text:
Characteristics and effects of nurse dosing over-rides on computer-based intensive insulin therapy protocol performance
Objective To determine characteristics and effects of nurse dosing over-rides of a clinical decision support system (CDSS) for intensive insulin therapy (IIT) in critical care units.
Design Retrospective analysis of patient database records and ethnographic study of nurses using IIT CDSS.
Measurements The authors determined the frequency, direction—greater than recommended (GTR) and less than recommended (LTR)— and magnitude of over-rides, and then compared recommended and over-ride doses' blood glucose (BG) variability and insulin resistance, two measures of IIT CDSS associated with mortality. The authors hypothesized that rates of hypoglycemia and hyperglycemia would be greater for recommended than over-ride doses. Finally, the authors observed and interviewed nurse users.
Results 5.1% (9075) of 179 452 IIT CDSS doses were over-rides. 83.4% of over-ride doses were LTR, and 45.5% of these were ≥50% lower than recommended. In contrast, 78.9% of GTR doses were ≤25% higher than recommended. When recommended doses were administered, the rate of hypoglycemia was higher than the rate for GTR (p=0.257) and LTR (p=0.033) doses. When recommended doses were administered, the rate of hyperglycemia was lower than the rate for GTR (p=0.003) and LTR (p<0.001) doses. Estimates of patients' insulin requirements were higher for LTR doses than recommended and GTR doses. Nurses reported trusting IIT CDSS overall but appeared concerned about recommendations when administering LTR doses.
Conclusion When over-riding IIT CDSS recommendations, nurses overwhelmingly administered LTR doses, which emphasized prevention of hypoglycemia but interfered with hyperglycemia control, especially when BG was >150 mg/dl. Nurses appeared to consider the amount of a recommended insulin dose, not a patient's trend of insulin resistance, when administering LTR doses overall. Over-rides affected IIT CDSS protocol performance.
- Health-information exchange
- qualitative/ethnographic field study
- system implementation and management issues
- surveys and needs analysis
- social/organizational study
- improving the education and skills training of health professionals
- machine learning
- clinical decision support system
- intensive insulin therapy
- nurse protocol
- critical care
- intensive care unit
- over-ride
Intensive insulin therapy (IIT) is the standard of critical care, but recent studies questioned the treatment's mortality benefit and safety.1–4 Intensive care units commonly employ IIT, a nurse-driven treatment combining frequent blood glucose (BG) measurements and insulin titrations, to achieve tight control of patients' BG levels (eg, 80–110 mg/dl). Factors affecting IIT performance include patient populations, BG monitoring techniques, BG target ranges, nutrition provisions, nurse staffing ratios, and molecular and cellular features.5 Institutions increasingly use computerized clinical decision support systems (CDSS) to deliver protocol-based IIT,6 ,7 and computer-based workflow has been identified as another source of variability affecting IIT.6 ,8–10 Researchers have shown a relationship between timing of BG measurements and hypo- and hyperglycemia.9 ,10 Previously, we demonstrated the effect of data-entry error on IIT CDSS recommendations and BG variability.8 In the present study, we examined nurse insulin-dosing over-rides, or deviations from IIT CDSS protocol recommendations, to determine if and how the behavior affected IIT performance.
Existing studies have measured the frequency and rationale of nurse over-rides, but little is known about the quantitative characteristics of IIT CDSS over-rides and their effect on BG variability and insulin resistance, two measures of IIT CDSS protocol performance associated with mortality.11 ,12 Compliance with IIT CDSS recommendations at other institutions varies from 77%13 to up to 98%.10 ,14 ,15 Nurses' reasons for over-rides include concerns about hypoglycemia due to data trends, administration of glucose-affecting medications, and comorbidities15; disagreement with dose recommendations14 ,15; and workflow issues.14 ,15 The objective of this study was to determine the conditions leading to and resulting from nurse over-ride of IIT CDSS recommendations. We compared BG variability and insulin resistance when nurses administered recommended and over-ride doses. We hypothesized that rates of hypoglycemia and hyperglycemia would be greater for recommended than over-ride doses. Additionally, we used ethnographic methods to understand nurse perceptions of IIT CDSS and the manner in which nurses over-rode system recommendations.
The Vanderbilt University Institutional Review Board approved this study.
This study examined IIT CDSS usage in the 21-bed surgical and 31-bed trauma intensive care units (SICU and TICU) at Vanderbilt University Hospital, a 501-bed academic urban tertiary care facility in Nashville, Tennessee. Critical-care attending physicians from the Division of Trauma and Surgical Critical Care oversaw unit management and patient-care decisions using evidence-based protocols intended to standardize care and reduce practice variability.16–18 Although clinicians in other intensive care units at the institution treated patients using IIT CDSS, we focused our investigation on SICU and TICU because of the units' common management and care processes. On average, the ratio of patients to nurses was 2:1 overall and 1:1 for complex patients. All patients admitted to the SICU and TICU received regular human insulin and standardized nutrition.
SICU piloted IIT CDSS in November 2004 and required nurses to treat all eligible patients using IIT CDSS starting in December 2005.19 In June 2005, IIT CDSS was modified to require nurses to identify a patient's primary dextrose source and automatically trigger an order for intravenous 10% dextrose if a patient had no primary dextrose source and a current BG less than 80 mg/dl. The intent of the change was to minimize hypoglycemia. TICU implemented IIT CDSS as the standard of care in October 2005.20 The IIT CDSS recommendation algorithm has remained unchanged since November 2004, and SICU and TICU researchers have demonstrated effective hyperglycemia control with limited hypoglycemia.19 ,20 We investigated all SICU and TICU IIT CDSS recommended and over-ride doses over the period of this study.
IIT CDSS description
Critically ill or injured20 mechanically ventilated patients with a BG value above 110 mg/dl received IIT according to a protocol embedded in the institution's computerized order entry system. Clinicians accessed the order entry system using desktop computers located near the bedside. Figure 1 depicts the IIT CDSS workflow.
As described elsewhere,6 ,8 ,19 ,20 a physician confirmed the initial protocol order, which directed a nurse to measure a patient's BG and administer insulin according to CDSS recommendations at 1 or 2 h intervals to maintain BG between 80 and 110 mg/dl. IIT CDSS instructed a nurse to administer an intravenous 50% dextrose dose in 5 ml increments19 and recheck the patient's BG in 1 h if BG was less than 80 mg/dl. For BG less than 60 mg/dl, the protocol additionally instructed a nurse to stop insulin administration for 1 h. All other IIT CDSS protocol iterations occurred at 2 h intervals. IIT CDSS did not remind nurses to measure BG. Nurse adherence to the protocol's timing of BG measurements was 86%; 8% of measurements were taken late.9
Based on Bode21 and White's22 dosing equation, IIT CDSS adjusted a coefficient 'multiplier,' an estimate of a patient's insulin resistance according to current and previous BG measurements, for use in this formula: insulin dose in units/h=(current BG in mg/dl–60)×multiplier.19 The multiplier was initially set to 0.03, but increased by 0.01 when BG levels indicated hyperglycemia, decreased by 0.01 if BG was less than 80 mg/dl, decreased by 0.02 if BG was less than 60 mg/dl, and could not fall below zero.19 A greater multiplier value reflected increased insulin resistance. After the initial order set the multiplier, IIT CDSS obtained the previous multiplier not by retrieving it from the system database but by solving the dosing formula using the previous BG and insulin rate stored by the order entry system as inputs (ie, multiplier=insulin dose/(previous BG–60)).
IIT CDSS calculated recommendations using the formula and logic above after a nurse manually transcribed, or entered via keyboard, a BG value obtained from a handheld testing device, selected a patient's primary dextrose source from a list of radiobuttons, and clicked the 'calculate recommendations' button.6 ,8 ,19 ,20 If a nurse agreed with the recommended dose displayed on screen, he or she clicked the 'submit' button to accept the recommendation. If a nurse disagreed with the recommended dose, he or she replaced the recommended dose value via keyboard and then clicked the 'submit' button to over-ride the recommendation. After a nurse clicked the 'submit' button, the order entry system updated the existing order and logged the insulin rate, multiplier, over-ride status, BG value, primary dextrose source, and timestamp along with patient and nurse identifiers. The nurse then adjusted the intravenous insulin pump to use the IIT CDSS insulin rate. There was no electronic interface between intravenous insulin pumps and clinical information systems. Handheld testing devices stored each BG value with a timestamp as well as a nurse identifier and patient medical record number; nurses recorded these identifiers by scanning barcodes or entering them manually. At the beginning of each 12 h nursing shift, a nursing assistant collected all handheld BG testing devices and placed them in docking stations for transfer to the clinical data repository.6
Retrospective data collection and analysis
We retrospectively collected order entry and handheld BG testing device data from the institution's clinical data repository for all SICU and TICU patients with more than five IIT CDSS values between 1 November 2004 and 1 February 2009. We stored study data in a secure, password-protected database and deidentified data prior to analysis and reporting.
Because IIT CDSS logged both recommended and over-ride doses that nurses administered but not calculated doses nurses elected to over-ride (eg, IIT CDSS calculated an insulin dose of 4.2 U/h that the nurse over-rode with 2.2 U/h; the system logged 2.2 U/h but not the calculated 4.2 U/h), we recreated the conditions for each insulin administration to determine calculated doses. For each patient, we processed BG values and insulin rates to determine multiplier and recommendations per the IIT CDSS dosing algorithm. If the care team discontinued and later reinitiated the protocol for a patient, we treated these as separate runs of IIT CDSS to assure correct calculation of recommendations and comparison of BG values. We identified instances that did not recreate multipliers and/or recommended insulin doses in the log data. To control for the effect of keystroke error of BG values contributing to over-ride decisions, we linked each IIT CDSS BG value with a corresponding device BG value and identified pairs of mismatched values as well as IIT CDSS values lacking a device value.8 To assure quality, we examined only recommended and over-ride instances with successfully recreated output and matching BG values8 so that we could reliably determine calculated doses in the event of over-ride.
We determined the frequency, BG variability, and insulin resistance associated with recommended and over-ride doses. We divided over-rides into greater than recommended (GTR) and less than recommended (LTR) doses. Additionally, for each over-ride dose, we computed the degree of deviation of an actual dose from a calculated dose by determining the absolute value of the difference of the actual dose and the calculated dose divided by the actual dose.23 We identified three types of deviations: 'small' as ≤25%, 'medium' as 26% to 49%, and 'large' as ≥50%.23
Previous studies have associated BG variability and insulin resistance with mortality in SICU and TICU patients treated with IIT CDSS.11 ,12 Several measures of BG variability have been correlated with mortality in critically ill patients.24 ,25 To assess BG variability, we examined BG values before (BGn−1), during (BGn), and after (BGn+1) each insulin administration (n) for both recommended and over-ride doses. Additional measures of BG variability included successive BG change, which reflects both regular and abrupt fluctuations in the distribution of BG values,12 as well as hypoglycemia and hyperglycemia, which measure IIT safety and effectiveness, respectively. We defined hypoglycemiai ,26 as BGn ≥ 60 mg/dl at the time of dose followed by subsequent BGn+1 <60 mg/dl and hyperglycemiaii as BGn<200 mg/dl at the time of dose followed by subsequent BGn+1≥200 mg/dl. Thresholds of 60 and 200 mg/dl for hypoglycemia and hyperglycemia, respectively, are common in the IIT literature, although definitions vary across studies.27 We assumed nurses performed IIT CDSS iterations independently; thus, we considered BG input to be correct and examined each dose instance BG value along with immediately preceding and succeeding dose BG values. Although the timing of IIT CDSS iterations varied,9 we assumed nurses made a good-faith effort to adhere to the protocol, and we evaluated records chronologically for each patient. To assess insulin resistance,11 a proxy for the body's stress response and BG metabolism related to illness severity and mortality risk,11 ,12 we compared insulin dose and multiplier between recommended, GTR, and LTR doses. For over-ride instances, we compared actual versus calculated insulin doses. Greater insulin dose and multiplier levels indicated greater insulin resistance.11
We summarized and compared normally distributed continuous variables using mean±SD and two-sample t tests for independent samples. For non-normally distributed continuous variables, we summarized and compared data using median and IQR and used the Wilcoxon rank-sum test for unpaired data and Wilcoxon signed rank test for paired data. To compare differences in proportions, we used a χ2 test. Data represent grand summaries of IIT data and do not address repeated measures within patients. A two-sided p value of <0.05 indicated statistical significance. We used STATA version 10.1 to perform calculations.
Ethnographic data collection and analysis
To understand over-ride behavior in the context of actual system use, a researcher trained in ethnographic methods (TRC) conducted 49 h of direct observation and unstructured interviews with 25 nurses using IIT CDSS in SICU and TICU between 16 February 2010 and 18 March 2010 as part of a larger investigation of IIT CDSS with respect to other clinical information systems and care processes. Having completed a pilot study6 and quantitative analysis of data entry8 and over-ride behavior, the researcher was familiar with use of the system studied. In sessions lasting 2 to 3 h, the researcher followed one or more nurses through clinical shift work. Observations focused on the interaction of people, process, and technology in IIT CDSS delivery while unstructured interviews clarified observations. While conducting observations and interviews, the researcher used pen and paper to record narrative text and direct quotes describing nurse use of and attitudes toward IIT CDSS. Notes were then transcribed electronically for subsequent analysis. Verbal assent was obtained from clinicians, patients, and families (if present) before data collection. Data were analyzed inductively using a grounded theory28 approach to allow themes to emerge. Data collection concluded after reaching a point of saturation when observations no longer yielded new concepts.28 As in other qualitative informatics studies29 using ethnographic methods,30 ,31 we ensured analytical rigor by using standard techniques of naturalistic inquiry including peer debriefing, member checking, and prolonged engagement.32
Retrospective data analysis
Table 1 presents patient demographics. 203 188 IIT CDSS instances and 423 463 BG testing device values were available. Figure 2 shows the IIT CDSS instances included and excluded from dose analysis. Manual process error by nurses and nursing assistants explains the presence of missing and mismatched data excluded from this analysis (appendix 1, available as an online data supplement at www.jamia.org). During the process of data cleaning and determining descriptive statistics, we discovered through a manual review that IIT CDSS misidentified 27 instances as over-rides that had actual doses equal to calculated doses, which may have resulted from users modifying existing insulin orders. We analyzed dosing for the remaining 179 452 IIT CDSS instances.
|Surgical intensive care unit
|Trauma intensive care unit
|Study period
|1 November 2004–1 February 2009
|5 October 2005–1 February 2009
|Patients admitted, no
|Patients treated with intensive insulin therapy clinical decision support system, no (%)
|1883 (35.1%)
|2152 (26.3%)
|Age, years
|Male sex
|1130 (60%)
|1576 (73%)
|Body mass index, kg/m2
|Admission service
|71 (3.8%)
|2044 (95%)
|Liver transplant
|342 (18.2%)
|Emergency general surgery
|338 (18.0%)
|Vascular surgery
|194 (10.3%)
|General surgery
|154 (8.2%)
|62 (2.9%)
|Cardiac/thoracic surgery
|119 (6.3%)
|1 (<0.1%)
|Oncology/endocrine surgery
|97 (5.2%)
|1 (<0.1%)
|83 (4.4%)
|76 (4.0%)
|20 (0.9%)
|409 (21.7%)
|24 (1.1%)
|Acute Physiology and Chronic Health Evaluation II (surgical intensive care unit)
|Injury Severity Score (trauma intensive care unit)
|History of diabetes
|206 (10.9%)
|71 (3.3%)
|Hospital length of stay, days
|Intensive-care-unit length of stay
|Hospital mortality
|284 (15.1%)
|323 (15.0%)
Data represent mean±SD unless noted.
Over-rides accounted for 5.1% of IIT CDSS activity, of which 83.4% of over-ride doses were less than recommended and the remainder greater than recommended (table 2). The majority of greater than recommended doses differed from calculated doses by a small deviation whereas the plurality of less than recommended doses differed from calculated doses by a large deviation.
|IIT CDSS doses, n (%) (N =179 452)
|Degree of over-ride deviation, n (%)
|Small (≤25%)
|Medium (26–49%)
|Large (≥50%)
|Recommended doses: 170 377 (94.9%)
|Over-ride doses: 9075 (5.1%)
|3966 (43.7%)
|1549 (17.1%)
|3560 (39.2%)
|Greater than recommended: 1505 (16.6%)
|1188 (78.9%)
|202 (13.4%)
|115 (7.6%)
|Less than recommended: 7570 (83.4%)
|2778 (36.7%)
|1347 (17.8%)
|3445 (45.5%)
Nurses chose to over-ride 5.1% of intensive insulin therapy (IIT) clinical decision support system (CDSS) recommended insulin doses, and more than four out of five over-ride doses were amounts less than those recommended by IIT CDSS.
When examining insulin administration by BG band (table 3), nurses administered the highest proportion of recommended doses when BG was <60 mg/dl (recommended dose was zero) and the lowest proportion when BG was 60–80 mg/dl. The number of less than recommended doses exceeded the number of greater than recommended doses in every BG band, including when BG exceeded 110 mg/dl, except when BG was less than 60 mg/dl and the protocol instructed nurses not to administer insulin.
|Recommended, n (%)
|2113 (99.8%)
|9262 (87.0%)
|73 045 (96.0%)
|64 543 (95.5%)
|16 521 (93.2%)
|4893 (92.4%)
|Greater than recommended
|4 (0.2%)
|66 (0.6%)
|411 (0.5%)
|489 (0.7%)
|336 (1.9%)
|199 (3.8%)
|Less than recommended
|0 (0%)
|1321 (12.4%)
|2639 (3.5%)
|2531 (3.7%)
|873 (4.9%)
|206 (3.9%)
Percentages are based on column total, and BG values ranges are presented in mg/dl. The protocol specifies that nurses should not administer insulin when BG <60 mg/dl.
Nurses administered the highest proportion of less than recommended doses when BG was 60–80 mg/dl and greater than recommended doses when BG was >200 mg/dl. However, the number of greater than recommended doses did not exceed the number of less than recommended doses when BG was >200 mg/dl.
BG values differed before, during, and after each insulin administration for recommended greater than recommended and less than recommended doses (table 4).
|R versus GTR
|R versus LTR
|BG (mg/dl), mean±SD before (BGn−1)
|BG mean±SD during (BGn)
|BG mean ± SD after (BGn+1)
|BG change before (BGn−1–BGn)
|BG change after (BGn–BGn+1)
|Hypoglycemia, n (%)
|1872 (1.1%)
|12 (0.8%)
|64 (0.8%)
|1411 (0.8%)
|23 (1.5%)
|118 (1.6%)
As shown in figure 3, recommended doses showed a gradual trend of BG values toward the protocol target range as evidenced by downward trends for mean BG and high BG (+1 SD) and a slight upward trend in low BG (−1 SD). The BG value following a recommended dose was lower than those following greater than recommended and less than recommended doses. Greater than recommended doses showed a pronounced downward BG trend with hyperglycemic BG levels preceding and at the time of dose followed by a continued downward trend.
Greater than recommended insulin administration appears to have reduced elevated BG levels on average and for high BG and maintained levels in the target range for low BG (figure 3). BG values following administration of a greater than recommended dose were mostly higher than those following recommended and less than recommended doses. Less than recommended doses showed a pronounced upward trend with lower BG values preceding and at the time of dose compared to recommended and greater than recommended doses. A continued upward trend followed and resulted in BG values out of range for mean and high BG and in range for low BG (figure 3). BG values following less than recommended doses were higher than those following recommended doses.
Most measures of successive BG change, hypoglycemia, and hyperglycemia differed between recommended, less than recommended and greater than recommended doses (table 4). Successive BG change before and after each insulin administration differed for recommended (p<0.001) and less than recommended doses (p<0.001) but not for greater than recommended doses (p=0.621). The proportion of hypoglycemia was significantly greater for recommended doses than for less than recommended doses (p=0.033); however, the proportion of hypoglycemia was not significantly greater for recommended doses than for greater than recommended doses (p=0.257). The proportion of hyperglycemia was significantly lower for recommended doses compared to greater than recommended doses (p=0.003) and less than recommended doses (p<0.001).
Table 5 summarizes the insulin-resistance parameters. Comparing overall calculated insulin dose, recommended differed significantly from greater than recommended (p<0.001) and less than recommended (p=0.002) doses. Hypoglycemia and hyperglycemia occurred infrequently, and some insulin parameters differed for these conditions between recommended, greater than recommended and less than recommended doses. When nurses administered less than recommended doses overall and in the event of hyperglycemia, the multiplier was dramatically elevated compared to recommended doses.
|R versus GTR
|R versus LTR
|Overall, n (%)
|170 377 (94.94%)
|1505 (0.84%)
|7570 (4.22%)
|Actual dose, median (IQR)
|3.9 (1.7 to 6.1)
|6.0 (3.1 to 9.0)
|2.5 (0.4 to 4.6)
|Calculated dose
|4.8 (2.3 to 7.4)
|3.7 (0.8 to 6.7)
|0.068 (0.042 to 0.110)
|0.066 (0.029 to 0.102)
|0.080 (0.043 to 0.118)
|Hypoglycemia, n (%)
|1872 (1.04%)
|12 (0.01%)
|64 (0.04%)
|Actual dose
|5.1 (1.8 to 6.8)
|5.1 (2.4 to 7.8)
|2.0 (0 to 4.5)
|Calculated dose
|3.3 (1.1 to 5.5)
|2.45 (0 to 5.0)
|0.080 (0.045 to 0.115)
|0.065 (0.024 to 0.106)
|0.057 (0.030 to 0.084)
|Hyperglycemia, n (%)
|1411 (0.79%)
|23 (0.01%)
|118 (0.07%)
|Actual dose
|4.1 (1.8 to 6.5)
|5.0 (2.8 to 7.3)
|2.25 (0 to 5.3)
|Calculated dose
|3.0 (1.1 to 4.9)
|4.55 (0 to 8.9)
|0.060 (0.026 to 0.095)
|0.030 (0.019 to 0.041)
|0.085 (0.053 to 0.116)
Ethnographic data analysis
Nurses said they trusted IIT CDSS because it was evidence-based and made appropriate recommendations. Typically nurses transcribed BG values, selected other required parameters, clicked the calculate button, and accepted recommendations within 2 s and without objection. However, when electing to over-ride, nurses appeared concerned about on-screen insulin recommendations (eg, wincing facial expressions upon seeing doses), which nurses said were higher than they felt comfortable dispensing. Asked to explain over-ride decisions, nurses cited BG trends, primary dextrose sources, general intuition, and a desire to prevent patients' BG levels from 'bottoming out' in hypoglycemia. Nearly all over-rides observed were to administer less than recommended doses. Nurses said they found IIT CDSS to be valuable but cited the time required to administer the therapy, especially during episodes of hypoglycemia or emergent care situations, along with additional documentation of BG, insulin, and primary dextrose source data in a separate nurse charting system as impediments to workflow.
Nurses expressed favorable attitudes toward a CDSS for IIT and administered 94.9% of recommended insulin doses. Although studies from other institutions have reported IIT CDSS over-ride rates,10 ,13–15 this investigation is the first to our knowledge to determine the direction and magnitude of over-rides. Nurses elected to over-ride 5.1% of dosing recommendations generated using a commonly adopted algorithm, and 83.4% of over-ride doses were less than recommended by CDSS; 45.5% of these doses were ≥50% less than recommended. For over-ride doses, the rate of hypoglycemia was lower and the rate of hyperglycemia higher compared to recommended doses. Nurse over-rides emphasized prevention of hypoglycemia, reflecting the 'fear of hypoglycemia' in intensive care units,33 and occasionally interfered with hyperglycemia control.
Recommended, less than recommended and greater than recommended insulin doses exhibited significantly different BG variability and insulin-resistance characteristics, and may represent different populations. When nurses administered less than recommended doses overall, patients required more insulin as estimated by the multiplier than when nurses administered recommended and greater than recommended doses. This behavior suggests that nurses considered the amount of a recommended dose, not the trend of past insulin resistance, when over-riding IIT CDSS with less than recommended doses. Results of the ethnography help us understand this observation, as nurses appeared concerned about on-screen insulin recommendations prior to administering less than recommended doses.
Based on BG and insulin trends observed in this study, we have identified opportunities to improve IIT CDSS protocol compliance and BG control through nurse education, interface changes, and algorithm modifications. Although mean BG following administration of less than recommended doses increased to clinically acceptable levels below 140 mg/dl5 (figure 3), BG nonetheless moved away from the target range. Current IIT CDSS recommendations may be sufficient and require user training to encourage nurses to administer recommended doses more frequently instead of less than recommended doses. The system studied displayed BG trends on screen, and showing the multiplier value on screen might provide decision support regarding patients' insulin resistance to prevent nurses from administering less than recommended doses as frequently. However, displaying the multiplier may also create visual clutter and confusion. For high BG, BG levels following less than recommended doses continued above 150 mg/dl after increasing prior to the dose (figure 3). An alert triggered when BG increases from below to above 150 mg/dl might encourage users to administer a recommended insulin dose instead of an less than recommended dose. When BG was below the target range, nurses administered less than recommended doses that were followed by BG values in the target range (figure 3). Changing the protocol logic to reduce the multiplier by 0.02 rather than 0.01 when BG is <80 mg/dl will generate lower recommended insulin doses that nurses might be more likely to accept, increasing protocol adherence and potentially BG target range achievement.
The 94.9% IIT CDSS protocol compliance rate observed in this study compares to 77%,13 91%,14 94%,14 ,15 95%,14 97%,10 and 98%14 at other institutions. Variation in compliance across sites may be explained by differences in case mix and other concurrently administered therapies as well as IIT CDSS protocol and workflow differences.27 In this study, nurses accessed IIT CDSS through a computerized provider order entry system, a central part of the institution's workflow that facilitated improved IIT protocol compliance.19 However, nurses also documented IIT CDSS data in a separate nurse charting system, reducing the time nurses could spend on direct patient care including IIT. Clinical information systems developers should try to reduce double documentation of IIT CDSS data to maximize care process efficiency. This investigation identified sociotechnical interactions involved in nurse IIT CDSS over-rides, and we recently completed a broad ethnographic investigation aimed at understanding how IIT CDSS affects and is affected by other care processes, clinical information systems, and personnel. Explicit disclosure of computer-based workflow factors will facilitate comparison of IIT CDSS studies.7 ,27
The strengths of our study include the use of a large data set derived from clinical practice in an institution with cultural acceptance of clinical information systems. Several institutions34–37 use a similar dosing equation21 ,22 to that studied, so results may be generalizable to other critical care unit settings. Limitations include conclusions not being generalizable to other settings due to high clinical informatics commitment38–42 at the study institution; the unit of analysis being the data point rather than the patient; the observational study design; and measurement of glucose control instead of achievement of therapy goals including reduced rates of infection and cognitive impairment.5 Additionally, we excluded almost 12% of IIT CDSS instances from dose analysis to ensure data quality and recognize the over-ride rate could be greater than reported. Missing data, failure to reproduce log data, and incorrectly marked system over-rides can occur due to device malfunction, data-transfer failure, undocumented code changes, and other process errors inherent to the ecology of clinical information systems. Mismatched BG data affect IIT CDSS recommendations,8 and we encourage investigators to similarly control for data discrepancies when conducting clinical research. This study used qualitative methods drawn from the field of ethnography to illuminate user behavior, which decision support43 ,44 and over-ride researchers45 have advocated. Although only one researcher conducted the ethnographic observations, several useful studies in the informatics literature have also been conducted by single researchers.31 ,46–50
By examining insulin resistance and BG variability for recommended, greater than recommended and less than recommended IIT CDSS doses, we identified potential modifications to IIT CDSS that might improve protocol compliance and BG control. This investigation focused on IIT CDSS using a linear equation,21 ,22 and more sophisticated quadratic or model-based approaches might lead to better performance.51 ,52 Examining how nurse over-ride behavior changes over time may also provide insight to improve IIT CDSS performance. Researchers and practitioners at other institutions may find our approach useful for understanding and improving IIT CDSS.
Nurse over-ride of CDSS dosing recommendations is a source of variability in IIT in critical care unit settings. Nurses accepted almost 95% of IIT CDSS recommendations, but when electing to over-ride, nurses overwhelmingly administered insulin doses that were less than recommended. Nearly all measures of BG variability and insulin resistance differed between recommended, less than recommended, and greater than recommended IIT CDSS doses. When over-riding IIT CDSS with less than recommended doses, nurses appeared to consider the amount of a recommended insulin dose, not the patient's trend of insulin resistance. For the system studied, nurse education, interface changes, and algorithm modifications might improve BG control while minimizing hypoglycemia. Examining the frequency, direction, and magnitude of IIT CDSS over-rides and associated BG variability and insulin resistance might be useful to researchers and practitioners at other institutions seeking to improve IIT CDSS protocol performance.
TRC received support from National Library of Medicine Training Grant NLM T15 007450-07.
Ethics approval
Ethics approval provided by Vanderbilt University Institutional Review Board.
Provenance and peer review
Not commissioned; externally peer reviewed.
The authors thank D Carr, G Holder, and anonymous JAMIA reviewers for manuscript feedback.
- © 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.


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Publication Date: 2011
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Publisher's Description
Gil Montgomery had his life all planned out, until a roadside bomb in Iraq ended his army career. When his dad suggested he work for him at the Hazy Holloway Ranch, Gil wasn't too thrilled with the idea; but, he needed a job and there were worst things he could be doing with his time.
Gil is used to taking orders, even from women. What he isn't prepared for are the feelings this little firecracker of a woman triggers in him. The unexpected death of her husband has left her jaded and afraid to risk her heart getting broken again. Somehow, he has to gain her trust and prove he isn't going anywhere.
Product Reviews
touchdownOHAge: 55-65Gender: female5 Stars Out Of 5title is deceivingMay 3, 2012touchdownOHAge: 55-65Gender: femaleQuality: 5Value: 5Meets Expectations: 5Yes I wrote the title is deceiving. When I saw it and the picture on the front cover, I thought another predictable love story. I should have known better. After all Anne Patrick did write it and she never fails to satisfy. Compared to the cover the love part of this book is a quiet growing love. There is so much more to it than that. Jenny is really fighting her battles of being a widow and running a ranch and always wanting to be in charge. Gil has his memories to deal with. Then there is the mystery that I won't talk about because I want the reader to be surprised. Jenny and Gils problems are very believable and I came to like all the characters in this book. Ther price is great.
ChristianReaderAge: 35-44Gender: female5 Stars Out Of 5Touching and RomanticJanuary 26, 2012ChristianReaderAge: 35-44Gender: femaleQuality: 5Value: 5Meets Expectations: 5I've read Anne Patrick before, so I knew I'd be in for a great read. And I was in no way disappointed. These two have great chemistry -- that zing we all love -- but respect for each other and their morals are grounded without it being a sore spot in the book. I really enjoyed it.
Jasmine5 Stars Out Of 5Delightful reading!December 6, 2011JasmineQuality: 5Value: 5Meets Expectations: 5This is a great book for an uplifting afternoon. The characters are strong, witty, and interesting enough to keep you reading. Enjoyed it very much.
FrannieTexasAge: 35-44Gender: female5 Stars Out Of 5You won't be disappointed!October 25, 2011FrannieTexasAge: 35-44Gender: femaleQuality: 5Value: 5Meets Expectations: 5Renegade Hearts is a wonderful read with romance, family and spiritual relationships, and real life issues all wrapped up in an entertaining package.
CindyWAge: 25-34Gender: female5 Stars Out Of 5An A+ ReadOctober 25, 2011CindyWAge: 25-34Gender: femaleQuality: 5Value: 5Meets Expectations: 5A wonderful book! I loved getting to know Jenny and the rest of the characters in this sweet romance. Finding a man to fill the void left in her heart from the passing of her husband is the least thing on Jen's mind. Along comes Gil and her peaceful world is seriously rocked. I absolutely loved the way Gil befriended young Zach, and how the romance between Gil and Jenny slowly evolved. Totally believable. And the inspirational messages weaved into the story weren't overbearing in the least. A truly great read you'll want to place in your permanent library.


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TULSA, Okla. (AP) An 8-year-old Tulsa boy has died after being run over by the family minivan.
Police say the boy's mother had placed him and his 18-month-old sibling in the van on Sunday afternoon. She realized she had forgotten her cell phone and went back inside the house.
A moment later, she heard a scream from outside.
Police say the woman ran outside and saw her son being run over. Police don't know how the boy got out of the van or why it started rolling.
Tulsa Police Sgt. Terry Maurer says that the incident was a "pure accident."
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We're not surprised that you've found yourself enamored with these sleek red heels, because after all, their fabulous level is through the roof. From the platform soles to the classic T-strap cut, you just can't get enough of these fierce pumps!
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We've heard your feedback and are continuing to build a better Slickdeals. Click here to check out the updated site.
Welcome, Unregistered.
You last visited: Today at 03:04 PM
Net Worth $7,561.50
Overall Gains $2,561.50
Overall Returns 51.23%
This is really becoming frustrating. I'm using this game as a three month trial period to see if I know the hell I am doing when researching and investing stocks. I hate seeing gains in "fake" money.
Last edited by MSUSteve280; 10-22-2012 at 06:40 AM..
Obviously you can also open a paper trading account and do the same, too. Probably a better idea if you're serious because then you can learn the platform at the same time.
Last edited by barnz008; 10-22-2012 at 11:38 AM..
It's like buying NFLX for $300/share on seeing them expand globablly, while the CEO sells weekly prior to him doubling the subscription price, announces spliting the company, and then retracts the split announcement, while the price of subscription remains doubled, causing share prices to fall to $60, and pisses off 14 Million subscribers.
How to Start Living a better Life
1) Have Expenses <<< than your income
2) Invest your money to increase you passive income
3) Get your free time back to develop better relationships with those you care about!
4) Find inner peace from your past, for your future, and for your happiness with freeing your chains in the present!
5) Start questioning the Media and Government, to make sure they are generally on a right path for existence and moral standing.
A123 is a battery company based in MA, with plants near where I live in Michigan. A guy in my sub works there as an engineer. In this game, I had stock in JCI (a client of mine), which I sold for AONE after hearing they filed chapter 11. Crane's Detroit wrote a piece about how JCI and a chinese company were both interested in buying A123. This was not just a blind buy.
Just to get on my soapbox again cuz I know u all luv it, use the game to your advantage. For ex, I could have signed up and bought SVU for fun, but took the trade for real. Filled at 1.88 sold at 3.06 (some). Did I know it would pop? No, but I've watched price action for months and the data suggested something would happen. When the opportunity presents, you pull the trigger - no thinking, no emotion, no bias on direction. Also doesn't hurt I work right next to their HQ and see what's at stake, so going to $0 doesn't appear to be likely.
Anyway, good luck. Earnings is a great time to sharpen your skills, esp if volatility jumps quite a bit. I like to hear folks here are bank rolling actual monies from something like this.
That said, I sold it at .16 cents. Wanted to sell earlier this morning, but meetings got in the way.
Still playing with house money, so to speak.
I bought a stock a few weeks ago in another game and it apparently has a reverse split tomorrow (1:4) yet I went from 750 shares to 188 shares and the price is the same. WTF!
Basically lost $2000...
My plan was to do nothing for three months.
Too short a horizon for investing.
How'd I do?
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Today im featuring a guest post by Gabe Tuft. Gabe was a former WWE Superstar, and has recently reunited with his former tag team partner Curt Hawkins.
After retiring from the WWE, Gabe established Body Spartan. A fitness site with a team of elite athletes including many former WWE superstars. Today he is talking to us about Detox. Take it away Gabe!


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Tired of Electric Bowel Movement industro crap? Enjoy alot of my favorites from neofolk, neoclassical, and martial music.
5cl Experimental, 3cl Industrial, 3cl NeoFolk , 3 cl Military Pop, 2 cl Ritual & a slice of good old Gnosticism.... Served in a 24h/Day Broadcast ! TASTE THIS !
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Best dark music mayhem that you never heard. Listen deeply to the latest evil music from US, Europe and Mexico. Go toward within and embrace the dark music experience. Goth, Industrial, Synthpop, EBM, Aggrotech, Darkwave and Goth Metal
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An ethereal timeless travel between dreams and nightmares, where hope and grief, life and death, gather to rise feelings. Music picked from Ethereal, Gothic, Dark Ambient, Neofolk and sometimes Classical.
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May 15th - 31st: NEW 00tz 00tz, Mindless Faith, Intent:Outtake, Headdreamer, Gore Tech, Eisbrecher, Edge of Dawn, The Synthetic Dream Foundation, Mechanical Moth, The Millipede, Max Lilja, Justin Symbol, BAsementgrrr, Huron and others.
The Archives.....Industros Gothium Melodius......Mlada Fronta...Chrome...Coil...Bigod 20...Die Form...Tarmvred...et al
Dark Cabaret, Circus Noir, Gypsy Punk, Carnivale, Southern Gothic and Funeral Ballads
A totally indiscriminate mishmash of industrial, EBM, power noise, dark ambient, IDM, post-punk, neofolk, experimental, and noise. The new and the old. The popular and the obscure. The good, the loud, and the ugly. Ad free!!
a dark soundscape that spins the colors of the grey and Night...goth darkwave electro industrial witchouse...radio twiNight /greyskycast twiNight
Dark ambient, drones and experimental music at it's best featuring Lustmord, Atrium Carceri, Raison d'etre, Caul, Herbst9, Amon, Megaptera, Yen Pox, Henrik Nordvargr Bjorkk, Sephiroth, Svarstinn, Kammarheit, Gustaf Hildebrand, Bass Communion, etc.
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underground goth, deathrock, and dark punk...


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Please use this identifier to cite or link to this item: http://hdl.handle.net/10355/8601
|The Age and Density of Ancient and Modern Oak Wood in Streams and Sediments
|Guyette, Richard P. (Richard Paul); Stambaugh, Michael C. (Michael Charles)
specific gravity
woody debris
|IAWA Journal
|IAWA Journal, Vol. 24 (4), 2003: 345-353.
|Large wood of oak trees (Quercus spp.) has resided in the streams and sediments of north Missouri, USA for many thousands of years. This wood affords the opportunity to compare a chronosequence of differences in wood density over a very long period. We analyzed the relationship between the age (residence time) and density of heartwood from oak boles using tree-ring and 14C dating methods and discuss their implications. The residence time of large oak wood (> 25 cm diameter) sampled in the streams and sediments ranged from less than 14 years to more than 12,320 years. The oak wood ranged in density from 0.82 g cm-3 for a tree that had recently fallen into the stream to 0.14 g cm-3 for ancient oak wood. Two regression equations relate age (residence time) and density of oak wood and explain 88 percent of the variance in the dependent variables. Equation 1, heartwood density = age, can be used for studies in carbon cycling, wood as invertebrate habitat, or other questions related to the density and ecology of wood in streams such as wood retention and export. Equation 2, age = heartwood density, can be used for estimating when oak wood was formed on a very coarse scale over many thousands of years.
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Mickelson takes 2-shot lead at Quail Hollow
Sergio Garcia twice made news for his work on the greens.
Garcia used his wedge to knocked in a 5-footer on the third hole, only this wasn't any protest about the overall conditions of Quail Hollow. He had a scrape mark left by cleats, which he described as 3 inches long and nearly an inch high.
"I thought the only way I could make this putt was to get lucky," Garcia, and he wasn't feeling lucky on this day. The prudent move was to hit a 52-degree wedge, chip it just over the rough turf, and he pulled it off beautifully. It was a throwback to the days of the stymie, when players didn't mark their golf balls, or to a generation ago in summer events when spike marks could be an inch high.
Garcia didn't sign for his 68 - he was five shots behind - until talking to rules officials and going over the videotape. A TV viewer said it appeared Garcia did not replace his ball in the same spot where he marked it on the 17th. Garcia, demonstrating later for reporters, said he slid the coin to the side of the ball, and turned his hand around when he replaced the ball so he wouldn't brush the coin. He said it appeared his ball was a fraction of an inch away from the original spot. PGA Tour rules officials signed off on it, and Garcia said they even called the USGA to confirm.
"I said, `If you guys feel like I gained something by moving it - I don't know how much, like a centimeter or couple centimeters, whatever it is - I'm fine with the two-stroke penalty. I'd rather take the two- stroke penalty than come out here like I was a cheater,'" Garcia said. "Obviously, they felt that wasn't the case. I told them exactly what I did, and they felt it was fine."
Garcia also said he tweaked his back on a tee shot at the 10th and would get treatment on it, uncertain he would play depending on how it felt Saturday.
Through it all, there was plenty of aggravation. Bubba Watson opened with a three-putt from 10 feet, added a four-putt from about 65 feet on the 12th hole, and had another three-putt from 15 feet.
But it was like that for everyone, which is why McNeill had a peculiar answer when asked what the winner had to do well this weekend.
"It's the guy who keeps control of his emotions the best," McNeill said. "The greens will have an effect on you. You've just got to keep positive. You're going to have good putts that miss, and you might have some bad putts that go in."
Mickelson is less concerned with his run of amazing putting than with getting the ball in play. He has hit only 11 fairways going into the weekend, though he found something in his alignment early on the back nine and was hitting it where he was aiming the rest of the way.
"It's fun to be in contention. It's fun to be in the mix," Mickelson said. `It's great to be leading, but we're only halfway home. There is a lot of golf left. I have to come out and play very well. But I've been putting very well this week, and I've been driving the ball very well before I got here. And I think if I drive the ball the way I've been before I got here, and not the way I did the first few days, I think it's going to be a fun weekend."
The Associated Press


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I've just received some lovely testimonials from great people who've bought my first item in ThemeForest and I'm feeling great!
I want to thank you Envato to give us this opportunity to work with fantastic people around the world! At first I was thinking that being an author in ThemeForest is somehow just another job but now I feel it's far far greater than codes and design. It's about people that make you enjoy your work.
Being in this community is really great! Thank you Envato. Thank you other authors as I've learnt too much from you and thank you people who are supporting this community by purchasing our hand crafts!
congrats mate
Goodluck and Keep Moving Forward. There has an strange purchasers there and be the patient
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Amsterdam, Netherlands
My Rating
This was a great saver. Heineken experience was great you need to give yourself about and 1 hour 40 mins to take it all in. The staff on the cruise were great as soon as our beer was finished another one was brought right over. Pizza was great too. Nice touch with olives and toast on the table to
Amsterdam, Netherlands
My Rating
This was great from beginning to end one of the best things we did during our stay. If you want to see traditional holland you have to do this. Windmills are stunning, Bart the clog maker is so funny and Diana the tour guide was very informative and friendly
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Latest: 11:53 am, 9/24/14, Wednesday
FAYETTE COUNTY -- Marcus Battice was taken into custody early Wednesday morning.
DECATUR -- Investigators reveal exactly how an inmate managed to escape from jail and what they're doing to make sure it never happens again.
Latest: 10:01 pm
DECATUR -- An inmate escaped. Now investigators are trying to figure out how he pulled it off.
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Tag Archives: Retirement
Conversations with my elder self
A few weeks ago, I competed in the season-ending doubles championship at a local tennis club. In the first round, my partner and I lost a tough three-setter to a talented father-son duo.
Now in his 80s, the father had … Read more
Happy graduation! Your gift is a Roth IRA
Graduation season is upon us, and you, like me, may be pondering what to get our loved ones. Thinking back, I remember four letters that meant a lot to me when I was graduating: C-A-S-H! But that's too boring. This … Read more
Me against myself
In sixth grade, I'd take my allowance to Phil's Pizza, exchange the bills for quarters, and feed a week's worth of funds into the Pac-Man machine. Within 15 minutes, I was broke. To behavioral economists, I was a case study … Read more
Long-term perspective: Essential for athletics and investing
If you're looking for insight on investments and personal finance, you could do a lot worse than asking a long-distance runner.
Vanguard is a second career for me. After college, I had the great fortune to compete as a professional … Read more
Maximizing retirement account balances
Too gloomy a view
Deciding what's important amid competing priorities
About a year ago, I wrote my first Vanguard Blog post to commemorate 529 College Savings Day. In that post I encouraged investors to start saving for college as early as possible. I also asked them to pay attention to … Read more
Fees: out of sight, out of mind
One of the vexing questions in the investment world is why many investors are inattentive to fees. While Vanguard has helped create a class of investors that's fee-conscious and fee-aware, the fact remains that many individual investors remain in high-cost … Read more
Negotiating your retirement date
The headline "He Wants to Retire … but She Doesn't" was one of the most popular articles in the April 9 Wall Street Journal.
What struck me most was the author's comment that many of the people she interviewed … Read more
Investment costs hit retirees with double whammy
A while back, I wrote about how people often miss the impact of investment costs on wealth accumulation. Today, I want to make sure readers know that it's as critical for retirees (people spending money) to think about how costs … Read more


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The truest answer to violence is love. The truest answer to death is life. The only prevention for violence is for the heart to have no violence within it. We cannot prevent evil through any system devised by mankind. But we can grapple with evil and defeat it, but only with love—real love.
Personally, I wouldnt be comfortable with my child walking to school alone at any age.
I walked 6 blocks to kindergarten by myself in a suburb of NYC. All the kids in the neighborhood did. I don't think the world is any more dangerous now than it was then, although the level of paranoia has certainly changed.
I don't see a problem with a 5yo and 7yo walking to school together.
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19.03.07 - By Evan Young - Boxingforecast.com. Frenchman Jean Marc Mormeck took back the WBA and WBC cruiserweight titles he lost to American via ONeil Bell last Saturday night in France. As a 4-1 underdog Bell stopped Mormeck via 10th round stoppage over a year ago in Madison Square Garden. I picked Bell last year and I went with him again even though he was only a slight underdog this time and was fighting on the road in France.
The scenario I envisioned mostly played out except the part about Mormeck not making it to the final bell. The fight opened at a brisk pace and like the first fight, Mormeck was able to win most of the early rounds with punching volume and speed. But the thing with Mormeck is that hes an eight round fighter meaning that he fights like hell for 8 rounds and then hits the wall and runs out of gas. And that is clearly what happened here. Bell, on the other hand, is impervious to heavy shots on the chin and has tremendous stamina late in a fight..
The fight was playing out perfectly for Bell as Mormeck was exhausted after 7 rounds and Bell was now coming on. Mormeck was in survival mode from the eighth round for two reasons; he knew he was ahead by 4 points due to an open scoring experiment (the judges scores were announced after the 4th and 8th rounds) and he was used up and had nothing left. Mormeck seemed like easy pickings and Bell banged him around pretty good for the remainder of the fight but couldnt land the coup de grace to end Mormeck's night.
But in my view, this win for Mormeck was not without some shenanigans. You see, the fight was televised on television (Fox Sports) at the 11th hour and I noticed a disturbing happening. The French timekeeper was ringing the bell early in many of the later rounds when it appeared that Bell was about to vaporize Mormeck. And they did it in the 12th and final round when a full 20 seconds was chopped off the clock when Mormeck could barely stand up anymore.
Don King promotes Mormeck and to me it seemed like a hollow victory for Mormeck as they had to cheat to get it and Mormeck didnt fight at all for the last 4 rounds of the fight. I thought Bell should have won a decision because he won some of the early rounds and all of the late rounds. I though Bell deserved at least 7 rounds out of twelve. And to top it off, the Colonel Bob Sheridan did the telecast for Don King and he annoys me to the max. He sucks the ass of the house fighter and in this case it was Mormeck. For a guy that has called so many prize fights, his lack of acumen about boxing is shocking. He is a buffoon that only a more ignorant person will find credible.
But Bell has to take some blame here as well. He was fighting in a cavalier manner when he had extremely wounded pray in front of him. Bell was content to mock Mormeck frequently and walk him down but he wasnt fighting with enough urgency to get the job done. Still, Mormeck looked about as done as a chop cooked at 1000 degrees for an hour. He was toast but without Bells urgency and with the timekeepers help, he limped across the finish line in the 12th round.
He looked like some of those triathlon athletes that literally crawl their way over the finish line. And Bell was surprisingly fresh at the end of the fight. And his reserve was evidenced by his desire to continue the fight at the post fight press conference. Apparently, Bell walked in on Mormeck when he was complimenting Bells toughness but said he didnt like him as a person. Bell heard that part being translated and rushed the podium attempting to renew acquaintances with the victor but he was held back, luckily for Mormeck, who could barely lift his water glass at this point. If Bell added a bit of that intensity during the official fight he would have certainly gotten himself a KO win.
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I've been getting scrill, diamonds in my grill
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Everyone else just looks like a tool.
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13 years of experience
Video profile
Accepting new patients
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You won't find a more prolife doctor. He truly has a vested interest in your health.
An immediate feeling of ease when meeting. Thorough examination, listens to patient without interrupting or giving the one eyebrow up "suspicious" look. Doesn't give you that sense of "I'm really trying to seem caring, but you're just another symptom to be moved along". Knows what tests to order and usually knows what the problem is before the results of the tests. Very intelligent, whipsmart, and a gentleman. Kudos. Holland shouldn't have access to Dr. Harrison's patients.
Dr Harrison has been my Doctor for 15 years. I couldn't ask for a better Doctor, mentor and friend! Dr Harrison is compassionate, honest(even if I don't want to hear it!) and fair. I couldn't recommend anyone anymore than I would recommend Dr Matt Harrison!
Okay I have been a RN for 34yrs and have worked in all acute and chronic care units. I have worked with many doctors. In fact I worked with Dr Holland while he was in training. I was impressed with his skills and his bedside honesty. So when he went into his own practice I was delighted. I now have Dr Harrison and of course Dr Holland would have only choose partners who shared the same degree of care and concern that he does. This entire group as I know them have always been honest,smart,and eager to find the diagnosis and willing to provide treatment and comfort. They demonstrate empathy, which is the ability to look at the patients as the person they are and not the disease or illness. Basically they treat their patients as they would want to be treated. If you need a family physician Northgate is a great service......
My family and I have been visiting this practice for approximately nine years now. We have always been treated with respect and received nothing but excellent care. Dr. Harrison goes out of his way to listen and prescribe the best treatment possible.
The only NFP doctors that I know of in the Charlotte area. Great practice, they are now our family physician.
I've been seeing Dr. Harrison for about 3 years. His staff is wonderful and Dr. Harrison is second to none for taking the health and welfare of his patients seriously. You will never be rushed when you go to see this doctor and he takes the time to explain reasons for your illness and treatment to you. He is a great doctor.
Knowledgeable regarding diabetes concerns, uses tact regarding psychiatric and sexual issues, but beware of assuming everything is covered by insurance.
As a nurse practitioner myself, I can say with great confidence, that this group of physicians and the PA provide clinically appropriate competent care. Always nice. Great staff. Clean office environment. They are also one of the few medical offices in
I have gone to him for prenatel care for 5 months now. He neglects important things during the visit for example on the first visit he did not even tell me when my appoximate due date it. He started to pull out his stethoscope to listen for the baby's hea
Dr. Harrison has a great bedside manner. Courteous and professional. Highly recommended


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- Phabricator is our new bug tracker, see the list of known bugs, log in with your commons account.
- Commons:Upload Wizard blacklist issues is a page for reporting and discussing issues with the title blacklist that is used by Wikimedia Commons
- Commons:Upload Wizard carries summary information, and Commons talk:Upload Wizard is for strategic community discussions.
To resolve issues, it helps us to have exact steps to reproduce. Please also read the Questions and Answers page and check the archives.
Archives (older archive dates indicate date of initial comments and may span several months; newer archives span one month per archive and are generated by MiszaBot):
- 1 Unable to install on my mediawiki server
- 2 Bilder konnten nicht hochgeladen werden
- 3 Subir archivo
- 4 Fair use license on Upload wizard on KN Wiki
- 5 Autobahnbrücke Katharineplatz / Frankfurt am Main
- 6 Verweigerung des Hochladens
- 7 terminal de autobuses de morelia
- 8 como subir un archivo
- 9 Link didn't work
- 10 Files with the same name but different extensions
- 11 mistake of uploading
- 12 Importation Image
- 13 Problems when uploading multiple images
- 14 mon travail
- 15 hickup
- 16 cryptic message
- 17 Photo
- 18 Bug in the upload wiazrd form
- 19 Error during final phase of upload
- 20 Assistent zum Hochladen von Dateien
- 21 The uploader doesn't work properly
- 22 help
- 23 hebrew upload wizard doesn't work
- 24 Estancamiento de subida
- 25 tres décadas de teatro y de cultura europea
- 26 Sticks
- 27 Echec à la dernière étape du chargement d'un fichier .djvu
- 28 Bild hochladen
- 29 moi nue
- 30 Wieso wurde die Datei denn überhaupt gelöscht???
- 31 Problem beim Hochladen
- 32 This site is world best
- 34 Tuttinfamiglia
- 36 marleneharnoisJOdéfilé.jpg
- 37 Harnois Marlene Taekwondo 7069.jpg
- 38 Falha no envio?
- 39 Upload Wizard: Cannot replace files
- 40 fisier Pierdut_in_Iran.jpg
- 41 Flavia Ferreira Ferreira
- 42 Bill O'Neill.jpg
- 43 Para o concurso
- 44 Latitude, Longitude
- 45 Erroneous "file too large" message
- 46 Schon wieder englisch
- 47 Fotos Rio De Janeiro
- 48 Informações sobre imagens
- 49 Problem when my login is thrown off
- 50 Go back option
- 51 Name für Upload Datei wird nicht akzeptiert.
- 52 Photo Upload Licence
- 53 Not working
- 54 upload-probleme wiki loves earth
Unable to install on my mediawiki server[edit]
I am running debian. Whenever I go to activate the extension, it disables my site.
Bilder konnten nicht hochgeladen werden[edit]
Ich habe vier Bilder von Schwarzblond hochgeladen, von denen ich die Rechte besitze diese hochzuladen, diese Bilder wurden gelöscht wegen "copyright violation" Ich bitte Sie hiermit diese Bilder wieder hochzuladen. Sollten Sie den Kontakt zum Uhrheber Benny Hiller wünschen, so wird dieser Ihnen gerne bestätigen, das ich die Bilder hochladen und veröffentlichen darf. Seine E-Mail ist email@example.com Kray66 (talk) 12:29, 26 February 2015 (UTC)
Subir archivo[edit]
Ayuda para subir un archivo, gracias Jorge Antonio Gaviola Carrera (talk) 15:33, 27 February 2015 (UTC)
Fair use license on Upload wizard on KN Wiki[edit]
I don't find a fair use license and the file upload has been replaced with the Upload wizard. This is troubling me in creating some of the new articles which will have movie posters, book cover pages etc. Please help where should I report this issue. Thanks ~ Omshivaprakash /talk/Contributions 18:04, 28 February 2015 (UTC)
- Fair use is not a license, but a limitation to copyright protection in some jurisdictions under certain circumstances. Because Wikimedia Commons (this site) is a general media repository, those circumstances don't apply here, and therefore, fair use content is not permitted on Commons. Thus, the lack of such an option is intentional and not an issue to be reported. —LX (talk, contribs) 22:39, 7 March 2015 (UTC)
Autobahnbrücke Katharineplatz / Frankfurt am Main[edit]
Ich beginne mich jetzt langsam ein wenig zu ärgern. Die Einverständniserklärung leigt doch jetzt wirklich vor. Ähnlich verhält es sich nebenbei gesagt mit den Bidern des SWR zur Schiersteiner Brücke. --Nixnubix (talk) 13:39, 1 March 2015 (UTC)
Verweigerung des Hochladens[edit]
Fordert unverständliche Namensänderungen, verweigert fortgesetzt die Arbeit selbst nach Namensänderungen Simsalabimbam (talk) 15:05, 5 March 2015 (UTC)
terminal de autobuses de morelia[edit]
estimado Gunnex como puedo conseguirlo de la imagen ya sea foto de la computadoura o no sera aceptada saludos. ZOE MORA (talk) 01:25, 8 March 2015 (UTC)
como subir un archivo[edit]
como puedo subir un archivo en wikipedia, me dice no sube archivo con terminaciones doc. Jose perez saviñon investigador (talk) 15:54, 8 March 2015 (UTC)
Link didn't work[edit]
I copied and pasted the link to use on the wiki but it doesn't work. Curranlee (talk) 19:43, 10 March 2015 (UTC)
Files with the same name but different extensions[edit]
It doesn't appear to be possible to upload files with the same name but different file extensions. I often upload large PNGs, and I accompany them with JPGs.
Curly Turkey (talk) 01:06, 12 March 2015 (UTC)
mistake of uploading[edit]
What the problem?
Хомелка (talk) 17:38, 13 March 2015 (UTC)
- The Upload Wizard (the default interface for uploading files to Commons) is pretty much in a perpetual state of brokenness. It isn't broken for everyone all the time, but I don't recall a time since it was introduced that we went more than a few days without people reporting enigmatic problems with indefinitely spinning wheels, unhelpful error messages, or simply no way to move forward. Have you tried Commons:Upload? It tends to be much more reliable. —LX (talk, contribs) 20:25, 13 March 2015 (UTC)
Importation Image[edit]
Bonjour Pourquoi cette image est-elle refusée, alors que je souhaite la partager avec les droits correspondants. Je l'avais retiré d'un article, car elle n'avait alors pas de licence. Comment la réinstaller ?
Costemane (talk) 13:29, 15 March 2015 (UTC)
Problems when uploading multiple images[edit]
(Copied from the Help Desk.) I just uploaded 33 pictures I had taken at a French Cabaret Show in Helsinki, Finland in last December, after getting permission from the casino staff. Since there were so many, I used UploadWizard instead of the old upload form I normally use. UploadWizard failed to show me a thumbnail of any of the pictures, so I added the descriptions and categories going by the order they appeared in on the directory where I uploaded them from. However, UploadWizard didn't upload them in this order, causing most of the descriptions and categories to go all wrong. I had to fix them by hand. Why didn't UploadWizard upload the images in the order they appeared in when I selected them? Why couldn't UploadWizard show me thumbnails? The pictures themselves seem to have uploaded OK. And if this happens, is there any easier way to solve it than what I did now? JIP (talk) 19:49, 19 March 2015 (UTC)
- I have the same problem. I need to upload 30 images at once, and I need them sorted from the first to the last one. The wizard seems to sort them randomly, maybe depending on which one gets uploaded faster than the others. This problem did not exist some months ago. It was working fine. Can someone help?--Jordiferrer (talk) 12:25, 9 April 2015 (UTC)
mon travail[edit]
Bonjour, J'ai essayé à plusieurs reprises de mettre mon travail en ligne.Les liens (reportages tv) sont bien enregistrés. quant aux peintures et sculptures bronze je n'y arrive pas; Merci de me guider Cordialement
Culcasi (talk) 11:20, 30 March 2015 (UTC)
uploading 6 files at once dosent work, only 1 by 1. time measure gets mad. — Preceding unsigned comment added by Molekuel (talk • contribs) 18:24, 31 March 2015 (UTC)
cryptic message[edit]
> * = This field is required.
But there is no fields visible.
> The stashed file was not found when attempting to upload it from the stash.
Whatever that means.
> None of the uploads succeeded. > Retry button
That is the only option, retry, fail, retry fail. No way to leave, no way to actually see what's the problem.
grin ✎ 22:07, 31 March 2015 (UTC)
I have uploaded the picture of Mukhlesur Rahman Chowdhury here. Plese complete the process.
The Prekshit (talk) 01:29, 9 April 2015 (UTC)
Bug in the upload wiazrd form[edit]
Hi there,
During the "Describe" step, if the "next" button is clicked while having entered a title with an incorrect character, such as the slash "/" character, then the "next" button will then disappear from the form, forcing me to restart the upload from the beginning.
Kind regards, Christopher.
Christopher Crouzet (talk) 10:38, 9 April 2015 (UTC)
Error during final phase of upload[edit]
Hello, After uploading 7 files of a commune in France (Nohanent, Puy-de-Dôme), 2 of 7 files have been uploaded successfully (File:Nohanent_église_2015-04-10.JPG and File:Entrée_Nohanent_par_D_764_depuis_Sayat_2015-04-10.JPG) but 3 not with a warning sign (File:Nohanent_entrée_par_D_2E_2015-04-10.JPG, File:Arrêt_de_bus_Place_de_la_Farge_2015-04-10.JPG, and File:Route_de_Nohanent_à_Clermont-Ferrand_2015-04-10.JPG): api-error-internal_api_error_DBQueryError. Details of these 2 files (File:Nohanent_Place_de_la_Farge_2015-04-10.JPG and File:Route_de_Nohanent_vers_Sayat_et_Blanzat_2015-04-10.JPG) could not be submitted. So I should have to re-upload last two files. tabltrai - talk 13:55, 11 April 2015 (UTC)
In French: Bonjour, Après avoir téléchargé 7 fichiers d'une commune française (Nohanent, Puy-de-Dôme), 2 des 7 l'ont été avec succès (File:Nohanent_église_2015-04-10.JPG et File:Entrée_Nohanent_par_D_764_depuis_Sayat_2015-04-10.JPG) mais 3 ne l'ont pas été avec un message d'avertissement (File:Nohanent_entrée_par_D_2E_2015-04-10.JPG, File:Arrêt_de_bus_Place_de_la_Farge_2015-04-10.JPG, and File:Route_de_Nohanent_à_Clermont-Ferrand_2015-04-10.JPG): <api-error-internal_api_error_DBQueryError>. Les détails des deux fichiers (File:Nohanent_Place_de_la_Farge_2015-04-10.JPG and File:Route_de_Nohanent_vers_Sayat_et_Blanzat_2015-04-10.JPG) n'ont pu être soumis. Je dois donc ré-uploader les deux derniers fichiers. tabltrai - talk 13:55, 11 April 2015 (UTC)
Assistent zum Hochladen von Dateien[edit]
nach einer Pflichtfeldfehlermeldung zum Lemma-Namen lässt sich die Funktion nicht mehr ausführen
Goesseln (talk) 18:31, 11 April 2015 (UTC)
The uploader doesn't work properly[edit]
The uploader doesn't work properly. I tried to uploaad files not made by my self. The step 'release rights' does not show up and the next button in the step 'describe' doesn't do anything. Tried it several times - no chance.
Ogmios (Talk) 06:56, 12 April 2015 (UTC)
it said i put a non supported letter, like ' and / after that i tried to rename the title but it doesn't work
Mrkenjiex24 (talk) 06:41, 13 April 2015 (UTC)
hebrew upload wizard doesn't work[edit]
i tried from home as well as from my working place's computer - doesn't work. previously i succeeded, uploaded about 20 photos. i hope you can solve it. אהוד אמיר (talk) 18:12, 19 April 2015 (UTC)
Estancamiento de subida[edit]
Hola, quisiera saber por qué motivo no puedo pasar a la ultima sección llamada "Usar". Ya he completado la información requerida (titulo y fecha) y al apretar en el boton Siguiente la pagina no hace nada. Espero se solucione pronto este problema. Saludos, Howen.
Howen rava (talk) 18:49, 20 April 2015 (UTC)
tres décadas de teatro y de cultura europea[edit]
quiero subir mi experiencia teatral con la famosa Cia independiente de teatro de Paris "Le Grand Magic Circus" que actuo entre 1970 y 1995 en mas de 150 teatros y con una asistencia de publico de mas de dos millones de espectadores en toda Europa
Pablo amaro (talk) 13:35, 21 April 2015 (UTC)
When i upload,it wont go to the "use" page
Myadarchive (talk) 16:21, 21 April 2015 (UTC)
Echec à la dernière étape du chargement d'un fichier .djvu[edit]
"Renan_-_Histoire_des_origines_du_christianisme_-_6_Eglise_chretienne,_Levy,_1879.djvu <api-error-internal_api_error_MWException>" Erreur répétitive. Apparaît aussi pour le chargement de "Renan - Histoire des origines du christianisme - 5 Evangiles, Levy, 1877.djvu" qui a été ensuite chargé avec succès à l'aide du formulaire classique. Des fichiers .jpg ont été chargés avec succès le même jour sur la même machine.
Nyapa (talk) 09:15, 23 April 2015 (UTC)
Bild hochladen[edit]
Darf ich eine Fotomontage hochladen, bestehend aus dem Cover, der ersten und der letzten Seite einer Broschüre von 1969 ?
G. v. Luchs (talk) 13:14, 24 April 2015 (UTC)
- Hallo G. v. Luchs, ohne weitere Details zu kennen: Sehr wahrscheinlich nein. Ausnahmen können evtl. greifen wenn die entsprechenden Teile der Broschüre extrem simpel gehalten sind was grafische Aufmachung und Inhalt betrifft (siehe dazu de:Schöpfungshöhe). Das kann man ohne nähere beschreibung aber nicht abschätzen. --El Grafo (talk) 14:24, 24 April 2015 (UTC)
moi nue[edit]
j ai bien faire des photos nue
Angela201 (talk) 05:54, 25 April 2015 (UTC)
Wieso wurde die Datei denn überhaupt gelöscht???[edit]
Lizenzen, Erlaubnis, Urheber... alles war geklärt! Warum werden hier einfach Bilder gelöscht? Ich wurde "gewarnt". Ja, aber ich habe die Erlaubnis und dies auch Wikipedia bzw. Wikimedia mitgeteilt! Unverzöglich! Da lagen zwei Minuten zwischen. Dann war ich nicht mehr am PC. Komme nach Hause und das Bild ist weg. Was soll das? Will mich hier jemand verarschen!? Sorry Leute. Da fehlt mir jegliches Verständnis.
MattesKoeln (talk) 22:38, 27 April 2015 (UTC)
Problem beim Hochladen[edit]
Nachdem ich alle Daten zu den Dateien eingegeben habe, geht es bei Klick auf "Weiter" nicht weiter. Es gibt auch keine Fehlermeldung.
CTHOE (talk) 11:10, 28 April 2015 (UTC)
This site is world best[edit]
This site is world best site for sharing Images... Thanks!!
Dkinred (talk) 23:31, 30 April 2015 (UTC)
MAMTA PUBLICATIONS[edit]
RAKIB AHMAD ZIA (talk) 06:13, 1 May 2015 (UTC)
Ecco qui il logo della trasmissione di Canale 5.
Hulk1981 (talk) 02:34, 2 May 2015 (UTC)
Bonjour, Je suis en effet l'auteur et la propriétaire de cette photo car elle a été pris de mon appareil à la soirée Adidas aux JO de Beijing! Merci, de bien vouloir arrêter de retirer cette photo, car elle est libre de droits et ils m'appartiennent!
Marlene HARNOIS email@example.com
Tkdfan1212 (talk) 04:58, 2 May 2015 (UTC)
THIS PICTURE BELONGS TO ME! PLEASE LET ME BE ABLE TO PUBLISH THIS PICTURE, I OWN IT AND IT WAS TAKEN FROM MY CAMERA! firstname.lastname@example.com
Tkdfan1212 (talk) 05:23, 2 May 2015 (UTC)
Harnois Marlene Taekwondo 7069.jpg[edit]
I owned the rights to this studio picture taken back in 2003 in Montreal by Amilie Surprenant and had her sign the release and paid 500 for a one hour shooting! Thank you for letting me use my pictures
Tkdfan1212 (talk) 05:25, 2 May 2015 (UTC)
Falha no envio?[edit]
Não consegui enviar com êxito outras duas imagens, o que fazer?
Fabio E. Marques (talk) 21:46, 3 May 2015 (UTC)
Upload Wizard: Cannot replace files[edit]
I corrected a graphics file twice, but the new upload wizard does not allow me overwriting the obsolete versions. Please delete:
Duane 1922 Fig 4 mod.svg
Duane (1922) Fig 4 mod.svg
Strasburger (talk) 13:34, 4 May 2015 (UTC)
fisier Pierdut_in_Iran.jpg[edit]
Buna seara, va rog sa-mi spune-ti de ce fisierul mentionat in subiect a fost sters de pe site? Nu incalca nici una din regulile dvs.
Cataloi (talk) 17:50, 5 May 2015 (UTC)
Flavia Ferreira Ferreira[edit]
Informação se o site esta recebendo meus arquivos enviados, fotos e descrições.
Flavia Ferreira Ferreira (talk) 16:22, 7 May 2015 (UTC)
Bill O'Neill.jpg[edit]
I want to transfer this photo to Bill O'Neill (media) on Wikipedia to replace the photo currently being used as this one is more current, taken on May 7, 2015.
Seeliesamara (talk) 15:08, 8 May 2015 (UTC)
Para o concurso[edit]
Poderá inclui-las no concurso fotográfico. Se usarem, favor dar os créditos.
Joaquim Corrêa Prado (talk) 20:23, 10 May 2015 (UTC)
Latitude, Longitude[edit]
Estas fotos, faitas : Av. Senador Pedro Ludovico, Não sei a latitude, longitude
Ida Imbach (talk) 18:59, 11 May 2015 (UTC)
Erroneous "file too large" message[edit]
You can only upload files with a size of up to -1 B. You tried to upload a file that is 424 KB.
Difference engine (talk) 01:11, 13 May 2015 (UTC)
- According to reports at the village pump, this has now been resolved. —LX (talk, contribs) 22:57, 15 May 2015 (UTC)
Schon wieder englisch[edit]
Bitte stellen Sie sicher, dass nur deutsche Begriffe in Ihren helfenden Zeilen auftauchen! Upload Wizard feedback?
Siebenbergefan (talk) 09:14, 13 May 2015 (UTC)
Fotos Rio De Janeiro[edit]
Fotos tiradas na cidade do Rio de Janeiro, localizações de diferentes angulos entre eles o Parque da Pedra Branca, a linha Amarela, a praia da Barra e a Ponte Rio Niterói
Luciana Nascimento Guerra (talk) 03:49, 14 May 2015 (UTC)
Informações sobre imagens[edit]
Gcostaneto (talk) 04:35, 17 May 2015 (UTC)
Problem when my login is thrown off[edit]
I have experienced the following problem several times. If I am using the Upload Wizard to upload some images, Wikimedia sometimes automatically throws me off my login without telling me. If I then, without knowing that I've been thrown off, try to complete the upload, the wizard just returns an error message saying "You must be logged in to save files in the upload stash.". Yes, of course, I know that, but I WAS logged on, you just threw me off automatically without telling me. What's really annoying is that the wizard doesn't allow me to fix the problem by logging on and then attempting another upload of the same images I've already prepared for upload. Instead, I have to go to another page, logon, and then start the wizard procedure all over again from scratch. This is just not good enough - definitely a bug that needs to be fixed, and asap.
Bahnfrend (talk) 13:57, 22 May 2015 (UTC)
Go back option[edit]
I made an error inputting data in release right, get an (unhelpful) error message but no way to go back and fix it. Same problem with multiple files, copying data. Made a mistake, want to go back and correct it, not starts all over. Am giving up, again. Back to old form --Zoeannl (talk) 03:03, 25 May 2015 (UTC)
Name für Upload Datei wird nicht akzeptiert.[edit]
Auch nach Änderung des Dateinamens wird dieser nicht aktzeptiert, wie IMG 0809 Schlaubetal nahe Schlaubemühle.
Stromer7 (talk) 11:16, 26 May 2015 (UTC)
Photo Upload Licence[edit]
How do I indicate a non-existent licence for an old photo that belongs to my family?
Jetrev27 (talk) 06:30, 27 May 2015 (UTC)
- Hi Jetrev27, first of all it doesn't really matter who owns the physical photographs. The important question is: who owns the copyright? – which usually translates to: who took the photograph? If it was taken by a now deceased family member and you are the only heir (or all other potential heirs have agreed), {{PD-heirs}} may be the way to go. I'm not sure if the UploadWizard offers this as a license option, though. In that case, you may need to upload it with a different license and change that to {{PD-heirs}} immediately afterwards. In any case, please provide as much information about photo as possible (who took it when and where? if it was published before: when and where was it published first?). Hope that helps a bit? --El Grafo (talk) 08:17, 27 May 2015 (UTC)
Not working[edit]
If the form gets a error that the file name already exists, the submit button disapears for ever and there is NO way to get i back - so you have to start all over again!
wassini (talk) 19:00, 31 May 2015 (UTC)
upload-probleme wiki loves earth[edit]
das uploaden der bilder funktioniert, bleibt aber nach dem ankreuzen des feldes eigenes werk hängen. kann keine Lizenz wählen, keine Beschreibung eingeben etc. muss alles wieder von vorne beginnen..
Wald1siedel (talk) 16:18, 2 June 2015 (UTC)


text:
FMLY Fest assembles dozens of musicians for DIY weekend
By Emily Eveland
Hollow Boys embrace the dark on third album
By Sarah Stanley-Ayre
10 Thousand Sounds 2014: Behind the bands
By CP Staff
Black Market Brass delivers hip-shaking funk rhythms
By Zach McCormick
For the Love brings hip-hop festivities to Lowertown
By Jack Spencer
Kitty Cat Klub hosts Tourniquet Noise series
By Sarah Stanley-Ayre
Max Gremillion steps into the spotlight
By Rob van Alstyne
The world of Howler's sophomore album
By Zach McCormick
For some smaller festive action in the other downtown, the Fine Line hosts its second ThingamaGIG outdoor/indoor showcase on Friday and Saturday. Friday's lineup, starting at 6 p.m., includes Dixie & The Cannibals, Sacred Chao, Crown Victorias, Liquid Ernies, Fitzmen, rainTribe, and Peal. On Saturday at 7 p.m., it's Sea Biscuits, Big Sky, Bone Shakers, Fire Under Water, and The Wonsers. The first two bands each night will play in the Fine Line alley. $5/night. 318 First Ave. N., Mpls.; 338-8100.
Cheapo in Uptown and the TRG label have paired up to bring us a Friday night in-store series, the subtly dubbed Supersonic Indie Power Hour. This Friday at 6 p.m., Vinnie and the Stardusters will play a belated Independence Day set--though it's rumored the Dusters plan to rally for the U.S. to rejoin the British Empire. Whatever. Coming soon to Cheapo: The Honeydogs (July 12); Like Hell (July 19); Colfax Abbey (July 26); Dylan Hicks (Aug. 2); and more. Free. Cheapo, 2919 Hennepin Ave., Mpls.; 827-8238.
And finally, Walker Art Center's Summer Movies and Music Series (the grandpappy of 'em all) is back in Loring Park, and it's one of the best rites of summer this city has to offer. It kicks off this Monday with Milk with Rebel Without A Cause (July 8); Flatstor with Visit to a Small Planet (July 15); Hmong rappers STX with The Subterraneans (July 22); The Strawdogs and A Bucket of Blood (July 29); Eddie Berger and the Jazz All-Stars with Too Late Blues (Aug. 5); and Phull Surkle/Casino Royale with Beat Girl (Aug 12). Don't forget the bug spray, and pray for no rain. Music at 7 p.m.; movie at sundown. 375-7577. (Groebner)
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Ryte Pizza & Grill, or something like that....: Breakfast at its Best
It had a cool atmosphere, great trendy waitor, and the best full english breakfast you can imagine. Scrambled Eggs, toast Bacon, Sausage, mushrooms, tomatoe and baked beans... A real stomach filler! Yummo!
Favorite Dish: The Full English Breakkie is a must...
- Budget Travel
- Food and Dining
Rhapsody's: 2km from falls
Sells all kinds of food.
1)Starters 22,000 to 40,000 kwacha 2) salads 26,000 to 48,000 kwacha, 3) mains 48,000 to 78,000 kwacha 4) Pasta 35,000 to 49,000 kwacha 5) deserts 10,000 to 15,000 kwacha.
They sell meats, pasta, seafood, chicken, salads, veg side dishes,vegetarian.
They do deliver to some places and ask if they do transfers.. (cost involved)I think they do to some hotels.
Favorite Dish: www.rhapsodys.co.za
tel livingstone 03 322014/5
Email firstname.lastname@example.com
- Family Travel
- Singles
Cafe Zambezi: Chill with Zambian Cuisine
This is popular with tourists and locals. It is a clean place with good service and a nice relaxing atmosphere where you can meet friends or just relax with a cold Mosi beer. I ate here four times in the five nights I was in Livingstone.
Favorite Dish: The crocodile was terrific, both as ribs as an entree and on toothpicks as an appetizer. The Village Chicken, with a tomato and onion sauce, is quite good and the caterpillar is worth a try as well.
Hungry Lion fast food: Hungry Lion
"Hungry Lion" is a famous eating house in Livingstone downtown. It's centrally situated close to the path for tourists. The fastfood taste good. Price example: Medium beef burger with chips and a coke was 19,900 Kwacha (4 USD in 2009).
Favorite Dish: Fast food. Hamburger, french fries, coca cola.
- Food and Dining
- Backpacking
- Adventure Travel
Thatos Beergarden & restaurant: Thatos beer
I followed the steps of DAO, and stumbled uppon Thatos Beergarden. The restaurant was closed when I arrived at 9 PM. DAO writes: "Want a quick dip in the pool and an ice cold beer? Sit in or out and enjoy sports on the big screen TV. This is the way bars should be! They do food as well. Paradise found. Drink here, eat here, relax here!". Maybe it's like that in the daytime... I thought it was a shady place in the dark.
- Road Trip
- Backpacking
- Food and Dining
Ngoma Zanga: The Best Zambian Food Around!
We had a great evening at this restaurant. The atmposhere is great: they have an inside restaurant but on a nice evening you can sit outside in the garden. We had our own coalburner next to our table and a blanket each while being served by a very friendly waitress dressed in a traditional Zambian outfit. There were dancers performing near a campfire: it was magical.
But most importantly, they offered all the best things Zambian Cuisine has to offer. According to my Zambian friend, it was all very authentic and well-made.
Nogoma Zanga is a relatively new restaurant set up by famous singer Jane Osbourne. She has done a great job and deserves to do well with this venture.
Favorite Dish: The Vesaci (spinach with groundnuts!)
- Luxury Travel
- Romantic Travel and Honeymoons
- Road Trip
Crocodile Cafe: Close Restaurant to Victoria Falls
This little restaurant is located on the grounds of the Zambezi Sun, next to the banking center and the day activity center. This section of the hotel grounds are open to the public, and serve as a general booking center for many of the activities in and around Victoria Falls.
The restaurant serves as a lunch counter for those visiting the day activity center as well as serving food to hotel guests, who enter this section of the hotel grounds through a separate gate.
Many of the items here are sanwich and chip combinations.
The open air seating is a great touch, but somewhat hazardous during the rainy season.
Servers wear the standard uniform for those working at the Zambezi Sun, which is decorated in an African fashion but also has obvious influences from Europe / North America as well.
Favorite Dish: There are quite a number of items on the list here, but unfortunately many of them are fairly standard lunch type items you will find most anywhere. The prices are probably higher than most other places in Livingstone, but I can't confirm since I didn't get much of a chance to explore the city proper.
- Photography
Green Tree Lodge: Excellent Food, Relaxed Atmosphere
The Green Tree Lodge serves excellent food, from traditional Zambian dishes with nshima to delicious variations on continental-style steaks and pastas (Andrew, the owner of the lodge, is also a chef). Many of the vegetables, spices, and fruits used in the dishes are grown on premises, and all of the sauces, marinades, chutneys, etc., are made on site too. Even the granola at breakfast is home-made – Andrew doesn't like store bought anything.
Since I was staying here for so long, I got to try some things on request, too – like crocodile, local crayfish, and mopane worms (caterpillars) with nshima – and the girls on staff prepared some drinks for me made from various seasonal local fruits and roots we bought at the market. It's worth asking, if you're adventurous.
There are seats for about 20, although they told me they have handled parties of up to 50. Meals are served on the porch or, less formally, on the patio by the pool. The restaurant isn't the primary business, and isn't advertised, but you can come here for lunch or dinner, or even a full English breakfast, even if you're not staying at the lodge. For lunch or dinner you should call a few hours beforehand to make sure there's someone around to cook.
- Safari
Laughing Dragon: Chinese
Chinese foods sold here, just off main road near the Hungry Lion. Its not far from the Jolly Boys backpackers.. just walk straight past the museum
- Singles
- Family Travel
Ocean Basket: Seafood, Ocean Basket
This restaurant is on the main road and sells seafood. This is a South African Chain restaurant in Livingstone.
- Family Travel
Unknow: The forgotten treat
The place who's name has eluded me was on the right side heading from Zim and had yummy yummy breakfast, wish i rememebred its name, but i devoured the food with such gusto i went back for seconds.
- Food and Dining
Rite Pub & Grill: Rite Pub & Grill
Rite Pub & Grill looks like an American restaurant. It's a nice place to visit on Wednesday nights for live local music and entertainment.
Favorite Dish: Spare ribs and steaks.
- Adventure Travel
- Backpacking
- Food and Dining
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