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Air Force 'appalled' by $1B IT system that produced few capabilities
Friday - 4/20/2012, 5:17am EDT
The Air Force says it's restructuring one of its major enterprise resource planning systems after spending several years building it and getting almost no new capability. The system is one of several that the Defense Department will need in place in order to prepare for a full financial audit by 2017.
All the military services and Defense agencies are relying on huge enterprise resource planning systems to meet the auditability milestones DoD leaders charged them with achieving in 2014 and 2017. DoD and the Government Accountability Office have concluded the ERPs are the only way to centralize and track the vast quantities of logistics, financial and pay and personnel data DoD has in a way that would satisfy outside auditors.
Dr. Jamie Morin, Air Force comptroller (Air Force photo)
In the Air Force's case, three big ERPs are under development, but the Enterprise Combat Support System has been the most troublesome, officials told lawmakers this week. The Air Force wanted to create a single, seamless system to track transportation, supply, maintenance, engineering and acquisition information.
Dr. Jamie Morin, the Air Force comptroller, said it hasn't worked out that way.
"We're now approaching seven years since funds were first expended on this system. The total cost is now over $ 1 billion. I'm personally appalled at the limited capabilities that program has produced relative to that amount of investment," Morin told the Senate Armed Services Committee's subcommittee on readiness and management support this week.
Air Force falls behind
Morin said the service was restructuring ECSS with the support of senior leadership. Morin promised to report back to lawmakers on the outcome in the next month or so.
The lackluster performance of ECSS is one reason the Air Force is behind the rest of the military services in the effort to prepare for both an auditable statement of budgetary resources by 2014 and a full financial audit by 2017. The service already has said it would have to rely on legacy systems and a lot of manual labor in order to meet that target &mdash and Morin assessed that the Air Force is at "moderate risk" for missing the deadline.
But it's by no means the first instance of a failed ERP program in DoD. The most famous example might be the Defense Integrated Human Management Resources (DIHMRS). The Pentagon spent 12 years and approximately $1 billion building DIHMRS before giving up on the effort in 2010.
Col. Robert McVay, program manager, Integrated Pay and Personnel System-Army (Army photo)
Sen. Claire McCaskill (D-Mo.) said plenty of other examples existed. The money wasted on failed ERP systems in DoD makes the recent GSA conference scandal look like lost change under the couch cushions, she said.
"If I add up all 11 of the ERP programs cumulatively, we're $6 billion over budget and 31 years behind schedule. That's a problem," she said.
The Army has struggled with managing enterprise information as well. It's already rolled out its ERP for financial information, the General Fund Enterprise Business System (GFEBS) to several locations, and the system has yielded positive audit results.
But the service still is struggling with pay and personnel information. GAO recently found the Army has no reliable way to even count the total number of soldiers on active duty at any one time. It's a problem the Army doesn't dispute. Col. Robert McVay told a recent FOSE conference that it's not just a financial management problem, it's an operational problem.
Too many HR systems required to get personnel data
Today, a brigade commander would have to tell his staff to look through at least three separate HR systems and manually aggregate data from various spreadsheets just to find out how many troops he was commanding, McVay said.
"We'd get a result that's correct to about 3 percent, plus or minus," he said. "That might be great for Gallup, but 3 percent of 100,000 soldiers is 3,500 soldiers. There's no corps commander in his right mind that's going to accept that. And by the way, Congress doesn't like the fact that we can't tell them how many soldiers we pay every year."
McVay is the program manager of the Army ERP designed to solve that problem. Integrated Pay and Personnel System-Army (IPPS-A) is supposed to integrate the pay and personnel systems of the Active, Guard and Reserve components of the Army. The Army awarded a contract for the first increment of the system in February.
Robert Work, undersecretary of the Navy (Navy photo)
The Navy has decided not to continue pursuing a new ERP for pay and personnel. Instead, it will focus on improving the business processes around its existing systems. The Navy has already started deploying its primary ERP for most of the rest of the business functions an audit would require.
"Re-engineering and mapping our business processes across the Navy is the key," said Robert Work, the Undersecretary of the Navy. "Our methodology requires base-lining and mapping business processes, allowing the business owners across the department to identify and prioritize their problems and then exploit their opportunities for improvement. A second key is data standardization and a third is having good internal controls. We're focused on all three of these things, and auditable financial statements will be the outcome of all three of these efforts."
Navy is close to auditability
The Navy Department is shooting to have its statement of budgetary resources auditable in 2013, a year before the current DoD deadline. The Marine Corps had hoped to have its statement in audit-ready condition by this year, but decided to refocus its efforts on 2013 after realizing that the 2012 books would have taken a few more months of work.
The ERP work the Navy's department already has done has led to the shutdown of 1,400 of the systems and applications it used to use for financial management, Work said. The Army already has terminated 80 legacy systems, with 700 more still to come if all goes according to plan.
The Air Force initially had planned to cut off 240 legacy systems with its ECSS system, but with that program in limbo, the legacy systems are going to have to continue working, at least in the short term.
Keep the deadline in place
McCaskill wondered whether the cost of implementing the manual workarounds it will take to make those legacy systems work together over the short term is worth the cost.
Morin said even though some of the Air Force systems date back to the Vietnam War, they won't have to deploy an army of auditors to get the audit results they need.
"In some cases, we'll have to do manual reconciliations between those systems because they don't interface, but it won't take thousands of people to do it," he said.
Robert Hale, the DoD comptroller, said even if it does cost more money to meet the short term 2014 audit goal with manual processes, relaxing the deadline would do more harm than good.
"I would argue strongly that we need the pressure that's generated by the 2014 deadline," he said. "It's like turning an aircraft carrier. We've got to get this organization moving, and I think we've done it. If it drives us to some modest, manual workarounds, so be it. I think it will let us get to the ultimate 2017 end game sooner.
Panetta wants full accounting of money in, money out by 2014
DoD audit goals achievable, Congressional inquiry finds
Army systems leave soldiers vulnerable to late, inaccurate pay


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Media Inquiries: For all MAVA media inquiries, please contact us at 703-506-9300 or email firstname.lastname@example.com.
Check back regularly for news, coverage, and announcements about MAVA.
Following a meeting of the Maryland Venture Fund Authority, Maryland Department of Business and Economic Development (DBED) Secretary Christian S. Johansson and Maryland Venture Fund Authority Chairman Peter Greenleaf issued the following statement on the Authority's progress in selecting private venture capital firms that will receive funds through the State's InvestMaryland program.
"Today, we took another significant step in moving InvestMaryland forward by reviewing proposals from 37 private venture firms that applied to manage the available funds, and approved a select number of those for further review. Those selected will now undergo a more detailed due diligence process that will be conducted by our partner, Altius Associates. We plan to notify all firms of their application status in two weeks. We look forward to working with the selected firms and continuing our progress with InvestMaryland, which is helping to position Maryland as a national leader in innovation and entrepreneurship."
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subset: commoncrawl


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text:
doxorubicin - injection, Adriamycin, Rubex
GENERIC NAME: DOXORUBICIN - INJECTION (dox-oh-REW-beh-sin)
BRAND NAME(S): Adriamycin, Rubex
Warning | Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes | Missed Dose | Storage
WARNING: This medication must be given slowly into a vein only. It is very important not to inject this medication into a muscle or beneath the skin. If this medication accidentally leaks into surrounding tissue, the skin/muscle may be severely damaged. Notify your doctor immediately if redness, blistering, sores, pain, or swelling occur at or near the injection site.
Doxorubicin may cause heart problems, including possibly fatal heart failure. Heart problems may occur during doxorubicin therapy or months to years after receiving this medication. Your risk of developing heart problems depends on your dose, medical history (including previous heart disease, radiation therapy in the chest area), and previous use of this and other drugs (including daunorubicin and cyclophosphamide). Children are at higher risk and should be monitored later in life for delayed heart problems. See also Side Effects section.
Very rarely, people with cancer who are treated with this type of medication have developed other cancers (e.g., secondary leukemia). The risk is greater if you are over age 50 or have received certain types of chemotherapy or radiation therapy. Consult your doctor for more details.
This medication may cause certain severe (rarely fatal) blood disorders (bone marrow suppression leading to low red blood cells/white blood cells /platelets). This can lower your body's ability to fight infection and stop bleeding. Tell your doctor immediately if you develop any signs of infection (e.g., fever, chills, persistent sore throat), unusual tiredness, or easy bleeding/bruising.
Your doctor will closely monitor you while you are being treated with this medication.
Different types of this medication work in different ways. Do not switch types of this medication without your doctor's permission.
Medically Reviewed by a Doctor on 4/16/2014
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Need help identifying pills and medications?
Back to Medications Index


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Spine surgery is performed at the Swedish Health Services. The rotation is designed to provide training in the evaluation and management of patients with disorders of the spine. It is expected that upon completion of this rotation, fellows will demonstrate an understanding of the anatomy, physiology, pathophysiology, and presentation of disorders of the spine, its connecting ligaments, the spinal cord, the cauda equina, and the spinal roots. Additionally fellows will demonstrate the ability to formulate and implement a diagnostic and treatment plan for diseases of the spine, its connecting ligaments, the spinal cord, the cauda equina, and the spinal roots that are amenable to surgical intervention.
Clinical Care
Competency Based Curriculum Objectives
Non-SNS Exposure
Research Activity
Recommended Reading
Technical Skills
The fellowship's primary emphasis is ensuring that the fellow has the highest level of technical expertise possible.
- Pathology includes:
- Deformity
- Degenerative
- Tumor
- Infection
- Trauma
- Performance/techniques that will be mastered include:
- Posterior Screw Fixation
- Cervical Lateral Mass
- Thoracic and Lumbar Pedicles
- Occiput
- Pelvic Fixation
- Anterior Abdominal
- Anterior Thoracolumbar
- Anterior Cervical
- Posterior Cervical Foraminotomies
- Thoracic OstotranVersectomies
- Vertbrectomies-Cervical, Thoracic, and Lumbar
- Minimally Invasive
- Lumbar
- Thoracolumbar
- Tube Decompression
- Pedicle Screws
- Wiltse Muscle-Splitting Lumbar Fusions
- Intra-Dural Spinal Tumors
- Osteotomies
- Three Column
- Multiple Chevron
- Posterior Screw Fixation
Performance Skills
The fellowship incorporates an athletic performance coach to implement performance skills in the operating room utilizing the "Awake at the Wound" program.
Awake at the Wound Model
Skill = Performance – Interference
- Awake at the Wound
- Introductory Seminar
- Ongoing Intra-Operative Coaching
- Individual Coaching
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Clinical Care
Post-Operative Care
Fellows are involved in the post-operative care for both spine and non-spine patients; fellows are also expected to see all of the patients they perform surgery on until discharge.
- Post-Op ICU Care
- Spine Patients
- Non-Spine Patients
- Post-Op Surgical Patients
Comprehensive Non-Operative Care (DOCC Project)
The DOCC (Defined, Organized, Comprehensive Care) project is an operative structured framework of spine care conceived by the fellowship's co- director, David Hanscom, M.D.
- Fellows will read the book "Back In Control"
- Key book topics will be adderssed in collaborative discussions
All spine physicians are in clinic on Thursday. During this time, fellows are expected to:
- Spend equal time in clinic with each physician
- Conduct specific literature searches on usual problems
- Visit post-ops or interesting cases
- Participate in non Swedish Neuroscience Specialists (SNS) activities
General Neurosurgical Call
Fellows will participate in the general neurosurgical call organized by SNI Chief of Neuroscience, David Newell, M.D.
Return to Top
Wednesday Morning Conferences/Case Presentations
These are working conference sessions during which fellows collect questions. Click here to learn more.
Wednesday Afternoon Conferences
Conference agendas will be altered depending on the fellows' interests and cases that week.
- Discussion of relevant spine topics
- Problem Solving (Staff and fellows share feedback.)
Competency Based Curriculum Objectives
Medical Knowledge
Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
- Review the biomechanics of the craniocervical junction, cervical spine, and thoracolumbar and lumbar spine.
- Review the biomechanics of common internal spinal fixation devices.
- Review the definition of spinal instability based upon the principles of Punjabi, White and other authors.
- Recognize the radiographic signs of degenerative neoplastic, traumatic, and congenital spinal instability.
- Review the indications for, uses, and relative effectiveness of common spinal orthoses. Discuss the degree of segmental and regional immobilization these orthoses provide.
- Review the indications for, and physiology of, intraoperative spinal cord monitoring. Describe the technical aspects of intraoperative spinal cord monitoring.
- Compare and contrast indications for anterior and posterior approaches to the cervical spine for the treatment of herniated cervical discs, spondylosis, and instability.
- Discuss the role of corpectomy in the management of cervical disorders.
- Compare and contrast the indications for anterior cervical discectomy with and without anterior interbody fusion.
- Discuss the indications and techniques for anterior and posterior cervical spinal internal fixators.
- Explain the biology of bone healing and options for bone grafting and use of osteobiological agents in spinal surgery.
- Review the diagnosis and management of primary spinal tumors, spinal cord tumors, and spinal metastatic disease including indications for dorsal decompression, ventral decompression, and radiotherapy.
- Discuss the management principles for gunshot and other penetrating wounds to the spine.
- Review the signs, symptoms, and management options in the treatment of the adult tethered cord syndrome and syringomyelia.
- Review management principles for spontaneous and postoperative spinal infections.
- Review the management principles for intraoperative and postoperative cerebrospinal fluid leaks.
- Discuss the surgical management of intradural congenital, neoplastic, and vascular lesions.
- Review evaluation and management of arthritic and metabolic disorders of the spine.
- Discuss principles of evaluation and management of pediatric and adult spinal deformity
- Describe indications for the use of angiography and endovascular procedures in the management of spinal disorders.
- Discuss the management of cervical degenerative disease secondary to rheumatoid arthritis. Describe factors that make it different from the management of non-rheumatoid disease.
- Compare and contrast the treatment options for cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament, including multilevel anterior cervical corpectomy and fusion, laminectomy, laminectomy and fusion, laminoplasty, and nonoperative therapies.
- Discuss the indications for posterior cervical spinal internal fixators.
- Compare and contrast the transthoracic, transpedicular, costotransverse, and lateral extracavitary approaches to a herniated thoracic disc, thoracic tumor, or thoracic spinal injury.
- Discuss the indications for lumbar fusion for congenital disorders, iatrogenic disease, and degenerative disease, ranking indications from least to most controversial.
- Compare and contrast the indications for anterior or posterior lumbar interbody fusion and intertransverse fusion for lumbar disease.
- Discuss internal fixation options for posterior lumbar interbody fusion and intertransverse fusion.
- Summarize the most common types of spinal tumors in the following categories:
- Intradural/intramedullary
- Intradural/extramedullary
- Extradural/extramedullary.
- Discuss nonoperative and operative treatment options for fractures and dislocations affecting the atlas and axis.
- Compare and contrast the indications for nonoperative treatment, anterior approaches, and posterior operative approaches for the treatment of fractures and dislocations of the subaxial cervical spine.
- Describe the indications for anterior, posterior, and posterolateral procedures in the management of thoracolumbar tumor, trauma, or infection.
- Compare and contrast the indications for anterior and posterior spinal fixators in the management of thoracolumbar tumor, trauma, or infection.
- Discuss reconstruction options for vertebral body defects after corpectomy for tumor, trauma, or infection.
- Discuss reconstruction options for pediatric and adult spinal deformity.
- Discuss surgical options for low and high grade spondylolisthesis.
Patient Care
Fellows must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health.
- Demonstrate the ability to prepare structural allografts for use in spinal surgery.
- Determine the need for postoperative inpatient or outpatient rehabilitation in patients with spinal disorders.
- Demonstrate the ability to perform a ventral exposure of the cervical spine followed by anterior cervical discectomy.
- Demonstrate the ability to perform an anterior cervical interbody arthrodesis.
- Demonstrate the ability to place anterior cervical instrumentation.
- Demonstrate the ability to perform posterior cervical decompressive laminectomy.
- Demonstrate the ability to perform posterior cervical foraminotomy with or without discectomy.
- Demonstrate the ability to perform medial and lateral approaches to a far lateral lumbar disc herniation.
- Demonstrate appropriate surgical technique in the management of recurrent lumbar disc herniations and recurrent lumbar stenosis.
- Demonstrate the ability to perform posterior lumbar arthrodesis with or without the use of interbody instrumentation.
- Demonstrate exposure of the cervical lateral masses, thoracic and lumbar transverse processes, and the sacral ala.
- Demonstrate the ability to perform posterior/intertransverse arthrodesis in the cervical, thoracic and lumbar regions.
- Demonstrate the ability to perform a laminectomy with or without transpedicular decompression for tumor, infection, or trauma.
- Demonstrate techniques for spinous process arthrodesis of the subaxial cervical spine for fracture or dislocation.
- Demonstrate the ability to manage postoperative complications of spinal surgery including:
- Hematoma
- Infection
- Spinal fluid leak
- New neurologic deficit
- Demonstrate the ability to perform a tethered cord release.
- Demonstrate the ability to function independently in all phases of management of patients with spinal disorders.
- Demonstrate the ability to perform occipital-cervical arthrodesis.
- Demonstrate the ability to properly place sublaminar wires, lateral mass screws, lower cervical/upper thoracic pedicle screws, C2 pars interarticularis screws, and C1-2 transarticular screws for the management of cervical spine disorders.
- Demonstrate the ability to perform, with assistance if necessary, transoral odontoidectomy.
- Demonstrate common techniques for performing C1-2 arthrodesis.
- Demonstrate the ability to perform anterior cervical corpectomy followed by arthrodesis.
- Demonstrate the ability to perform, with assistance if necessary, transthoracic, thoracoabdominal, retroperitoneal, and transabdominal approaches to the thoracic and lumbar spine.
- Demonstrate the ability to perform costotransverse and lateral extracavitary approaches to the thoracolumbar spine.
- Demonstrate the ability to excise a herniated thoracic disc by use of the above-mentioned approaches.
- Demonstrate the ability to perform vertebral corpectomy of the thoracolumbar spine for tumor, infection, or trauma, utilizing the above-mentioned approaches.
- Demonstrate the ability to perform anterior arthrodesis of the thoracolumbar spine.
- Demonstrate the proper placement of transpedicular screws in the thoracic and lumbar spine.
- Demonstrate the proper placement of laminar, transverse process, and pedicle hooks in the thoracic and lumbar spine.
- Demonstrate the ability to resect intradural spinal neoplasms.
- Demonstrate the ability to perform methylmethacrylate vertebroplasty and Kyphoplasty.
- Demonstrate techniques of open reduction of fractures and dislocations of the cervical, thoracic, and lumbar spine.
- Demonstrate the ability to surgically manage arachnoid cysts and spinal cord syrinx.
- Demonstrate the ability to perform intradural procedures for congenital, neoplastic, and vascular lesions.
- Demonstrate the ability to perform spinopelvic fixation techniques.
Return to Top
Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
- Demonstrate care and compassion for spine patients and their families
- Demonstrate respect for patients and colleagues from diverse cultural, ethnic and religious backgrounds
- Demonstrate honesty in all professional interactions
- Demonstrate punctuality for scheduled conferences and rounds
- Provide consultation to the ED and other services in timely fashion and/or arrange for back-up consultation if unavailable
- Demonstrate dress, grooming and comportment consistent with institutional guidelines and earning confidence and respect from supervisors, peers and patient families
- Comply with all GME and Departmental regulations regarding duty hour restrictions and report personal schedule in timely and accurate fashion
- Accurately self-report fatigue in situations that may compromise safety and/or patient care
Return to Top
Interpersonal and Communication Skills
Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and health professionals.
- Demonstrate the ability to communicate complex care plans to families
- Demonstrate the ability to provide sensitive, accurate and complete information and consent regarding a surgical procedure or other intervention, particularly in difficult situations:
- Parents consenting on behalf of young minor
- Consent via a translator
- Consent with non-traditional religious or cultural boundaries
- Demonstrate the ability to communicate effectively with nurses in NNICU, NIMU and as well as the Neurosurgery Nurses and Nurse Practitioners and peers on other services
- Provide complete and effective sign out and sign in with on call neurosurgery residents covering the service
- Communicate effectively with other members of the neurosurgery team.
Return to Top
Practice Based Learning and Improvement
Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
- Maintain a list of all morbidity and mortality cases. Prepare cases with attending supervision to be discussed at the quarterly Morbidity and Mortality Conference. If appropriate, produce a Quality Improvement project.
- Prepare and present cases from the Spine Service at the Interesting Case conference. Describe the outcomes of neurosurgical intervention in infants and children through longitudinal follow-up at subsequent conferences.
- Perform at least one literature search from recent articles on an interesting case of your choosing.
- Prepare and present a lecture at the Neurosurgery Teaching Conference under the supervision of an attending.
- Perform a self-assessment evaluation prior to the end of the rotation. Discuss the results with your attending or program director.
Return to Top
Systems Based Practice
Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
- Describe the nature of complex interdisciplinary team management in "Disease-focused Care" in a tertiary hospital.
- Manage communication with the NNICU, NIMU, Orthopedic Surgery and Trauma teams regarding co-care patients
- Interact with Neurosurgical Nurse Practitioners, Physical Therapists and Social Workers in planning longitudinal care of pediatric neurosurgery patients.
- Demonstrate effective participation in interdisciplinary conferences:
- Neuropathology Conference
- Saturday Pediatric Neuroradiology Conference
- Spine conference
- Neurovascular conference
- If possible, prepare a systems-improvement project (such as dedicated order set, documented policy improvement, etc.)
Return to Top
Rotation Assessment and Evaluation
- Written faculty evaluation of all 6 competencies (Neurosurgery Resident evaluation)
- Completion of study questions and assignments from Medical Knowledge and Patient Care Competency Curriculum.
- 360 degree evaluation by Fellow, NNICU Unit Manager, Neurosurgery Nurse Practitioner, and Transcription specialist
- Goals met for surgical case experience.
- On the fly Surgery evaluation
- Morbidity and Mortality Log
- Review of presentations at Interesting Case conference and M&M conference.
- Review of performance during Mock Oral board examinations.
- Conference attendance statistics
- Review of Medical Documentation Biopsy (Discharge Summary, Operative Note) by Neurosurgery attending
- Duty hours tracking data, weekly review by Program Administrator and review as needed
- Review of Systems- or Quality Improvement Project (if performed)
- Lecture prepared and given under attending supervision.
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Non-SNS Exposure
Physical Therapy
Fellows are encouraged to spend a minimum of four half days throughout the year becoming familiar with the language and techniques utilized by physical therapy.
Pain Specialists
Fellows are encouraged to spend a minimum of four half days throughout the year becoming familiar with the pain specialists' approach and resources.
Spine Injections
Fellows are encouraged to spend a minimum of four half days throughout the year exposing themselves to the actual performance of this type of procedure.
Back On Track
Swedish Pain and Headache Center has a back school run by the physical therapy program that is two two-hour sessions in a group setting of 8-12 patients; fellows sit in both sessions to:
- Understand how the session is set up
- Get feedback from patients
- Understand how their future practice can develop this resource
Return to Top
Research Activity
Individual Projects
Fellows are expected to choose a research project, or they will have one assigned to them. The timeline follows:
- Topic to be decided by end of August
- Research plan and schedule by end of September
- Outline and abstract draft ready by end of December
- Paper submitted to journal in mid-June
Recommended Reading
Herkowitz Harry N (Ed). Rothman-Simeone, The Spine. Fourth Edition, W. B. Saunders, Philadelphia, 1994.
Menezes Arnold H, Sonntag Volker K (Eds). Principles of Spinal Surgery. McGraw-Hill, Inc., New York, 1996.
Spine/Peripheral Nerve:
Birch R, Bonney G, Wynne P. Surgical Disorders of Peripheral Nerves. Churchill-Livingstone, London, 1998.
Gelberman R (Ed). Operative Nerve Repair and Reconstruction. I. P. Lippincott Co.,Philadelphia, 1991.
Kline D, Hudson A. Nerve Injuries: Operative Results for Major Nerve Injuries, Entrapments and Tumors. W. B. Saunders Co., Philadelphia, 1995.
Lunborg G. Nerve Injury and Repair. Churchill-Livingstone, New York, 1998.
MacKinnon S, Dellon A. Surgery of Peripheral Nerves. Thieme, New York, 1988.
Ormer G, Spinner M, Van Beeb A. Management of Peripheral Nerve Problems. Second Edition,W. B. Saunders Co., Philadelphia, 1998.
Seddon H. Surgical Disorders of Peripheral Nerves. Second Edition, Churchill-Livingstone,Edinburgh, 1975.
Sunderland S. Nerve Injuries and Repair: A Critical Appraisal. Churchill-Livingstone, Edinburgh, 1991.
Sunderland S. Nerve and Nerve Injuries. First and Second Editions, E & S Livingston Stone, London, 1968 and 1978.
Terzis J (Ed). Microreconstruction of Nerve Injuries. W. B. Saunders, Philadelphia, 1987.
Kline D, Hudson A, Kim D. Atlas of Peripheral Nerve Surgery. W. B. Saunders Co., Philadelphia, 2001.
Birch R, Bonney G, Winn-Parry c: Surgical Disorders of the Peripheral Nerve Churchill-Livingston, London 1998.
Dawson D, Hallett M, Millender *I: Entrapment Neuropathies, 2nd Ed, Little and Brown Co., Boston, 1990.
Dellon A: Evaluation of Sensibility and Re Education of Sensation in the Hand, Williams, & Wilkins, Baltimore 1981.
Dyck P, Thomas PK, Asbury A, Winegood A, Porte D: Diabetic Neuropathy, W.B. Sanders Co. Phila, 1987.
Dyck P, Thomas PK: Peripheral Neuropathy 3 rd Ed., W.B. Saunders Co. Philadelphia, 1993
Gelberman, R: (Ed) Operative Nerve Repair and Reconstruction, JB Lippincott, Philadelphia 1991.
Haymaker W, Woodhall B: Peripheral Nerve Injuries. Priniciples and Diagnosis, 2nd Ed. W.B. Saunders Co., Phila. 1953.
Hawkins J, Reed R: Tumors the Peripheral Nervous System AFIP Atlas of Tumor Pathology – 2nd Series, Fasicle 3, AFIP, Washington, D.C. 1968.
Henry AK: Extensile Exposure: Applied to Limb Surgery, Williams and Wilkins, Baltimore, 1945.
Kempe L: Operative Neurosurgery Vol. 2, Springer, NY, 1970.
Kline DG, Hudson AR: Nerve Injuries, Operative Results for Major Nerve Injuries, Entrapments and Tumors W.B. Saunders, Phila. 1995.
Kline DG, Hudson AR, Kim D: Atlas of Peripheral Nerve Surgery, W.B. Saunders, Phila. 2001.
Leffert R: Brachial Plexus Injuries, Churchill Livingstone, Edinburgh 1988.
MacKinnon S, Dellon A: Surgery of the Peripheral Nerve, Thieme, New York, 1988.
Medical Research Council Nerve Injuries MRC was Memorandum No. 7 London, His Majesty's Stationary Office, Balliere Tindall, London 1943.
Midroni G, Bilbao J, Cohen S: Biopsy Diagnosis of Peripheral Neuropathy Butterworth-Heinemann, Toronto 1995.
Omer G, Spinner M (Eds) Management of Peripheral Nerve Problems W. B. Saunders, Phila., 1980.
Omer G. Spinner M VanBeek A, IBID 1996.
Seddon H: Surgical Disorders of Peripheral Nerves, E&S Livingston, Edinburgh and London, 1972.
Seddon H: Peripheral Nerve Injuries, MRC Report 282. Her Majesty's Stationary Office, London, 1954.
Spinner M.: Injuries to the Major Branches of Peripheral Nerves of the Forearm. 2nd Ed., W.B. Saunders, Phila. 1978.
Sunderland S., Nerve and Nerve Injuries, Williams and Wilkins Baltimore, 1968.
Sunderland S., IBID 1978.
Sunderland S., Nerve Injuries and Their Repair: A Critical Appraisal, Churchill Livingston, Edinburgh, 1991.
Woodhall B, Beebe G: Peripheral Nerve Regeneration V.A. Monograph, U.S. Gov't. Printing Office, Washington, DC, 1957.
Rothman-Simeone. The Spine. 1999.
Clark CR. The Cervical Spine. CSRS.
Menezes A. Benzel E. Spine Surgery: Techniques, Complication Avoidance, and Management.
Caspar W. Anterior cervical fusion and interbody stabilization with the trapezial osteosynthetic plate technique. #12 Aesculap.
Aebi M. Principles in Spine Surgery. AO/ASIF.
Aids to the examination of the peripheral nervous system, 4th edition. W. B. Saunders, Philadelphia, 2000.
Grant GA, Goodkin R, Kliot M. Evaluation and surgical management of peripheral nerve problems. Neurosurgery 44:825-40, 1999.
Birch R, Bonney G, Wynn Parry CB. Surgical Disorders of the Peripheral Nerves. Churchill Livingstone, Edinburgh, 1998.
Mackinnon SE, Dellon AL. Surgery of the peripheral nerve. Thieme, New York, 1988.
Gelverman RH. Operative Nerve Repair and Reconstruction. J B. Lippincott Co. Philadelphia, 1991.
Kline DG, Hudson AR. Nerve Injuries. W. B. Saunders, Philadelphia, 1995.
Omer GE, Spinner M, Van Beek AE. Management of Peripheral Nerve Problems, 2nd ed. W. B. Saunders,
Philadelphia, 1998.
Sunderland S. Nerves and Nerve Injuries, 2nd ed. Churchill Livingstone, Edinburgh, 1978.
Turnbull IM. Microvasculature of the human spinal cord. J Neurosurg 35:141-147, 1971.
Lu K, Liang CL, Lee TC, Chen HJ, Su TM, Liliang PC. Changes of bilateral palmar skin temperature in transthoracic endoscopic T-2 sympathectomy. J Neurosurg (Spine 1 Suppl) 92:44-49, 2000.
Milhorat TH, Kotzen RM, Anzil AP. Stenosis of central canal of spinal cord in man: incidence and pathological findings in 232 autopsy cases. J Neurosurg 80:716-722, 1994.
Menezes, AH, Sonntag VKH, Principles of Spinal surgery. McGraw Hill, NewYork, 1995
Rothman, RH, Simeone FA. The Spine. WB Saunders, Philadelphia, 1999
Balliere. Aids to the examination of the peripheral nervous system. Tindall, London, 1986
Omer GE, Spinner M, Van Beek,AL Management of Peripheral Nerve Problems. WB Saunders, Philadelphia, 1998.
Kline DG, Hudson, AR, Kim, DH WB. Atlas of Peripheral Nerve Surgery. Saunders, Philadelphia, 2001
Contact Information
Neuroscience Institute Administrative Office550 17th Avenue
Suite 500
Seattle, WA 98122
Phone: 206-320-2800
Fax: 206-320-2827
8 a.m. - 4:30 p.m.
Map & Directions
Swedish Neurosurgery Fellowship Program
For fellowship inquiries, please contact:
Sue Thomas
Program Coordinator
Phone: 206-320-3782
Program Overview
Upcoming CME Programs
Click here to view all Spine CME programs.
Seattle Science Foundation
Spine Conference
1st & 3rd Wednesdays
6:30-8 a.m.
One Fellow's Story
"I came to SNI for a broader experience that would strengthen my abilities in the future."


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Pag-IBIG Fund would like to welcome you to our Official Website. We encourage you to spend some time browsing and learning more about us and our services. Thank You!
2014 Accomplishment Report
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National Budget Circular 542, issued by the Department of Budget and Management on August 29, 2012, reiterates compliance with Section 93 of the General Appropriations Act of FY2012. Section 93 is the Transparency Seal provision.
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Your opinion is important to us. Please relay to us your suggestions, complaints, or any concern by sending us an E-mail or letter, visiting our Servicing Counters, or calling the Pag-IBIG Fund Hotline 7244244.Thank you for your continued support to the Fund. We look forward to serving you better.


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Advice on upgrading.
by kingkurt360 - 12/21/12 10:22 PM
Bit of a random question but I experience lag when playing newer games like skyrim and farcry3. I have a radeon 6870 1gb ddr5 also an additional 8 GB onboard ram that is only ddr2 not sure the the speed. I was wondering if spending the money on a motherboard capable of supporting ddr3 ram + the ram itself (roughly 150$) or would getting a better graphics card be the way to go?? Would switching from ddr2 to ddr3 have a big impact? Keeping in mind low costs. Would appreciate all advice


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NORFOLK--Joe Flanagan joined a group of women taking a course in stand-up comedy from Ken Phillips in Norfolk. The final exam was doing stand-up at a local club.
Joe, along with Amy Mahon, Karen Causey, Kara Latorella and Alicia Camden attended a workshop with Phillips at the Muse Writers Center in the Ghent.
Phillips has a lifetime of comedy experience, from running clubs and managing talent to performing.
He conducts an eight-week course that takes trainees from impromptu stream-of-consciousness to writing original material.
'So, that's what this course does. If someone wants to do better in sales and marketing I recommend the class. If they want to be a stand-up comedian, if they want to get over the fear of speaking in front of people, it's a great class for that too,' said Philips.
Karen Causey learned how to write but says it was the performance part that was hard.
'Definitely terrified in the beginning. But I've gotten more comfortable over the weeks and I am excited and I am still scared because it's not something that I do normally,' said Causey.
Alicia Camden already has a job working for PETA, but Joe says she's funny!
'It's the Missy department. And I really can't bring myself to shop there cause that's the most offensive thing you can call a grown woman,' quipped Alicia, practicing her stand-up.
Joe says he heard crickets when he practiced his routine.
'Feature act, it takes about four to six years to be a really good feature act. High energy, clean. And about six years, sometimes as many as 10 years, to be a top headliner,' Phillips said.
Kara Latorella isn't a headliner. She's a research engineer at NASA Langley.
'I love donuts. That's not surprising because food is like a religion to me. You'd think I wouldn't eat too much. I am half Italian and half Irish. One hand's drinking and the other hand is talking all the time,' said Latorella as she ran through her monologue during practice.
The new comedy students gathered at the Seaboard Sports Grill in Virginia Beach to take their final.
Philips taught Joe to write about life experiences, so he talked about the time he christened his new boat and was nearly run over in the channel by a giant coal collier.
'And this big thing is rolling past us and friends are like, 'I can see the captain. Look Joe!' I had to call the Coast Guard and get towed in. Miserable first christening with the boat,' Joe joked.
More laughter than crickets this time.
Everyone was appreciated by the audience. Everyone learned that it is best to write and tell stories about their own lives.
'Definitely, because when you are writing about yourself, and you are writing about things you are used to, you feel a little bit more confident about it. You kind of laugh about it, which is the whole point of stand-up anyway,' Amy Mahon said.


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Live Web-based (Webinar) sessions are available for attorneys, law firm administrators, and legal staff members wishing to register for eFiling. The sessions last approximately 90 minutes, with time for questions at the conclusion of the presentation.
If you have previously registered your firm and previously attended training for eFiling and eServing in a particular district court, you do not need to re-register and attend training again. Registration and training is applicable statewide, regardless of when you plan to or are able to eFile in a particular court.
A recording of a live Web-based (Webinar) session is also available for attorneys, law firm administrators, legal staff members, and others wishing to register for eFile and eServe. Viewing this recorded Webinar is an option for those whose schedule does not permit attendance at either the live Web-based (Webinar) sessions or the in-person training sessions in Hennepin County District Court. The recording runs 1 hour and 42 minutes.
Request a Link to a Recorded Webinar- While viewing this recording, you do not need to call in as instructed. Call-ins are only necessary when particpating in the live sessions listed above.
In-person training is being offered by court staff at the Hennepin County Government Center.
Sign up for in-person training in a Hennepin County location
Since September 16, 2013, attorneys have been required to file civil cases electronically in nine more county district courts in addition to Hennepin and Ramsey (Cass, Clay, Cook, Dakota, Faribault, Kandiyohi, Lake, Morrison, and Washington). Carla Heyl, Director, Legal Counsel Division, and Michael B. Johnson, Senior Legal Counsel of the Minnesota State Court Administrator's Office, cover court rules that attorneys need to know about eFiling in Minnesota district courts. Topics covered include common errors by attorneys, the new requirement that all electronically-filed documents must be submitted in a searchable PDF format, eService requirements, and confidentiality requirements, including restrictive identifiers. This CLE is not intended to replace eFile and eServe training (see the options above) that is available for those wishing to register for and use the Judicial Branch eFile and eServe system.
PowerPoint Presentation
Recorded on September 10, 2013, at the Office of the Revisor of Statutes. Presenters: Carla Heyl, Director, Legal Counsel Division, State Court Administrator's Office; Michael Johnson, Senior Attorney, Legal Counsel Division, State Court Administrator's Office. An overview of areas of focus for attorneys that are using eFile & eServe in Minnesota. Learn about: signing up for eService; searchable PDFs; document security classification; case types; and other helpful information.


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More lenses
Mount type
To provide photographers with a broader perspective about mobiles, lenses and cameras, here are links to articles, reviews, and analyses of photographic equipment produced by DxOMark, renown websites, magazines or blogs.
Launched in July 1999, the Canon EF300mm f/2.8L IS USM lens has been one of the most popular super telephoto lenses in the Canon range for wildlife and sports photographers alike. As expected for a super telephoto lens with a constant f/2.8 aperture and an Image Stabilizer, it is right at the top of the tree in terms of cost. But does the performance match the price? DxOMark presents the results, including a comparison of the Canon with the Pentax smc DA Star 300mm f/ 4 ED (IF) SDM, a lens also recently tested in our laboratories.
16 years on from its launch the Canon EF 135mm f/2L prime is still going strong and available to buy brand new today. With a wide maximum aperture, useful telephoto focal length and good build quality it offers some attractive features. Costing $1,000 however it's at the expensive end of the range for a standard telephoto prime. So with newer, fresher and cheaper competition coming on to the market all the time is this old-timer still relevant?
Added by Toshik | January 16, 2013
There are several incorrections in the review. For example sharpness (P-Mpix) score is confused with overall DXomark Score.
For example:
Attached to the APS-C sensored EOS 7D, the EF300mm f/2.8L IS USM once again puts in a strong performance, scoring 16.7P-Mpix, relative to the EOS 7D's resolution of 18megapixels. Equally, the Pentax lens scores very well, managing 15.0P-Mpix compared to the 16.3megapixels available on the K-5. Overall, this shows the EF300mm f/2.8L IS USM is as good as it's made out to be, but in this comparison, the Pentax on a K-5 is not that far behind.
EF300mm f/2.8L IS USM + 7D =11P-Mpix not 16.7P-Mpix as mentioned.
DA Star 300mm f/4 ED (IF) SDM + Pentax K-5=only 7P-Mpix not 15.
Reply | Read all replies for this comment
Added by Nicolas | January 18, 2013
Re: incorrections
There was indeed a mistake.
This part was only talking about DxOMark score.
Thanks a lot for letting us know, it should now be corrected.
Best regards,
Added by Toshik | January 19, 2013
Re: incorrections
Furthermore in the [url=http://www.dxomark.com/index.php/Publications/DxOMark-Reviews/With-new-STM-technology-does-Canon-s-updated-18-135mm-still-deliver/Comparisons]review[/url] of Canon EF-S 18-135mm f3.5-f5.6 IS STM lens
In comparison section:
Tested on the flagship APS-C DSLRs from Canon and Nikon, the 7D and D7000, these two Super Zooms achieve remarkably similar results. Overall we can say they're the same optically although the Nikon version hits a DxOMark Score of 13 just nudging out the Canon with 12.
The screenshot shows us not D7000 but D300 with the score 10 not 13 as mentioned.
Added by Toshik | February 15, 2013
Re: incorrections
Error in screenshot
What does it mean "Not available"?


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Geography is a fundamentally interdisciplinary field, often seen as straddling the natural and social sciences and increasingly drawing upon the arts and other forms of expression and representation. For these reasons, Sarah Lawrence College provides an exciting context, as the community is predisposed to welcome geography's breadth and interdisciplinary qualities. Geography courses are infused with the central questions of the discipline. What is the relationship between human beings and "nature"? How does globalization change spatial patterns of historical, political, economic, social, and cultural human activities? And how do these patterns provide avenues for understanding our contemporary world and pathways for the future?
Two seminars are taught on a regular basis: Introduction to Development Studies: The Political Ecology of Development and The Geography of Contemporary China and Its Place in a Globalizing World Economy. In addition, a lecture course, Food, Agriculture, Environment, and Development, provides students an opportunity to investigate these issues and their connections both in lecture and in group conference activities that include debates and special presentations.
As a discipline built on field study, students in geography classes participate in field trips—most recently, for example, to farming communities in Pennsylvania but also to Manhattan's Chinatown, where students engage aspects of Chinese culture in walks through the community that expose the heterogeneity of China through food, art, religion, and language while simultaneously clarifying the challenges facing recent immigrants and legacies of institutions imbued with racism that are carved into the built environment. That is one of the overarching goals of contemporary geography: to investigate the ways that landscape and place both reflect and reproduce the evolving relationship of humans to each other and to their environments.
Geography courses
- Geographies of Inequality: Planning and Politics in New York City
- Mapping the World? Critical Cartography and GIS for Social and Environmental Justice
- The Geography of Contemporary China: A Political Ecology of Reform, Global Integration, and Rise to Superpower
- The Political Ecology of Global Land Grabs: Food, Resources, Environment, and Development


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Green Machines
These environmentally conscious fans put a new spin on energy efficiency.
Feature Galleries
Vintage industrial touches are right at home in fan design.
This year's Ambiente in Frankfurt offered a cross-category assortment that showcased fresh forms and directional hues. Home Fashion...
Things look up as this category graduates from plain-Jane commodity to close-to-ceiling statement.
New versions of existing solid-state products offer increases in efficiency, output and cost-effectiveness.


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Got the captcha problem fixed looking into the reply thing.
I'm thinking it might have to do something with the usergroups not 100% sure yet.
Everyone should be able to see the editing tools now!
Is it just me or is the "hot thread with new topic" and the "hot thread with no new topic" envelopes the same color? I usually use the color coding to scan the new posts. Lately I've been checking the dates.
Hey Nick, I just noticed realized that I created a BBCode for google maps on our old board and created this thread on the board to utilize it. Can you make a BBCode so that map can be view on the board again?
"...a glass can only spill what it contains..."
Along those lines....is it possible to get a user map like discgolfersr.us has? It would be nice to know who's close to what course so if I head out somewhere I could contact somebody to play.
I think it would be good for meeting new players from the boards to play with and could be a nice addition for bag tags too.
There are currently 1 users browsing this thread. (0 members and 1 guests)


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At Grainger, your career path is important to us. We work hard to foster an exciting and challenging environment that encourages independent thinking, problem solving and growth. We offer a complete career path geared towards your success. Check it out!
Grainger helps customers save money and time, by getting them the right products to keep their facilities up and running.
We serve over 2 million businesses and institutions worldwide. These organizations have facilities - and challenges - unique to them, yet they share the same requirement: When they need a product, they often need it right away. We're there for them.
Our team - over 18,000 strong - works closely with customers to understand their challenges and provide cost-saving, time-saving, headache-saving answers. We serve customers more than 115,000 times a day, through a variety of channels.
A Fortune 500 company, Grainger posted 2011 sales over 8 billion. The company is a perennial member of Fortune magazine's list of Most Admired Companies.


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Toppings, Honey & Spreads
- Butternut Mountain Farm Maple Syrup $16.95 – $39.95
Dessert Toppings, Food Toppings & Gourmet Toppings
It is no secret that Dessert Toppings hold the power to kick your after dinner delicacy up a notch or two. Our carefully selected collection of gourmet toppings and food toppings includes honey, spreads and dessert sauces that are delicious. Adding these toppings gives you a chance to get innovative with your everyday food and makes it interesting. You can choose from delicious offerings such as lemon curd, strawberry ice cream topping, salted caramel sauce and more. All you need is to cut open a pack of one of our cupcake mixor breakfast mixes that will allow you to prepare a variety of dishes in no time.


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Select the tabs in the bid tracker to view anticipated bids, bids in development, open bids, and the status of submitted bids. You can also use the bid tracker to download bid documents, review bid tabulations and review Park District vendor contract documents.
The Chicago Park District's playgrounds and play lots provide various types of playground equipment for use by park patrons. The equipment is in constant need of maintenance to keep it in safe condition.
The Chicago Park District is anticipating an Invitation For Bid for waste and recycling containers.
Note: to view the actual contract documents, please visit our Contracts Library.


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YPF Partners Update
What do Chardonnay and truck tires have in common? They are two of the many ways corporate partners are making a difference in Yellowstone...
Next time you're at a restaurant in Yellowstone National Park, enjoy a bottle of Fetzer wine along with the knowledge you are helping Yellowstone and supporting environmental sustainability.
The Yellowstone Park Foundation, with the help of Yellowstone concessioners Xanterra Parks & Resorts and Delaware North Companies, has partnered with Fetzer Vineyards to benefit the Park. For each bottle of Fetzer wine -- or wine from sister-vineyard Bonterra -- purchased at a Yellowstone restaurant or store, Fetzer will donate $1 to the Yellowstone Park Foundation.
Fetzer Vineyards adopted sustainable operations practices nearly two decades ago, and has been a leader in growing organic grapes. Fetzer and Bonterra Vineyards use solar energy, have dramatically reduced water and glass usage, and employ composting and recycling procedures that allow them to be zero-waste facilities. In fact, in 2007 the U.S. Environmental Protection Agency awarded Fetzer a "Best-of-the-Best" Ozone Protection Award.
Learn more about what Fetzer, Xanterra, and Delaware North are doing to reduce their environmental footprints.
Yellowstone has more than 460 miles of roads to maintain and more than three million visitors to welcome each year. Michelin is helping the Park achieve its goal to reduce its greenhouse gas emissions by 30 percent by the year 2016 by providing its green, energy-saving tires for the Park's fleet.
Since then, Michelin has provided green, fuel-saving tires to a wide variety of vehicles in the Park, including dump trucks, front-end loaders and other service vehicles. Often unseen by visitors, these work vehicles are essential to maintaining the Park for visitors and staff. Check out on YouTube how these work vehicles are using Michelin tires in Yellowstone.
Assuring that the fleet is fuel-efficient saves money and significantly reduces carbon emissions, plus the Michelin tires are lasting twice as long as the previous tires, further reducing environmental impact.
Yellowstone's historic Lamar Buffalo Ranch has become an important home base for hundreds of youth participants in Expedition: Yellowstone! each spring and fall, and for students of the Yellowstone Institute each summer. It is also becoming a showcase for promoting environmental stewardship, and through the YES! Initiative, the Yellowstone Park Foundation is working to help further increase energy efficiency and decrease water use. Currently, around 70% of all electricity used at the Ranch is produced by the sun, but the remaining 30% comes from an inefficient propane generator.
We are pleased to announce that Kohler has recently unveiled a new, technologically advanced propane generator, the XP 100, and has donated one for the Buffalo Ranch. It has the ability to operate in the Park's severe winters – rated to minus 50 degrees Fahrenheit – and with substantial reductions in greenhouse gas emissions over traditional generators. Yellowstone will be the first location west of the Mississippi to use this new generator.


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Politwoops no longer follows this account.I'm using @TweetBackup by @backupify to archive my tweets http://t.co/6pW13h35
An archive of the public statements deleted by U.S. politicians. Explore the tweets they would prefer you couldn't see.
To meet the Twitter API Terms of Service, all deleted tweets shown here since June 22, 2012 have been reviewed and approved by the Sunlight Foundation.


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Bob Marshall, CEO, Earth Networks
Click below to hear the interview
Jump to main content.
Tuesday - 2/1/2011, 11:33am EST
Click below to hear the interview
More data on greenhouse gases will be flowing into the National Oceanic and Atmospheric Administration. The agency has teamed up with Earth Networks (formerly AWS Convergence Technologies), which will provide NOAA with the data for use in research. Earth Networks runs Weather Bug, which monitors and distributes global weather information. Bob Marshall, CEO of Earth Networks, joins us to discuss the goals of the partnership.