text:
The authors have no conflict of interest.
Does the Combination of Two BMD Measurements Improve Fracture Discrimination?†
Version of Record online: 1 NOV 2003
DOI: 10.1359/jbmr.2003.18.11.1955
Copyright © 2003 ASBMR
Journal of Bone and Mineral Research
Volume 18, Issue 11, pages 1955–1963, November 2003
Additional Information
How to Cite
Blake, G. M., Patel, R., Knapp, K. M. and Fogelman, I. (2003), Does the Combination of Two BMD Measurements Improve Fracture Discrimination?. J Bone Miner Res, 18: 1955–1963. doi: 10.1359/jbmr.2003.18.11.1955
- †
Publication History
- Issue online: 2 DEC 2009
- Version of Record online: 1 NOV 2003
- Manuscript Accepted: 2 JUL 2003
- Manuscript Revised: 8 MAY 2003
- Manuscript Received: 18 FEB 2003
- Abstract
- Article
- References
- Cited By
- bone densitometry;
- fracture risk;
- osteoporosis
Combining information from different types of BMD measurement should improve the evaluation of patients' risk of fracture. This study used a bivariate gaussian model to examine the effect of combining two different BMD measurements. The results show that, in practice, there is little benefit unless the measurements are completely unrelated.
Introduction: Intuitively, the combination of information from two or more different types of bone densitometry investigation should improve our ability to identify patients at high risk of fracture. However, the best way to combine measurements and the resulting gain in fracture discrimination are not known.
Materials and Methods: In this study, we used a bivariate gaussian model to investigate the effect of combining two different types of bone densitometry measurements. The measurements had individual relative risk values RR1 and RR2 and a correlation coefficient r between their Z-scores. Different approaches to the combination of the two measurements were compared by calculating the area under the curve (AUC) for the receiver operating characteristic (ROC) curve, which was obtained by plotting the percentage of fracture patients against the percentage of the whole population with a Z-score below some chosen threshold. ROC curves were calculated for three cases: (1) one type of measurement only; (2) two different types of measurements combined using their mean Z-score weighted according to the theoretical optimum weighting factors predicted by the bivariate gaussian model; and (3) two different types of measurements combined using the conventional World Health Organization (WHO) approach, where one or other measurement is below a set threshold. The theoretical model was tested using measurements of speed of sound (SOS) in the radius, phalanx, and metatarsal in patients with vertebral and Colles' fractures.
Results: Results were calculated for RR values of 1.5, 2.0, and 2.5 and r = 0, 0.5, and 0.7. Although a significant improvement in fracture discrimination was obtained when r = 0 and RR1 = RR2, the improvements obtained when r ≥ 0.5 or RR1 ≠ RR2 were relatively modest. Slightly better fracture discrimination was obtained using the weighted mean Z-score approach compared with the WHO approach, although the differences were small. The results of the in vivo study in Colles' and vertebral fracture patients showed close agreement with the predictions of the bivariate gaussian model.
Conclusion: In practice, from a theoretical point of view, there is unlikely to be any benefit from combining information from different types of bone densitometry measurements unless they are completely unrelated.
Growing awareness of the impact of osteoporosis on the elderly,(1) the consequent costs of healthcare,(2) and the development of new treatments to prevent fractures(3–7) have all contributed to a rapid growth in the demand for bone densitometry services. Today, scans to measure bone mineral density (BMD) have an essential role in evaluating patients at risk of osteoporosis.(8–10) In 1994, a World Health Organization (WHO) report(11) recommended that osteoporosis should be defined by expressing BMD measurements as T-scores. T-scores are calculated by taking the difference between a patient's measured BMD and the mean BMD of healthy young adults matched for gender and ethnic group and dividing by the young adult SD. The WHO report defined osteoporosis as a T-score ≤ −2.5 measured at the spine, hip, or forearm. BMD measurements may also be interpreted using Z-scores.(12) Z-scores are calculated by taking the difference between the measured BMD and the mean BMD for healthy subjects matched for age, gender, and ethnic group, and dividing by the respective SD. Although they cannot be used to diagnose osteoporosis, Z-scores are useful because they express a patient's skeletal status relative to their peers. A patient's T- and Z-scores are related by the equation:
- (1)
where the population mean T-score depends on the patient's age and gender and the type of measurement.(13)
Fundamental to the role of BMD scans in diagnosing osteoporosis is the ability to assess a patient's risk of fracture. The most reliable approach to evaluating the effectiveness of bone densitometry is through prospective studies of incident fractures.(14,15) Studies are analyzed using a proportional hazards model in which the findings are expressed as the relative risk (RR), defined as the increased risk of fracture for each unit decrease in Z-score.(16) The results of fracture studies can also be expressed by plotting the percentage of fracture patients against the percentage of the whole study population with BMD values below some chosen threshold. As the threshold is varied, one obtains a receiver operating characteristic (ROC) curve(17) in which the true positive fraction (those patients who sustained a fracture and were correctly identified to be at risk by the BMD measurement) is plotted against the false positive fraction (those patients identified as being at risk but who did not fracture). ROC curves are often parameterized by the area under the curve (AUC). The larger the AUC, the better the discrimination of the BMD measurements at identifying those patients at greatest risk of fracture.(18)
The need to optimize the ROC curve raises the question of what improvement in fracture discrimination is obtained by combining information from two or more different measurements. For example, it is common to perform BMD scans of the spine and hip and make the diagnosis of osteoporosis if the T-score at either site is less than −2.5.(12) However, it is unclear what gain in discrimination is obtained by this practice, or even whether individual interpretation of T-scores using the WHO threshold is the best way of combining the data. More generally, one might wish to examine the effect of other combinations such as BMD and heel ultrasound(19) or speed of sound (SOS) measurements at different skeletal sites.(20) In this report we consider these issues by developing a mathematical model to illustrate the gains and limitations that apply when information is combined from two different measurements. The predictions of the model are compared with SOS data obtained in patients with vertebral and Colles' fractures.
Estimation of the ROC curve for a single BMD measurement
We first give a brief description of the model for a single type of measurement. We assume that for a group of subjects from the general population with a narrow range of ages (say, a 5-year age range), the distribution of Z-score values approximates to a gaussian curve with its peak at Z = 0.(18)
- (2)
Based on the proportional hazards model, the fracture risk can be modeled by an exponential curve that scales with Z-score as exp(−βZ), where β is the logarithm of the relative risk [β = ln(RR)]. The Z-score distribution for the fracture population is found by multiplying Equation 2 by the fracture risk curve. It is found to be a gaussian equation with the same SD as Equation 2 but with its peak at Z = −β(18):
- (3)
The gaussian model may be used to predict points on the ROC curve by calculating the area under the curves representing the fracture and the general populations up to a chosen Z-score threshold (Fig. 1A). As the threshold is varied, the ROC curve is traced out and the AUC can be calculated.
Estimation of the ROC curve for the combination of two BMD measurements
The effect of combining two different types of measurement with Z-scores Z1 and Z2 can be studied by using a bivariate gaussian function(21) to represent the population distribution. For the general population the equation is:
- (4)
where r is the Pearson correlation coefficient between Z1 and Z2.(22)
The bivariate gaussian representing the fracture population is similar to the function describing the general population, but with its peak at the point Z1 = −β1, Z2 = −β2:
- (5)
That Equation 5 has the correct form to represent the fracture population can be verified by projecting the distribution onto the Z1 axis when it reduces to the single measurement gaussian in Equation 3 with β = β1. It is clear, therefore, that the constant β1 is related to the relative risk of the first BMD measurement by the equation β1 = ln(RR1). In the same way it can be shown that the constant β2 is related to the relative risk of the second measurement by the equation β2 = ln(RR2). Figure 1B shows the functions in Equations 4 and 5 plotted together as contours of constant number density.
There is an important relationship between β1, β2, and r. If two different types of measurement are correlated, then part of the fracture prediction capability of one is derived through its correlation with the other. If Equation 5 is rewritten to express Z2 in terms of its correlation with Z1 and a residual, the β value associated with the residual is βres = (β2 − rβ1)/√(1 − r2) Because an increased risk of fracture is always associated with a decrease in BMD, βres > 0, and hence we derive the condition β2 > rβ1, or equivalently r < β2/β1. This condition must apply if the combination of two different measurements is to provide increased fracture discrimination compared with a single measurement alone. There is a similar condition, r < β1/β2, but given that the correlation coefficient r is less than unity, one of the two conditions is trivial.
In this study, the bivariate gaussian functions representing the general and the fracture populations were integrated to derive the form of the ROC curve in a manner similar to the single measurement model (Fig. 1A). Two different methods of combining the two BMD's to set a threshold for identifying the high-risk individuals were considered. In the first approach, a weighted mean of the two Z-scores was used (Fig. 1B). The second approach was based on the WHO interpretation of BMD results in which individuals are identified as being at risk if one or other of the two measurements is below a set threshold (Fig. 1C). These two approaches are described in turn below.
Combination of two BMD measurements using the weighted mean Z-score
In the first approach, a weighted mean of the two Z-scores was used to specify the threshold for the integration of the bivariate gaussian functions (Fig. 1B). We begin by considering the case where the two measurements are equally effective at predicting fracture risk. In this case β1 = β2 = β, and it is clear the measurements should be given equal weight. A simple way of achieving this is to rotate the axes in Fig. 1B through 45° to give new axes Z+ and Z− that are oriented along the major and minor axes of the bivariate gaussian distributions, respectively. The Z+ and Z− values associated with Z1 and Z2 are:
- (6)
- (7)
When the bivariate gaussian is projected onto the Z+ axis, a gaussian curve is obtained with an SD of √(1 + r). Because the peaks of the functions representing the two populations are at (0, 0) and (−β, −β), respectively, the separation of the two peaks is √2β. When normalized by the SD of the projected gaussian, the separation is √2B/√(1 + r). It follows from the example of the single measurement model illustrated in Fig. 1A that the β value for the Z+ combination of Z1 and Z2 is given by:
- (8)
When the bivariate gaussian is projected onto the Z− axis, the peaks of the two populations coincide. Hence Z− gives no information about fracture risk. We shall refer to Z+ as the weighted mean Z-score. As the value of the Z+ threshold in Fig. 1B is varied, the ROC curve is traced out and the AUC can be calculated.
The general case when β1 and β2 are unequal also has a simple solution. In this case, Z1 and Z2 are combined with weighting factors cosϕ and sinϕ, giving the following generalized equation for the weighted mean Z-score:
- (9)
By an argument similar to that given above for the derivation of Equation 7, in which the separation of the two peaks projected on the Z+ axis is normalized by the SD of the projected single gaussian, the β value for the weighted mean Z-score is:
- (10)
The value of βcomb is a maximum when the angle ϕ takes the value:
- (11)
Combination of two BMD measurements using the WHO approach
In the second method of combining two measurements, an approach equivalent to the WHO interpretation of BMD results was modeled in which the patient was defined to be at high risk of fracture if one or the other of the two Z-scores was below a set threshold (Fig. 1C). A computer program was written to integrate the functions representing the two populations according to the limits shown in Fig. 1C and calculate the corresponding ROC curve. For the sake of presenting a simple example, the calculations were performed assuming that the population mean T-score in Equation 1 was the same for both measurements. In this case, the two axes have equal Z-score thresholds, as shown in Fig. 1C. This is approximately true for lumbar spine and femoral neck BMD measurements.(13) Note that although the above description of the bivariant gaussian model is given in terms of Z-scores, the point on the ROC curve corresponding to a T-score of −2.5 is readily calculated by substituting T = −2.5 in Equation 1.
Subjects and measurements for the in vivo study
Data from an in vivo study were used to compare the predictions of the theoretical model described above with the improvements in fracture discrimination found by combining multisite axial transmission SOS measurements in patients with vertebral and Colles' fracture. A Sunlight Omnisense device (Sunlight Medical Ltd., Tel-Aviv, Israel) was used to measure SOS at the radius, phalanx, and metatarsal in a study population that consisted of 110 healthy postmenopausal women, 64 women with atraumatic vertebral fractures, and 31 women with low trauma wrist fractures.(20,23) All patients gave informed consent, and the study was approved by the Local Research Ethics Committee. Logistic regression analysis was used to calculate the age-adjusted odds ratios (ORs) for fracture discrimination. Although the mathematical model used for logistic regression analysis of cross-sectional fracture studies differs slightly from the proportional hazards model used for prospective studies,(24) the resulting ORs are essentially equivalent to relative risks.(25,26) OR values for the combinations of pairs of SOS sites were therefore calculated by taking the weighted mean of the two Z-scores, and the results were compared with the predictions of the theoretical model calculated from the single site OR using Equations 9 and 10.
When the single measurement model was used to calculate the ROC curves for RR values of 1.5, 2.0, and 2.5 (Fig. 2A), the values of the AUC were 0.613, 0.688, and 0.741, respectively (Table 1). At the point on the ROC curve representing the lowest quartile of the general population, the percentage of the fracture population captured was 39%, 51%, and 60%, respectively (Fig. 2A).
For the combination of two BMD measurements using the weighted mean Z-score approach, the simplest case is when the measurements have equal RR values. The greatest improvement in fracture discrimination is obtained for r = 0 when βcomb = √2β (Equation 7). As the correlation coefficient increases to r = 1, the value of βcomb decreases to β, and no improvement is obtained compared with a single measurement. The value of RR corresponding to βcomb can be calculated using the equation RRcomb = exp(βcomb). For RR1 = RR2 = 1.5, the values of RRcomb (and AUC) for r = 0, r = 0.5, and r = 0.7 are 1.77 (0.657), 1.60 (0.630), and 1.55 (0.622), respectively (Table 1). For RR1 = RR2 = 2.0, the equivalent values are 2.67 (0.756), 2.23 (0.714), and 2.13 (0.702), and for RR1 = RR2 = 2.5 the values are 3.65 (0.820), 2.89 (0.773), and 2.71 (0.759). The ROC curves for RR = 2.0 are plotted in Fig. 2B. For the point on the curves representing the lowest quartile of the general population, the percentage of the fracture population captured was 62%, 55%, and 53%, respectively, for r = 0, 0.5, and 0.7 compared with 51% for a single BMD measurement with the same RR value.
When the two BMD measurements have unequal RR values, the angle ϕ for calculating the optimum weighting factors in Equation 8 was found using Equation 10. The angle ϕ was plotted as a function of the correlation coefficient for three different sets of RR values (Fig. 3). When r is less than the critical value rc = β2/β1, both weighting factors are positive, and the combination of the two measurements improves fracture discrimination. However, when r = rc, ϕ = 0 and no additional discrimination is obtained. When r > rc, the weighting factor for the second measurement is negative, and the additional discrimination provided by the second measurement associates an increased fracture risk with an increased BMD. This is the opposite of what is usually observed and will not be considered further here.
When the weighted mean Z-score approach was analyzed for RR1 = 2.0 and RR2 = 1.5, the values of RRcomb (and AUC) for r = 0 and r = 0.5 were 2.23 (0.715) and 2.01 (0.689), respectively (Table 1). The case for r = 0.7 was not considered because it exceeds the critical value rc = 0.58. For RR1 = 2.5 and RR2 = 2.0, the critical value is rc = 0.76, and the values of RRcomb (and AUC) for r = 0, r = 0.5, and r = 0.7 are 3.16 (0.791), 2.61 (0.750), and 2.51 (0.742), respectively. For RR1 = 2.5 and RR2 = 1.5, the critical value is rc = 0.44, and the value of RRcomb (and AUC) for r = 0 is 2.72 (0.760).
For the combination of two BMD measurements using the WHO approach, the ROC curves were calculated by performing the numerical integration over the two population distributions shown in Fig. 1C. The AUC values obtained are compared with the weighted mean Z-score approach in Table 1. In each instance, slightly better fracture discrimination was obtained using the mean Z-score approach. For equal RR values, the AUC values for the WHO approach lay between those for the mean Z-score approach and a single BMD measurement. The ROC curves for a single BMD measurement and two measurements combined using the mean Z-score and WHO approaches for RR1 = RR2 = 2.0 and r = 0 are plotted in Fig. 2C. For the point on the curves representing the lowest quartile of the general population the percentage of the fracture population captured was 62%, 57%, and 51% for the mean Z-score, the WHO approach, and a single BMD measurement, respectively. For r = 0.5, the corresponding values were 55%, 53%, and 51%.
The results for the WHO approach when the two BMD measurements have unequal RR values are also included in Table 1. As with the case for equal RR values, the weighted mean Z-score approach performed slightly better than the WHO approach. The comparison between the two approaches is summarized in Fig. 4, which shows the AUC plotted as a function of the correlation coefficient for the weighted mean Z-score, and the WHO approaches for examples of equal RR values (RR1 = RR2 = 2.0) and unequal values (RR1 = 2.0, RR2 = 1.5), respectively.
Details of the subjects included in the cross-sectional studies of vertebral and Colles' fracture patients using the Sunlight Omnisense device have been published previously.(20,23) OR values obtained from logistic regression analysis for radius, phalanx, and metatarsal SOS considered singularly and then combined in pairs using the optimum weighting factors for the weighted mean Z-score are listed in Table 2. For the paired SOS data, Table 2 also lists the theoretical values of OR calculated using Equation 9. Values for the correlation coefficient r varied between 0.27 and 0.32. The average OR value for the single site measurements was 1.55, for the paired SOS data analyzed using logistic regression was 1.75, and for the paired SOS data predicted using the bivariant gaussian model was 1.74. The latter two figures show good agreement, and the in vivo data confirm the modest improvement in the ORs predicted by the model.
The clinical value of bone densitometry investigations depends on two factors: (1) the ability of the measurements to discriminate patients who will have a fracture from those who will not; and (2) how effectively the scan findings are interpreted. The first factor depends on the RR value of the BMD measurements, which determines the area under the ROC curve. The larger RR, the larger the percentage of future fracture patients identified when treating any given percentage of the population.(18) At present, the best technique is the use of a hip BMD measurement to predict hip fracture risk for which RR = 2.6.(16) The second factor determining the value of BMD scanning is how effectively the findings are interpreted. Here, the prevailing paradigm is the WHO definition of osteoporosis of a T-score ≤ −2.5 at the spine, hip, or forearm. The ROC plot is a useful tool for evaluating the outcome of bone densitometry investigations because the operating point on the curve indicates the overall effectiveness of BMD scans taking into account both the RR of the measurement technique and the way the findings are interpreted.(18)
Intuitively, the combination of two or more different types of measurement should improve the ability of bone densitometry investigations to identify patients at risk of fracture so that a more favorable point is achieved on the ROC curve. Ideally, this means moving the operating point towards the top left of the diagram so more fracture cases are identified and fewer patients treated overall. When more than one measurement is made (for example spine and hip BMD), most clinicians would agree that a diagnosis of osteoporosis should be made if one or other site is below the WHO T-score threshold.(12) However, it is not known whether this widely used practice is the optimum method of using the data in terms of the ROC plot. An alternative is the conventional statistical approach of combining two noisy measurements by taking their mean. If each measurement has the same error, they are given equal weights, and there is an overall gain in signal to noise by a factor of √2. Bone density measurements should certainly be regarded as noisy data, because random accuracy errors caused by the effects of soft tissue composition account for around 50% of the population SD,(27) suggesting that their effect might be reduced by averaging over sites. Therefore, an important objective of this study was to quantify and compare the improvement in fracture discrimination for the WHO and the weighted mean Z-score approaches.
Of the two approaches, it is easier to calculate the ROC curve for the weighted mean Z-score. In this case, the effect of combining two measurements is equivalent to a single BMD measurement with an increased RR value that can be calculated from Equation 7 for the case RR1 = RR2 and from Equations 9 and 10 for the case when RR1 ≠ RR2. The greatest improvement in fracture discrimination is obtained when the two measurements have RR values, and their correlation coefficient is zero. In this case, βcomb = √2β, and we obtain the √2 factor familiar from basic statistics. However, as the correlation coefficient increases to r = 1, the value of βcomb decreases to β, and there is no gain compared with a single measurement. When two measurements are completely uncorrelated, the improvement in discrimination is substantial. For example, for two measurements where RR1 = RR2 = 2.0, the value of RRcomb is 2.67, which is equivalent to the optimal bone densitometry study using hip BMD to predict hip fracture risk.(16) However, in practice the correlation coefficient between different measurements often lies in the range r = 0.5–0.7,(28) and in this case, the value of RRcomb is substantially less and lies in the range of 2.13–2.23. A good example of the important effect of the correlation coefficient is dual-femur DXA scanning.(29) In this case RR1 = RR2 = 2.6,(16) and r ≈ 0.95,(29) giving RRcomb = 2.63, which represents a negligible improvement. In comparison, for two uncorrelated measurements with RR = 2.6, the RRcomb value would be 3.86. Were it possible to achieve this latter example in practice, it would represent a substantial gain in fracture discrimination.
The case when RR1 ≠ RR2 is more complicated because the weighting factors are unequal. The greatest improvement in fracture discrimination is still obtained when r = 0. In this case tanϕ = β2/β1 (Equation 10), and the two measurements are weighted in proportion to their β values. It is readily shown from Equation 9 that in this case the β values of the weighted combination is βcomb = √(β12 + β22). As the correlation coefficient increases from zero, proportionally more weight is given to the measurement with the larger RR value, and the contribution of the second measurement becomes zero when rc = β2/β1 (Fig. 3). An example of unequal weights is the use of spine and hip BMD to predict hip fracture risk. The Marshall meta-analysis lists RR values (and 95% CIs) of 1.6 (1.2–2.2) for spine BMD and 2.6 (2.0–3.5) for hip BMD.(16) Assuming RR = 2.6 for hip BMD and a correlation coefficient r = 0.7, the minimum allowed RR value for spine BMD is 1.95. We therefore combined the hip RR figure of 2.6 with the 95% confidence upper limit for spine BMD of 2.2 to obtain RRcomb = 2.64. As with the example of dual-femur scanning discussed above, this represents a negligible improvement.
The poor correlation between different types of bone densitometry measurement is often a cause for concern because of the potential for conflicting findings between different sites.(18) If two types of measurement were to correlate perfectly, they would identify exactly the same patients for treatment. However, in practice, different types of measurement often correlate poorly, with r ≈ 0.6–0.7 between BMD results from different sites and r ≈ 0.4–0.5 between QUS and BMD measurements.(28) Although the poor correlation between different types of measurement can create difficulties when comparing results, it turns out that the correlations found in practice are rather too good to achieve more than a modest improvement in fracture discrimination by combination of measurements.
In this study, when the weighted mean Z-score approach was compared with the WHO approach, the former was found to perform consistently slightly better in terms of the ROC curve (Table 1). However, the differences are greatest when the correlation coefficient is zero, and in practice, for correlations of r = 0.5–0.7, the differences in the ROC curves between the two approaches were very small.
An important limitation of the analysis presented here is that the results depend on the assumptions that the BMD distributions for the age-matched general population are gaussian and that the fracture risk curves are exponential. We believe that these are sufficiently good approximations to provide useful insights into the effects of combining different types of BMD measurement. Although we were able to show good agreement with the results of the theoretical model presented here and data from a cross-sectional study of fracture patients, it is important that the predictions of the model are compared with data from a prospective fracture study. We note that the conclusions of the present study are consistent with an analysis of data from the Study of Osteoporotic Fractures reported by Genant et al.,(30) who also drew attention to the limited benefit of combining BMD data from different sites.
It was concluded from the present study that when two different types of BMD measurement are combined, the largest gain in fracture discrimination is obtained when the correlation coefficient is zero and they have equal RR values. In this case, by using the mean Z-score approach, the exponent β in the exponential curve relating fracture risk to BMD is increased by a factor √2. In practice, however, the effects of the correlation between different measurements and of unequal values of RR ensure that the real gains in fracture discrimination are considerably smaller than this ideal case. Second, it was concluded that when the weighted mean Z-score approach was compared with the WHO approach the former performed slightly better when judged by the ROC curve, although in practice the clinical effect of this difference was found to be small.
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|Hi, We are a 1 year old company looking to expand his vision to the www. We already have a website which is not good-looking (Based on a template). We are looking for our OWN website design built using today's newest technologies. Our old website: http://gibsonsecurity.ca/ We want a real HTML/ CSS3 pro. There is no articlesthat need to be wrote, someone is already paid to write...
|PHP, Website Design, Graphic Design, HTML
|Jul 27, 2016
|Today6d 22h
|Transfer magento website through teamviewer
|Please read subject. I am looking into transferring a magento website through teamviewer or logme in. I currently have the database and files uploaded on the site already.
|Jul 27, 2016
|Today6d 21h
|Set up a Wordpress website
|Looking for a freelancer to set up a Wordpress site WITH ONLINE STORE. I like the look of http://themes.kadencethemes.com/virtue/ HOWEVER I am flexible as to what theme so let me know if you have a preferred theme. Pages: Home - Portfolio (Photo Album) - Blog - Shop (Store). Would like woocommerce plug in installed with a product page. At the moment would like it set up to sell 4 (four) PLACEH...
|PHP, Website Design, Graphic Design, Wordpress, HTML
|Jul 27, 2016
|Today6d 21h
|reed and write australian barcode
|I need you to reed the australian barcode that i have uploaded, it contains personaly sensitive data that i know of. Once you had reed the data and send it back to me for the confirmation i will give you new data that you have to input and create new barcoode.
|C Programming, Game Design, Icon Design, Linear Programming, Coding
|Jul 27, 2016
|Today6d 19h
|Design a Logo - AA Racks
|I need a new logo design for AA RACKS AA Racks sell heavy duty roof racks for cars, trucks, jeeps ect. I uploaded the AA logo, I would want the AA to stay a bit similar, but if you have good idea work it in. Those are the colors to work with Blue and Red in that order.
|Anything Goes, Graphic Design, Logo Design, Photoshop, Website Design
|Jul 27, 2016
|Today4d 18h
|Web development
|I need a new website. I need you to design and build a website for my small business. Looking to have a website designed and uploaded to Amazon for free hosting. It's for a small ice cream van hire company we offer vans, machine hire I would like a calendar-based booking system to take bookings and payments upfront for birthday parties and e calendar-based booking system to take bookings ...
|PHP, Website Design, Graphic Design
|Jul 27, 2016
|Today6d 18h
|Design a Flyer
|Iam in urgent situation. I already have logo and details. Its just a simple design i need. I have picture of my old one. Wants to finish in few hours. I have uploaded picture. Front side has to be like that. I have logo pds file. And back side just some letters.
|Graphic Design, Flyer Design
|Jul 27, 2016
|Today6d 17h
|Create a bespoke database of Pro Golfers
|I am looking to create a database of pro golfers that will contain hundreds of thousands of rounds of golf as well as the details of those players. The database should be able to do a few basic mathematical calculations. I have a more in depth document detailing the project which I will send to a few select applicants. The database can be written in whatever code the developer prefers but data...
|SQL, Cloud Computing, Big Data, Database Programming, Database Development
|Jul 27, 2016
|Today6d 17h
|Write HTML for an online form for my squarespace website.
|I need a form created that has users input name, email, and answer a couple questions from a drop down menu. Then based on their responses they are given different prompts to upload different photos and write information. I need the uploaded photos and text responses sent to me via email. Should be a pretty quick project.
|Jul 27, 2016
|Today6d 16h
|Create a WordPress Template
|I have a domain and site already up. I uploaded a theme that i like, but need help...its a mess to a degree. I have attended many WP Meetup/WORD CAMPS 4...still development and truely understanding all is not my thing. I need help with getting the site up, mobile, optimized where it is driving business and with that at a fair price.
|PHP, Wordpress, CSS, HTML
|Jul 27, 2016
|Today16h 12m
|Build a Website
|Hello Web Designers, I'd like to have a one designed web page. The basic HTML and text can be found at: http://task36.com/gmf, and it now needs colors, text-sizes and fonts, layout, icons, etc. Please feel free to suggest and go in any direction you think will fit. As a reference you can use: http://task36.com/gmf/reference.html * The resulting page should be responsive - it shoul...
|Website Design, Graphic Design, CSS, HTML
|Jul 27, 2016
|Today6d 15h
|Criar um Site para Busologos -- 2
|Gostaria de um site no mesmo estilo desse www.onibusbrasil.com que seria um rede social para busologos (admiradores de ônibus) onde membro se cadastram e publicam fotos e curtem comentam fotos de outros membros seria uma rede social de posta fotos, comentário e curtidas. Teria que ter uma area restrita para qualquer pessoa se cadastras e começar a posta fotos e que o site seja ...
|PHP, Website Design, Graphic Design, MySQL, HTML
|Jul 27, 2016
|Today6d 14h
|Create a Mobile Website
|I have a APP In need cloned, and the screen layout different, this app will download to a tablet daily, it will be sql data off a server, it will be displayed and allow a customer to sign each page, te electronic signature and client number will be uploaded back to server end of the day, with a push of button on the app, upload data. This app will download a list of items to be delivered and a cus...
|Mobile Phone, Android, HTML5, jQuery / Prototype
|Jul 27, 2016
|Today6d 14h
|Design a Banner
|A very simple task: Please create a good Coming Soon Graphic banner for my 100mph app platform. The Banner should be used on Facebook as well as websites. It should represent multiple sports or general category, should have an Android app button icon & saying "Coming soon". One should be with my company logo, one should be without it. I need 2 designs, both in HQ and multiple ...
|Graphic Design, Banner Design
|Jul 27, 2016
|Today6d 13h
|Website Seo in Low Budget
|i want to promote my website safe and genuine way don't bid black hat user only contact me genuine SEO and SMO developers my website url is here check it and give a genuine price for long term work.. http://www.gadgetpopo.com www . gadgetpopo . com
|SEO, Social Networking, Google Adwords, Article Rewriting
|Jul 27, 2016
|Today6d 13h
|Build a Website for MiLo apartments
|Creative work plan for a new website Agency: erickson digital Client: MiLo Residences (apartments) Framework We will use the DIVI version 2.7.8 wordPress theme from ElegantThemes.com. I have an annual license with Elegant Themes. YOUR SKILL It helps if you have previous experience with the DIVI theme. Their page builder is unusual Number of pages 8 Number of photo galleries 1 ...
|PHP, Website Design, Graphic Design, HTML
|Jul 27, 2016
|Today6d 12h
|Build an affiliate coupon and deals site in ajax/php/mysql
|We want to start a website like thuttu dot com, should be built using ajax/php/mysql, fast loading, easy admin panel conrol, xml/jason/api or csv feed format handling (easy to handle), live chat module, please check the site and show me your work if you have developed the similar site.
|AJAX, HTML, MySQL, PHP, Web Scraping
|Jul 27, 2016
|Today6d 12h
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The Journey to Successful Execution of Outsourced Testing
Whether we like it or not, outsourcing has become mainstream in the development world and is now being imposed on testing organizations. If not done properly, an outsourcing venture can add costs, distract the internal QA organization, and increase business risks to the enterprise. This session describes practical steps to successfully execute outsourced QA projects. Rutesh Shah, who has years of experience on both sides of the table, explains what should and should not be outsourced, common vendor practices, risk management issues, relationship management, and a practical, proven process for outsourcing test activities. Use the knowledge gained from this session to ensure that your team makes efficient and informed decisions before outsourcing testing. Measure progress and determine the true ROI (or lack of it) when outsourcing testing.
- Outsourced vendor processes and perspective
- Strategies for qualifying activities for outsourced testing
- Transition and ongoing process to manage the outsourced testing
Upcoming Events
|Sep 19
Software Testing Training Week (Washington, DC)
Specialized training for QA, test, and software professionals
|Oct 02
Software Testing Conference in Anaheim
|Oct 23
Software Testing Conference in Toronto
|Nov 13
Agile Dev East
The Conference for Agile Practitioners


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Photo - Daily Inspiring Quote Pictures
Best fire starter ever from recycled materials! - Scouts now recommended to use saw dust from natural wood and mix it with wax and put in into a cardboard egg container. Break off a section and you have more natural fire starter without all of those toxins from laundry lint.
life inspiration quotes: Number of friends inspirational quote
Real femininity v. "fluff" femininity // "A lady is not frilly, flouncy, flippant, frivolous and fluff-brained, but she is gentle, she is gracious, she is godly and she is giving."
Instant Gratification #ChoreChart | You need #rewards too! Make progress with #PlexusSlim found at www.LexingtonSlim.com
101 Fashion Tips and Tricks Every Girl Should Know
Turkey Avocado Goat Cheese Panini
good reminder...
A lady at the post office taught me this trick and I have realized very few people know about it! You can turn a flat rate envelope into a pouch to increase the capacity. It holds more than a small flat rate box ($5.80) and about as much as a medium ($12.35) for only $5.60. So worth it! I do this all the time! Just fold the bottom both ways, and flatten it out from the inside, folding the corners and taping them up into a rectangular bottom. Secure with lots of tape. Happy shipping!
Awesome things will happen today if you choose not to be a miserable cow. ahhahaaa
99 Family Conversation Starters - Kids Activities Blog
Get your kids family talking today with these great questions!
Family Dinner Discussion Starters
I Am Momma - Hear Me Roar: How to Have Your Pictures Removed from Other Sites (and other internet privacy tips)
what you make it: 50 MORE things to do together (other than watching movies)
Parents Guide To Children's Teeth!
I should try this...
Good to know!
Teach girls to sew--18 Easy Sewing Projects for Beginners
Once a month, add a cup of Distilled White Vinegar & 1 Cup of Baking Soda directly into the drum and use HOT water for washing. Then, I add about ½ cup of vinegar into the fabric softener compartment and ½ cup of baking soda into the detergent compartment. Set the wash on "Quick Wash" with HOT water and High Spin Cycle. If the mold situation is really bad,use bleach instead of vinegar and baking soda. But make sure you run a few empty cycles just with hot water before doing a load of wash.
Pool noodles cover the springs! No more getting pinched and so cute too!
Teach Your Daughter To Sew.... 18 Easy Sewing Projects For Beginners....
For those mamas with girls! No more naked dolls! // YEAH!
Cheer on TEAM USA and use these outdoor activity ideas to have your own backyard games this summer.


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Third Grade Worksheets and Printables
Our third grade worksheets help your students learn key third grade skills with fun exercises and beautiful illustrations. If your students need math practice, try our multiplication, decimals, money or division exercises. In reading and writing, we cover important topics such as irregular verbs and descriptive adjectives. To try some material in the next level, check out our fourth grade worksheets.
2,136 Results
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Conjunctions #1 Conjunctions are words that link different parts of a sentence!
Apostrophes in Contractions Help your third grader tackle apostrophes with this worksheet that challenges him to add apostrophes to contractions where needed.
Reading Pictographs: Building a New Town Building a new town takes time, not to mention new houses!
Shapes With Right Angles Knowing how to identify right angles is a huge part of geometry.
Quotation Marks in Titles Kids learn how to cite different kinds of titles by adding underlining them or adding quotation marks.
Quotation Mark Practice Help your third grader learn how to use quotation marks with this worksheet that asks him to place quotes where they're needed.
Reading Pictographs: Going to the Theater If your child already knows how to read a basic pictograph, try this intermediate worksheet to test your child's pictograph savvy.
Spooky Sudoku Spooky Sudoku shouldn't frighten anyone. It's fun!
Cursive Handwriting: "C" is for Caterpillar Kids practice writing capital and lowercase "C" in cursive on this third grade writing worksheet by tracing the letters and then writing their own.
Order of Operations: First Things First How many steps does it take to get to the end of the math problem?
Times Table Birds #1 Help these little birds join their feathered friend on the telephone wire by solving these multiplication problems.
Units of Measurement: Comparing and Converting Give your third grader's measurement muscles a workout with this worksheet that's packed with comparison and conversion questions.
Comparative and Superlative Adjectives Better or best? Go for the gold in this Olympic adjectives worksheet.
The Wampanoag Here's a worksheet on the Wampanoag, the tribe that the Pilgrims feasted with, just in time for Thanksgiving.
Geometry Basics: Review Quiz #1 Filled with questions on lines and polygons, this practice quiz makes a great review sheet or study guide for an upcoming test.
The Selma to Montgomery March Learn more about the Civil Rights Movement as you read about the Selma to Montgomery March.
Our third grade worksheets help your students learn key third grade skills with fun exercises and beautiful illustrations. If your students need math practice, try our multiplication, decimals, money or division exercises. In reading and writing, we cover important topics such as irregular verbs and descriptive adjectives. To try some material in the next level, check out our fourth grade worksheets.
Teaching with Third Grade Worksheets
In third grade, students will be asked to work more independently as they piece together the skills they have learned to complete more complex tasks. The worksheets above target key skills, such as multiplication, and will help kids practice on their own. Here is a run-down of some of the key skills covered in third grade:
- Language Arts: This year, kids will be introduced to more literary genres. They will also be given more tools for organizing their thoughts about what they have read. Third grade writers will create personal narratives, stories and reports on famous people or interesting animals.
- Math: Knowing the times tables is one of the most important math skills third graders will master this year. This will be crucial for helping them to build the math fluency for more complex math in the upper elementary grades. Times tables can be found in our multiplication worksheets section. Kids will also continue their exploration of division, fractions, and decimal numbers.
- Science: During this year, third graders study more complex scientific subjects, such as the food chain and states of matter. They will also take a closer look at the globe, as they learn to identify land masses and bodies of water.
- Social Studies: Third graders are beginning to understand the ways in which people can interact with their environment. They will learn about modes of transportation and the ways that people communicate around the world and in their community.


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Skydiving.com provides a network skydiving site catering to Milford, as well as some other towns in Beaver County and the whole state of Utah. Exactly what are you waiting on? Call our team right away at 1-800-617-7948 for additional information. Do not forget to ask our team about ongoing skydiving specials in the Milford area!
Each year, 1000s of men and women out of Utah reach out to Skydiving.com to execute their first skydiving event in close proximity to Milford. We strive to service everyone hoping to skydive within the whole entire United States of America. With hundreds of sites across the country, there is no question that Skydiving.com has the most significant amount of sky diving network partners! The 1st step to feel the incredible world of skydiving is to give us a ring at 1-800-617-7948 and enable one of our helpful team members get you on your way! This is unquestionably an one of a kind experience that you will recollect for the remainder of your life, so what exactly are you waiting for?


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A polished version of my Gothica Template is now available for sale on Themeforest:
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New York Newswire (Page 3)
Comprehensive Real-Time News Feed for New York, NY. (Page 3)
Results 41 - 60 of 241 for "u:foxnews.com" in New York, NY
HBO producer, ex-con arrested in doctor's cocaine overdose w/Photo
An HBO producer and an ex-con were busted on drug charges for allegedly plying with cocaine a married Long Island doctor who died of an overdose while partying with the TV exec, authorities said. Dr. Kiersten Rickenbach Cerveny , 38, was found dying in a Chelsea doorway - with her panties in her purse - early on Oct. 4 after the wild drug binge with the married producer, Marc Henry Johnson, 51. She and Johnson, whom she had met in 2009, met up during Cerveny's girls' night out on the Lower East Side before they went to his drug dealer's apartment on West 16th Street, sources have said. Comment?
New York man arrested for murder after seen wheeling dead wife onto lawn w/Photo
Authorities in New York arrested a man Saturday who allegedly was seen wheeling a woman's dead body on a dolly and leaving it on the front lawn of a home. Anthony Lopez, 31, was charged with murder and concealing a human corpse. Comment?
America's insane bachelor pads w/Photo
It's pretty easy to tell someone's relationship status by his or her residence. For many single men today, the dream isn't finding a hot trophy wife-- it's finding a bachelor pad so cool it will make their married buddies want to be single again. Comment?
Thousands of NYC commuters stranded at Grand Central station after track fire w/Photo
A four-alarm fire directly below elevated train tracks in New York City left thousands of commuters stranded at Grand Central Terminal Tuesday evening. The fire broke out at a garden nursery at 119th Street and Park Avenue in the East Harlem section of Manhattan at around 6:30 p.m. local time. Comment?
Nearly 170 NY houses of worship open for tours this weekend w/Photo
This undated photo provided by the New York Landmark Conservancy shows the Unitarian Universalist Church in Canton, N.Y. It is one of the religious institutions across New York state showcasing their art, architecture and history during the New York Landmark Conservancy's annual "Sacred Sites Open House Weekend," from May 21-22, 2016. MANDATORY CREDIT This undated photo provided by the New York Landmark Conservancy shows the Trinity Memorial Episcopal Church in Binghamton, N.Y. It is one of the religious institutions across New York state showcasing their art, architecture and history during the New York Landmark Conservancy's annual "Sacred Sites Open House Weekend," from May 21-22, 2016. Comment?
Revealing photos used in art project on rape stirs controversy at NYC school w/Photo
A group of students at a New York City high school tried using art last week to make a social statement about rape, only to stir controversy with school administrators over the images they chose to do it with. Students at Susan Wagner High School on Staten Island told the Staten Island Advance newspaper the school removed from an art exhibit displayed in the lobby of the building due to its subject matter and its depiction of a bare-backed teen. Comment?
School Horror Story Probe: Teacher involved in alleged rape kept working w/Photo
Rodney Alejandro worked from 2004 to 2010 at Robert Wagner Jr. Secondary School for Arts and Technology in Long Island City and was fired after his state license expired, officials said A former Queens biology teacher who allegedly forced an underage student to repeatedly have sex and demanded she have two abortions skirted authorities after a prominent Catholic school quietly fired him, allowing him to work for years in city public schools, officials report. Rodney Alejandro abused the 15-year-old girl at St. Francis Preparatory School in Queens, and then went on to work for the Department of Education, a 2015 probe by the city's Special Commissioner of Investigation charges. Comment?
Former NTSB official says drone isn't going to bring airplane down w/Photo
Jan. 1, 2015: An airplane flies over a drone during the Polar Bear Plunge on Coney Island in the Brooklyn borough of New York. Airline pilots need to cool their jets about banning drones in their airspace, a former National Transportation Safety Board member said Saturday. 1 comment
Todd Starnes Nyc mayor's Chick-fil-a boycott for the birds w/Photo
Mayor Bill de Blasio and members of the New York City Council are calling for a city-wide boycott of Chick-fil-A - urging citizens to refrain from eating plump juicy chicken breasts tucked between hot buttered buns. "I'm certainly not going to patronize them and I wouldn't urge any other New Yorker to patronize them," the mayor told DNAInfo.com. Comment?
California raises legal age to buy tobacco from 18 to 21 w/Photo
The governor of California on Wednesday approved raising the legal age to buy tobacco for smoking, dipping, chewing and vaping from 18 to 21. Supporters of the law regarding age aimed to deter adolescents from the harmful, sometimes fatal effects of nicotine addiction. The Institute of Medicine reports that 90 percent of daily smokers began using tobacco before turning 19. In April, Hawaii became the first state in the nation to raise the legal smoking age to 21 and more than 100 local jurisdictions around the country have made the change, including New York, Chicago and San Francisco. Comment?
Byrne stayed home for months w/Photo
Rose Byrne arrives at The Metropolitan Museum of Art Costume Institute Benefit Gala, celebrating the opening of "Manus x Machina: Fashion in an Age of Technology" on Monday, May 2, 2016, in New York. Just three months after giving birth to her son Rocco, Rose Byrne looked stunning on the red carpet at the Met Gala Monday. Comment?
Body with cement shoes washes up on NYC beach w/Photo
Police are trying to identify the body of a man who washed up along a Brooklyn beach wrapped in plastic bags with his arms tied around his back, his feet in "cement shoes." New York Police Department Chief of Detectives Robert Boyce said Tuesday the victim had his feet "submerged in poured concrete." Comment?
Rose Byrne didn't leave her house for 3 months after having a baby w/Photo
Rose Byrne arrives at The Metropolitan Museum of Art Costume Institute Benefit Gala, celebrating the opening of "Manus x Machina: Fashion in an Age of Technology" on Monday, May 2, 2016, in New York. Just three months after giving birth to her son Rocco, Rose Byrne looked stunning on the red carpet at the Met Gala Monday. Comment?
Daymond John's Top 7 Tips on How to Launch Your Product Like a Shark w/Photo
Daymond John intimately knows the power of broke . After three failed attempts, the Shark Tank star launched his first business with just $40 and a hope and a prayer. Comment?
Pasta, martinis and wine helped these Italian-Americans get to 100 w/Photo
It's 3 p.m. on Arthur Avenue in The Bronx, and Filomena Magavero settles in for a late lunch inside the venerable Mario's, a favorite Italian restaurant on this strip of Old World butcher shops, fish stores and bakeries. She sips a gin martini , and orders filet of flounder oreganata. Comment?
Autism-friendly Broadway performances allow families to enjoy theater together w/Photo
A child plays in one of the designated quiet areas in the lobby during the February 7, 2016 autism-friendly performance of "Wicked." Una Albers, 15, with her collection of signed Playbills. Comment?
Mexican immigrant cook wins $7 million lotto jackpot in New York w/Photo
A Mexican immigrant chef in New York- who at one point made just $160 a week - collected his $7 million New York lottery prize Wednesday. Eduardo Reyes, a Staten Island restaurant cook, spent 50 bucks on two Golden ticket scratch offs at a liquor store while he was running errands on his day off on March 16th. Comment?
Former college basketball star Pearl Washington dies at 52 w/Photo
Aug. 20, 1986: Dwayne "Pearl" Washington, the first draft pick by the New Jersey Nets, holds up his new uniform during a press luncheon at the Meadowlands Arena in East Rutherford, N.J. There was a gleam that shone through the sorrowful tears in Jim Boeheim's eyes as he recalled the first time he saw Pearl Washington play. It was Washington's sophomore year in high school in New York in the early 1980s, and for the 71-year-old Syracuse coach it will always seem fresh. Comment?
Doc streams breast surgeries w/Photo
Dr. Matthew Schulman, a board-certified plastic surgeon in New York City , works with his team to perform and broadcast his operations on Snapchat. He is part of a growing handful of plastic surgeons in the United States who are using the social media app to educate their patients and market their practices. Comment?
Can these superfood cocktails cure hangovers? w/Photo
After nearly two decades of making hangover-inducing cocktails for Manhattan boozehounds - Iggy Pop among them - at joints such as Le Souk, Jules Aron became a juicehead in the best sense of the word. Burned out on bartending, fatigued by the hours, tired of deflecting peer pressure to drink and sick of being surrounded by drunk people, Aron retreated to a cabin in upstate New York, where she struck upon the idea for her new healthy cocktail book "Zen and Tonic" . Comment?
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By Luca Bonaccorsi, Birdlife.org Exhausted migratory birds are trapped in glue, in agony from thirst …Read More »
Dear Friends and partners We wish you and your family a very blessed EID Mubarak. May God bless you...
Lebanon declares protected area in the World Heritage Site of Byblos
By Majd Abu Zaghlan, The World Heritage Site of Byblos is now officially the 17th Hima in Lebanon. T...
Want to become Homat Al-Hima member? Socialize!
By Vanessa Khaddage For most of us, social media has changed our lives in some meaningful way. Colle...
Celebrating the day of 27,000 protected areas
By Irene Lorenzo, Birdlife.org Over 27,000 sites across Europe have one goal: ensuring the survival ...
Shock and… understand: a strategy to end the Illegal Killing of Birds
By Luca Bonaccorsi, Birdlife.org Exhausted migratory birds are trapped in glue, in agony from thirst...
New study reveals over 75% of bird killing and trapping in Egypt is illegal
Preliminary assessment of the scope and scale of illegal killing and taking of birds in the Mediterranean
Eight million birds killed illegally at 20 Mediterranean locations each year
Slaughter of the song birds
Protecting the Mediterranean's migratory birds
Birdfair 2015 Rutland Water: Hope for migratory birds in the Eastern Mediterranean
Mediterranean Basin Aiming Higher
New scientific report reveals: "2.6 million birds illegally slaughtered in Lebanon every year"
Extent of illegal killing of birds in the Mediterranean revealed in BirdLife report
The new offices of Cambridge-based Birdlife International
The new offices of Cambridge-based conservation charity Birdlife International was opened last month. The new Cambridge …Read More »
Transnational conservation in Turkey could save six threatened bird species
Safe skies for migratory birds in Sudan
Celebrating the day of 27,000 protected areas
The Messengers – what birds tell us about the threats from climate change
By Assad Adel Serhal, Director General, SPNL The Hima approach is a traditional/cultural community-based approach used …Read More »
Hima Women Empowerment workshop in Qolaileh
UN Women launches the 16 days campaign against gender-based violence in the Arab Region
Women Empowerment in Hima Al-Qoleileh: a story of change
Empowerment of women through vocational training on carpet weaving
Providing Water for Birds during hot summer
Like all animals, birds need water to survive. Though they can extract some moisture from …Read More »
Awareness Campaign at Bureau Veritas, Beirut
Moving 2015's historic agreements into action: IUCN World Conservation Congress 2016
Places matter, they map our lives
Marine Heritage Lebanon's Lighthouses Linking culture to nature
New book and mobile app to guide people's interest in nature of Qatar
The Friends of the Environment Center in Qatar (BirdLife Partner for Qatar) have used both …Read More »
Book Review: Back from the Brink
Bird Identification Manual
HBW and BirdLife International Illustrated Checklist of the Birds of the World
The Book of Eggs: A Lifesize Guide to the Eggs of Six Hundred of the World's Bird Species
UN adopts resolution promoting sustainable pastoralism and rangelands
A new resolution on Combating desertification, land degradation and drought and promoting sustainable pastoralism and …Read More »
On the Move Exhibition Opening in Pindos
On the Move Keeps Moving
On The Move is going to Asturias, Spain
On the move exhibition: Geneva Chapter
Storks fly over Lebanon
Storks fly over the town of Faitroun, North East of the capital Beirut, on …Read More »
News in Photos: Farmer stops traffic taking his 5,000 ducks for a walk to the local pond
News in Photos: The Evergreen Lebanon's Forests
News in Photos: Hima Anjar
News in Photos: Transhumance in Sghar, Batroun
Field guide to Butterflies of Lebanon and the Middle East Written and Illustrated by Husein Ali Zorkot
A vivid world of butterflies awaits in this comprehensive field guide. For the first time, …Read More »
Field Guide to the Mammals of the Middle East: Second Edition [Hardcover]
Places matter, they map our lives
SPNL Launches The Hima Guideline Manual
Marine Heritage Lebanon's Lighthouses Linking culture to nature
SPNL's News
July, 2016
4 July
SPNL Mapping platform
4 July
Sensational Butterflies at the Natural History Museum
Enjoy a perfect family experience at the Natural History Museum's Sensational Butterflies exhibition this summer. Assad Serhal, Director General of Society for the Protection of Nature in Lebanon- SPNL , visited the exhibition and met with the Butterflies expert discussing future collaboration with SPNL. SPNL recently published a "Field guide to Butterflies of Lebanon and the Middle East Written and Illustrated by Husein …Read More »
4 July
Dear Friends and partners We wish you and your family a very blessed EID Mubarak. May God bless you with good health, peace, joy, and prosperity for the holiday and always. For those who celebrate the holiday, we wish you a blessed EID and for those who do not, we wish you the best for the years to come. Let …Read More »
June, 2016
4 June
Homat Al Hima training on Water and Sustainable Agriculture
As part of the series of trainings that SPNL is conducting under Homat Al Hima, the 7th training on Water and Sustainable Agriculture took place on Saturday June 4th, 2016. The training workshop was conducted in Al Hima center located in the village of Kfar Zabad, with the attendance of participants from the local communities of both Anjar and Kfar …Read More »
May, 2016
24 May
Mescapes Project Results Summary
By Shalimar Sinno , Project Coordinator MedScapes Project, which has been funded by the multilateral cross-border cooperation "Mediterranean Sea Basin Programme" of the European Neighbourhood and Partnership Instrument (ENPI CBC-MED 2007-2013), has successfully come to an end. For the past two years, MedScapes brought together eight partners from four countries –Cyprus, Greece, Jordan and Lebanon: Laona Foundation for the Conservation …Read More »
24 May
Want to become Homat Al-Hima member? Socialize!
By Vanessa Khaddage For most of us, social media has changed our lives in some meaningful way. Collectively it is changing the world for good. Given the pace of innovation and adoption, change has become a constant. Every so often we find the need to stop and reflect on its most recent and noteworthy developments, hence the following list. As …Read More »
21 May
Homat Al Hima Training on Flora and Fauna identification
As part of the series of trainings that SPNL is conducting under Homat Al Hima, the 6th training on Flora and Fauna identification took place on Saturday May 21st, 2016 within the EU funded project "Enhancing livelihoods of Local Lebanese communities in Hima territories; from social, economical and natural prespectives". The training workshop took place in Al Hima center located …Read More »
April, 2016
2 April
MAVA celebrate conservation hero Dalia Al Jawhary
Mava Foundation Annual Report filled with more conservation success stories from partners. As well as offering a review of some of 2015's highlights. The report share an overview of Mava's new strategy for the years 2016-2022. Inside, we discover how IUCN's PROMETEOS project set about creating an atlas of the Mediterranean's amazing system of seamounts and canyons to support better marine governance; …Read More »
March, 2016
13 March
Waterbury joins SPNL Homat al-Hima Activity in Anjar-Kfarzabad Hima
Dr . John Waterbury, former AUB President, visited Hima Anjar Kfarzabad in the Beqaa Valley, Lebanon, accompanied by Dr. Ghassan Jaradi for bird watching in the Hima sites. During the visit Dalia Jawhary, Hima Programme manager introduced Dr. Waterbury to several SPNL initiatives in both Anjar and Kfarzabad where He toured the Hima site in the presence of Anjar mayor Garo …Read More »
7 March
Participate in the photo contest MED-PHARES
Premises The main theme is the lighthouses, semaphores and maritime signaling systems of our coastline. In particular, pictures submitted in the contest must refer to one of the following geographical areas: Italy, France, Tunisia, Lebanon. Participation in the competition Participation in the competition is restricted to citizens of the partner countries of the project, and can be individual or group. In the latter …Read More »
December, 2015
31 December
Season's Greetings
Dear colleagues and friends Blame it on the Christmas spirit, or simply on the fatigue of a frantic season of work, but for once, we are tempted to indulge in a little optimism. Wishing you happy holidays and a prosperous New Year. It has been a pleasure working with you and we look forward to our continued partnership in 2016. …Read More »
31 December
Extraordinary 2015: Collaboration is the engine of innovation at SPNL
Our mission at SPNL is to work together for nature and people. As part of our longstanding commitment to Nature, we work with our partners to develop innovative approaches to the local communities. Collaboration is the engine of innovation at SPNL. Many events in 2015, have warmed our hearts and will live with us in the years to come, the …Read More »
13 December
International Conference on Landscape of the Eastern Mediterranean
International Conference on Landscape of the Eastern Mediterranean: Challenges, Opportunities, Prospects and Accomplishments Under the patronage of Her Royal Highness Princess Basma Bint Ali, the German Jordanian University GJU and the Royal Society for the Conservation of Nature RSCN organized the international conference on "Landscapes of the Eastern Mediterranean: challenges opportunities, prospects and accomplishments". The Conference is conducted on 13th and 14th …Read More »
November, 2015
28 November
SPNL recognised as a finalist for the Equator Prize 2015
The Society for the Protection of Nature in Lebanon chosen as a finalist for the Equator Prize 2015. The Equator Prize is awarded biennially to recognize and advance local sustainable development solutions for people, nature and resilient communities. As local and indigenous groups across the world chart a path towards sustainable development, the Equator Prize shines a spotlight on their efforts …Read More »
27 November
SPNL Participates at IUCN Regional Forum of Conservation
Under the title ; "Innovative natural solutions: Motivating change" The 8th Regional Conservation Forum (RCF) was be held in Amman, Jordan from the 10th – 12th November, 2015. The Regional Conservation Forum (RCF) aims at providing governments, NGOs, partners and the private sector a platform to engage; to discuss key conservation issues as well as provide an opportunity to prepare for an …Read More »
Wings and Waves June 2016
No Images? Click here Field guide to Butterflies of Lebanon and the Middle East Written and Illustrated by Husein Ali Zorkot A vivid world of butterflies awaits in this comprehensive field guide. For the first time, the butterflies of Lebanon as well as those from Morocco to Mesopotamia and the Arabian Peninsula are found together in one volume. In …Read More »
Wings and Waves Newsletter April – May 2016
Wings and Waves Newsletter February – March 2016
Wings & Waves Newsletter December 2015
Wings & Waves Newsletter November 2015


text:
John DeLorean Quote
Interview for SPIEGEL (spiegel.de), in 2008
"Liberty is the right of every man to be honest, to think and to speak without hypocrisy."
―Jose Marti
Martí : Thoughts/Pensamientos (1994)
"It's a bizarre but wonderful feeling, to arrive dead center of a target you didn't even know you were aiming for."
―Lois McMaster Bujold
Cordelia's Honor (1996), Author's Afterword
"Life is like playing a violin solo in public and learning the instrument as one goes on."
―Samuel Butler (novelist)
Speech at the Somerville Club, February 27, 1895.
As quoted in: Newsday, 11 February 1988
Picture Source: WikipediaJohn DeLorean
Born: January 6, 1925
Died: March 19, 2005 (aged 80)
Nationality: American
Occupation: Businessman
Bio: John Zachary DeLorean was an American engineer and executive in the U.S. automobile industry, most notably with General Motors, and founder of the DeLorean Motor Company.
Quote of the day
"Don't be afraid. The dead cannot hurt you. They give you no pain, except that of seeing your own death in their faces. And one can face that, I find."


text:
Printed Writings 1641-1700: Part One - Volume 4: Writings on Medicineby Lisa Forman Cody, Elizabeth Cellier, Mary Trye, Lisa A. Cody
Pub. Date: 03/01/2002
Publisher: Taylor & Francis
The four works in this volume are the only known exclusively medical texts written by women during the Restoration. Their importance is denoted by their dramatic challenge to the generalisations once made about medical practice and female healers in this period. Jane Sharp's The Midwives Book was the first and only midwifery manual to be printed in English before 1700, and continued to be influential into the early eighteenth century. The principal focus of Elizabeth Cellier's To Dr.--- (1688) is the attempt to legitimate the notion of a female corporation of midwives through historical precedent. To Dr.--- was in fact borne out of a previously unpublished effort, 'A Scheme for the Foundation of a Royal Hospital', sent to James II in 1687. In the document, Cellier outlined a specific scheme for training female midwives and supporting poor, pregnant women and abandoned children. Mary Trye began practising 'chymical physic' at her father's side in London in 1663. Her only known work, Medicatrix, was published in 1675. Trye claimed female medical authorship to be unique, in that women observed nature truly and administered genuine medical solutions to the sick. The writings of Sharp, Cellier and Trye have helped to overturn historians' assumptions about a woman's role in medicine and healing. These texts reveal their female authors to be as learned in the humanities and sciences as they were in medical matters.
Product Details
- 9780754602149
- Publisher:
- Taylor & Francis
- Publication date:
- 03/01/2002
- Pages:
- 638
- Product dimensions:
- 5.90(w) x 9.30(h) x 2.10(d)
Table of ContentsContents: Introductory Note; The midwives book. Or the whole Art of Midwifry discovered, Jane Sharp; To Dr.-an answer to his queries, concerning the colledg of Midwives 'A scheme for the foundation of a royal Hospital'; Elizabeth Cellier; Medicatrix, or the woman-physician, Mary Trye; Appendix: The mid-wives just petition: or, a complaint of the divers good gentlewomen of that faculty.
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test kit Equipment in Manitoba
In Manitoba | Available in Manitoba| Near Manitoba
2 Results found
Current filtering criteriaYou can remove a filter by clicking on the x
Complete Test Weight Determination Kitby DIMO'S TOOL & DIE/Labtronic based in Winnipeg, MANITOBA (CANADA)
Complete Test Weight determination kit: includes New ABS Plastic 0.5L measure, ABS Regulation Cox Funnel, Strike-Off Stick and conversion charts. Bottom pan not included.
Level TROLL Familyby In-Situ, Inc. Distributor in MANITOBA (CANADA)
From advanced aquifer characterization, to long-term monitoring, to economical data collection, you'll find a water level instrument perfectly suited to your application and budget.


text:
Replicating and reshaping segments
Replicating and reshaping segments
All right, so I have gone ahead and traced the left side of this creature's formidable head here, his right side of course. As well as the series of four of these spikes or scales or whatever they are and I have gone ahead and saved off my illustration thus far as the Sharp scales.ai found inside the 09 Pen tool folder. Now wouldn't it be nice if we could take some of the scales that we have drawn and go ahead and replicate them in order to create some more of these scales, more of these spikes. And truly we can, there are ways to shortcut things in Illustrator so the shortcut we will take one that we will further our understanding of the program.
So, I'm going to go ahead and armed with my White Arrow tool drag across these scales like so, in order to enclose a bunch of the points. Actually let's go ahead and zoom in so we can see them more closely. Now, I want to copy these spikes and replicate them, but the way I have done it so far you will notice that I got this anc...
Replicating and reshaping segments provides you with in-depth training on Design. Taught by Deke McClelland as part of the Illustrator CS4 One-on-One: Fundamentals
- Subject:
- Design
- Software:
- Illustrator
- Author:
- Deke McClelland
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Combating Criminalized Power StructuresRowman & Littlefield Publishers 2016; US$ 34.99
Criminalized Power Structures: The Overlooked Enemies of Peace, articulates a typology for assessing the threats of CPS illustrated by many case studies. more...
Role of IntellectualsReal African Publishers 2016; US$ 19.99
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Children, Youth and DevelopmentTaylor and Francis 2016; US$ 90.00
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Living Class in Urban IndiaRutgers University Press 2016; US$ 29.95
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A Corporate Solution to Global PovertyPrinceton University Press 2016; US$ 24.95 US$ 19.96
World leaders have given the reduction of global poverty top priority. And yet it persists. Indeed, in many countries whose governments lack either the desire or the ability to act, poverty has worsened. This book, a joint venture of a Harvard professor and an economist with the International Finance Corporation, argues that the solution lies in the... more...
Professions and Power (Routledge Revivals)Taylor and Francis 2016; US$ 44.95
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text:
Child of Light Complete Edition (Playstation Vita)
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- PEGI Rating: Ages 7 and Over
- Media: Video Game
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The kingdom of Lemuria is in despair. The Black Queen has stolen the sun, the moon, and the stars. You play as Aurora, a young princess with a pure heart whose soul is brought to the kingdom of Lemuria. Embark on a quest to recapture the three sources of light, defeat the Black Queen, and restore the kingdom of Lemuria. An adventure waits! Created by the talented team at Ubisoft Montréal using the UbiArt framework, Child of Light is an RPG inspired by fairytales. Take an extraordinary journey through the vast world of Lemuria and explore its mythical environments, interacting with its inhabitants as you discover new locations and their secrets. Key features The breathing world of Lemuria. Across your experience through Lemuria you will meet encounters that you will remember, from friendly fairies and gnomes to vile wolves and dark dragons. Fight monsters and evil mythical creatures. Aurora has the power to fight creatures from the dark and to restore the Stolen Lights. Fight alongside the Igniculus in Active Time Battle systems. Your firefly ally can be controlled by another player, so you can live this adventure with your friends.
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our 8 year old niece loves this game. her daddy is also a fan. good to see some games with a female protagonist tooPublished 1 month ago by kelsurprise
Bought as a gift for my son, so the five stars are his and this is what he had to say: "Great art and story with fun gameplay."Published 11 months ago by ManicScribbler
Guess I'm playing a different game to everyone else here. It's awful! Boring and badly written storyline. And it's NOT an RPG. Rubbish!Published 14 months ago by J.wms
Already have the PC version on it and already beat it.
This is a very beautiful (and easy) rpg game that I suggest to everyone!
I'm loving re-playing it on my PS Vita!!
Everything was fine. The parcel has arrived after few days. Personally, i recommend the game.Published 16 months ago by Valiant
Unbelievably beautiful game with stunning artistic visuals and soundtrack. Slightly bizarre story but wonderful game nevertheless.Published 16 months ago by Laurence
A good game very entertaining and with nice music/soundtrack , works also great in high resolution on my Vita TVPublished 18 months ago by Alex N
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StartUpHire is the place to find Culture Development Intern jobs. Review the list of Culture Development Intern career opportunities to the left. These Culture Development Intern jobs represent some of the most rewarding careers available.
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at Houzz Irvine Houzz is looking for a smart, highly organized, creative, hard working (paid) Intern to join our Marketplace team in Irvine. This individual should be prepared to work in a fast-paced team environment and will finish the internship having gained broad experience7/19/2016 Irvine, CA Save This Job
at Houzz Palo Alto Upgrade your career at one of the hottest startups in Silicon Valley! If you are great at what you do, thrive in a highly collaborative environment, and don?t mind the occasional meeting in the bathroom (don?t worry, it?s just one of our conference rooms), we6/19/2016 Palo Alto, CA Save This Job
Description MarkMonitor?the world leader in brand protection and a Thomson Reuters Intellectual Property & Science business?is looking for a college-level accounting intern for 30 hours per week, seeking to gain experience and knowledge in a professional accounting6/7/2016 Boise, ID Save This Job
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Friday, February 19, 2016 OVERVIEW Catalyst is a fast-growing application development services company with development centers in Baltimore, Maryland and Beaverton, Oregon providing onshore Agile application solutions. Using a Moneyball-like analytics-based approach to team6/5/2016 Baltimore, MD Save This Job
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Engineer The Future SpaceX is a U.S.-based advanced technology company founded by residing CEO and CTO, Elon Musk. Founded in 2002, SpaceX builds rockets and spacecraft from the ground up, including cutting edge electronics, software, vehicle structures, and engine systems. The7/19/2016 Hawthorne, CA Save This Job


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Home > My timeline > This blog has been replaced…
This blog has been replaced…
by my new blog.
Categories: My timeline
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Your gains from Scientology
Purpose: To help differentiate between the Scientology philosophy and the Church of Scientology.
Feel free to contribute by adding your comments to the blog posts. When you do, please observe the rules of this blog.
Note: I will not post or link to confidential material on this blog. Scientologists should feel safe coming here to get truth.
Spread the word: Feel free to translate my Doubt write-up and spread it far and wide. Use OpenOffice to open the file. Please keep the formatting so that it remains a valid WOIM list. It is already translated into German
Recent blog posts
- This blog has been replaced…
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- And the Why is … *drumroll*…
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- OSLO May 16 – Confirmations
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Missouri's First All Black Town
Sr., John A. Wright
Ce livre peut être téléchargé sur votre Mac ou appareil iOS avec iBooks, et sur votre ordinateur avec iTunes. Les livres peuvent être lus sur votre Mac ou appareil iOS avec iBooks.
Kinsman Township is part of the Connecticut Western Reserve. It is more reflective of this connection than many communities because John Kinsman, one of 35 men who formed the Connecticut Land Company in 1795 to purchase the land and have it surveyed into five-mile-square townships, actually made this his home and encouraged his Connecticut neighbors to do likewise. Kinsman first saw his land in 1799, traveling via horseback with his brother-in-law Simon Perkins, an agent for the land company who would become the most prominent settler of nearby Warren. Their small entourage entered the area that would become Kinsman and built a cabin near the southeast corner of the current square. The Lakeshore and Southern Michigan Railway came through the area in 1873, leading to a flurry of entrepreneurial activity. A fire dramatically altered the face of the original square, but many new fashionable homes rose out of the ashes. The Kinsman Fair also became a major event in the area, drawing thousands to its commodious facilities. This book commemorates the rich history of Kinsman through vintage photographs.
- 4,99 €
- Catégorie: États-Unis
- Sortie : 27 nov. 2000
- Éditeur : Arcadia Publishing
- Pages : 128
- Langue : Anglais