this request to at least ten other RPCVs and supporters. Keep reminding your friends and family because it takes a few reminders, but people will call and the momentum will build.
Finally, last week's article in The Huffington Post, What Happened to the Promise of 16,000 Peace Corps Volunteers by 2011 , attracted lots of attention. Please read it and forward it. This Huffington article is the letter we need President Obama to read.
If you do take action, please let us know so we can keep track of number by sending a quick email: email@example.com.


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Frank Thompson
Senior Fellow
Department: Rockefeller Institute of Government
Professor Emeritus
Department: Public Administration and Policy
Health care policy and implementation; Medicaid; federalism and health care policy
Campus phone: (518) 443-5522
Campus email: email@example.com
Thompson conducts research in health care policy studies for the Institute. He is a professor of public affairs and administration at Rutgers-Newark, The State University of New Jersey, and at the Rutgers Center for State Health Policy, as well as professor emeritus and former dean at Rockefeller College of Public Affairs & Policy at the University at Albany.
Thompson has served as fellow with the U.S. Public Health Service and published extensively on issues of health policy and implementation. He has focused particular attention on issues of federalism and health care policy. He has written on the political and substantive implications of the growing use of Medicaid waivers to foster significant changes in this program.


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Definitions for radishˈræd ɪʃ
This page provides all possible meanings and translations of the word radish
Random House Webster's College Dictionary
rad•ishˈræd ɪʃ(n.)
the crisp, pungent, edible root of the plant, Raphanus sativus, of the mustard family, usu. eaten raw.
Category: Plants
the plant itself.
Category: Plants
Origin of radish:
bef. 1000; radish(e), var. (cf. OF radise, radice) of ME radich(e), OE rǣdic < L rādīc- (s. of rādīxroot1)
Princeton's WordNet
pungent fleshy edible root
radish, daikon, Japanese radish, Raphanus sativus longipinnatus(noun)
radish of Japan with a long hard durable root eaten raw or cooked
pungent edible root of any of various cultivated radish plants
radish, Raphanus sativus(noun)
Eurasian plant widely cultivated for its edible pungent root usually eaten raw
radish plant, radish(noun)
a cruciferous plant of the genus Raphanus having a pungent edible root
Kernerman English Learner's Dictionary
radish(noun)ˈræd ɪʃ
a small round red salad vegetable
A plant of the Brassicaceae family, Raphanus sativus, having an edible root
The pungent root of this plant, usually eaten raw in salads etc
Origin: redic, rædic, from radice, the ablative singular of radix; later readopted from radis, from raditz, from Latin. Also see: eradicate.
Webster Dictionary
the pungent fleshy root of a well-known cruciferous plant (Raphanus sativus); also, the whole plant
The radish is an edible root vegetable of the Brassicaceae family that was domesticated in Europe, in pre-Roman times. They are grown and consumed throughout the world. Radishes have numerous varieties, varying in size, color and duration of required cultivation time. There are some radishes that are grown for their seeds; oilseed radishes are grown, as the name implies, for oil production. Radish can sprout from seed to small plant in as little as 3 days. The descriptive Greek name of the genus Raphanus means "quickly appearing" and refers to the rapid germination of these plants. Raphanistrum, from the same Greek root, is an old name once used for this genus. The common name "radish" is derived from Latin radix. The radish has been used over many centuries. Although the radish was a well-established crop in Hellenistic and Roman times, which leads to the assumption that it was brought into cultivation at an earlier time, Zohary and Hopf note that "there are almost no archeological records available" to help determine its earlier history and domestication. Wild forms of the radish and its relatives, the mustards and turnip, can be found over west Asia and Europe, suggesting that their domestication took place somewhere in that area. However Zohary and Hopf conclude, "Suggestions as to the origins of these plants are necessarily based on linguistic considerations."
Translations for radish
Kernerman English Multilingual Dictionary
a plant with a red-skinned white root used as food.
- radysAfrikaans
- فُجْلArabic
- репичкаBulgarian
- rabanetePortuguese (BR)
- ředkvičkaCzech
- das RadieschenGerman
- radiseDanish
- ραπανάκιGreek
- rábanoSpanish
- redisEstonian
- ترب چهFarsi
- retiisiFinnish
- radisFrench
- צְנונִיתHebrew
- मूलीHindi
- rotkvicaCroatian
- retekHungarian
- lobakIndonesian
- hreðka, radísaIcelandic
- ravanelloItalian
- はつか大根Japanese
- 무Korean
- ridikëlisLithuanian
- redīssLatvian
- lobakMalay
- radijsDutch
- reddikNorwegian
- rzodkiewPolish
- ترب چهPersian
- مولۍ، تيربه، تربPashto
- rabanetePortuguese
- ridicheRomanian
- редискаRussian
- reďkovkaSlovak
- redkevSlovenian
- rotkvicaSerbian
- rädisaSwedish
- หัวไชเท้าThai
- turpTurkish
- 蘿蔔Chinese (Trad.)
- редискаUkrainian
- مولیUrdu
- cây củ cảiVietnamese
- 小萝卜Chinese (Simp.)
Get even more translations for radish »
Find a translation for the radish definition in other languages:
Select another language:
Discuss these radish definitions with the community:
Use the citation below to add this definition to your bibliography:
"radish." Definitions.net. STANDS4 LLC, 2014. Web. 21 Dec. 2014. <http://www.definitions.net/definition/radish>.


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The State Senate Democrats of the Connecticut General Assembly
Representing Bridgeport, Monroe & Trumbull
Contact: Dan Doyle
March 22, 2012
Two pieces of legislation addressing the needs of foster children and both their biological and adoptive families passed the General Assembly's Human Services Committee today, said committee Co-Chair Senator Anthony Musto (D-Trumbull).
When two or more siblings enter the care of the state Department of Children and Families (DCF), they are not always able to be placed with the same foster family. Senate Bill 156 would require that foster children visit with their siblings at least once a week on average, provided the visits would be in the children's best interests.
"Entering the state's foster care system is never easy for a child, and it often occurs in the context of other difficult and life-changing events. For foster children, siblings can be a great source of comfort and a mutual connection to each other's earlier lives. Preserving family ties, whenever possible, should always be a top priority," said Senator Musto.
"At around the age of 6 I was taken into care for the first time. It was scary. I was young, innocent, and confused. What would happen? Where was I going? Will I see my brothers and sisters? These questions weighted heavily on my mind . . . DCF did their part in making sure that we had monthly (or at least bi-monthly) visit, however it simply was not enough to build or maintain a solid relationship," said Alixes Rosado, a 23 year old who grew up in the care of the state.
In a separate effort to improve Connecticut's system of foster care, Senate Bill 294 would require a DCF worker to visit foster families and their children at least once every 60 days, rather than 90 days under current policy.
"More regular DCF visits to foster families are in the best interest of both children and parents. The children know that they have someone watching out for them, and the parents know they have the support they need as well. This is a minimum—in many cases DCF will visit much more often—but at least some ongoing contact is necessary to ensure that both the children and the parents are doing well," Senator Musto said.
State Senator Anthony Musto represents the 22nd District towns of Trumbull, Bridgeport and Monroe. He is Senate Chair of the Human Services Committee.
Chair: Government Administration & Elections
Member: Finance, Revenue & Bonding; Judiciary; Public Health
Dave Steuber
Legislative Office Building
Room 2200
Hartford, CT 06106-1591
To see more news releases by Senator Musto, visit our Press page (also includes releases by other Senate Democrats).
Subscribe to Senator Musto's RSS news feed.
Download Senator Musto's biography and publication-quality head shots.
Musto.doc (MS Word format)
Musto-hi.jpg (JPG)
Musto-low.jpg (JPG)


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Lost Pyramids and Other Hidden Ancient Artifacts ,Need a break, week end viewingSubmitted by doctor011 on Sun, 02/10/2013 - 17:04
- Login to post comments
That was
a lot of fun. Enjoyed it.
Is this that Ancient Alien stuff?
If so, I enjoy watching it a lot...and I am an evangelical Christian. Of course, I also like watching "The Walking Dead."
But seriously, I like watching it because there are extremely interesting sites out there that I love to learn about. Still don't believe in NAzi Aliens, but I enjoy watching.
There are similarities in this lecture
and ancient aliens. If you have the time check it out, there is some really cool stuff here.
"I like nonsense, it wakes up the brain cells. Fantasy is a necessary ingredient in living."
― Dr. Seuss
This is exactly what I wanted to watch this weekend.
My notes.
"Klaus firmly believes that we are not alone… never have been." It really is as simple as that isn't it?
7:04. Bronze statue from Mongolia. At first glance I would have said it was the sun also, but the idea that it is an orb of energy is interesting. Leave it up to the Russians.
9:00 The pyramid in Tahiti. Speaker says "I do not think it exists in our day." That is so sad. One of the most heartbreaking things in this world is lost history. Just sayin.
13:15 Pyramids of Bosnia. They are bigger than the ones in Egypt? Speaker says "government prohibited further excavation. Motherfuckers.
14:40 Sardinia is breathtaking. Not a relevant comment, just a comment.
18:21 "Legends of the giants" or…. From the bible (no, I am not extremely religious I just like words and I like the eloquence of the bible) "There were giants in the earth in those days." I am a daydreamer and I love giants. I wonder why people are not afraid to accept the idea that there have been pygmy civilizations before but there is a fear of accepting giant civilizations.
25:43 I didn't understand what he was talking about with the silver and gold in the water and it being "the strongest water." Is he talking about purity?
30:07 "He spoke and wrote more than 40 languages perfect." Well…. Then he is my new hero. Pre Sanskrit "older than the oldest writing." It's almost hard to conceptualize.
Anyways, I have more notes, but I'll leave it there for now.
"I like nonsense, it wakes up the brain cells. Fantasy is a necessary ingredient in living."
― Dr. Seuss
Colloidal gold and silver
are said to be good for human health. For water to be colloidal gold or silver, the gold or silver particles need to be tiny nano particle sized for the body to be able to use it. Google it there is a lot of info about colloidal gold and silver.
Accepts Bitcoin
Check out my blog:
Be Ready To Be Downvoted
By any and all "Christian" viewers. Hah! (If they bother to watch this)


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In July 2009, judging solely by total revenue, Abbott was assigned the rank of the eighth-largest pharmaceutical company in the Fortune Global 500. Nearly a year later, the company is looking to move up at least a few notches. On May 21, Abbott acquired Indian generic giant Piramal for a cool $2.12 billion up front, with additional promised of payments of $400 million for four years starting in 2011. That totals $3.72 billion—money well spent when you take into account the amount of access to India the deal gives Abbott.
The Indian pharmaceutical market is set to grow to $8 billion in 2010—thanks in part to an expanding middle class and the second largest workforce in the world. Generics are dominating the market at a 92 percent share, according to a study conducted by research firm RNCOS. Rather than set up shop and build brands—or even branded generic offerings—from scratch, attempting to squeeze into an already overcrowded space, acquiring an already-established company (like Piramal) is a more cost-efficient step. Abbott anticipates this move will put it at the top of the (very tall) totem pole on the subcontinent.
Piramal doesn't yet have any proprietary drugs on the market, but it does have several candidates that have either completed or are near completion of Phase II trials. Two oncology targets are being developed with Merck as a partner; Eli Lilly is partner for two in the diabetes/metabolic arena.