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a new moon rising.
Sunday, September 16, 2012
I have had a rough week actually, I remember the word "miserable" coming out of my mouth! But right now, I'm happy.
Today I did one hour with Floss. my personal trainer, it was absolutely the hardest yet - I have very little memory of what we did.. I remember losing the ability to see at one point lol, thats how hard we worked out, There was 100 club, boxing, running up and down stairs, speed walking.. skipping, pushups, tricep dips, wall sits.. KETTLEBALL!... it's all a blur..
You better believe I was hungry after. Kelvin and I (he did it with me) went out for lunch and I ordered a beef lasanga with chips and salad.. not usually the kind of thing I eat.. I'm not sure how much calories are in it, but I could see oil and cheese in it.. bleh.. Still I believe it was the best option I could have taken that was offered to me... It took me 40 mins to eat it!
by the time we finished eating, my body had completely seized up and we went to bed at 1pm on a sunday lol,, and slept for FOUR HOURS!!!
The tracker on here says I burnt 1015 calories.. erm.. yes I'd believe it!
The best thing is tho, I hardly complained at all... I LOVE IT!
I love working out, I miss it.. it's weird....
I never imagined those words to come out of my mouth when I first signed up for Spark haha.
Ok some new goals:
The Pegasus Fun Run- in 3 weeks on Oct 7th. I am doing the 10k, (WALK) but I will be power walking.
By tomorrow walking I am starting my training. 1 Hour walking x 5 a week 2 hours walking x 2 a week. Both using interval.
Another goal. The Coast to Coast 2014.
I don't actually know if this is physically, mentally or financially possible to do in 18 months... BUT.
I do know that if I set my mind and heart to something, I will do my best and most likely get it done. So.. while I am taking unsure steps presently....
I have found a training partner and we're meeting for coffee tomorrow :)
I will need something around 3000$, a new bike, a new kayak, a certificate in kayak and learn how to swim, and mountain running training.
Did I mention it's the hardest race in the entire country? And I've never done a race before! lol.
It's tag line is:
"Tasman Sea to the Pacific Ocean, 243kms across the Southern Alps"
I know it takes about 3 hours in the car.. so that's probably about 3 days on the body! lol... Over mountains.... :I
Okay well... I'm rather daunted.. but.. I met a guy who did it once, I asked him - was it hard?
"no.. it's a piece of piss"
oh come on really?
"yeah! i mean, if you do your training it's a piece of piss, don't do your training and you're gonna get into trouble"
Typical southern man.. says stuff without saying stuff lol!
My training partner's name is Saskia... I'm excited to meet her.. she also has a ban on running and can't for the next four months (just like me)
Sounds like she's super motivated tho. Will let you know more next entry!
Ok so in the mean time, I will enter every race I'm physically capable of doing.
I believe my body can do anything - it's my mind that's in need of... a shot of confidence.
First race in 3 weeks!! I have never walked ten k in my life......
I walked 5k when I joined Spark and my best time was 54 mins.. so er..
Hrm! Perhaps I'll go 10 tomorrow so I have a time to measure against. :)
I also am committing to the 90 day Jillian program, if i finish it, i will gift myself a medal :) And that brings me up to 1 hour and a half a day.. when I don't have other exercise classes, I will do this cute workout I found online:
and by cute - I mean the guy! hahaha.
Ok so that's my physical stuff sorted..
Eating.. yeh.. I don't think it's gone that well.. Consumed a fair amount of chocolate this week - and didnt' eat fully or at right times, skipped meals..
In my mind doing the 90 day body revolution program, is EASIER than eating properly for 90 days. Crazy a?
But tomorrow I'm going to write a beautiful meal plan and I've decided to cut one of my snacks out cos I don't really need it.. Might try and follow a bit of Jillians Meal Plan guide.. (that came with body revolution). and merge it with my own vegan creations =]
I found a show on you tube called "losing it with jillian" its WAY better than watching biggest loser imo..
One funny thing I noticed tho... they often have excess stuff in the house.... (as well as their excess weight)
I have that..
and excess debt
and excess low self esteem....
And then she'll get it all sorted for them by Wednesday? (the stuff I mean)lol.
Then... one of the girls lost.. 74 pounds in 2 months.. _on her own_ that just floored me!!!
What's the difference?
Not wanting to take part in life, living life in fear == vs, loving life and being involved in it and carving out your own path....
So what really truly, would ignite that fire in me?
What would make me say .. YES I am doing that race, and I will do everything in my power to get it done - Cos I am strong and I deserve it and I want it..
What would make me say.. YES I am a beautiful women, and I love myself and take care of my health and fitness..
What would make me say YES I am confident, energetic, vibrant and unafraid and deserving of love...
Hmm..Some sort of shift.... I guess?
Hmm.. I need to really aim for this.
But one thing I CAN say..
In January of this year, I committed to getting my finances in order. I put a LOT of effort into it, a full month of daily meetings and thinking and planning - I broke my spending habit, and I repayed so much debt.. I actually can't remember but I officially am out of interest free debt, and I have just my student loan and private debt to Kelvin left! =]
All of that - while not working so that's wonderful,
This led to a confidence. that I decided to invest into business studies which brought about success in my home business
Which then led to an investment into my health... and I am starting to get fitter and stronger, and I think that led into my confidence into working again
and eventually it will be love again :)
So yeah.. I seem to be going from one strength to another...
But if Jillian can get people to chuck their junk out by Wed.. I think I can do that by Christmas! that'd be wonderful!!!
I wanna put some time into that as well as fitness =)
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You can do anything you put your mind to!
1370 days ago
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That sounds extreme, but I have no doubt that you can do it.
Oh my goodness!
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The working paper series on international investment – including policies and trends and the broader implications of multinational enterprise – makes available selected studies by the OECD Investment Committee, OECD Investment Division staff, or by outside consultants working on OECD Investment Committee projects.
OECD Corporate Governance Working Papers provide analysis and information on national and international corporate governance issues and developments, including state ownership and privatisation policies.
OECD Corporate Governance Working Paper No.17. This report examines the influence of institutional shareholders and their activities towards good corporate governance, the historical changes to practices within shareholder meetings and the role that institutional shareholders have played in the improvement of corporate governance within Japanese listed companies.
This paper examines key developments in public and private corporate governance enforcement in the Middle East and North Africa region, highlighting the growing level of public enforcement as expertise within the securities regulators grows and providing policy recommendations on specific aspects of governance frameworks.
State-owned and other state-invested enterprises (SIEs) have become more prominent in the global economy over the last decade. This paper compares the difference between SIEs and non-SIEs in five sectors: air transportation, electricity, mining, oil & gas and telecommunication.
This paper examines shareholder claims for reflective loss under investment treaties in light of comparative analysis of advanced systems of corporate law; considers the impact of allowing shareholder claims for reflective loss on key characteristics of the business corporation; and explores possible responses by different categories of investors to the availability of shareholder claims for reflective loss under investment treaties.
Investment treaties are often thought to be silent on investors' responsibilities to host societies and on their contributions to sustainable development. This paper establishes a factual and statistical basis for understanding the relationship between investment treaty law and governments' ability to advance the sustainable development agenda and promote responsible business conduct.
This paper provides a framework for analysing ownership engagement by institutional investors. It argues that the general term "institutional investor" in itself doesn't say very much about the quality or degree of ownership engagement. It is therefore an evasive "shorthand" for policy discussions about ownership engagement.
This report evaluates the corporate governance practices of Colombian SOEs against the OECD Guidelines on Corporate Governance of State-Owned Enterprises. The assessment was prepared based on information provided by the Colombian authorities, an analysis of the available literature and interviews with authorities, consultants, academics, and company as well as stakeholder representatives.
English, PDF, 913kb
Many investor-state dispute settlement (ISDS) claims are by shareholders for so-called "reflective loss" incurred as a result of injury to "their" company. This paper (i) compares the wide acceptance of such claims in ISDS with their general prohibition in advanced systems of national corporate law; and (ii) analyses policy issues raised by such claims (e.g., risk of double recovery, high legal costs, injury to creditors, etc.).

subset: commoncrawl


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Welcome to the Human Resources Department at the College of Marin
For over 80 years, the College of Marin has served the needs of Marin County's diverse student population. The College has two campuses located in Kentfield and Novato, both with close proximity to San Francisco, the Pacific Ocean, and Sonoma/Napa. The Kentfield campus sits at the base of Mount Tamalpais and is undergoing a physical transformation with several new buildings and modernized learning environments. The Indian Valley Campus is located in the picturesque hills of Novato and also has two fully modernized or new facilities.
We welcome you to explore the employment opportunities at College of Marin. Our fine faculty, staff, and administrative professionals have a long history of supporting the educational goals of our students in transferring to baccalaureate institutions, training for a new career, learning basic skills, or enjoying the many benefits of lifelong learning.
The College provides its employees with competitive compensation packages, comprehensive benefit plans, and the opportunities for professional development.
The Human Resources Department is an excellent resource for employees and the public to obtain information and assistance with current employment opportunities, benefits, policies, procedures, and general inquiries.
We strive to consistently attract, retain, train, and develop, a skilled and diverse workforce in support of the mission of the Marin Community College District.
Thank you for your interest in joining the College of Marin.
Human Resources Web Site
If you have questions about the Human Resources web site, please contact 415.485.9340, or see Contact Information page.


text:
2012: Played in 35 games and started 24 times in the outfield or as the designated hitter ... Batted .269 for the season with a .337 on-base percentage ... Finished with 30 hits, 17 runs and six RBI ... Went 2-for-3 in season opener at Stetson (3/2) ... Entered as a pinch-hitter, going 1-for-1 with a RBI against North Dakota State (3/11) ... Nine-game hitting streak from March 21-April 2 ... Totaled five hits and three runs scored in the series against Lafayette (3/23-24) ... Singled, walked, stole a base, drove in a run and scored two runs in Penn's Liberty Bell Classic quarterfinal win over Villanova (3/27) ... Had two hits, a walk, two stolen bases and a run scored in a win over Yale (4/1) ... Produced a base hit and scored a run in each of Penn's two games at Dartmouth (4/7) ... Went 3-for-4 with two stolen bases and two runs in a win at Columbia (4/28).
2009: Played in 35 games while making 35 starts … Led all rookies with 32 runs scored … Went 3-for-6 with four runs scored in first career start against Georgetown (3/7) … Had six hits and five runs scored in four-game series at Mt. St. Mary's (3/21-22) … Drove in three runs while scoring two in win over Villanova (3/25) … Went on a six-game hitting streak from 3/25-3/31 … Had two hits in five of those six games … Ended season on a seven-game hitting streak (4/19-4/26) … Had 14 total multi-hit games for the season.
Personal: Son of Teresa and Christopher Mraz ... Enrolled in the College of Arts and Sciences as an economics major.


text:
Supergirl TV Series Statue
It's a bird, it's a plane, it's Superman? No, it's Supergirl! This Supergirl TV Series Statue features the likeness of actress Melissa Benoist and stands about 12 1/2-inches tall. Sculpted by Adam Ross, this is one statue no Supergirl fan will want to miss out on!
The Big Blue Report is the Superman Homepage Newsletter sent out twice a month. It contains exclusive content not seen on the website. Subscribe now!
Cover date: February 2009
"New Krypton" - Part 8: "Death in the House of El"
Writer: Sterling Gates
Penciller: Jamal Igle
Inker: Keith Champagne
Reviewed by: Jeffrey Bridges
Zor-El dies in Kara's arms in a scene that reminded me a lot of Superman dying in Lois's arms, and Brainiac's robots disappear from the city, with Superman surmising they were but a distraction to allow Metallo and Reactron to get close enough to attack Zor-El.
Cat and Lana clash over Cat's timing on her latest story, and a news report on the mysterious new Superwoman is on the television. Alura gives a speech about how great Zor was and how humans have treated Kryptonians with violence and thinks they should respond in kind.
Kal wants to know who was responsible for the deaths of the guards at Stryker's island, but Kara wants to wait as she needs to get her things from Metropolis as she's moving back to be with her mother, and then worries her actions got her father killed.
Alura shows up and blames humanity for the death of Zor, despite Superman's protests that Metallo and Reactron aren't representative of all of humanity, and Alura then chastises Kal and Kara for not doing a better job cleaning up earth before she arrived.
Angry, Supergirl leaves, and is found by Superwoman. They fly together and Superwoman tells Kara that her mother is wrong and she also can't control the people of Kandor. Nightwing and Flamebird lament having to use their identities to fight "the good guys", and notice Alura's security team have blueprints to the White House.
Alura goes to Zod's remaining troops and asks them to help her.
Superwoman makes Kara promise not to do anything rash, and says she'll reveal her identity when the time is right.
Story - 4: I'm finding it difficult to rate this issue, because it's part of the larger ongoing story in books that I'm not reviewing. Granted this was the case last month as well, but this issue was much more ensconced in the greater overall story than the previous.
So much so that to anyone not following the entire story and only reading the Supergirl comic, they'd probably be pretty lost and confused... but this is the price for ongoing stories with "triangle numbers" and so that's to be expected.
So how does one review what amounts to one chapter of a novel? You can't judge the story or the character development, because those play out over the course and not just in one installment.
And what we're then left with is a bunch of action, some emotional moments, and some mystery. But the key thing here is that they work in a logical sense. Everyone is in character, even Alura when she sort of turns to the dark side. She's grieving and she's angry and the story even points out (perhaps just a little too bluntly) that the combination of the two can make people do unfortunate things.
Kara is conflicted and worried, Kal is concerned and supportive, and Superwoman is... whoever Superwoman is (though I did appreciate tossing in a line as to Kara not being able to see through her mask, because I was immediately thinking to myself that every other Kryptonian would instantly know who she was).
So in short, this book had everything that you could honestly expect it to have as part of an ongoing crossover story. I can't know where that story is going or how it will play out, and what (if any) lasting ramifications on the characters will be had, and sometimes that's a lot clearer in ongoing arcs contained only to one book.
That said, I feel I can't give the book a 5 without being able to see more of the story as a whole, but there wasn't a single thing in this entire issue that threw me off, or took me out of the story, or made me stop and wonder what was going on or lament at terrible writing or characterization (or both).
As far as I'm concerned this is just about as good as you could hope for a chapter of a crossover like this to be, and I thoroughly enjoyed it.
I'm almost to the point where I'm ready to declare this book is finally actually on the right track for the long-term, and I'm excited for the future.
Art - 4: Loved it. Not the best I've ever seen, but it was excellent.
Cover Art - 4 (Superwoman): Kind of plain, and with annoying words, yet the execution of the image itself is so strong that I'm in love with it. The coloring is also exceptionally nice.
Cover Art - 3 (Angry Kara): Kind of generic, but what really loses points here for me is Kara's expression, which looks more joyous than sad or enraged or how she should be feeling to unleash that kind of blast (the interior of the book accomplished this much more effectively). Decent enough, but not wow-inducing.
January 2009
Check out the Comic Index Lists for the complete list of Superman-related comics published in 2009.


text:
Re: About War Driving ..
- From: Roman Shirokov <insecure@xxxxxxxxx>
- Date: Fri, 1 Dec 2006 15:18:32 +0000
You wrote 29 ноября 2006 г., 17:17:15:
Hi ,
I was wondering if it is possible to locate and catch
a guy who is connecting to our wep wireless network
and downloading stuff from torrents and using up our
bandwidth ..
I checked up with arp scan and found 2 unknown IPs
192.168.1.246 and 247
Is there anyway of locating the guy in a building of 7
floors and how to stop this ..I have tried changing
the Wep keys so . he is cracking the wep key.
Any Suggestion People ?
You may try authentication based on MAC-address of client machine.
Although attacker may be able to spoof MAC-address too. I think you
need a complex desicion, based on strong cryptography (WPA2),
mac-address filtering, proxy-server (where you autheticate users with
login and pass), etc..
Best regards,
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text:
Parisian Window Planter Lets and Raise and Lower Your Veggies for More Sun
Start Slideshow
- Volet Vegetal-Barreau&CharbonnetNo balcony space? No problem - you can still have a garden with this handy dandy window planter system. Designed by French design team Barreau&Charbonnet, "Volet Végétal" is an urban gardening device that lets you suspend planters in your window and raise and lower the system to get more sun. The sturdy frame holds three planter trays that pivot to remain upright regardless of whether the device is lowered or vertical.1
- Volet Vegetal-Barreau&Charbonnet"Volet Végétal" is a design for an urban planting system that allows apartment dwellers to grow veggies and herbs, even if they don't have much space.2
- Volet Vegetal-Barreau&CharbonnetThe system neatly fits within a window frame and holds three planter trays in a pivoting holder.3
- Volet Vegetal-Barreau&CharbonnetA simple set of tension bars, strings and pulleys allows the user to lower the frame from vertical to horizontal to gain more sun.4
- Volet Vegetal-Barreau&CharbonnetOr the system can remain locked in a vertical position during inclement weather.5
- Volet Vegetal-Barreau&CharbonnetBarreau&Charbonnet, which is run by Nicolas Barreau and Jules Charbonnet based in Paris and Nantes respectively, came up with the design as a way to find a connection between plants and people even within a dense urban city.6
- Volet Vegetal-Barreau&CharbonnetThey presented "Volet Végétal" this year at the Jardin des Tuileries as a finalist in the Jardins Jardin design contest.7
- Volet Vegetal-Barreau&CharbonnetThey hope that the final design can also be used indoors as a standing planter.8
- Volet Vegetal-Barreau&CharbonnetParts for the advanced version of Volet Vegetal.9
- Volet Vegetal-Barreau&CharbonnetAlthough the system isn't for sale now, the duo are refining the project and working on developing the project further for production.10


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Pharmacy Practice (Internet)
versión On-line ISSN 1886-3655
Pharmacy Practice (Internet) vol.10 no.1 ene./mar. 2012
Evaluation of an intensive insulin transition protocol in the intensive care unit setting: a before and after study
Evaluación de un protocolo de transición de insulina intensiva en una unidad de cuidados intensivos: estudio antes-después
Leigh Anne Jacobson1, Kathleen Jerguson2, LeeAnna Spiva3, Danielle Fraser4
1Pharm.D. Clinical Pharmacist. WellStar Kennestone Hospital. Marietta, GA (United States).
2Pharm.D. Clinical Pharmacist. WellStar Kennestone Hospital. Marietta, GA (United States).
3PhD, RN, PLNC. Director of Nursing Research and Professional Practice WellStar Health System. Marietta, GA (United States).
4MS, RN, GCNS-BC, Clinical Nurse Specialist. WellStar Kennestone Hospital. Marietta, GA (United States).
The benefits of controlling blood glucose levels in intensive care units (ICUs) are well documented.
Objective: This study determined the effectiveness and safety of a standardized transition order set for converting a continuous insulin infusion to a subcutaneous insulin regimen in non-cardiovascular surgery ICUs patient population.
Methods: A retrospective study was conducted. Patients presenting with diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome were excluded. One hundred patients were included prior to and 100 patients were included after initiating the transition order set. Blood glucose control was reviewed for up to 72 hours following the transition.
Results: A total of 115 patients were included in data analysis: 85 prior to and 30 after transition protocol. All patients transitioned using the protocol were transitioned to basal insulin, compared to only 40% of the prior to protocol group. Patients transitioned correctly per the transition order set, "per protocol," had 54% of blood sugars within the desired range, no increase in hypoglycemic events, and on average 5.56 hyperglycemic events (blood glucose >180 mg/dL) per person during the 72 hours compared to 6.68 and 9.00 for the prior to protocol group and the "off protocol" group (transitioned different than the protocol recommended), respectively (p= 0.05). There were significant differences in blood sugar control at 48 and 72 hours between the "per protocol" and "off protocol" groups (p= 0.01) and a 40% reduction in sliding scale or correctional insulin coverage.
Conclusion: The addition of basal insulin to transition regimens resulted in fewer hyperglycemic events with no increase in hypoglycemic events. Patients transitioned "per protocol" had better glucose control demonstrated by: less hyperglycemic events, lower mean blood glucose levels at 48 and 72 hours, and lower need for correctional insulin. These findings showed benefits of glycemic control in the ICU by following a standardized transition protocol.
Key words: Insulin. Blood Glucose. Intensive Care Units. Postoperative Care. United States.
Los beneficios de controlar la glucemia en las unidades de cuidados intensivos (UCI) están ben documentados.
Objetivo: Este estudio determinó la efectividad y seguridad de un orden de transición estandarizado para convertir un régimen de insulina de infusión continua a un régimen de insulina subcutánea en una población de pacientes de UCI de cirugía no vascular.
Métodos: Se realizó un estudio retrospectivo. Se excluyó a los pacientes que presentaban cetoacidosis diabética o síndrome hiperglucémico hiperosmolar. Se incluyo a 100 pacientes antes y después de iniciar el sistema de transición. Se revisó la glucemia hasta 72 horas después de la transición.
Resultados: Un total de 115 pacientes fueron incluidos para el análisis de datos: 85 antes y 35 después del protocolo de transición. Todos los pacientes que transitaron usando el protocolo pasaron a insulina basal, comparados con sólo el 40% del grupo de antes del protocolo. El 54% de los pacientes que transitaron correctamente con el protocolol, "por protocolo" tuvieron la glucemia en el rango deseado, sin aumento de eventos hipoglucémicos, y con un 5,56% de eventos hiperglucémicos (glucemia>180 mg/dL) durante las 72 horas de vigilancia, comparados con el 6,68% y 9,00% respectivamente para el grupo anterior al protocolo y el grupo "fuera de protocolo" (que transitó diferente a lo recomendado por el protocolo) (p=0,05). Hubo diferencia significativas en el control glucémico a las 48 y 72 horas entre los grupos "por protocolo" y "fuera de protocolo" (p=0,01) y un 40% de reducción en la escala descendente o cobertura de insulina de corrección.
Conclusión: La adición de insulina basal a los regímenes de transición provocó menores eventos hiperglicémicos sin aumento de eventos hipoglicémicos. Los pacientes que transitaron "por protocolo" tuvieron mejor control glucémico, demostrado por: menores eventos hiperglucémicos, menores niveles medios de glucemia a las 48 y 72 horas, y menor necesidad de corrección de insulina. Estos hallazgos demostraron los beneficios de un control glucémico en la UCI siguiendo un protocolo estandarizado de transición.
Palabras clave: Insulina. Glucemia. Unidades de Cuidados Intensivos. Cuidados Postoperatorios. Estados Unidos.
Hyperglycemia commonly occurs during hospitalization and is of particular concern in intensive care units (ICUs).1-8 Hyperglycemia can result from administration of medications such as glucocorticoids, parenteral feeding, or as a natural response to critical illness with increased release of stress hormones. Poor glycemic control increases the risk of infection, electrolyte abnormalities, and mortality.1-8 The importance of maintaining normoglycemia in the ICU setting has been emphasized over the past decade.1-8,10-15 Current literature supports maintaining blood glucose levels less than or equal to 180 mg/dL to adequately control blood sugar without increasing the risk of hypoglycemia.8,19 An insulin infusion provides reliable blood glucose control and is the preferred route of administration in the ICU setting.19
At the study site, a continuous insulin infusion is recommended for ICU patients with two consecutive blood glucose readings exceeding 180 mg/dL. In 2009 the study site began using GlucommanderTM devices, a computer-based algorithm that calculates insulin infusion rate adjustments based on patient specific blood glucose levels drawn by a nurse every one to two hours.18 Blood glucose levels are entered into the device, and the GlucommanderTM provides instructions on how to adjust the rate of the continuous insulin infusion. Although a physician order is required to initiate the protocol, all subsequent adjustments are nurse-driven.
The GlucommanderTM machines provide safe and effective control of blood glucose levels; however, use of a continuous insulin infusion to treat hyperglycemia is restricted to the ICUs. Patients must be transitioned off the insulin infusion prior to transfer to a medical-surgical unit. Current literature favors the inclusion of scheduled subcutaneous insulin with basal, nutritional, and correction components to provide pro-active blood glucose control rather than reactive, sliding scale insulin.7,16,19 However, there is still limited evidence as to how to best transition patients safely to a subcutaneous regimen.20 At the study site, patients were transitioned off the GlucommanderTM per the discretion of the rounding physician. The transition regimens were inconsistent and at times unsuccessful, resulting in re-initiation of the insulin infusion.
In 2010, a formal transition order-set was developed by the Diabetes Task Force Committee for use in non-cardiovascular surgery ICUs to aid in transitioning patients to a subcutaneous insulin regimen. This transition order set sought to standardize how patients are transitioned and aid physicians in selecting an insulin regimen. Based on their nutritional intake, a patient was transitioned onto one of two regimens. If requiring parenteral nutrition or continuous tube feeds, the patient transitioned to a twice daily injection of a long-acting insulin and correctional insulin. If tolerating an oral diet, the patient transitioned to a once daily injection of a long-acting insulin, scheduled prandial insulin, and correctional insulin. The amount of insulin was selected based on the insulin sensitivity factor calculated by the GlucommanderTM. Further investigation was warranted to evaluate the safety and efficacy of the new standardized transition order set with respect to blood glucose control after discontinuing the insulin infusion.
The study´s primary purpose was to determine the effectiveness of the new protocol with regards to blood glucose control up to 72 hours after discontinuation of the continuous insulin infusion (goal blood glucose <180 mg/dL). Secondary objectives included examining the frequency of hypoglycemic and hyperglycemic events in the sample. Hypoglycemia, per hospital protocol, was defined as blood glucose less than 70 mg/dL. Hyperglycemia was defined as blood glucose greater than 180 mg/dL. Patients transitioned using the new protocol had additional secondary objectives that included: the number of patients correctly transitioned per protocol and the amount of correctional insulin coverage needed.
A retrospective study was conducted in a 633 bed, community hospital located in Georgia. The setting included four non-cardiovascular surgery ICUs. With approximately 76 ICU beds, the patients reviewed included both medical and surgical ICU.
Inclusion criteria consisted of the following: patients on the GlucommanderTM more than 24 hours, patients with a stable insulin sensitivity factor for more than four hours, and patients transitioning off of the continuous insulin infusion. Exclusion criteria included: patients treated for diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, or patients not transitioned using the transition order-set.
Ethics approval was obtained from the Institutional Review Board for the Protection of Human Subjects. Patients were identified via a secure, online database. One hundred patients requiring a continuous insulin infusion during hospitalization from September 2009 to December 2009 served as the prior to protocol group. The time frame was chosen based on the most current practices.
Following full implementation of the formal transition order-set another 100 patients requiring a continuous insulin infusion during his or her hospitalization from October 2010 to March 2011 were included. If the formal transition order-set was used, the patient was included. Patients transitioned using the formal transition order-set were further separated into those patients transitioned as the protocol recommended, referred to as "per protocol," and those transitioned different than the protocol recommended, referred to as "off protocol."
Baseline demographic data were collected in addition to, information on comorbidities, transition regimen, concurrent steroid therapy, nutrition, and blood glucose values for 72 hours after transitioning. Data were collected using a standardized data collection form.
Data were analyzed with descriptive and inferential statistics using SPSS for Windows Release 18.0. Statistical methods included frequencies, percentages, means, standard deviations, Kruskal-Wallis test, and Mann-Whitney U test. A p value of 0.05 was considered statistically significant.
A retrospective chart review was conducted on 200 patients, of which 115 patients were eligible for inclusion. Eighty-five charts were included and reviewed before the formal transition order set was implemented and 30 charts were included and reviewed after the formal transition order set was implemented. The reasons for exclusion included patient expired prior to transitioning or the transition protocol was not used for the after protocol groups (Figure 1).
For the entire sample (N=115), there was an equal representation of females (56.5%) and males (43.5%). Patients ranged in age from 25 to 86 years with a mean age of 61.57 years (SD=12.73). The majority of patients had Type 2 diabetes (65.2%), only four patients had Type 1 diabetes (3.5%), and 36 patients did not have a pre-existing diagnosis of diabetes (31.3%). Mean Hemoglobin A1C (HgbA1C) was 8.11 (SD=2.54). Fifty patients (43.5%) were on concurrent steroid medications and the remaining 65 (56.5%) were not on steroids (Table 1). The most common comorbidities consisted of the following: hypertension n=80 (50.3%), coronary artery disease n=32 (20.1%), hyperlipidemia n=31 (19.5%), and cerebral vascular accident n=8 (5%) (Table 1).
Because of unequal variances, a Kruskal-Wallis nonparametric analysis of variance (ANOVA) was used to compare the prior to protocol, "per protocol," and "off protocol" treatment groups. Significant differences were found for all three groups for day two mean blood glucose levels chi-square (3,N=100)=6.13, p=0.05. Using the Holm´s sequential Bonferroni approach, follow-up tests were conducted to evaluate pair wise differences among the groups controlling for Type I error. The results indicated a significant difference between the prior to protocol group and "off protocol" group versus the "per protocol" group. The second day mean blood glucose levels were higher in the prior to protocol group (M=189.16 mg/dL, SD=53.56) and "off protocol" group (M=227.75 mg/dL, SD=61.22) than the "per protocol" group (mean=183.02 mg/dL, SD=54.89). Important to note, the mean blood glucose level for day three was also lower for the "per protocol" group (M=152.02 mg/dL, SD=46.39) compared to the prior to protocol group (M=183.86 mg/dL, SD=55.83) and "off protocol" group (M=213.51 mg/dL, SD=75.14). The total amount of correctional insulin for the 72 hours was lower for the "per protocol" group (M=10.2 units, SD=8.96) compared to the prior to protocol group (M=13.0 units, SD=10.77) and the "off protocol" group (M=16.8 units, SD=8.92). There was no significant increase in the rate of hypoglycemic events between the groups with 1%, 2%, and 4% of blood glucose levels considered hypoglycemic for prior to protocol, "per protocol," and "off protocol" groups, respectively (p=0.225). Of interest, compared to the other groups the "per protocol" group had no severe hypoglycemic events (BBG<50 mg/dL). (Table 2 and Figure 2).
In order to examine the optimal use of the transition order set a Mann-Whitney U test was conducted to evaluate the formal transition order set comparing the "per protocol" and "off protocol" groups. Significant differences were found between the two groups for the following variables: total number of hyperglycemic events within the 72 hour timeframe, mean blood glucose levels at 48 and 72 hours post transition, and the total amount of correctional insulin within the 72 hour timeframe. The "per protocol" group had a significantly lower number of hyperglycemic events within the 72 hour timeframe (M=5.56, SD=5.19), z=52.50, p=0.01, than the "off protocol" group (M=9, SD=3.21) (Figure 3). Between 24 and 48 hours after transitioning the "per protocol" group had significantly lower mean glucose levels (M=183.02 mg/dL, SD=54.89), z=58, p=0.04, than the "off protocol" group (M=227.75 mg/dL, SD=61.22) (Figure 4). Between 48 and 72 hours after transitioning the "per protocol" group had significantly lower mean glucose levels (M=152.02 mg/dL, SD=46.40), z=48.50, p=0.01, than "off protocol" group (M= 213.51 mg/dL, SD=75.14) (Figure 4). The "per protocol" group had significantly less requirement of correctional insulin within the 72 hours from the sliding scale coverage (M=10.2 units, SD=8.96), z=62.50, p=0.04, than the "off protocol" group (M=16.8 units, SD=8.92) (Figure 5). Hypoglycemia occurred in only 2% of the "per protocol" group compared to 4% of the "off protocol" group. (Table 2 and Figure 2).
Current medical practice recommends combined basal-prandial insulin as a therapeutic option for the management of hyperglycemia. In this study, insulin glargine was the long acting insulin subcutaneously administered to provide blood glucose control overnight and in between meals. The prandial component, insulin lispro, includes a shorter acting subcutaneous insulin administered prior to meals. This method best simulates normal pancreatic insulin secretion.17
Critically ill patients are predisposed to hyperglycemia and have been proven to benefit from basal-prandial insulin regimens. Over the last decade, specific blood sugar goals for this patient population have varied. The NICE-SUGAR Investigators raised the blood glucose threshold to maintain blood sugar control via insulin infusions between 110 and 180 mg/dL to optimize outcomes and minimize hypoglycemia.8 While on the continuous insulin infusion and during transition, target blood glucoses were consistent with current recommendations. Regimens were encouraged to be adjusted to address blood glucoses outside of target range at any point, both hypoglycemia and hyperglycemia. This continues to be an area for improvement as regimens on average were not changed until 33 or 45 hours, "per" and "off" protocol respectively. The protocol regimen is meant for initial transitioning and is intended to be adjusted based on blood glucose levels. Insulin regimens should be increased to address continued uncontrolled blood glucose levels or decreased to accommodate return to normal insulin response as clinical status improves. Additional observation of clinical practice is needed to assess response to normalized blood sugars and prevention of hypoglycemia.
This study showed that following a standardized intensive insulin transition protocol significantly improved glycemic control. All patients transitioned using the protocol were transitioned to basal insulin providing a more proactive approach to blood sugar control. Despite the inherent increased risk of hypoglycemia using basal insulin, there was no significant increase in the number of hypoglycemic events in patients transitioned correctly per the transition protocol. In comparison to the control group prior to the transition protocol, patients transitioned "per protocol" required less correctional insulin administration and had fewer hyperglycemic events.
Additionally, patients transitioned "per protocol" had significantly better blood sugar control than patients transitioned "off protocol." All groups had poor blood sugar control during the first 24 hours but at 48 hours the "per protocol" group had significantly better blood glucose control. Blood glucose control improved further at 72 hours. The "per protocol" group also required less correctional insulin via sliding scale insulin and had fewer hyperglycemic events.
While the continuous insulin infusion provides ideal blood sugar control, it is not practical to have in non-ICU settings secondary to the high risk and acuity of the drug. Similar to the recommendations of The Northwestern Experience by DeSantis, the formal transition order-set was developed with the intention to better standardize the approach to discontinuing a continuous insulin infusion.6 It removes the guesswork from selecting a transition regimen in patients without a history of diabetes or patients with diabetes requiring increased coverage of elevated blood sugars.
Unlike DeSantis´s protocol patients in which patients were transitioned off of the continuous insulin infusion once tolerating an oral diet, this study considered patients eligible for transition independent of their critical illness and nutrition status. In the DeSantis study, 80% of the average total amount of daily insulin given via continuous infusion was selected as the initial amount of subcutaneous insulin to administer. The current study used the insulin sensitivity factor to select a transition regimen eliminating potential mathematical and documentation errors. One value was required to determine the insulin transition regimen and resulted in a simpler and safer process for physicians.
Similar to The Northwestern Experience, the most common error observed in this study was the under dosing of insulin. Patients in this study correctly transitioned according to the transition protocol had 54% of blood sugars within goal range (target 70 mg/dL > BBG < 180 mg/dL) as compared to 58.3% of DeSantis´ (target 80 mg/dL > BBG < 180 mg/dL). As a result of this study, hopefully there will be an increase in compliance with the transition regimen selected.
Overall the study´s glycemic control goals were consistent with current recommendations from the American Association of Clinical Endocrinologists and NICE-SUGAR Trial with a target glucose level less than 180 mg/dL.8,14 Contrary to the current study, comparative studies used 40 or 50 mg/dL as the cutoff for hypoglycemia or severe hypoglycemia.1,7-8,12-13 Per the study hospital´s definition (blood glucose <70 mg/dL) the "per protocol" group had two percent of blood sugars that were considered hypoglycemic; however, using comparative literature´s standard there were no blood sugars less than 50 mg/dL.
Despite being available to intensivists there was an overall lack of utilization of the protocol. This was secondary to concerns for increased development of hypoglycemia in patients previously not requiring insulin therapy. Additionally, patients were transitioned with lower amounts of basal insulin than the protocol recommended. However, study findings support the use of the recommended amount of basal insulin with no significant increased risk of hypoglycemia. Patients transitioned with lower amounts of basal insulin required increased correctional insulin for hyperglycemia. This likely contributed to the observed increased incidence of hypoglycemia in patients transitioned "off protocol."
Limitations of this study included a retrospective design and an overall lack of use of the transition order set resulting in a limited sample size. Further studies should be conducted with a larger sample. Additional studies should correlate blood sugar control with the history of diabetes or hemoglobin A1C at baseline.
Implementation of a formal transition order set significantly improved glycemic control in patients transitioned off of a continuous insulin infusion without adverse outcomes. Maintaining normoglycemia has demonstrated improvement in patient outcomes by decreasing infection rate and mortality. Additionally, by acutely controlling hyperglycemia long-term organ damage, a known consequence of poor glucose control, can hopefully be minimized. The findings of this study provide evidence of the effectiveness of an intensive insulin transition protocol in the ICU setting.
Conflict of interest
No conflicts of interest to disclose.
No funding was received for research.
1. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive Insulin Therapy in Critically Ill Patients. N Engl J Med. 2001;345(19):1359-1367. [ Links ]
2. van den Berghe G. How does blood glucose control with insulin save lives in the intensive care. J Clin Invest. 2004;114(9):1187-1195. [ Links ]
3. van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, van Wijngaerden E, Bobbaers H, Bouillon R. Intensive Insulin Therapy in the Medical ICU. N Engl J Med. 2006;354(5):449-461. [ Links ]
4. McCowen KC, Malhotra A, Bistrian BR. Stress-Induced Hyperglycemia. Crit Care Clin. 2001;17(1):107-124. [ Links ]
5. Pittas AG, Siegel, Lau J. Insulin Therapy for Critically Ill Hospitalized Patients. Arch Intern Med. 2004;164(18):2005-2011. [ Links ]
6. DeSantis AJ, Schmeltz LR, Schmidt K, O'Shea-Mahler E, Rhee C, Wells A, Brandt S, Peterson S, Molitch ME. Inpatient Management of Hyperglycemia: The Northwestern Experience. Endocr Pract. 2006;12(5):491-505. [ Links ]
7. Shogbon AO, Levy S. Intensive glucose control in the management of diabetes mellitus and inpatient hyperglycemia. Am J Health Syst Pharm. 2010;67(10):798-805. [ Links ]
8. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hébert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ. Intensive versus Conventional Glucose Control in Critically Ill Patients. N Engl J Med. 2009;360(13):1283-1297. [ Links ]
9. Furnary AP, Braithwaite SS. Effects of Outcome on In-Hospital Transition from Intravenous Insulin Infusion to Subcutaneous Therapy. Am J Cardiol. 2006;98(4):557-564. [ Links ]
10. Weant KA, Ladha A. Conversion from Continuous Insulin Infusions to Subcutaneous Insulin in Critically Ill Patients. Ann Pharmacother. 2009;43(4):629-634. [ Links ]
11. Rady MY, Johnson DJ, Patel BM, Larson JS, Helmers RA. Influence of Individual Characteristics on Outcome of Glycemic Control in Intensive Care Unit Patients With or Without Diabetes Mellitus. Mayo Clin Proc. 2005;80(12):1558-1567. [ Links ]
12. Schmeltz LR, DeSantis AJ, Schmidt K, O'Shea-Mahler E, Rhee C, Brandt S, Peterson S, Molitch ME. Conversion of Intravenous Insulin Infusions to Subcutaneously Administered Insulin Glargine in Patients with Hyperglycemia. Endocr Pract. 2006;12(6):641-650. [ Links ]
13. Olansky L, Sharon S, Lover C, Yared JP, Hoogwerf B. Cleveland Clinic Cardiovascular Intensive Care Unit Insulin Conversion Protocol. J Diabetes Sci Technol. 2009;3(3):478-486. [ Links ]
14. Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, Inzucchi SE, Ismail-Beigi F, Kirkman MS, Umpierrez GE; American Association of Clinical Endocrinologists; American Diabetes Association. American Association of Clinical Endocrinologist and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15(4):353-369. [ Links ]
15. Kavanagh BP, McCowen KC. Glycemic Control in the ICU. N Engl J Med. 2010;363(26):2540-2546. [ Links ]
16. ACE/ADA Task Force on Inpatient Diabetes. American College of Endocrinology and American Diabetes Association consensus statement on inpatient diabetes and glycemic control: a call to action. Diabetes Care. 2006;29(8):1955-1962. [ Links ]
17. Edelman S, Dailey G, Flood T, Kuritizky L, Renda S. A practical approach for implementation of a basal-prandial insulin therapy regimen in patients with type 2 diabetes. Osteopath Med Prim Care. 2007;1:9. [ Links ]
18. Davidson PC, Steed RD, Bode BW. Glucommander: A computer-directed intravenous insulin system shown to be safe, simple, and effective in 120,618 h of operation. Diabetes Care. 2005;28(10):2418-2423. [ Links ]
19. American Diabetes Association. Standards of medical care in diabetes-2011. Diabetes Care. 2011;34(Suppl 1):S11-S61. [ Links ]
20. Schmeltz LR, DeSantis AJ, Schmidt K, O'Shea-Mahler E, Rhee C, Brandt S, Peterson S, Molitch ME. Conversion of intravenous insulin infusions to subcutaneously administered insulin glargine in patients with hyperglycemia. Endocr Pract. 2006;12(6):641-650. [ Links ]
Received (first version): 15.09.11
Accepted: 17.01.12


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This morning, The Leonardo museum brought in their latest attraction—thousands of years in the making.
Preserved mummies for the Mummies of the World exhibition arrived today in full entourage. It resembled a presidential following complete with Utah Highway Patrol escort and black SUVs full of VIPs and security personnel dressed in black garb and sunglasses. The chosen vehicle for the mummies themselves was a full-size, climate-controlled silver semi-trailer. The spectacle was fitting for the mystery, legend and celebrity status garnered by this exhibition over the last few years.
The star power lies in the unique journey it took for Mummies of the World to get to the Leonardo, a rags to riches or basement to penthouse story if you will. It started out as an obscure 20 specimen re-discovery in the basements of the Reiss-Engelhorn Museums in Germany. It became a world wide attraction by utilizing modern technology and cutting-edge scientific methods that provide very detailed information about who and what these specimens really were. So the story doesn't just begin today or 10 years ago; the many miles these mummies traveled predates the 21st century by hundreds and thousands of years.
A true mix of the new and old makes this exhibition a living and breathing testament of humanity's history.
Executive Director of The Leonardo Alexandra Hesse signs the loan agreement next to Marc Corwin, president American Exhibitions, Inc.
The exhibition was outlined at a short press conference in the museum lobby, where Executive Director at The Leonardo Alexandra Hesse, signed the loan agreement for the collection. She said the exhibition was important because the tools of science and technology can now "unlock the stories about people of the past."
The public must wait until Feb. 16 to see the stars of the exhibit in full display. The mummies arrived in specially-designed crates that control the mummies' environment. Careful packaging incorporated modern mummification materials such as foam and acid free, waterproof and tear-proof paper that cocooned each of the specimens inside. Continued preservation is necessary in order for them to remain intact. After all, natural or intentional preservation methods preserved them for hundreds and thousands of years. What's just a few days more?
The mystery didn't lessen the star appeal at all. Even though there wasn't a red carpet, photographers clicked away and a small crowd watched as crates were wheeled into a secret entrance.
The mummies were carefully unloaded in crates by a large staff.
Mummy crates were wheeled into a side entrance at The Leonardo.
The public, yet private, arrival of this exhibition reflects the choice of Salt Lake City as the next host.
After starting out in bigger cities, the focus shifted to smaller markets where the exhibition could be the main focus in the community. Marc Corwin, president of American Exhibitions, Inc., said Salt Lake was among the cities chosen for this exhibition because "the people of Salt Lake embrace this museum." He also lauded The Leonardo's efforts to incorporate innovative thinking, knowledge, education and science into its exhibitions.
As a young museum, the dedication The Leonardo has shown in bringing these important exhibits to Salt Lake in its infancy is sure to continue during its maturity in years to come.
"Mummies of the World" runs Feb. 16–May 27, 2013 at the Leonardo Museum in downtown, Salt Lake City.


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TC TO JOHN A. CARLYLE ; 1 October 1847; DOI: 10.1215/lt-18471001-TC-JAC-01; CL 22: 101-102
Gill, 1 octr, 1847—
My dear Brother,
Here is a Letter from Alick, enclosing one addressed specially to yourself by little Tom: it came yesterday, and we send it off to you, not yet including Jean at Dumfries among the readers of it, who is said to be somewhat dilatory occasionally in doing her part in such cases; you can forward it to her at your leisure. Mother and I came whirling over hither thro' the brisk autumn wind; I write this little Note, and will try to get the whole stuck into the Post-Office at Ecclefechan as we return.
Nothing new has occurred here since I suppose you have heard almost daily thro' Jane what nothings I reported. Our Mother is really tolerably well; complaining of heat today as we came along, tho' the wind is high and really cold for the season: she occasionally takes frail fits, but not often, and has had none of a bad sort since my arrival in these parts.— Poor Mary here is complaining a little; we had heard the other day that she was "rather ill," worth reporting as "ill," and even in bed for one day; but today we find her astir again, and not worse than when I was last here,—which indeed is no great height of health; for she looks worn, weary, and decidedly in a feeble kind of state. So far as my non-medical character can entitle me to inquire, I find she has a constant complaint of laxity in the bowels, these many weeks past; in fact all the symptoms she used to correspond with you upon,—excepting, which I suppose is an important exception, that there is nothing "ulcerous" without or within, only tendencies that way. I conjecture that some medicine, especially some directions as to diet, might do her good: pray send such, immediately if you can.— The rest are very well here; have a superior crop, potatoes and all, and seem doing well. Jamie knows nothing of the address alluded to in Alick's Letter; but Peter of Carstammon probably does;1 to whom application shall be made.
You have had a rather bad bout, poor Jane and you, I find! Today she is come back into your neighbourhood, as I like to fancy, and I hope will get herself taken care of again. At Addiscombe, I seemed to trace in her Letter, she had been somewhat thrown off the rails in that respect. She speaks with warm gratitude of your attention to her, and felicitous treatment of her; for which, as I need not state, I also feel deeply indebted. This is the first real Doctor-praise you ever got from her: from which am I to infer that you found her worse than you had ever chanced to do before, and so first took a real hold of her? I fear sometimes she has been worse than has yet been intimated to me! I beg you very especially to keep watch over her, and be of all the help to her you can, till my return; which I think now will not be delayed much.
In Annandale your fame as a Doctor has a decidedly high footing, as I everywhere get to understand. Poor old Graham says, with enthusiasm, "Hi might have the whoal practice of Annandale," and then in a tone rising ever higher, "the whoal of it! All!" Oh whow!— But really this point ought


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Edition: 8th
Author(s): Kerin, Roger A.; Berkowitz, Eric N.; Hartley, Steven W.
ISBN: 9780072828801 / Hardcover / 10/1/2005
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Down syndrome is a genetic condition where the existence of some or all of an extra 21st chromosome results in 47 total chromosomes compared to the typical 46. Also referred to as Trisomy 21, this condition results in a wide range of physical and mental distinctions, which can directly effect the development of the brain and body. Besides certain differences in physical attributes, individuals with Down syndrome may also be susceptible to complications such as heart issues, ear/eye problems, gastrointestinal blockage, and Endocarditis. Though there are variations of Down syndrome referred to as Mosaicism and Translocation, Trisomy 21 is the most common form, accounting for approximately 95% of reported cases.
What they don't tell you...
Your child will be capable of great things.
Chances are, your child will:
- Smile and laugh
- Play sports with friends
- Be naughty and mischievous
- Relish family occasions
- Make you proud
Indeed, raising a child with Down syndrome usually does involve some further responsibility. But after you learn more, you'll discover that there are amazing supports and resources to help your child thrive and grow. Love, patience, and determination are some of the qualities that nurture all children; this is no different for a child with Down syndrome. Emotions will likely run the gamut during this decision making process; dig deep; find the inspiration you need to say "I can do this." Your child will be capable of more than you can dream, so we urge you to not be distracted by one-sided negative impressions that are loosely grounded in old stereotypes. Open your heart to a bright and positive future filled with promise.
Welcome To Holland: By Emily Perl Kingsley
I am often asked to describe the experience of raising a child with a disability - to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It's like this......
When you're going to have a baby, it's like planning a fabulous vacation trip - to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It's all very exciting.
After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, "Welcome to Holland."
"Holland?!?" you say. "What do you mean Holland?? I signed up for Italy! I'm supposed to be in Italy. All my life I've dreamed of going to Italy."
But there's been a change in the flight plan. They've landed in Holland and there you must stay.
The important thing is that they haven't taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It's just a different place.
So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met.
It's just a different place. It's slower-paced than Italy, less flashy than Italy. But after you've been there for a while and you catch your breath, you look around.... and you begin to notice that Holland has windmills....and Holland has tulips. Holland even has Rembrandts.
But everyone you know is busy coming and going from Italy... and they're all bragging about what a wonderful time they had there. And for the rest of your life, you will say "Yes, that's where I was supposed to go. That's what I had planned."
And the pain of that will never, ever, ever, ever go away... because the loss of that dream is a very very significant loss.
But... if you spend your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland.
Copyright 2016 Knowmefirst.com


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Why? Because you can! And pickle, and jam, or otherwise celebrate the resurgence of the domestic arts our forebears held so dear. Put on your best apron and step into our kitchen, won't you?
Super easy sugar free sweet and sour apricots, a blast of sunshine at any time of year!
over a period of 9 days organic apricots preserved by the glace method
Cranberry & Apricot Relish is perfect for all turkey and ham occasions, be that Thanksgiving, Christmas, leftovers or picnics, go on think outside the holidays!
A sweet and spicy cranberry chutney with a touch of novelty from diced apricots. Perfect for any meal and of course your thanksgiving table.
Apricot Jam - perfect on its own, or as a glaze for fruit tarts and other desserts throughout the winter and the holiday season.
Honey, apricots, and vanilla bean slow roasted in the oven yield a delicious apricot butter, even with late-season fruit.
Apricot jam with a sneaky twist-- not too spicy, just zingy enough to be interesting.
This is a jam that has put together two wonderful sweet taste into one. The apricot and the raspberry compliment one another wonderfully. Plus, a recipe for straight up raspberry jam.
A luscious, velvety apricot jam infused with vanilla bean and spiced rum. It tastes like sunshine in the Indies.
Summer is the time for all things Apricot. This wonderful jam is full of flavor and like all the jam's I make we use everything for our jam. Rich and delicious.


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S hōnarchy! Thirteen of Elex's 19 manga and manhwa this 10 September are targeted at boys, boys, boys! No pejorative meant though—not when the second volume of C.M.B. and Rocket Man volume 4, shōnen titles I fangirl, swagger (stagger?) into next week's list.
And much as I rave over Katou Motohiro-sensei squirreling in C.M.B. and RM, Katou-sensei's not the only Kodansha manga-ka with two titles on offer. Maekawa Takeshi-sensei likewise flogs two: Kungfu Boy Legends 3 and the premiere of Roulette Battler, which is a month late like the manga-ization of L. Frank Baum's The Wizard of Oz (illustrated by Igarashi Yumiko-sensei) and Souryuuden, retitled for Indonesia as Dragon Brothers.
The one new manga (of four) that follows schedule is the shōjo Pink Innocent by Momoyuki Kotori-sensei, creator of How to Make a Prince.
Elex Media manga and manhwa (2008.09.10)
Release links are hide/unhide. Click for more details and cover scans.
- C.M.B. (C.M.B. Shinra Hakubutsukan no Jiken Mokuroku) 2 of 8+ by Katou Motohiro
- Cantarella 10 of 10+ by Higuri Yuu
- Detektif Conan Seri TV Animasi (Meitantei Conan) 15 by Aoyama Gosho
- Dewi Karin Chu (Kamichama Karin Chu) 3 of 7 by Koge-Donbo
- [Premiere] Dragon Brothers (Souryuuden) 1 of 5 by Tanaka Yoshiki, Megumi Koji
- Eat-Man 3 of 19 by Yoshitomi Akihito
- Eyeshield 21 16 of 31+ by Inagaki Riichiro, Murata Yusuke
- Kungfu Boy Legends (Tekken Chinmi Legends) 3 of 5+ by Maekawa Takeshi
- Legend of the Cursed Sword (Pageomgi) 21 of 35+ by Park HuiJin, Yeo BeopRyong
- MÄR Omega 2 of 4 by Anzai Nobuyuki, Hoshino Koichiro
- Mr. Fullswing 15 of 24 by Suzuki Shinya
- [Premiere] Pink Innocent 1 of 3 by Momoyuki Kotori
- Rocket Man 4 of 10 by Katou Motohiro
- [Premiere] Roulette Battler 1 of 4 by Maekawa Takeshi
- Sersan Keroro (Keroro Gunsou) 11 of 17+ by Yoshizaki Mine
- A Story of Heroes 18 by Choi Mir
- Tail of the Moon (Tsuki no Shippo) 7 of 15 by Ueda Rinko
- Trinity Blood 10 of 10+ by Kyujyo Kiyo, Sunao Yoshida
- [New] The Wizard of Oz by L. Frank Baum, Igarashi Yumiko (The Kumon Manga Library)
C.M.B. Shinra Hakubutsukan no Jiken Mokuroku
Cantarella 「 カンタレラ 」 by Higuri Yuu
Kamichama Karin Chu 「 かみちゃまかりんchu 」 by Koge-Donbo
Souryuuden 「 創竜伝 」
Eat-Man 「 EAT-MAN 」 by Yoshitomi Akihito
Eyeshield 21 「 アイシールド21 」
Tekken Chinmi Legends
Pageomgi 「 파검기 」
MÄR Omega 「 MARΩ 」
Mr. FULLSWING 「 Mr.FULLSWING 」
Pink Innocent 「 ピンク・イノセント 」
Rocket Man 「 ロケットマン 」 by Katou Motohiro
Roulette Battler 「 剣豪伝ルーレットバトラー 」
Keroro Gunsou 「 ケロロ軍曹 」 by Yoshizaki Mine
Tsuki no Shippo 「 月のしっぽ 」 by Ueda Rinko
Trinity Blood 「 トリニティ・ブラッド 」
N.B. The Wizard of Oz manga retails for IDR 12,500.
mangazines (2008.09.09)
Shonen Magz 50/2008 (Kodansha's Weekly Shounen Magazine in Indonesian)
Currently in serialization:
- BECK by Harold Sakuichi
- Fairy Tail by Mashima Hiro
- Kagetora by Segami Akira
- Kindaichi Case Files by Amagi Seimaru, Sato Fumiya
- Kungfu Boy Legends by Maekawa Takeshi
- Sanzoku Ou by Sawada Hirofumi
- Tokkyu!! by Komori Yoichi
- Toto! by Osada Yu-Ko
- Tsubasa Reservoir Chronicle by CLAMP
- Vinland Saga by Yukimura Makoto
Source: Elex Media STO 10 September 2008
By popularity
I already hinted as to which titles have queues long enough to spiral like unbroken apple peels, but to reiterate (and complete), they are:
Eyeshield 21 volume 16
MÄR Omega 2 (b'cause, y'know, the prequel's Indonesian run ain't done yet)
Kungfu Boy Legends 3 (which also appears in its serial form in ShoMagz 50)
Mr. Fullswing 15
Sersan Keroro 11
Tail of the Moon 7
Trinity Blood 10
Eat-Man 3
Rocket Man 4
The hopefully not nominal shōjo Tsuki no Shippo 7 also runs away with the coveted fastest turnover honor. The preceding volume came out the first week of September. By contrast, the most Patience-stretching award goes to Keroro Gunsou 11 (last released one year ago—12 September 2007).
By original publisher
As indicated by the presence of the Indonesian version of Weekly (or Monthly) Shounen Magazine, this roster is heavy on Kodansha which has seven titles up for grabs. Not including the monthly anthology, these manga were/are serialized in Gekkan Shounen Magazine (3); Nakayoshi (2); Weekly Shounen Magazine (1); and BonBon (1).
The next most "prolific" is Shueisha, with its three Shonen Jump- and Margaret-serialized manga.
Level Comics 9 September 2008 manga
~niki DBA huamulan03 (花木蘭03) who observes that two titles—Cantarella and Trinity Blood—release their respective on-hiatus-after-this volume 10's this 10 September—and you know what that means.
Technorati tags
manga, manhwa, boys' love, shoujo, shounen, sonyun, Elex Media, Shonen Magz, C.M.B., Cantarella, Chronicles of the Cursed Sword, Eat-Man, Eyeshield 21, Kamichama Karin Chu, Keroro Gunsou, Kungfu Boy Legends, Legend of the Cursed Sword, MAR Omega, Meitantei Conan, Mr. Fullswing, Pageomgi, Pink Innocent, Rocket Man, Roulette Battler, Souryuuden, Tail of the Moon, Tekken Chinmi Legends, Trinity Blood, Katou Motohiro, Maekawa Takeshi


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FORT LAUDERDALE, Fla.—Cindy Starfall is flying into Fort Lauderdale for a whirlwind appearance at the Exxxotica expo. From May 2 through May 4, fans will be able to meet the popular performer at the Star.xxx booth, where she will be posing for pictures and signing autographs. This is the first time Cindy will be appearing at Exxxotica Fort Lauderdale.
"I'm very excited about this weekend," she said. "I love the Exxxotica shows because it is one big party. Most importantly, I'll get to meet some of my East Coast fans. I'm so looking forward to it. The Star.xxx booth is going to be non-stop naughty fun."
While at Exxxotica, Cindy will have available her latest hardcore adult DVDs, super sexy and personally signed 8x10s and her recently released T-Shirt line. Fans unable to make the event can purchase some of Cindy's goodies from her official online store.
On the Saturday of the expo, Cindy will be joining award winning adult actress Tanya Tate as one of her "cougar cubs" for the Tanya Tate Great Cougar Hunt seminar. There, Cindy and Tanya will present tips on landing "Cougars." The Tanya Tate Great Cougar Hunt seminar takes place Saturday at 5pm.
The Exxxotica expo takes place at the Broward County Convention Center located at 1950 Eisenhower Blvd in Ft. Lauderdale. Ticket and other show information can be found on the event website.
For more information on Cindy Starfall, visit here, here, Twitter and Facebook.
Cindy Starfall is represented by OC Modeling. Contact email@example.com at
(818) 626-9550 or email@example.com at (818) 298-6939.


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Chicory, (Cichorium intybus) grows just about everywhere in the US but it's not a native plant. Like the dandelion it was brought over here by European settlers. Its origins are from central Europe. In its first year it forms a rosette of leaves and a long straight tan taproot like a carrot. The leaves are similar to dandelion leaves. In the second and subsequent years it will put up long stems of blue flowers in late summer unless it is kept mowed or grazed. Leaves and stems may leak a milky sap when broken. Chicory reproduces from seed.
Chicory flowers are blue and daisy like although the plant is rather straggly and not much to look at in the garden setting, the flowers can look quite pretty along the roads and meadows mixed with white Queen Anne's lace and yellow goldenrod. Occasionally chicory may have pink, purple or white flowers. Each flower opens and closes at the same time each day and chicory is sometimes used in floral clocks. Common names include blue daisy, blue sailors, and coffeeweed. The type of chicory used as greens is sometimes called Belgian endive, and a red form is called radicchio.
Using chicory
If you have eaten a FiberOne bar you have eaten chicory. The roots of this lovely roadside weed with its daisy-like blue flowers yields an interesting food additive, inulin. Inulin is a sugar molecule with a different makeup than other sugars, a sugar molecule that doesn't cause a rise in blood sugar levels when consumed. Inulin also imparts a smooth creamy mouth feel to foods that allows food makers to reduce fats and it adds dietary fiber in the form of indigestible carbs called fructans. So much fiber in fact that if you eat FiberOne bars you may have experienced some of the gastrointestinal side effects, (they cause a lot of gas), especially if you pigged out because they taste so good.
The fructans in inulin also cause the digestive system to absorb more calcium and magnesium, and studies show they can help prevent osteoporosis. They also stimulate the production of intestinal bifidobacteria, the good bacteria in our guts that help us digest food properly and ramp up our immune system. Fructans are being added to some yogurts that promise to build good intestinal bacteria. And if you start with small amounts of food with fructans or inulin you build up tolerance to the gastro effects and won't blow everyone out of the room.
In other countries inulin powder is being widely used in dairy products like ice cream, baked goods, cereals and granola bars. It reduces the need for sugar and fat and doesn't cause the problems associated with other artificial sweeteners and fat substitutes in the cooking/preparation process and it doesn't have an unpleasant taste. It can be used exactly like sugar, although it isn't quite as sweet. It is an excellent substitute for high fructose corn syrup.
Inulin has been pushed as a good food additive for diabetics for many years. Besides chicory, Jerusalem artichokes, onions, garlic and a few other foods also contain inulin. Agave is the newest inulin producer, being promoted in more tropical areas. Most food grade inulin is being produced from chicory roots however and the largest factories producing it are in the Netherlands and France.
There is a company in the US that is producing inulin for pet foods, but the US is slow to get behind this product, probably because we have so many sugar producing plants in the US that aren't happy about a new rival. Idaho and Nebraska however have studies in place to see if chicory can become an economically important crop.
Inulin is produced much like sugar is produced from sugar beets and sugar beet factories could easily be converted to inulin production. Harvesting equipment for chicory roots can be adapted from beet harvesting equipment. But US farmers do not like perennial crops, and chicory is a perennial plant. Still there is hope that this valuable plant could become another money making crop for US farmers.
Other Chicory uses
Chicory is being studied as a forage crop for livestock and is getting good reviews. Chicory has as much protein as alfalfa, high amounts of vitamins and minerals and evens inhibits the growth of intestinal worms in livestock. Livestock enjoy eating chicory and well managed fields produce as much forage as alfalfa and specially selected pasture grasses. It also grows well in poor soil and under drought conditions. (You can see that as chicory grows well along dusty road edges.) In New Zealand chicory is widely used as a forage crop and named varieties have been developed. West Virginia in the US is sponsoring several large forage trials of chicory.
People have been eating a type of chicory that forms loose heads of leaves, called wiltlof chicory for hundreds of years and it is still a specialty greens crop. The dried and ground roots of chicory have long been used as a coffee substitute or additive. Some people even prefer the chicory coffee over regular coffee. Beer brewers sometimes add chicory root powder to beers, especially Belgian style ales.
In Germany the chicory flower is much used in herbal medicine and is claimed to cure almost any ailment. It is said that chicory can magically open locked doors. Bruised chicory leaves have long been used as a poultice for wounds and bruises. The leaves of chicory are used to make a blue dye.
As a caution, in herbal remedies chicory has been used as an emmenagogue and abortifacient. That means the herb was used to bring on a menstrual period or cause an abortion. Anyone who is pregnant may want to avoid the use of chicory in herbal remedies or as a coffee drink although using products containing commercial inulin is perfectly safe.
You may want to consider allowing some chicory to grow in your garden as a helpful herb. Remember not to forage for wild herbs along roadsides as the plants accumulate toxins from auto exhaust and products applied to the road and may have been sprayed with herbicides.
Here are some additional articles you may want to read.
How to grow Jewelweed
How to grow and use lemon verbena
How to store summer bulbs through the winter
To contact the author you can email her at email@example.com
You can see the authors weekly email garden newsletter here; http://gardeninggrannysgardenpages.blogspot.com/


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Spring 2016—Saturday, May 7, 2016 at 10:00 a.m. in the Main Arena, Community Center
If you are planning to graduate from Penn State Fayette, it will be necessary to take the following steps:
Meet with your advisor
Meet with your adviser: Run a degree audit on eLion and review it with your academic adviser to ensure that all requirements have been met. If you are missing course, credit, or grade requirements, you will NOT be able to graduate.
Transfer your credits
Transfer your credits: You should avoid taking classes at another institution during your intended semester of graduation. If you do, you MUST ensure that Penn State receives the grades on time. Transfer credits should be sent to:
- Undergraduate Admissions
201 Shields Building
The Pennsylvania State University
University Park, PA 16802
- Undergraduate Admissions
Declare your intent to graduate
Declare your intent to graduate (policy 86-00): It is your responsibility to notify the University of your intent to graduate. By now you should have declared your intent to graduate by using the "Graduating This Semester" application on eLion. If you missed the activation deadline for your intended semester of graduation, you must contact the Registrar's Office.
Have your finances in order
Satisfy all financial obligations with the University Bursar, and complete your exit interview online at studentloans.gov.
Check your permanent address
Check your address on eLion by selecting the "Address Information" tab. Make sure that your permanent residence address is correct.
Participate in the Commencement Ceremony at Penn State Fayette
If you have declared your intent to graduate, you will receive important graduation information in the mail. This information will include:
- The date and time of the commencement ceremony.
- The deadline to RSVP to the Academic Affairs Office. Please RSVP even if you are NOT planning to attend.
- Tickets are not required.
- Please notify Jennifer Anto in the Student Affairs Office if you or your guests will require special accommodations, such as handicap access by calling 724-430-4137 or emailing email@example.com.
- How and when to purchase your cap and gown from the bookstore. In observance of tradition, all commencement participants will wear full academic regalia, consisting of a traditional gown and mortarboard with tassel.
All diplomas will be mailed from University Park, approximately four weeks after the commencement ceremony to your permanent residence address..
Additional information can be found here www.registrar.psu.edu/graduation/graduation_index.cfm
Celebrate your accomplishment, make another's life better and give back to the Penn State Fayette Community!
- Grades


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Declining a Latin Noun
They say that old Latin teachers never die — they just decline. Whether this is true of teachers, declining and declension are facts of life that all Latin nouns must face. A declension is a group of nouns [more…]
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Helpful Latin Verb Endings
In Latin, you don't always need two words to form a complete sentence. The ending of a verb can provide a pronoun, so the quote attributed to Julius Caesar — [more…]
Latin Noun Cases
In Latin, what form a noun takes depends on how it's being used. You use different forms of a noun if it's a subject, another if it's an indirect object. The following table lists noun cases and uses. [more…]
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Ablatives are to Latin grammar what black holes are to space: They suck in all matter and energy. Well, sort of. Actually, the ablative case is the case for all sorts of time and space-related uses. In [more…]
Useful Little Latin Words
In Latin, as in other languages, little words can mean a lot. How can you make a point without being able to say, I see your point, but . . .? The short Latin words in the following table provide some [more…]
Understanding Latin Legalese
Most lawyers love to throw around Latin phrases. The reason for this is that ancient Rome's legal system has had a strong influence on the legal systems of most western countries. After all, at one time [more…]Found in: Law


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Back Neck & Shoulder Massage
An invigorating 30 min massage concentrating on the tension hot-spots of the back, neck and shoulders.
During this massage your therapist will ease all tension from your back, neck and shoulders using warm massage oils and expert techniques, leaving you feeling relaxed and de-stressed.
The back, neck and shoulder massage is specifically designed to hit the strains and sore spots to give your whole upper half that refreshment it needs to leave feeling like you could take on the world. Various techniques are used to perform both a relaxing and effective treatment, leaving you feeling fantastically fresh and free from any strains!
A great way to relieve tension and to get rid of any built up stress, this amazing back, neck and shoulder massage is the perfect gift for anyone who you think deserves a bit of stress-relieving relaxation.
Available in 18 different locations around the UK, there really is no excuse not to treat someone with this fantastic gift! Or, if you're feeling the strain of daily life, why not take some time to treat yourself to this brilliant package, and return feeling rejuvenated, relaxed and renewed!
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This gift certificate is valid for 6 months from the day of purchase. Not to be used in conjunction with any other offers. Please arrive 15 minutes early for your appointment. This experience is for one person. This experience is not suitable for spectators.
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text: Business Intelligence & Analytics 51 credits Why Business Intelligence & Analytics? The business intelligence and analytics major provides the knowledge and training for analytically focused careers in business. The emphasis of the major is on applications of data analysis, business forecasting, modeling, operations management, market analysis and project management techniques. The student in this major will learn information technology skills to provide information for decision support systems. The major is based on the functional areas of business such as finance, operations and marketing and enhanced with statistical and decision science techniques. Students with this major are equipped for careers in any of the functional area of business that requires business data analysis. M 148/149 or M151 and BU215 are recommended for this major. Career Options Financial analysis, market analysis, operations management, business intelligence, analytics, and data analysis High School Preparation Accounting; Business; Calculus; Microeconomics; Statistics Sample Schedule (Paradigm) and Course Descriptions General Transfer Guidelines Transfer Guides for Business Majors Business-major-specific transfer guides Anoka Ramsey Community College Century College College of DuPage Dakota County Technical College Harper College Inver Hills Community College Minnesota State College - Southeast Technical College Normandale Community College Riverland Community College Rochester Community & Technical College Western Technical College For more information contact: Shelly McCallum-Ferguson, D.B.A. Chair, Business Department Saint Mary's University of Minnesota 700 Terrace Heights #1439 Winona, MN 55987-1399 (800) 635-5987, Ext. 7279 firstname.lastname@example.com


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Edward George Quirk
Position: FB-MG-LB
Height: 6-1 Weight: 231 lbs.
Born: February 27, 1925 in St. Louis, MO
Died: June 13, 1962
High School: St. Louis Academy
College: Missouri (school history)
Drafted by the Washington Redskins in the 15th round (128th overall) of the 1948 NFL Draft.
Weighted Career AV (100-95-...): 0 (15060th overall since 1950)
Sponsor this page for $5 and help Pro-Football-Reference.com provide this service. Your message will replace this ad.


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"Morgan Park Recreation Ground" Crowthorne Sports & Outdoors Tip by easyoar
Crowthorne Sports & Outdoors: 2 reviews and 1 photos
Morgan Park Recreation Ground has a childrens playground at the end against the High Street. It then has a big field where you frequently see Football games being played at the weekend.
The behind the football pitch there is a basketball court. Apart from when organised matches are being played, it is pretty much just turn up and play, and the the facilities are free for the public to use whether it be for football or cricket or whatever. I do not believe that Golf is allowed however! Not only are golf balls hard and therefore dangerous, but it is a good way to dig up the grass!
Equipment: A football, or a cricket bat and stumps. A frisbee or pretty mcuh whatever you fancy playing!
Address: Morgan Park Recreation Ground is off the High Str
Directions: Just behind the Fire Station
Theme: Other
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Cookie Pizza!
It isn't a hard task to get any child to eat sweets. They can be served almost anything with sugar and eat every bit of it. The following recipe came from an idea that one of my daughters had. She went to a sleepover at her friend's house and they made cookies in a brownie tin. I changed things a bit and made this my recipe for a cookie pizza. My youngest child had a blast turning the red m&ms into pepperonis and chocolate sprinkles into olives. Here's what is needed:
1) A tube of pre-cooked cookie dough
2) A round cake pan
3) Half container of cake frosting
4) Half a bag a of m&m's, we used candy apple flavored to make red colored pepperonis
5) 2 tablespoons chocolate sprinkles
Here's what needs to happen:
1) Put the whole tube of cookie dough in the cake pan. Bake it at 350 degrees for 15 minutes.
2) Let it cool for about 15 minutes, then add the frosting.
3) Next, kids love this part, decorate the cookie to look like a pizaa. Use red m&m's to make pepperonis and sprinkles to make olives. Anything can be added on the cookie to make it more pizza-like. Mine was lined with mini-marshmallows to resemble crust.
4) Enjoy!


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William J. Vasarhelyi, 76, of Brunswick, passed away Wednesday, August 20, 2014 at Southwest Hospital. He was born June 27, 1938, to William and Rose (nee Zackal) Vasarhelyi in Cleveland.
Bill was proud to have gotten to serve his country and was a proud veteran of the United States Air Force. Bill then spent 32 years of his life working at Warner and Swasey Co., in Cleveland, before the plant closed.
Left to celebrate his life are his beloved wife, Anita; his cherished step-children, Julie (Clint), Lance (LeeAnn) and Scott; his adoring mother, Rose; sister, Marilyn (Gary); and his loving nieces, Lisa and Diana.
He was preceded in death by his father, William A. Vasarhelyi.
Bill will be privately laid to rest at the Ohio Western Reserve National Cemetery, Rittman.
In lieu of flowers, donations may be made to the American Diabetes Association, 4500 Rockside Rd. #440, Independence, OH 44131.
Online condolences may be left at www.waitefuneralhome.com