text:
Number: 0010
Aetna considers continuous passive motion (CPM) machines medically necessary durable medical equipment (DME) to improve range of motion in any of the following circumstances:
Members who have undergone certain surgeries and may not be able to benefit optimally from active PT, for example members with:
Members who are unable to undergo active PT.
Note: Where the CPM device is used for surgical rehabilitation, the use of this device must commence within 2 days following surgery to meet medical necessity guidelines. Although the usual duration of CPM usage is 7 to 10 days, up to 3 weeks of CPM therapy may be considered medically necessary upon individual consideration. Use of the CPM machine beyond 21 days post-op is not supported by the medical literature. There is insufficient evidence to justify use of these devices for longer periods of time or for other applications.
Published studies suggest that continuous passive motion (CPM) can improve range of motion (ROM) in those patients undergoing surgical release of arthrofibrosis of the knee or manipulation of the knee under anesthesia. In these settings, CPM provides for early post-operative motion and is considered a substitute for active physical therapy (PT). Once the patient is participating in active PT, CPM is no longer medically necessary. These observations may be extended to other joints, such as the elbow where arthrofibrosis is a common complication of trauma.
Of all the applications of CPM, the scientific evidence is perhaps strongest for its use in promoting cartilage growth. In addition, clinical studies suggest that CPM can enhance cartilage healing during the non weight-bearing period following surgery for intra-articular cartilage fractures, chondroplasties of focal cartilage defects and surgical treatment of osteochondritis dissecans. Once the patient is weight-bearing, CPM is no longer necessary.
Systematic evidence reviews have found weak or limited evidence for CPM for a number of indications. In a Cochrane review, Handoll et al (2006) evaluated the effects of rehabilitation interventions in adults with conservatively or surgically treated distal radial fractures. Fifteen trials, involving 746 mainly female and older patients, were included. Initial treatment was conservative, involving plaster cast immobilization, in all but 27 participants whose fractures were fixed surgically. Though some studies were well-conducted, others were methodologically compromised. For interventions started during immobilization, there was weak evidence of improved hand function for hand therapy in the days after plaster cast removal, with some beneficial effects continuing 1 month later (1 trial). There was weak evidence of improved hand function in the short- term, but not in the longer term (3 months), for early occupational therapy (1 trial), and of a lack of differences in outcome between supervised and unsupervised exercises (1 trial). For interventions started post-immobilization, there was weak evidence of a lack of clinically significant differences in outcome in patients receiving formal rehabilitation therapy (4 trials), passive mobilization (2 trials), ice or pulsed electromagnetic field (1 trial), or whirlpool immersion (1 trial) compared with no intervention. There was weak evidence of a short-term benefit of CPM (post-external fixation) (1 trial), intermittent pneumatic compression (1 trial) and ultrasound (1 trial). There was weak evidence of better short-term hand function in participants given physiotherapy than in those given instructions for home exercises by a surgeon (1 trial). The authors concluded that available evidence from randomized controlled trials is insufficient to establish the relative effectiveness of the various interventions used in the rehabilitation of adults with fractures of the distal radius.
A systematic evidence review by Michlovitz et al (2004) of non-surgical interventions to restore ROM to persons with injuries to the upper extremities found insufficient evidence to support the use of continuous passive motion. The systematic evidence review identified 1 cohort study, which found CPM to be similar to ROM exercises at improving ROM and extension, but better at improving flexion, after surgery for elbow flexion contractures. The review identified another cohort study that found CPM to be no better than passive ROM exercises after rotator cuff repair. The investigators concluded that "[t]he quality and quantity of evidence in this area were moderate to low."
In a Cochrane review, Massy-Westropp et al (2008) compared the effectiveness of post-operative therapeutic regimens for increasing hand function following metacarpophalangeal (MCP) arthroplasty in adults with rheumatoid arthritis. Randomized controlled trials and controlled clinical trials were accepted if they evaluated the efficacy of a post-operative therapeutic regimen for MCP arthroplasty. No data analyses were performed as only 1 controlled clinical trial was found. The data from that study were described. These investigators' search only identified 1 controlled clinical trial involving 22 subjects. The majority of the evidence for various splinting and exercise regimens consisted of case series and case studies. Results from the 1 (poor quality) trial suggested that the use of CPM is not effective in increasing motion or strength after MCP arthroplasty. The authors concluded that well-designed randomized controlled trials which compare the effectiveness of different therapeutic splinting programs following MCP arthroplasty are required. At this time, the results of 1 study suggested that CPM alone is not recommended for increasing motion or strength after MCP arthroplasty.
In a randomized controlled study, Lenssen and colleagues (2008) examined the effectiveness of prolonged CPM use in the home setting as an adjunct to standardized PT. Effectiveness was assessed in terms of faster improvements in ROM as well as functional recovery, measured at the end of the active treatment period, 17 days after surgery. A total of 60 patients with knee osteoarthritis undergoing total knee arthroplasty (TKA) and experiencing early post-operative flexion impairment were randomized into 2 treatment groups. The experimental group received CPM + PT for 17 consecutive days after surgery, whereas the usual care group received the same treatment during the in-hospital phase (i.e., about 4 days), followed by PT alone (usual care) in the first 2 weeks after hospital discharge. From 18 days to 3 months following surgery, both groups received standardized PT. The primary focus of rehabilitation was functional recovery (e.g., ambulation) and regaining ROM in the knee. Prolonged use of CPM slightly improved short-term ROM in patients with limited ROM at the time of discharge after TKA when added to a semi-standard PT program. Assessment at 6 weeks and 3 months after surgery found no long-term effects of this intervention. These researchers also did not detect functional benefits of the improved ROM at any of the outcome assessments. The authors concluded that although results indicate that prolonged CPM use might have a small short-term effect on ROM, routine use of prolonged CPM in patients with limited ROM at hospital discharge should be re-considered, since neither long-term effects nor transfer to better functional performance was detected.
In a Cochrane review, Gray et al (2012) evaluated the effectiveness of interventions for congenital talipes equinovarus (CTEV). The review found, among other things, a lack of evidence for continuous passive motion treatment following major foot surgery. The authors could draw no conclusions from other included trials because of the limited use of validated outcome measures and lack of available raw data; and future randomized controlled trials should address these issues.
There is also a scarcity of peer-reviewed evidence on the use of CPM for other conditions including degenerative joint diseases (e.g., rheumatoid arthritis) as well as rehabilitation following quadriceps tear and temporo-mandibular joint repair.
Ring and colleagues (1998) examined if a post-operative rehabilitation protocol incorporating CPM would increase the total ROM obtained 6 months following silicone interposition arthroplasty of the metacarpophalangeal joints in patients with rheumatoid arthritis. A prospective trial randomizing patients to receive either CPM or the standard dynamic splint protocol (modified Madden protocol) was undertaken. A total of 15 hands (60 joints) were treated with the modified Madden protocol and 10 hands (40 joints) had CPM. The mean 6-month post-operative ROM was 7 degrees in the modified Madden cohort compared with 39 degrees in the CPM cohort, representing an improvement of 22 degrees in the modified Madden cohort compared with an improvement of only 5 degrees in the CPM cohort. Residual ulnar deviation 8 degrees versus 12 degrees and grip strength (2.3 kgf versus 3.7 kgf) were both lower in the CPM cohort. The authors concluded that incorporation of the CPM machine in the post-operative rehabilitation protocol does not offer sufficient advantages to justify the added costs.
An UpToDate review on "Total joint replacement for severe rheumatoid arthritis" (Weisman and Rinaldi, 2013) states that "It is unclear whether the use of continuous passive motion devices in the postoperative management of total knee arthroplasty results in enough clinical benefit to justify the inconvenience and expense of the procedure".
In a systematic review, Rogan and colleagues (2013) evaluated treatment effects of CPM after surgical cartilage repair. These researchers performed a literature search in the Cochrane Central Register of Controlled Trials, EMBASE, International Clinical Trials Registry Platform, MEDLINE, Trip Database and in bibliographies of included studies. Two independent researchers evaluated the quality of original investigations by the Cochrane Risk of Bias tool. Systematic reviews were checked by the CBO/Dutch Cochrane Centre Guideline. A total of 1,541 studies were initially retrieved from the databases. After screening for inclusion criteria, 1 review and 10 original papers could be included for further evaluation. Studies showed methodological weaknesses. Heterogeneity of outcome measures and the fact that 6 of 9 studies with a 1-group pre-post design measured the combined effect of surgical treatment and CPM prevented a meta-analysis. The authors concluded that 3 studies described significant improvements with regard to subjective outcome such as pain, swelling, Quality Life Survey, Knee Society score, WOMAC score or rating Cincinnati due to the surgical treatment and the CPM intervention of cartilage defects in the knee; 6 (case) studies suggested an enhanced cartilage quality of the patients after CPM. They stated that more high-quality RCTs are needed to provide high-level evidence.
Tabor (2013) determined which total knee replacement (TKR) patients, if any, benefit from the use of the CPM machine. For the study period, most patients received active PT. Patients were placed in the CPM machine if, on post-operative day 1, they had a ROM less than or equal to 45° and/or pain score of 8 or greater on a numeric rating scale (NRS) of 0 to 10, 0 being no pain and 10 being the worst pain. Both groups of patients healed at similar rates. The incidence of adverse events, length of stay, and functional outcomes was comparable between groups. The author concluded that given the demonstrated lack of relative benefit to the patient and the cost of the CPM, this study supported discontinuing the routine use of the CPM.
Nikolaou and colleagues (2014) noted that TKR is a widely used operation that has radically improved the quality of life of millions of people during the last few decades. However, some technical details, concerning the surgical procedure and the rehabilitation following TKA, are still a matter of a strong debate. In this review of the literature, these investigators have included the best evidence available of the last decade, in an effort to shed light on some of the most controversial subjects related to TKR surgery: (i) Posterior-stabilized or cruciate-retaining prosthesis? (ii) To use a tourniquet during operation or not? (iii) Do patients need CPM for their post-surgery rehabilitation? and (iv) To resurface patella or not? These are some of the most controversial topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature were highly controversial. These conflicting results were an indication that larger and more well-conducted high-quality trials are needed in order to gain more secure answers.
In a RCT, Herbold et al (2014) examined the effects of using a CPM device for individuals with poor ROM after a TKR admitted for post-acute rehabilitation. Adults (n = 141) after TKR with initial active knee flexion less than 75° on admission to the Inpatient rehabilitation facility (IRF) were included in this study. Two randomized groups: group 1 (n = 71) received the conventional 3 hours of therapy per day, and group 2 (n = 70) received the addition of daily CPM use for 2 hours throughout their length of stay. The primary outcome measure was active knee flexion ROM. Secondary outcome measures included active knee extension ROM, length of stay, estimate of function using the FIM and Timed Up and Go test, girth measurement, and self-reported Western Ontario and McMaster Universities Osteoarthritis Index scores. All subjects significantly improved from admission to discharge in all outcome measures. However, there were no statistically significant differences in any of the discharge outcome measures of the CPM group compared with the non-CPM group. The authors concluded that CPM did not provide an additional benefit over the conventional interventions used in an IRF for patient after TKR, specifically in patients with poor initial knee flexion ROM after surgery.
In a RCT, Boese and colleagues (2014) determined the effectiveness of CPM following TKA. Post-operative outcomes of interest were: swelling, drop in hemoglobin, self-reported pain scores, ROM, and hospital length of stay. A total of 160 subjects were randomized into 1 of 3 treatment groups: (i) CPM device on and moving from the immediate post-operative period, (ii) CPM device on and stationary at 90 degree flexion for the 1st night and then moving throughout the rest of their stay, and (iii) no CPM (n = 55, 51, and 54, respectfully). Subjects were followed during the 1st and 2nd post-operative day until their first follow-up appointment approximately 3 to 4 weeks post-operatively. Cost of CPM was further evaluated. The authors concluded that CPM provided no benefit to patients recovering from TKA.
On behalf of the National Health and Medical Research Council (NHMRC) of Australia, Mak et al (2014) evaluated the evidence for different interventions in the pre-operative, peri-operative and post-operative care for people undergoing elective TKR and total hip replacement (THR). A multi-disciplinary working group comprising consumers, managers and clinicians from the areas of orthopedics, rheumatology, aged care and rehabilitation evaluated randomized controlled trials (RCTs) and systematic reviews/meta-analyses concerning aspects of pre-operative, peri-operative and post-operative clinical care periods for THR/TKR through systematic searching of Medline, Embase, CENTRAL and the Cochrane Database of Systematic Reviews from May 2007 to April 2011. Multiple reviewers determined study eligibility and one or more members extracted primary study findings. The body of evidence was assessed and specific recommendations made according to NHMRC guidelines. A total of 25 aspects were identified for review. Recommendations for 16 of 25 areas of care were made: impact of waiting, multi-disciplinary preparation, pre-operative exercise, smoking cessation, interventions for co-morbid conditions, predictors of outcome, clinical pathways, implementation of a blood management program, antibiotic prophylaxis, regional anesthesia and analgesia, use of a tourniquet in knee replacement, venous thromboembolism prophylaxis, early post-operative cryotherapy, early mobilization and CPM. In the post-operative period, study heterogeneity across all aspects of care precluded specific recommendations. The authors concluded that there was a deficiency in the quality of the evidence supporting key aspects of the continuum of care for primary THR/TKR surgery. Consequently, recommendations were limited. Prioritization and funding for research into areas likely to impact clinical practice and patient outcomes after elective joint replacement surgery are the next important steps.
In a Cochrane review, He and colleagues (2014) examined the effectiveness of CPM therapy for preventing venous thromboembolism (VTE) in patients after TKA. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Coordinator searched the Specialised Register (last searched February 2014), CENTRAL (2014, Issue 1), Ovid MEDLINE (to week 1 February 2014) and EMBASE (to Week 07 2014). Randomized controlled trials comparing the use of CPM with control in preventing deep venous thrombosis (DVT) or pulmonary embolism (PE) following TKA were selected for analysis. People aged 18 years and older who had undergone TKA were included in this review. These researchers excluded studies of patients who presented with DVT at baseline. The experimental and control groups received similar postoperative care and therapy other than the CPM. Two review authors independently assessed the citations retrieved by the search strategies for reports of relevant RCTs. They independently selected trials that satisfied the inclusion criteria, extracted data and undertook quality assessment. Effects were estimated as risk ratios (RRs), mean differences or standardized mean differences (SMD) with 95 % CIs. Meta-analyses were performed using a fixed-effect model for continuous variables. Where heterogeneity existed (determined by the I(2) statistic) a random-effects model was used. A total of 11 RCTs involving 808 participants met the inclusion criteria. The methodological quality of the included studies was variable and most of the pre-defined outcomes were reported by only 1 or 2 studies, therefore the quality of the evidence was low. Five studies with a total of 405 patients reported the incidence of DVT. In the CPM group (205 patients) 36 developed DVT (18 %) compared to 29 (15 %) in the control group (200 patients). The results of the meta-analysis showed no evidence that CPM had any effect on preventing VTE after TKA (RR 1.22, 95 % CI: 0.84 to 1.79). One trial (150 participants) did not find PE in any of the patients during hospitalization or in the subsequent 3 months. Pulmonary embolism was not reported in the other included studies. None of the trials reported deaths among the included participants. The authors concluded that there is not enough evidence from the available RCTs to conclude that CPM reduces VTE after TKA. These researchers cannot assess the effect of CPM on mortality because no such events occurred among the participants of these trials. The quality of the evidence was low. The results were supported by only a small number of studies, most of which are of low to moderate quality.
In a Cochrane review, Harvey et al (2014) evaluated the benefits and harms of CPM and standard post-operative care versus similar post-operative care, with or without additional knee exercises, in people with TKA. These investigators searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12), MEDLINE (January 1966 to 24 January 2013), EMBASE (January 1980 to 24 January 2013), CINAHL (January 1982 to 24 January 2013), AMED (January 1985 to 24 January 2013) and PEDro (to 24 January 2013). Randomized controlled trials in which the experimental group received CPM, and both the experimental and control groups received similar post-operative care and therapy following TKA in people with arthritis were selected for analysis. Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias. The primary outcomes of interest were active knee flexion ROM, pain, quality of life, function, participants' global assessment of treatment effectiveness, incidence of manipulation under anesthesia and adverse events. The secondary outcomes were passive knee flexion ROM, active knee extension ROM, passive knee extension ROM, length of hospital stay, swelling and quadriceps strength. These researchers estimated effects for continuous data as mean differences or SMD, and effects for dichotomous data as risk ratios; all with 95 % CIs. If appropriate, these investigators performed meta-analyses using random-effects models. They identified 684 papers from the electronic searches after removal of duplicates and retrieved the full reports of 62 potentially eligible trials. A total of 24 RCTs of 1,445 participants met the inclusion criteria; 4 of these trials were new to this update. There was moderate-quality evidence to indicate that CPM does not have clinically important short-term effects on active knee flexion ROM: mean knee flexion was 78 degrees in the control group, CPM increased active knee flexion ROM by 2 degrees (95 % CI: 0 to 5) or absolute improvement of 2 % (95 % CI: 0 % to 4 %). The medium- and long-term effects were similar although the quality of evidence is lower. There was low-quality evidence to indicate that CPM does not have clinically important short-term effects on pain: mean pain was 3 points in the control group, CPM reduced pain by 0.4 points on a 10-point scale (95 % CI: -0.8 to 0.1) or absolute reduction of -4 % (95 % CI: -8 % to 1 %). There was moderate-quality evidence to indicate that CPM does not have clinically important medium-term effects on function: mean function in the control group was 56 points, CPM decreased function by 1.6 points (95 % CI: -6.1 to 2.0) on a 100-point scale or absolute reduction of -2 % (95 % CI: -5 % to 2 %). The SMD was -0.1 standard deviations (SD) (95 % CI: -0.3 to 0.1). There was moderate-quality evidence to indicate that CPM does not have clinically important medium-term effects on quality of life: mean quality of life was 40 points in the control group, CPM improved quality of life by 1 point on a 100-point scale (95 % CI: -3 to 4) or absolute improvement of 1 % (95 % CI: -3 % to 4 %). There was very low-quality evidence to indicate that CPM reduces the risk of manipulation under anesthesia; risk of manipulation in the control group was 7.2 %, risk of manipulation in the experimental group was 1.6 %, CPM decreased the risk of manipulation by 25 fewer manipulations per 1,000 (95 % CI: 9 to 64) or absolute risk reduction of -4 % (95 % CI: -8 % to 0 %). The risk ratio (RR) was 0.3 (95 % CI: 0.1 to 0.9). There was low-quality evidence to indicate that CPM reduces the risk of adverse events; risk of adverse events in the control group was 16.3 %, risk of adverse events in the experimental group was 17.9 %, CPM decreased the risk of adverse event by 150 fewer adverse events per 1,000 (95 % CI: 103 to 216) or absolute risk reduction of -1 % (95 % CI: -5 % to 3 %). The RR was 0.9 (95 % CI: 0.6 to 1.3). The estimates for risk of manipulation and adverse events were very imprecise and the estimate for the risk of adverse events did not distinguish between a clinically important increase and decrease in risk. There was insufficient evidence to determine the effect of CPM on participants' global assessment of treatment effectiveness. The authors concluded that CPM does not have clinically important effects on active knee flexion ROM, pain, function or quality of life to justify its routine use. It may reduce the risk of manipulation under anesthesia and risk of developing adverse events although the quality of evidence supporting these findings is very low and low, respectively. The effects of CPM on other outcomes are unclear.
Husted et al (2014) noted that traditions are passed on from experienced surgeons to younger fellows and become "the right way to do it". Traditions associated with arthroplasty surgery may, however, not be evidence-based and may be potentially deleterious to both patients as well as society, increasing morbidity and mortality, slowing early functional recovery, and increasing cost. These investigators identified selected traditions and performed a literature search using relevant search criteria (June 2014). They presented a narrative review grading the studies according to evidence, and suggested some lines of future research. These researchers presented traditions and evaluated them against the published evidence. Pre-operative removal of hair, urine testing for bacteria, use of plastic adhesive drapes intra-operatively, and pre-warming of the operation room should be abandoned; as should use of a tourniquet, a space suit, a urinary catheter, and closure of the knee in extension. The safety and effectiveness of tranexamic acid is supported by meta-analyses. Post-operatively, there is no evidence to support postponement of showering or postponement of changing of dressings to after 48 hours. They also stated that there is no evidence to recommend routine dental antibiotic prophylaxis, CPM, the use of compression stockings, cooling for pain control or reduction of swelling, flexion of at least 90 degrees as a discharge criterion following TKA, or having restrictions after THA. The authors presented evidence supporting the use of NSAIDs, early mobilization, allowing early travel, and a low hemoglobin trigger for transfusion. Moreover, they stated that revision of traditions and myths surrounding hip and knee arthroplasty towards more contemporary evidence-based principles can be expected to improve early functional recovery, thus reducing morbidity, mortality, and costs.
Also, an UpToDate review on "Total knee arthroplasty" (Martin et al, 2014) states that "The use of continuous passive motion (CPM) devices to improve knee range of motion is common in postoperative rehabilitative care in many institutions, but there is uncertainty regarding whether the clinical benefits justify the inconvenience and expense of CPM". Also, an UpToDate review on "Total joint replacement for severe rheumatoid arthritis" (Weisman and Rinaldi, 2014) states that "It is unclear whether the use of continuous passive motion devices in the postoperative management of total knee arthroplasty results in enough clinical benefit to justify the inconvenience and expense of the procedure".
Furthermore, the American Physical Therapy Association (APTA) recommended against CPM following TKR. In the Choosing Wisely Campaign, the APTA stated "Don't use continuous passive motion machines for the postoperative management of patients following uncomplicated total knee replacement". The APTA stated that CPM treatment does not lead to clinically important effects on short- or long-term knee extension, long-term knee flexion, long-term function, pain and quality of life in patients undergoing TKA.
In a Cochrane review, Gray et al (2014) evaluated the effectiveness of interventions for congenital talipes equinovarus (CTEV). On April 29, 2013, these investigators searched CENTRAL (2013, Issue 3 in The Cochrane Library), MEDLINE (January 1966 to April 2013), EMBASE (January 1980 to April 2013), CINAHL Plus (January 1937 to April 2013), AMED (1985 to April 2013), and the Physiotherapy Evidence Database (PEDro to April 2013). They also searched for ongoing trials in the WHO International Clinical Trials Registry Platform (2006 to July 2013) and ClinicalTrials.gov (to November 2013); and checked the references of included studies. They searched NHSEED, DARE and HTA for information for inclusion in the Discussion. Randomized controlled trials and quasi-RCTs evaluating interventions for CTEV were selected for analysis. Participants were people of all ages with CTEV of either 1 or both feet. Two authors independently assessed risk of bias in included trials and extracted the data. They contacted authors of included trials for missing information; and collected adverse event information from trials when it was available. These researchers identified 14 trials in which there were 607 participants; 1 of the trials was newly included at this 2014 update. The use of different outcome measures prevented pooling of data for meta-analysis even when interventions and participants were comparable. All trials displayed bias in 4 or more areas. One trial reported on the primary outcome of function, though raw data were not available to be analyzed. These investigators were able to analyze data on foot alignment (Pirani score), a secondary outcome, from 3 trials. Two of the trials involved participants at initial presentation. One reported that the Ponseti technique significantly improved foot alignment compared to the Kite technique. After 10 weeks of serial casting, the average total Pirani score of the Ponseti group was 1.15 (95 % CI: 0.98 to 1.32) lower than that of the Kite group. The second trial found the Ponseti technique to be superior to a traditional technique, with average total Pirani scores of the Ponseti participants 1.50 lower (95 % CI: 0.72 to 2.28) after serial casting and Achilles tenotomy. A trial in which the type of presentation was not reported found no difference between an accelerated Ponseti or standard Ponseti treatment. At the end of serial casting, the average total Pirani scores in the standard group were 0.31 lower (95 % CI: -0.40 to 1.02) than the accelerated group. Two trials in initial cases found relapse following Ponseti treatment was more likely to be corrected with further serial casting compared to the Kite groups which more often required major surgery (risk difference 25 % and 50 %). There is a lack of evidence for different plaster casting products, the addition of botulinum toxin A during the Ponseti technique, different types of major foot surgery, CPM treatment following major foot surgery, or treatment of relapsed or neglected cases of CTEV. Most trials did not report on adverse events. In trials evaluating serial casting techniques, adverse events included cast slippage (needing replacement), plaster sores (pressure areas) and skin irritation. Adverse events following surgical procedures included infection and the need for skin grafting. The authors concluded that from the limited evidence available, the Ponseti technique produced significantly better short-term foot alignment compared to the Kite technique and compared to a traditional technique. The quality of this evidence was low to very low. An accelerated Ponseti technique may be as effective as a standard technique, according to moderate quality evidence. Relapse following the Kite technique more often led to major surgery compared to relapse following the Ponseti technique. These investigators also noted that no conclusions could be drawn from other included trials because of the limited use of validated outcome measures and lack of available raw data. They stated that future RCTs should address these issues,
Hill et al (2014) stated that the use of CPM in the post-operative treatment of intra-articular fractures around the knee is increasing. These researchers determined the effects of a CPM device on knee ROM after operative treatment of intra-articular fractures around the knee. A total of 40 patients with intra-articular fractures of either the proximal part of the tibia or the distal end of the femur were prospectively randomized to the use of CPM or standardized PT in the immediate post-operative period for 48 hours. The primary outcome was knee ROM. Secondary outcome measures included pain scores, Lower Limb Outcomes Questionnaire scores, and Short Musculoskeletal Function Assessment scores. Evaluations were conducted at 48 hours, 2 weeks, 6 weeks, 3 months, and 6 months post-operatively. There was no significant difference in knee extension between the groups at any time-point measured. Knee flexion was significantly greater at 48 hours in the group managed with the CPM device than in the group managed without the CPM device (p < 0.005). However, there was no significant difference in knee flexion at any other time-point. There was no significant difference in knee pain at 48 hours between groups. Six (30 %) of 20 patients were unable to tolerate the use of the CPM device. There were no significant differences in overall complications. The authors concluded that the findings of this study suggested that the use of CPM in the immediate post-operative period following the treatment of intra-articular fractures offered no benefit with regard to knee motion at 6 months and was not tolerated by all patients.
In a prospective, randomized, waiting-list-controlled (WLC) trial, Gavish et al (2014) evaluated the effectiveness of a novel, angular, CPM device for self-treatment at home in patients with mild-to-moderate, non-specific, chronic low back pain (LBP). A total of 36 patients with a score less than or equal to 6 on the NRS for pain were enrolled; 28 patients completed treatment. Participants were randomized to receive the Kyrobak (Radiancy, Hod-hasharon, Israel) at enrollment [immediate treatment (IT) group] or 3 weeks later (WLC group). Self-treatment was prescribed for 10 minutes, 1 to 3 times per day, for 3 weeks. The treatment period was followed by a 3-week follow-up period. Primary outcome was self-reported pain level (NRS). Three weeks of self-treatment with the Kyrobak reduced pain levels significantly in the IT group compared with the WLC group {mean [standard deviation (SD)] ΔNRS score from baseline to post-treatment: IT group, 1.4 (1.5), 95 % CI: 0.5 to 2.3; WLC group, -0.1 (2.2), 95 % CI: -1.1 to 1.2; effect mean difference 1.5}. This benefit was maintained over the follow-up period [from baseline to end of follow-up, mean (SD) ΔNRS score 1.1 (1.8), 95 % CI: 0.4 to 1.8]. Multi-linear regression analysis found that higher baseline pain resulted in greater pain reduction (p = 0.003). Eighty-three percent of participants with a baseline NRS score greater than 4.35 (threshold determined by logistic regression, p = 0.01) achieved the minimal important change criterion of ΔNRS score greater than or equal to 2. Daily NRS score reduced gradually over the treatment period [regression slope -0.052 (0.01), 95 % CI: -0.07 to -0.03]. The authors concluded that preliminary evidence suggested that the Kyrobak may be beneficial for short-term relief of non-specific, chronic LBP, particularly in participants with a moderate level of pain. They stated that a longer treatment period may lead to a further reduction in pain. These preliminary findings need to be validated by well-designed studies with larger sample size and longer follow-up periods.
|CPT Codes / HCPCS Codes/ ICD-10 Codes
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":
|ICD-10 codes will become effective as of October 1, 2015 :
|Other CPT codes related to the CPB:
|21240 - 21243
|Arthroplasty, temporomandibular joint
|Quadricepsplasty (eg, Bennett or Thompson type)
|Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
|Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes
|HCPCS codes covered if selection criteria are met:
|Continuous passive motion exercise device for use on knee only
|Continuous passive motion exercise device for use other than knee
|Other HCPCS codes related to the CPB:
|Jaw motion rehabilitation system
|Replacement cushions for jaw motion rehabilitation system, package of 6
|Replacement measuring scales for jaw motion rehabilitation system, package of 200
|Dynamic adjustable elbow extension/flexion device, includes soft interface material
|Dynamic adjustable forearm pronation/supination device, includes soft interface material
|Dynamic adjustable wrist extension/flexion device, includes soft interface material
|Dynamic adjustable knee extension/flexion device, includes soft interface material
|Dynamic knee, extension/flexion device with active resistance control
|Dynamic adjustable ankle extension/flexion device, includes soft interface material
|Replacement soft interface material, dynamic adjustable extension/flexion device
|Dynamic adjustable finger extension/flexion device, includes soft interface material
|Dynamic adjustable toe extension/flexion device, includes soft interface material
|Dynamic adjustable shoulder flexion/abduction/rotation device, includes soft interface material
|ICD-10 codes covered if selection criteria are met:
|Complex regional pain syndrome I (CRPS I)
|Internal derangement of knee and other joints
|Palmar fascial fibromatosis [Dupuytren]
|Peripheral and other enthesopathies
|Numerous options
|Musculoskeletal and connective tissue injuries, sequela
|Osteochondritis dissecans
|Sprain of cruciate ligament of knee
|Presence of orthopedic joint implants
|ICD-10 codes not covered for indications listed in the CPB:
|Inflammatory polyarthropathies [in the absence of a listed covered condition]
|Ankylosis of joint
|Temporomandibular joint disorders
|Fusion of spine
|M43.8x9, M53.84 - M53.9
|Other spinal dorsopathies
|Spinal stenosis (other than cervical)
|M53.2x7 - M53.2x8, M53.3, M53.87 - M53.88
|Disorders of the sacrum
|Panniculitis affecting regions of the neck and back
|Sciatica, lumbago, low back pain and other dorsalgia
|Pain in thoracic spine
|Congenital talipes equinovarus
|S12.000+ - S12.9xx+,
S22.000+ - S22.9xx+,
S32.000+ - S32.9xx+
|Fracture of spine and trunk [includes sequela]
|S13.100+ - S13.29x+
S23.100+ - S23.29x+
S33.100+ - S33.39x+
|Dislocations of vertebra, other, and unspecified
S13.8xx+ - S13.9xx+
S23.3xx+, S23.9xx+
S33.5xx+ - S33.9xx+
|Sprains of back, other and unspecified
|Spinal cord injury [includes sequela]
|Fracture of lower end of radius (open or closed)
|S72.141+ - S72.26x+
|Intertrochanteric or subtrochanteric fracture of femur
|Fracture of calcaneus
|S92.201(A or B) - S92.356 (A or B)
|Fracture of other and unspecified tarsal and metatarsal bone(s) [closed and open]
|Sprain of foot
|Presence of artificial hip joint


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The Portrait of Dorian Gray Book Sculpture by wetcanvasWatch
©2013-2016 wetcanvas
The portrait of the seemingly immortal Dorian Gray pops from the pages of this book. Framed by the book's cover, the half skeletal/half flesh portrait stares out of the pages.
very beautiful artwork!
Really good work.
Why the half helmet? O_0
Wonderful as always. The cutting of the cover fascinates me. So neat and such a clean cut with the angles remaining the same throughout.
Wow! Great concept for this sculpture!
Oooh, LOVE IT! This one is exceptionally awesome!!!

subset: commoncrawl


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A new set of reports shows that federal policy on chemicals testing neglects breast health.
"I wish I could understand the failure of logic in not testing mammary glands," says Jeanne Rizzo, director of the Breast Cancer Fund, a California-based nonprofit. But she says she's heartened that the discussion is even on the table. "Ten years ago, when we said we need to look at the environment and we need to look at prevention, people thought we were nuts."
It's becoming increasingly clear, though, that mammary glands belong on a slide and not in the dumpster. Recent studies show that some pesticides, pharmaceuticals, and plastic additives appear to change when and how the mammary gland develops. Even low doses, close to what average Americans are exposed to currently, have been linked to altered development, cell growth, and gene expression in animal mammary glands. The chemicals include the notorious baby-bottle chemical bisphenol A, dioxin (a by-product from burning plastic and a common food contaminant), phthalates (plastic additives), atrazine (a top-selling herbicide in the United States, now banned in Europe), flame retardants, and stain repellants. PFOA, a common chemical used to make Teflon, appears to delay puberty in animal pups and reduce the size of the mammary gland, while chemicals that mimic estrogen may accelerate puberty.
The good news is that the mounting data on the sensitivity of breast cells has caught the attention of scientists within state and federal government. Some are calling for reform. "There's a growing body of animal evidence and sporadic human evidence that things we're exposed to across a lifetime can cause breast cancer," says Marion Kavanaugh-Lynch, director of California's Breast Cancer Research Program, a governmental grant-making organization that helped fund the 2009 workshop with proceeds from the state's cigarette tax. "If we can identify these chemicals now, we can more easily avoid them," she says.
The question is whether, and how fast, regulatory agencies can update their toxicity protocols. New tests have to be proven effective and then standardized across numerous labs. In a victory for breast-cancer advocates, the National Toxicology Program, under pressure from its own scientists, is actively rewriting its testing guidelines to look more carefully at mammary glands. But this is only a partial victory, as the NTP does not have the authority to regulate chemicals (it's a research and advisory body), and the agency tests only about six to eight substances per year.
The NTP's Fenton is a big fan of a new testing procedure, the gruesome-sounding "whole mount," a way of preparing dissected rodent tissue to look for changes both subtle and overt. A rodent's fourth or fifth mammary glands—those near the stomach—are removed, flattened, stained, and mounted flat to a slide, where they can be carefully examined for changes in cells or structures. Soon, Fenton hopes, every government lab will use it. If approved, NTP's guidelines would also require that certain tests include doses of chemicals both in-the-womb and around the time of puberty.
The EPA is watching closely to see if and how the NTP's new tests pass political and scientific muster. So is the Organisation for Economic Cooperation and Development, which guides chemicals testing in Europe. With added data from mammary glands, policymakers could have more reasons to keep unsafe substances off the market. If your breasts won't benefit, your daughters' just might.


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After getting off to a sludgy start out west, the New York Rangers appear to be finding their stride, closer to home, under new head coach Alain Vigneault. Unfortunately, the club will likely have to forge ahead for the foreseeable future without star forward Rick Nash. As noted by ESPNNY.com's Katie Strang, Nash was placed on injured reserve earlier this week with what's described as a suspected concussion.
Fact is, the dynamic winger is still dealing with unpleasant symptoms following a nasty hit to the head on Oct. 8 compliments of San Jose Sharks defenseman Brad Stuart. He has yet to return to practice. And while we can surely hope for a speedy recovery from Nash, the fantasy fallout among the Rangers' top-six -- both determined and unsettled -- deserves attention.
First and foremost, Ryan Callahan benefits nicely from a promotion to the top line alongside a smoldering Brad Richards and Derick Brassard. However, the odds of scooping up Callahan as a fantasy free agent, given that he's owned in 97 percent of ESPN.com leagues, are tissue-thin at best. Not only that, but he'll be out for up to another month with a broken thumb.
You can volley a trade offer for the Rangers captain (not a bad idea, if you can handle not having him for the next three to four weeks), or look beyond the Rangers' top trio. It's no secret that Vigneault hasn't been pleased with the performance of his second line, most recently made up of Mats Zuccarello, Derek Stepan, and Benoit Pouliot. Which brings us to winger Carl Hagelin (owned in 0.9 percent of ESPN.com leagues).
Due to return from a shoulder injury before the end of October, Hagelin has the potential to make an immediate impact with the Rangers. Scoring 38 points in 64 games in 2011-12 -- and averaging a point every couple of games last season -- the 25-year-old Swede could easily carve out a spot on the second line, all the while earning treasured power-play minutes. Even once Nash returns, Hagelin is favored to remain a top-six forward.
Beyond Hagelin, young winger J.T. Miller belongs on a wider fantasy radar as a potential asset. While the 20-year-old was recently recalled from the AHL to skate as a bottom-six forward, Vigneault has promised and/or threatened to promote Miller if the team's other, more experienced forwards don't get up to snuff fast. This isn't to suggest you immediately drop what you're doing and add Miller to your roster, only that the kid is worth watching. Even if he's demoted again in the near future, the former first-round draft pick is expected to have a very bright future in the NHL.
Trending up
Mason Raymond, LW/RW, Toronto Maple Leafs (owned in 81 percent of ESPN.com leagues): Already finding favor with savvy fantasy owners, Raymond is riding a better than point-per-game pace (four goals, four assists) with his new club. And while James van Riemsdyk remains sidelined with back spasms, Raymond becomes even more useful. Snag the speedy, versatile winger if you can.
Cory Conacher, LW, Ottawa Senators (owned in 24 percent of ESPN.com leagues): As long as he sticks on the Senators' top line with Jason Spezza and Milan Michalek, Conacher merits ownership in most leagues. And coach Paul MacLean is looking to keep those three together, at least for now. Hopefully the 23-year-old's recent overtime game-winner against the Phoenix Coyotes is just a hint of more productive times ahead. Before joining the Senators last season, Conacher was mighty effective as a member of the Tampa Bay Lightning (24 points in 35 games).
Dustin Penner, LW, Anaheim Ducks (owned in two percent of ESPN.com leagues): Following a clumsy start to the campaign, Penner is finally settling into his predestined slot on the Ducks' top line with Ryan Getzlaf and Corey Perry. Now it's up to the veteran power forward to not bungle it up. If all goes well, Penner could be a genuine fantasy force this season. And judging from his latest post-game tweet, the 31-year-old is relishing his return to Anaheim.
Morgan Rielly, D, Toronto Maple Leafs (owned in two percent of ESPN.com leagues): If the Maple Leafs opt to retain their under-age defenseman beyond the nine-game NHL tryout limit, a prominent role and spot on the secondary power-play will be his to lose. We're betting Dave Nonis and Co. don't send the gifted offensive defenseman back to the WHL Moose Jaw Warriors. And those in keeper leagues should give the 19-year-old an extra long look. For those who count power play points in their league, two of Rielly's three assists have counted with the man advantage.
Nino Niederreiter, RW, Minnesota Wild (owned in three percent of ESPN.com leagues): How much fun do you think this kid is having in his fresh start with the Wild, competing on a No. 1 line with Zach Parise and Mikko Koivu? After a dismal experience with the New York Islanders, the answer is: lots. Don't be shocked to see the 21-year-old really come into his own this season. There's no doubting his talent.
Brad Boyes, RW, Florida Panthers (owned in 21 percent of ESPN.com leagues): So far, the one-year, $1-million gamble made in late September is paying off handsomely for the Panthers. Skating on a line with current points leader Tomas Fleischmann and rookie Aleksander Barkov, Boyes -- roundly ignored as a free agent all summer -- is averaging nearly a point-per-game. In keeper leagues, Barkov is also worth more than a passing glance. The mature 18-year-old is owned in only six percent of ESPN.com leagues.
Jason Demers, D, San Jose Sharks (owned in four percent of ESPN.com leagues): Just because Dan Boyle says he "feels great" after being plowed head-first into the boards by Blues skater Maxim Lapierre doesn't mean we can reasonably expect to see the veteran defenseman back on the ice soon. Boyes was literally knocked out, and a couple of days off might not be sufficient recovery time. So, in the meantime, the Sharks will look to Demers to step it up in the role of offensive defenseman, particularly with the man advantage. And even if Boyle returns to the lineup sooner than expected, the addition of Demers to your fantasy team could still work to your benefit; the 25-year-old has already been enjoying a fairly productive campaign (four points, with a plus-5 in plus/minus).
Trending down
Brad Marchand, LW, Boston Bruins (owned in 94 percent of ESPN.com leagues): Supplanted by Reilly Smith within the Bruins' top six, Marchand is currently skating with third-liners Chris Kelly and Jordan Caron. Not the best position from which to better a dreary one-goal-through-five-game pace (with zero assists). But there's no need for panic; the feisty winger shouldn't remain in that position for too long.
Tyson Barrie, D, Colorado Avalanche (owned in 49 percent of ESPN.com leagues): Barrie has some work to do as far as impressing his new coach is concerned. So far, Patrick Roy hasn't seemed all that smitten with the promising 22-year-old, to the point of booting Barrie up to the press box for the club's past two games. If you can afford to be patient, keep the former Kelowna Rocket on your bench for now. Beyond Andre Benoit, Colorado's blue line lacks significant fantasy sparkle.
Matt Moulson, LW, New York Islanders (owned in 100 percent of ESPN.com leagues): Just about any player would drop in value once removed from a scoring line including John Tavares, and Moulson is no exception. Unfortunately for Moulson (and his fantasy owners), Jack Capuano is electing to skate Michael Grabner and Kyle Okposo with Tavares at the moment. As an aside, it's worth noting that Okposo is currently available in the overwhelming majority of ESPN.com leagues. That doesn't feel right.
Matt Niskanen, D, Pittsburgh Penguins (owned in 90 percent of ESPN.com leagues) : While a healthy Kris Letang bumps Paul Martin from the Penguins' dynamic top power-play unit, the Penguins' No. 1 defenseman essentially body-checks Niskanen square into the realm of fantasy irrelevancy. And Letang is due back from a lower-body injury within the week. Once Letang is back, Niskanen can be ignored until another injury strikes.
Jiri Tlusty, LW, Carolina Hurricanes (owned in 51 percent of ESPN.com leagues) : Dropped from the top line in favor of a seemingly better fit Tuomo Ruutu, Tlusty loses a fair amount of fantasy luster away from Eric Staal and Alexander Semin. And with zero points in seven games, Tlusty's "shine" has been more dull than usual to start this campaign.
Karri Ramo, G, Calgary Flames (owned in seven percent of ESPN.com leagues) : The biggest knock on Ramo ahead of the regular season was that he competes for a team in the midst of a tear-down and re-build. Now, over two weeks in, the Flames are holding their own (3-2-1), but veteran Joey MacDonald is shouldering most of the goaltending load. Strike it up to lousy luck for the capable Finn. We can only suppose that if or when Ramo muscles the starter's gig away from MacDonald, the Calgary club will evolve into the sub-mediocre squad it's pegged to be this season.
Short-term substitutes
Tye McGinn, LW, Philadelphia Flyers (owned in 0.7 percent of ESPN.com leagues): Recently called up from the AHL, McGinn has subbed in agreeably for an injured Scott Hartnell (lower-body injury) on the Flyers' top line with center Claude Giroux and winger Jakub Voracek. Even while Philly's offense has struggled as a whole, McGinn has managed to pot three goals in two games. And Hartnell isn't due back for at least another couple of weeks.
Sven Baertschi, LW, Calgary Flames (owned in 35 percent of ESPN.com leagues): Jiving nicely with linemates Jiri Hudler and Sean Monahan, Baertschi has a goal and a couple of assists (and is a plus-2) in his last five games. Just keep in mind, this trio probably won't stay intact for long. Even if Monahan isn't sent back to the OHL, there are a lot of moving parts in Calgary right now.
Mattias Tedenby, LW, New Jersey Devils (owned in 0.0 percent of ESPN.com leagues): Not your archetypical fantasy figure, Tedenby carries potential value via the on-ice company he's about to keep, beginning Thursday against the Ottawa Senators. Recovered from a groin injury suffered in September, Tedenby is expected to make his season debut on a Devils forward line with Travis Zajac and Michael Ryder. We're more than a little curious to watch that story unfold.
Jonas Gustavsson, G, Detroit Red Wings (owned 15 percent of ESPN.com leagues). Emphasis on the short, in short-term substitute here. Gustavsson is due another start -- maybe two -- as the Red Wings ensure Jimmy Howard fully recovers from a swollen hand. But while the 28-year-old Swede has been more than solid in relief, Gustavsson should only see the very occasional start when workhorse Howard is back to form.
Notable injuries
After taking a puck off his foot Tuesday, Lighting forward Martin St. Louis is listed as a game-time decision for Thursday's tilt against the Wild … Evander Kane of the Winnipeg Jets is listed as just day-to-day with a minor lower-body injury. That's great news, considering the winger was reportedly unable to put much weight on his right leg after getting hurt during Wednesday's skate … We'll have to wait a while longer for MRI results after Montreal Canadiens forward Max Pacioretty suffered a lower-body injury during Tuesday's win over the Jets. Stay tuned …


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NEW YORK, Jan. 29, 2013 (GLOBE NEWSWIRE) -- GNCC Capital, Inc. (PINKSHEETS:GNCP) ("the Company") will be filing its Annual Financial Statements for the year ended September 30, 2012 on Wednesday January 30, 2013. This removes the Stop annotation currently affixed to the Company.
|Contact Information:
|N.E. "Ted" Blom – President & CEO
|Telephone: (702) 942-3347
|E Mail: email@example.com
|Investor Relations Contact:
|E Mail: email@example.com


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I'm actually using WP3.0.3 with Next Gen 1.7.2
It appears that you can now only have 50 images in a gallery or perhaps i'm missing something in the new version. Anything under 50 images, no problem. As soon as I have more than 50 images the gallery page shows a blank page with just the page header.
I've deleted all images, uploaded them individually to see if it was a file causing the problem but it's not and I have tried uploading as a zip file. It all uploads fine, shows in the manage console that there are 146 images but it just fails to show anything on the page.
Any ideas?


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Located approx. a block from the hip shops and restaurants of Fillmore St, this 2 bedroom, 1 bath penthouse unit is one-of-a-kind. True to it's circa 1900 heritage, this Victorian maintains it's original architectural character on the outside, yet inside the dynamics change to a thoroughly modern ambiance with amazingly bright and open spaces and dramatic lofty ceilings of exposed beams and vaulted ceilings. Hardwood floors, interior wall openings, partial walls and carefully placed skylights enhance the appeal of this home. The main level offers an updated open kitchen with bar area and a living/dining room with expansive ceilings. The spacious master bedroom, located on the rear of the unit, has triple pane windows and a walk-in closet. The bath is updated with granite counters and custom cabinets. The upper level mezzanine loft has stunning views, vaulted ceilings and endless possibilities; office, media room or second bedroom. Washer/dryer in unit. 98 walkscore.
# of Rooms: 3
# of Bedrooms: 2
# of Full Bathrooms: 1
Hardwood Flooring
Washer/Dryer in Unit
City/Skyline View


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* CompleteMonster: The Titan [[BigBad Cronus]] after he escapes from Tartarus (where he was imprisoned for being an evil tyrant and for trying to [[OffingTheOffspring kill his kids]]). He waste no time in seeking to resume his dominance over the world and all in it. With nothing but hatred for his children and the other Gods, Cronus is utterly brutal and merciless in his tactics, which include [[ColdBloodedTorture torturing]] and [[AbusiveParents trying to kill his own children]] while throwing the world into chaos and disarray. Cronus eventually gets tired of the human heroes resisting him and makes it a point to attempt to [[KillAllHumans exterminate the entire human race]] in retribution. At other points, Cronus releases the [[SavageWolves savage werewolf]] Lycaon from imprisonment to eat "whomever he may please" and tries to get his [[AlmightyMom mother Gaea]] to kill Zeus for him. [[FauxAffablyEvil Sophisticated, suave, seemingly polite]] and never at loss for a vicious plan, Cronus repeatedly proves how nothing will stand in the way of his goals of domination and destruction.
* MostAnnoyingSound: During their expedition to Atlantis, Neil frequently says "Ping!" for no other discernible reason than that it annoys Archie half to death.
* TrueNeutral:
** The Oracle. In "Chaos 101", Cronus tries to say that the Oracle works for him, but the Oracle tersely reminds him that "I work for ''everyone''." Throughout the series, he proves this, providing information not only for Cronus but also for the seven heroes, of whom he seems to be rather fond.
** Also Thanatos, the god of death, whose purpose is very simple: to collect the deceased. He is neither good nor evil, and will obey only whoever wears the Helmet of Darkness.
* UncannyValley: In "Cronus 2.0", Odie devises a computer program that simulates Cronus. Hephaestus builds a robot to utilize the program for training, but the resemblance to the actual Cronus terrifies Theresa. [[spoiler:With good reason, as it turns out.]]


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Rock Climbing Photos : Comments
Bad Beta 2008
She will be mine, oh yes, she will be mine.Rating: | Vote: 1 | Comments: 2
Submitted by: limeydave on 2008-04-28 | Last Modified: 2009-07-21 | Views: 2503
One more move eh?
yeah, 2009: feet out on the ledge to the right, stuck the slopey sidepull above my head. next year, the lightning hold. haha!


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Archive for November 8th, 2012
Football fans – it's a twofer this weekend!
This coming weekend, November 10 and 11, both the University of Washington (UW) Huskies and the Seattle Seahawks will be playing in town at Century Link Field with huge crowds turning out to cheer them on. The Seattle Center will also be jumping with multiple events Friday through Sunday, including the Affordable Art Fair, Pacific […]
Posted: November 8th, 2012 under Commute, Event traffic, Greater Downtown, Greater Duwamish, Pedestrians, Queen Anne/Magnolia, SODO, Traffic Advisories, Trucks.


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Shell Scripts in Waiting: the Waitmax Tool
Linux consultant Matthias Kettner has just released Version 1.0 of his Waitmax Software. It gives programs a specified time to complete after terminating them.
Waitmax is designed for use in shell scripts. The tool launches another program in a new process and then waits for a configurable period. If the process has not completed by then, Waitmax sends a "TERM" signal to it. The "-s" command line parameter gives users the ability to send other signals.
In the provides a practical example. The following command uses scp to copy a large file. If the process takes longer than an hour, it is killed:
waitmax 3600 scp bigfile.tar.gz somehost:/tmpWaitmax is released under the GPLv2 and can be downloaded from the author' homepage here. Both the source code and a statically linked RPM package are available.
Issue 25: Raspberry Pi Handbook 4th Ed./Special Editions
Buy this issue as a PDF
Ubuntu 16.04 LTS released
"Xenial Xerus" comes with a new packages format and several improvements for the enterprise.
Microsoft Visual Studio Code v1.0 is Available for Linux!
Linux users can now download and install the Windows code editor
Open Container Initiative announces Image Format Project
New initiative will address security and interoperability concerns around container technology.
Red Hat Lures Developers with Free RHEL and Container Development Kits
Developers can use RHEL as a development platform without a subscription fee.
Microsoft Brings the Linux Command Line to Windows
Windows users will soon have native access to the Bash shell.
Internet Research Group Proposes Better Email Standard
Improvements to SMTP will provide better guarantee of confidentiality
New Nvidia Driver Offers Wayland Support
Graphics vendor embraces new reality in Linux graphics
Inventor of Email Dies
Pioneer Ray Tomlinson bequeathed the @ sign to billions of Internet users
Microsoft Announces Linux Version of SQL Server
Redmond says its classic database tool will run without Windows
Strange New Attack Lets an Intruder Gain Access Through a Mouse Dongle
New intrusion technique affects most non-Bluetooth wireless mice


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Funding via Paglaum Multi-Purpose Cooperative (PMPC)
One challenge that Madam C. faces is that she always runs out of drinks because she has to make an advance payment before she receives the shipment from her suppliers. Her suppliers include the Coca Cola company of Ghana and the Ghana Breweries.
She is therefore asking for a loan of US $1,000 to enable her to buy more crates of minerals (Malta Guinness, Coca Cola, Fanta, and Sprite) to fill her drinking spot attached to her chop bar.
Success!! The loan was 100% repaid


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Harrison County Middle School has offered the Reading Counts Program in seventh grade for 12 years under the direction of Tammy Bunch and Tamara King.
Reading Counts is designed to encourage student reading at the middle school level.
Throughout the school year, students read books and take comprehension tests on the computer. Books are assigned a point value based on reading level. The higher the reading level, the more points the book is worth. Each nine weeks, the top 13 students with the highest points are recognized and their photo appears in the Democrat.
Samantha Cecile Stubbs graduated cum laude from Kentucky Christian University in Grayson, Ky. on May 7, 2011, with a Bachelor of Arts in Counseling Psychology.
She is a 2007 graduate of Harrison County High School, and the daughter of Linda Stubbs and Mark Stubbs.
Harrison County residents seeking employment opportunities now have more computer access, training and job workshops at the new Public Library Workforce Center (PLWC).
The Cynthiana-Harrison County Public Library is one of 45 public libraries in the state that will have a PLWC.
The centers house computers and software that will be used to provide training in a formal workshop setting to Kentucky residents seeking employment opportunities.
Lesley Ann Hatfield, Valedictorian of the 2011 graduating class at Lee High School, is the daughter of Myron and Joyce Hatfield of Pennington Gap, Va., formerly of Cynthiana.
Her school activities included JV basketball, JV softball, varsity softball, and Color Guard, and the Lee High Generals Marching Band. She was a member in Spanish Club, Science Club, Senior Beta Club, Co-ed Hi Y, DECA and FBLA.
Hatfield has been recognized as a National Honor student. She is a member of Phi Theta Kappa and has been a Girl Scouts of America member for 13 years.
Gary Allen Perkins of Cynthiana graduated from Samford University during spring commencement on May 14, 2011. Perkins earned a Doctor of Pharmacy degree.
Samford University is consistently ranked in the top tier of its peer group by U.S. News & World Report. Founded in 1841, it is the largest private university in Alabama.
Who among us is guilty of not noticing it until it's too late?
Yes, all of a sudden there is nothing left of your blue spruce or arborvitae.Bagworms have been munching on the needles for weeks and we wonder how it all happened.
Well, they are at work right now so go outside and take inventory of your evergreens because that's what the bagworm likes the most. Now is the time they do their damage unless we put a stop to it.
Ten years ago or so I saw the worst bagworm infestation I have ever seen in my life.
If you are a female or a Hispanic farmer or rancher and you believe that the United States Department of Agriculture (USDA) improperly denied farm loan benefits to you for certain time periods between 1981 and 2000 because of your gender or race, you may be eligible to apply for compensation. "We want all producers in Kentucky who may be eligible to have the opportunity to participate in this claims process," said John W. McCauley, Kentucky Farm Service Agency State Executive Director.
Copyright © 2016
The Cynthiana Democrat is your source for local news, sports, events, and information in Cynthiana, KY and the surrounding area.


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Main Page
Welcome to Argonath RPG Wiki
The free encyclopedia based on Argonath.
Argonath RPG was created on July 11, 2006 based on our experiences with MTA:VC. After writing our own script based on a mix of public domain and our own ideas, we opened doors on July 28, 2006. The name has been chosen by seeking a combination of the founders RON and Agent. After choosing the name, the founders and developers chose to use nicknames from Lord Of The Rings. Argonath was founded because the founders could no longer find themselves agreeing with the happenings on another community, so they decided to create their own community which thrived to success because of the open natured, strong admin team.
The first server opened was for MTA:VC; scripts were made by Gandalf based on public source scripts released by Jax and Oli. Apart from the RPG server, a stunt server was opened as well, with minimal scripts. Despite multiple attacks and attempts to bring down the server community, (often thought to be originating from the previous community), Argonath RPG grew rapidly and soon became the most popular RPG server on MTA:VC.
Initially we had to survive several attacks on our server from other communities, however what they did not count on was that the owners were not kids but IT professionals, meaning we increased our security and stability with every attack.
Over time, the community grew, and more servers were opened to support many other multiplayer clients for games in the Grand Theft Auto series, as well as TeamSpeak and even other games.
Other areas


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I know there is a lot of bad mojo out there when it comes to this remake of ROBOCOP but do yourself a favor and watch this new trailer. I think you'll come away feeling a little better about things. This one don't hit till February of next year but I think this trailer did its job, I'm interested. Did …Read More »
New Trailer For GRAVITY Will Have You Grasping For Your Life!
The first trailer peaked my interest by this second trailer, well it is just damn good. October 4th will bring this Warner Brothers film to theaters. Starring heavy hitters George Clooney and Sandra Bullock GRAVITY tell the following tale: Bullock plays Dr. Ryan Stone, a brilliant medical engineer on her first shuttle mission, with veteran astronaut Matt Kowalsky (Clooney) in …Read More »
One Sheet For ESCAPE FROM TOMORROW Is Nothing Short Of Awesome!
The fact that Disney is on board for all of this just amazes me. We talked about ESCAPE FROM TOMORROW a week or so back on THE OFFICIAL HORRORNEWS.NET PODCAST, it's the black and white film that debuted at Sundance and caused a stir because if was filmed at Disneyland without the companies permission and tells the dark tale of …Read More »
SCREAM FACTORY Rolls Out NIGHT OF THE DEMONS Artwork
You already know what a fan of all things SCREAM FACTORY. One of the main reasons is the awesome new artwork that they have had commissioned for all these Collector's Edition releases and they have done it again with this brand new art for their upcoming release of NIGHT OF THE DEMONS. They announced it on their Facebook page and …Read More »
Chucky Is Back And It's Dinner Time – The First Clip From CURSE OF CHUCKY
Tonight I have for you the first official clip from CURSE OF CHUCKY which as I have told you before will hit Blu-ray and DVD on October 8th. Here's the clip:Read More »
CARRIE Gets Some New Stills And A Nice New Featurette
With CARRIE's date with the prom inching ever closer we are all beginning to be treated to more and more goodies from the remake and today I have for you a handful of new images plus a featurette that features some cast interviews and some new footage as well. Let's get right to it. Here's the eye candy:Read More »
TRUE BLOOD To Get Staked In 2014
Big news today from the folks over at HBO. Seems one of their most popular shows is going to call it quits. TRUE BLOOD will cease to exist after next season, so says programming head Michael Lombardo. "True Blood has been nothing short of a defining show for HBO," he also explains "Alan Ball took the books by Charlaine Harris, …Read More »
New Poster For AMERICAN HORROR STORY: COVEN Is A Real Mouthful
Another day done, another day closer to the FX premiere of AMERICAN HORROR STORY: COVEN and with each passing day we seem to get ourselves another hunk of promotional strangeness and today it came in the form of a new poster. You ready?Read More »
Check Out The Frightfest Premiere Of CURSE OF CHUCKY In This New Featurette
Still got a while to wait till our favorite "Good Guy" returns here in the states but those attending Frightfest in London have already seen the goods, and they want to talk about it. Hence we know have the following featurette where con attendees sing the praises of everyone's favorite possessed doll. In CURSE OF CHUCKY it appears we will …Read More »
See What Happens When A Good Ass Demon Goes Bad
We've talked about BAD MILO a few times. If for no other reason you should remember it because it's the flick about the dude who poops out a little demon every time someone upsets him and said demon heads on out and takes care of business. Yeah, that's BAD MILO. It's currently in the midst of its VOD run and …Read More »
IFC Midnight Pick Up HAUNT
A new picture is heading our way from the IFC Midnight label. It's titled HAUNT and according to Screen Daily it tells the tale of "a boy who gets involved with a mysterious neighbour when his family moves into a new home and unwittingly summons a demon." Don't you hate it when that happens? The film stars Jacki Weaver and …Read More »
Is Simon Pegg On Board For The X-FILES?
A few days ago there was some buzz online that perhaps fan favorite Simon Pegg could be pegged to take part in a rumored new chapter in the X-FILES mythos. Today Mr. Pegg himself has sounded off on the possibility. "I was a big fan of 'The X Files' and I've become friends with Gillian since. I've always loved that …Read More »
Abrams/Nolan Bringing WESTWORLD To HBO
Our fascination with Michael Crichton's WESTWORLD has been going strong ever since we all watched Yul Brenner saunter on screen way back in 1973. As a kid that scene of them taking the face off the Brenner robot was one that has stuck with me to this day. A new version is heading out way and it's coming at us …Read More »
ROOM 237 Checks In To Blu-ray
If you listen to our podcast (and if you don't, what the hell is wrong with you!) then you are already familiar with the documentary ROOM 237 which shows us the films and its fans in a way that you have never seen before. It's been on VOD for a while now and finally it is making the trip to …Read More »
You Have Got To See These Kick Ass HALLOWEEN Shirts!
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The musical career of Newry-born brothers Brendan and Declan Murphy the songwriting nucleus of The 4 of Us spans more than a decade. They shot to early fame with their debut Songs For The Tempted, which featured the massive hits Mary and Drag My Bad Name Down. The follow up Man Alive made Q magazines prestigious Top 50 albums of 1992 and included the UK Top 30 song She Hits Me.
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Dr. Rhonda McClellan
Mashburn Hall 235
--Congratulations to Tim Bullington for successfully defending his dissertation on March 31st. Dr. Bullington's multi-phased, mixed-method study focused on emergent leadership and followership in a faith-based community. The study was titled "Followers that Lead: Relating Leadership Emergence through Follower Commitment, Engagement, and Connectedness."
Recognition also goes to his dissertation committee: Drs. Rhonda McClellan (chair), Diana Pounder, R. B. Lenin, and Tim Atkinson.
--QP & Dissertation policies - The most recent version of our Handbook can be found under the Student Resources page. Pages 14-21 of the Handbook layout the QP/Dissertation process, the components of the proposal, QP defense, Candidacy, Dissertation procedures, IRB, Dissertation Defense, Graduation, and more.
--On the Student Resources page, you can find forms for the Program of Study in Degree Works and forms for graduation, the QP Rubric, and a few dissertations from our students who have graduated.
Dr. Rhonda McClellan
Mashburn Hall 235
UCA dedicates itself to academic vitality, integrity, and diversity.
University of Central Arkansas · 201 Donaghey Ave., Conway, AR 72035 · (501) 450-5000
UCA is accredited by the Higher Learning Commission.
Copyright © 2016 · All Rights Reserved


text:
Tudgay made just four appearances for Forest last season after breaking his collarbone while on loan at Barnsley in December.
The 30-year-old featured in two games for Forest at the end of the campaign under manager Billy Davies, who signed him from Sheffield Wednesday in January 2011.
Tudgay began his career at Derby and made over 200 appearances during a five-year stint at Hillsborough after signing for Wednesday for an undisclosed fee in 2006.
- Sports & Recreation
- Forest
- Billy Davies


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by Isaac Asimov
Foundation Religion Quotes
How we cite our quotes: (Part.Chapter.Paragraph)
Quote #10
"No. I'm a Master Trader. Money is my religion. All this mysticism and hocus-pocus of the missionaries annoy me, and I'm glad you refuse to countenance it." (V.5.19)
Religions come in all shapes and sizes. And although worship of science helped the Foundation in the past, it looks like a new "religion" will be needed as the universe changes. Any ideas? (Calling L. Ron Hubbard….)
People who Shmooped this also Shmooped...


text:
George H. Clowes, Jr., MD Trauma Lecture and Visiting Professorship
- Starts: 7:00 am on Monday, May 5, 2014
- Ends: 4:00 pm on Monday, May 5, 2014
This year's Visiting Professorship will be Lena M. Napolitano, MD, FACS, FCCP, FCCM, Professor of Surgery; Division Chief, Acute Care Surgery; Associate Chair of Surgery, Department of Surgery; Director, Trauma and Surgical Critical Care at University of Michigan Health System in Ann Arbor, MI.
- Location:
- Please refer to the link below with a complete schedule of event details.
- Registration:
- http://www.bumc.bu.edu/surgery/clowes/


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History (BA)
Stimulate your historical imagination by gaining a BA History degree by distance learning
Designed to incite, energise and stimulate your historical imagination, the BA History provides a structured route into the past in all its guises. The diverse subject matter ranges from an introduction to ancient philosophy to civil rights in 1960s America, and from ethnicity, identity and citizenship in modern British life to the interpretation and writing of history.
This programme will enable you to:
- expand your knowledge and understanding about the past, and reflect on the diversity of past human experience
- gain a critical insight into the range of interpretations, theories and approaches that historians have adopted and tested over time
- cultivate a broad range of skills which are highly valued by employers, such as the ability to think critically, assess evidence of many kinds and express ideas with precision. These skills can be transferred to many different careers or provide a grounding for further academic study.
|Key dates
|Application deadline
|1 October in the year before you intend to sit your first exams
|Registration deadline
|30 November
|Start studying
|Study materials are usually available from mid-August
|Examinations take place
Prestige and career progression
The programme has been developed by academics within the Department of History at Royal Holloway, University of London. Royal Holloway's History Department is currently ranked 12th out of 92 History and History of Art departments in the country, according to the 2012 Guardian University Guide.
Studying history will equip you with a broad range of skills, including critical thinking and writing, that can be tranferred to many different careers. History graduates can go on to be anything from advertising executives to journalists, teachers to museum curators.
Flexible study period, flexible payment
You have between 3-8 years to complete the programme, which consists of 12 courses. You can choose to pay the total fee in advance (£13,278) or pay as you go (a one-off registration fee plus a fee for each course studied).
Structure and Syllabus
The BA degree in History is divided into 3 levels. Choose the equivalent of 4 full courses from each level. Courses can be half courses, full courses or double courses. To complete the degree you have to take the equivalent of 12 full courses.
Level 1
Two half Foundation courses from
- History and meanings (Half Foundation course)
- State, society and the individual in the non-western world (Half Foundation course)
- British social and economic history 1945-97 (Half Foundation course)
Level 1
Plus three full Gateway courses from
- The birth of western Christendom AD 300-1215 (Gateway course)
- Republics, kings and people: the foundations of modern political culture (Gateway course)
- The rich tapestry of life: A social and cultural history of Europe c. 1500-1780 (Gateway course)
- Conflict and identity in modern Europe c1770 to 2000 (course PDF to follow)
Level 2
Three Group A courses from
- From nation state to multiple monarchy: British history, 1485-1649 (Group A)
- British history 1770-1990 (Group A)
- Modern times: international economic history c.1901-1990 (Group A)
- Twentieth century world history (Group A)
- History of the USA since 1877 (Group A)
Level 2
Plus one Group B course from
Level 3
Two Group B courses from
Level 3
Plus one Group C double course from
Note: Not all courses will necessarily be available in every year.
How you study
The BA History is offered through distance and flexible learning.
We supply learning materials which are specially designed by University of London academics for self-directed study. You also have access to a significant array of online resources including a fully supported virtual learning environment and online library.
The materials guide you through the syllabus for each course and direct your reading of the textbooks, study packs and library resources.
Virtual learning environment (VLE)
The VLE is like a virtual classroom that we use to deliver the content of the degree through the internet. It provides everything you need to study and to help you manage your learning. The VLE allows you to:
- access your study materials
- take part in discussions and seminars with your tutor and other students
- exchange ideas with fellow students on the course and organise mutual support via email
- receive notices, seminar dates, project support and other programme-related information
- ask questions regarding the administration of the programme
- seek help for technical problems you may encounter.
Study support
Other ways of engaging in online networking and communication include:
- Online seminars - all courses on the BA History feature a number of online seminars. These are regular, formal, asynchronous discussions that are led by a tutor.
- Course tutor - the tutor is available to support the course from the time you register through to your examination. We expect you to take part in between three and seven seminars for each course that you study. The seminars take place on set dates usually over a period of about two weeks.
- Peer to peer support - you can exchange ideas with your fellow students and organise mutual support via email.
- Student cafe - an informal space within the VLE where you can socialise.
Study materials
We will provide you with the core study materials you need to complete the programme. When you register, we will provide you with:
- CD-ROMs that direct your studies
- Textbooks (for some courses)
- The Arts Good Study Guide
- Access to the VLE and University of London Online Library
- a Programme handbook
- a Guide to the International Programmes
- Regulations
- Past examination papers
We also provide all students with a student registration card.
Sample study material
You are welcome to download the sample course overview and introduction for the course in British Social and Economic History 1945-1997:
The fees below relate to the 2016-2017 session and are subject to annual review.
|Academic year
|Registration fee
|£ 1,050
|Half course fee
|£ 510
|Full course fee
|£ 1,019
|Double course fee (Group C courses)
|£ 2,038
|£ 13,278
ConvertGBP x 1
Disclaimer: the currency conversion tool is provided to you for convenience only and does not constitute an endorsement or approval by the University of London; the exchange rates are provided dynamically via a third-party source, consequently, the University of London International Programmes is not responsible for their accuracy.
When to pay
You can pay fees for BA History in one of two ways: either, on registration, make a single payment covering the registration fee and all course fees, or, if you prefer to spread out your payments, you can pay the registration fee plus the fee for each course you take in your first year and then in subsequent years pay the fee for each new course you take.
The registration fee and course fees are payable by the closing date for registrations 30 November.
How to pay
All University fees must be paid in pounds sterling (GBP). The University accepts:
- Western Union - Quick Pay
- Credit/debit card (Visa, MasterCard, Maestro, Electron, JCB)
- Sterling banker's draft/cheque
- International money/postal order
Further details are given in payment methods.
Other costs
In addition to the fees payable to the University, you should also budget for:
- textbooks (this may well be in the region of £300 per year if you are taking four courses in one year);
- tuition costs (if studying at a teaching institution);
- the fee charged by your local examination centre to cover its costs; this fee will vary.
Fees are subject to annual revision and typically may be increased by up to 5% per annum. For a full list fees that may be applicable, please see the fee schedule.
At Level 1, each half course is assessed by one two-hour written examination. At Levels 2 and 3, Group A and Group B units are assessed by one three-hour written examination. The Group C double course is assessed by one three-hour written examination and a dissertation of 10,000 words. These examinations are held once a year, usually in May.
You do not have to come to London to take your examinations as we have examination centres around the world, as well as in London. Examinations are arranged mainly through Ministries of Education or the British Council. Your local examination centre will charge you a fee to cover its costs. This fee will vary from centre to centre. For further information please see the assessment and examinations pages of our website.
As well as the formal assessment outlined above, you are strongly encouraged to submit written assignments to be marked by tutors. The assignments are completed on a voluntary basis and do not contribute to your final mark, but do provide an excellent opportunity to review your progress and get feedback from Royal Holloway on your understanding of the subject matter.
Academic Requirements
To be eligible for the BA History you must
- normally* be aged 17 or above by the 30 November in the year of registration and
- satisfy the University's General Entrance Requirements.
*Applications will be considered from applicants who do not meet the normal minimum age requirement for admission. Each application will be considered on an individual basis, and the decision taken at the discretion of the University of London.
If you are not automatically eligible then you will be individually considered by the Admissions Panel. The Admissions Panel will consider qualifications which are not published under the Qualifications for Entrance Schedule, incomplete qualifications (e.g. diplomas / degrees) and substantial relevant work experience. If we cannot accept you with your current qualifications and experience, we will advise you what qualifications you could take in order to become eligible in the future.
English language requirement
The language of instruction, reading and assessment is English. To succeed on our programmes you need a good level of competence in English. If you doubt your ability in written or spoken English we advise you take a course and test in English language before enrolling on the programme.
Required standard of English
You will usually meet the English language requirement for undergraduate programmes if you:
- hold a UK GCSE / GCE O level in English at grade C or above
- have five years secondary schooling taught solely in English or have passed GCE A levels or IB in essay-based subjects
- have passed an International Foundation programme that permits entry onto a recognised UK bachelor degree
- hold a full Postgraduate award, or a full first degree or Associate degree taught and examined in English from an institute that is acceptable to the University
- have passed, within the past three years, an Associate degree, Diploma or Higher Diploma awarded by an acceptable institute / polytechnic / university in Hong Kong, Malaysia or Singapore, or
- have passed, within the past three years, a test of proficiency in English language from an organisation acceptable to the University.
Where an applicant does not meet the required English language level but believes they can demonstrate the required level for admission the University may, at its discretion, consider the application.
Please note if an applicant satisfies one of the above conditions yet provides evidence of a test of proficiency in English language, awarded within the past three years, which is below the University's minimum requirements then they will be required to retake such a test before being offered admission.
Accreditation of prior learning
If you have studied a syllabus as part of a previous qualification which is comparable in level, content and standard, you might not have to take a particular course as part of your University of London International Programmes degree if we believe that the subject has been covered to the same breadth and depth. This is called Accreditation of prior learning or APL. It is also sometimes known as Credit Transfer or Exemption.
APL may be awarded for up to four full courses at Level 1. For more information about APL please see the APL section of the website.
Computer Requirements
You must have regular access to a computer (or mobile device*) with an internet connection to use the University of London International Programmes website and the Student Portal. These are where your programme's study resources are located. Through the Student Portal you can register as a student, enter exams and use your programme's Virtual Learning Environment (VLE). The VLE provides you with electronic learning materials, access to the University of London Online Library, networking opportunities, and other resources.
To get the most from your studies, your computer should have at least the following minimum specification:
- screen resolution of 1024 x 768 or greater
- sufficient bandwidth to download documents of at least 2 MB
and the following applications installed:
- a word processor that reads Microsoft Word format (.doc)
- Adobe, or other pdf reader.
* Full mobile access is not available for all programmes.
Royal Holloway - The Department of History
Royal Holloway [external website] is ranked among the top research-led universities in the UK. It is an innovative and forward-looking institution, acknowledged worldwide for cutting-edge research and excellent teaching. Originally founded in 1886, Royal Holloway is today the third largest multidisciplinary College of the University of London.
The Department of History [external website] has more than 30 research-active staff and over 100 PhD students, making it the largest History department in the University of London and one of the largest in the United Kingdom. The Department is rated in the top national assessment category for teaching and is recognised as world-leading in its research.
Academic leaders
Dr Emmett Sullivan - Programme Director
Emmett Sullivan is the Senior Departmental Tutor in History at Royal Holloway, University of London. He is responsible for the Department's distance learning provision and the undergraduate research methods and economic history courses. Employed at Royal Holloway for the past 15 years, Emmett previously worked at VUW (New Zealand), La Trobe (Melbourne, Australia), the ANU (Canberra, Australia) and Leicester University, and holds a doctoral degree from the economics programme at the ANU.


text:
I'm so lame I forgot the schedule for solid foods and this is my 3rd baby.
LO has been on rice cereal 2X a day for 2 weeks now, what comes next??
LO has been on rice cereal 2X a day for 2 weeks now, what comes next??
Veggies, then fruits.
Miracles happen to those who believe!
Soon to be Debt Free
schedule? whoops. We started at about 4 1/2 months. LO didn't like the plain cereals so I let her try sweet potatoes and she devoured them. We kinda added on from there. Now she usually gets oatmeal + fruit for breakfast, and a veggie in the midafternoon. No negative reactions to anything so far.
Penny Jane born 08/11/2012!
We did oatmeal, and have been doing avocado for the past week (avocado for lunch, then oatmeal for dinner) and we're starting on sweet potatoes this weekend.


text:
Searched for: "using encrypting file system and bitlocker to protect microsoft dynamics crm data on outlook clients running windows xp or windows vista"
Content Types
About 96 results for "using encrypting file system and bitlocker to protect microsoft dynamics crm data on outlook clients running windows xp or windows vista"
Get familiar with the Windows 10 Recovery Drive... before you need it
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Get to know File Explorer's Contextual tabs in Windows 10
Greg Shultz explores the Contextual tabs on the Ribbon toolbar in Windows 10's File Explorer for recent Windows 7 and Windows XP users.
Windows 10 Enterprise edition: What are the key features for businesses?
Inside Microsoft's latest operating system are a number of significant features that business users need to understand.
Windows 10 review: Full of promise, but not a must-have just yet
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Environmental Company Simplifies Endpoint Protection with PC Management Tool
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Raritan Bay Federal Credit Union (RBFCU) is a small financial cooperative that competes against big New York City banks. It upgraded its Windows XP PCs to mobile PCs running the Wi...
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BT needed to replace field service engineers' aging Windows XP laptops. It deployed Panasonic Toughbook CF-C1 convertible tablets running the Windows 8 operating system and saw inc...
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YES Prep Public Schools is a model of success. Founded in 1998 to increase the number of low-income students in Houston. The school district needed to centrally manage encryption. ...


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"Mill Bay, BC" Cobble Hill Travelogue by canuck68
Cobble Hill Travel Guide: 0 reviews and 7 photos
I think the scenery is probably the best aspect of Mill Bay. Lovely homes surround or look down on the Bay. The water is never dull to look at. Eagles can be seen gliding among the trees or sitting in the trees calling to one another.
Canada geese are often seen in the water in huge or small gaggles. Otters are playful and fun to watch.
Arbutus trees lean over the banks and add to the beauty.
The private school sits right on the water and must be a pleasure to attend.
What is most impressive for me is when the sculls go by early in the morning as the students train. The coach is calling instructions as the boats glide smoothly on the water, rowers all in synch.
Sail boats are a common site on the Bay.
There is a small but interesting shopping center in Mill Bay. A very fine grocery store leads the way. Walk along the sidewalks and check out the other shops. A great bakery, bank, clothing store, gift store, liquor store and a drug store are among the stores in the mall.
It is also the place where you can board the Island bus either south to Victoria, or north to Duncan, Ladysmith and Nanaimo and many other points on the Island.
Many residents set traps and are rewarded with crabs for a fresh crab dinner.
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