text:
Download citation file:
From Università di Modena e Reggio Emilia, Modena, Italy; Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri, Milan, Italy; Centre for Statistics in Medicine, University of Oxford and UK Cochrane Centre, Oxford, United Kingdom; Ottawa Methods Centre, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada; Annals of Internal Medicine, Philadelphia, Pennsylvania; The Nordic Cochrane Centre, Copenhagen, Denmark; University of Ioannina School of Medicine, Ioannina, Greece; School of Nursing and Midwifery, Trinity College, Dublin, Ireland; McMaster University, Hamilton, Ontario, Canada; Kleijnen Systematic Reviews Ltd, York, United Kingdom; School for Public Health and Primary Care (CAPHRI) and University of Maastricht, Maastricht, The Netherlands.
Acknowledgments: The following people contributed to this paper: Doug Altman, DSc, Centre for Statistics in Medicine (Oxford, United Kingdom); Gerd Antes, PhD, University Hospital Freiburg (Freiburg, Germany); David Atkins, MD, MPH, Health Services Research & Development Service, Veterans Health Administration (Washington, DC); Virginia Barbour, MRCP, DPhil, PLoS Medicine (Cambridge, United Kingdom); Nick Barrowman, PhD, Children's Hospital of Eastern Ontario (Ottawa, Ontario, Canada); Jesse A. Berlin, ScD, Johnson & Johnson Pharmaceutical Research and Development (Titusville, New Jersey); Jocalyn Clark, PhD, PLoS Medicine (at the time of writing, BMJ; London, United Kingdom); Mike Clarke, PhD, UK Cochrane Centre (Oxford, United Kingdom), and School of Nursing and Midwifery, Trinity College (Dublin, Ireland); Deborah Cook, MD, Departments of Medicine, Clinical Epidemiology and Biostatistics,
McMaster University (Hamilton, Ontario, Canada); Roberto D'Amico, PhD, Università di Modena e Reggio Emilia (Modena, Italy) and Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri (Milan, Italy); Jonathan J. Deeks, PhD, University of Birmingham (Birmingham, United Kingdom); P.J. Devereaux, MD, PhD, Departments of Medicine, Clinical Epidemiology and Biostatistics, McMaster University (Hamilton, Ontario, Canada); Kay Dickersin, PhD, Johns Hopkins Bloomberg School of Public Health (Baltimore, Maryland); Matthias Egger, MD, Department of Social and Preventive Medicine, University of Bern (Bern, Switzerland); Edzard Ernst, MD, PhD, FRCP, FRCP(Edin), Peninsula Medical School (Exeter, United Kingdom); Peter C. Gøtzsche, MD, MSc, The Nordic Cochrane Centre (Copenhagen, Denmark); Jeremy Grimshaw, MBChB, PhD, FRCFP, Ottawa Hospital Research Institute (Ottawa, Ontario, Canada); Gordon Guyatt, MD, Departments of Medicine, Clinical Epidemiology and
Biostatistics, McMaster University (Hamilton, Ontario, Canada); Julian Higgins, PhD, MRC Biostatistics Unit (Cambridge, United Kingdom); John P.A. Ioannidis, MD, University of Ioannina Campus (Ioannina, Greece); Jos Kleijnen, MD, PhD, Kleijnen Systematic Reviews Ltd (York, United Kingdom), and School for Public Health and Primary Care (CAPHRI), University of Maastricht (Maastricht, the Netherlands); Tom Lang, MA, Tom Lang Communications and Training (Davis, California); Alessandro Liberati, MD, Università di Modena e Reggio Emilia (Modena, Italy), and Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri (Milan, Italy); Nicola Magrini, MD, NHS Centre for the Evaluation of the Effectiveness of Health Care–CeVEAS (Modena, Italy); David McNamee, PhD, The Lancet (London, United Kingdom); Lorenzo Moja, MD, MSc, Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri (Milan, Italy); David Moher, PhD, Ottawa Methods
Centre, Ottawa Hospital Research Institute (Ottawa, Ontario, Canada); Cynthia Mulrow, MD, MSc, Annals of Internal Medicine (Philadelphia, Pennsylvania); Maryann Napoli, Center for Medical Consumers (New York, New York); Andy Oxman, MD, Norwegian Health Services Research Centre (Oslo, Norway); Ba' Pham, MMath, Toronto Health Economics and Technology Assessment Collaborative (Toronto, Ontario, Canada; at the time of the first meeting of the group, GlaxoSmithKline Canada [Mississauga, Ontario, Canada]); Drummond Rennie, MD, FRCP, FACP, University of California, San Francisco (San Francisco, California); Margaret Sampson, MLIS, Children's Hospital of Eastern Ontario (Ottawa, Ontario, Canada); Kenneth F. Schulz, PhD, MBA, Family Health International (Durham, North Carolina); Paul G. Shekelle, MD, PhD, Southern California Evidence-Based Practice Center (Santa Monica, California); Jennifer Tetzlaff, BSc, Ottawa Methods Centre, Ottawa Hospital Research
Institute (Ottawa, Ontario, Canada); David Tovey, FRCGP, The Cochrane Library, Cochrane Collaboration (Oxford, United Kingdom; at the time of the first meeting of the group, BMJ [London, United Kingdom]); and Peter Tugwell, MD, MSc, FRCPC, Institute of Population Health (Ottawa, Ontario, Canada). Dr. Lorenzo Moja helped with the preparation and the several updates of the manuscript and assisted with the preparation of the reference list. Dr. Liberati is the guarantor of the manuscript.
Grant Support: PRISMA was funded by the Canadian Institutes of Health Research; Università di Modena e Reggio Emilia, Italy; Cancer Research UK; Clinical Evidence BMJ Knowledge; The Cochrane Collaboration; and GlaxoSmithKline, Canada. Dr. Liberati is funded, in part, through grants of the Italian Ministry of University (COFIN-PRIN 2002 prot. 2002061749 and COFIN-PRIN 2006 prot. 2006062298). Dr. Altman is funded by Cancer Research UK. Dr. Moher is funded by a University of Ottawa Research Chair. None of the sponsors had any involvement in the planning, execution, or write-up of the PRISMA documents. Additionally, no funder played a role in drafting the manuscript.
Potential Financial Conflicts of Interest:Employment: M. Clarke (His employment is as Director of the UK Cochrane Centre. He is employed by the Oxford Radcliffe Hospitals Trust on behalf of the Department of Health and the National Institute for Health Research in England. This is a fixed-term contract, the renewal of which is dependent upon the value placed upon his work, that of the UK Cochrane Centre and of The Cochrane Collaboration more widely by the Department of Health. His work involves the conduct of systematic reviews and the support of the conduct and use of systematic reviews. Therefore, work—such as this manuscript—relating to systematic reviews might have an impact on his employment).
Corresponding Author: Alessandro Liberati, MD Università di Modena e Reggio Emilia, Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156 Milan, Italy; e-mail, email@example.com.
Current Author Addresses: Dr. Liberati: Università di Modena e Reggio Emilia, Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156 Milan, Italy.
Dr. Altman: Centre for Statistics in Medicine, University of Oxford, Wolfson College Annexe, Linton Road, Oxford OX2 6UD, United Kingdom.
Ms. Tetzlaff and Dr. Moher: Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, Critical Care Wing (Eye Institute), 6th Floor, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
Dr. Mulrow: Annals of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Gøtzsche: Nordic Cochrane Centre, Rigshospitàlet, Dept 3343, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Dr. Ioannidis: Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, Ioannina 45110, Greece.
Dr. Clarke: School of Nursing and Midwifery, Trinity College, 24 D'Olier Street, Dublin 2, Ireland.
Dr. Devereaux: Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 2C8 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
Dr. Kleijnen: Kleijnen Systematic Reviews Ltd, Westminister Business Centre, 10 Great North Way, Nether Poppleton, York YO26 6RB, United Kingdom.
Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.
Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.
The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (www.prisma-statement.org) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
Editor's Note: In order to encourage dissemination of the PRISMA explanatory paper, this article is freely accessible on the Annals of Internal Medicine, PLoS Medicine, and BMJ Web sites. The authors jointly hold the copyright of this article. For details on further use, see the PRISMA Web site (www.prisma-statement.org).
Systematic reviews and meta-analyses are essential tools for summarizing evidence accurately and reliably. They help clinicians keep up-to-date; provide evidence for policy makers to judge risks, benefits, and harms of health care behaviors and interventions; gather together and summarize related research for patients and their carers; provide a starting point for clinical practice guideline developers; provide summaries of previous research for funders wishing to support new research (1); and help editors judge the merits of publishing reports of new studies (2). Recent data suggest that at least 2,500 new systematic reviews reported in English are indexed in MEDLINE annually (3).
Unfortunately, there is considerable evidence that key information is often poorly reported in systematic reviews, thus diminishing their potential usefulness (3–6). As is true for all research, systematic reviews should be reported fully and transparently to allow readers to assess the strengths and weaknesses of the investigation (7). That rationale led to the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement; those detailed reporting recommendations were published in 1999 (8). In this paper we describe the updating of that guidance. Our aim is to ensure clear presentation of what was planned, done, and found in a systematic review.
Terminology used to describe systematic reviews and meta-analyses has evolved over time and varies across different groups of researchers and authors (see Box 1). In this document we adopt the definitions used by the Cochrane Collaboration (9). A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria to answer a specific research question. It uses explicit, systematic methods that are selected to minimize bias, thus providing reliable findings from which conclusions can be drawn and decisions made. Meta-analysis is the use of statistical methods to summarize and combine the results of independent studies. Many systematic reviews contain meta-analyses, but not all.
The QUOROM Statement, developed in 1996 and published in 1999 (8), was conceived as a reporting guidance for authors reporting a meta-analysis of randomized trials. Since then, much has happened. First, knowledge about the conduct and reporting of systematic reviews has expanded considerably. For example, The Cochrane Library's Methodology Register (which includes reports of studies relevant to the methods for systematic reviews) now contains more than 11,000 entries (March 2009). Second, there have been many conceptual advances, such as "outcome-level" assessments of the risk of bias (10–11), that apply to systematic reviews. Third, authors have increasingly used systematic reviews to summarize evidence other than that provided by randomized trials.
However, despite advances, the quality of the conduct and reporting of systematic reviews remains well short of ideal (3–6). All of these issues prompted the need for an update and expansion of the QUOROM Statement. Of note, recognizing that the updated statement now addresses the above conceptual and methodological issues and may also have broader applicability than the original QUOROM Statement, we changed the name of the reporting guidance to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses).
The PRISMA Statement was developed by a group of 29 review authors, methodologists, clinicians, medical editors, and consumers (12). They attended a three-day meeting in 2005 and participated in extensive post-meeting electronic correspondence. A consensus process that was informed by evidence, whenever possible, was used to develop a 27-item checklist (Table 1; see also Table S1, for a downloadable template checklist for researchers to re-use) and a four-phase flow diagram (Figure 1; see also Figure S1, for a downloadable template document for researchers to re-use). Items deemed essential for transparent reporting of a systematic review were included in the checklist. The flow diagram originally proposed by QUOROM was also modified to
show numbers of identified records, excluded articles, and included studies. After 11 revisions the group approved the checklist, flow diagram, and this explanatory paper.
Flow of information through the different phases of a systematic review.
The PRISMA Statement itself provides further details regarding its background and development (12). This accompanying Explanation and Elaboration document explains the meaning and rationale for each checklist item. A few PRISMA Group participants volunteered to help draft specific items for this document, and four of these (DGA, AL, DM, and JT) met on several occasions to further refine the document, which was circulated and ultimately approved by the larger PRISMA Group.
PRISMA focuses on ways in which authors can ensure the transparent and complete reporting of systematic reviews and meta-analyses. It does not address directly or in a detailed manner the conduct of systematic reviews, for which other guides are available (13–16).
We developed the PRISMA Statement and this explanatory document to help authors report a wide array of systematic reviews to assess the benefits and harms of a health care intervention. We consider most of the checklist items relevant when reporting systematic reviews of non-randomized studies assessing the benefits and harms of interventions. However, we recognize that authors who address questions relating to etiology, diagnosis, or prognosis, for example, and who review epidemiological or diagnostic accuracy studies may need to modify or incorporate additional items for their systematic reviews.
We modeled this Explanation and Elaboration document after those prepared for other reporting guidelines (17–19). To maximize the benefit of this document, we encourage people to read it in conjunction with the PRISMA Statement (11).
We present each checklist item and follow it with a published exemplar of good reporting for that item. (We edited some examples by removing citations or Web addresses, or by spelling out abbreviations.) We then explain the pertinent issue, the rationale for including the item, and relevant evidence from the literature, whenever possible. No systematic search was carried out to identify exemplars and evidence. We also include seven Boxes that provide a more comprehensive explanation of certain thematic aspects of the methodology and conduct of systematic reviews.
Although we focus on a minimal list of items to consider when reporting a systematic review, we indicate places where additional information is desirable to improve transparency of the review process. We present the items numerically from 1 to 27; however, authors need not address items in this particular order in their reports. Rather, what is important is that the information for each item is given somewhere within the report.
Identify the report as a systematic review, meta-analysis, or both.
"Recurrence rates of video-assisted thoracoscopic versus open surgery in the prevention of recurrent pneumothoraces: a systematic review of randomised and non-randomised trials" (20).
"Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis" (21).
Authors should identify their report as a systematic review or meta-analysis. Terms such as "review" or "overview" do not describe for readers whether the review was systematic or whether a meta-analysis was performed. A recent survey found that 50% of 300 authors did not mention the terms "systematic review" or "meta-analysis" in the title or abstract of their systematic review (3). Although sensitive search strategies have been developed to identify systematic reviews (22), inclusion of the terms systematic review or meta-analysis in the title may improve indexing and identification.
We advise authors to use informative titles that make key information easily accessible to readers. Ideally, a title reflecting the PICOS approach (participants, interventions, comparators, outcomes, and study design) (see Item 11 and Box 2) may help readers as it provides key information about the scope of the review. Specifying the design(s) of the studies included, as shown in the examples, may also help some readers and those searching databases.
Helping To Develop the Research Question(s): The PICOS Approach.
Some journals recommend "indicative titles" that indicate the topic matter of the review, while others require declarative titles that give the review's main conclusion. Busy practitioners may prefer to see the conclusion of the review in the title, but declarative titles can oversimplify or exaggerate findings. Thus, many journals and methodologists prefer indicative titles as used in the examples above.
Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; funding for the systematic review; and systematic review registration number.
"Context: The role and dose of oral vitamin D supplementation in nonvertebral fracture prevention have not been well established.
Objective: To estimate the effectiveness of vitamin D supplementation in preventing hip and nonvertebral fractures in older persons.
Data Sources: A systematic review of English and non-English articles using MEDLINE and the Cochrane Controlled Trials Register (15), and EMBASE (15). Additional studies were identified by contacting clinical experts and searching bibliographies and abstracts presented at the American Society for Bone and Mineral Research (14). Search terms included randomized controlled trial (RCT), controlled clinical trial, random allocation, double-blind method, cholecalciferol, ergocalciferol, 25-hydroxyvitamin D, fractures, humans, elderly, falls, and bone density.
Study Selection: Only double-blind RCTs of oral vitamin D supplementation (cholecalciferol, ergocalciferol) with or without calcium supplementation vs calcium supplementation or placebo in older persons (>60 years) that examined hip or nonvertebral fractures were included.
Data Extraction: Independent extraction of articles by 2 authors using predefined data fields, including study quality indicators.
Data Synthesis: All pooled analyses were based on random-effects models. Five RCTs for hip fracture (n = 9294) and 7 RCTs for nonvertebral fracture risk (n = 9820) met our inclusion criteria. All trials used cholecalciferol. Heterogeneity among studies for both hip and nonvertebral fracture prevention was observed, which disappeared after pooling RCTs with low-dose (400 IU/d) and higher-dose vitamin D (700-800 IU/d), separately. A vitamin D dose of 700 to 800 IU/d reduced the relative risk (RR) of hip fracture by 26% (3 RCTs with 5572 persons; pooled RR, 0.74; 95% confidence interval [CI], 0.61-0.88) and any nonvertebral fracture by 23% (5 RCTs with 6098 persons; pooled RR, 0.77; 95% CI, 0.68-0.87) vs calcium or placebo. No significant benefit was observed for RCTs with 400 IU/d vitamin D (2 RCTs with 3722 persons; pooled RR for hip fracture, 1.15; 95% CI, 0.88-1.50; and pooled RR for any nonvertebral fracture, 1.03; 95% CI, 0.86-1.24).
Conclusions: Oral vitamin D supplementation between 700 to 800 IU/d appears to reduce the risk of hip and any nonvertebral fractures in ambulatory or institutionalized elderly persons. An oral vitamin D dose of 400 IU/d is not sufficient for fracture prevention" (23).
Abstracts provide key information that enables readers to understand the scope, processes, and findings of a review and to decide whether to read the full report. The abstract may be all that is readily available to a reader, for example, in a bibliographic database. The abstract should present a balanced and realistic assessment of the review's findings that mirrors, albeit briefly, the main text of the report.
We agree with others that the quality of reporting in abstracts presented at conferences and in journal publications needs improvement (24–25). While we do not uniformly favor a specific format over another, we generally recommend structured abstracts. Structured abstracts provide readers with a series of headings pertaining to the purpose, conduct, findings, and conclusions of the systematic review being reported (26–27). They give readers more complete information and facilitate finding information more easily than unstructured abstracts (28–32).
A highly structured abstract of a systematic review could include the following headings: Context (or Background); Objective (or Purpose); Data Sources; Study Selection (or Eligibility Criteria); Study Appraisal and Synthesis Methods (or Data Extraction and Data Synthesis); Results; Limitations; and Conclusions (or Implications). Alternatively, a simpler structure could cover but collapse some of the above headings (e.g., label Study Selection and Study Appraisal as Review Methods) or omit some headings such as Background and Limitations.
In the highly structured abstract mentioned above, authors use the Background heading to set the context for readers and explain the importance of the review question. Under the Objectives heading, they ideally use elements of PICOS (see Box 2) to state the primary objective of the review. Under a Data Sources heading, they summarize sources that were searched, any language or publication type restrictions, and the start and end dates of searches. Study Selection statements then ideally describe who selected studies using what inclusion criteria. Data Extraction Methods statements describe appraisal methods during data abstraction and the methods used to integrate or summarize the data. The Data Synthesis section is where the main results of the review are reported. If the review includes meta-analyses, authors should provide
numerical results with confidence intervals for the most important outcomes. Ideally, they should specify the amount of evidence in these analyses (numbers of studies and numbers of participants). Under a Limitations heading, authors might describe the most important weaknesses of included studies as well as limitations of the review process. Then authors should provide clear and balanced Conclusions that are closely linked to the objective and findings of the review. Additionally, it would be helpful if authors included some information about funding for the review. Finally, although protocol registration for systematic reviews is still not common practice, if authors have registered their review or received a registration number, we recommend providing the registration information at the end of the abstract.
Taking all the above considerations into account, the intrinsic tension between the goal of completeness of the abstract and its keeping into the space limit often set by journal editors is recognized as a major challenge.
Describe the rationale for the review in the context of what is already known.
"Reversing the trend of increasing weight for height in children has proven difficult. It is widely accepted that increasing energy expenditure and reducing energy intake form the theoretical basis for management. Therefore, interventions aiming to increase physical activity and improve diet are the foundation of efforts to prevent and treat childhood obesity. Such lifestyle interventions have been supported by recent systematic reviews, as well as by the Canadian Paediatric Society, the Royal College of Paediatrics and Child Health, and the American Academy of Pediatrics. However, these interventions are fraught with poor adherence. Thus, school-based interventions are theoretically appealing because adherence with interventions can be improved. Consequently, many local governments have enacted or are considering policies that mandate increased physical activity in schools, although the effect of such interventions on body composition has not been
assessed" (33).
Readers need to understand the rationale behind the study and what the systematic review may add to what is already known. Authors should tell readers whether their report is a new systematic review or an update of an existing one. If the review is an update, authors should state reasons for the update, including what has been added to the evidence base since the previous version of the review.
An ideal background or introduction that sets context for readers might include the following. First, authors might define the importance of the review question from different perspectives (e.g., public health, individual patient, or health policy). Second, authors might briefly mention the current state of knowledge and its limitations. As in the above example, information about the effects of several different interventions may be available that helps readers understand why potential relative benefits or harms of particular interventions need review. Third, authors might whet readers' appetites by clearly stating what the review aims to add. They also could discuss the extent to which the limitations of the existing evidence base may be overcome by the review.
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
"To examine whether topical or intraluminal antibiotics reduce catheter-related bloodstream infection, we reviewed randomized, controlled trials that assessed the efficacy of these antibiotics for primary prophylaxis against catheter-related bloodstream infection and mortality compared with no antibiotic therapy in adults undergoing hemodialysis" (34).
The questions being addressed, and the rationale for them, are one of the most critical parts of a systematic review. They should be stated precisely and explicitly so that readers can understand quickly the review's scope and the potential applicability of the review to their interests (35). Framing questions so that they include the following five "PICOS" components may improve the explicitness of review questions: 1) the patient population or disease being addressed (P), 2) the interventions or exposure of interest (I), 3) the comparators (C), 4) the main outcome or endpoint of interest (O), and 5) the study designs chosen (S). For more detail regarding PICOS, see Box 2.
Good review questions may be narrowly focused or broad, depending on the overall objectives of the review. Sometimes broad questions might increase the applicability of the results and facilitate detection of bias, exploratory analyses, and sensitivity analyses (35–36). Whether narrowly focused or broad, precisely stated review objectives are critical as they help define other components of the review process such as the eligibility criteria (Item 6) and the search for relevant literature (Items 7 and 8).
Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address) and, if available, provide registration information including the registration number.
"Methods of the analysis and inclusion criteria were specified in advance and documented in a protocol" (37).
A protocol is important because it pre-specifies the objectives and methods of the systematic review. For instance, a protocol specifies outcomes of primary interest, how reviewers will extract information about those outcomes, and methods that reviewers might use to quantitatively summarize the outcome data (see Item 13). Having a protocol can help restrict the likelihood of biased post hoc decisions in review methods, such as selective outcome reporting. Several sources provide guidance about elements to include in the protocol for a systematic review (16, 38–39). For meta-analyses of individual patient-level data, we advise authors to describe whether a protocol was explicitly designed and whether, when, and how participating collaborators endorsed it (40–41).
Authors may modify protocols during the research, and readers should not automatically consider such modifications inappropriate. For example, legitimate modifications may extend the period of searches to include older or newer studies, broaden eligibility criteria that proved too narrow, or add analyses if the primary analyses suggest that additional ones are warranted. Authors should, however, describe the modifications and explain their rationale.
Although worthwhile protocol amendments are common, one must consider the effects that protocol modifications may have on the results of a systematic review, especially if the primary outcome is changed. Bias from selective outcome reporting in randomized trials has been well documented (42–43). An examination of 47 Cochrane reviews revealed indirect evidence for possible selective reporting bias for systematic reviews. Almost all (n = 43) contained a major change, such as the addition or deletion of outcomes, between the protocol and the full publication (44). Whether (or to what extent) the changes reflected bias, however, was not clear. For example, it has been rather common not to describe outcomes that were not presented in any of the included studies.
Registration of a systematic review, typically with a protocol and registration number, is not yet common, but some opportunities exist (45–46). Registration may possibly reduce the risk of multiple reviews addressing the same question (45–48), reduce publication bias, and provide greater transparency when updating systematic reviews. Of note, a survey of systematic reviews indexed in MEDLINE in November 2004 found that reports of protocol use had increased to about 46% (3) from 8% noted in previous surveys (49). The improvement was due mostly to Cochrane reviews, which, by requirement, have a published protocol (3).
Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
Types of studies: "Randomised clinical trials studying the administration of hepatitis B vaccine to CRF [chronic renal failure] patients, with or without dialysis. No language, publication date, or publication status restrictions were imposed … " (50).
Types of participants: "Participants of any age with CRF or receiving dialysis (haemodialysis or peritoneal dialysis) were considered. CRF was defined as serum creatinine greater than 200 µmol/L for a period of more than six months or individuals receiving dialysis (haemodialysis or peritoneal dialysis). … Renal transplant patients were excluded from this review as these individuals are immunosuppressed and are receiving immunosuppressant agents to prevent rejection of their transplanted organs, and they have essentially normal renal function … " (50).
Types of intervention: "Trials comparing the beneficial and harmful effects of hepatitis B vaccines with adjuvant or cytokine co-interventions [and] trials comparing the beneficial and harmful effects of immunoglobulin prophylaxis. This review was limited to studies looking at active immunization. Hepatitis B vaccines (plasma or recombinant [yeast] derived) of all types, dose, and regimens versus placebo, control vaccine, or no vaccine … " (50).
Types of outcome measures: "Primary outcome measures: Seroconversion, ie, proportion of patients with adequate anti-HBs response (>10 IU/L or Sample Ratio Units). Hepatitis B infections (as measured by hepatitis B core antigen [HBcAg] positivity or persistent HBsAg positivity), both acute and chronic. Acute (primary) HBV [hepatitis B virus] infections were defined as seroconversion to HBsAg positivity or development of IgM anti-HBc. Chronic HBV infections were defined as the persistence of HBsAg for more than six months or HBsAg positivity and liver biopsy compatible with a diagnosis or chronic hepatitis B. Secondary outcome measures: Adverse events of hepatitis B vaccinations … [and] …mortality" (50).
Knowledge of the eligibility criteria is essential in appraising the validity, applicability, and comprehensiveness of a review. Thus, authors should unambiguously specify eligibility criteria used in the review. Carefully defined eligibility criteria inform various steps of the review methodology. They influence the development of the search strategy and serve to ensure that studies are selected in a systematic and unbiased manner.
A study may be described in multiple reports, and one report may describe multiple studies. Therefore, we separate eligibility criteria into the following two components: study characteristics and report characteristics. Both need to be reported. Study eligibility criteria are likely to include the populations, interventions, comparators, outcomes, and study designs of interest (PICOS; see Box 2), as well as other study-specific elements, such as specifying a minimum length of follow-up. Authors should state whether studies will be excluded because they do not include (or report) specific outcomes to help readers ascertain whether the systematic review may be biased as a consequence of selective reporting (42–43).
Report eligibility criteria are likely to include language of publication, publication status (e.g., inclusion of unpublished material and abstracts), and year of publication. Inclusion or not of non-English language literature (51–55), unpublished data, or older data can influence the effect estimates in meta-analyses (56–59). Caution may need to be exercised in including all identified studies due to potential differences in the risk of bias such as, for example, selective reporting in abstracts (60–62).
Describe all information sources in the search (e.g., databases with dates of coverage, contact with study authors to identify additional studies) and date last searched.
"Studies were identified by searching electronic databases, scanning reference lists of articles and consultation with experts in the field and drug companies. … No limits were applied for language and foreign papers were translated. This search was applied to Medline (1966-Present), CancerLit (1975-Present), and adapted for Embase (1980-Present), Science Citation Index Expanded (1981-Present) and Pre-Medline electronic databases. Cochrane and DARE (Database of Abstracts of Reviews of Effectiveness) databases were reviewed. … The last search was run on 19 June 2001. In addition, we handsearched contents pages of Journal of Clinical Oncology 2001, European Journal of Cancer 2001 and Bone 2001, together with abstracts printed in these journals 1999-2001. A limited update literature search was performed from 19 June 2001 to 31 December 2003" (63).
The National Library of Medicine's MEDLINE database is one of the most comprehensive sources of health care information in the world. Like any database, however, its coverage is not complete and varies according to the field. Retrieval from any single database, even by an experienced searcher, may be imperfect, which is why detailed reporting is important within the systematic review.
At a minimum, for each database searched, authors should report the database, platform, or provider (e.g., Ovid, Dialog, PubMed) and the start and end dates for the search of each database. This information lets readers assess the currency of the review, which is important because the publication time-lag outdates the results of some reviews (64). This information should also make updating more efficient (65). Authors should also report who developed and conducted the search (66).
In addition to searching databases, authors should report the use of supplementary approaches to identify studies, such as hand searching of journals, checking reference lists, searching trials registries or regulatory agency Web sites (67), contacting manufacturers, or contacting authors. Authors should also report if they attempted to acquire any missing information (e.g., on study methods or results) from investigators or sponsors; it is useful to describe briefly who was contacted and what unpublished information was obtained.
Present the full electronic search strategy for at least one major database, including any limits used, such that it could be repeated.
In text: "We used the following search terms to search all trials registers and databases: immunoglobulin*; IVIG; sepsis; septic shock; septicaemia; and septicemia … " (68).
In appendix: "Search strategy: MEDLINE (OVID)
01. immunoglobulins/
02. immunoglobulin$.tw.
03. ivig.tw.
04. 1 or 2 or 3
05. sepsis/
06. sepsis.tw.
07. septic shock/
08. septic shock.tw.
09. septicemia/
10. septicaemia.tw.
11. septicemia.tw.
12. 5 or 6 or 7 or 8 or 9 or 10 or 11
13. 4 and 12
14. randomized controlled trials/
15. randomized-controlled-trial.pt.
16. controlled-clinical-trial.pt.
17. random allocation/
18. double-blind method/
19. single-blind method/
20. 14 or 15 or 16 or 17 or 18 or 19
21. exp clinical trials/
22. clinical-trial.pt.


text:
->''"I wish the first word I ever said was the word 'quote,' so right before I die I could say 'unquote.'"''
->''More Weight."
-->-- [[Theatre/TheCrucible Giles Corey]]
->''Last words are for fools who haven't said enough.''
-->--Supposed last words of '''Karl Marx'''
->You guys suck! [[LampshadeHanging I can't believe those are going to be my last words...]]
-->--'''Vile''', ''Webcomic/TwoEvilScientists''
->As last words go, not very memorable.
-->--'''The Narrator''' on Sidorak's last words, ''{{Toys/Bionicle}}''
-> '''Angelica''': Spare me the histrionics, Jim. I wouldn't expect that kind of juvenile trick from you, [[LookBehindYou staring over my shoulder and widening your eyes as if there were someone behind me]]. I'm not going to turn and look. You're not getting out of this one alive.
-> '''Slippery Jim''': Famous last words.
-->-- ''Literature/TheStainlessSteelRat''
-> "Well, that was unexpected..."
-->-- Varon the Undefeatable, ''TabletopGame/{{Warhammer 40000}}: The Traitor's Hand''
->'''Sultan:''' Have you any famous last words?\\
'''[[TheMunchausen Baron Munchausen]]:''' Not yet.\\
'''Sultan:''' [[CompletelyMissingThePoint "Not yet"? Is that famous?]]
->''Die, my dear? Why that's [[ExactWords the last thing I'll do!]]''
-->-- '''Groucho Marx'''
-> "Any last words? Didn't think so."
-->-- Item description for Chaotic Executioner Hood in ''VideoGame/AdventureQuestWorlds''
->''Don't let it end like this. Tell them I said something.''
-->-- '''Pancho Villa'''
->''My God, don't shoot!''
-->-- '''Soapy Smith'''
-->-- '''[[Film/CitizenKane Charles Foster Kane]]'''
->''"Have a nice day..." (Collapses) "CLEAN UP! REGISTER 6!"''
-->-- '''Steven Chapman''', ''VideoGame/DeadRising''
-> Take me into your heart! Accept me as your savior! Nail me to the fucking cross and let me be '''''REBORN!!!'''''
-->-- '''Vaas Montenegro''', ''VideoGame/FarCry3''
->'''Bergman:''' Don't you want to hear my last words?
->'''Joe Moore:''' ''(shoots him)'' I just did.
-->-- '''[[Creator/DavidMamet Heist]]'''
-> As for me, I'll do what I do best. Lie, cheat, steal, and survive!
-->-- [[spoiler: '''Roman torchwick''']], "WebAnimation/{{RWBY}}"
->''"I actually came up with [my last words] years ago. They've gone through a lot of rewrites, but that's what you get for being a writer, really. Always tinkering. Never satisfied. But finally, they're perfect, and I get to use them" (*Takes deep breath*) "No, Wait-" (*dies*)''
-->-- [[spoiler:'''Gordon Edgley''']], ''Literature/SkulduggeryPleasant''
->''"[[PrecisionFStrike Shut the fuck up]] and let me die in peace."''
-->-- '''Mike Ehrmantraut''', ''Series/BreakingBad''
->''"You always were... [[LiteralSplitPersonality my better half]]."''
-->--'''Cia''' to Lana, ''VideoGame/HyruleWarriors''
->'''Brigand:''' Fuck you!\\
'''Sandor Clegane:''' Those are your last words, "Fuck you"? Come on you can do better.\\
'''Brigand:''' Cunt!\\

subset: commoncrawl


text:
Graduating Seniors
Below you will find the most important issues that apply to being a Senior and prospective graduation:
- Check your UVM email no less than once a week
All reminders for requirements will be sent to your student UVM email address. Read any correspondence from the Dean's Office carefully.
- Complete the on-line Intent to Graduate Form
This form is required in order to graduate and should be completed the semester before you intend to graduate in order to assure that there aren't any last minute issues.
- Review ALL parts of your CATS Audit
The CATS Audit is utilized for certification of degree completion. Your CATS audit should correctly reflect your remaining requirements. If you believe there are errors, contact the Dean's Office as soon as possible. Check that your declared major and your minor are accurate. If not, correct it by accessing a change of major on-line form.
- Review Transfer credits, if applicable
Make sure all credit taken at institutions other than UVM has transferred in properly. If not contact Transfer Affairs at 802.656.0867 or firstname.lastname@example.com.
- Meet with your assigned Advisor during your last semesters at UVM to review what requirements you need or discuss any academic issues that may arise. Your advisor will be listed under your Student Records in the Student Information System.
- Grades Resolution
All Incompletes, Missing Grades, and SP's on your record must be resolved prior to graduation. (Check your transcript)
Commencement Information
- Only students who have completed all the necessary requirements at the end of the Spring semester are permitted to participate in the ceremony.
- Run your CATS audit once all of your final semester's grades are processed and if it states "All requirements identified below have been met" then you will be certified for graduation.
- You must have a cap and gown in order to be in the ceremony. They are available for purchase at the UVM Bookstore.
- University Honors will not be calculated until all grades for the Spring semester are processed. The medallion may be picked up at 438 College Street during normal work hours before commencement or given at the time of lineup Sunday morning.
- Information and details about Commencement are posted to the Commencement Website. This includes information about UVM's ceremony and the College of Arts and Sciences ceremony. Check the site frequently for updates. Changes to locations due to inclement weather are posted starting at 6:00 a.m. on Commencement day.
Last modified June 16 2015 05:27 PM


text:
Castle Rock, Colo. (AP) A hearing for a man accused of dragging his girlfriend to death has been postponed as prosecutors and defense lawyers huddled in meetings.
Thirty-eight-year-old Jose Luis Rubi-Nava is charged with murder and kidnapping in the September 2006 death of 49-year-old Luz Maria Franco Fierros.
A motions hearing was scheduled for Wednesday afternoon, but it was postponed until Thursday. Both sides declined to comment.
Rubi-Nava smiled at supporters and pumped his fist as he waited.
Franco Fierros' body was found near Castle Rock with a nylon strap around her neck at the end of a 1 ½-mile trail of blood. An autopsy report said she died from strangulation and massive head wounds from being dragged by a vehicle.
Prosecutors had said they were seeking the death penalty.
Post Your Comments


text:
Get Funagain Points by submitting media! Full details, including content license, are available here.
You must be logged in to your account to submit media. Please click here to log in or create a free account.
Home >
Knucklebones: Premiere Collector Edition
Notify me if/when this item becomes available:
(you will be asked to log in first)
Please Login to use shopping lists.
Product Description
- Ken Jennings
- 10 essential games
- Monopoly's checkered past
Product Information
Jones Publishing
Year: 2005
Weight: 211 grams
Language Requirements: The text of this item is printed in English. This is a domestic item.
Product Reviews
Other Resources for Knucklebones: Premiere Collector Edition:
Board Game Geek is an incredible compilation of information about board and card games with many descriptions, photographs, reviews, session reports, and other commentary.


text:
THE 4TH YOUGHAL ARTS NETWORK MIDSUMMER'S GALA BALL will be held in the Ballroom of the Walter Raleigh Hotel on Saturday 18th of June at 9pm. The evening will commence with a musical presentation by Youghal's own Lar na cruinne , who will play while the guests enjoy a beautiful buffet meal . After the guests are wined and dined , the Fabulous Swingin Blue Cats will take to the stage , to play a selection of jive, jazz and swing dance numbers to get everyone on the floor . This brilliant six piece band had the dance floor hopping last year and everybody will be looking forward to a repeat performance this year .
At 1am the Band will finish and make way for D.J.Hatz , who will play his selection of Oldies, Classics and chart music , into the early hours . The committee of The Arts Network look forward to seeing all the usual faces , who have loyally supported the first three Balls and lots of new faces also . All this wonderful entertainment is available for 25 Euro per person , which is great value in these testing times . So dust off the tux's and ball gowns and join us in what will be a great party night on the 18th. The fun starts at 9pm and finishes late . Tickets are available from usual outlets , Read + Write , Jack o patsy , Gallery 126 , Alan Prim's , The Walter Raleigh and committee members , Jennifer Kirwan , Donacha O' Cearuill , Michelle Murphy , Chris Kenifick , Barbara Kirwan , Martin Hynes and Jessica Gunn.
Click on related video below to see the inaugural Youghal Arts Network Ball back in June 2008


text:
on the master server run
../netbackup/bin/goodies/support > master.txt you will see the type of
license you have and what features is enabled ...
"Gary Richardson"
wrote in message
> Hi all,
> We installed Netbackup 3.4 business server last April. When the Veritas
> install guy was here to do the install and help us configure it, he
> configured OTM (Open Transaction Manager) on some of our NT clients.
> great to us! :-)
> Well, the other day I needed to restore some stuff from one of the NT
> backups and I find that it's not on any of my tapes! Yikes! I find out
> the stuff wasn't backed up because it was considered an "open file". I
> thought OTM was supposed to take care of that. After some testing, I
> on logging for OTM on the NT client. When I checked the log it said that
> there's no license on the server for OTM.
> That sure surprised me. Since the Veritas guy configured OTM for me I
> assumed (I guess that was a bad thing to do) that OTM came with NB
> Server.
> So I guess I have a couple of questions. 1) Is OTM part of NB Business
> Server or is it a separate package that I need to buy a license for? 2)
> it is a licensed product, do I just need to buy one license that'll cover
> all 8 clients (well 6 NT - 2 clients are Solaris) or do I need to buy one
> for EACH NT machine?
> Thanks for any help/info. Oh, BTW, my NB server is running on a Sun Ultra
> w/ Solaris 7 (if it matters).
> -Gary


text:
Miami Marlins shortstop Jose Reyes' slow start has resulted in his drop out of the leadoff spot.
Manager Ozzie Guillen said he just wants "a little different look" at the top of the lineup, which is why Reyes hit second Saturday and Sunday, the first time Reyes is not in the leadoff spot this season.
But don't get used to Emilio Bonifacio leading off.
"When he starts swinging the bat better, we'll move him back where he belongs," Guillen said about Reyes.
"Hopefully (Reyes will) see more fastballs, get more patient at the plate." Reyes is 2-for-his-last-21 after going 0-for-3 Sunday. He was not in Friday's starting lineup.
"I'm not feeling too comfortable," Reyes said. "I'm swinging at a lot of bad pitches."


text:
Restaurant Photos
See the sparkling-fresh seafood dishes at TJ's Seafood Market and Grill
Photo: Ben Torres/Special Contributor
Key lime pie cheesecake at TJ's is brought in from Tart Bakery.
To post a comment, log into your chosen social network and then add your comment below. Your comments are subject to our Terms of Service and the privacy policy and terms of service of your social network. If you do not want to comment with a social network, please consider writing a letter to the editor.


text:
The extremely successful and popular developers behind some of Android, iOS, and Facebook's most popular games Zynga have just released their latest game for Android. This is called Zombie Smash and they've taken over Android. Check out the video below as it's highly entertaining and then read on past the break for full details on this addicting new game.
They are calling this a "survival comedy" game and that is exactly what it is. Your skills will be tested as you try to escape the zombies, all while having fun at the same time. This is almost like Left 4 Dead meets castle defense meets physics-based games such as Angry Birds. It really is a unique and fun experience and has raving reviews so far for Android.
[youtube yKf9RVkXLqE]
Once purchased for $0.99 (ad-free unlike iOS) you'll be required to download an additional 55MB or so of game data for the impressive graphics used in the game, but that is to be expected with a game of this level. The touch controls should be very intuitive although some reports in the Play Store say they've been glitching out every few levels and users need to restart the game -- so hopefully that gets fixed.
This is zombie demolition as its finest. Players will slash, swipe, and tap their way through hordes of zombies and Zynga's provided over 30 specials or upgrades. Things like wrecking balls to crash through waves of enemies, liquid nitrogen and more. Then you have multiple playing modes including a Endless Siege Mode where the zombies will as last as long as you and your fingers can.
Get it today in the Play Store via the link below and let us know what you think. Finally, a game from Zynga that isn't Words with Friends or Scramble.


text:
Amir Khan or someone with access to his Twitter account has taken to the social media outlet to reveal Floyd Mayweather Jr. has picked Marcos Maidana ahead of the British welterweight for his next opponent.
However, it's not clear how Khan and Co. know this. No official announcement has been made by the undefeated American on who he will fight on May 3. Plus, Khan tweets only that he hasn't heard from Mayweather.
Still, Khan's camp seems convinced he is no longer in the running to be the chosen one.
The 27-year-old Englishman expressed his disappointment and anger over Mayweather's apparent snub in a series of tweets Friday. There was even a telling message of support for Maidana, whom Khan beat on points back in 2011.
"No response from Mayweather or his team," Khan tweeted. "Fights not happening. I should of taken the title fight last December against [Devon] Alexander…"
"Very disrespected by his team. Wasted my time. Good luck to Maidana, against Mayweather."
"Can I apologise to the thousands of people who are let down. You, me and everyone wanted the Mayweather fight. He's running scared."
Richard Schaefer of Golden Boy Promotions, Khan's promoter, told mlive.com that a Mayweather-Maidana deal has not been reached and that Mayweather advisor Al Haymon confirmed that fact.
Schaefer said he has been unable to reach Khan since the comments were tweeted.


text:
Filter by:
Content type:
Stage 1&2
Stage 2&3
Stage 3&4
Stage 4&5
Challenge level:
Can you describe this route to infinity? Where will the arrows take you next?
The triangle OMN has vertices on the axes with whole number co-ordinates. How many points with whole number coordinates are there on the hypotenuse MN?
Build gnomons that are related to the Fibonacci sequence and try to
explain why this is possible.
A game for 2 players
To avoid losing think of another very well known game where the
patterns of play are similar.
The aim of the game is to slide the green square from the top right
hand corner to the bottom left hand corner in the least number of
Some students have been working out the number of strands needed for different sizes of cable. Can you make sense of their solutions?
Show that all pentagonal numbers are one third of a triangular number.
Can you find a rule which connects consecutive triangular numbers?
Can you discover whether this is a fair game?
Triangle numbers can be represented by a triangular array of squares. What do you notice about the sum of identical triangle numbers?
Problem solving is at the heart of the NRICH site. All the problems
give learners opportunities to learn, develop or use mathematical
concepts and skills. Read here for more information.
Some puzzles requiring no knowledge of knot theory, just a careful
inspection of the patterns. A glimpse of the classification of
knots and a little about prime knots, crossing numbers and. . . .
Can you find a rule which relates triangular numbers to square numbers?
Two motorboats travelling up and down a lake at constant speeds
leave opposite ends A and B at the same instant, passing each
other, for the first time 600 metres from A, and on their return,
400. . . .
In a three-dimensional version of noughts and crosses, how many winning lines can you make?
Three frogs hopped onto the table. A red frog on the left a green in the middle and a blue frog on the right. Then frogs started jumping randomly over any adjacent frog. Is it possible for them to. . . .
Jo made a cube from some smaller cubes, painted some of the faces
of the large cube, and then took it apart again. 45 small cubes had
no paint on them at all. How many small cubes did Jo use?
How could Penny, Tom and Matthew work out how many chocolates there
are in different sized boxes?
Euler discussed whether or not it was possible to stroll around Koenigsberg crossing each of its seven bridges exactly once. Experiment with different numbers of islands and bridges.
The picture illustrates the sum 1 + 2 + 3 + 4 = (4 x 5)/2. Prove the general formula for the sum of the first n natural numbers and the formula for the sum of the cubes of the first n natural. . . .
A cyclist and a runner start off simultaneously around a race track each going at a constant speed. The cyclist goes all the way around and then catches up with the runner. He then instantly turns. . . .
A right-angled isosceles triangle is rotated about the centre point
of a square. What can you say about the area of the part of the
square covered by the triangle as it rotates?
P is a point on the circumference of a circle radius r which rolls,
without slipping, inside a circle of radius 2r. What is the locus
of P?
Imagine starting with one yellow cube and covering it all over with
a single layer of red cubes, and then covering that cube with a
layer of blue cubes. How many red and blue cubes would you need?
On the 3D grid a strange (and deadly) animal is lurking. Using the tracking system can you locate this creature as quickly as possible?
If all the faces of a tetrahedron have the same perimeter then show that they are all congruent.
Can you use the diagram to prove the AM-GM inequality?
Can you see how this picture illustrates the formula for the sum of
the first six cube numbers?
The opposite vertices of a square have coordinates (a,b) and (c,d). What are the coordinates of the other vertices?
This article for teachers discusses examples of problems in which
there is no obvious method but in which children can be encouraged
to think deeply about the context and extend their ability to. . . .
Players take it in turns to choose a dot on the grid. The winner is the first to have four dots that can be joined to form a square.
What happens to the perimeter of triangle ABC as the two smaller
circles change size and roll around inside the bigger circle?
There are 27 small cubes in a 3 x 3 x 3 cube, 54 faces being
visible at any one time. Is it possible to reorganise these cubes
so that by dipping the large cube into a pot of paint three times
you. . . .
Bilbo goes on an adventure, before arriving back home. Using the
information given about his journey, can you work out where Bilbo
This is an interactive net of a Rubik's cube. Twists of the 3D cube become mixes of the squares on the 2D net. Have a play and see how many scrambles you can undo!
Use the animation to help you work out how many lines are needed to draw mystic roses of different sizes.
A spider is sitting in the middle of one of the smallest walls in a
room and a fly is resting beside the window. What is the shortest
distance the spider would have to crawl to catch the fly?
Watch these videos to see how Phoebe, Alice and Luke chose to draw 7 squares. How would they draw 100?
Place a red counter in the top left corner of a 4x4 array, which is
covered by 14 other smaller counters, leaving a gap in the bottom
right hand corner (HOME). What is the smallest number of moves. . . .
Square It game for an adult and child. Can you come up with a way of always winning this game?
On the graph there are 28 marked points. These points all mark the
vertices (corners) of eight hidden squares. Can you find the eight
hidden squares?
How efficiently can you pack together disks?
ABCD is a regular tetrahedron and the points P, Q, R and S are the midpoints of the edges AB, BD, CD and CA. Prove that PQRS is a square.
Can you recreate these designs? What are the basic units? What
movement is required between each unit? Some elegant use of
procedures will help - variables not essential.
What can you see? What do you notice? What questions can you ask?
See if you can anticipate successive 'generations' of the two
animals shown here.
Seven small rectangular pictures have one inch wide frames. The
frames are removed and the pictures are fitted together like a
jigsaw to make a rectangle of length 12 inches. Find the dimensions
of. . . .
I found these clocks in the Arts Centre at the University of
Warwick intriguing - do they really need four clocks and what times
would be ambiguous with only two or three of them?
Discover a way to sum square numbers by building cuboids from small
cubes. Can you picture how the sequence will grow?


text:
Diabetes Health Center
Kids' Waists May Show Pre-Diabetes Problem
Aug. 1, 2005 -- Children with large waists are more likely to have trouble controlling their blood sugar.
The blood sugar problem, called insulin resistance, rears its ugly head before obvious diabetes develops.
In insulin resistance, the body starts to lose its ability to respond to the hormone insulin. Insulin helps to move sugar (glucose) from the blood into the cells to be used for energy. As insulin resistance worsens, the body's blood sugar levels slowly rise.
Insulin resistance is a hallmark of the metabolic syndrome, a group of abnormal conditions linked to heart disease and diabetes.
Signs of metabolic syndrome include excess body fat (especially around the belly), insulin resistance, high blood pressure, and poor cholesterol/blood fat levels.
Metabolic syndrome has been seen inand
Waist size could be a clue about whether a child may have metabolic syndrome, researchers write in the Archives of Pediatrics & Adolescent Medicine.
Latest Study
Doctors working on the study included Valeria Hirschler, MD, of the Durand Hospital in Buenos Aires, Argentina. They studied 44 girls and 40 boys aged 6-13. The kids ranged from being obese or overweight to normal weight.
Their waists were measured. The kids also got blood tests to check levels of insulin. Insulin levels rise as insulin resistance develops.
Bigger Waists, Bigger Problem?
Larger waists were tied to insulin resistance, write the researchers. They plan to study the kids over time.
"Waist circumference is a predictor of insulin resistance syndrome in children and adolescents," write the researchers.
Measuring a child's waist could be a simple way for doctors to help identify kids at risk of metabolic syndrome, write Hirschler and colleagues.
Risky Waists
The researchers used previously created charts to determine waist sizes that were associated with an increased risk of metabolic syndrome.
Researchers determined that waist sizes greater than 90% of other kids were associated with too much belly fat. This level also predicted the presence of insulin resistance.
Examples of risky waist sizes are:
- A 5-year-old boy or girl with a waist size of 22 inches or more
- A 10-year-old boy with a waist size of 26 inches or more
- A 10-year-old girl with a waist size of 25 inches or more
- A 15-year-old boy with a waist size of 31 inches or more
- A 15-year-old girl with a waist size of 28 inches or more
Metabolic Syndrome Can Be Reversed
If metabolic syndrome is found, positive lifestyle changes could greatly improve future health.
For instance, in December 2004, another research team reported thatTheir report appeared in the American Journal of Preventive Medicine.
Today on WebMD
WebMD Special Sections
- Managing Diabetes, Insulin, and High Blood Sugar
- Your Child and Type 1 Diabetes
- Next-Level Fitness When You Have Diabetes
- I Have Diabetes: Now What?
- Live Better Daily With Diabetes
- 8 Snacks That Won't Spike Your Blood Sugar
- Living with Diabetes Assessment
- Diabetes: Keys to Better Daily Control
- I Have Diabetes: Is Insulin Right For Me?
- What Kinds of New Insulin Are Out There?
- Diabetes as You Age: Stay Active, Live Better
- Diabetes: Ready to Lower Your Blood Sugar?


text:
Order Reprints
Journal: Int. J. Mol. Sci., 2011
Volume: 12
Number: 3409
Article: Study on the Expression and Clinical Significances of Lewis y Antigen and Integrin αv, β3 in Epithelial Ovarian Tumors
Authors: Yifei Wang, Juanjuan Liu, Bei Lin, Changzhi Wang, Quanrong Li, Shuice Liu, Limei Yan, Shulan Zhang and Masao Iwamori
Link: http://www.mdpi.com/1422-0067/12/6/3409
MDPI provides reprints in high quality with convenient shipping to destinations worldwide. The articles are printed in on premium paper with high-resolution figures. Our covers are customized to your article and designed to be complimentary to the journal. These reprints are ideal additions to your portfolio. Copy details: 135g/m2 paper, 2x stitched, full colour and glossy finish, orderable in quantities from 10 to 1000.
If you have any questions, or special requests, please write to firstname.lastname@example.com; we are happy to provide you with the information you need.


text:
WildEarth Guardians protects and restores the wildlife, wild places, wild rivers, and health of the American West.
With new coal mining threatening local communities, the
climate, and clean energy, WildEarth Guardians took aim at illegal federal
approvals at three active mines in Colorado. The legal filings seek to halt expansions
of these mines, collectively keeping nearly 90 million tons of coal in the
ground and more than 150 million metric tons of carbon out of our atmosphere.
In July, WildEarth Guardians defended quiet winter landscapes that provide
important habitat for wolverine, lynx, grizzly, and big game from snowmobiles on
the Beaverhead-Deerlodge National Forest. We filed an objection to the
U.S. Forest Service's decision to allow extensive snowmobile use across the
forest's 3.35 million acres.
"Wildlife Services," the
federal wildlife killing program, used our tax dollars to kill over 1.6 million
native animals last year, including 731 bobcats, 1,511 gray foxes, 1,534 red foxes,
20,334 black tailed prairie dogs, 480
black bears, 21,557 beavers, 69,905 coyotes, 284
cougars, 384 gray wolves and one critically endangered Mexican wolf. These horrifying numbers highlight the urgent need
for reform of the rogue program.
Amidst increasing pressure, plans to
auction off more than 2,000 acres of publicly owned oil and gas leases for
fracking near Chaco Canyon National Historical Park have been canceled by the Bureau of Land Management.
WildEarth Guardians joined a broad coalition of groups earlier this year in calling
on the agency to abandon its plans.
Slider Photo credits: Bears Ears, Northwest Colorado—Jeffrey Beall, Creative Commons, Flickr. lesser prairie chicken—Greg Kramos, USFWS. cows—WildEarth Guardians. Thumbprint photos: Peabody coal mining—WiildEarth Guardians. wolverine—Oregon Dept Fish and Wildlife. bobcat—dollarphotoclub.com Chaco mark—WildEarth Guardians.
About Us | Newsroom | Support Us | Take Action | Publications | Programs | Top Priorities | Species Conservation
Offices also in California * Wyoming


text:
Asian Tribune is published by World Institute For Asian Studies|Powered by WIAS Vol. 12 No. 1587
Four envoys in Korea were among the recipients awarded a plaque of appreciation
In recognition of the outstanding contribution to developing friendly relations between the Republic of Korea and the Democratic Socialist Republic of Sri Lanka through the promotion of trade, Ambassador of Sri Lanka, Tissa Wijeratne, was presented a plaque of appreciation by the Chairman of Korea Importers Association (KOIMA).
The Korea Importers Association (KOIMA) recently, celebrated the 42nd anniversary of the organization, with more than 400 participants in attendance from Korean company representatives, foreign ambassadors, the diplomatic community and Korean government officials.
. Three other Ambassadors were also presented the plaque including the Russian Ambassador, Konstantin V. Vnukov, the Argentine Ambassador, Carlos Alberto Arganaraz, and the Slovak Ambassador, Dusan Bella.
- Asian Tribune -


text:
Mr. Chairman, distinguished members of the committee, thank you for affording me the opportunity to address the committee on the role the United States Transportation Command (USTRANSCOM) played during Kosovo operations, and to make you aware of our observations and lessons learned. First, I want to thank the committee for its strong and continuing support of the Defense Transportation System. Your efforts have not only helped sustain a ready force of the right people and equipment, they have also played an important role in our being able to continue to answer the Nations call, on short notice, anytime, anywhere. Recent operations in and around Kosovo challenged us to go places and to do things in ways we had not been challenged before. Thanks to your support, the soldiers, sailors, airmen, Marines, and civilians of USTRANSCOM were not only able to answer the call, they were able to do so superbly.
Simply put, USTRANSCOMs mission is to provide air, land, and sea transportation in support of our National Security objectives--in times of both peace and war. To accomplish this daily global mission, USTRANSCOM relies on the resources of its three transportation component commands: the Armys Military Traffic Management Command (MTMC), the Navys Military Sealift Command (MSC) and the Air Forces Air Mobility Command (AMC). To achieve maximum effectiveness and efficiency, this mobility triad, in turn, leverages both a superb blend of active duty, reserve and civilian professionals, as well as the strong partnerships we have built with the commercial transportation industry. It is the increasing synergy of this team, coupled with the strong support of those who provide and comprise our forces, that has helped ensure USTRANSCOMs ability to rapidly meet its taskings and to be able to respond to any challenge, anytime, anywhere in the world.
Although USTRANSCOM is constantly, and heavily, committed around the globe and across the spectrum of National Security operations, we are always mindful of our vital "core" mission: readiness to support the regional CINCs in their prosecution of two nearly simultaneous Major Theater Wars (MTWs). The strategic mobility capabilities required to support this requirement are defined in the 1994/1995 Mobility Requirements Study Bottom Up Review Update (MRS BURU). Currently being updated by the Office of the Secretary of Defense and the Joint Staff in MRS-05, MRS BURU identified significant deficits in our Nations ability to meet oversize and outsize airlift cargo requirements. The MRS BURU analysis, in fact, led to a decision in 1995 to significantly modernize the Air Forces strategic airlift fleet. And, with the support of our service components, we are making good progress toward achieving that capability; basically a one MTW force now, designed to serve two nearly simultaneous MTWs. Against that backdrop, I report today on the success of that "in transition" force in meeting the Kosovo challengeand on the lessons we learned from the Kosovo operations.
In reviewing USTRANSCOMs role in ALLIED FORCE, several key observations and lessons learned require special, up-front mention.
Observation One: Kosovo was not the classic military conflict, pitting one massed military force against another. As a consequence, as the operation unfolded, NATO identified a number of disparate mobility missions and requirements to be filled. In the face of that uncertain and rapidly evolving environment, I can only describe the flexibility demonstrated and support provided by the USTRANSCOM team to ALLIED FORCE as magnificent!
Observation Two: ALLIED FORCE was a "tanker" intensive conflict, requiring nearly an "MTW" sized tanker aircraft and aircrew force--over 160 tanker aircraft and over 300 aircrews--to support the 78 day round-the-clock bombing operation.
Observation Three: The C-17, as it did in Bosnia, and in a host of contingency operations since, once again proved its tremendous value to the air mobility equation. Not only did the aircraft demonstrate daily its outstanding Continental United States (CONUS) to theater direct delivery capability into austere airfield environments, but its intratheater capability was once again highlighted as one of the true keys to mobilitys success. Add to that the contributions of the remainder of AMCs strategic intertheater airlift fleet of C-5s and C-141s providing time-critical movement of key materials, personnel, and supplies (including precision munitions), as well as MTMC and MSCs Herculean efforts in the transportation of huge stocks of munitions, supplies and equipment, and its easy to see that the combined success of ALLIED FORCE was due, in large part, to the highly effective surface, air and sea movement capabilities of USTRANSCOM and its components.
Good news aside, USTRANSCOMs ALLIED FORCE successes were not without challenges and lessons learned. I will mention three here, up front, and cover them in more detail later in this statement.
Challenge One: As we have observed in almost every contingency and war game since the end of the Cold War, the level of intensity required in modern air operations requires a significantly higher KC-135 tanker crew ratio than we have been able to afford since the "Berlin Wall" days when the KC-135 crew ratio was set at a 1.36/1.27 (Active Duty/Reserve) crew-to-aircraft ratio. Early during ALLIED FORCE, the supported CINC requested a ratio more on the order of 1.8 to one to support longer tanker missions. This generated considerable turbulence in both our planning and execution efforts. More on this later.
Challenge Two: Although we were able to overcome the C-5s shortcomings with "mass" in ALLIED FORCE, its mission capability (MC) rates continue to raise "Red Flags." Expected, by MRS BURU, to operate at a 75 percent MC rate in our "two, nearly simultaneous, Major Theater Wars" National Security Strategy scenario, the C-5s MC rate through Allied Force hovered around 60 percent and has declined to 56-58 percent since. This significantly reduced capability not only requires extraordinary work-arounds in peacetime, it portends significant shortfalls should we ever face a classic MTW strategic airlift requirement. I will get into another level of detail on this significant concern later in this statement.
Challenge Three: The hostile skies over Kosovo presented a threat to air mobility aircraft and crews that we have only recently begun to recognize the "tip of the iceberg" of a threat we see growing in significance in future contingencies. In short, a highly effective air defense system coupled with the proliferation of Man Portable Air Defense Systems (MANPADs) forced air mobility planners to seek alternative, inefficient routings around threats due to the lack of on-board defensive systems to combat the threat.
Despite these challenges, and I cant say this emphatically enough, the outstanding professional soldiers, sailors, airmen, Marines, and civilians in MTMC, MSC, and AMC performed brilliantly. As we write the history of ALLIED FORCE, and chronicle the tremendous success of politics, weapons systems and weapons, I suggest that among the most significant contributions we must record are the sacrifices that the participating men and women, and their families, endured in support of our National Security objectives.
At the commencement of Operation ALLIED FORCE, USTRANSCOMs primary support to the North Atlantic Treaty Organization (NATO) and the United States European Command (USEUCOM) was through the strategic deployment of combat and combat support aircraft from the CONUS to the USEUCOM area of responsibility (AOR). In this phase, AMC established a robust tanker "air bridge" across the Atlantic to deploy both combat aircraft as well as strategic airlift aircraft tasked to transport accompanying personnel and equipment. Additionally, AMC deployed a significant number of additional tanker aircraft to Europe, transferring operational control of these assets to the U.S. Commander in Chief (CINC), Europe. During this phase, MTMC and MSC also began to deploy what was to become a steady flow of ammunition via sealift from CONUS, through European ports, onward to NATO airbases.
As NATOs air campaign intensified, the pace of combat and combat support aircraft deployments increased commensurately, along with the requirement for supporting air tankers in Europe. At the same time, the changing nature of the operational environment in and around Kosovo presented us with three additional missions in support of NATO and USEUCOM. The first, Operation ALLIED HARBOR, involved support to the humanitarian efforts associated with providing relief to refugees fleeing Kosovo. The second, an extension of ALLIED FORCE, was deployment of Task Force (TF) Hawk from Central European and CONUS bases to Albania. Finally, as the air campaign ended we were tasked to support a third additional mission: Operation JOINT GUARDIAN-the deployment of NATOs peacekeeping force via air, land, and sea into Kosovo. In effect, we were beginning new deployments, in a crisis action environment, at the same time we were transitioning to sustainment of an existing deployment within the same region. These simultaneous requirements were challenging to USTRANSCOMs planners, as I suspect they were to other supported and supporting staffs. But, as I suggested earlier, this is the nature of our business today and it promises to grow only more complicated in the future.
By cessation of hostilities, AMC had deployed a nearly
"MTW-size" air refueling force of 160 aircraft of AMCs total strategic tanker fleet to support NATO and USEUCOM. Our tankers operated from 11 bases in Europe, mainly in support of combat and combat support aircraft in and around Federal Republic of Yugoslavia airspace.
In recent contingency operations, Air Force tankers are increasingly dedicated as intratheater assets in support of the air campaign. During ALLIED FORCE, Air Force tankers, placed under the operational control of USEUCOM, performed nearly 7000 missions, greatly extending the range and "station time" of United States and allied combat aircraft. An additional 654 strategic air refueling missions were performed in support of deploying units. There are some in NATO and EUCOM who refer to the deployed tanker force as the campaigns "most valuable player." Future air campaigns will require at least commensurate tanker support.
The strategic environment has changed since the Cold War when most of our tankers were dedicated to support the strategic bomber fleet. As described earlier, one lesson we learned in Kosovo, and unfortunately not a new lesson in this "post-Cold War" world in which were operating, is the fact that our current air tanker crew ratio of 1.36 (1.27 for the Air National Guard and Air Force Reserve) is inadequate to sustain the pace of modern, high intensity air operations. ALLIED FORCE required a higher crew ratio than is normally planned, which essentially drove our early request for a Presidential Selected Reserve Call-up (PSRC) of Air National Guard and Air Force Reserve aircrews and maintenance personnel. For USTRANSCOM, a decision to request PSRC is not a "business as usual" proposition. A request for PSRC is an extraordinary decision, made with full knowledge of the great sacrifices we know it will demand of our dedicated "citizen soldier" teammates and their families. From our perspective, a PSRC can be characterized as a withdrawal from our "rainy day" savings account an action not taken often, or lightly. The actual impact of the Kosovo reserve component recall is still to be determined. It may have significant impacts on retention and recruiting; or based on popular support for the war in this country, and the relative short length of the recall, it may be minimal. Time will tell. Even so, AMCs currently ongoing Tanker Requirement Study is exploring alternatives to our tanker aircraft fleet size and crew ratio challenges.
As suggested earlier, from an airlift perspective, ALLIED FORCE did not significantly stress our organic airlift system, even though, proportionally, more materiel was deployed via organic air than we anticipate in our normal MTW planning exercises. For example, during DESERT SHIELD/DESERT STORM, 9.4 percent of dry cargo was deployed via organic airlift. For ALLIED FORCE, the figure was 67 percent. I attribute this heavy reliance on airlift to the quickly changing nature of the operational environment and the austere transportation infrastructure in the region. As a data point, AMC flew 1,108 strategic airlift missions in support of Kosovo operations: 205 in the C-5, 104 in the C-141, and 799 in the C-17. An additional 66 commercial airlift missions were also flown.
The importance of our C-5 fleet was highlighted again during Kosovo operations. Although C-5s flew only 20 percent of our overall strategic airlift missions, they were critical in moving outsize equipment along the "long leg" of the deploymentfrom CONUS to Europe. In his testimony, General Shelton, Chairman of the Joint Chiefs of Staff, testified that Allied Force prosecuted " the most precise and lowest-collateral-damage air campaign in history-with no U.S. or allied combat casualties in 78 days of around-the-clock operations and over 38,000 combat sorties." A portion of that success belongs to the C-5s responsive movement of precision munitions from CONUS into the AOR.
Successes aside, the C-5s readiness remains a significant concern as its MC rate continues to decline from the 61 percent I reported to you earlier this year, to about 58 percent today. This aircraft, important to every peacetime deployment we undertake today, is even more critical in an MTW scenario where we would be required to move significantly more unit equipment from CONUS. As stated earlier, to meet the MRS BURU "two MTW" requirement, we need a 75 percent MC rate for the C-5. We are putting a C-5 modernization program in place in an effort to raise the C-5s reliability to the required level, but even if we succeed, based on the length of time required to complete the associated research, development, testing and subsequent modifications, we will not see MC rates rise significantly until 2005 nor, assuming full funding for the current program, and assuming the modifications are successful in reversing the C-5s declining reliability rates, will we begin to approach the required 75 percent MC rate until 2014. As we move in this direction, Air Mobility Commands "Oversize and Outsized Analysis of Alternatives", using MRS-05 scenarios, is currently examining these future combat power projection deficiencies alongside the MRS-05 requirements. We are hopeful that the recommendations from that analysis will suggest operationally effective, best value force mixes of C-5 and C-17 aircraft to meet todays and tomorrows Oversize/Outsize requirements.
The use of the C-17 in the intratheater role was a genuine success story, validating once again its critical importance as an instrument of national strategy. Twelve C-17s, placed under the tactical control of USEUCOMs air component, flew 430 intratheater airlift missions, mostly in support of TF Hawks deployment. With its large cargo capacity and superb ground maneuverability, the C-17 gave the supported commander the maximum flexibility possible to deploy his forces into Albania. As successful as it was though, we have to be very cautious as we come to depend on future use of the aircraft in this role. Only because of the minimal demand for strategic airlift were we able to dedicate C-17s for intratheater use. As you know, we are replacing 270 C-141s with just 134 C-17s being procured primarily to replace the C-141 in support of its MRS BURU strategic, intertheater role. In addition, even though tonnage capabilities remain close to the same, we lose tremendous flexibility with so many fewer "tails." In other words, 134 C-17s can only be in half as many places as 270 C-141s a tremendous capability shortfall in peacetime. And, if the demand for strategic airlift is higher in future conflicts, and we know it will be in an MTW, we will probably not be able to take C-17s out of the strategic flow for intratheater support at the currently planned force structure numbers. A separate Intratheater Lift Analysis is in progress to determine the force structure necessary to support worldwide intratheater aircraft lift requirements.
Our planners were very concerned with the threat of MANPADS. Our airlifters and tankers are valuable national assets, and carry equally valuable (and frequently precious human ) cargoes that are not easily replaced. Because of this threat, we were forced to fly less than optimal routes and altitudes during Allied Force. In spite of this, we were still able to accomplish the mission. However, as the MANPAD threat continues to proliferate throughout the world, especially in the hands of terrorists and other rogues, the threat may become great enough to force us to curtail mobility operations in a particular area. To counter this threat, we must develop a comprehensive program to protect our air mobility assets. Currently, the Air Force is examining alternatives to add large aircraft defensive systems to some portion of the air mobility fleet.
MTMC operated Military Ocean Terminal-Sunny Point, North Carolina for ammunition shipments to Europe, and the port of Beaumont, Texas for deployment of unit equipment for TF Hawk. In Europe, MTMC operated Port Thames, United Kingdom; Augusta Bay, Italy; and Bandirma, Turkey for ammunition shipments and Bremerhaven, Germany for reception of unit equipment. MTMCs forward presence in peacetime at these and other ports in Europe contributed immeasurably to our success in exploiting these much needed lines of communication during operations in Kosovo.
In Southern Europe, MTMC operated three additional ports for the first time: Brindisi, Italy; Durres, Albania; and Thessaloniki, Greece overcoming challenging limitations in each. Brindisi, although a very capable port, was across the Adriatic from the intended cargo destination Albania. Use of this port required intratheater watercraft, mainly barges and United States Army Logistics Support Vessels, to get equipment and supplies into the AOR. Durres is a shallow port with minimal infrastructure and a poor road structure leading inland. Thessaloniki, a very good deep-water port, was the choice for offload of most unit equipment, but required lengthy overland movement to get equipment and supplies into Albania.
Although USEUCOM and MTMC did a superb job of utilizing available ports for reception of unit equipment, we have to be concerned about access and capabilities for future operations. Had we not had access to an adjacent allied nations port, the challenges of closing unit equipment would have been substantial. Only through the capabilities provided by Joint Logistics Over the Shore (JLOTS) operations could we have overcome the lack of suitable ports. JLOTS is a joint Navy and Army operation that utilizes a variety of landing craft, floating causeways and cranes, tug boats and specially trained personnel to offload ships at sea and move cargo ashore without benefit of suitable port depths or infrastructure. Presently, we have minimal forward-deployed JLOTS equipment and can only offload vessels during Sea State Two conditions or less. We believe the regional CINCs will benefit from a Sea State Three (SS3) capability that substantially decreases offload operating times in rough seas. The Army and Navy have programs in place that should give us the SS3 capability by 2005.
Our MSC organic and chartered ships deployed everything from humanitarian supplies to ammunition to unit equipment. Before the conflict ended, ALLIED FORCE was supported by 34 strategic sealift ships, moving 7,594,674 barrels of fuel, 245,280 square feet of ammunition, 1,225,849 square feet of vehicles and equipment, and 1,533 twenty foot equivalent containers. To put this in perspective, this is enough fuel for 20 million minivans, and enough cargo to fill the floor space of 13 Super Walmarts.
Three of our prepositioning program ships, as part of MSCs force, also provided direct support: one tanker with JP5 fuel and two ammunition ships with munitions for the air campaign. Again, the value of prepositioned afloat stocks and our partnering with the commercial sealift industry proved vital. We saved considerable time and effort by calling these ships forward instead of activating or contracting shipping, loading in CONUS, and waiting on transit time to the theater.
Support to operations in Kosovo was a Total Force effort for USTRANSCOM. USTRANSCOM, more than any other warfighting unified command, relies on our reserve components for peacetime responsiveness and wartime capability: 61 percent of our CONUS surface transportation capacity, 57 percent of our airlift capability, and 93 percent of our aeromedical evacuation capability are provided by our Guard and Reserve partners. For sealift, we rely on commercial liner service to move 81 percent of the warfighters requirements. During Kosovo operations, we had a significant response to our call for reserve volunteers; however, as described earlier, ultimately we had to use the PSRC to source approximately 3,300 personnel, mostly to support our deployed tanker aircraft operations. Fortunately, the use of personnel already forward deployed in Europe and the limited requirement for strategic (intertheater) transportation made a more significant call-up unnecessary. That said, the PSRC is essential and vital to USTRANSCOM at the start of our support to any complex contingency. Simply put, USTRANSCOM cannot execute its National Security Strategy requirements without significant reserve force participation.
In the aftermath of Kosovo operations, it is my Air Force component, AMC, and in particular, AMCs tanker aircraft fleet, that requires recovery time. The Air Force has implemented a "Reconstitution" program to prepare its personnel and equipment for the next contingency. "Reconstitution" is especially challenging for AMC because our global commitments in support of the warfighting CINCs and Services in contingency operations, peacetime engagement, and training have not gone away. Our goal, however, has been to support the Chief of Staff of the Air Forces program of "Reconstitution" by lowering the commitment rates of recently deployed units and personnel for 120 days and by not deploying them to another operation for 6 months. Bottom line: We must take care of our people, and have time to "fix" our equipment, if we are to be ready to fight another day.
And along those lines, finally, and most importantly, the Kosovo operations reminded us of the importance of our most valuable commodity, our people. I am extremely proud of todays USTRANSCOM and its team of active and reserve soldiers, sailors, airmen, Marines, and civilians not to mention our "always ready" commercial partners. I am confident that we will continue to provide the most effective and responsive strategic mobility capability in the world.
I cannot close without reminding the committee of several important points: First, it is important to realize that USTRANSCOM is presently a one MTW equipped force tasked to support two nearly simultaneous MTWs. That said, we can support two MTWs, although at a higher level of risk in the second, by "swinging" our mobility forces from one MTW to the other. Even so, it is equally important to realize that our continued ability to support this strategy (and our ability to reduce risk in the second MTW) not to mention our peacetime readiness and responsiveness hinges on the success of several on-going and projected initiatives: continued acquisition of the C-17, our new and renovated fleet of Large Medium Speed Roll-on Roll-off ships, and our new suite of aircraft loadersthe 60K Tunner loader and our Next Generation Small Loader; improvement of the C-5s maintenance reliability; modernization and standardization of our C-130 fleet; modernization of the avionics and defensive systems of our airlift and air refueling fleets; continued support for the readiness of our prepositioning and Ready Reserve Force fleets; maintenance (and improvement) of our JLOTS capability; and continued modernization of our CONUS and overseas enroute infrastructures.
Finally, as you know, our current, very healthy economy, coupled with the high personnel tempo resulting from frequent deployments, is fueling the exodus of trained men and women from our armed forces. I ask for your continued strong support for enhancements to the quality of life of our service members.
And I thank you again, on behalf of the men and women of USTRANSCOM, for your continued strong support.


text:
Promoting Credible Internet Journalism
Recent investigations by federal officials found more than 800 web sites and newsgroups with questionable information about six major medical conditions. The Securities and Exchange Commission has filed charges against 44 stock promoters that paid online investment "experts" to rave about their companies' stocks.
Concerns about developments such as these have led Knight Foundation to fund two initiatives moving the field of online journalism toward establishing voluntary standards ensuring the credibility of information on the Internet:
- The Foundation has joined with the Pew Charitable Trusts and the Open Society Institute to provide $4.8 million to fund the Consumers Union's Web Credibility Project.
- Knight has also awarded $225,000 to the Online News Association (www.journalists.org) for its Web Credibility Study on the credibility and values for online journalism.
Consumers Union tackles Web credibility
The CU's Web Credibility Project aims to establish, promote and win adherence for core standards to help ensure the credibility of information on the Internet.
The Web Credibility Project will also develop effective voluntary standards and best practices for credible information and information disclosure on the Web, and work with other organizations to promote them and encourage Web publishers to adopt them.
Education of consumers is another primary goal of the project, which will seek to inform consumers about how to evaluate the information practices of Web sites, and ensure the information they obtain is reliable and trustworthy.
The initiative will examine broad trends and underlying business models on the Web as well as specific information practices on health, finance, travel, consumer shopping and journalism sites. The findings will be reported to the public through Consumer Reports magazine, Consumer Reports Online, and CU's other media and publications.
Consumer Reports Online (www.consumerreports.org) will evaluate the disclosure policies and credibility of information of selected Web sites and report the findings through its e-Ratings.
ONA begins Internet Journalism study
The Online News Association's Web Credibility Study has been designed to develop and promote principles and guidelines for online journalism.
The ONA has retained Howard Fineberg, president of Digital Futurist Consultancy, and Martha Stone, president of Whole Media Consulting, to direct the study on the credibility of and values for online journalism.
The study will focus on proper relationships between editorial content, advertising and e-commerce; the development of ethical standards and avoidance of conflicts of interest; and appropriate use of hyperlinking in a journalistic environment.
\"As digital media become a common news resource, it is important that the ONA address the issues that pertain to online journalists,\" said Stone.
Research for the yearlong study will include interviews with journalists, academics, lawyers, marketers, and technologists discussing setting guidelines for online journalism. This feedback will be compiled into a report with recommendations for enforcement of principles and guidelines to set a standard for online news integrity.
\"The results generated from ONA panel discussions and research will provide a foundation for the ongoing discussions regarding credibility in this very new medium. It is a chance to help shape solid journalistic practices early,\" said Finberg.
About the John S. and James L. Knight Foundation
Knight Foundation supports transformational ideas that promote quality journalism, advance media innovation, engage communities and foster the arts. We believe that democracy thrives when people and communities are informed and engaged. For more, visit www.knightfoundation.org.


text:
Dior Chérie Bow Makeup for Spring 2013 two new Edition harmonies: Powder Pink and Pearl Pink each hues for highlighting, shading and sparkly pink gloss to complete the look.
Two brushes creamy black eyeliner included the compact serves a mini makeup counter in palm of your hand.Dior Girly nail polishes this spring are "Tutu," a soft pink in a cotton candy shade.
Read Also


text:
My Account
Shopping Cart (0)
Part # 2-017-0002
The Handlebar Clamp allows 4" or 8" rods to be attached to standard 15mm rods (60mm spacing), typically used for creating hand grip support for handheld or shouldermount rigs.
Customers who purchased this item also purchased:
Price: $22.50
Price: $15.00
PO Box 271395 Flower Mound, TX 75027 USA Copyright © 2016 Redrock Microsystems, LLC. All rights reserved.


text:
Home › Skin Care › Moisturizers › Face Cream and Moisturizer
SkinCeuticals Daily Moisture
This lightweight pore-minimizing moisturizer for normal or oily skin hydrates, nourishes, and helps reduce the appearance of pore size with an exclusive combination of natural extracts. High levels of pure vitamin E heal and protect while Brazilian sea algae deliver proteins, amino acids, and essential minerals to the skin. Daily Moisture contains burnet, cinnamon and ginger to help reduce pore size without leaving the skin feeling greasy.
60 ml
60 ml
Apply one or twice daily to face, neck, and chest. For optimal results, use after a SkinCeuticals antioxidant and before a SkinCeuticals sunscreen.
SkinCeuticals Daily MoistureWrite A Review
1 Reviews(Avg 5.0/5)
Moisturizer provides perfect balance! Very light on skin7/21/2014
This moisturizer is perfect for my "normal" sometimes "combination" skin. I needed something that would provide a lot of moisture to my skin, yet not leave it feeling heavy throughout the day and eventually make my skin look oily. This is the perfect moisturizer for that. It is a great base and makeup can be applied immediately after cream is put on. My skin tone is much more even and by using the SkinCeuticals exfoliator beforehand, the red, more sensitive areas of my skin are now balanced and even. Skin feels great too!
Load More Reviews
1 Reviews(Avg 5.0/5)