text:
My husband and I have been having an ongoing argument for the past two days about Caleb Moore's snowmobiling accident in this year's X Games.
In case you don't already know, Moore was attempting a backflip when he came up short, and his 450-pound snowmobile landed on top of him. As of press time, he was still in critical condition with major head and chest trauma, and his grandfather told The Denver Post that his prognosis was pretty dire.
Ryan's take is sort of a "boys will be boys" perspective.
"Why is everyone blaming ESPN? How is it their fault?" he bellowed, his volume rising as it often does when his mouth is open and words are coming out of it.
"Why are you yelling?" I said, my computer on my lap as I stalked people I no longer speak to on Facebook. "You don't think prime-time television, sponsor dollars and prize money is going to encourage someone to go too far?"
He flashed me one of those don't-you-dare-disagree-with-the-king looks, pursing his lips together in frustration before he spoke.
"No, I don't. We did that kind of stuff as kids all the time. I'm lucky I never got killed."
I didn't say, "I wouldn't call driving your Chrysler E-Class nose-first into a frozen lake the same thing as doing backflips on a snowmobile." Instead I said, "I'm not having this argument with you. We'll just have to agree to disagree."
Here's the thing. Over the course of my career, I've known a lot of athletes who have risked their lives and some who have died.
Whenever an athlete dies doing something that is inherently risky and sometimes just plain stupid, they are regarded as a martyr. They are revered for "dying doing what they loved." They are forever immortalized and cherished by the people who are left behind and are forced to make these kinds rationalizations in order to survive their grief.
While I get that these athletes often are beloved because of the very qualities that make them the best at what they do in the first place, I don't see it that way. I see it as selfish, and it seriously pisses me off.
I have a friend who is a professional snowboarder who is constantly pushing the limits of riding big mountains. He's been doing this now for well over a decade, taking what he calls "calculated risks" and reiterating to me and anyone who asks that he is not afraid to walk away when things don't feel right. He is deeply respected and highly regarded by everyone who works with him for his meticulousness in risk assessment and backcountry expertise.
When his daughter was born almost eight years ago, I asked him, "So now that you've had a baby, are you going to stop doing this stuff?"
A typically mellow dude, he was as incensed as he was perplexed by this question.
"Why would I stop now? I'm the strongest I've ever been," he said, dismissing me as much with his words as with his tone.
Now that he has two kids, I asked his wife how she copes with it.
"I really don't know much about what he's doing until it's already over," she said, hidden behind a frozen smile.
I remember that when I asked her about it before they were even married, she said, "He told me if I express my fears or my doubts, it could jeopardize his safety, just planting that seed in his head. So I don't say anything."
Other athletes' wives I've talked to over the years say they just learn to accept it.
"It's like being married to a pilot or a firefighter," one said. "It's who he is."
In the trailer for an upcoming documentary on Shane McConkey, who died ski BASE jumping in Italy in 2009, Scot Schmidt said, "People like Shane would say they're not afraid of death. They would say they're afraid of not living life fully."
In Shane's own words, "It's not that I like to scare myself. It's just a byproduct of what we do."
In the three-minute trailer, there are photos of his wedding, of his baby girl, of his father crying and his friends tearing up.
Everyone loved Shane, but I'm sorry: Isn't it time to think about hanging up your BASE-jumping parachute when it's not just your life at stake but the people who love you and will suffer heartbreaking grief when you're gone?
In the documentary, Shane's wife is as stoic as she is beautiful when she says, "I would never stop him from doing what he loved."
We've lost members of our own community to skiing and snowboarding accidents and avalanches, some of them the result of risk taking or poor judgment, and some of them were just accidents.
The same could be said of Moore. This was a trick he'd landed dozens of times, so what went wrong? Was it some random, arbitrary, butterfly-flapped-its-wings event that can cause any number of fatal accidents? You always hear people defend their dangerous pursuits with the line, "It's no less dangerous than driving on the freeway in your car," but I'm not so sure.
What I see are people who, despite their expertise, are increasing their odds every time they take a "calculated risk," and sooner or later, as we have witnessed countless times, it catches up with you.
I also find it disturbing that ESPN has remained silent in terms of covering Moore's story other than to release a statement that essentially denies responsibility. I guess an accident of this magnitude wasn't supposed to be part of the show.
While I do think it's a little, er, extreme to hold ESPN accountable, I also think there's a point when the whole concept of "extreme" becomes something else entirely, like insane.
To donate money to help pay Moore's medical bills, go to www.giveforward.com/calebmoore. Send your love to email@example.com.


text:
Tie Your Pink On is World Council's Global Women's Leadership Network campaign concept that Joe Schroeder, CEO of Ventura County Credit Union and Kim Hester, EVP of CO-OP Financial Services suggested to engage all genders in the network.
"World Council's GWLN is a one of a kind network," stated Patsy Van Ouwerkerk, GWLN Advisory Group, GWLN Golf Committee Chair and CEO of Travis Credit Union. " It was created to provide women with access to a global community of credit union leaders dedicated to advising each other and to cultivating the leadership potential of women in the United States and worldwide. As a credit union CEO, I appreciate the importance of having a place to connect with other leaders facing similar challenges in a drive to effect positive change."
The World Council's Global Women's Leadership Network is making a difference in the U.S.:
· scholarships,
· outreach programs,
· regional and global network societies,
· Ventura County Engagement,
· community efforts and professional development.
"We wanted to get the word out on our important work, and have some fun promoting the network and engaging others, why not join us?" asked Patsy.
You can "Tie Your Pink On" with a $20 donation at the World Council booth or look for people with pink ties who have committed to establishing this one of a kind credit union network. Learn more about getting involved in Global Women's Leadership Network by visiting, cuwomen.org or contact Nicole Bice, email@example.com or Valerie Breunig, email@example.com .

subset: commoncrawl


text:
Back in the mid-1990s, I attended an event on the Microsoft campus, and happened to overhear a conversation between two engineers who worked on the company's popular Excel product. The more experienced programmer was offering advice and guidance to a new recruit, and part of the discussion included a warning not to modify certain portions of the internal Excel source code "because nobody knows how those parts work." Having spent a lot of quality time on customer projects grappling with some long-gone programmer's attempt at source code, I didn't doubt the gist of the conversation. But I had no ability to examine any of the Microsoft Office source code to see for myself if there were in fact portions beyond the comprehension of mere mortals.
Until now, that is. This week, Microsoft announced the public release of the source code for an early version of its Word for Windows application, as well as for two initial releases of its MS-DOS operating system. Microsoft donated the code for Word version 1.1a (from 1990), and for MS-DOS versions 1.1 (from 1982) and 2.0 (from 1983), to the Computer History Museum (press release). The files are posted on the Museum's web site, and either MS-DOS or Word can be yours for the price of a simple click on a license agreement button.
Be aware: the code is really, really old, at least in terms of geologic software time. Yet those were simpler times. The MS-DOS 1.1 release fit into just 12K of memory—try that with Windows 8.1—a feat accomplished by coding directly in assembly language. It's compact and terse, and a perfect magnet for bloatware. By the 2.0 edition (included in the same download), the size of the source had grown more than tenfold.
The Word for Windows code is mostly a C-language endeavor. Programming in managed languages and client- and server-side script has dulled me to the former harsh realities of Windows development. I had forgotten that world of message loops, obsessive-compulsive memory management, and the need to draw almost everything on the screen by yourself, including the blinking cursor.
If assembly language and non-OOP C code aren't your style, you might also consider Microsoft's .NET Framework Reference Source web site. For years, Microsoft has made much of it's .NET Framework source code available to developers as a debugging aid, but that access was limited to the Visual Studio environment or a brute-force download of the entire library. A few weeks ago, Microsoft simplified access to the source by webifying it. The updated Reference Source web site lets you browse through Framework source files, a mixture of C# and Visual Basic content.
Beyond these Microsoft sources, the Computer History Museum also offers glimpses of computer code for other historic systems, including Apple II DOS, MacPaint, and an early release of Adobe Photoshop. If you have any geek blood in you at all, take a moment to pull back the veil from these programs.
This article was posted on March 29, 2014. Related articles: Technology.
Footnotes for "Read Real Microsoft Source Code!"
Do you think that it would be better to put the date the article was posted at the beginning? To me that gives a better perspective when reading the article. Few things are timeless and unchanging.
This article is a good find. Thanks for posting it.
Thanks for the input, Jon. I do put the month and day at the top, but the year only at the bottom near the comments. If you're reading the article through a third-party RSS reader, you might not see them. I'll consider having the date more prominent the next time I make major changes to the site's design.


text:
Dear VIP families and friends,
As many of you know, I am retiring from my position as Administrator of our region's Very Important Player Program (VIP). VIP has been near and dear to my heart. I would like to take this moment to share some of the history of the program and the lessons I have learned from it.
I helped launch VIP in the fall of 2006, when my 12 year-old daughter, Kara, was looking for a way to be of service to the community. Kara loved playing soccer on both AYSO travel and non-travel teams. We learned that our AYSO region was interested in offering a soccer program to kids with special needs; this program, called VIP, already existed in other AYSO regions. With Kara's enthusiasm in mind, I agreed to launch VIP for our region starting Fall 2007.
That first fall we had a handful of players; Kara corralled friends and soccer teammates to assist as peer volunteers. Within the year, Julie Sarne and her mother, Nancy, and Marissa Leib-Neri and her mother, Lisa, volunteered to help coordinate the VIP program.
As coordinators, we had little experience with kids with special needs. Through the patient help of parents, we learned to maintain consistency and predictability in our practices and cultivate independence in our players. Most importantly, we learned the value of developing relationships between kids with special needs and typically developing kids.
The program is continually evolving as we gather new knowledge and adjust to each year's participants and coaches, but one aspect that remains constant is having youth volunteers assist players.
I am passionate about our decision to include youth volunteers. It is a unique opportunity for our city's adolescents to give back to their community in a meaningful and independent way. I have relished watching these young volunteers grow to enjoy and interact with others who communicate and learn differently from them.
Another constant that became clear early in the development of our regions' VIP is its pluralistic nature. We have a broader range of nationalities than the mainstream programs in our region, including families with limited understanding of the English language, access to technology or financial resources. I am grateful to the Region's board and fellow Coordinators for striving to accommodate these families, whether through financial aid, additional registration days, or translations.
As I reflect upon the history of our program's development, I proudly embrace how our program is about so much more than offering soccer to kids with special needs. I am most grateful to our players, who have deepened my understanding of human nature and "disability." As a result of my involvement with the program, I have a greater appreciation for the spectrum of how we express our feelings: fears, obsessions, love, joy. I can more effectively intuit ways to communicate with others, including touch, tone of voice, gesture, and simply presence.
VIP reminds us that our challenges and vulnerabilities are part of the human condition and that we are all connected, regardless of our ethnic, economic, physical, social or cognitive differences. In sum, the VIP program is a unique and vital opportunity for all of our community.
I am excited about the capability and enthusiasm of next years' Coordinators, including Jonathon Weatherly, who will be taking my place as VIP Administrator, and Hedy Keiderling, who will continue as Volunteer Coordinator.
Thank you all for honoring me with the opportunity to learn from and work with you and your children over the past 7 years.
Ellyn Bank
August 20, 2013


text:
The 29-year-old from Mohacs is one of the reasons why tens of thousands of people flock every year to the track in the outskirts of Budapest.
'Norbi' himself cannot explain why he is so popular at home.
"When I first saw, in 2011, the kind of crowds coming to support me, I was completely flabbergasted," he said.
"It was certainly one of the most emotional moments in my life. I do feel all this support and love every time at the Hungaroring, it is something that I cannot explain, but that makes me very happy. Every year, I can't wait to get to my home race."
This year, it may prove more difficult for 'Norbi' to repeat success at home, as he did in 2012, but he'll try.
"It is going to be more challenging. It has been a tough start of the season, in terms of performance, and we have a big task ahead to develop the new Honda.
"We want to progress as much as possible, be consistent and aim at the podium, but I can promise my fans I will give my utmost to reward them for their support."
- Sports & Recreation


text:
Miranda Velarde will be a senior next year at Yreka High School and for her senior project, she is coordinating a fireworks sale to raise money for Ringe Pool. Ringe Pool is the city pool in Yreka managed by SPLASH, a nonprofit organization. Many improvements are needed to upgrade and enhance the over-50-year-old facility.
Everyone can help Miranda in her efforts to improve Ringe Pool for the entire community by shopping at the fireworks booth (TNT products) located in the Raley's parking lot in Yreka. Hours of operation are this Saturday from noon-8:30 p.m., this Sunday thru July 3 from 8:30 a.m.-8:30 p.m. and on Friday from 8:30 a.m.-2:30p.m.
Location, ST | website.com


text:
shoppers recently viewed this!
Melissa & Doug
Numbers, Stack And Sort, & Abacus Set
- Color:
- multi
Qty: 1
- 1
- 2
Description: Magnetic Wooden Numbers
- Enough numerals to count from zero through twenty AND five math signs in a convenient wooden case
- 37 colorful magnetic pieces can help children learn their numbers and solve basic math problems
- Dimensions: 1½" x 5½" x 8" Packaged
- Recommended Ages: 3+ years
Stack & Sort Board
- The 15 wooden pieces in this first-manipulatives set offer a variety of colors, shapes and opportunities for leaning
- A printed key on the wooden base offers guidance when it's wanted, but the possibilities for play are endless!
- Use these colorful blocks to encourage matching, counting, stacking, dexterity, fine motor skills, color recognition and more
- Dimensions: 4½" x 2½" x 13.3" Assembled
- Recommended Ages: 2+ years
- This wooden "calculator" helps teach math skills, patterning and color recognition
- Slide and count the beads with this timeless counting frame
- Fun activity ideas included!
- Dimensions: 11.9" x 12" x 3" Assembled
- Recommended Ages: 3+ years
Material: Activity Set
Brand: Melissa & Doug
Origin: Imported


text:
The first three months of 2013 featured a heavy rain event, an ice storm and heavy snow. However, severe storms were few, with only six tornadoes (mostly weak) counted.
The severe weather season got kick started briefly on April 10th. Four tornadoes (rated EF1/EF2) were spawned, with the most significant of these tracking through Van Buren County. Wind gusts reached 90 to 100 mph at Horseshoe Bend (Izard County), and this caused extensive structural damage.
Storms didn't keep coming because the spring was just too cool. Adding up all of the numbers, it was the fifth coolest March through May (meteorological spring) on record (an average temperature of 57.3 degrees).
Spring highlights included much below normal temperatures in March (by 3 to 6 degrees). Freezes in April were the latest since 1960 at Booneville (Logan County), and since 1963 at Batesville Lock and Dam (Independence County) and Harrison (Boone County). In early May (on the 3rd/4th), light snow fell in the northwest counties. There had not been any snow in the state this late in spring. The previous latest snow was on April 30, 1903. All-time May cold temperature records were also broken.
Up to this point, not only was severe weather absent in Arkansas, it was also quiet nationally. Across the country, the tornado count from May, 2012 through April, 2013 was the lowest on record since 1954. That all changed in late May, with numerous tornadoes spawned from the upper Midwest into the Plains.
One of the biggest events of the year happened on May 20th. A tornado widened rapidly just west of Moore, OK and tore through town. Neighborhoods were flattened and became unrecognizable. Winds swirling around the tornado (rated EF5) were estimated over 200 mph. At least 24 people were killed. It was perhaps the worst tornado disaster since the Joplin, MO tornado in May, 2011.
As May ended, there was an outbreak of severe weather locally. The central third of the state was affected by a total of 14 tornadoes on the 30th/31st, with a fatality at Tull (Grant County). There was another tornado in Madison County early on June 1st. Parts of Scott, Polk and Montgomery Counties received more than 10 inches of rain. Floods/flash floods claimed 6 lives.
There was enough rain through mid-June to stave off drought conditions in much of Arkansas. However, rain shut off late in the month and into July. Drought began spreading eastward through the area.
As the ground water supply dwindled, the sky opened. There were some ten to fifteen inch precipitation totals (and locally more) across the northern and western counties to finish July and begin August. Sites receiving this much rain included Harrison (Boone County), Mountain Home (Baxter County), Calico Rock (Izard County), Gilbert (Searcy County), Mena (Polk County), Waldron (Scott County) and Murfreesboro (Pike County). These amounts were 1st or 2nd highest all-time in the thirty day period ending at 700 am CDT on August 14th.
Of course, this much rain resulted in some flooding in early August. On the 8th, Highway 7 at Harrison (Boone County) was under four feet of water on the west side of town. Highway 65 was blocked off due to flooding. Not far from Omaha (Boone County), Bear Creek rose 18 feet and covered Highway 14.
On the 10th, low water crossings near Pyatt (Marion County) had more than a foot of water over them. Some roads in Bergman (Boone County) looked more like rivers. A bridge near Pineville (Izard County) was seriously damaged, with two foot bridges washed away by an overflowing creek at a park in Calico Rock (Izard County).


text:
These products were recalled recently. Watch out!
Fisher-Price 3-in-1 high chairs – falling
Acer Predator desktops – burning
FloraCraft Solar System Kits and DNA Kits – lead
Fleece child hoodies with drawstrings, various brands – strangulation
Zebco children's fishing poles – lead
Four Star Fresh Décor 10 Count LED Star String Lights – fire
OKK Trading Baby Necessities pacifiers – choking
Aviva trampoline – falling
Human Touch "Perfect Chair" – entanglement
Montessori N' Such containers – lead
Recent Recalls
These products were recalled recently. Watch out!
Jebus. Everything is out to kill us.
Looks like lead wins this weeks contest.
Hasbro's "My First Methlab" – Trailer Park Fires
Seriously, the "drawstring" strangulation recalls are idiotic. Does no one WATCH their children anymore?
@Oranges w/ Cheese: Do you watch your 10 year old playing on the playset in your own backyard 100% of the time standing no more than 5 feet away from them at any given point in time so that when the drawstring gets caught on the edge of the slide and their full weight of their body is transfered to the drawstring that is around their head and the child can not get oriented to remove their body weight from the drawstring, you will be ready to lift the child up and save them from strangulation? Doubtful. The concern is not kids tightening the drawstrings to make them look like Kenny on Southpark, the concern is that the strings will get caught in something while the kids are playing and strangle themselves.
As kids get older parents will watch by opening up a window and listening for the kids who are running and laughing (eerything is fine), crying (kid fell down and hurt themselves, or silence (usually means trouble). If you are not letting your 10-12 year old more than a arm's length away from you they will probably have social issues to deal with as they become adults.
The bigger question is why are manufacturers still after 12 years of this issue coming to light still not replacing the drawstring with elastic?
@Rachacha: Don't most drawstrings come out – I mean, that's what they do – they tighten on both sides from the middle and will come loose if you pull only on one end.
@Oranges w/ Cheese: Take a look at this image [images.google.com] and I think you will get an idea of how easily a child could become strangled by a drawstring if the free end were to get caught on a piece of playground equipment.
@Oranges w/ Cheese: If the drawstring is a choking hazard it shouldn't be there in the first place and you shouldn't have to "fix" it yourself. That's kind of the job of the manufacturer. To make it as safe as possible to begin with. PERIOD. This has nothing to do with parents not watching closely enough, and everything to do with a poorly made, dangerous jacket for children. That could choke them. Better safe then sorry, no? I don't see the complaint here at all.
@Oranges w/ Cheese: Uh, kids are sneaky and a handful, and I do not want a drawstring that could choke them near them. If you turn away to pet the dog and they strangled themselves, something tells me you would be suddenly up in arms about the drawstring.
@Oranges w/ Cheese: And it's a JACKET! Do you watch your children closely so they don't choke on the clothing they wear? Something tells me … no.
I wish someone would come out with a vaccine against lead so we could quit having all these recalls.
@Canino: Like a giant magnet? Wait is lead magnetic?
Also, what a great invention – that high chair – they put the "fold up now" button RIGHT where the kid can kick it! Great idea!
I actually found a pretty serious defect in a baby safety product last week. I emailed the company and reported it to the CPSC. I got the typical "we take this seriously" response promising a callback by the end of the week. If I don't get a callback I'm planning to submit to the Consumerist. Maybe we can all learn something about the process.
@KyleOrton: What was it?
@Oranges w/ Cheese: On one hand I want to give the company a chance to fix it, but on the other I would have a problem if someone was hurt between now and then. Conscience wins.
It is a flexible lock set for securing cabinet doors. Right out of the package I went to use it and the flexible portion snapped into a small piece and the whole thing fell apart. Had I tightened it a bit less, it would have fallen apart if my daughter tried to use it to pull herself up, opening a cabinet full of glassware and creating a choking hazard on the plastic piece.
I'm submitting it to the tip email now.
@KyleOrton: Um yeah, that does kind of suck! Good luck!
They recalled a single brand/model of trampoline because of a falling hazard? I thought that was kind of the deal with trampolines – people fall off of them.
@magic8ball: I plan on being a fairly laissez faire parent – except regarding trampolines. No trampolines! Or firearms. I know, total bummer, but that's a line that won't be crossed.
@magic8ball: It's actually that the frame collapses (and one adult was injured assembling one, which kind of makes me laugh–if you recalled everything that had injured me during my assembly of it, you'd be left with a world of fluff).
But I'm kind of with you, oneandone, on trampolines in general. Last weekend the kids in the house behind me pulled theirs to the side of their house and were jumping off of the roof onto it. Yikes.
Seriously, what's up with China? It's literally insane that we're still seeing these problems. Recalls are incredibly expensive, you think that they'd all spring for some lead tests every once and a while.
@Mad Dog McCree: Not all of the products came from China. The Fisher-Price chair for instance, was manufactured in Mexico. The FloraCraft kits were manufactured in the U.S. as well as China. The Human Touch chair was made in Thailand.
@pecan 3.14159265: All of the products on the list that contained lead were made in China. I was only talking about lead, not strangulation or other things.
I should be surprised when a product named "Predator" turns out to be dangerous?
These types of recalls are why I get short-tempered at all the hand-wringing over CSPIA. Yes, it needs to be modified a bit and, yes, the timetables are ridiculous, but there is no basis for assuming that any product is lead-free. The default assumption should be that it must be tested, and I haven't seen any reason to start relying on any untested product from any manufacturer or any country. As pecan pie pointed out, it's not just China. It's sad, but there's no safety w/o testing.
No drawstrings! how hard is it? This has to be the most common recall.
@Canino: Or perhaps quit worrying about it. Back in the 30s & 40s kids used to play with toy lead soldiers, for poop's sake. My dad and his generation seemed to make it through just fine.
Regarding the "Perfect Chair"…
Yeah. It's comfortable. It could also be called, "The Most Comfortable Chair In The World". (Yes, like that sofa in "The Tick" or the couch in "Invader Zim")
@Canino: I hope you are kidding.
This isn't a disease that can be vaccinated.
@lotussix: This isn't a disease that can be vaccinated.
Not yet…
Since my mercury vaccine I've been able to enjoy plenty of liquid metal goodness.


text:
FEB 05, 2013 - Mashable
A Must Read - Share
Experiments suggest that monitoring viewer behavior via set-top boxes could help make TV commercials much more effective.
More About: ad targeting, att, online advertising, tv commercials
Editor's Picks
Hey you have no friends!!! Get to work and start inviting friends to help build your Comunitee. Click Here to invite friends.
© 2011 Comunitee, Inc.


text:
Clinique Coupons & Promo Codes
Most popular now: Fresh & Pretty Kit With $35+ Purchase.
Latest offer: Free 3 Piece Weekender Kit with any $35+ Purchase.
Fresh & Pretty Kit With $35+ Purchase
Includes 3 minis.
Free Mini Duo with $35+ Purchase
Receive Free Minis with $40+ Purchase
Free 3 Piece Weekender Kit with any $35+ Purchase
Sign Up for Clinique Emails and Receive Exclusive Offers and Product Updates
New Chubby Stick Shadow Tint for Eyes for only $17
15% Off First Order Of Moisture Surge Face Spray
Check Out New Arrivals Today!
Free Shipping on Your Purchase
Free 4 Piece Smart Kit with $45+ Orders
Free Beauty Mini Trio with Any $40+ Orders
Shop New Clinique Pop™ Matte Collection
Free 4-Piece Summer Essentials Kit with Any $55+ Orders
Free 4 Minis with $40+ Orders
Free 2-Day Shipping with Any Order
Free Travel-Size Serum- Repair with Any $40+ Purchase
Free Travel-Size Serum - Even with Any $40+ Purchase
Free Travel-Size Serum - Pores with Any $40+ Purchase
Free Travel-Size Serum- Sculpt with Any $40+ Purchase
Free Travel-Size Serum- Smart with Any $40+ Purchase
Free Travel-Size Serum- Acne with Any $40+ Purchase
Enjoy 3 Free makeup mini faves with any $30 purchase
Free 5 Minis with $40+ Purchase + Smart Eye Mini and Cosmetics Bag with $65+ Purchase
Free Summer Tote with $55+ Purchase
Free Instant Pretty Kit with $50+
Exclusions apply.
Free Summer Tote with Any $55+ Purchase
Exclusions apply.
Free Makeup Bag with Any $35+ Purchase
Free Summer Tote with Any $55+ Purchase
How to use a Clinique coupon
Browse the Clinique website before making your final selections to see their current promotions. They have an "Offers" section on their website where the current deals and promotional offers are listed, complete with coupon codes needed to enter at checkout. Clinique also offers free shipping on all orders of $50 or more every day. Don't forget to check their "Last Chance" section where soon-to-be discontinued products are sold at a discounted price.
How to Use Clinique Coupons
If you are going to be using a promo code you found on the Clinique website or at Coupons.com, simply enter that code in the appropriate box on the checkout page when you are paying for your order. The discount should be immediately reflected in your total. Alternately, if you found a code with a link on Coupons.com clicking the link will generally set up the code and discount for you automatically so all you have to do so complete the checkout process via that link.
About Clinique
In 1968, Clinique launched the concept of dermatologist-created skin care with a customized approach and allergy tested, 100% fragrance free formulations. It is part of the Estee Lauder umbrella of companies, which includes the likes of M A C, La Mer and Coach.


text:
Last week was kind of insane. You may have noticed a dearth of posts and Tweets and Facebook updates. That's because of the insanity that was my week.
I will elaborate, because it was a great week for me to tell you, in particular, all about. I'm going to doll it out to you in bite-sized pieces throughout this week.
Let's start with last Tuesday, when I enjoyed a leisurely lunch with Career Renegade, Tribal Author and fellow New Yorker, Jonathan Fields.
Jonathan Fields is a guy who's done a great job of striking out an authentic-for-him career path (read on for more on that). I love this about him, because this is what I help people do. By all standards, he's been extremely successful – but there's so much more to it than that.
Me and Jonathan and Everyone You Know
What struck me most about Jonathan is how very present and relaxed he is — and, how candid he was with me.
I'm not going to bore you with the details (like how he wouldn't let me pay, when I asked HIM to lunch – generous gesture! – and how he gave me VERY good and non-icky marketing and strategic advice, unsolicited, for my much-newer-than-his business).
What I want to tell you about is how you and me and Jonathan Fields are basically on the same path. You and me and everyone we know are dealing with the same stuff, and it's all going to be great. Huh, how about that? (Right???)
We talked, shared ideas and where we are both "at" right now, and it all boils down to this…
#1 There is no le grande arrival.
Jonathan honored who he was by leaving the law and diving into the realm of fitness and yoga, selling his businesses and transitioning into what I see as a kind of coach – though, his bio says he has:
established himself as a thought leader in the world of online entrepreneurship, social media, marketing and blogging
Whatever, I still think he's a coach.
And, you know what? He is still a work in progress.
He's not a superior than you expert any more than anyone else can be. Because no one really gets there.
For example, he was telling me how he's in the middle of a big career transition himself. As of recently, he is merging his blogs and pegging down the steps in his bigger game plan.
And, friends, I'm right there with him.
- I've started some career coaching for lawyers who want to leave the law, and still doing weight loss coaching and career coaching for the other stuck people out there.
But, for me, how I balance it all and which direction(s) I'll continue in? Work in progress.
Jonathan was telling me how he would never claim to be a guru that knows it all. There is no person who knows it all. We are, all of us, students that learn and grow and change without ceasing.
Here's your take away: You, out there — person who has a new project in mind that's different from your career, or is hopeful for a job switch or desperate to know what work you would love doing — you're right smack dab on the same path to authenticity that Jonathan and I are both walking down.
We both are dealing with what you are dealing with.
You may have recently started this journey, or you may just be thinking about thinking about starting this journey. No matter where you are today, if you're reading this blog,the odds are good that you're somehow into being the youified version of you.
Here's your other take away: We-are-all-in-the-same-place thing is so cool because the more you can accept where you are right now and meet yourself where you are today, and take the journey to youifying the work you do one step at a time, the happier you can be in your current life, and the more you realize… there is no big arrival.
You've already arrived. And, continue to do so at each moment. Jonathan's business is evolving, because it's alive. Like all living things, it will always change.
The process never ends.
#2 Big stuff needs s p a c e .
Jonathan and I both left our big, fancy law firms. And both of us decided to do so after carving out time and space to make this decision. He took a month's leave of absence to get clear on what was right for him to do, and I took what amounts to a year-long sabbatical.
Why were we both intentional in doing this?
Because, when you're in a heap of badness with your work and you've been there for a while, even if you make the right decision for you, you're not going initiate it from the right place.
I'm not saying that one month away from your job is a magic bullet to solve all of your problems, but if you take some time to rest, to grow calmer and more clear on your priorities, proclivities and the stuff you want to give to the world, you're going to look back at your decision, and process, and see it for the well-deliberated choice that it was. Just sayin'.
Here's your take away: Take a break from the thing you feel stuck about, and poll the sources you respect for guidance. Spend time alone. Connect to what you really want and why you're not doing that right now. Take some time for yourself on this.
Otherwise, you'll keep doing what you've always done, and get where you've always gotten. Which is kind of nowhere.
#3 Mindsets Over Matter
The delightful Mr. Fields and I talked about a mindset that we both struggle with, that gets us into trouble. This mindset, like all unhelpful thinking, requires freaking constant correction to avoid it building, over and over, the same dungeon from which you've escaped.
He was telling me that he is not exactly in the place that he, being uniquely him, should be. Huh. In the words of Larry David, pretty, pretty, pretty, pretty cool to hear such honesty.
- Similarly, I love working with people to reconnect with themselves in order to identify work that suits and then making it happen. And I love my weight loss clients, who are learning to reconnect and to love themselves as-is in order to be naturally thin. And I'm now beginning work with lawyers who are feeling stuck and unhappy, to sort out the necessary changes to their career and to their own unhelpful mindsets.
Two weeks ago, I realized, just like Jonathan has, that it's time to slow down to speed up.
- My business is growing and changing quickly, and I decided to slow down to be sure the speeding ball of fire that is my coaching practice is headed in the right direction for me. (Hence, insane week.)
I'm still in slow down mode, so the resolution to that question is still a-brewin'…
But! Here's what I do know: I battle, like Jonathan battles, a particular mindset.
We tend to pick a goal and relentlessly drive at it (not very learning lucky). When really, staying connected to myself, in each moment, and taking the right next move only after evaluating where I am after each move that I make, is the way to manifest work that's my right work.
- I slow down to remind myself to stay in the present moment, and follow the opportunities that feel good and energizing – even when they don't make sense.
Here's your take away: Your mindset is the single most important piece for you to work on, as you seek to identify your passion, and as you pursue it, and forever.
That's what I call a power lunch.


text:
skip navigation
Create an Account
Great Basin Youth Soccer League
Current Section
Sierra Rec Soccer
U12 Coaches
Related Pages
Recreational Photos
U4 Coaches
U6 Coaches
U8 Coaches
U10 Coaches
U12 Coaches
Home of Great Basin Youth Soccer
U12 Recreational Coaches Corner
U12 Session 1
U12 Session 2
U12 Session 3
U12 Session 4
U12 Session 5
U12 Session 6
U12 Session 7
The Game
Game Like Activities for U12
Warm - up Activities for U12
Warm - up Activities for U12
Outline for "Meeting with Your Team Parents"
Some Tips on Running a Successful Youth Practice
What to Do on Game Day
Practice Lesson Outline
©2016 Great Basin Youth Soccer League /
. All Rights Reserved.
Terms of Use
Privacy Policy


text:
Top Apps
- Audio & Video
- Business & Enterprise
- Communications
- Development
- Home & Education
- Games
- Graphics
- Science & Engineering
- Security & Utilities
- System Administration
Agnix Embedded Real-time OS Kernel
Agnix is an educational, network operating system kernel. It is ideal starting point to learn about operating systems. The main goal of the project is to provide a network kernel fully compatible with the Linux Kernel in the system call layer1 weekly downloads
LukOS is operating system written in C++1 weekly downloads
New Linux Based OS primarily for smart devices and PDA's, laptops, and eventually desktops. It offers an alternative to the "embedded" approach. All OS versions and applications will be hosted and then made available to the subscribers of cloud svs
NotOS is multitasking, multithreading simple operating system based on monolithic kernel. NotOS haves paging-based memory management and software-based task switching. It works on Intel Pentium processor and others, based on Pentium.
OSDev.pl Project
Wspólny projekt społeczności OSDev.pl


text:
Softball team advances to finals, loses to Centurians
By Bill Tamburrino
Coach Antoinette Rodriguez's varsity softball team advanced to the CIF championship game for the first time in school history.
Ramona beat Cathedral Catholic in a slugfest in the semifinals on May 26 and lost to the number one seed University City (25-3) in the finals May 28. The Lady Bulldogs had defeated University City earlier in the playoffs to put the Centurions in the losers bracket.
The Lady Bulldogs got off to a slow start against Cathedral Catholic (17-12, 6-4), but things heated up in a hurry. Cathedral Catholic scored three unearned runs in the bottom of the first inning to take a 3-0 lead.
Ramona then put on its rally caps and scored four runs to take a lead it would not relinquish.
With one down, KK Melgoza doubled. Kellsie Domnitz drove in Melgoza with a single, her first of three hits. Amber Davis reached on a fielder's choice. Emily Vandervort then reached on an error.
In stepped freshman Kailey Hill. Hill looked more like a cleanup hitter than the leadoff batter that she is. Hill hit a line drive over the leftfield fence for a three-run homer and the slugfest was on.
The Lady Dawgs added to their lead in the third inning. Julie Ward started the rally with a single. Melgoza ripped her second hit of the game. Domnitz drove in Ward with a single.
Davis then doubled to centerfield driving in Melgoza. Vandervort came up with an RBI single scoring Domnitz. Kim Whelehon drove in with a fielder's choice, and the Lady Dawgs had an 8-3 lead.
Cathedral Catholic scored a run in the bottom of the third, but Ramona was not done scoring. With one out, Melgoza stroked her third hit of the game and then stole second to lead off the fourth inning. Davis reached on an error and Melgoza scored on the play.
Cathedral Catholic hit two home runs in the bottom of the sixth inning and scored three runs to make it a 9-7 game. Hill replaced Ward in the circle and slammed the door shut to pick up the save. Ward went the first five and a third innings and gave up seven runs (four earned) and scattered nine hits to pick up the win.
The Lady Bulldog defense came up with some great plays during the game. In the bottom of the second inning, KK Melgoza literally ran through the centerfield fence to rob a Cathedral hitter of a grand slam home run and keep the Dons from taking the lead.
In the sixth inning, Hill started a 1-3-6 double play to end the inning. Lexi Slater played a stellar game at shortstop and Cassie Ford kept the defense together from her position as catcher.
Two-time defending champion University City High School scored seven runs in the first inning of the championship game to put the game out of reach. The final score was 12-2.
"We tried to keep the girls fired up after giving up seven runs in the first inning, said Rodriguez. "For the most part, we put the ball in play. All season we have worked on putting the ball in play. That is all that we ask our girls to do.
"It was an awesome experience getting to the championship game. Getting here was one of the goals that we set in February. This was our dream."
Ramona could only get three hits off University City's ace, Amanda Hansen. Melgoza doubled in Ward, and Domnitz ended her Lady Bulldog career by driving in Melgoza with a single in the same inning. Slater also singled in the championship game.
Slater received the CIF Sportsmanship Award during the awards ceremony after the game. A patch is given to a player on each team that exemplifies the CIF's Victory with Honor program. The patch can be worn on Slater's letter jacket.
Seniors Cassie Ford, Kellsie Domnitz and Lexi Slater ended their RHS careers by leading their team to the CIF championship game.


text:
Yesterday I showed you this studio headshot B&A:
I get such a rush out of these types of edits. The transformation can be so dramatic and looking at it B&A is phenomenal. I did this edit in both LR and PSE which can be downloaded for 30 days for free {here}.
I started this process in LR. In the tools section on the top right is an adjustment brush:
When you click it, the brush options drop down:
This is where almost the whole edit takes place. Click 'new' to start a new brush. I started with the hair. The drop down menu you see above which says 'exposure' is where you click to see the different settings for certain effects. For her hair, I chose the 'contrast' brush. I slid the sliders to bring up the contrast and also the 'clarity' right up to the maximum and increase the sharpness a tad. Make sure that the 'auto mask' option is clicked. This will make it so that the edge of the brush falling onto other areas won't affect those areas. To paint with an auto mast brush, just make sure that the crosshairs in the middle of the brush remain only touching the areas on which you intend to paint.
Take a look at this. The left side of her hair is where I've painted you can see the difference:
When you're happy with that, you can start a new brush by clicking again in the 'effect' drop-down and choose the 'soften skin' brush. This brush works it's magic by taking down the clarity all the way so make sure that you only brush over the skin and avoid lips, eyes, glasses, etc. The default skin softening brush can make skin look dull so I adjust the brightness slider just a teeny weeny bit up to +7 to brighten the skin.
If you want to verify that you've hit all the areas you intended, you move your mouse over the little dot which represents the brush you're wondering about and it will light-up the area you touched with the brush like this:
Next, click new brush again and this time, we're using an itty bitty brush to darken the eyeliner and lashes. See below for the slider settings I used for the lashes.
After painting the eyeliner and lashes, I did yet another brush for the irises. This one makes adjustments to the clarity, sharpness and contrast and here is the after:
A couple tips about using the brush: 1.} To edit a brush you did previously, click the little circle which represents that brush and you can change the sliders and watch it make changes to your work. and 2.} My favourite thing to do it continuously type the \ key because that gives you a before/after toggle. Just keep clicking it for editing ecstasy.
Zoom back out on the image and now we'll tweak the coat with a brush that pumps up the contrast and clarity a bit.
Next, to erase the blemishes. Click the spot removal brush and adjust the brush size. Click the blemish you want to erase and suddenly, a second circle pops out next to it. If you're happy with the replacement area inside the circle, go on to click the next blemish. If it's not a good match, then click and drag the second circle to a better area until the replacement is perfect. In this way, erase all the blemishes. And this is the finished work we've done in LR:
Now export that image and open it in PSE. I used the healing brush tool to erase the missing white background area on the right. Holt alt and click an area that is appropriate just next to where we will be painting and then start brushing over the white.
Then in the layers pallette on the right, click the 'background' image and click duplicate layer.
Just above in the drop down menu, choose the soft light blend mode. And slide the slider down to around 60%. Click the visibility button to the left of the layers to see the effect of turning the layer on and off.
And that's it! Here again is the after:


text:
This year, the most municipalities ever joined the GIC's health coverage effective July 1, 2009. Despite these challenges, annual enrollment ran smoothly and new municipal members will enjoy a smooth transition thanks to a team effort by municipal staff and the GIC. A total of 14,500 members from 14 municipalities, representing 29,000 lives, enrolled in coverage during enrollment. Danielle Chaplick, the GIC's Municipal Coordinator, was the municipalities' key contact person, coordinating all aspects of the implementation and she praised all of the municipalities for their efforts, "All of the municipalities were committed to the process and this was key to the success of these implementations," she stated.
Work began in the fall to make the transition smooth with a series of in-person and teleconference calls. John Harney, the GIC's Chief Information Officer, says the receipt of data is particularly challenging. To assist, the GIC developed a new software application that allowed municipalities to input their data in the same format, eliminating the need for subsequent edits and helping to ensure that all information was included. Test files from the municipalities were sent in January and the final data were received at the beginning of March. "Working with the dedicated GIC Municipal Team members was a valuable learning experience," said Ginny Ray, Municipal Benefits Coordinator in Stoneham. "They shared their past enrollment experiences and provided us with detailed instructions on what works and what to avoid. When our health fair arrived, we were well-prepared and confident thanks to our training and the many resources at our disposal," she added.
Gathering documentation for eligibility - Medicare documentation, birth and marriage certificates, and divorce decrees - is particularly important. Many municipalities asked that their employees and retirees send them their documentation in advance of annual enrollment. Paul Murphy, the GIC's Director of Operations, commended many of the municipalities for putting together effective filing systems of eligibility documents, which were subsequently matched to enrollment applications, thereby making a big difference in entering the data in the GIC's system on a timely basis so that members would receive their health plan ID cards in time for their July 1 effective date.
Communication also played a key role in a smooth transition. New municipalities collaborated with the GIC to ensure that communications were accurate and complete. Nancy Dinofrio, Benefits Analyst for the City of Pittsfield, said, "As soon as the decision was made to go with the GIC, the City, with the GIC's help, notified employees and retirees as to exactly what was going to happen and what our insureds needed to do in order to keep their health insurance coverage."
For these fourteen municipalities, the hard work is over and they are all enjoying a much deserved breather. Jeff Cannon, Treasurer of the Town of Millis, which joined in July 2008, said, "While there was some additional work in the setup phase, the cost savings to the Town of Millis and its active and retired employees is gratifying and substantial. Our town made an excellent choice when it decided to join the GIC."
Thank you to the following municipalities for all your hard work and making this year's annual enrollment a success! Blue Hills Vocational School District, Cities of Melrose, Quincy, and Pittsfield, Groton-Dunstable Regional School District, Pioneer Valley Planning Commission, Towns of Norwood, Randolph, Stoneham, Swampscott, Watertown, Wenham, Weston, and Weymouth.
Editor's Note: Information to assist municipalities with weighing the GIC health option is located within the of the GIC's website.
This information provided by the Group Insurance Commission .


text:
From the Departments of Internal Medicine (Dr Bonten) and Methodology and Statistics (Mr Ambergen), University Hospital Maastricht, Maastricht, the Netherlands; and the Division of Infectious Diseases, Cook County Hospital (Drs Bonten, Slaughter, and Weinstein and Mss van Voorhis and Nathan), and Rush Medical College (Drs Slaughter, Hayden, and Weinstein), Chicago, Ill.
The spread of nosocomial multiresistant microorganisms is affected by compliance with infection control measures and antibiotic use. We hypothesized that "colonization pressure" (ie, the proportion of other patients colonized) also is an important variable. We studied the effect of colonization pressure, compliance with infection control measures, antibiotic use, and other previously identified risk factors on acquisition of colonization with vancomycin-resistant enterococci (VRE).
Rectal colonization was studied daily for 19 weeks in 181 consecutive patients who were admitted to a single medical intensive care unit. A statistical model was created using a Cox proportional hazards regression model including length of stay in the medical intensive care unit until acquisition of VRE, colonization pressure, personnel compliance with infection control measures (hand washing and glove use), APACHE (Acute Physiology and Chronic Health Evaluation) II scores, and the proportion of days that a patient received vancomycin or third-generation cephalosporins, sucralfate, and enteral feeding.
With survival until colonization with VRE as the end point, colonization pressure was the most important variable affecting acquisition of VRE (hazard ratio [HR], 1.032; 95% confidence interval [CI], 1.012-1.052; P=.002). In addition, enteral feeding was associated with acquisition of VRE (HR, 1.009; 95% CI, 1.000-1.017; P=.05), and there was a trend toward association of third-generation cephalosporin use with acquisition (HR, 1.007; 95% CI, 0.999-1.015; P=.11). The effects of enteral feeding and third-generation cephalosporin use were more important when colonization pressure was less than 50%. Once colonization pressure was 50% or higher, these other variables hardly affected acquisition of VRE.
Acquisition of VRE was affected by colonization pressure, the use of antibiotics, and the use of enteral feeding. However, once colonization pressure was high, it became the major variable affecting acquisition of VRE.
INFECTION CONTROL measures are key to preventing the spread of microorganisms within hospitals, especially in high-risk areas such as intensive care and transplant units. Hand washing is heralded as the single most important control measure, and effective hand-washing techniques have been shown to reduce the rate of nosocomial infections in several studies.1,2 However, compliance with this basic function has been reported to be as low as 22% to 42%,1- 3 and achieving 100% hand-washing compliance is an elusive goal. Intensive antibiotic control programs also have been advocated as a means to decrease selective pressures that favor the emergence and persistence of antibiotic-resistant bacteria.4,5 These programs have been successful in decreasing targeted antibiotic resistance rates for specific bacteria,4 but published reports are limited.
In addition to compliance with infection control measures and antibiotic use guidelines, other factors may affect cross-acquisition of microorganisms. For instance, the number of patients already colonized ("colonization pressure") may be an important factor in determining chances of cross-colonization6; ie, the risk of cross-infection for a noncolonized patient probably is higher when 80% of patients are already colonized than when only 10% are colonized.
To determine the relative importance of these variables, we studied the effects of colonization pressure, compliance with infection control measures, antimicrobial use, and other risk factors on acquisition of vancomycin-resistant enterococci (VRE) in a medical intensive care unit (MICU).
Cook County Hospital, Chicago, Ill, is a 900-bed public teaching hospital. The MICU contains 16 beds: 12 in single rooms and 4 in double rooms. As part of ongoing surveillance monitoring supervised by the hospital's Infection Control Committee, rectal cultures were obtained daily for 19 weeks from all patients admitted to the MICU for at least 48 hours (October 26, 1994, to March 7, 1995). In addition, personnel compliance with infection control measures was monitored as described below, and demographic data and antibiotic use were recorded for all patients. At the beginning of the study and every 1 to 2 weeks thereafter, educational meetings were held with MICU nurses, house staff, and attending physicians to review infection control measures and to provide encouragement and feedback about compliance. During this period, gloves and gowns were worn during the treatment of patients in half of the unit, whereas only gloves were used for care of the patients in the other half. Personnel were required to wear clean, nonsterile gloves for all room entries and to remove the gloves and wash their hands with antibacterial soap (containing triclosan) before leaving the room. In double rooms, hands were to be washed and fresh gloves were to be put on if the health care worker moved between patients. In addition, in the 8 gloves-and-gown rooms, personnel were required to wear isolation gowns for all room entries and to remove them before leaving the room. The results of this intervention have been reported7; wearing of gowns did not reduce acquisition of VRE, ie, the VRE acquisition rates were similar in the 2 groups (25.8% in the gloves-and-gown group and 23.9% in the gloves-only group). Therefore, results of acquisition for the 2 groups are combined in the analyses described below.
Rectal swab specimens were obtained daily from all patients in the MICU, and specimens were inoculated onto Enterococcosel agar (Becton Dickinson Microbiology Systems, Cockeysville, Md) supplemented with vancomycin, 6 µg/mL. Plates were examined after 48 hours of incubation at 35°C. Isolates were identified to the species level by API 20 STREP system (bioMerieux Vitek Inc, Hazelwood, Mo), motility, and pigmentation. Antibiotic susceptibility was tested by standard disk diffusion and agar dilution methods.8,9
Compliance by all health care workers was charted by unobtrusive observers (S.S. and J.V.) who monitored rooms from a raised nurses station in the center of the MICU. Observations (n=4364) were made on all shifts approximately 7 hours per week. Beds were monitored for 10 minutes in random order. Compliance with hand washing, donning gloves on entry, and removal of gloves before leaving was monitored for all beds. Because continuous monitoring was not done, compliance data were aggregated and expressed as weekly compliance rates for the entire unit.
We created a statistical model of the relative effects of colonization pressure, infection control compliance rates, antibiotic use, APACHE (Acute Physiology and Chronic Health Evaluation) II score on admission to the MICU, enteral feeding, and use of sucralfate on acquisition of VRE. All patients not colonized with VRE on admission, during the entire 19 weeks, were included in this analysis.
Colonization on admission and acquired colonization were defined as isolation of VRE from rectal cultures obtained within or later than the first 48 hours of admission, respectively. For each study day, the point prevalence of VRE in the MICU was calculated as follows: number colonized with VRE on that day divided by the number treated in the MICU on that day. Subsequently, for each patient who was not colonized with VRE on admission, the average point prevalence of VRE for all MICU days until acquisition of VRE or until discharge (if the patient did not acquire colonization) was calculated. This calculated number reflects the colonization pressure with VRE for the period in the MICU that the patient was not colonized.
Personnel compliance rates for hand washing, donning gloves, and removing gloves were expressed as percentages per week, and this rate was attributed to each day of the week. Using these compliance rates, an attributed mean personnel compliance until acquisition of VRE or discharge was calculated for each patient. The percentage of days that noncolonized patients received vancomycin or a third-generation cephalosporin ("antibiotic pressure") was calculated until acquisition of VRE or discharge from the ward, as were the proportion of days that patients received enteral feeding and sucralfate.
The effects of colonization pressure, the hand-washing and gloving compliance rates, antibiotic pressure, APACHE II score on admission, and use of enteral feeding and sucralfate on acquisition of VRE were analyzed in a Cox proportional hazards regression model (SPSS for Windows, release 6.1.2, SPSS Inc, Chicago, Ill) in which the number of days until acquisition of VRE was the dependent variable. Each variable was separately analyzed in a Cox regression model, and the best-fitting model was constructed by the simultaneous inclusion of the significantly related variables. Hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were computed. An HR of a variable with 2 categories is the ratio of the 2 category-dependent probabilities for occurrence of the event. The integration of the hazard function for a certain period, eg, day by day, gives the probability of acquiring VRE in that period. The significant covariates were obtained by means of a forward stepwise selection using the P values of the likelihood ratio test. Goodness-of-fit was assessed from the 3 plots of partial residuals against time, with 1 plot for each covariate. In the plots, the points were randomly distributed.
In all, 181 patients were admitted for at least 48 hours, and 7 patients were present in the MICU when the study started. The mean±SD age of the study population was 51±15 years; the mean±SD APACHE II score on admission was 23±8, and 60% of the patients were men.
One hundred fifty-three patients were not colonized with VRE on admission to the MICU, and 45 (29%) of them acquired rectal colonization with VRE after a mean±SD of 7.4±5.3 days (Table 1). The calculated colonization pressures for these 153 patients ranged from 9% to 67%. Compliance was monitored approximately 7 hours per week, yielding 4364 observations equally divided over the study period. Weekly compliance rates ranged from 16% to 73% for hand washing, from 59% to 91% for donning gloves, and from 60% to 100% for removing gloves. When calculated for individual patients, compliance rates ranged from 29% to 65% for hand washing, from 58% to 95% for donning gloves, and from 58% to 96% for removing gloves. The antibiotic pressure analysis focused on vancomycin and third-generation cephalosporins because these agents were prescribed most frequently7 and have been associated with colonization and infection with VRE.10- 12 Ninety-three patients (61%) received third-generation cephalosporins, 34 patients (22%) received vancomycin, and 102 patients (67%) received any of these agents. For both antibiotics, the proportion of days with antibiotic use ranged from 0% to 100%. Metronidazole, which also has been associated with VRE infections in an oncology ward,12 was used in only 21 patients, 10 of whom acquired colonization with VRE. The use of enteral feeding and sucralfate were included because they were significantly related to acquisition of VRE when used as dichotomous variables in a previous multivariate analysis.7 In the current analysis, sucralfate was administered to 62 patients (41%), and 66 patients (43%) received enteral feeding. As for antibiotics, the proportion of days with use of sucralfate or enteral feeding ranged from 0% to 100%. Patients who acquired VRE had been exposed to a higher colonization pressure and to more days of use of vancomycin or third-generation cephalosporins, enteral feeding, and sucralfate and tended to have higher APACHE II scores (Table 1).
When each variable was tested individually in a Cox regression analysis with duration until VRE acquisition, death, or discharge as "survival time," each was associated with acquisition of VRE. The P values for these associations ranged from .004 for the daily point prevalence to .10 for donning gloves. When all variables were tested as covariates in a Cox regression model, a clear distinction between 3 relevant variables and the other, unrelated variables was observed. The best model included the daily point prevalence of VRE (colonization pressure) (HR, 1.032; 95% CI, 1.012-1.052; P=.002), the proportion of days with enteral feeding (HR, 1.009; 95% CI, 1.000-1.017; P=.05), and the proportion of patient days with cephalosporin use (HR, 1.007; 95% CI, 0.999-1.015; P=.11). The other variables were not selected as significant risk factors because their P values were greater than .3 for the use of sucralfate and greater than .5 for the remaining variables. Analysis of vancomycin use did not add significantly to the impact of the use of third-generation cephalosporins. An HR of 1.032 for colonization pressure means that for each 1% that colonization pressure increased, the risk of acquisition of VRE increased by 3.2%. For each 1% increase in enteral feeding and cephalosporin use, the risk of acquisition of VRE increased by 0.9% and 0.7%, respectively.
We used this model (colonization pressure and either enteral feeding or antibiotic pressure) to calculate the median time until acquisition of VRE. Given the compliance rates observed during the present study, colonization pressure seemed to have a greater effect on acquisition of VRE than did antibiotic pressure or enteral feeding, eg, the time to acquisition was shorter with high colonization pressure and low antibiotic pressure (or enteral feeding) than with the converse condition (Figure 1, Figure 2, and Figure 3). Although the HRs may seem small, the expected duration of a noncolonized patient to remain VRE negative was 5 days when colonization pressure and antibiotic pressure were 75% and 19 days when both variables were 25%. Moreover, once colonization pressure was greater than 50%, the other variables had only a slight effect on time to acquisition of VRE (Figure 1). With a colonization pressure of 75%, the calculated duration until acquistion of VRE was 5 days when antibiotic pressure was 75% and 6 days when antibiotic pressure was 25%.
The median number of days until acquisition of vancomycin-resistant enterococci (VRE) in relation to the "colonization pressure" (prevalence) and the use of third-generation cephalosporins. The days until acquisition were calculated from the relation among acquisition of VRE, VRE colonization pressure, third-generation cephalosporin use, and enteral feeding in a Cox regression analysis according to the following formula: log (hi(t) / h0 (t))=0.0314 X coli + 0.0086 X efi + 0.0065 X cepi, where i indicates the index patient; X coli, the "VRE colonization pressure" for patient i; X cepi, the use of third-generation cephalosporins for patient i; X efi, the use of enteral feeding for patient i; hi(t), the hazard; and h0 (t), the hazard of a fictitious patient with 0 for all variables. For X efi, the mean of the study population was used, ie, 28.2157.
The median number of days until acquisition of vancomycin-resistant enterococci (VRE) in relation to the "colonization pressure" (prevalence) and enteral feeding: log (hi(t) / h0 (t)) = 0.0314 X coli + 0.0086 X ef i + 0.0065 X cep i, with 47.5686 for X cepi as the mean of the study population.
The median number of days until acquisition of vancomycin-resistant enterococci (VRE) in relation to the use of third-generation cephalosporins and enteral feeding: log (hi(t) / h0 (t))= 0.0314 X coli + 0.0086 X efi + 0.0065 X cepi, with 32.2353 for X coli as the mean of the study population.
Our analyses, performed in a single MICU, demonstrate the relative impact of colonization pressure, antibiotic pressure, and other factors on acquisition of VRE. In a Cox regression analysis, colonization pressure was the most important variable affecting VRE acquisition. Antibiotic use and enteral feeding had important effects mainly when the prevalence of VRE colonization was relatively low. According to our analysis, the expected median time until acquistion of VRE is 19 days when both antibiotic pressure and colonization pressure are 25% but 6 days when colonization pressure is 75% and antibiotic pressure is 25%.
Low compliance with infection control procedures and high antibiotic use have been associated with the spread of antibiotic-resistant bacteria. The analysis of the interaction of these risk factors with colonization pressure is new. In another study,6 one of us (M.J.M.B.) found that an increase in the number of patients colonized with nosocomial gram-negative bacteria was associated with higher rates of acquisition of these bacteria, and a shorter colonization-free period, for noncolonized patients. However, compliance with infection control procedures and antibiotic pressures were not monitored in that study.
The high prevalence of VRE colonization in our MICU may seem to be an extreme case. However, during the study only 8 patients had VRE recovered from clinical specimens, demonstrating that the number of recognized infections with VRE only represents the tip of the iceberg. Compared with the reported proportion of nosocomial enterococcal infections caused by VRE in US hospitals (>10%-14%),13 our situation probably is no exception, and high rates of colonization with VRE may already be established in many hospitals, although prevalence rates may vary considerably from one geographic area to another.
VANCOMYCIN-RESISTANT enterococci are thought to be spread mainly via cross-colonization.14 The present study reveals additional important observations that bear on preventing the spread of VRE and possibly other nosocomial pathogens. First, rates of cross-colonization were affected by the prevalence of colonization. We suspect that this occurred because a higher prevalence of VRE colonization increased the chance for health care workers to contact a patient colonized with VRE and thus made any lapses in compliance more of a risk. These data seem to underscore observations made by Haley and coworkers15 studying methicillin-resistant Staphylococcus aureus. They found that overcrowding and understaffing, which increase the number of patient contacts for each health care worker, predisposed to the spread of methicillin-resistant S aureus in a neonatal ICU.15
Second, degree of compliance with infection control measures has been associated with risk of transmission of nosocomial pathogens. In the present analysis, the weekly hand-washing compliance rates ranged from 16% to 73%, and compliance rates ranged from 59% to 100% for glove use. Albert and Condie3 found compliance rates with hand washing of 28% and 41% in ICUs in a university and a private hospital, respectively. Simmons and coworkers2 found a compliance rate with hand washing of 22%, which was increased to 30% without affecting infection rates. More recently, Doebbeling and coworkers1 studied hand washing during a total of 152 hours with 1233 observations and found a compliance rate of 42%. Reaching compliance rates of 100% seems elusive, and even with 100% compliance, there still is a possibility of acquisition of VRE via contaminated environmental sources.14
The fact that compliance rates were not significantly related to acquisition of VRE in our Cox regression analyses may be a result of the relatively small range of compliances. However, our analyses on compliance with infection control measures have 2 limitations. First, the data on compliance were calculated from all observations made in the MICU each week. Therefore, despite 4364 observations, compliance data are not patient specific. This also may have led to the small differences in compliance rates between patients who acquired and those who did not acquire colonization with VRE. However, without truly continuous personnel compliance monitoring, unit-wide compliance rates may be the best measure of infection control activity in the MICU each week. Second, we did not monitor staffing ratios and, therefore, could not relate changes in staffing ratios to acquisition of VRE.
Third, the risk for acquisition of VRE may be affected by the differences in antibiotic use. Vancomycin and third-generation cephalosporins have been associated with increased infection rates with VRE,10- 12 and antibiotic use was a significant variable in the Cox regression analysis. Overall, third-generation cephalosporin use (58% of all patient-days) is high in our MICU. In a general ICU in a Dutch university hospital, where neither VRE nor methicillin-resistant S aureus have been found, the use of vancomycin and cephalosporins during 1994 were 4% and 5% of the patient-days, respectively.16 However, in a 1-day point prevalence infection surveillance study of 1417 ICUs in 17 European countries, 62.3% of 10038 patients were receiving antibiotics on the day of study, and 43.6% of the patients taking antibiotics received cephalosporins.17 Preliminary observations suggest that reducing use of cephalosporin antibiotics may result in decreased rates of acquisition of VRE.18
Finally, enteral feeding proved to be significantly related to acquisition of VRE. Because cultures of enteral feeding were consistently negative,7 it seems likely that enteral feeding introduced a risk for acquisition of VRE either because of a more frequent need for hands-on care of patients by the nursing staff or because of alterations of the intestinal microenvironment. An association between enteral feeding and nosocomial acquisition of ampicillin-resistant enterococci and VRE has been reported previously.19,20 In another study,21 enteral feeding had a protective effect against the spread of β-lactamase-producing aminoglycoside-resistant Enterococcus faecalis in an infant-toddler surgical ward. However, this finding was regarded as an epiphenomenon of patients with intact gastrointestinal tract function who could better resist colonization by the bacteria.21 In contrast to excessive antibiotic use, administration of enteral feeding should not be limited. There are good reasons to feed critically ill patients as soon as possible, and enteral feeding has obvious advantages compared with parenteral feeding.22 However, it may be possible that different modes of administration of enteral nutrition (such as intermittent instead of continuous feeding or intrajejunal instead of intragastric feeding) have different effects on colonization with VRE. More studies are needed to confirm if, and to elucidate why, enteral feeding promotes colonization with VRE and if alternative ways of feeding affect this process.
In conclusion, what can be done to minimize cross-colonization when VRE colonization pressure is high, as in our setting? Compliance with hand washing and the use of gloves is important, but, under the circumstances tested, even above-average hand-washing compliance and a high rate of glove use, as in the present study, were insufficient to control spread. Reducing movement of health care workers between colonized and noncolonized patients may be achieved by creating cohorts of either patients or nursing staff and by limiting the number of physicians entering patient rooms during rounds. In many studies,10- 12 the presence of VRE is related to the use of antibiotics, such as vancomycin and third-generation cephalosporins. Because these agents provide VRE with a selective growth advantage, restricted and prudent use is probably essential to control further spread of VRE.18,23 Moreover, controlling antibiotic use has been easier logistically and more readily achieved than improving hand-washing compliance. Hospitals that currently have a low prevalence of VRE should be aggressive with surveillance and control measures now rather than waiting until the colonization pressure is high.
Accepted for publication September 11, 1997.
Supported in part by a stipend from the Dutch and Flemish Society of Infectious Diseases, and Merck, Sharp, and Dohme, Haarlem, the Netherlands (Dr Bonten).
Reprints: Robert A. Weinstein, MD, Division of Infectious Diseases, Cook County Hospital, 1835 W Harrison St, Room 129, Durand Bldg, Chicago, IL 60612.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers' bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence to Support the Update
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence Summary and Review 1
All results at
JAMAevidence.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Need assistance?
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.


text:
This is an excerpt from EERE Network News, a weekly electronic newsletter.
November 19, 2008
California Streamlines Approvals for Renewable Energy Projects
California Governor Arnold Schwarzenegger signed an executive order on November 17 to streamline the state's approval process for renewable energy projects. Executive Order S-14-08 requires the California Resources Agency to lead a joint collaboration between the California Energy Commission (CEC) and the California Department of Fish and Game to create a "one-stop" permitting process. The collaboration, called the Renewable Energy Action Team, will allow for concurrent reviews of permit applications, and will also work with the U.S. Bureau of Land Management and the U.S. Fish and Wildlife Service to help expedite the permit process. The new team will also identify top priority areas in California for renewable energy development and will start a planning process to allow appropriate development in those areas while protecting habitats and species. The process, called Natural Community Conservation Planning, will first be applied to the Mojave and Colorado Desert regions, where large solar power projects are under consideration.
The executive order also establishes a new renewable energy target for California, calling for all retail sellers of electricity to draw on renewable energy for 33% of their electricity supply by 2020. Executive orders don't have the force of law over utilities, but the order does instruct all state government agencies, such as the California Public Utilities Commission, to take all appropriate actions to implement the new target in all regulatory proceedings. That puts the wheels in motion to require utilities to meet the new target. The state currently has a legislative mandate for utilities to draw on renewable energy for 20% of their electricity supply by 2010. Meanwhile, state agencies are directed to keep the 33% target in mind as they handle the siting, permitting, and procurement for renewable energy power plants and transmission lines. See the governor's press release, which includes the full text of the executive order.


text:
The TWU Nutrition and Food Sciences offers an MS in Food Science and an MS in Food Systems Administration. Both of these programs are currently going through program changes. Both programs are on hold at this time. If you are interested in a graduate program in the Nutrition and Food Sciences profession, we encourage you to consider our MS in Nutrition, Online MS in Nutrition, or MS in Exercise and Sports Nutrition.
Program Description
The MS in Food Systems Administration is a predominantly online program (combination of online and three to four Saturday or evening classes at Denton or Houston campus) preparing students for administrative positions in the following areas:
- School foodservice administrator
- Healthcare foodservice administrator
- Business owner/entrepreneur
- Foodservice management consultant
- Food distributor account manager
Admission Requirements
- BS from an accredited university with a minimum 3.25 GPA (on 4.0 scale)
- Graduate Record Exam (GRE) with preferred minimum score of 143 (350 original) on verbal portion and 141 (450 original) on quantitative portion
- Prerequisite courses*:
o Introduction to Nutrition (3 hrs)
o Microbiology (4 hrs)
o Quantity Food Production & Service (4-5 hrs)
o Upper level Foodservice Management and/or Business courses (6 hrs)
o Introduction to Accounting (3 hrs)
*Students who lack some of the prerequisite courses may complete them at a local community college.
Degree Program Requirements
NOTE: Students in the Master of Science coursework only option programs in Nutrition, Food Systems Administration, and Food Science admitted before fall semester 2014 may choose to take the exit exam or complete the capstone seminar course for degree completion. Students admitted for or after fall semester 2014 must complete the capstone seminar course for degree completion.
How to Apply to NFS
- Apply to TWU
- Submit resume to Marcella Ettinger
- Application form and other
Vicky Imrhan, PhD, RDN, LD
Rose Bush, MS, RDN, LD
Associate Clinical Professor
This program is not currently accepting applications.
page last updated 8/16/2016 11:11 AM


text:
PORTSMOUTH — Police are investigating after guests staying at several local hotels woke up Thursday morning to find their windshield wipers had been damaged.
Sgt. Rich Webb said at least half a dozen cars had been reported damaged as of the early afternoon. Webb said the calls continued to come in however.
"Guests of several hotels on the north side went out to their vehicles this morning to find that their windshield wipers had been bent or damaged on their cars," he said.
The victims' cars were parked at the Best Inn, Hampton Inn and the Anchorage Inn as well as at a private residence on Woodbury Avenue.
Webb said several vehicles had the windshield wipers and arms damaged causing the owners not be able to drive during the winter storm.
The damage is believed to have happened overnight, Webb said.
Authorities are looking for anyone with information on who may be responsible for the damage to call officer Chris Kiberd at 610-7504 or leave anonymous tips with Seacoast Crimestoppers by phone at 431-1199, online at www.seacoastcrime stoppers.org, or by SMS text to CRIMES (274637) with TIPSCS in the message.
Location, ST | website.com


text:
- Text Size:
- ASmall Text
- AMedium Text
- ALarge Text
Authorities say they've broken up a Manchester-based, multimillion-dollar marijuana ring that imported the drug from Canada the same way earlier rings did: in hockey bags labeled with the drug's destination.
Assistant U.S. Attorney Donald Feith says state, local and federal law enforcement have been investigating the ring for the past year, using wiretaps, surveillance, undercover operations and controlled buys to gather evidence.
He says 10 people were charged last week, all charged with distribution of controlled substances and conspiracy. During the arrests, police found 30 pounds of marijuana, two pounds of MDMA - also known as Molly or Ecstasy - $85,000 in cash and numerous guns, including a machine gun and silencer.
This investigation came from information gathered during a similar drug operation in 2008.


text:
Manchester United Message Board
A Yahoo! User May 14, 2007 04:21 Flag
Electronic Assistance?
is anybody else having bother with there sat nav? Mine keeps telling me that manchester is not in europe.
What a joke
Ratings pleaseSort: Newest | Oldest | Most Replied Expand all replies
so is that an admission of defeat then ?.
your purpose here, which you perform admirably, is to raise issues like this so I can have a jolly good rant.
you're not exactly polite most of the time. I had to re-read your post and check the sender several times to make sure it really was you.
My car is not that special, but yes it pisses all over a honda prelude.
Enjoy the CL 3rd/4th place playoff as my scouse neighbour delights in calling it. Having to support chelsea must be a real burden.
boleyn boy boleyn boy May 14, 2007 05:06 Flag
That's not so strange because my sat nav tells me that 99.9% of ManU supporters don't live and never have lived in Manchester
- 2 Replies to boleyn boy
That's strange; I thought they were just supposed to give directions, not spout unimaginative bullshit. Must have been programmed by a bitter City fan or something - I hope you both kept your reciepts.
I suggest when you get your replacement sat-navs, you take a trip up to Manchester. You can walk through the city counting the number of people you see in United shirts and compare them to the number of people wearing any other football shirts. When you've realized how ridiculous your assumptions are, take yourself for a look around the Old Trafford museum. If you get there early on in the day, you might be lucky enough to see the Premier League trophy being polished.