text:
- Features
- Discussion
- Events
- Food
- Restaurant Reviews
- New Restaurants
- Food Trucks
- Beer, Wine & Spirits
- Treats to Try
- Coffee Addiction
- A Kitchen Inspired
- RSS Feed
Unusual Eats: The Hot Dog Bun at Ichiban Bakery
This isn't just any Hot Dog Bun. In honor of Memorial Day Weekend —…
Taste the Best Barbecue in Columbus on June 23rd
Nothing says summer better than kicking back and enjoying some barbecue with your friends.…
- Shopping
New Short North Grocery Store Working Toward Summer Opening
The new Oats and Barley Market has delayed its grand opening a bit, but…
Bluescreek Relocating from North Market to Plain City
The North Market is losing a butcher, but Plain City is gaining a new…
- Art
- Art News
- Art Reviews
- Columbus Makes Art Presents
- Gallery Hop
- Local Artist Spotlight
- Young Art Collectors
- RSS Feed
Columbus Makes Art Presents: Nannette Maciejunes on Welcoming Picasso to Columbus
Nannette V. Maciejunes has been the executive director of the Columbus Museum of Art…
Review: CCAD 2016 Senior Fashion Show
To most college students, Mid-May means one thing: Graduation. To Columbus College of Art…
- Metro
Local Leaders Debate Police Body Cameras
Government transparency sits at ends with privacy as city officials and civil rights representatives…
Columbus Commons Celebrates Fifth Birthday
Any Columbus-native older than the age of six remembers City Center Mall in Downtown…
- Business
- Civics
- Columbus Politics
- Franklin County Politics
- Ohio Politics
- National Politics
- Upcoming Civic Meetings
- RSS Feed
Local Leaders Debate Police Body Cameras
Government transparency sits at ends with privacy as city officials and civil rights representatives…
North Market "Sip n Stroll" Legislation Passes Ohio Legislature
Business opportunities are expanding for the vendors of North Market after legislation passed permitting…
- Entertainment
- Mega Weekend
- Nightlife
- Sports
- Music
- Film
- Video Games
- Theatre
- Comedy
- Parks & Recreation
- Books
- Travel
- Lifestyle
- RSS Feed
First Look: Black Brick Bar
Donatos officially launched the Black Brick Bar tonight — a first of its kind…
Mega Weekend Summer 2016 – Vol. 3
Enjoy making your weekend plans and have a great long weekend! Win tickets to Promowest shows:…


text:
See the best of southern India on a cycling tour of Kerala
Unwind in India's fertile South, a land dotted with spice plantations, crumbling ruins and scenic ocean shores. An active and fun way to see this relaxed corner of India, this cycling tour winds its way from Mysore to Varkala, crossing through lush national parks and laid-back Kerala backwaters. Pedal around old forts and through the colourful villages of rural India before boarding a boat and cruising through the backwaters to coastal Varkala. For those looking for an energetic way to experience the chilled-out sights of Southern India, this Cycling Kerala & Tropical India is the perfect fix.
- Cycle through rural villages where life has changed little over centuries
- Spot wildlife in lush national parks
- Cruise the Kerala Backwaters on a traditional houseboat
- Enjoy spectacular views of mountains, jungles and tea plantations
- Witness the laidback pace of traditional fishing villages
Day 1 Mysore
Day 2
Day 3 Bandipur National Park
Day 4 Mudumalai National Park
Day 5 Ooty Hill Station
Day 6 Guruvayoor
Day 7
Day 8 Kochi
Day 9
Day 10 Kerala Backwaters
Day 11
Day 12 Varkala
Day 13
Day 14
Meals14 breakfasts, 11 lunches, 2 dinners
Transport4x4, Bicycle, Ferry, Support vehicle
AccommodationHotel (12 nights), Houseboat (1 night)
Included activities
- Jeep safari
There are currently no departures for this trip.
{{departure_day.departure_date | date:'EEE d MMM yyyy'}} Sale {{departure_day.departure_day_cheapest_price | noFractionCurrency:product.currency_symbol}} Fully booked Bookings closed
Style: {{departure.style}}
Total price per person {{room.room_type | lowercase}}
Includes {{departure.kitty_currency_code}} {{departure.kitty | noFractionCurrency:departure.kitty_currency_symbol}} kitty
Includes {{extra.extras_code}} {{extra.extras_symbol}}{{extra.extras_value}} in local payments Single supplement available from {{product.currency_code}} {{departure.single_supp | noFractionCurrency:product.currency_symbol}}
Contact us to arrange an alternative departure for you
Important notes
Trip notes
Want an in-depth insight into this trip? Your trip notes provide a detailed itinerary, visa info, how to get to your hotel, what's included - pretty much everything you need to know about this adventure and more.View trip notes

subset: commoncrawl


text:
(719) 392-1126
2690 E Las Vegas
Colorado Springs , CO 80906
Friday 7:30am - 4:30pm (show)
Monday: 7:30am - 4:30pm
Tuesday: 7:30am - 4:30pm
Wednesday: 7:30am - 4:30pm
Thursday: 7:30am - 4:30pm
Friday: 7:30am - 4:30pm
Saturday: closed
Sunday: closed (hide)
Full Service Scrap Metal Recycler in Colorado Springs & Surrounding Areas.
Evraz Recycling is a full service scrap metal recycler in Colorado Springs and surrounding areas. We offer top prices for ferrous and non-ferrous metals. We will provide rolloff service to manufacturers, demolitions, construction sites, auto salavges and farm clean outs.
Here at Evraz, we can proudly say that ALL the ferrous metal we purchase, process and ship stays in the state of Colorado and goes directly to our steel mill in Pueblo.
Call Us Today For Current Pricing!
(719) 392-1126


text:
Alex Archer - Serpent's Kiss
seeders: 0
leechers: 0
Alex Archer - Serpent's Kiss (Size: 68.43 MB)
Head on over TODAY and become a member of our exciting new site MyAnonamouse.net for the BEST in audiobook, ebooks and ALL things for the musician such as sheets, music books, instructional videos, etc. See you there! http://www.myanonamouse.net
The tenth book in the Rogue Angel series
Some say they are a cursed people. But those who try to find them will be just as unlucky… Working on a dig on the southern coast of India, the last thing Annja Creed expects is to be hit by a tsunami. Or to strike archaeological gold. But that's exactly what happens when several objects wash ashore in the storm.
The relics carry unfamiliar markings that hint at a legendary city. Excited by the prospect of discovering a culture believed lost to civilization, Annja embarks on a perilous journey deep into the heart of danger.
She learns of a mysterious artifact that could provide clues to the whereabouts of the lost city, which means trekking through an inhospitable jungle and forbidding terrain. But nature's denizens and death traps are not the only threats: someone else is also pursuing the prize. Just as Annja's grail comes into view, she must ward off an even greater evil. Because deep in the Nilgiris mountains is a race of people that the world forgot.
And they don't like strangers.
Sharing Widget
To share this torrent use the code below and insert it into comments, status messages, forum posts or your signature.Torrent: Alex Archer - Serpent's Kiss


text:
Results 1 to 8 of 8
- 10-01-2009, 09:22 AM Thread Author #1iMore Intermediate
- Posts
- 240 Posts
iPhone desk chargers that plug into a wall socket?
Are there any iPhone desk chargers that plug into a wall outlet instead of a USB cord to plug into the computer? I had this nifty little desk charger pod for my Blackberry that I could just drop my Pearl into to charge it, which plugged into a wall outlet, and want something like it for my iPhone. Seems like every dock charger I see for the iPhone being offered plugs into the computer by way of a USB cord, and I don't want that.
Any suggestions?
- 10-01-2009, 10:01 AM #2Distinguished
- Posts
- 2,150 Posts
- Global Posts
- 18,012 Global Posts
The current charging pod for the iPhone 3G has a USB end, but, you can connect it to a jack for the wall, sold by Apple. Plus, you get that said jack in the box with the iPhone 3G S...
- 10-01-2009, 10:04 AM Thread Author #3
- 10-01-2009, 10:10 AM #4Distinguished
- Posts
- 2,150 Posts
- Global Posts
- 18,012 Global Posts
Exactly. That's how I have mine setup
- 10-29-2009, 11:36 AM #5iPhone Newbie
- Posts
- 9 Posts
- Global Posts
- 13 Global Posts
- 11-16-2009, 02:56 PM #6iPhone Elite
- Posts
- 2,020 Posts
- Global Posts
- 2,026 Global Posts
USB is the new standard for all phone charging in Europe.
it will become the standard in the US only if because phone companies don't want to design a charging port twice
everything will be usb. you'll just need a standard wall adaptor for any phone.
- 11-25-2009, 07:32 AM #8iMore Intermediate
- Posts
- 424 Posts
- Global Posts
- 427 Global Posts
Chargers on Sale!
Buy.com has two bargains on chargers today:
Kensington Nightstand Charging Cradle - K33458US - Buy.com
Apple iPod & iPhone Rapid Travel Black Wall Chargers - 2 Pack - IP-WALLBKVP2 - Buy.com


text:
eduroam is a secure and encrypted wireless network available to Calvin College students, faculty, and staff. A Calvin email address and passphrase is required to connect to eduroam.
Guest is an open public wireless network available to guests and visitors. As this Internet access is intended for campus guests, not all campus Internet services are available through guest access. The Guest network requires registration every 7 days.
Connect to eduroam
Your device must be capable of 802.11x enterprise authentication and wireless G or N connections in order to work on eduroam
Connecting to Guest
To connect to Guest wireless, just select the network from the list of available wireless networks that your computer provides, open a web browser and fill out the form. If you do not see Guest in your list of available networks, you are not in an area where wireless is available.
Click here for more information, setup instructions, and a detailed list of available locations.
Wireless Bleed
If you are near one of the available wireless locations, you may experience wireless bleed from a nearby access point. That means your wireless-ready device may see a wireless network, but the signal may not be strong enough to make a reliable connection. This may also happen in some classrooms.
Responsible Use of Technology


text:
Sheaffer Pens
For your daily battles
Arm yourself with the new Sheaffer Sagaris fountain pen, rollerball or ballpoint. Bold metallic lacquer finishes in silver, blue, red or brown cover this light-weight design and are trimmed in chrome. A basic tool for daily battles in the board… read more
Sheaffer Sagaris
New finishes for the Sheaffer 300
We are proud to again present the classic Sheaffer 300 series, this time in three brand new finishes: brushed chrome with gold toned trim; glossy blue and metallic grey, both with chrome trim. These popular cigar-shaped fountain pens, rollerballs, and twist ballpoints are well-balanced and comfortable in the hand. This series is the perfect opportunity to mix and match for a… read more
Sheaffer 300
Just the start
Perhaps the first fountain pen you will try. Maybe the initial inspiration you need to tackle a new project. Possibly a motivational gift to launch a college freshman. The new Sheaffer Prelude collection is a perfect start to many great thoughts. The shiny black onyx lacquer barrel is paired with a bright palladium cap that has very subtle lines. A new matte black cap and barrel model is also available. Both options come in fountain pen, rollerball and … read more
Sheaffer Prelude Black


text:
Many of you have been hoping for a deal on Lego Friends (for girls) and Walmart has a great one! Head on over and choose 2 Lego Friends sets for just $32! You can choose FREE site-to-store shipping or get free shipping on an order of $45 or more.
UPDATE: The bundles start at $37 (not $32) and go up depending on which set you add.


text:
- Mark all as New
- Mark all as Read
- Float this item to the top
- Subscribe
- Bookmark
- Subscribe to RSS Feed
- Invite a Friend
Click here to see all the articles in this Category.
The best New York State B&Bs
From city-centre boutiques to chic rural getaways, our favourite New York State B&Bs are wonderfully varied. Whether you're flying into Rochester, Buffalo, Syracuse or New York City, a relaxed all-American bolthole is well within reach. Take a look at our top bed and breakfasts in New York State for everything from urban estates to wild Finger Lakes retreats and active trips in the Catskills and Hudson Valley.Read more...
On Business in Rochester NY
From luxury hotels and craft spirits to indie concert venues, Rochester is the perfect place to mix business with pleasure. With the rapid transformation of the 'Neighborhood of the Arts' district (NOTA), Rochester is enjoying a creative revival in its art, food and drinks scene, meaning there's plenty to enjoy here when the working day is done. Take a look at our guide to the best places to visit on business in Rochester NY.Read more...
Letchworth State Park and the Grand Canyon of the East
Located an hour away from Rochester, Letchworth State Park (or as it's known locally, 'the Grand Canyon of the East') is a beauty to behold, whichever season you happen to visit.Read more...
The Best Ryder Cup Courses
With the Ryder Cup returning to golf's spiritual home in Scotland for this year's tournament at Gleneagles Hotel in Perthshire, it's only fitting to look back at some of the other memorable courses that have played host to one of the biggest tournaments in the history of the sport. Here we remember some of the best Ryder Cup courses.Read more...
The Best Beaches on Lake Ontario
Lake Ontario is considered one of the Great Lakes of North America and a trip to its expansive shoreline will confirm just why it holds such lofty acclaim. The expansive and varied beaches are just a short jaunt from Rochester, and offer visitors ample opportunity to explore the diverse natural backdrop, while also indulging in some well-deserved sand time. Here we take a look at some of the best beaches on Lake Ontario, to inspire your next trip.Read more...
Visit the Finger Lakes | Rochester'
s Local Sanctuary
Visit the Finger Lakes of upstate New York and discover the crowning glory of the region – home to diverse wildlife, scenic views and the leading wines on the east coast. It's no surprise that the area remains a magnet for tourists and locals alike.Read more...


text:
Puff the Chinese Dragon by o-kemonoWatch
©2012-2016 o-kemono
Something quick I did today. PussyCat and the Year of the Dragon.
Its early, but Happy Chinese New Year!
artwork © 2012 Alex Cockburn
Its early, but Happy Chinese New Year!
artwork © 2012 Alex Cockburn
wook at da puttytat! and da dwagon! >W<
That dragon is so adorable.
The dragon is SOOOO CUTE! I want him...
I love the Dragon!
Happy Chinese New Year to you too Alex!
i like green plants and green panties too
This brilliant this one, she seriously is beautiful...
....oh god, the cuteness is killing me....=3
Wow this is neat thanks for the submission
Does he roar "Peep-Peep" for orange milkshakes?
This is insanely cute, great work!
This is insanely cute, great work!
very very cool OwO
Dawwww <3
It's so cute, and nothing is wrong with liking green plants.
not a single thing PussyCat, not a Single thing
I like Kitty's hat ^^
I like Kitty's hat ^^
she's so sweet and nascent


text:
Real-world effects — not emotional, irrational arguments — should be basis for work comp changes
MIXING secrecy with sleaze is a poor recipe for convincing the public to support a cause. An effort to stop a workers' compensation system reform bill has both ingredients.
The secrecy part we can overlook. Nothing is apparently illegal about how a group calling itself "Oklahoma Works" fails to disclose who's paying for the anti-reform effort. In the past, pro-business groups have promoted or opposed legislation behind a veil of secrecy regarding donors.
The sleaze part, though, is hard to ignore. "Oklahoma Works" is obviously a front group for lawyers who benefit from the comp system status quo. They profit because the state forces disputed comp claims into a special court system with politically appointed judges. Most states use an administrative system.
A handful of law firms specialize in comp claims and would be hurt by the reform bill. Too bad! As it is, the whole state is hurt by a system in which workers' comp coverage premiums are among the highest in the nation and far higher than in neighboring states.
A secretly funded website and advertising campaign run by "Oklahoma Works" portrays the reform issue in irrational, emotional terms — trotting out injured workers for testimonies about how the current system worked for them and how the reform plan would have left them high and dry. This is the standard tactic for the trial bar as they hide behind their own millionaire status to claim that reform would hurt the least among us. We saw this with the tort reform debate of recent years, but the Republicans who control state government managed to enact reforms anyway.
Workers' comp reform is at a critical juncture and has been threatened by a clash of egos in the highest levels of government. Nevertheless, we expect that cooler heads will prevail and a reform bill will hit the governor's desk soon. Rather than the emotional, irrational arguments being used by "Oklahoma Works," this debate should center on the real-world effects of the workers' comp system on small-business owners who pay some of the highest premiums in the country. Their workers wouldn't suffer because of the change from a judicial system to an administrative system.
Who would suffer are the relatively few lawyers who specialize in workers' comp claims, raking in cash by doing little but paying secretaries and paralegals to keep the paperwork moving from point to point. If ever an issue called for rational, nonemotional arguments, this is it. The rational argument is that Oklahoma workers' comp system is needlessly adversarial. This not only benefits lawyers for the claimants but those who defend the cases as well. This was also true of tort reform. In fact, attorneys defending sued parties are paid regardless of the outcome. Lawyers for the plaintiffs typically collect only if they win.
The business community has waited a long time for workers' comp reform. Incremental steps to achieve reform haven't gotten the job done. The fix being proposed isn't a panacea. Nor is it a devastating blow to the rights of injured workers — as "Oklahoma Works" and other reform opponents would have you believe.
We would have more respect for the anti-reform forces if they would come clean and admit that they're funding the emotion-laden campaign because they stand to lose money if reform is enacted. The state as a whole stands to gain money from reform by making the system less adversarial and by communicating to the nation that Oklahoma is a state that wants businesses to prosper rather than see revenues soaked up by workers' comp attorneys.


text:
Obama way ahead of Romney in Minnesota, says new SurveyUSA poll [GRAPHIC]
Minnesota hasn't gone for a Republican candidate in a presidential election since 1972, when incumbent Richard Nixon edged Democrat George McGovern by five percentage points. Fear and loathing on the campaign trail, indeed.
After November, it looks like it'll be 40 years and counting since a GOP presidential candidate took Minnesota, as a new SurveyUSA poll shows Barack Obama with a commanding lead over presumptive Republican nominee Mitt Romney.
A survey of 600 Minnesotans conducted May 9 and 10 shows Obama over Romney by a spread of 52 percent to 38 percent. The poll's margin of error is 4.4 percent. A late January poll showed Obama ahead of Romney 51 percent to 41 percent, so if anything he's slightly widened his lead since then.
In 2008, Obama defeated GOP nominee John McCain in Minnesota by a 54 to 44 margin, meaning it looks like the president is on track to enjoy a similarly comfortable margin in the Land of 10,000 Lakes this time around.
Courtesy of Talking Points Memo, here's a handy-dandy chart showing how the Obama/Romney race has evolved in Minnesota since late 2010:
Related coverage:
-- Poll: Obama crushes all GOP candidates in Minnesota [GRAPHIC]
Get the This Week's Top Stories Newsletter
Every week we collect the latest news, music and arts stories — along with film and food reviews and the best things to do this week — so that you'll never miss City Pages' biggest stories.
In Case You Missed It
Popular Stories
Sponsor Content


text:
Stewed Rhubarb ( Rhabarberkompott )
Total Time
Prep 15 mins
Cook 10 mins
We love Rhubarb, we even grow it. Strawberries can be added to make a good fruit compote. Can be made with SPLENDA for diabetic.
Ingredients Nutrition
- 2 lbs rhubarb
- 1 -1 1⁄2 cup sugar
- 1 cup water
- 1 slice lemons, rind of or 1 slice orange rind or 1 teaspoon vanilla
- Variations; White wine can be substituted for water, in which don't use vanilla.
- Whole strawberries can be add to the hot compote.
- Wash rhubarb, if young and tender, do not peel; otherwise strip off tough stringy coating, Cut in 1/2 to 3/4 inch pieces.
- Place in pot and sprinkle with sugar.
- Add lemon or orange peel.
- Cover and simmer slowly 5 to 10 minutes or until tender, but doesn't lose its shape.
- If using vanilla stir in now, taste to see if more sugar is needed, if so stir sugar in while fruit is hot so sugar can dissolve.
- Chill to serve.
Most Helpful
Yum! I halved the recipe because I only had one pound of rhubarb. I used Splenda instead of sugar to cut down on calories. This is sooo good. I have been eating this with cottage cheese and and can't wait to try it over some ice cream. Thanks for sharing this keeper.
i made this with lemon and added a pint of strawberries at the end of cooking time. wonderful sauce, i served it over a custard pudding. this was the first time i ever tried rhubarb, but it won't be the last. thanks barb for another good one!
Very good, I used splenda instead of the sugar and the lemnon rind. I put some on my cod for supper tonight, very good!! DH put some on his icecream, and i will freeze the rest to enjoy later, thanks for posting.


text:
Bames x Rick Owens
Posted on Jan 23rd, 2015
The new Rick Owens Men's RTW collection made a lot of noise in Paris this week for it's full frontal fashion. And the soundtrack was just as ballsy, courtesy of none other than FG's own Bames, who were enlisted by Rick to create custom extended mixes of their DRTY BWTY tracks "Sippin" and "Posted" for the catwalk. Check it out on Bames' Soundcloud, grab DRTY BWTY on iTunes, and stay tuned for their new EP coming this Spring on Fool's Gold!


text:
Flying to a cruise port after February 1? Know this: All those upgraded airport security programs come at a cost -- to airline passengers -- as the U.S. Department of Transportation is adding additional fees to airline tickets. The "security fee" is $2.50 per flight (if you fly a connecting itinerary that's $2.50 per segment) for a maximum of $10 per passenger, based on roundtrip travel.
The government's hoping the fees will generate some $900 million, which will be used to invest in new technology and hire additional passenger screeners and law enforcement officers.
Taxes on airline travel are becoming almost as complicated as the taxes we pay on gasoline for our cars; airline travelers are already paying up to $18 apiece, based on roundtrip tickets, for airport improvements.
Your Ultimate Cruise Guide
- Reviews
- Find A Cruise
- Deals
- Cruises to
- All Destinations
- Alaska Cruises
- Australia & New Zealand
- Bahamas Cruises
- Bermuda
- Canada & New England
- Caribbean Cruises
- Caribbean - Eastern
- Caribbean - Southern
- Caribbean - Western
- Europe Cruises
- Europe - Baltic Sea
- Europe - British Isles & Western
- Europe - Eastern Mediterranean
- Europe - Western Mediterranean
- Mexican Riviera
- Panama Canal
- How to Cruise
- News
- Community
Home >
New Airline Ticket Tax
New Airline Ticket Tax
January 4, 2002


text:
Contact Us
Enter Your Search:
Search tips
Search criteria
Journal titles
Results 1-25 (52)
Sort by:
Journal Title
Publication Date
« Previous
Go to page number:
Next »
Clipboard (0)
Clear All Filters
BMC Family Practice (52)
« less
Vermeire, Etienne (3)
Aertgeerts, Bert (2)
Buntinx, Frank (2)
Edwards, Adrian (2)
Elwyn, Glyn (2)
Upshur, Ross EG (2)
Aerssens, Peter (1)
Ahluwalia, Sanjiv (1)
Allgar, Victoria L (1)
Ament, Andre JHA (1)
more »
Andersson, Stig J (1)
Andersson, Sven-Olof (1)
Andén, Annika (1)
Ashkin, Evan (1)
Austoker, Joan (1)
Backlund, Lars (1)
Baldwin, Donna M (1)
Ban, Nobutaro (1)
Bartelds, Aad IM (1)
Bartoces, Monina G (1)
Barton, Barbara (1)
Belzile, Eric (1)
Besson, Jacques (1)
Blazeviciene, Aurelija (1)
Bliudziute, Egle (1)
Boltri, John M (1)
Bor, David H (1)
Brett, Jo (1)
Briel, Matthias (1)
Bring, Johan (1)
Bruijn, Camiel De (1)
Bruyninckx, Rudi (1)
Bryant, Eleanor (1)
Bucher, Heiner C (1)
Buciuniene, Ilona (1)
Bukach, Colleen (1)
Burge, Frederick I (1)
Burrow, Caroline E (1)
Carey, Iain M (1)
Carr, David (1)
Chaillet, Marie-Pierre (1)
Chambers, Larry W (1)
Childs, John D (1)
Christ-Crain, Mirjam (1)
Cole, Martin G (1)
Cook, Derek G (1)
Cooke, Jo (1)
Crebolder, Harry FJM (1)
Critchley, Julia (1)
Davies, Peter (1)
« less
Year of Publication
« less
Document Types
research-article (52)
« less
Chaperone use during intimate examinations in primary care: postal survey of family physicians
Price, David H
Tracy, C Shawn
Upshur, Ross EG
BMC Family Practice
Physicians have long been advised to have a third party present during certain parts of a physical examination; however, little is known about the frequency of chaperone use for those specific intimate examinations regularly performed in primary care. We aimed to determine the frequency of chaperone use among family physicians across a variety of intimate physical examinations for both male and female patients, and also to identify the factors associated with chaperone use.
Questionnaires were mailed to a randomly selected sample of 500 Ontario members of the College of Family Physicians of Canada. Participants were asked about their use of chaperones when performing a variety of intimate examinations, namely female pelvic, breast, and rectal exams and male genital and rectal exams.
276 of 500 were returned (56%), of which 257 were useable. Chaperones were more commonly used with female patients than with males (t = 9.09 [df = 249], p < 0.001), with the female pelvic exam being the most likely of the five exams to be attended by a chaperone (53%). As well, male physicians were more likely to use chaperones for examination of female patients than were female physicians for the examination of male patients. Logistic regression analyses identified two independent factors – sex of physician and availability of a nurse – that were significantly associated with chaperone use. For female pelvic exam, male physicians were significantly more likely to report using a chaperone (adjusted Odds Ratio [OR] 40.62, 95% confidence interval [CI] 16.91–97.52). Likewise, having a nurse available also significantly increased the likelihood of a chaperone being used (adjusted OR 6.92, 95% CI 2.74–17.46). This pattern of results was consistent across the other four exams. Approximately two-thirds of respondents reported using nurses as chaperones, 15% cited the use of other office staff, and 10% relied on the presence of a family member.
Clinical practice concerning the use of chaperones during intimate exams continues to be discordant with the recommendations of medical associations and medico-legal societies. Chaperones are used by only a minority of Ontario family physicians. Chaperone use is higher for examinations of female patients than of male patients and is highest for female pelvic exams. The availability of a nurse in the clinic to act as a chaperone is associated with more frequent use of chaperones.
Related Articles
Difficulties associated with outpatient management of drug abusers by general practitioners. A cross-sectional survey of general practitioners with and without methadone patients in Switzerland
Pelet, Anne
Besson, Jacques
Pécoud, Alain
Favrat, Bernard
BMC Family Practice
In Switzerland, general practitioners (GPs) manage most of the patients receiving methadone maintenance treatment (MMT).
Using a cross-sectional postal survey of GPs who treat MMT patients and GPs who do not, we studied the difficulties encountered in the out-patient management of drug-addicted patients. We sent a questionnaire to every GP with MMT patients (556) in the French-speaking part of Switzerland (1,757,000 inhabitants). We sent another shorter questionnaire to primary care physicians without MMT patients living in the Swiss Canton of Vaud.
The response rate was 63.3%. The highest methadone dose given by GPs to MMT patients averaged 120.4 mg/day. When asked about help they would like to be given, GPs with MMT patients primarily mentioned the importance of receiving adequate fees for the care they provide. Secondly, they mentioned the importance of better training, better knowledge of psychiatric pathologies, and discussion groups on practical cases. GPs without MMT patients refuse to treat these patients mostly for emotional and relational reasons.
GPs encounter financial, relational and emotional difficulties with MMT patients. They desire better fees for services and better training.
Related Articles
A rare case of disseminated cutaneous zoster in an immunocompetent patient
Gupta, S
Jain, A
Gardiner, C
Tyring, SK
BMC Family Practice
Disseminated cutaneous herpes zoster in healthy persons is uncommon, though it has been described in immunocompromised patients.
Case presentation
We describe a case of disseminated cutaneous herpes zoster in an elderly man with no apparent immunosuppressive condition. The patient was treated successfully with intravenous Acyclovir.
We suggest that disseminated zoster can occur in an immunocompetent host and should be promptly recognized and treated to prevent serious complications.
Related Articles
Primary healthcare provision and Chronic Fatigue Syndrome: a survey of patients' and General Practitioners' beliefs
Thomas, Marie A
Smith, Andrew P
BMC Family Practice
The current study was conducted as part of a research project into the evaluation and assessment of healthcare provision and education in Chronic Fatigue Syndrome (CFS). One aim of the study was the development of informative and educational literature for both General Practitioners (GP) and sufferers. Issues such as diagnosis, management and treatment of the syndrome should be included in information booklets written by healthcare professionals. It was important to begin the process by assessing the level of specialist knowledge that existed in typical GP surgeries. This data would then be compared to data from CFS patients.
197 survey booklets were sent to CFS sufferers from an existing research panel. The patients approached for the purpose of the study had been recruited onto the panel following diagnosis of their illness at a specialised CFS outpatient clinic in South Wales. A further 120 booklets were sent to GP surgeries in the Gwent Health Authority region in Wales.
Results from the study indicate that the level of specialist knowledge of CFS in primary care remains low. Only half the GP respondents believed that the condition actually exists.
Steps are recommended to increase the knowledge base by compiling helpful and informative material for GPs and patient groups.
Related Articles
How and why community hospital clinicians document a positive screen for intimate partner violence: a cross-sectional study
Gerber, Megan R
Leiter, Karen S
Hermann, Richard C
Bor, David H
BMC Family Practice
This two-part study examines primary care clinicians' chart documentation and attitudes when confronted by a positive waiting room screen for intimate partner violence (IPV).
Patients at community hospital-affiliated health centers completed a screening questionnaire in waiting rooms that primary care providers (PCPs) were subsequently given at the time of the visit. We first reviewed the medical records of patients who screened positive for IPV, evaluating the presence and quality of documentation. Next we administered a survey to PCPs that measured their knowledge, attitudes and practice regarding IPV.
Seventy-two percent of charts contained some documentation of IPV, however only 10% contained both a referral and safety plan. PCPs were more likely to refer patients (p < .05) who screened positively for mood or anxiety disorders, disclosed that they feared for their safety or were economically disadvantaged. Those that feared for their safety or endorsed mood or anxiety disorders were more likely to have notation of a safety plan in their records. When surveyed, 81.6% of clinicians strongly agreed that it is their role to inquire about IPV, but only 68% expressed confidence in their ability to manage it. In contrast, 93% expressed confidence in managing depression. Sixty-seven percent identified time constraints as a barrier to care. Predictors of PCP confidence in treating patients who have experienced IPV (p < .05) included hours of recent training and clinical experience with IPV.
Mandatory waiting room screening for IPV does not result in high levels of referral or safety planning by PCPs. Despite the implementation of a screening process, clinicians lack confidence and time to address IPV in their patient populations suggesting that alternative methods of training and supporting PCPs need to be developed.
Related Articles
Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records
Neal, Richard D
Hussain-Gambles, Mahvash
Allgar, Victoria L
Lawlor, Debbie A
Dempsey, Owen
BMC Family Practice
Missed appointments are a common occurrence in primary care in the UK, yet little is known about the reasons for them, or the consequences of missing an appointment. This paper aims to determine the reasons for missed appointments and whether patients who miss an appointment subsequently consult their general practitioner (GP). Secondary aims are to compare psychological morbidity, and the previous appointments with GPs between subjects and a comparison group.
Postal questionnaire survey and prospective medical notes review of adult patients missing an appointment and the comparison group who attended appointments over a three week period in seven general practices in West Yorkshire.
Of the 386 who missed appointments 122 (32%) responded. Of the 386 in the comparison group 223 (58%) responded, resulting in 23 case-control matched pairs with complete data collection. Over 40% of individuals who missed an appointment and participated said that they forgot the appointment and a quarter said that they tried very hard to cancel the appointment or that it was at an inconvenient time. A fifth reported family commitments or being too ill to attend. Over 90% of the patients who missed an appointment subsequently consulted within three months and of these nearly 60% consulted for the stated problem that was going to be presented in the missed consultation. The odds of missing an appointment decreased with increasing age and were greater among those who had missed at least one appointment in the previous 12 months. However, estimates for comparisons between those who missed appointments and the comparison group were imprecise due to the low response rate.
Patients who miss appointments tend to cite practice factors and their own forgetfulness as the main reasons for doing so, and most attend within three months of a missed appointment. This study highlights a number of implications for future research. More work needs to be done to engage people who miss appointments into research in a meaningful way.
Related Articles
The epidemiology of suicide and attempted suicide in Dutch general practice 1983–2003
Marquet, Richard L
Bartelds, Aad IM
Kerkhof, Ad JFM
Schellevis, François G
van der Zee, Jouke
BMC Family Practice
Many patients attempting or committing suicide consult their general practitioner (GP) in the preceding period, indicating that GPs might play an important role in prevention. The aim of the present study was to analyse the epidemiology of suicidal behaviour in Dutch General Practice in order to find possible clues for prevention.
Description of trends in suicide and suicide attempts occurring from 1983–2003 in the Dutch General Practice Sentinel Network, representing 1% of the Dutch population. The data were analysed with regard to: 1) suicidal behaviour trends and their association with household situation; 2) presence of depression, treatment of depression and referral rate by GPs; 3) contact with GP before suicide or suicide attempt and discussion of suicidal ideation.
Between 1983 and 2003 the annual number of suicide and suicide attempts decreased by 50%. Sixty percent of the patients who committed or attempted suicide were diagnosed as depressed, of whom 91% were treated by their GP with an antidepressant. Living alone was a risk factor for suicide (odds ratio 1.99; 95% CI 1.50 to 2.64), whereas living in a household of 3 or more persons was a relative risk for a suicide attempt (odds ratio 1.81; 95% CI 1.34 to 2.46). Referral to a psychiatrist or other mental health professionals occurred in 65% of the cases. GPs recalled having discussed suicidal ideation in only 7% of the cases, and in retrospect estimated that they had foreseen suicide or suicide attempts in 31% and 22% of the cases, respectively, if there had been contact in the preceding month.
With regard to the prescription of antidepressants and referral of suicidal patients to a psychiatrist, Dutch GPs fulfil their role as gatekeeper satisfactorily. However, since few patients discuss their suicidal ideation with their GP, there is room for improvement. GPs should take the lead to make this subject debatable. It may improve early recognition of depressed patients at risk and accelerate their referral to mental health professionals.
Related Articles
Effects of screening and brief intervention training on resident and faculty alcohol intervention behaviours: a pre- post-intervention assessment
Seale, J Paul
Shellenberger, Sylvia
Boltri, John M
Okosun, IS
Barton, Barbara
BMC Family Practice
Many hazardous and harmful drinkers do not receive clinician advice to reduce their drinking. Previous studies suggest under-detection and clinician reluctance to intervene despite awareness of problem drinking (PD). The Healthy Habits Project previously reported chart review data documenting increased screening and intervention with hazardous and harmful drinkers after training clinicians and implementing routine screening. This report describes the impact of the Healthy Habits training program on clinicians' rates of identification of PD, level of certainty in identifying PD and the proportion of patients given advice to reduce alcohol use, based on self-report data using clinician exit questionnaires.
28 residents and 10 faculty in a family medicine residency clinic completed four cycles of clinician exit interview questionnaires before and after screening and intervention training. Rates of identifying PD, level of diagnostic certainty, and frequency of advice to reduce drinking were compared across intervention status (pre vs. post). Findings were compared with rates of PD and advice to reduce drinking documented on chart review.
1,052 clinician exit questionnaires were collected. There were no significant differences in rates of PD identified before and after intervention (9.8% vs. 7.4%, p = .308). Faculty demonstrated greater certainty in PD diagnoses than residents (p = .028) and gave more advice to reduce drinking (p = .042) throughout the program. Faculty and residents reported higher levels of diagnostic certainty after training (p = .039 and .030, respectively). After training, residents showed greater increases than faculty in the percentage of patients given advice to reduce drinking (p = .038), and patients felt to be problem drinkers were significantly more likely to receive advice to reduce drinking by all clinicians (50% vs. 75%, p = .047). The number of patients receiving advice to reduce drinking after program implementation exceeded the number of patients felt to be problem drinkers. Recognition rates of PD were four to eight times higher than rates documented on chart review (p = .028).
This program resulted in greater clinician certainty in diagnosing PD and increases in the number of patients with PD who received advice to reduce drinking. Future programs should include booster training sessions and emphasize documentation of PD and brief intervention.
Related Articles
A framework to evaluate research capacity building in health care
Cooke, Jo
BMC Family Practice
Building research capacity in health services has been recognised internationally as important in order to produce a sound evidence base for decision-making in policy and practice. Activities to increase research capacity for, within, and by practice include initiatives to support individuals and teams, organisations and networks. Little has been discussed or concluded about how to measure the effectiveness of research capacity building (RCB)
This article attempts to develop the debate on measuring RCB. It highlights that traditional outcomes of publications in peer reviewed journals and successful grant applications may be important outcomes to measure, but they may not address all the relevant issues to highlight progress, especially amongst novice researchers. They do not capture factors that contribute to developing an environment to support capacity development, or on measuring the usefulness or the 'social impact' of research, or on professional outcomes.
The paper suggests a framework for planning change and measuring progress, based on six principles of RCB, which have been generated through the analysis of the literature, policy documents, empirical studies, and the experience of one Research and Development Support Unit in the UK. These principles are that RCB should: develop skills and confidence, support linkages and partnerships, ensure the research is 'close to practice', develop appropriate dissemination, invest in infrastructure, and build elements of sustainability and continuity. It is suggested that each principle operates at individual, team, organisation and supra-organisational levels. Some criteria for measuring progress are also given.
This paper highlights the need to identify ways of measuring RCB. It points out the limitations of current measurements that exist in the literature, and proposes a framework for measuring progress, which may form the basis of comparison of RCB activities. In this way it could contribute to establishing the effectiveness of these interventions, and establishing a knowledge base to inform the science of RCB.
Related Articles
Satisfaction is not all – patients' perceptions of outcome of general practice consultations, a qualitative study
Andén, Annika
Andersson, Sven-Olof
Rudebeck, Carl-Edvard
BMC Family Practice
Evaluation of outcome in general practice can be seen from different viewpoints. In this study we focus on the concepts patients use to describe the outcome of a consultation with a GP.
Patients were interviewed within a week after a consultation with a GP. The interviews were made with 20 patients in 5 focus groups and 8 individually. They were analysed with a phenomenographic research approach.
From the patient's perspective, the outcome of a consultation is about cure or symptom relief, understanding, confirmation, reassurance, change in self-perception and satisfaction.
General practice consultations are often more important for patients than generally supposed. Understanding is the most basic concept.
Related Articles
Frequent attenders in general practice: problem solving treatment provided by nurses [ISRCTN51021015]
Schreuders, B
van Oppen, P
van Marwijk, HWJ
Smit, JH
Stalman, WAB
BMC Family Practice
There is a need for assistance from primary care mental health workers in general practice in the Netherlands. General practitioners (GPs) experience an overload of frequent attenders suffering from psychological problems. Problem Solving Treatment (PST) is a brief psychological treatment tailored for use in a primary care setting. PST is provided by nurses, and earlier research has shown that it is a treatment at least as effective as usual care. However, research outcomes are not totally satisfying. This protocol describes a randomized clinical trial on the effectiveness of PST provided by nurses for patients in general practice. The results of this study, which currently being carried out, will be presented as soon as they are available.
This study protocol describes the design of a randomized controlled trial to investigate the effectiveness and cost-effectiveness of PST and usual care compared to usual care only.
Patients, 18 years and older, who present psychological problems and are frequent attenders in general practice are recruited by the research assistant. The participants receive questionnaires at baseline, after the intervention, and again after 3 months and 9 months. Primary outcome is the reduction of symptoms, and other outcomes measured are improvement in problem solving skills, psychological and physical well being, daily functioning, social support, coping styles, problem evaluation and health care utilization.
Our results may either confirm that PST in primary care is an effective way of dealing with emotional disorders and a promising addition to the primary care in the UK and USA, or may question this assumption. This trial will allow an evaluation of the effects of PST in practical circumstances and in a rather heterogeneous group of primary care patients. This study delivers scientific support for this use and therefore indications for optimal treatment and referral.
Related Articles
The future prospects of Lithuanian family physicians: a 10-year forecasting study
Starkiene, Liudvika
Smigelskas, Kastytis
Padaiga, Zilvinas
Reamy, Jack
BMC Family Practice
When health care reform was started in 1991, the physician workforce in Lithuania was dominated by specialists, and the specialty of family physician (FP) did not exist at all. During fifteen years of Lithuania's independence this specialty evolved rapidly and over 1,900 FPs were trained or retrained. Since 2003, the Lithuanian health care sector has undergone restructuring to optimize the network of health care institutions as well as the delivery of services; specific attention has been paid to the development of services provided by FPs, with more health care services shifted from the hospital level to the primary health care level. In this paper we analyze if an adequate workforce of FPs will be available in the future to take over new emerging tasks.
A computer spreadsheet simulation model was used to project the supply of FPs in 2006–2015. The supply was projected according to three scenarios, which took into account different rates of retirement, migration and drop out from training. In addition different population projections and enrolment numbers in residency programs were also considered. Three requirement scenarios were made using different approaches. In the first scenario we used the requirement estimated by a panel of experts using the Delphi technique. The second scenario was based on the number of visits to FPs in 2003 and took into account the goal to increase the number of visits. The third scenario was based on the determination that one FP should serve no more than 2,000 inhabitants. The three scenarios for the projection of supply were compared with the three requirement scenarios.
The supply of family physicians will be higher in 2015 compared to 2005 according to all projection scenarios. The largest differences in the supply scenarios were caused by different migration rates, enrolment numbers to training programs and the retirement age. The second supply scenario, which took into account 1.1% annual migration rate, stable enrolment to residency programs and later retirement, appears to be the most probable. The first requirement scenario, which was based on the opinion of well-informed key experts in the field, appears to be the best reflection of FP requirements; however none of the supply scenarios considered would satisfy these requirements.
Despite the rapid expansion of the FP workforce during the last fifteen years, ten-year forecasts of supply and requirement indicate that the number of FPs in 2015 will not be sufficient. The annual enrolment in residency training programs should be increased by at least 20% for the next three years. Accurate year-by-year monitoring of the workforce is crucial in order to prevent future shortages and to maintain the desired family physician workforce.
Related Articles
Length of patient-physician relationship and patients' satisfaction and preventive service use in the rural south: a cross-sectional telephone study
Donahue, Katrina E
Ashkin, Evan
Pathman, Donald E
BMC Family Practice
Physicians and patients highly value continuity in health care. Continuity can be measured in several ways but few studies have examined the specific association between the duration of the patient-doctor relationship and patient outcomes. This study (1) examines characteristics of rural adults who have had longer relationships with their physicians and (2) assesses if the length of relationship is associated with patients' satisfaction and likelihood of receiving recommended preventive services.
Cross-sectional telephone survey of health care access indicators of adults in selected non-metropolitan counties of eight U.S. predominantly southern states. Analyses were restricted to adults who see a particular physician for their care and weighted for demographics and county sampling probabilities.
Of 3176 eligible respondents, 10.8% saw the same physician for the past 12 months, 11.8% for the previous 13–24 months, 20.7% for the past 25–60 months and 56.7% for more than 60 months. Compared to persons with one year or less continuity with the same physician, respondents with over five years continuity more often were Caucasian, insured, a high school graduate, and more often reported good to excellent health and an income above $25,000. Compared to those with more than five years of continuity, participants with either less than one year or one to two years of continuity with the same physician were more often not satisfied with their overall health care (OR 2.34; OR 1.78), participants with less than one year continuity were more often not satisfied with the concern shown them by their physician (O.R. 1.90) and having their health questions answered, and those with one to two years continuity were more often not satisfied with the quality of their care (OR 2.37). No significant associations were found between physician continuity and use rates of any of the queried preventive services.
Over half of this rural population has seen the same physician for more than five years. Longer continuity of care was associated with greater patient satisfaction and confidence in one's physician, but not with a greater likelihood of receiving recommended preventive services.
Related Articles
A qualitative study of the impact of the implementation of advanced access in primary healthcare on the working lives of general practice staff
Ahluwalia, Sanjiv
Offredy, Maxine
BMC Family Practice
The North American model of 'advanced access' has been emulated by the National Primary Care Collaborative in the UK as a way of improving patients' access in primary care. The aim of this study was to explore the impact of the implementation of advanced access on the working lives of general practice staff.
A qualitative study design, using semi-structured interviews, was conducted with 18 general practice staff: 6 GPs, 6 practice managers and 6 receptionists. Two neighbouring boroughs in southeast England were used as the study sites. NUD*IST computer software assisted in data management to identify concepts, categories and themes of the data. A framework approach was used to analyse the data.
Whilst practice managers and receptionists saw advanced access as having a positive effect on their working lives, the responses of general practitioners (GPs) were more ambivalent. Receptionists reported improvements in their working lives with a change in their role from gatekeepers for appointments to providing access to appointments, fewer confrontations with patients, and greater job satisfaction. Practice managers perceived reductions in work stress from fewer patient complaints, better use of time, and greater flexibility for contingency planning. GPs recognised benefits in terms of improved consultations, but had concerns about the impact on workload and continuity of care.
AA has improved working conditions for receptionists, converting their perceived role from gatekeeper to access facilitator, and for practice managers as patients were more satisfied. GP responses were more ambivalent, as they experienced both positive and negative effects.
Related Articles
Avoidance as a strategy of (not) coping: qualitative interviews with carers of Huntington's Disease patients
Lowit, Alison
van Teijlingen, Edwin R
BMC Family Practice
Since Huntington's Disease (HD) is a familial disease with an average onset in the mid-thirties, one might expect that spousal carers are concerned with providing care for off-spring who may turn out to be affected.
This study involved ten face-to-face interviews with carers of spouses affected by HD in Northeast Scotland. Carers were recruited through two channels: a genetic clinic and the Scottish Huntington's Association (SHA). Interviews were conducted in carers' own homes. A thematic analysis of the transcripts was conducted.
Although carers did worry about their children, they did not envisage being involved in their care. Many avoided talking about the disease, both within and outwith their family; this may have greatly reduced the level of support provided by family members. Conversely, avoidance was often accompanied by symptom-spotting. For example, several people had given up driving, before they were incapable of doing so. The explanation appears to be that they avoided getting into situations in which HD may express itself.
Support meetings seem to be valued amongst patients with other serious diseases and their carers, however, although all participants had had contact with the SHA, only one regularly attended meetings. It was felt that seeing others with HD provided a constant reminder of the possible effect of HD on the wider family, which seemed to outweigh the benefit of attending. Overall, the analysis highlighted 'avoidance' as a key theme.
Many denied symptoms of HD in their spouses, pre-diagnosis. All had pretended at some point that it was not happening, through ignoring early signs and 'obvious' symptoms. Some partners had refused to go to the doctor until it was no longer possible to deny symptoms. Formal health and social care seemed to play a very small role compared to informal care arrangements.
Related Articles
Implementing evidence-based medicine in general practice: a focus group based study
Hannes, Karin
Leys, Marcus
Vermeire, Etienne
Aertgeerts, Bert
Buntinx, Frank
Depoorter, Anne-Marie
BMC Family Practice
Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work.
We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants.
A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described.
In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed.
Related Articles
Signs and symptoms in children with a serious infection: a qualitative study
Van den Bruel, Ann
Bruyninckx, Rudi
Vermeire, Etienne
Aerssens, Peter
Aertgeerts, Bert
Buntinx, Frank
BMC Family Practice
Early diagnosis of serious infections in children is difficult in general practice, as incidence is low, patients present themselves at an early stage of the disease and diagnostic tools are limited to signs and symptoms from observation, clinical history and physical examination. Little is known which signs and symptoms are important in general practice. With this qualitative study, we aimed to identify possible new important diagnostic variables.
Semi-structured interviews with parents and physicians of children with a serious infection. We investigated all signs and symptoms that were related to or preceded the diagnosis. The analysis was done according to the grounded theory approach. Participants were recruited in general practice and at the hospital.
18 children who were hospitalised because of a serious infection were included. On average, parents and paediatricians were interviewed 3 days after admittance of the child to hospital, general practitioners between 5 and 8 days after the initial contact.
The most prominent diagnostic signs in seriously ill children were changed behaviour, crying characteristics and the parents' opinion. Children either behaved drowsy or irritable and cried differently, either moaning or an inconsolable, loud crying. The parents found this illness different from previous illnesses, because of the seriousness or duration of the symptoms, or the occurrence of a critical incident. Classical signs, like high fever, petechiae or abnormalities at auscultation were helpful for the diagnosis when they were present, but not helpful when they were absent.
behavioural signs and symptoms were very prominent in children with a serious infection. They will be further assessed for diagnostic accuracy in a subsequent, quantitative diagnostic study.
Related Articles
A randomized trial of mail vs. telephone invitation to a community-based cardiovascular health awareness program for older family practice patients [ISRCTN61739603]
Karwalajtys, Tina
Kaczorowski, Janusz
Chambers, Larry W
Levitt, Cheryl
Dolovich, Lisa
McDonough, Bea
Patterson, Christopher
Williams, James E
BMC Family Practice
Family physicians can play an important role in encouraging patients to participate in community-based health promotion initiatives designed to supplement and enhance their in-office care. Our objectives were to determine effective approaches to invite older family practice patients to attend cardiovascular health awareness sessions in community pharmacies, and to assess the feasibility and acceptability of a program incorporating invitation by physicians and feedback to physicians.
We conducted a prospective randomized trial with 1 family physician practice and 5 community pharmacies in Dundas, Ontario. Regular patients 65 years or older (n = 235) were randomly allocated to invitation by mail or telephone to attend pharmacy cardiovascular health awareness sessions led by volunteer peer health educators. A health record review captured blood pressure status, monitoring and control. At the sessions, volunteers helped patients to measure blood pressure using in-store machines and a validated portable device (BPM-100), and recorded blood pressure readings and self-reported cardiovascular risk factors. We compared attendance rates in the mail and telephone invitation groups and explored factors potentially associated with attendance.
The 119 patients invited by mail and 116 patients contacted by telephone had a mean age of 75.7 (SD, 6.4) years and 46.8% were male. Overall, 58.3% (137/235) of invitees attended a pharmacy cardiovascular health awareness session. Patients invited by telephone were more likely to attend than those invited by mail (72.3% vs. 44.0%, OR 3.3; 95%CI 1.9–5.7; p < 0.001).
While the attendance in response to a telephone invitation was higher, response to a single letter was substantial. Attendance rates indicated considerable interest in community-based cardiovascular health promotion activities. A large-scale trial of a pharmacy cardiovascular health awareness program for older primary care patients is feasible.
Related Articles
Procalcitonin-guided antibiotic use versus a standard approach for acute respiratory tract infections in primary care: study protocol for a randomised controlled trial and baseline characteristics of participating general practitioners [ISRCTN73182671]
Briel, Matthias
Christ-Crain, Mirjam
Young, Jim
Schuetz, Philipp
Huber, Peter
Périat, Pierre
Bucher, Heiner C
Müller, Beat
BMC Family Practice
Acute respiratory tract infections (ARTI) are among the most frequent reasons for consultations in primary care. Although predominantly viral in origin, ARTI often lead to the prescription of antibiotics for ambulatory patients, mainly because it is difficult to distinguish between viral and bacterial infections. Unnecessary antibiotic use, however, is associated with increased drug expenditure, side effects and antibiotic resistance. A novel approach is to guide antibiotic therapy by procalcitonin (ProCT), since serum levels of ProCT are elevated in bacterial infections but remain lower in viral infections and inflammatory diseases.
The aim of this trial is to compare a ProCT-guided antibiotic therapy with a standard approach based on evidence-based guidelines for patients with ARTI in primary care.
This is a randomised controlled trial in primary care with an open intervention. Adult patients judged by their general practitioner (GP) to need antibiotics for ARTI are randomised in equal numbers either to standard antibiotic therapy or to ProCT-guided antibiotic therapy. Patients are followed-up after 1 week by their GP and after 2 and 4 weeks by phone interviews carried out by medical students blinded to the goal of the trial.
Exclusion criteria for patients are antibiotic use in the previous 28 days, psychiatric disorders or inability to give written informed consent, not being fluent in German, severe immunosuppression, intravenous drug use, cystic fibrosis, active tuberculosis, or need for immediate hospitalisation.
The primary endpoint is days with restrictions from ARTI within 14 days after randomisation. Secondary outcomes are antibiotic use in terms of antibiotic prescription rate and duration of antibiotic treatment in days, days off work and days with side-effects from medication within 14 days, and relapse rate from the infection within 28 days after randomisation.
We aim to include 600 patients from 50 general practices in the Northwest of Switzerland. Data from the registry of the Swiss Medical Association suggests that our recruited GPs are representative of all eligible GPs with respect to age, proportion of female physicians, specialisation, years of postgraduate training and years in private practice.
Related Articles
The definition of disabling fatigue in children and adolescents
Fowler, Tom
Duthie, Pamela
Thapar, Anita
Farmer, Anne
BMC Family Practice
Disabling fatigue is the main illness related reason for prolonged absence from school. Although there are accepted criteria for diagnosing chronic fatigue in adults, it remains uncertain as to how best to define disabling fatigue and Chronic Fatigue Syndrome (CFS) in children and adolescents. In this population-based study, the aim was to identify children who had experienced an episode of disabling fatigue and examine the clinical and demographic differences between those individuals who fulfilled a narrow definition of disabling fatigue and those who fulfilled broader definitions of disabling fatigue.
Participants (aged 8–17 years) were identified from a population-based twin register. Parent report was used to identify children who had ever experienced a period of disabling fatigue. Standardised telephone interviews were then conducted with the parents of these affected children. Data on clinical and demographic characteristics, including age of onset, gender, days per week affected, hours per day spent resting, absence from school, comorbidity with depression and a global measure of impairment due to the fatigue, were examined. A narrow definition was defined as a minimum of 6 months disabling fatigue plus at least 4 associated symptoms, which is comparable to the operational criteria for CFS in adults. Broader definitions included those with at least 3 months of disabling fatigue and 4 or more of the associated symptoms and those with simply a minimum of 3 months of disabling fatigue. Groups were mutually exclusive.
Questionnaires were returned by 1468 families (65% response rate) and telephone interviews were completed on 99 of the 129 participants (77%) who had experienced fatigue. There were no significant differences in demographic and clinical characteristics or levels of impairment between those who fulfilled the narrower definition and those who fulfilled the broader definitions. The only exception was the reported number of days per week that the child was affected by the fatigue. All groups demonstrated evidence of substantial impairment associated with the fatigue.
Children and adolescents who do not fulfil the current narrow definition of CFS but do suffer from disabling fatigue show comparable and substantial impairment. In primary care settings, a broader definition of disabling fatigue would improve the identification of impaired children and adolescents who require support.
Related Articles
Assessing, treating and preventing community acquired pneumonia in older adults: findings from a community-wide survey of emergency room and family physicians
Krueger, Paul
Loeb, Mark
Kelly, Caralyn
Edward, H Gayle
BMC Family Practice
Respiratory infections, like pneumonia, represent an important threat to the health of older Canadians. Our objective was to determine, at a community level, family and emergency room physicians' knowledge and beliefs about community acquired pneumonia (CAP) in older adults and to describe their self-reported assessment, management and prevention strategies.
All active ER and family physicians in Brant County received a mailed questionnaire. An advance notification letter and three follow-up mailings were used to maximize physician participation rate. The questionnaire collected information about physicians' assessment, management, and prevention strategies for CAP in older adults (≥60 years of age) plus demographic, training, and practice characteristics. The analysis highlights differences in approaches between office-based and emergency department physicians.
Seventy-seven percent of physicians completed and returned the survey. Although only 16% of physicians were very confident in assessing CAP in older adults, more than half reported CAP to be a very important health concern in their practices. In-service training for family physicians was associated with increased confidence in CAP assessment and more frequent use of diagnostic tests. Family physicians who reported always requesting chest x-rays were also more likely to request pulse oximetry (OR 5.6, 95% CI 1.40 to 22.5) and recommend both follow-up x-rays (OR 5.4, 95% CI 1.7 to 16.6) and pneumococcal vaccination (OR 3.4, 95% CI 1.1 to 10.0).
The findings of this study provide a snapshot of how non-specialists from a non-urban Ontario community assess, manage and prevent CAP in older adults and highlight differences between office-based and emergency department physicians. This information can guide researchers and clinicians in their efforts to improve the management and prevention of CAP in older adults.
Related Articles
Preconception care by family physicians and general practitioners in Japan
Kitamura, Kazuya
Fetters, Michael D
Ban, Nobutaro
BMC Family Practice
Preconception care provided by family physicians/general practitioners (FP/GPs) can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan.
A survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents.
Two hundred and sixty-eight of 347 (77%) eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%), and the least was about folic acid supplementation (12%). Many participants reported providing smoking cessation in their practice (60%), though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10%) or folic acid supplementation (4%). About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care.
FP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education.
Related Articles
Patients' views on outcome following head injury: a qualitative study
Morris, Paul Graham
Prior, Lindsay
Deb, Shoumitro
Lewis, Glyn
Mayle, Wendy
Burrow, Caroline E
Bryant, Eleanor
BMC Family Practice
Head injuries are a common occurrence, with continuing care in the years following injury being provided by primary care teams and a variety of speciality services. The literature on outcome currently reflects areas considered important by health-care professionals, though these may differ in some respects from the views of head injured individuals themselves. Our study aimed to identify aspects of outcome considered important by survivors of traumatic head injury.
Thirty-two individuals were interviewed, each of whom had suffered head injury between one and ten years previously from which they still had residual difficulties. Purposive sampling was used in order to ensure that views were represented from individuals of differing age, gender and level of disability. These interviews were fully transcribed and analysed qualitatively by a psychologist, a sociologist and a psychiatrist with regular meetings to discuss the coding.
Aspects of outcome mentioned by head injury survivors which have received less attention previously included: specific difficulties with group conversations; changes in physical appearance due to scarring or weight change; a sense of loss for the life and sense of self that they had before the injury; and negative reactions of others, often due to lack of understanding of the consequences of injury amongst both family and general public.
Some aspects of outcome viewed as important by survivors of head injury may be overlooked by health professionals. Consideration of these areas of outcome and the development of suitable interventions should help to improve functional outcome for patients.
Related Articles
Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention
Fritz, Julie M
Childs, John D
Flynn, Timothy W
BMC Family Practice
Patients with low back pain are frequently encountered in primary care. Although a specific diagnosis cannot be made for most patients, it is likely that sub-groups exist within the larger entity of nonspecific low back pain. One sub-group that has been identified is patients who respond rapidly to spinal manipulation. The purpose of this study was to examine the association between two factors (duration and distribution of symptoms) and prognosis following a spinal manipulation intervention.
Data were taken from two previously published studies. Patients with low back pain underwent a standardized examination, including assessment of duration of the current symptoms in days, and the distal-most distribution of symptoms. Based on prior research, patients with symptoms of <16 days duration and no symptoms distal to the knee were considered to have a good prognosis following manipulation. All patients underwent up to two sessions of spinal manipulation treatment and a range of motion exercise. Oswestry disability scores were recorded before and after treatment. If ≥ 50% improvement on the Oswestry was achieved, the intervention was considered a success. Sensitivity, specificity, and positive likelihood ratio were calculated for the association of the two criteria with the outcome of the treatment.
141 patients (49% female, mean age = 35.5 (± 11.1) years) participated. Mean pre- and post-treatment Oswestry scores were 41.9 (± 10.9) and 24.1 (± 14.2) respectively. Sixty-three subjects (45%) had successful treatment outcomes. The sensitivity of the two criteria was 0.56 (95% CI: 0.43, 0.67), specificity was 0.92 (95% CI: 0.84, 0.96), and the positive likelihood ratio was 7.2 (95% CI: 3.2, 16.1).
The results of this study demonstrate that two factors; symptom duration of less than 16 days, and no symptoms extending distal to the knee, were associated with a good outcome with spinal manipulation.
Related Articles
Correlation of same-visit HbA1c test with laboratory-based measurements: A MetroNet study
Schwartz, Kendra L
Monsur, Joseph C
Bartoces, Monina G
West, Patricia A
Neale, Anne Victoria
BMC Family Practice
Glycated hemoglobin (HbA1c) results vary by analytical method. Use of same-visit HbA1c testing methodology holds the promise of more efficient patient care, and improved diabetes management. Our objective was to test the feasibility of introducing a same-visit HbA1c methodology into busy family practice centers (FPC) and to calculate the correlation between the same-visit HbA1c test and the laboratory method that the clinical site was currently using for HbA1c testing.
Consecutive diabetic patients 18 years of age and older having blood samples drawn for routine laboratory analysis of HbA1c were asked to provide a capillary blood sample for same-visit testing with the BIO-RAD Micromat II. We compared the results of the same-visit test to three different laboratory methods (one FPC used two different laboratories).
147 paired samples were available for analysis (73 from one FPC; 74 from the other). The Pearson correlation of Micromat II and ion-exchange HPLC was 0.713 (p < 0.001). The Micromat II mean HbA1c was 6.91%, which was lower than the 7.23% from the ion-exchange HPLC analysis (p < 0.001). The correlation of Micromat II with boronate-affinity HPLC was 0.773 (p < 0.001); Micromat II mean HbA1c 6.44%, boronate-affinity HPLC mean 7.71% (p < 0.001). Correlation coefficient for Micromat II and immuno-turbidimetric analysis was 0.927 (p < 0.001); Micromat II mean HbA1c was 7.15% and mean HbA1c from the immuno-turbidimetric analysis was 7.99% (p = 0.002). Medical staff found the same-visit measurement difficult to perform due to the amount of dedicated time required for the test.
For each of the laboratory methods, the correlation coefficient was lower than the 0.96 reported by the manufacturer. This might be due to variability introduced by the multiple users of the Micromat II machine. The mean HbA1c results were also consistently lower than those obtained from laboratory analysis. Additionally, the amount of dedicated time required to perform the assay may limit its usefulness in a busy clinical practice. Before introducing a same-visit HbA1c methodology, clinicians should compare the rapid results to their current method of analysis.
Related Articles
Results 1-25 (52)
« Previous
Go to page number:
Next »
Remove citation from clipboard
Add citation to clipboard
This will clear all selections from your clipboard. Do you wish proceed?
Clipboard is full! Please remove an item and try again.
Contact Us
PubMed Central Canada is a service of the
Canadian Institutes of Health Research
(CIHR) working in partnership with the National Research Council's
national science library
in cooperation with the
National Center for Biotechnology Information
at the
U.S. National Library of Medicine
(NCBI/NLM). It includes content provided to the
PubMed Central International archive
by participating publishers.


text:
- MLB Tickets
- NBA Tickets
- NFL Tickets
- NHL Tickets
- Boxing Tickets
- Soccer Tickets
- Auto Racing Tickets
- WWE Tickets
- UFC Tickets
- more tickets...
- Alternative Tickets
- Bluegrass Tickets
- Children/Family Tickets
- Comedy Tickets
- Country / Folk Tickets
- Hard Rock / Metal Tickets
- Holiday Tickets
- Jazz / Blues Tickets
- Latin Tickets
- Other Tickets
- Pop / Rock Tickets
- Rap / Hip Hop Tickets
- Reggae / Reggaeton Tickets
- Techno / Electronic Tickets
- more tickets...
- Ballet Tickets
- Broadway Tickets
- Children / Family Tickets
- Cirque Du Soleil Tickets
- Las Vegas Tickets
- Musical / Play Tickets
- Off-broadway Tickets
- Opera Tickets
- more tickets...
The images appearing herein are for informational purposes only. OnlineSeats is not affiliated with Ticketmaster or any other ticketing company, any box office, venue, performing artist or sporting organization such as: NBA, NFL ,NHL, MLB, NCAA, NASCAR, USTA, PGA, LPGA, USGA, WNBA or any other sporting organizations. All logos and names of any of the aforementioned are used for purposes of factual description only. OnlineSeats is a nationwide events ticket-shopping directory and was purchased by Alliance Tickets in August of 2012. OnlineSeats is managed by Alliance Tickets and is an Alliance Tickets website.
Radio City Christmas Spectacular
Radio City Christmas Spectacular Tickets
The Radio City Christmas Spectacular is a lavish tradition set at the Radio City Music Hall in New York City. This Broadway revue attracts an audience from across the nation and even across international borders. Each year the show celebrates the holidays with a production revolving around Santa Claus and the world-famous Rockettes. Radio City tickets for this upcoming 2010 revue are available now to celebrate the upcoming season of good cheer with the Christmas Spectacular.
This is a show with long-established roots dating back to 1933 when radio was still king and movie houses were palaces. That first year, the Radio City Music Hall Christmas Show accompanied a movie, Flying Down to Rio. Leon Leonidoff and Vincente Minelli crafted a show with an overture conducted by Erno Rapee and the Radio City Symphony, a Mighty Wurlitzer Organ solo, a toy shop ballet, a Russell Martin-choreographed "Parade of the Wooden Soldiers" featuring the Rockettes, and "The Living Nativity." As the years have passed and the show expanded from a 30-minute companion piece to a feature film to a 90-minute feature, the Rockettes rendition of parading wooden soldiers and a live rendition of the nativity scene have become New York holiday traditions.
The Radio City Christmas Spectacular made that jump from a short program to a long program in 1979, after the Music Hall stopped showing feature films. With each passing year, the show is wise enough to update much of the program, keeping it fresh and contemporary. Eventually the Christmas Spectacular became so sensational, the revue left the Radio City Music Hall and embarked on a full-fledged national tour.
Radio City Christmas Spectacular 2013
This tour was an annual event from 1994 until 2003. Though the New York show would remain popular, the national tour lost steam and the tour ceased. The holiday spirit exhibited by Broadway could not be constrained for long. In 2008 the Radio City Christmas Spectacular once again took to the road, this time featuring the 2007 Broadway revue.
The current show includes a 3D movie to open the show in Broadway, Ring Out the Bells, Twelve Days of Christmas, the Nutcracker, the Parade of the Wooden Soldiers, New York at Christmas, Here Comes Santa Claus, Magic is There, Ragdolls, Let Christmas Shine, and the Living Nativity.
The Radio City Christmas Spectacular is scheduled to play in 25 cities across the United States, beginning in Madison, Wisconsin at the Coliseum at the Alliant Energy Center on November 10, 2010 and ending its trek in Austin on January 2, 2011 at the Bass Concert Hall at the University of Texas. The New York show at the Radio City Music Hall (1260 Avenue of the Americas, New York, NY 10020) begins on November 5, 2010 and runs through December 30, 2010.
OnlineSeats will have Radio City Christmas Spectacular tickets for the 2010 traveling holiday show and the production at the Radio City Music Hall. Look for wonderfully cheap seats close to the stage or more affordable seats in the back row and enjoy this Christmas extravaganza. See rock and roll Santa, high kicks, and much more.
Finding the right seats at the right price to the event you want can at times be overwhelming. Customers want to make sure that they're getting a good deal on the tickets they're purchasing. Here at Online Seats we do our very best to offer the best seats available at the most competetive price. We've been doing this for over 25 years now and we have helped thousands and thousands of customers get great seats at a great price. Sometimes we even help customers get not so great seats but at extremely cheap prices. Whatever it is you're looking for, you can be assured that we'll do our best to help you find the tickets you want. We have a staff of professionals that have been servicing the ticket needs of clients for many many years. If you don't find what you're looking for on our website, give us a call and one of our professional staff members will do whatever it takes to help you find what you're looking for. We wouldn't still be in business for over 25 years if not for the pride we take in providing quality and friendly customer service. OnlineSeats.com is your trusted and reliable ticket broker.


text:
Bucerias Art Walk: An amazing array of arts set out along a charming cobblestone street is what made the Bucerias Art Walk a triumph in its inaugural 2006-2007 year. This season the art walk in this Nayarit pueblo on the beach is back, with more artists, more events and more special plans designed to entice visitors to come enjoy the abundance of excellent talent and fine crafts.
Taking Hand to Brush: So, you're bending the elbow a bit, practicing the gentle art of Margaritaville on the beach when you decide to get more creative. Once it's time to dig your toes out of the sand, where can you find something for the soul? Surprisingly, many locals artists offer classes, for advanced students or even beginners.
Scallop Ceviche with "Red Sky" Sauce: Scallop Ceviche with "Red Sky" Sauce courtesy of Le Bistro.
Hot Spot: El Anclote: El Anclote means "the small anchor," and this special neighborhood at the entrance to Bahía de Banderas on the exclusive Punta de Mita peninsula does indeed fulfill its name, serving as the "town" and focal point for activities and dining outside the nearby fashionable hotels and estates.
Puerto Vallarta: A Real Estate Success Story: What we can establish as being "a success"? Well, in 2000 Puerto Vallarta had roughly $50 million in resort real estate sales ("resort real estate" is defined as real estate purchased primarily by retirees or second-home purchasers). There were rarely homes selling for more than $1 million and few large real estate developments.
A Treasure Trove of Experiences and Information: Vallarta Lifestyles Digital Edition: In the dictionary, the word "magazine" is defined as a noun, but the Vallarta Lifestyles Digital Edition is more than an online evolution of a paper publication - it's an experience! Whether you are a full or part-time resident in the Puerto Vallarta area, have visited us before and want to keep current on what's happening here or are planning an upcoming trip to our tropical paradise, this digital magazine is for you!
Artesanias: Situated in the prestigious El Tigre golf development in Paradise Village, Nuevo Vallarta, only 10 minutes from the airport, and 20 minutes from downtown Puerto Vallarta. El Tigre offers a professional golf course with a magnificent Mexican club house, a world-class spa with social and full sports facilities, and a private luxurious beach club.
Letting Someone Else Do the Chores: An Overview of Labor Laws for Domestic Employees in Mexico: Cooking without having to do the dishes or even not cooking at all! A beautiful garden without the weeding! The availability of reasonable domestic help makes all this possible for most North Americans living in Vallarta, but be aware that the casual arrangement you make with Maria to straighten up your condo three days a week is a binding legal contract.
360 Landmark: Marina Vallarta: Peaceful and pretty and a world apart from the hurly-burly of town, yet just 15 minutes away, this is the perfect place for those who dare to dream. Yachts glisten in the sun, coming and going on exciting adventures around Banderas Bay and the globe. (Quicktime Panoramic Image)
Doing Your Homework: If you are reading this, chances are that you have a vested interest in real estate in the Vallarta region. You are most likely a buyer or a seller (or both) or a professional involved in the industry, and you need sources of clear and current information about the state of the market.
Best Place to Retire?: During the past 15 years, International Living magazine has calculated its Annual Global Retirement Index; a resource intended to assist retirees and future retirees in evaluating and comparing the world's most popular retirement destinations. It is based on a number of criteria, giving various weights to each, depending on its importance to retirees.
360 Landmark: Yelapa's Main Dock: A popular day trip and an unforgettable rustic getaway, Yelapa has been attracting visitors for decades. When we recently asked Susan Pasko, chef/owner of Cafe Bahia on the pier, about the Yelapa experience, she eloquently described it as "camp for grown-ups," a place where returning visitors meet year after year. (Quicktime Panoramic Image)
360 Landmark: Cuale Pedestrian Bridge: The first in a new series of panoramic images produced around Puerto Vallarta by Paco Ojeda, this 360 displays the picturesque view from the Cuale's Pedestrian Bridge. (Quicktime Panoramic Image)
360 Landmark: Malecón Sand Sculptures: Aside from the magnificent sculptures that adorn our Malecon, one is endlessly surprised by the creativity of sand sculptors, who constantly reinvent the beachfront with unique figures. (Quicktime Panoramic Image)
360 Landmark: Guadalupe Church: Year after year, it welcomes thousands of Catholics, particularly during an involved 12-day festival known as the Feast of Guadalupe every December. (Quicktime Panoramic Image)
Photographer Spotlight: Jay Ailworth: From the time Jay Ailworth first saw the ocean at the age of five, he knew the sea would always be part of his life. The Coast Guard further convinced him. Later, while in the service in Viet Nam, Jay was convinced by some buddies to buy a bargain camera, and he discovered another essential element in his existence. (Slide Show)
El Tuito Sound Slide Show: This sound slide show complements our article on El Tuito, providing additional information on places to visit as well as more images. Check it out! (Sound Slide Show)
A Touch of Mexico: Is anything more captivating than a touch of Mexico in your home? We talked with three local Mexican designers, asking for ideas and input for providing that special Mexican touch. Whether you live here or want to pick up something for your home elsewhere, you'll appreciate the input they offered.
Dreaming Downtown into a New Existence: It takes a visionary to conceive a new reality for a space long taken for granted. We've all appreciated an evening or morning stroll on the Malecon, bumping into friends or acquaintances and exchanging a few pleasantries, if not salacious gossip.
Find It All Now!: Fashionable, stylish, chic, trendy, elegant, hip, smart and modish — not shoes or hairstyles, but everything required for your Vallarta home! From sofas to refrigerators, lighting to rugs, find it all — for indoors and out — just a short ride north of the airport in Las Juntas, along the highway to Tepic.


text:
Follow NMW
Donate to NMWPlease help NMW by donating to the project. Your donations will be used to pay for the website, online maps, mailing etc.
Tags2016 A DC Virding Blog art bait BAMONA Belize Books bug girl Collaborators data David Wagner Discover Life education Encyclopedia Of Life entomologist event events Evolution India Japan Jim Arnosky John Himmelman kids Lepidopterists' Soc light setup mothing MVL natural history New Jersey news NMW participants partner partners photography project noah SAB Science Advisory Board Seabrooke Leckie set-up silk moth Sponsors 2013 UV light Wild NJ Win a book
International Registration – 2014
3 Responses to International Registration – 2014
I'm not sure where these went. We registered out event but were unable to find it in a list.
Moth Night 23 July 2014 6-9:30 pm
Pequest Hatchery & Resource Center
605 Pequest Rd.
Oxford, NJ 07863
caterpillars to moths, egg collecting, bait & light stations,photography, and more!
Sponsored by Liberty Township Environmental Commission


text:
Open water wake in the sea ice.
One of the many forms of sea ice
Small pancake ice
Pancake ice adrift on the Ross Sea
Mount Melbourne near Terra Nova Bay Antarctica. 74 21 S Latitude 164 42 E Longitude.
Royal Society Mountain Range in the Transantarctic Mountains across from McMurdo Sound on Ross Island. 78 10 S Latitude 162 40 E Longitude.
Iceberg drifting in the Ross Sea
Icebergs grounded on Pennel Bank
Pancake ice adrift on the Ross Sea.
Sunset over the Ross Sea.
The NATHANIEL B. PALMER moving through pancake ice
Nighttime operation of collecting thin sea ice cores for analysis.
Lyttleton Harbor, New Zealand. Home port for the NATHANIEL B. PALMER
Hanging out on the bridge of the NATHANIEL B. PALMER
Entering Lyttleton Harbor, New Zealand. Home port for the NATHANIEL B. PALMER
Recovering a RDI upward-looking Acoustic Doppler Current Profiler near the Ross Ice Shelf
Ice on the super structure of the NATHANIEL B. PALMER
The wake of the NATHANIEL B. PALMER in thin sea ice
Thin rafted sea ice
Deploying the Conductivity/Temperture/Depth (CTD) and rosette water sampler through the baltic room door of the NATHANIEL B. PALMER
The Ross Ice Shelf at the Bay of Whales. This is the southern-most navigable point on the planet and the point where Amundsen started his successful trek to the South Pole. 78 30 S Latitude 164 20W Longitude.
Sea smoke forming towards open water from first year ice at the Bay of Whales.
A bright view from the bridge and of the NATHANIEL B. PALMER
Sea smoke over open water along the Ross Ice Shelf at the Bay of Whales. 78 30 S Latitude 164 20 W Longitude.
The NATHANIEL B. PALMER at port in Lyttleton Harbor, New Zealand.
Statue of Robert Falcon Scott along the Avon River in Christchurch, New Zealand.
The Wizard speaking in Cathedral Square in Christchurch New Zealand.
of the U.S. Department of Commerce, National Oceanic & Atmospheric
Adminstration (NOAA),
NOAA Central Library
NOAA Privacy Policy
| NOAA Disclaimer
Last Updated:
July 7, 2015