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Hotel Conde de Penalba
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TripAdvisor Reviews Hotel Conde de Penalba Santo Domingo
Travel Blogs from Santo Domingo
Adventures With Columbus
... technically not enclosed, the worker there explained that it was not technically a cavern, hence the name of the park. Each body of water was truly beautiful in its own rite, vibrant in colour and crafting, and reminded me a bit of human beings. We have been crafted with innate beauty and value, and our differences in culture and personality, although sometimes create communication barriers, nonetheless add richness and depth to our world.
Santo Domingo; the dirty city
... wrong directions and walked for an hour for no reason. a local guy helped us out to get a taxi that wouldn't over charge us and we went to the caves.
it was about noon when we got there, which sorta stunk cause online it had said to try and make it before noon since the sunlight is better in the caves before then. Still, it was worth it.
Chapter One - Santo Domingo - Day 1
... br>
"Oops! Sorry! I'll make another one."
It seems a bit fishy to me. Meanwhile the girls who are following some way behind sail through the exit door, and are then unable to re-enter the airport to complete the new document. The signing is done by the agent reaching through the door, and us signing on the other side, watched over by a suspicious airport guard.
Finally we encounter ...
Last Blog before STL!
... practice because of the boys. I cried, but then we talked about all the possibilities for that not to happen.
The girls wanted another place to play where no one could bother them so they could focus even more. There was no other land in Guasumita to practice...so it was the cacao factory across the street to the rescue! We were told if we wrote a letter they could bring some tractor/machine to clean land (because they had so much ...
Whales, mom, independence day...
... just as Lo was walking through customs! That was the first of many things that went just our way during her brief 4 night stay... The resort was amazing to say the least- the bell boy took us up to our room, said "abra cadabra," and opened the curtains to our private balcony, about 30 ft from the beach. Lo was speechless, and I was more than a little impressed.� That first night we grabbed some drinks, walked the beach, got dinner and crashed hard. It was ...


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Cawo Abdi
Educational Background & Specialties
Educational Background
- PhD: Sociology, University of Sussex, United Kingdom, 2006.
- MA: University of Guelph, Canada, 2002.
- BSocSc: Economics, University of Ottawa, Canada, 1995.
- Migration; Gender, Race and Class; Family; Islam; Education, Development Studies; Human Rights; Globalization; Africa; Middle East.
Courses Taught
- Soc 1001: Introduction to Sociology
- Soc 3505: Transnational Migration
- Soc 3681: Gender and Family in the Islamic World
- Soc 8390: Topics in Soc: Comparing Migrations
- Soc 8390: Topics in Soc: Global Migrations
Research & Professional Activities
- One of my new projects examines the educational attainment and school choices of new migrants. For children of migrant parents, the American education system can be their ladder to social mobility and the realization of their American dream, or it can leave them behind as a part of millions of Americans whose lives remain precarious. This study investigates the increasing role ethnocentric charter schools are playing in new refugee and migrant groups' education in Minnesota and how this shapes their long-term settlement and integration in the United States.,
- "Elusive Jannah: The Somali Diaspora and a Borderless Muslim Identity," University of Minnesota Press, 2015.
- "Threatened Identities and Gendered Opportunities: Somali Migration to America."2014. Signs: Journal of Women in Culture and Society 39, no. 21: 459-483.
- "Muslim-American Youth and Homeland Politics: Competing Narratives on the War on Terror." 2011. In Looming Shadows: Migration and Integration at a time of Upheaval. European and American Perspectives. Vedran Dzihic/Thomas Schmidinger (eds.), Center for Transatlantic Relations: John Hopkins University pp. 273-289.
- "Moving Beyond 'Xenophobia': Structural Violence, Conflict and Encounters with the 'Other' Africans." 2011. Development Southern Africa 28(5): 691-704.
- "Convergence of Civil War and the Religious Right: Re-Imagining Somali Women." 2007. Signs: Journal of Women in Culture and Society 33(1):183-207.
- Fulbright Research Fellowship to South Africa, 2012 - 2013

subset: commoncrawl


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Parsnips are a quintessential cold weather vegetable. They look like carrots but are white and somewhat sweeter, characteristically starchy with a hint of citrus.
Like many of the tastiest foodstuffs, parsnips were once a staple among the poor in Italy and elsewhere in Europe. When the potato came from the New World and disseminated throughout the continent, parsnips fell out of favor. For centuries, they were used almost exclusively as animal feed.
Parsnips are complex in flavor, remarkably versatile and easy to cook. Their earthiness works well in broths and soups but also comes through when roasted or braised.
I like to slice parsnips thinly and cook them with rendered pancetta for a simultaneously crisp and toothsome pasta sauce. Don't crisp the slivers like potato chips, just cook all the way through and toss with spaghetti and a few ladles of pasta water.
- Our state's greatest gift to the nation just got canceled
- Watch: Former Mariners great Ichiro Suzuki pitches — yes, pitches — for the Marlins
- Clay Matthews tells Colin Kaepernick: 'You ain't Russell Wilson, bro'
- Gun violence: Don't fear gun laws; let gun-owners help pay to fix the problem
- Evergreen High School football player critically injured during game
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Or try this side dish next to a turkey or with poultry or braised meat for weekday meals. It beautifully captures the flavors of autumn.
Mario Batali is the owner of Babbo, Lupa, Otto and other renowned restaurants. His latest book, from which this recipe is excerpted, is "Molto Batali," published by Ecco.


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Obese adults have worse sexual health than their slimmer counterparts, despite having less sex with fewer partners, research has found.
According to research carried out by a team at France's National Institute for Health and Medical Research (INSERM), obese women on both sides of the Channel have, on average, four times as many unplanned pregnancies as those of a healthy weight.
Furthermore, obese men were found to suffer from higher rates of sexual diseases, despite having had fewer sexual partners and despite the fact they are also more likely to suffer from erectile dysfunction.
Writing up the findings in the British Medical Journal, lead researcher Professor Nathalie Bajos has suggested that low levels of self-esteem could be behind the trend.
One example of this could be women being deterred from seeking for contraceptive advice or asking their doctors for the pill.
According to the National Obesity Forum, one in five UK adults can now be regarded as being officially obese.
Independent advice on private healthcare


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Heather Stewart's economics comment + Austerity
Economists are starting to line up to warn of the danger behind the chancellor's £25bn onslaught on public services
Argentina defaulted in 2001, and is still not free of its creditors. There needs to be a clear resolution to the blight of vulture funds and neverending austerity
Heather Stewart: The polished governor will inherit unprecedented circumstances in which success will be almost as hard to manage as failure
Heather Stewart: Forget talk of the 'burden' of government debt on future generations. Look at how austerity scars young people now
Heather Stewart: The crisis now threatening the British economy is a chronic and widespread lack of growth. The blame for that lies firmly at the door of the party of austerity
Heather Stewart: The coalition came to power with the promise of austerity and small government. Now, on the brink of disaster, state-sponsored initiatives are suddenly back in fashion
Heather Stewart: The idea that Italy's and Greece's new technocratic governments will be apolitical is nonsense. And it's becoming clear that, in Athens, austerity is already turning a crisis into a disaster
- Economics
- Austerity
- Economic policy
- Economic growth (GDP)
- Eurozone crisis
- Greece
- George Osborne
- Economic recovery
- Unctad
- Global economy
- Liberal-Conservative coalition
- Bank of England
- United Nations
- Conservatives
- Mark Carney
- Public sector cuts
- International Monetary Fund (IMF)
- Women
- Communities
- Banking


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Your products, customized just the way you want them!
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Transform your creativity into beautiful products, sell them on CafePress and make money. It's easy and fun.
T-shirts are your way of saying what you want to say, without saying anything at all. Big Ds here to make it easier to express yourself.


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Palms Bistro to become Bourbon & Tunns Tavern
We've wondered for a while now what's going on at Palms Bistro, 221 N. Broadway, and finally, the owners announced there will be a name and concept change at the Third Ward bar and eatery.
The new Bourbon & Tunns Tavern will have a different look and feel, including a dark-stained wood bar. The menu will feature comfort foods and small-plate options and the bar will focus on dark liquors, craft cocktails, craft beer and a large wine list.
The opening date is set for Tuesday, Dec. 11.
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Recent Articles & Blogs by Molly Snyder
Local jewelry maker caught Steve Madden's eye
Published Oct. 2, 2015
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"Romeo Is Bleeding" heals violence through Shakespearean tragedy
Published Oct. 2, 2015
When Donté Clark read Shakespeare's "Romeo & Juliet" he realized that the feud between the Montagues and the Capulets was similar to the struggle in his city - Richmond, Calif. - where North and Central Richmond have literally been at war for decades. "Romeo Is Bleeding" screened today as part of the Milwaukee Film Festival.
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The Waxwing needs your support
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Support Westallion Brewing Company
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Wild Haven Fiber Company brings more DIY to KK
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"My Skinny Sister" offers meaty commentary on eating disorders
Published Sept. 28, 2015
Because "My Skinny Sister" explores a teenaged ice skater's eating disorder, it had the dangerous possibility of falling into the cheesy After-School Special / Lifetime Movie category. Luckily, it didn't. The Swedish film runs two more times during the Milwaukee Film Festival.
Frawley finds friendship in felines
Published Sept. 25, 2015
Vivian Frawley didn't grow up with cats, nor did she have them for the first part of adult life, because she was allergic to them. However, in 1986 some friends invited her over for dinner and instead of a doggie bag, she left with a kitten in her purse. Today, she has dedicated much of her life to cat welfare.
6 Milwaukee men who love cats
Published Sept. 25, 2015
In the world of stereotypes, men's best friends are dogs and ladies are crazy for cats. However, many male celebrities remind us that there's nothing unmanly about expressing feline affection. Locally, we tracked down multiple men who really love cats and they shared their stories - and their photos - with us.


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Give a wild Valentine's Day Party favor to your guests.The Wild Hearts Personalized Candy Jar shows off a funky zebra background along with Valentine's Day design. Each 4 ounce glass Zebra Heart Candy Jar measures 3 inches high x 2 1/2 inches wide with an opening that measures 1 3/4 inches in diameter. Fill with red and pink candies to match your Valentine's Day event.
Please allow ample time for delivery. Our ship date for this product is noted in your shopping cart. Many items are shipped separately, so please allow extra time for these items to arrive. Shipping charges are based on the value of the merchandise and not the number of shipments. For additional shipping information, contact our Customer Service Department at (email@example.com or 1-800-227-2789).
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Editors' Note: Beta or prerelease software is not intended for inexperienced users, as the software may contain bugs or potentially damage your system. We strongly recommend that users exercise caution and save all mission-critical data before installing and/or using this software.
Publisher's Description+
What's new in this version:
- The New Document save panel can now be dismissed when running on the latest 10.11 beta.
- Page tags are now properly preserved when migrating a document.
- Fixed a bug where some unencrypted documents could not be opened because of a failure to parse storeinfo.plist.


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HN-QRK019 Sprout
Sprout Childrens Table - Green and WhiteItem # HN-QRK019
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- Made from recycled pre-consumer material
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- Not for outdoor use
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The Sprout Childrens Table - Green and White is perfect for drawing, playing, or projects. Use it like a folding table by breaking it down when you don't need it and setting it up again in seconds when you do. Assembly is simple enough for your kids to figure out. Made of CARB compliant MDF - a sustainable pre-consumer recycled wood product - the Sprout Childrens Table is eco-friendly furniture your children will love. Weight Limit: 150 lbs.About Sprout Kids FurnitureDesigned to be more than just f


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Staying here for the evening was a great choice and am sure you will not be disappointed. The staff is great and the comfort was well received... this is a "will stop by again" kind of "comfort suites.
Staying here for the evening was a great choice and am sure you will not be disappointed. The staff is great and the comfort was well received... this is a "will stop by again" kind of "comfort suites.
Nice, clean, with a friendly staff. Stopped short of SIU, to stay 1 hour from the school. It was a nice choice. Nice clean breakfast area, and hotel was close to retail stores. overall a good experience.
Beyond Excellent facility and service! Every employee we spoke with was courteous, professional, kind, and helpful. A Thank You to Nichol & Ruth at the desk! A Special THANK YOU to Ms. Lisa Wright at the desk who went above and beyond for us in a stressful situation! And a Thank You to the great ladies in housekeeping that we... More
On behalf of our hotel staff, I am writing to let you know how delighted we were to receive your kind words of praise on the employees. Day or night, good service depends upon people willing to give their very best at all times. That's why it is truly rewarding when a guest recognizes our staff's efforts, and takes the... More
When we tried to check into this hotel, the front desk women was very rude. Stated they had no rooms (parking lot empty). Even though we are members of the Comfort/ Quality Suites rewards program, she would not acknowledge that & could care less. So glad that she did turn us away. We went across the street to Drury Inn... More
I am very sorry to hear of the inappropriate treatment you received from our front desk clerk when you were a guest in our hotel. I have discussed her attitude with her and she joins me in offering a sincere apology for her behavior. Please be assured a poor attitude by any of our staff members will not be tolerated... More
The rooms were spacious and plenty of cable channels. The breakfast was very good sized and had plenty of options and lots of those options. The wi-fi was terrible. It was slow and constantly was kicking me off. The other thing that was a bit sad was on the bill as Choice properties have done in the past is try... More
Thank you for taking the time to due a review on trip advisor about your experience at our hotel. I am sorry you had problems with the WI-FI and want to reassure you that we are looking into the problem. We sincerely appreciate your feedback. It provides us with information needed to correct problems and improve the services we offer... More
Didn't know what to expect but after driving 6 hours late at night to get a head start on our trip, this was a welcome place. Clean comfortable surroundings with a very comfortable bed. Definitely would stay again.
Thank you so much for taking the time to post a review. We appreciate the feedback. Should you be returning to Mount Vernon, we would love to have you stay with again at Comfort Suites. Safe travels! Rebecca S. More
This hotel is very nice, clean and comfortable. Ruth,working the front desk was very nice and even gave us a call in our room to make sure everything was satisfactory. The beds were so comfortable we almost overslept. We would definitely stay again.
I want to take this time to thank you for filling out a review. I am very pleased to hear that Ruth gave you great service. I cant wait to share the feed back with my team. Yours in hospitality! Rebecca S. More
The room was clean and the wifi was decent. We enjoyed the pool and the hot tub, except when the fire alarm went off and we had to go outside. The staff was very polite and the breakfast was good, better than most places. The major downside and the part that lowered my rating is that there was a billing... More
Hello! Thank you so much for taking time to post a review. We appreciate the feedback. We are glad you enjoyed your stay. I want t to personally apologize for your billing issue that it took so long to get it resolved . Please know that we would love to have you stay with us should you return to Mount... More
Nice staff the beds were great... and I enjoyed the breakfast. I frequently drive from Dallas to Detroit AND Chicago. .. my new midway stop. They had a nice workout room also. But i was too sleepy for that
Thanks for the positive feedback, Matthew....we're glad you appreciated the convenience of our location and glad that you like our work room. We look forward to your return. Safe Travels! Rebecca S. More
Stopped here with my 2 grandchildren on our way home for Florida. Great room, great service. Nice pool area. Wonderful breakfast in the morning. It was crowded at 8 a.m. and over at 9 so get there early.
Thank you for taking the time to complete our online survey regarding your recent stay at our hotel. Your feedback is very important to us and we can assure you that we will use this information to do everything possible to create an enjoyable experience for each of our guests. We hope to see you again soon! Sincerely, Rebecca S. More
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Tip a Cop will generate funds for Christmas program.
Diners at Motor Company Grill may not get the best service next Thursday, but it certainly will be service with a smile, and for a good cause. Servers at the restaurant will be members of local law enforcement agencies and 100 percent of all tips will be donated to the county's Shop with a Cop program.
After 17 years playing Santa in Macon County, the Macon County Shop with a Cop program hit a record high last year when they were able to take 258 local children shopping. The number of children served, which has grown from 16 children when it first started, is both a testament to the community support of the program and the need for such a program in the county.


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by: 3D Live Wallpaper Creators | 6
Game Over Wallpaper on your home screen with a moving Cube!
Game Over Wallpaper Live Wallpaper Cube: Motion on your home screen!
TO USE: Home -> Press MENU -> Wallpapers -> Live Wallpapers -> Game Over Wallpaper Live Wallpaper
This free app is ad supported and may contain ads in the notification tray and/or home screen.
Help Keep Our apps Free, Rate us and tell everyone how great Game Over Wallpaper is! If we hear enough we will definetly publish a paid version of Game Over Wallpaper with no ads in it for all of our fans.
Game Over Wallpaper is Free to customize your homescreen and your lockscreen with amazing light weight 3D graphics. Ultra small file size for quick downloads, Game Over Wallpaper doesnt hog your battery life like other poorly written Live Wallpapers, Game Over Wallpaper is sure to be great to enjoy all without draining your battery!
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from 6 reviews


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Possible Answer
Payer or remitter identification number Numéro d'identification du payeur ou de l'agent Exemption code Code d'exemption Gross income Revenu brut Non-resident tax ... - read more
This guide explains how and when to withhold non-resident tax, how to remit it and how to file the NR4 return. - read more
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I had 3 csections in roughly 4 years. That was 4 years ago but I feel like my scars are just ripping open its so sore all the time I can hardly move without the pain. If I cough or sneeze or laugh I have to hold myself or it will hurt even worse. Anyone have this problem any suggestions on how to help the pain
3 c-sections in 4 years
Posted 07/02/2013
Comments (3)
JennieB28 · Original Poster
Posted 07/02/2013
Oh and gas is killer. No way to describe it just painful
Posted 07/02/2013
This will be my third section. I had one in 2010 and one in 2012. My incision scar itches and stings alot. I know its from all the stretching but it still freaks me out.
Alissa married to Zach 9/6/08 ♥ Mommy to Zachary Lane born 6/23/10 ♥ Madison Grace born 8/15/12 ♥ Austin William born 12/24/13♥
JennieB28 · Original Poster
Posted 07/02/2013
I'm going to have to talk to my dr because it is just getting worse
Your growing child
Your 20-month-old: Week 2
Don't overreact to your toddler's behavior. Read More
Your 20-month-old: Week 3
If washing your toddler's hair is always a struggle, consider cutting his locks short so there's less to fuss with. Read More
Your 20-month-old: Week 4
Pacifier and bottle use often linger far into the second year. Read More
Your 21-month-old: Week 1
Your 21-month-old is probably interested in rearranging furniture, assisting with chores, and using her own play shelves, table, and chairs. Read More
Your 21-month-old: Week 2
Sharing isn't one of your child's strong suits. Read More


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Paula Poundstone on the Craft of Comedy
The comedian reflects on over 30 years of making audiences laugh as she returns to Tucson for a Feb. 19 show at Centennial Hall.
The comedian reflects on over 30 years of making audiences laugh as she returns to Tucson for a Feb. 19 show at Centennial Hall.
Hear how one student's fascination with yeast and sugars turned into three years of award-winning research at the Sonoran Science Academy.
What happens when teachers don't have an answer to the question 'why'? Learn how one classroom at Amphi High School aided in healing from the January 8th shootings.
Learn about AVID, a program that prepares under-served students in the Sunnyside School District for college.
Learn how the dedicated staff of the TWC stands ready to help injured wildlife, whether they are feathered, furred, or scaled.
The city seeks to expand its bicycle friendly corridors
A conversation with Dr. Marian Binder, Director of Counseling Services at the University of Arizona
Hear an essay by Jacquelyn Jackson, an eye-witness to the events of January 8th.
Gabrielle Giffords chose this song to send into space in 2008, and here is a previously unheard version...
The weekend host of All Things Considered talks about the latest round of his "Three-Minute Fiction" contest.
Learn about Opening Minds Through the Arts, which uses the power of students' creativity to unlock learning.
At age 87, the celebrated children's book author and former Tucson newspaper writer is living a simple life in a solar-powered house in the desert.
Tucson author Cathy Hufault recounts the tragedy that sparked the largest search for missing persons in Arizona history
On this week's Teachers Voices, hear how digital media is re-defining community storytelling in the Sunnyside School District.
Hear about the impacts of studying abroad while writing limericks in the city of Limerick.
Buddhist Temple and Meditation Center opens at former school for landscape architecture.
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China and Darfur: the Spielberg factor
Five years ago today, the crisis in Darfur was ignited by a rebel attack. The government responded, backed by janjaweed militia – and now, five years on, an estimated 200,000 people have been killed, and two and a half million have lost their homes. Call it genocide, as the US does, or "the greatest humanitarian disaster the world is facing" as the UN does – whatever you call it, it is a tragedy of immense proportions.
So far, so familiar. But suppose there was a hint of some good news out of Darfur on this grim anniversary. Suppose that even as thousands more people are fleeing from their homes to escape renewed aerial bombardments by Sudanese government warplanes and more ground attacks by the feared janjaweed – suppose that there is now a real prospect of deploying the full 26,000-strong multi-national peace-keeping force that the UN and African Union are meant to be putting in place.
And suppose the Sudanese government's belated acquiescence in that deployment was the result of increased – and increasingly public – pressure from Beijing. Might the film director Steven Spielberg, and the other "genocide Olympics" campaigners like actress Mia Farrow, actually have made a difference?
According to the British Foreign Office minister Mark Malloch Brown, there is now a "tactical meeting of minds" between Beijing, Washington and London. (You can hear my interview with him here, and there's a transcript here.) He is now cautiously optimistic that the joint UN/AU force will be in place over the coming months. Khartoum, apparently, has now pretty much agreed to the composition of the force – although you won't need reminding that previous Khartoum agreements have sometimes not lasted very long.
The New York Times reported at the weekend: "China has begun shifting its position on Darfur, stepping outside its diplomatic comfort zone to quietly push Sudan to accept the world's largest peacekeeping force …"
The British government agrees. It doesn't mean that peace is around the corner, but it might mean that pressuring China to pressure Khartoum – with the Beijing Olympics now only months away – is having an effect. (For more background, read the Darfur analyst Alex de Waal's blog, and some interesting comments on it here.)
Oh pleeeeze, what has a UN force ever done to protect anyone's life anywhere? A worthless expensive figleaf, the UN should be disbanded. Will 26,000 UN soldiers be willing and able to protect even some of the 2.5 million refugees the Sudanese government wants to see dead? I wouldn't bet a plugged nickel on it. There is only one force in this world that could make a difference and that force, the United States of America will not get involved. The US is NOT the world's policeman.Complain about this post


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Komatsu America Corp. is a U.S. subsidiary of Komatsu Ltd., the world's second largest manufacturer and supplier of construction, mining and compact construction equipment. Komatsu America also serves forklift and forestry markets. Through its distributor network, Komatsu offers a state-of-the-art parts and service program to support the equipment. Komatsu has proudly been providing high-quality reliable products for nearly a century. Visit the website at www.komatsuamerica.com for more information.
The PC45MR-5 and PC55MR-5 excavators have 38-horsepower 4D88E-7 engines
The 191-horsepower WA380-8 wheel loader has a Tier 4-Final Komatsu SAA6D107E-3 engine that uses up to 6 percent less fuel than its Tier 4-I predecessor
Komatsu says its WA470-8 wheel loader uses up to 6 percent less fuel than the Dash 7 version.
The PC210LC-11 excavator has a Tier 4-Final SAA6D107E-3 engine that provides 7 more horsepower, at 165, than its predecessor.
The D65Pxi-18 crawler dozer incorporates Komatsu's intelligent machine control technology and a Tier 4-Final, 217-horsepower SAS6D114E-6 engine.


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Kitty goes crazy seeing snow flakes!
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Cat loses mind watching twirly toy.
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Cat gives dog hypnotherapy the little guy enjoys massaging the dog so much.
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This super-focused cat can't keep his eyes off the birds outside a window.
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Welcome to the joys of owning a shoulder cat. The novelty doesn't wear off... Just don't let your cat get fat and have him/her climb up and hold on fo ...
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Momma cat dragging the ducklings back by their little tail feathers.
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The fishing cat seems to believe its own illusion.
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Thirteen dogs and a cat have a holiday feast with human hands, this is a guaranteed laugh.
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The cat is clearly making fun of humans.
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Think of it like a cute and cuddly murderous fantasy.
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VideoBash is your first and final stop for free funny videos, games and pictures guaranteed to brighten up your day. The funniest jokes and the most unbelievable pranks caught on tape have been collected in one spot for your viewing pleasure. This is entertainment at its best and no one does it better than VideoBash. These funny clips crackle with humor and they will definitely have you laughing till your sides hurt. Quality is our number one priority and the free funny vids here are the best of the best. There are no mediocre videos here. All the videos, jokes, pranks on VideoBash are the cream of the crop and you'll be hooked from the get go. The best part is you don't have to keep all this good stuff to yourself, you can share all the free entertainment videos with your friends.


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By Greater Media Radio, Inc
Open iTunes to buy and download apps.
Listen live to the Motor City's Classic Rock Station, 94.7 WCSX. Find videos, latest music news, Ken Calvert, Karen Savelly, Doug Podell, Steve Kostan, The Motor City Blues Project.
What's New in Version 3.1
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- Updated: 04 August 2015
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Compatibility: Requires iOS 6.0 or later. Compatible with iPhone, iPad, and iPod touch.


text: More from SI Report: Dodgers release pitcher Freddy Garcia Report: Dodgers release pitcher Freddy Garcia Marshawn Lynch sports gold cleats for Super Bowl Marshawn Lynch sports gold cleats for Super Bowl Louisville vs. FIU: Game time, live stream, TV coverage Louisville vs. FIU: Game time, live stream, TV coverage Pittsburgh-area high school football player dies after... Pittsburgh-area high school football player dies after... Close Tweet0 Share0 Comment0 Share0 Share0 Stumble It0 Print0 More SI Wire Ravens LB Ray Lewis Fined $20K for Hit on Steelers' Hines Ward by Will Yoder Email Posted: Wed Nov. 9, 2011 Baltimore Ravens linebacker Ray Lewis has been fined for his hard hit on Pittsburgh Steelers wide receiver Hines Ward, the Carroll County Times reports. NFL Insider Adam Schefter tweets Lewis was fined $20,000 for the hit.During the game, Lewis' play did not result in a penalty but the league believed the helmet-to-helmet hit was worthy of a fine. The play left Hines Ward "dazed" and the wide receiver did not play for the remainder of the game.Lewis spoke out about the fine:"Yeah, I heard from the league and like I said they fined me whatever they was going to fine me," Lewis told the Carroll County Times. "The thing is you definitely respect them trying to protect player safety. At the same time, it won't change not one way I play this week no matter what the fine is. You can't stop playing defense the way defense has always been created to play. When the receiver has the ball, your job is to disengage him from the ball. You never want to hurt nobody. I've been in this business too long. I just think once you start getting into these fines I don't know how they come up with the numbers most of the time."A 16-year veteran, Lewis has played his entire NFL career with the Ravens. This season, Lewis has amassed 60 tackles, two forced fumbles, two sacks and one interception. Pittsburgh Steelers safety Ryan Clark was fined $40,000 for a helmet-to-helmet hit in the same game. Clark was fined $15,000 last week for a illegal hit on an out of bounds player. Promoted Stories Comments


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September 12, 2013 - Industry News
Initial toll rates have been set for a massive construction project connecting Indiana and Louisville that includes placing tolls along Interstate 65.
Tags: Tolls, Indiana, Kentucky, Road Construction, Interstate 65, I-65
August 23, 2013 - Industry News
The Indiana Department of Transportation is launching an accelerated project that will close Interstate 65 and Interstate 70 between the north and south splits on the east side of downtown Indianapolis for approximately 59 days to reconstruct and lower one-half mile of pavement beneath seven bridges.
Tags: Indiana, I-70, Road Construction, Interstate 70, Interstate 65, I-65
We offer e-newsletters that deliver targeted news and information for the entire fleet industry.
The expert, Mark Betner from CITGO, will answer your questions
The expert, Rence Oliphant from Hendrickson, will answer your questions
Relay Bypass Kit Monitors Amperage Draw
Set of Tools Cleans Male Pins on Terminals
SecureFuel Provides Transparent Fuel Payments
McLeod Offers 'Branded' Driver App for Fleets


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Waimate cyclist Dylan Kennett is in excellent company after receiving a nomination in the emerging talent category for the Halberg Awards.
Kennett won three silver medals at the UCI Junior World Championships in Invercargill.
He also impressed in his elite UCI World Cup debut last month, finishing fourth in the individual pursuit in Scotland.
In Invercargill he broke the New Zealand 3000m individual pursuit record by four seconds, proving what a talent he is.
It will be very competitive to make the finalists with such outstanding young talent in the mix, but Kennett is a real chance. However, lifting the trophy will be a tough ask.
Kennett is up against women's world No 1 amateur golfer Lydia Ko, who is favourite to take the title.
North Canterbury's Anton Cooper made history this year when he became the first UCI cross-country mountain bike world champion, in any age group, from New Zealand.
Orienteer Mathew Ogden has won the middle distance junior world orienteering championship in Slovakia.
And, also in the mix, is Diamond Blacks baseball pitcher, BMX rider Trent Jones (BMX), sailor Andrew McKenzie, swimmer Corey Main and road cycling's Sophie Williamson.
The winner receives a $10,000 scholarship. Past recipients are ineligible.
Last year shot putter Jacko Gill beat Sam Meech (cycling), Shaun Johnson (league) and Byron Wells (freestyle skiing) for the title, while previous winners include swimmer Gareth Kean, winter X-Games free-skiing prospect Jossi Wells and under-19 world track cycling champion Sam Webster.
To be eligible an athlete must be under 20 as of November 30 of the year nominated and have represented New Zealand.
The emerging talent nominee must not have medalled at elite international level. The award is designed to identify and assist a young athlete in their quest to become an Olympic and/or world champion, and hopefully one day win the Halberg Award.
- The Timaru Herald
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Roncalli play off for 15th at national netball in Ashburton
Doudle's dedication rewarded by achievement of others
Roncalli outclassed at New Zealand Schools netball champs
Roncalli looking to take down Baradene
Spirited showing by South Canterbury junior footballers
Pelser wins Commonwealth silver in karate in India
Galbraith wins back-to-back NZ rally titles
South Canterbury girls finish third in national tournament
National champions for the first time
Kiwi rally driver Hayden Paddon finishes in top five in Corsica in WRC
Superb South Canterbury go top of Heartland
Heroic Horowhenua-Kapiti upset Mid Canterbury
'Heart in mouth' for Paddon in WRC in Corsica
Man who spat at Timaru cop convicted
Baby elephant seal dies at Timaru's Caroline Bay
Timaru real estate agents to take part in the Variety Trillian Mini Bash
'Broken woman' sentenced for friend's death in Pukaki crash
Person treated for smoke inhalation after Selwyn St fire in Timaru
Editorial: Have church, willing to negotiate
Crash victim's body heading home to Jordan
Rising basketball star Bianca Small aims to impress in the US
Residents gradually warming up to idea of home-heating appraisals
More jobs if wool scour firms merge
Charging battery bursts into flames
White crosses mark those who fell in WWI
Dream for Timaru Titans league team fails to get off the ground
Art feeds the soul at Bread of Life
Baby elephant seal dies at Timaru's Caroline Bay
Man who spat at Timaru cop convicted
'Broken woman' sentenced for friend's death in Pukaki crash
Timaru real estate agents to take part in the Variety Trillian Mini Bash
Person treated for smoke inhalation after Selwyn St fire in Timaru
Less insurance claims after big winds, but more for trampolines
Timaru police notebook: October 9, 2015
Imaginative young writers win Timaru competitions
Kayaking victims' bodies to be returned


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Carrie Daly , MS, RN, APN, AOCN concluded her presentation commenting, "MuGard has been adopted as the standard of care for Radiation Therapy patients at Rush University Medical Center that are at risk of developing mucositis as a result of cancer therapy. MuGard proves to be a critical tool in treating and preventing oral mucositis in our cancer patient population. Patients that used MuGard and were compliant with patient instructions had a significant clinical benefit, with lower grades of oral mucositis, reduced pain, and reduced analgesic use and were able to stay better nourished and maintain their weight."
The "Outsmarting Oral Mucositis" presentation poster can be viewed by visiting the MuGard website homepage at www.MuGard.com.
About Carrie Daly , MS, RN, APN, AOCN:
Carrie is the Chief Nurse at Rush University Medical Center's Radiation Oncology department. Daly has been a member of the Oncology Nursing Society (ONS) for more than 20 years and a member of the Radiation Oncology Special Interest Group through ONS. Having received excellence accolades like the American Society for Radiation Oncology (ASTRO) Nurse Excellence Award (2009) and ONS Excellence in Radiation Oncology Nursing (2005), Carrie goes above and beyond the normal standards of nursing practice. Carrie is also a member of the Cancer Committee and Cancer Survivorship Committee at Rush University Medical Center.
About ONS:
The Oncology Nursing Society (ONS) is a professional organization of over 35,000 registered nurses and other healthcare providers dedicated to exce
|SOURCE Access Pharmaceuticals, Inc.
Copyright©2012 PR Newswire.
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Maui Eco Retreat ~ Lotus RoomUnited States, Hawaii, Haiku
About this listing
WELCOME TO THE GREENEST SPOT ON MAUI! "Where your Vacation Becomes a Transformation!"
Whether you're seeking sanctuary, writing the next chapter of your life, or simply on vacation, come explore sustainable living at Maui's premier eco retreat.
Read the rules before booking
Space where guests can cook their own meals
Continuous access in the listing
The listing can accommodate a gathering of 25 or more attendees
Space where guests can cook their own meals
Towels, bed sheets, soap, and toilet paper
Central heating or a heater in the listing
In the building, free or for a fee
In the building, free or for a fee
Continuous access in the listing
Breakfast is provided.
The listing can accommodate a gathering of 25 or more attendees
Easy access to the building and listing for guests in wheelchairs
Private or Shared
Free, in the building or nearby
The Space
NOTICE: IF YOU WISH TO STAY SHORTER THAN THE MINIMUM REQUIRED STAY, PLEASE SEND US A MESSAGE. We will accept shorter stays if it fits between current bookings. Thank you.
Operating a short-term vacation accommodation in Maui is illegal without a permit. We have been fully licensed and permitted since 2009 our License number is BBPH0003. Upon Arrival we have to collect the %13.42 Hawaiian Transient Tax.
At Maui Eco Retreat You'll Enjoy:
Directly next to the ocean
Beautiful hiking trails
Waterfall lagoons
Romantic setting
Only 15 minutes from town
Sunrise views
Yoga and meditation classes
This listing features our elegant Lotus Room. The Lotus room, located on the ground floor of the Opua house, has a large room with an ocean view and floor to ceiling windows which overlook our lotus pond. Enjoy beautiful white lotus blossoms in summer and water hyacinths and purple lilies year round. The room includes a private bathroom room equipped with shower and a large in-room closet. Sliding glass doors open to a large deck for sunning and meditation.
You are sharing a spacious, beautiful kitchen with the other guests in the house. The Opua house kitchen is well equipped for all of your cooking needs.
*ONLY FITS 2 PEOPLE - thank you
*Please note that our offices are closed during the weekend and our normal business hours are M-F 10am-2pm Hawaiian Standard Time. We are a small family owned retreat and will always respond to your request as soon as we are able. Please do not send requests over the weekend, we will not be able to reply and will have our response time penalized due to this.
We greatly appreciate your understanding. Mahalo.
All of our buildings are ecologically built and are often adorned with spiritual art and hand-crafted masterpieces from Pacific and Asian countries. All our rooms have ocean views, and we are surrounded by lush jungle, ponds, flower gardens, fruit trees, and a nearby waterfall (reached by a short downhill climb) which flows into natural pools for swimming from which you can gaze upon the breath-taking view of the valley.
Our land is a wonderful place to wander and explore: you can take a short walk passing the chickens, the homes of our bees, countless species of flowers and plants and stop by our temples, where you can rest, relax and meditate. For the adventurer, our ocean trail is a moderately challenging cliff trail and the hike takes about a half an hour to get down to the ocean. You will enjoy the wild beauty and the untouched nature of this piece of rural Maui, which is occasionally visited by dolphins and turtles, and in the wintertime, the whales can be spotted breaching from the rooms. But be sure to prepare with a good pair of hiking shoes, some snacks and feel your feet, the trail can be very slippery after a heavy rain.
Location: We are on the North Shore of Maui's sunrise, just 40 minutes north/east of Kahului airport, and 30 minutes from Paia Town (on the way from the airport), which has lots of great restaurants and boutiques, a large health-food grocery store, internet cafés, bank, ATMs, post office, and lovely public sand beaches for walks or jogs, lounging, picnicking, sun bathing, swimming and surfing. We are in the heart of the island, where you will receive a full of experience of local living and no large hotels and tourism. Nature calls!
Please let us know if there are specific activities or services that you are interested in, and we'll be happy to get you connected!
If you would like to get married on Maui, Kutira is a licensed wedding officiant by the State of Hawaii.
All of our houses are built to code and we have an official permit by the county of Maui to host guests.
Children: The allowance of children is decided on a case-by-case basis (based on age, space, and location of your vacation rental). You need to have a confirmed approval from our office. If you arrive with a child without our consent, we will not be able to host your stay. Your reservation will be immediately cancelled with no money returned. Generally, we strive to maintain a meditative space and if we are able to do so while hosting your wonderful family, we would love to!
**UPON ARRIVAL**: We will charge you and additional 13.42% tax from the amount you have already paid to AirB&B. (This is the mandatory Hawaiian Transient State Tax of 9.25% and Hawaii State Tax of 4.166%). Our cleaning fee is based on a 5 night stay. If we accept a shorter stay a higher cleaning fee is due as well. Our cleaning fee is likely different during the high-season (December 15th - March 31st) and the summer season (July 1st - August 31st).
Late Arrival: There is an additional $45 charge for late arrivals between 7pm - 10pm and $65 from 10pm to midnight. We are a small family owned business and have to hire an after hour guest-services person to welcome late night arrivals and show you to your room or cottage. If you have planned to arrive before 6pm, and you come later than one hour after you agreed, we have the right to charge a waiting fee of $30. We request a courtesy call if you arrival time has changed, and in this case we will waive your waiting fee until 7pm. Again, thank you for understanding our situation.
Shopping Service For Late Arrivals: Please contact us in advance with a detailed shopping list and we will have your groceries waiting for you when you arrive. The cost for this service is $30 + 10% of the cost of goods.
We also request upon arrival a credit card imprint for potential overuse charges. In order to use our hiking trails, we need you to sign a release waiver.
Once we have accepted your booking we will send you a detailed informational email that will support your stay with us. Important: Please confirm this email as it will contain driving directions to the property and you will need to verify your arrival time.
We are really looking forward to hosting you at our magical place!
Other Things to Note
Our office is open Monday-Friday from 10am-2pm (Hawaii standard time). We are unable to respond to inquiries over the weekend but will get back to you first thing Monday morning!
No smoking indoors. Quiet time after 9pm. Kitchen must be cleaned after each use. We encourage our guests to conserve electricity and water.
We operate on solar energy from panels installed on our buildings, our water is pumped directly from our own well, and we live sustainably and self-sufficiently from the land through organic farming. We have a short welcome procedure that will inform you how to embrace a sustainable lifestyle including what your chicken's like and what is recyclable etc..
We are family owned small place and we are not prepared to host small children. Welcome to the new Eco-Conscious way of living and traveling elegantly green!
8 Reviews
Wunderschön gelegen und eingebettet in die Natur Mauis. Hier ist man abseits der Touristenpfade. Dafür sollte man aber auch ein Auto haben. Rafael hatte viele Tipps für uns und in der Gemeinschaftsküche kommt man gut mit anderen Gästen in Kontakt.
This place is surreal! It has a private waterfall and hiking trails. We stayed in the Lotus room. It was amazing. This place will always have a special place in my heart.. Loved the tropical/Asian decor.. Very spiritual! Bring your yoga gear and mosquito repellent and toiletries
Wonderful experience. It's hard to describe the beauty of the property: the waterfall, the ocean, the jungle. Great people and great experience. Very peaceful
We had three wonderful days at this fairy land - very quiet, private, clean, and everything's beautiful. Lotus room has an amazing view to the ocean and a pond. Raphael welcomed us when we checked in and introduced to us about the room, the land and the nearby restaurants and shops, which turned out to be very helpful. The place is relatively close to the summit area of the Haleakala National Park, and also not far away from the airport. What we love most is the greens, the trails, the fall, the pond, all these natural things are just within its own yard! Dawa and Moshi are soooooo cute! All people and staff there are super nice and resourceful. We left our two souvenir cups there and Kutira helped find them for our pick-up after we checked out. Mahola for everything! Will definitely recommend it to friends.
The Maui Eco Retreat property exceeded my expectations. What a beautiful paradise they have created. Lots of friendly people around, a fantastic room and I most enjoyed the abundance of Buddhas, Tibetan art were a pleasure to be surrounded by in this incredible and sprawling piece of land. Taking the ocean trail down to the shore and finding our way up the creek to the waterfall was an epic journey. my highest recommendation and what wonderful and inspiring conscious kind souls they are for nuturing this land I this way and making it available to many.
The Eco Retreat was fantastic! We didn't get a chance to meet Kutira, but Raphael was very kind and welcoming. William and Ben were also friendly, helpful, and fun to talk with.
Our room (the Lotus Room) was as described - awesome place with an awesome view.
The grounds of the Eco Retreat were incredible! We spent our first day exploring the area - the hike to the waterfall was amazing and the hike down to the ocean is a must as well.
Great way to start our vacation and we hope to be back in the future.
We still have lovely images in our minds of this idyllic retreat -- the large windows overlooking the pond and the ocean beyond. Our room and the quiet, privacy and exquisite surroundings perfectly suited our tastes and were incomparably better than any hotel we could have found. The focus on a self-contained, earth-friendly lifestyle also correspond with our own values and made us feel very much at home. We were married during our stay and our walks down to the ocean and swimming under the waterfall will be among our favorite memories.
This host has 60 reviews for other properties.View Other Reviews
About the Host, Alyson & Kutira
Hi, my name is Alyson and I am the office manager of our beautiful Maui Eco Retreat B& B on the North Shore of Maui. Together with the owners, Kutira and Raphael, I am taking care of your visit with us. I love that this place is truly embodying old Hawaii and the magnificent side of where eco tourism is fully alive. Come, visit us!


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jeb bush
Bush, Walker, Trump criticize gun ban in recruiting offices
Pres. Obama, Jeb Bush say no to peas in guacamole
Jeb Bush 'slow jams the news' with Fallon
Christie falls behind GOP rivals
Romney sparks new 2016 competition in GOP establishment
GOP's 2016 prospects: 14 hopefuls, including Christie
Two GOP candidates move closer to 2016 runs
Bush tops Republican candidates
The problem with Christie and Bush
As the reaction and speculation pours in after Jeb Bush's announcement this week, one issue between he and Gov. Chris Christie is that they are too much alike.


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Product Information:
This stainless steel product rivals the quality and strong culinary results produced by classic French copper. The construction allows for perfectly even heat distribution from the bottom to the sides of the pan. The composition of the metal is unique in that it is one continuous form that extends the entire piece. This pan has no weak points for potential breakage. It has curved hollow stainless steel handle with strong heavy duty rivets. The "Lyon" shaped handle ensures a secure grip for tilting and rotating the pan. This skillet is great for searing and flambéing any dish.
Product Details
Weights & Dimensions
10.25" Diameter Size
11" Diameter Size
12.5" Diameter Size
9.5" Diameter Size
|Dishwasher Safe: Yes
|Product Type: Frying pan/Skillet
|Color: Grey
|Material: Stainless steel
|Shape: Round
|Construction: Solid
Handles: Yes
|Country of Manufacture: China
About the ManufacturerWorld Cuisine sends you world class cookware, bakeware, cutlery, and appliances from around the globe. With its diverse selection, it is no wonder that people choose World Cuisine above everyone else. World Cuisine cookware embodies poise and style, while its bakeware helps combine tradition with modernity. Choose from quality World Cuisine frying pans and skillets, dutch ovens, sauce pans, grill pans, fondue sets, cookware utensils, bakeware, mixing bowls, pastry bags and more!
The World Cuisine Silex cutlery line boasts some very unique properties such as: purity of metal, unrivaled hardness and strength, and fineness of structure only equaled by the surgical scalpel. The World Cuisine appliances not only cut cooking time in half with their highly ergonomical efficiency, but also give the kitchen a more modern look. All in all, World Cuisine gives both the restaurant chef and the simple cook the tools they need to create culinary masterpieces.
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We want you to love it. If you don't, you may return your purchase within 30 days of delivery. All you need to do is visit our Self-Service Return Center for instructions. Return credits are issued within 24 hours once the item is received and inspected. Please note that shipping charges are non-refundable. The cost of return shipping will be deducted from your refund. 30-Day Return Policy
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Houston Cruises Past Tulsa, 38-24
Greg Ward Jr. threw for 273 yards and ran for 182 yards with three touchdowns, breaking the school record for rushing yards by a quarterback, to help lead Houston to a 38-24 victory over Tulsa on Saturday.
Game Book (PDF) | Notes |
Parking Details for Thursday Night SMU Game
Houston will receive national exposure as it faces in-state rival SMU on Thursday, Oct. 8, at 7 p.m. on ESPN2. With classes in session, entry in a limited number of game day lots is being slightly delayed and Houston fans wearing red will be allowed to ride METRO Rail's Purple Line free of charge Thursday.
Details for Houston Watch Parties Saturday
With Houston Football hitting the road to Tulsa on Saturday, UH fans are invited to a number of official UH watch parties in the Houston area. Houston faces the Golden Hurricane at 11 a.m. (CST) Saturday in a game that will air on CBS Sports Network and KPRC 950 AM.
Tickets |
From Island Boy to Student-Athlete
Explore senior offensive lineman Alex Cooper's journey from the Bahamas to the University of Houston in today's CHAMPIONS FOR LIFE feature.
Tickets |
Jackson Named American Player of the Week
Houston cornerback William Jackson III has been named The American Athletic Conference's Defensive Player of the Week while quarterback Greg Ward Jr. was named to the league's weekly Honor Roll for their performances in Houston's 59-14 win over Texas State.
Tickets |


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Lying-Down Spectacles, Shortage of Coal-Tar Chemicals and More
Eye Movements Do Not Reveal LyingMultiple tests of eye-movement direction and honesty found no correlation between lying and eye direction. Steve Mirsky reports
Big Liars Are Truthful about LyingFrequent fibbers, who tend to get high scores on tests measuring psychopathic traits, openly admit their untrustworthy tendency. Sophie Bushwick reports
Police car strikes, kills student lying on Massachusetts roadA Chatham, Massachusetts, police cruiserran over and killed a college lacrosse player lying on an unlitroad early on Thursday, authorities said.
Lying Liars
Is Lying Rational?://www.scientificamerican.com/article/is-lying-rational-transcript/"> Click here for a transcript of this video.
MRI Study Shows Lying Brains Look Different
Is Lying a Good Strategy?
A new documentary film presents the science behind when and why people lie. Daisy Yuhas reports
The Load of Lying: Testing for TruthGiving suspects an extra task helps to separate the liars from the truth-tellers
The Solar ChromosphereIt is a narrow region lying between the visible disk of the sun and the corona. Within it are found
Salvaging the Steamship "St. Paul"How a 13,000-ton Ship, Lying on Her Side Many Feet Under Water, Was Rolled Over and Floated
Swan on the SunDoes anybody else see a swan? Tangled magnetic fields lying just beneath the surface of the Sun
BP executive acquitted of lying about Gulf of Mexico oil spillA U.S. federal jury acquitted a former BP Plc executive on Friday of lying about how much oil
Volcano Blankets Chile in DustSmoke and ash billow from the Chaitén volcano in southern Chile, which erupted on May 2, 2008, after lying dormant since circa 7,400 B.C.
Is Lying Rational? [Transcript]
The paths from little fibs to big lies may be smaller than we'd like to think, as revealed by a new collaboration from director Yael Melamede and behavioral economist Dan Ariely
Lying by the Book
Bangladesh floods leave thousands homeless, damage crops-lying and densely populated country, with the wet season due to run into September.
Huge carp found in Kansas ditch is no fish story. An animal control officer in Olathe, Kansas, recently hauledin a 60-pound (27-kg) carp that was lying in a drainage ditch.
Imagine A 200-Pound Armadillowas once low-lying grassland. Steve Mirsky explains. With reporting by Harvey Black.
Pacific nations to highlight Cyclone Pam in climate talkslevels also pose threat to low-lying islands By Lincoln Feast SYDNEY, March 17 (Reuters) - Pacific


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University of Pennsylvania Health System
University of Pennsylvania's School of Medicine
Effectiveness & Quality Improvement (Intranet
Access Only)
Center for Evidence-based Practice
Access Only)
The mission of CEP is to support healthcare quality and safety at the University of Pennsylvania Health System (UPHS) through the practice of evidence-based medicine. To that end, the Center summarizes scientific evidence for UPHS decision making about high impact drugs, devices and processes of care, and is charged with building evidence-based collaborative enterprises with outside organizations.
The mission of CEP is to support healthcare quality and safety at the University of Pennsylvania Health System (UPHS) through the practice of evidence-based medicine. To that end, the Center summarizes scientific evidence for UPHS decision making about high impact drugs, devices and processes of care, and is charged with building evidence-based collaborative enterprises with outside organizations.
August 10, 2015 – Tray tables, bed rails, light switches, and toilets: All are common vectors for swapping germs between patients and health care workers. While a new systematic overview in this week's Annals of Internal Medicine points to several promising cleaning tactics of these "high-touch surfaces," there's a lack of evidence as to which is the most effective at reducing healthcare-associated infections (HAIs). Few studies measured patient outcomes or focused on newer technologies, and even less compared cleaning tactics against one another — important gaps to fill as the U.S. health care system works to reduce the 75,000 HAI-related deaths that occur annually.
The systematic overview was led by Craig A. Umscheid, MD, MSCE, an assistant professor of Medicine and Epidemiology in the Perelman School of Medicine at the University of Pennsylvania, and Senior Associate Director at the ECRI Institute-Penn Medicine Agency for Healthcare Research and Quality (AHRQ)-funded Evidence-Based Practice Center (EPC), Jennifer Han, MD, MSCE, an assistant professor of Medicine and Epidemiology, and Brian Leas, MS, MA, and Nancy Sullivan, research analysts in the ECRI-Penn AHRQ EPC, and revealed major gaps in existing evidence for the best practices for cleaning hospital room surfaces to prevent HAIs, including Clostridium difficile, MRSA, andVRE.
"The cleaning of hard surfaces in hospital rooms is critical for reducing healthcare-associated infections," said Han, the study's lead author. "We found that the research to date does provide a good overall picture of the before and after results of particular cleaning agents and approaches to monitoring cleanliness. Researchers now need to take the next step and compare the various ways of cleaning these surfaces and monitoring their cleanliness in order to determine which are the most effective in driving down the rate of hospital-acquired infections."
While studies examining HAIs have increased over the last 15 years, infections acquired in the hospital remain a leading cause of death and morbidity. In 2011, there were over 721,000 HAIs in the U.S., according to the most recently available data from the U.S. Centers for Disease Control and Prevention (CDC). What's more, many experts believe that only 50 percent of surfaces are typically disinfected during cleaning of a patient's room.
Examining 80 studies published between 1998 and 2014, the research team found that comparative effectiveness studies were uncommon. Such studies would have directly compared different ways of cleaning, disinfecting, and monitoring the cleanliness of hard surfaces in order to determine which were most effective. There were also relatively few studies that focused on measuring outcomes of most interest to patients, such as changes in HAI rates or the presence of pathogens on patients. Only five of the studies were randomized controlled trials.
Instead, the existing studies were largely before and after experiments, comparing the magnitude of surface contamination after cleaning with a particular agent to the magnitude of contamination before cleaning. Over 65 percent of the studies assessed surface contamination, such as bacterial burden and colony counts, as the primary outcome. Less than 35 percent reported on patient-centered outcomes, such as HAI rates or acquisition of a specific organism in the body, known as colonization.
The ECRI-Penn EPC team looked at three broad categories of evidence: 1) which agents and methods were used to clean hard surfaces; 2) what approaches were available to monitor the effectiveness of cleaning; and 3) what systems-level factors are needed for cleaning and monitoring to be successful. In addition to its literature review, the researchers interviewed a number of national experts.
"Our goal was to provide a comprehensive review of evidence in all three domains," said Umscheid, the study's senior author. "While there is a clear need for more patient-centered and comparative effectiveness research, the findings that do exist provide a good place to start in terms of a hospital or health care entity seeking information on ways to mitigate healthcare-associated infections."
Among its findings, the EPC team identified several studies showing that rates of C. difficile (or "C. diff"),the most common cause of hospital-acquired gastrointestinal infections, fell with the use of bleach-based disinfectants but that a chlorine dioxide-based product was ineffective in reducing C. diff contamination and infection rates. Patients taking antibiotics are at special risk of becoming infected with C. diff because antibiotics can disrupt the normal bacteria of the bowel. According to the CDC, C. diff caused almost half a million infections in the United States in 2011.
In addition, six studies integrating various wipes moistened with hydrogen peroxide and other chemicals into preventive strategies reported positive outcomes, including sustained reductions in HAIs. Seventeen studies implementing "no-touch" modalities to clean hard surfaces – such as devices that emit ultraviolet light or hydrogen peroxide vapor – reported positive findings, with three specifically demonstrating reductions in infection rates. Seven of eight studies evaluating enhanced coatings on hospital room surfaces, such as copper-coated bed rails, reported positive findings. Surfaces made of solid, copper-based metals or alloys continuously kill bacteria that cause infections.
The EPC team also highlighted several priority areas for future research, based on their review of the evidence and interviews with leading experts. Questions to emphasize in future studies include: what surfaces present the greatest infection risk to patients, what benchmarks should be established for measuring cleanliness, and what factors affect the quality of routine disinfection practices? Further research is also needed on recently emerging disinfection strategies.
"In addition to expanding the use of comparative effectiveness research and placing greater emphasis on patient-centered outcomes, future research should investigate the effectiveness of a number of promising new technologies and approaches," said Han. "These include self-disinfecting coatings and increasingly used surface markers for monitoring the presence of pathogens. Other challenges include identifying high-touch surfaces that confer the greatest risk of pathogen transmission and developing standard thresholds for defining cleanliness."
Other co-authors include David A. Pegues, MD, from Penn, and Janice L. Kaczmarek, MS from ECRI Institute.
Penn Study Shows Computer-Assisted Diagnosis Tool Helps Physicians Assess Skin Conditions Without Aid from Dermatologists: Tool Harnesses Photo Database to Improve Diagnostic Accuracy
April 22, 2015 – In the first major study to examine the use of a computer-assisted, photo-driven differential diagnosis generator for skin conditions, researchers at the Perelman School of Medicine at the University of Pennsylvania found physicians routinely used the tool, without an increase in calling for inpatient dermatology consultations. The software diagnostic tool, VisualDx, aids in diagnosing dermatologic conditions by allowing physicians to enter information such as the type and location of a rash, and associated symptoms such as pain or itching, and then generating a range of possible diagnoses accompanied by photographs. This enables users to rapidly compare the rash of an individual patient to a database of more than 1,300 pediatric and adult skin conditions represented by nearly 30,000 images, with the aim of improving diagnostic accuracy reducing misdiagnosis-related harm.
The study, published early online in Diagnosis (http://www.degruyter.com/view/j/dx.ahead-of-print/dx-2014-0058/dx-2014-0058.xml), found that the rate of dermatologic consultations at the Hospital of the University of Pennsylvania, the flagship hospital of Penn Medicine, did not change for the 18 months after VisualDx was introduced compared to the 12 months before it was introduced.
"This is important because these tools by design suggest numerous potential diagnoses, which could result in an increase in unnecessary testing and specialty consultation, and associated costs and harms, particularly in the hands of less experienced clinicians," says the study's senior author, Craig A. Umscheid, MD, MSCE, assistant professor of Medicine and Epidemiology and director of the Penn Medicine Center for Evidence-based Practice. "Conversely, if there were a significant reduction in dermatologic consultations, it would have suggested that general internists, emergency room physicians, family doctors and pediatricians, all of whom by definition are not specialists in dermatology, may have relied on the tool to make dermatologic diagnoses, rather than consulting a dermatologist for help."
The Penn team examined the use of VisualDx throughout the University of Pennsylvania Health System by month for the 18 months following its introduction in September 2012. Researchers found a median of 474 unique monthly VisualDx sessions by users, a rate that continued throughout the time period under study. The researchers found that, overall, VisualDx was accessed through mobile devices (35 percent); inpatient (34 percent), outpatient (11 percent), and emergency department (one percent) electronic health records; and via searches in UpToDate, a point-of-care evidence summary resource (19 percent).
"Technology like this has great promise, but it can't help patients unless it's actually used," says Umscheid. "Previous studies have been primarily simulations, where researchers take variables from case studies and input them into the software to retroactively assess the diagnostic accuracy of the software. However, our purpose was to determine if a differential diagnosis generator like VisualDx would actually be used by providers if implemented in a hospital, and we found that it is — most often on mobile devices and by inpatient providers."
Differential diagnosis generators have been suggested as a potential way of reducing misdiagnosis, which is estimated to result in 40,000 to 80,000 deaths in U.S. hospitals annually. "The technology can help users overcome cognitive shortcomings such as availability bias, in which providers diagnose patients with conditions they've recently seen or can easily recall, rather than those conditions that are most likely to occur. It can also reduce fund of knowledge deficiencies by directing users to diagnoses they might not have otherwise considered," commented the study's lead author John Barbieri, MD, MBA, a 2014 graduate of the Perelman School of Medicine and The Wharton School.
The other Penn co-author was Benjamin French, PhD. The study was supported in part by the National Institutes of Health (UL1RR024134 and UL1TR000003).The ECRI Institute-Penn Medicine Evidence-based Practice Center (EPC) was recently redesignated by the Agency for Healthcare Research and Quality (AHRQ) to serve as an EPC through 2019. ECRI Institute has maintained this designation since the inception of the EPC program in 1997. The ECRI Institute-Penn Medicine EPC was established in 2012.
AHRQ Redesignates ECRI Institute-Penn Medicine as Evidence-based Practice Center
New 5-year contract supports the Agency for Healthcare Research and Quality in its efforts to disseminate scientific research of important healthcare topics
January 30, 2015 — The ECRI Institute-Penn Medicine Evidence-based Practice Center (EPC) was recently redesignated by the Agency for Healthcare Research and Quality (AHRQ) to serve as an EPC through 2019. ECRI Institute has maintained this designation since the inception of the EPC program in 1997. The ECRI Institute-Penn Medicine EPC was established in 2012.
Under the new contract, known as EPC V, the ECRI Institute-Penn Medicine EPC will work with clinicians, policymakers, patients, consumers, and other scientific partners to develop topics and questions for systematic review of the literature, and to promote the synthesis, translation, and dissemination of research evidence. The EPC has reported on a variety of topics, many in the area of cancer, genetic testing, and imaging tests (access free reports).
As part of the new contract, all 13 Evidence-based Practice Centers will be eligible to bid on work to support the U.S. Preventive Services Task Force (USPSTF), an independent, volunteer panel of experts in prevention and evidence-based medicine dedicated to improving the health of Americans.
"Since we began working together, we've been able to utilize ECRI Institute's independent, evidence-based research and Penn Medicine's clinical and academic leadership to advance research to improve patient care," says Karen Schoelles, MD, SM, director of the ECRI Institute-Penn Medicine EPC. "This new contract inspires us to build on our previous collaborations and break into new research territory.
""We look forward to continuing our efforts to transform patient care delivery as we work alongside ECRI Institute and AHRQ," says Craig A. Umscheid, MD, MSCE, director of the Penn Medicine Center for Evidence-based Practice and senior associate director of the ECRI Institute-Penn Medicine EPC.
The EPC will work with Insight Policy Research, a small woman-owned disadvantaged business.
To learn more about ECRI Institute's work in evaluating health technologies through the Evidence-based Practice Center, membership in the Health Technology Assessment Information Service, and customized consultation and support for clinical practice guideline development, e-mail firstname.lastname@example.com, or call (610) 825-6000, ext. 5519.
Penn Medicine Experts Urge Expansion of Federal Incentives to Improve Patient Care Quality and Safety
Focusing on structural changes in addition to individual clinical outcomes would bring greater gains
January 13, 2015 — In an invited commentary published online by JAMA Internal Medicine, Patrick J. Brennan, MD, chief medical officer of the University of Pennsylvania Health System, and Craig A. Umscheid, MD, MSCE, director of Penn's Center for Evidence-based Practice, recommend that the Centers for Medicare and Medicaid Services shift its use of financial incentives from an exclusive focus on preventing specific clinical outcomes toward encouraging the creation of hospital-wide structures that promote the translation of research evidence into clinical practice to improve the quality and safety of patient care.
In 2008, Medicare implemented the Hospital-Acquired Conditions Initiative, a policy denying incremental payment for eight complications of hospital care, also known as "never events." Another study published in JAMA Internal Medicine led by Teresa Waters, PhD, of the University of Tennessee Health Science Center, found that after the new federal policy was introduced, central line-associated bloodstream infections fell by 11 percent and catheter-associated urinary tract infections fell by ten percent. But there was no significant reduction in hospital-acquired pressure ulcers and serious inpatient falls.
The study authors suggested that the difference in the policy's effects on infections as compared to falls and pressure ulcers were the result of the evidence available at the time to guide hospitals to improve these outcomes.
But the Penn authors disagreed. Instead, they suggested that the difference in the policy's effect had more to do with the challenge of improving complex quality outcomes such as pressure ulcers and inpatient falls, when compared to the easier-to-improve outcome of infections. Unlike infection prevention efforts, which often target care providers and involve changes to a limited set of procedures such as catheter insertion and occur in closely monitored settings such as intensive care units, efforts at reducing falls and pressure ulcers are much more complex. They require multidisciplinary, patient-centered collaboration across the entire spectrum of care, not just critical care.
"Incentives are indeed important," says Brennan. "But they must be the right incentives. There was good-quality evidence available to underpin fall and pressure ulcer prevention efforts when the CMS initiative was launched. Yet neither of these measures has significantly improved. This may be because it's simply not possible to reduce falls and pressure ulcers by taking a few clear-cut steps, as in the case of reducing infections. Instead, broader and more comprehensive structural changes within hospitals should be considered. Such efforts would reduce an even larger number of never events than by simply tackling them one at a time."
Hospitals should aim to bridge what's called the "knowing-doing gap," Umscheid says. "That's the disconnect between what we know works based on the best available evidence and what we actually practice. To bridge the gap, we are not advocating abandoning incentives that focus on individual clinical outcomes. Instead we are urging federal regulators to also encourage institution-wide structural changes. We believe these changes can create the necessary conditions for solving difficult problems such as falls and pressure ulcers -- and others as well."
The structural changes suggested by Brennan and Umscheid are the fabric of Penn Medicine's successful quality improvement program. They include:
Penn Medicine's "Sepsis Sniffer" Generates Faster Sepsis Care and Suggests Reduced Mortality: Early identification and intervention lead to better results for hospital inpatients
October 9, 2014 — An automated early warning and response system for sepsis developed by Penn Medicine experts has resulted in a marked increase in sepsis identification and care, transfer to the ICU, and an indication of fewer deaths due to sepsis. A study assessing the tool is published online in the Journal of Hospital Medicine.
Sepsis is a potentially life-threatening complication of an infection; it can severely impair the body's organs, causing them to fail. There are as many as three million cases of severe sepsis and 750,000 resulting deaths in the United States annually. Early detection and treatment, typically with antibiotics and intravenous fluids, is critical for survival.
The Penn prediction tool, dubbed the "sepsis sniffer," uses laboratory and vital-sign data (such as body temperature, heart rate, and blood pressure) in the electronic health record of hospital inpatients to identify those at risk for sepsis. When certain data thresholds are detected, the system automatically sends an electronic communication to physicians, nurses, and other members of a rapid response team who quickly perform a bedside evaluation and take action to stabilize or transfer the patient to the intensive care unit if warranted.
The study developed the prediction tool using 4,575 patients admitted to the University of Pennsylvania Health System (UPHS) in October 2011. The study then validated the tool during a pre-implementation period from June to September 2012, when data on admitted patients was evaluated and alerts triggered in a database, but no notifications were sent to providers on the ground. Outcomes in that control period were then compared to a post-implementation period from June to September 2013. The total number of patients included in the pre and post periods was 31,093.
In both the pre- and post-implementation periods, four percent of patient visits triggered the alert. Analysis revealed 90 percent of those patients received bedside evaluations by the care team within 30 minutes of the alert being issued. In addition, the researchers found that the tool resulted in:
• A two to three-fold increase in orders for tests that could help identify the presence of sepsis
• A 1.5 to two-fold increase in the administration of antibiotics and intravenous fluids
• An increase of more than 50 percent in the proportion of patients quickly transferred to the ICU
• A 50 percent increase in documentation of sepsis in the patients' electronic health record
The study found a lower death rate from sepsis and an increase in the number of patients successfully discharged home, although these findings did not reach statistical significance.
"Our study is the first we're aware of that was implemented throughout a multihospital health system," said lead author Craig A. Umscheid, MD, MSCE, director of Penn's Center for Evidence-based Practice. "Previous studies that have examined the impact of sepsis prediction tools at other institutions have only taken place on a limited number of inpatient wards. The varied patient populations, clinical staffing, practice models, and practice cultures across our health system increases the generalizability of our findings to other health care settings."
Umscheid also noted that the tool could help triage patients for suitability of ICU transfer. "By better identifying those with sepsis requiring advanced care, the tool can help screen out patients not needing the inevitably limited number of ICU beds."
In addition to Umscheid, the other Penn co-authors are Joel Betesh, MD; Christine Vanzandbergen, PA, MPH; Asaf Hanish, MPH; Gordon Tait, BS; Mark E. Mikkelsen, MD, MSCE; Benjamin French, PhD; and Barry D. Fuchs, MD, MS.
Dr. Umscheid's contribution to this project was supported in part by the National Institutes of Health, National Center for Advancing Translational Sciences, grant # UL1TR000003.
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A rodeo museum in South Dakota is planning a sculpture garden to recognize the state's saddle bronc champions.
Officials at the Casey Tibbs South Dakota Rodeo Center in Fort Pierre say the garden and large sculpture of five-time world champion saddle bronc rider Billy Etbauer will be unveiled one June 1.
The garden will also serve as a gathering area for receptions and special events.
Museum board member and project leader Tom Brown says South Dakota has had more saddle bronc champions than any other state and the sculpture garden is a great way to preserve that heritage.
The statute of Etbauer will show the rider aboard Painted Valley when he scored an 89 to win the 2009 Cheyenne Frontier Days saddle bronc event.
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by Jorin Lee in Health
October 3, 2015
New 'Bebop' drone features 14MP fish-eye camera, first-person view piloting
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© 2015 The Science Recorder. All Right Reserved.


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i've seen them. the dark ones. it's like in the harry potter movie, those soul eaters. they have haunted me since eternity it feels. i think they can jump into almost any human body. how do we strengthen the spiritual/mental immune system?
as i wrote this a very high pitch signal beams in my right ear.
maby angels are of such high frequency?
i don't want to steer what you wish to share, so tell me what you think of.
jesus saved me.
Anonymous Coward 27975931
yin/yang depicted the astral balance of the world. in the old times it was real that balance.
in the last era we slowly reached the point where darkness almost completely overcame light.
in 3d level it means purity of the souls slowly got corrupted from the Christ way, that is universal love, compassion and altruism.
egoism for one's self, one's family, one's nation, one's religion are all the same, their run contrary to the Light of Soul, CHrist
but the beauty of evolution, it seems, that when all the tension, the pressure of the darkness reaches the maximum, and light gets compressed in basically a point.
then something happens. like bing bang. light dawns from yet a Higher Level, and the process changes direction.
you can say that on ground, from the point of view of the pure soul being engulfed by all the darkness, it is Prayer that invokes the Spirit
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