text:
Jury: Man took cocaine into Erie courthouse
An Erie man has been convicted of all charges he tried to carry crack cocaine in an aspirin bottle through the front-door security system at the Erie County Courthouse in March.
A jury on Friday found William Gillespie, 30, guilty of charges of possession of drugs with intent to deliver, possession of a controlled substance and possession of drug paraphernalia stemming from the incident that occurred just before 9 a.m. on March 27. Sentencing is set for April 2.
An Erie County sheriff's deputy discovered the drugs when Gillespie emptied his pockets to pass through courthouse security. The deputy said he opened the bottle because it did not make a rattling sound as it would if it had pills inside. Inside, he found 15 rocks of crack cocaine wrapped in packets.
At trial Thursday, Gillespie maintained he was wearing his brother's clothing and was unaware of the cocaine.


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From $19,990
South Korean brand has added more power to its new high-riding hatch.
Korea's oldest car manufacturer was established in 1944 as Kyungsung Precision Industry, initially producing bicycles – first as parts then as complete products. From producing Korea's first bicycle, the company –trading as Kia from 1952 – compiled a number of other mobility milestones in Korea. The first car didn't arrive until 1974, though its production capabilities quickly drew the attention of Peugeot and Fiat – to build the 504 and 132, respectively. Australia's first taste of a Kia-made model was the Mazda 121 in 1987, followed by the (related) Ford Festiva. Kia entered Australia properly in 1997 with models including the popular Sportage. Hyundai bought a majority stake in its compatriot the same year during the Asian financial crisis, and the two brands continue to share significant resources for immense economies of scale. Kia vehicles are renowned for value – and Kia introduced a seven-year warranty locally in 2014 – though the company's models also adopted greater visual appeal after Peter Schreyer was appointed chief designer in 2006.Read more
Local testing sees affordable hatch retain five-star score.
$49,888 Drive Away
$20,990 Drive Away
$42,990 Drive Away

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When somebody awkwardly dry humps someone who doesn't want it, like Rampage Jackson did to that TV reporter.
Dude, I totally Rampaged this chick last night. She was all weird about me getting my grind on, but I kept doing it anyways.
από Go Sawx 17 Απρίλιος 2012
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Feltograph of my cat Sigmund
Sigmund the cat - Feltograph model
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Lowe Alpine Halcyon Jacket - Men's
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Lowe Alpine Men's Halcyon Jacket
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63-year-old in two-fatality crash is namedMarch 09,2013Local woman, 63,
named as fatality
QUECHEE A 63-year-old woman who was killed in a two-fatality crash Thursday in Quechee has been identified.
Nina Dimick of Woodstock was pronounced dead at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., after a crash that also killed Corey Daniels, 38, of Hartford.
Hartford Police said Dimick was driving east on Route 4 when she crossed the center line and struck the rear wheel of a utility trailer towed by Roger Cann, 71, of Macungie, Pa.
Dimick then hit Daniels vehicle head-on, police said. Cann was not hurt in the crash, but a teenager in his vehicle was injured.
Dimick was not identified at first while police were trying to reach her family.MORE IN This Just InMONTPELIER The Vermont State Colleges System Board of Trustees voted unanimously Thursday to... Full StoryWHITE RIVER JUNCTION An East Hardwick man who already has an active felony drug possession case... Full StoryA New York man who already served time for his connection with a cocaine-selling ring was... Full Story
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Bruce Porter, 54 - April 02, 2008
Bruce Eugene Porter, 54, of Inavale, formerly of Gothenburg, died Friday, March 14, 2008.
Graveside memorial services will be held at a later date in June, 2008, at Fort McPherson National Cemetery at Maxwell.
Porter was born June 25, 1953, at Gothenburg, to Norman and Margaret (Norsworthy) Porter.
He grew up and attended schools at Powell, WY, and Engelwood CO, and joined the U.S. Army, serving in Korea.
Following his discharge from the Army, he was employed as a construction worker.
Porter enjoyed all sports, however, Nebraska football was his favorite, according to family members.
He was preceded in death by his brother, Brian.
Survivors include: his parents, Norman and Margaret of Gothenburg; two brothers—Brad (Mary) of Fremont and Bill (Maureen) of Omaha; two sisters—Brenda (Russ) Huff of Taipei, Taiwan, and Beth (Mark) Jones of Midwest City, OK; three nieces and two nephews.
Online condolences may be sent to the family at www.blase strauser.com. Arrangements have been placed in the care of Blase-Strauser Memorial Chapel of Gothenburg.
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Lovely Tulips: Saarinen Tables, Burke Chairs & Mushroom Lamp
Mid Century Table - $425 • Brooklyn, NY: Nesso Mushroom Lamp - $300 • Santa Barbara, CA: Aluminum Patio Set - $1350 • Chicago, IL: Original Tulip Chairs - $600 • Boston, MA: Saarinen Tulip Chairs - $1500 Shoppers, check out the Classifieds for many more listings. Sellers, gather up your goods and list them in our Classifieds to turn them into a little extra spending cash. Go To: Classifieds Main Page Apartment Therapy is not the seller of these items. This is an edited selection of our favorite offerings from our Classifieds. For more information, see How it Works. Happy Scavenging!


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Show your colors with this Rainbow Fun Ultimate Party Pack!
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Nikon D4 Firmware Update 1.01
Latest Camera Reviews
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Nikon has issued a firmware update for the Nikon D4 professional DSLR camera. As with the Nikon D800/D800E, firmware version 1.01 resolves an issue that, on rare occasions, caused the camera to lock up; and addresses a couple of bugs related to network functions and Custom Setting F15. You can download the firmware update from the website below.
Website: Nikon D4 Firmware Update 1.01
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Maybe a good camera but wow it doesnt look nice at all!


text: First Budget Meeting for 2014 is Being Held Wednesday By Rick Brough • Dec 11, 2013 ShareTwitter Facebook Google+ Email Summit County's first budget hearing for 2014 is being held Wednesday. County Manager Bob Jasper said they will present a spending plan that is restoring a number of staff positions, and getting some service levels back on track. Rick Brough has more. Listen Listening... / 4:05 Related Program: Local News HourTags: Summit County Council2014 BudgetBob Jasperbudget hearing Related Content Agenda of Summit County Council Includes Public Hearing on Budget 2 years ago Council To Have Last Budget Talks Before Public Hearings Start 2 years ago Jasper On Council Agenda 2 years ago View the discussion thread.


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Skip to comments.La Raza President: Immigration Bill Would Make Living in Arizona a Police State for Hispanics
Posted on 04/23/2010 9:46:43 AM PDT by Nachum
(CNSNews.com) The head of the National Council of LaRaza pleaded with Arizona Gov. Jan Brewer Thursday not to sign into law a bill that could become the toughest immigration statute in the nation.
It perpetuates the fantasy that we can detain and deport millions of people from our country as a solution to our immigration problems and it propagates the notion that immigrants who are working hard in the Arizona economy are a criminal element to be rounded up and incarcerated, LaRaza President and CEO Janet Murguia said during a telephone news conference.
(Excerpt) Read more at cnsnews.com ...
Works for me...
La Raza doesn't speak for Hispanic Americans, it speaks for the illegals.
"The Race" grand dragon says laws are for gringos.
Sounds about right to me.
Common Sense Solutions Are The Best Solutions.
Poor babies. Let them squeal all they want. We have every right to defend our borders.
If they are illegals, the police should jail them yes, then send them back. How many people in our prison system are illegal aliens? I'd say about 1/3.
Not for ALL Hispanics, just the illegals. As it should be.
Yep. Now that would be money well spent.
"La Raza President: Immigration Bill Would Make Living in Arizona a Police State for Criminal Trespassers
There, fixed the title ;-)
Only the illegal one's!
A society has a right and a responsibility to maintain the integrity of its borders.
This is the most basic and essential function of a government. A government which fails to do so no longer merits the support of its people.
More like 50%. Federal prisons are in the 65% range.
they are illegal then they are not from this country and should not be here therefore they should be sent back
Over and above the millions who violate our borders, 1.5 million legal foreign workers come to the US each year, as a matter of course.
But this number isnt high enough for Dem Cong Gutierrez and his 92 co-sponsors. Their Comprehensive Immigration Reform bill includes a provision called recapture that will add up all the supposedly unused work visas since 1992 and issue them immediately.
This is a complete fraud, as all unused work visas are rolled over to the family reunification category the next year as it is.
Gutierrez' Comprehensive Immigration Reform bill will create 100,000 visas from countries that send the most illegal immigrants every year. According to the State Department, this will mean 550,000 new foreign workers.
AND GET THIS Mexico is the staging area for Third World and other illegals preparing to violate our borders. The Comprehensive Immigration Reform bill rewards Mexico b/c they calculatedly promote illegal immigration.
Gutierrez' bill will make it much easier for more illegal aliens to break in. Under the Bill, to prove they have jobs and were in the country BEFORE Congress passed amnesty, illegals are allowed to use stolen ID's, fake green cards, and fraudulent SS numbers....... without fear of prosecution.
Mexico facilitates the profitable staging area for global illegals to cross the border. Contrary to Obamas claim that CIR bill will increase border security, it does just the opposite.........
<> it guts successful enforcement measures,
<> limits raids on illegal immigrants,
<> prohibits use of troops on the border,
<> replaces E-Verify used to ensure employers hire legal American workers,
<> overturns all state and local US laws that crackdown on illegal immigration,
<> abolishes 287(g) that allows local L/E and federal authorities to apprehend criminal illegals.
Gutierrez makes Van Jones look like a patriot.
"...are a criminal element to be rounded up and incarcerated."
Illegal aliens are, by definition, a criminal element. But they should not be rounded up and incarcerated. They should be rounded up and DEPORTED.
Would Make Living in Arizona a Police State
Good... I hate you illegals... because you are... ILLEGAL!
There are other law enforcement groups in ARIZONA who approve of this measure!
[snip]But some of the largest rank-and-file police groups have come out strongly in favor of the bill.
The Phoenix Law Enforcement Association, the city police departments largest union, has promoted the bill as a common sense proactive step in the right direction in the continuing battle on illegal immigration.
The Fraternal Order of Police, which represents 6,500 officers statewide, endorsed the bill but said it had reservations over the potential costs to departments and the lack of training for local officers to identify who might be in the country illegally.
Bryan Soller, the president of the Fraternal Order of Police, said if officers ended up arresting large numbers of illegal immigrants, that could add to already crowded jails and costs. Mr. Soller also said departments were worried about the expense of defending any lawsuits by people contending that the law was not being enforced.
But he said he thought many concerns were overblown. His group initially opposed the bill but endorsed it after language was included that he and sponsors believe give officers discretion to use it, in part to ward off federal civil rights claims.
Works for me too. A strong clue someone may be an illegal is a poor ability to converse in English. That is an easy one, especially during a normal traffic stop.
Ok Sheriff Joe...You've got your marching orders...NOW GO CLEAN UP OUR GREAT STATE OF ARIZONA!!! Gotta luv Joe Arpaio.
Hopefully setting a trend.
Let's see...
No permit concealed carry, Pro 2nd, 10th, and 13th amendment government, big elk, and now the only state to aggressively address the illegal immigration problem... I think we might move to Arizona!
He's the BEST...Don't you agree?
"The liberal members of my family (read: all of them!) seem to think it impossible to deport millions of illegals. It's only "impossible" because we haven't actually tried it yet."
Seems like typical liberals that don't have any appreciation for the capabilities of a determined, free society.
Have them read up on the military/industrial logistics triumph that was the Berlin Airlift.
"The liberal members of my family (read: all of them!) seem to think it impossible to deport millions of illegals. It's only "impossible" because we haven't actually tried it yet."
Seems like typical liberals that don't have any appreciation for the capabilities of a determined, free society.
Have them read up on the military/industrial logistics triumph that was the Berlin Airlift.
They can move from Arizonia and back to Mexico anytime! I suspect many states will move to do the same thing.
From the article: "Around 488,000 illegal immigrants are claimed to have left voluntarily for fear of being apprehended. By September, 80,000 had been taken into custody in Texas, and the INS estimates that 500,000 to 700,000 had left Texas on their own."
Response: Good! However, it could be better, it could deputize thousands of citizens and use them to begin the necessary mass expulsions.
Today 0bama used a naturalization of active duty service men and woman to rip into AZ for upholding the laws regarding illegals.
He is threatening to investigate for civil rights violations.
"It perpetuates the fantasy that we can detain and deport millions of people from our country as a solution to our immigration problems"
awww, poor lil' illegals...
La Raza President: Immigration Bill Would Make Living in Arizona a Police State for Hispanics
As opposed to many of the same Hispanics making it a crime-ridden sh!thole for everybody????
OK. I stand corrected. Thanks.
La Raza is a 100 percent racist organization, right down to their name.
So, The Race is upset? Too bad, you pack of racist jackals.
Gov. Rick Perry!! ...are you watching?
Good. Now get the damn illegals out of our country.
You hit the nail on the head with that. My family is Cuban on my father's side. Everybody immigrated legally, and we are all Americans...nobody is a Cuban-American. This "gentleman" is an advocate for criminals, not for Hispanics.
Bump! Ever notice, also, how the "immigrant groups" only support amnesty for certian illegal immigrants (e.g. only Mexico or Latin America)? These groups never seem terribly vocal when illegal immigrants are from Russia, China, Italy, etc.
"La Raza President: Immigration Bill Would Make Living in Arizona a Police State for Hispanics"
You could try Mexico. It's Hispanic-friendly and right across the border.
>>Not a good test. There are many American Indians who
live in and were born in Arizona who don't speak English
at all.<<
I agree. I don't consider it a test, but just a strong clue. Fred Reed, when riding with cops in the Chicago Ghetto mentioned that when you saw white boys in a car it usually meant they were there to buy drugs. It was not a test, but it was a strong clue. In that case, it was a VERY strong clue.
In this case, if someone is Hispanic (and most illegal Mexicans are just "southern" American Indians) and can't speak English during a routine traffic stop, it would simply be more prudent for a reasonable police officer to use that as one of the clues to determine if examining the license as a forgery, etc. May be in order.
If someone is black or white or Asian it would probably be less of an issue. Racial and sexual profiling is arguably THE most useful weapon at the disposal of our police for effectively doing their job. I'd like to see the TSA embrace it.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.


text:
A man killed in a shooting in a house of ill-repute in Southwest Philadelphia Tuesday was identified today as 22-year-old Shirkey Warthen.
Police said Warthen lived on the 1200 block of South Ruby Street in the same Kingsessing neighborhood as the crime scene.
He was hit multiple times and a 34-year-old woman was wounded in the knee when gunfire erupted about 10 p.m. following an argument in the residence on Florence Avenue near 54th Street, described by police as a known location for drug activity and prostitution.


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text:
Windows OEM revenue (65% of division sales) is expected to show a "mid-teens" adjusted Y/Y drop in FQ1, Microsoft (MSFT) states on its FQ4 CC. OEM sales fell 15% in FQ4, as a 20%+ drop in consumer sales and pricing "incentives" offset healthy enterprise demand. CFO Amy Hood says Microsoft is still looking at ways to adjust Windows pricing, including for smaller devices. Server & Tools is expected to grow in the high-single-digits again. The Office division's business sales (85% of total) are seen growing in the mid-single-digits; consumer sales will be soft. Entertainment & Devices is seen declining in the low-single-digits ahead of the Xbox One launch. Capex is expected to keep growing thanks to Azure investments. Shares -6.4% AH. (FQ4: I, II) (slides - .ppt) (prepared remarks - .doc)
Windows OEM revenue (65% of division sales) is expected to show a "mid-teens" adjusted Y/Y drop...
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text:
SEATTLE -- About halfway to the basket, Kevin Durant decided his skinny frame wasn't about to shy away from taking on a 7-footer at the rim.
The result: 27 games into his NBA career, Seattle's 19-year-old rookie now has a poster-worthy dunk sure to be replayed and highlighted often.
Durant's baseline slam over 7-foot Toronto center Rasho Nesterovic was certainly impressive enough. But the dunk was only part of Durant's 27-point performance, as the SuperSonics held off the Raptors 123-115 on Friday.
When Durant caught the touch pass from Earl Watson and took one dribble toward the basket, he didn't plan on dunking over Nesterovic. But when the burly center went to challenge Durant, the rookie showed he can power the big guys on the inside.
"I've just got to start doing that more, trying to finish when guys attack," Durant said. "That was one of the turning points of the game."
The Sonics rebounded from a lackluster, uninspired effort two nights earlier against New Orleans, thanks largely to Durant, who made 11 of 18 shots, and 23 points from Wally Szczerbiak.
Durant scored 14 in the third quarter, including Seattle's first 11 of the second half. His dunk and subsequent free-throw pulled Seattle within 70-67, but it was Durant's no-look pass to Chris Wilcox for a fastbreak dunk minutes later that ignited a 21-9 Sonics' run to close the third quarter.
Seattle eventually built an 18-point lead in the fourth quarter, and it needed all of the advantage to hold off a late flurry by the Raptors.
Chris Bosh led Toronto with 26 points, 16 coming in the first half, but he had just two points in the fourth quarter and made just 1 of 6 attempts. The Raptors dropped their second straight game on a seven-game Western Conference swing, but made the Sonics sweat in the final seconds.
Seattle took its biggest lead at 116-98 on Durant's fourth 3-pointer with 4:09 left. Toronto made a furious rally, outscoring Seattle 13-0 over the next 2 1/2 minutes, behind 3-pointers from Carlos Delfino, Jason Kapono and Anthony Parker, and two baskets by Jose Calderon.
Szczerbiak's jumper with 1:25 left stemmed the surge, but Calderon scored again. Calderon finally missed, but a Seattle turnover gave Toronto the ball with 36 seconds left, down 118-113.
Delfino hit a wide open 3 with 31 seconds left, but officials correctly ruled his left foot was on the sideline when he caught the ball.
"We needed that call, no question," Szczerbiak said.
After Damien Wilkins made one of two free throws, Bosh dropped an inbound pass that Wilkins grabbed. He hit both free throws this time to seal the victory.
"We battled back, but then you have to try and play perfect basketball and you make one mistake and it deflates you," Toronto coach Sam Mitchell said.
Wilcox shot 7 of 7 and finished with 16 points and Nick Collison had 10 points and 10 rebounds, as seven Sonics scored in double figures. Watson, Jeff Green and Luke Ridnour all added 10 points.
Seattle took control with its run late in the third quarter, but it was the start of the quarter where Durant kept the Sonics close.
Durant added a deep 3 as part of Seattle's run, but it was Collison, Green and Szczerbiak doing most of the work. Collison assisted on three straight baskets and Szczerbiak capped the quarter with his third 3-pointer to give Seattle a 92-83 lead.
The lead grew to 18 on Durant's 3-pointer, before Toronto's final rally.
"We have to play better defense. I think we just had a couple of breakdowns and their confidence went up a little bit," Bosh said.
The Raptors matched their season-high with 13 3-pointers. Parker scored 18 and Kapono scored 16 off the bench. Delfino and Calderon both finished with 15.
Calderon had seven assists in the first quarter and finished with 16, matching his season-high. ... Toronto led 62-56 at halftime. The 62 points was Toronto's most in the first half this season. ... Seattle has three days off before playing Christmas night in Portland.


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Buy/Sell Medical Stuff
Shopping graphic by Freepik from Flaticon is licensed under CC BY 3.0. Made with Logo Maker
Request for Slots
Medical graphic by Freepik from Flaticon is licensed under CC BY 3.0. Made with Logo Maker
Request For Locums
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Singapore Locum Community
Parkway Shenton: Available Positions for Doctors
Last Updated on Thursday, 30 June 2016 09:24 Written by LocumSg Thursday, 30 June 2016 09:21
|Shenton Medical Group
|Executive Health Screeners
|Singapore Prison Service
|Juvenile Homes
|Mount Elizabeth Novena Hospital
Gleneagles Hospital
|Changi Prison
|Permanent (Full-time/Part-time)
|Permanent (Full-time/Part-time)
|Contract (Full-time)
|Contract (Full-time)
|Mon to Fri
8.00 am to 5.00 pm
Alternate Saturday
8.00 am to 1.00 pm
|Mon to Fri
8.00 am to 5.00 pm
8.30am to 12.30pm
|Mon to Fri
8.00 am to 5.30 pm
|Mon to Sun
8.00am to 1.00pm
|Desiree Yue
|Joline Ng
|Samantha Loh
|Samantha Loh
Last Updated on Wednesday, 08 June 2016 22:33 Written by LocumSg Wednesday, 08 June 2016 22:32
We are currently looking for Locum Resident Physician for Holistic Care for Medically Advanced patients programme. Please help us to post the following advertisement.
Responsibilities :
a) Screening patients for eligibility to be admitted into the Programme;
b) Providing clinical consultation for HOME team;
c) Conducting multidisciplinary team reviews of patients with the Programme;
d) Completing medical records in line with the HOME programme's requirements;
e) Working in close collaboration with restructured hospitals' and community hospitals' consultants to co-manage patients who are admitted into the Programme;
f) Assisting with ongoing review of clinical workflows and;
g) Assisting the Programme Director with any other duties as assigned.
Requirements :
a) A Singapore Medical Council registered doctor (full/conditional)
b) Specialist qualifications obtained in any internal medicine discipline, geriatrics will be an advantage.
Interested doctors kindly e mail us at
Project Ta Om 2016
Last Updated on Friday, 03 June 2016 21:52 Written by LocumSg Friday, 03 June 2016 21:51
Dear Sir/ Madam,
We are Sheryl Chng and Christine Wong and we will be organising a medical mission trip to the village of Ta Om, in Siem Reap, Cambodia. Our team would consist of 18 medical students and 2 doctors, and it will be held from 31 August 2016 to 11 July 2016. We are writing this email to you to propose a possible sponsorship opportunity with our team.
Introduction to Project Ta Om 2016
Our first medical expedition to the village of Ta Om was organized in 2013. Since then, 3 more projects were organized in 2014, 2015, and 2016. Each of these projects look to build upon the previous year's work and to provide continuity and sustainability, with the overall aim of developing Ta Om village's healthcare.
Our endorsing organization is Healthcare Expeditions International (HealthEx) and we are working with Build Your Future Today Centre (BFT) – an NGO local to Cambodia, with a mission to improve the lives of their people.
Project Aims
This year, we identified 4 main areas to work on, based on the information we collected from health records and surveys gathered from the team last year about the epidemiology of diseases in Ta Om. Our aims are also based on what BFT plans to develop in Ta Om in terms of their healthcare capabilities. The 4 areas are:
1. Non- Communicable Diseases
2. Mother and Child Health
3. Hygiene and Sanitation
4. Children Health
We aim to address these needs through the provision of acute medical care by setting up mobile clinics, conducting house-to-house health screening, selling hygiene products at low prices, and giving health education to villagers. Last year, the mobile clinic managed to reach out to 167 villagers over a span of 4 days. This year, we also aim to visit the villagers that we red-flagged last year, and provide them with a plan on how to manage their chronic illnesses. We will continue to screen the villagers for any new illnesses that may have arose over the year that has passed, since the previous team surveyed the place.
Thank you for your time and consideration, and we look forward to working with you, discussing about this collaboration through sponsorship in further details.
Yours sincerely,
Sheryl Chng and Christine Wong
Project Ta Om Leader
HealthEx International
Wellness Medical Doctor
Last Updated on Friday, 03 June 2016 21:52 Written by LocumSg Friday, 03 June 2016 21:47
SPRIM is an established worldwide health research consulting and service firm with over 500
employees in 22 offices and 15 countries around the globe. The company is focused on innovation in
human health, dedicated to leveraging its global expertise & networks to deliver effective solutions for
its clients. SPRIM experts have supported hundreds of successful projects around the world with 400+
clients from Fortune 500 corporations to small high-tech innovators.
Please visit www.sprim.com for more details.
Wellness Medical Doctor
• Provide high quality, primary health care services including health risk assessments to
members of an exclusive executive club
• Ordering diagnostic tests as needed, checking and informing patients of results in a timely
• Referring patients appropriately to relevant specialists if needed
• Documenting and maintaining all relevant treatment records accurately, as per professional and
company standards
• Recognized basic medical degree and be registered with the Singapore Medical Council
• Prior GP experience is mandatory
• Candidate should have been in continuous clinical practice
• Permanent position with a qualifying period of 3 months
Working at SPRIM
Sprim is a diverse, prosperous and rewarding place to work. We provide our employees with
competitive benefits and career growth opportunities. Employees are valued for their talents and
contributions. We all take pride in helping our clients achieve their goals, which in turn contributes to
the overall success of the company.
Nightingale Healthcare Pte Ltd
Last Updated on Wednesday, 08 June 2016 22:39 Written by LocumSg Tuesday, 31 May 2016 15:52
POSITION / JOB TITLE House Call Doctor (Fulltime)
ORGANISATION: Nightingale Healthcare Pte Ltd
ORGANISATION'S PROFILE: "Change is all around us, from a global population boom to a worldwide uberfication of everything, to massive digital/mobile explosion. The environment in which we live is rapidly shifting, and that change means opportunity. Now more than ever, a disruptive technology with innovation, will often bring about the next norm"
At Nightingale, we build the state-of-the-art Medical platform over the web & mobile to provide the best timely medical consultancy and services, where-ever you are.
ORGANISATION'S ADDRESS : 71 Ayer Rajah Crescent #05-24/25/26 Singapore 139951CONTACT NAME Anna / Yew Nan
WEBSITE http://www.nightingales.com.sg
We are a dynamic and forward looking medical company in Singapore. We strive to embrace the latest technology in medical field to unlock the maximum benefit for our Customers and our Doctors.
Using our proprietary technology, our House Call Doctors are able to provide the most timely medical consultancy and services to nearby patients.
We provide attractive basic salary and commission for every house call.
• Our House Call doctor enjoys a flexible working environment
• Doctors get to choose nearby patients.
• Excellent support for doctors in terms of technology, logistic and patient management.
• Safe environment
• Excellent remuneration package and unlimited opportunity for career enhancement.
• Recognized basic medical degree
• Any Post Graduate Diplomas in Family Medicine are highly regarded
• At least 3 years of clinical experience as a Medical Officer / GP after internship / housemanship
• Full Registration with SMC
• Possess excellent interpersonal and communication skills
Technical skills required: (e.g. computer skills, ability to use specific equipment)
• Basic computer or smartphone usage knowledge
Language skills required: (e.g. good English reading and writing skills, language certificates with a required minimum score, etc.)
• Good written and spoken English
• Chinese, Malay or Indian language is added advantage
Legal requirements: (e.g. citizenship, work permit, etc.)
• Singaporean / PR
• Required medical certificate and license in Singapore
GP Coverage, 13 month AWS, Performance Bonus and Commission incentives.
More Articles...
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Any good?
- Topic Archived
peterbrady69 4 years ago#1
I only played the demo, which was very underwhelming. In the demo at least, all you do is run straight at one enemy at a time, then either time your blocks to the enemy's attacks and then attack the enemy after that, then use your stun move when you have enough chi built up.
You can't attack if you don't block first, and you can't move anywhere other than straight toward the enemy (you can't even back up).
A little too close to the original, I think. There are 400 points of achievements, but when the game is so incredibly boring, I don't see the point. It's doesn't hold up like Prince of Persia does. Doesn't get by on Mechner's name alone. If the game gets any better later, the demo is far too short to show that (which makes me think that it won't).
My guess is that MS isn't putting out any good XBLA titles on purpose these two weeks knowing full well that Halo and Black Ops will get all the attention and that whatever comes out won't sell, regardless.
peterbrady69 (Topic Creator)4 years ago#3
Thanks for the reply. You can't move back? You could move back in the original. Oh well. I think he should have reimagined the game a bit, then included a mode that was similar to the original.
Back in the day it was pretty fun though.
Freakservo 4 years ago#4
I feel that's the mentality you need for this game if you're going to enjoy it, because it's a near-straightforward port almost to a fault. You'll need to treat this like an updated 80s game, or perhaps more like an arcade cabinet title you plunk a couple of quarters into for a few minutes of fun at a time.
What HAS been changed, however, is the way the fighting's been handled. Indeed, you can't move back, but the fighting's been modified so it's never really necessary to. Instead of moving back and forth to get the occasional kick or jab in, you rely on timed blocks, at which point the opponent leaves himself open to a flurry of punches and kicks. It succeeds in making the game move quicker, but it's also substantially easier as a result.
Second scar to the right...
peterbrady69 (Topic Creator)4 years ago#5
Kind of intriguing. If I get a chance I'll have to give the demo a try. Doesn't really sound like much of a buy though.
Carpetfluff 4 years ago#6
Once I played it a few times and started getting perfect fights - thanks to the music cues - it actually got kind of addictive.
peterbrady69 (Topic Creator)4 years ago#7
Thanks for the answers. It really helped me out. I got a bit of time this weekend, and tried the demo. There was some good and bad said about the game. I agree with them all, but I actually ended buying it. It's a rhythmic kind of fun. I wouldn't have even tried it without your input, so thanks.
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10 Ways to Beat Traffic Around Phoenix
Although traffic around Phoenix is pretty good compared to other big cities, it still sucks to be slowed down by congestion.
We have 10 tips for getting to work and getting home faster:
See also:
-10 Things Phoenix Drivers Need to Relearn From the Driver's License Manual
10.) 51 Over 17
Google Maps
If you live in north Phoenix, between State Route 51 and Interstate 17, the choice should be obvious -- 51.Next Page
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text:
Soldier of Orange (Soldaat van Oranje) (1977)
Directed by
Starring (View all)
Rutger Hauer
Erik Lanshof
Erik Lanshof
Jeroen Krabbé
Guus LeJeune
Guus LeJeune
Susan Penhaligon
Edward Fox
Colonel Rafelli
Colonel Rafelli
Lex van Delden
Derek de Lint
Huib Rooymans
Jan Weinberg
Jan Weinberg
Dolf de Vries
Jack Ten Brinck
Jack Ten Brinck
Written by (View all)
Erik Hazelhoff Roelfzema
book Soldaat van Oranje '40-'45
book Soldaat van Oranje '40-'45
Kees Holierhoek
438 votes1001 Movies You Must See Before You Die (1001 items)
list by upidipi
Published 7 years, 5 months ago 868 comments
162 votesIncredible Movies That Should Be WAY More Famous (52 items)
list by Severin Severin
Published 3 years, 9 months ago 27 comments
83 votes3003 Movies Into the Golden Age!!!...so far? (6124 items)
list by ToonHead2102
Published 5 years, 4 months ago 11 comments
58 votesWatched in 2014 (655 items)
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Published 2 years, 9 months ago 104 comments
51 votesThe Seventies (50 items)
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Published 5 years, 9 months ago
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A very good movie
1 year, 9 months ago at Dec 30 7:54read more
Description: 1938. A small group of Dutch students stop their tennis game momentarily to hear of England's entry into World War II. Erik and his friends don't show much concern at first. But when Queen Wilhelmina flees Holland for London and the Germans move in, it becomes necessary to choose sides. Soldier of Orange, directed by Paul Verhoeven (Turkish Delights) is based on the true life adventures of Erik Hazelhoff who received numerous decorations including Holland's highest honor — the Militaire Willems-orde. It is interesting to see how Erik's friends take different courses: a Jew inevitably dies once the German's arrive; another a ... (more)
Release date: 16 August 1979
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text:
Local News
The recommendation calls for the elimination of seven to 11 teacher assistants at Lee-Jackson Elementary School and more.
Mathews resident's information was important to case
If approved, changes would reduce costs
Breakwater application put on hold
Will discuss administrative variances
Computers don't work right and DMV operations inaccessible
To begin at 8:45 a.m. at Bethel Beach
Mathews supervisors grilled planning and zoning director John Shaw during the Dec. 20 board of supervisors meeting.
The Mathews County Wetlands Board will consider two applications for work that will disturb wetlands during its meeting Jan. 4
Fort Nonsense, a set of Civil War fortifications at the county line, has been transferred to county ownership.


text:
Office of Adaptive Services
Florida Gulf Coast University
10501 FGCU Blvd. S.
Fort Myers, FL 33965
Wellness Building
Phone: 239-590-7956
Fax: 239-590-7975
As the Americas Representative for Blind Sailing International, I am proud to announce the second of a series of match racing clinics in the US. The clinic is being organized by Blind Sailing Unlimited in collaboration with Sailing Education Association of Sheboygan and hosted by Edison Sailing Center. Liz Baylis, Executive Director of Women's International Match Racing Association will be the clinician.
WHEN: March 18-20, 2016 9am - 5pm
WHERE: Edison Sailing Center, 2000 W First St, Fort Myers, FL 33901
WHY: To have fun and learn about blind match racing and using the acoustic buoy system. To become more familiar with match racing rules and format. Prepare for the 2016 Blind Match Racing Worlds to be held at Sail Sheboygan September 20-25, 2016.
HOW TO REGISTER: Go to http://www.blindsailingunlimited.org/bmr-fl.php NOTE: DO NOT REPLY TO THIS EMAIL AS IT WILL GO TO THE ENTIRE LIST
MORE INFORMATION: For more information email firstname.lastname@example.com


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With the countdown to the Women's World Cup on, U.S. national team head coach Greg Ryan has reduced the residency training camp roster to 24 players.
Ryan will take 21 players to China for the finals and suit up 18 players for each of six games in the Women's National Send-Off Series, commencing on June 16 against China at Cleveland Browns Stadium.
To get to 24, Ryan released forwards Lauren Cheney and Megan Rapinoe and goalkeepers Kristin Luckenbill and Kim Bingham, while injured players Heather Mittsand Amy LePeilbet, both defenders, and goalkeeper Jenni Branam will not be healthy in time for the Women's World Cup.
GOALKEEPERS:Nicole Barnhart (Gilbertsville, Pa.), Briana Scurry (Dayton, Minn.), Hope Solo (Richland, Wash.);
DEFENDERS: Marian Dalmy (Lakewood, Colo.), Tina Ellertson (Vancouver, Wash.), Stephanie Lopez (Elk Grove, Calif.), Kate Markgraf (Bloomfield Hills, Mich.), Christie Rampone (Point Pleasant, N.J.), India Trotter (Plantation, Fla.), Cat Whitehill (Birmingham, Ala.);
MIDFIELDERS: Shannon Boxx (Redondo Beach, Calif.), Lori Chalupny (St. Louis, Mo.), Angela Hucles (Virginia Beach, Va.), Marci Jobson (St. Charles, Ill.), Carli Lloyd (Delran, N.J.), Joanna Lohman (Silver Spring, Md.), Leslie Osborne (Brookfield, Wis.), Aly Wagner (San Jose, Calif.);
FORWARDS:Natasha Kai (Kahuku, Hawaii), Kristine Lilly (Wilton, Conn.), Heather O'Reilly (East Brunswick, N.J.), Lindsay Tarpley (Kalamazoo, Mich.), Abby Wambach (Rochester, N.Y.), Christie Welsh (Massapequa Park, N.Y.)


text:
What is FORS?
The Fleet Operator Recognition Scheme is an accreditation scheme encompassing safety, fuel efficiency, vehicle emissions and improved operations.
Why FORS accreditation?
- Improve road safety
- Reduce fines
- Reduce fuel emissions
- Stand out from the crowd
Join today - just follow these three simple steps:
Share on:


text:
Government Relations
Do you enjoy discussing political issues and topics? Join the Government Relations group in the GBTA Hub!
Legislative Symposium 2016 May 9 - 11 | Washington, DCBrought to you by GBTA Government Relations
It is once again time to make your voice heard for the business travel industry. The annual GBTA Legislative Symposium brings together passionate professionals who want to advocate for the future of the business travel industry. This event presents attendees with the unique opportunity to:
GTP® Certification Holders: Earn 4 recertification credits by attending this event.
*Agenda Subject to Change
Event Agenda:
* Meetings will be different for attendees; we ask that all attendees try to remain in D.C. until 5:00pm to allow the scheduling of meeting with Representatives and Senators
Registration Type
GBTA Member
GBTA Chapter Member
GBTA Non-Member
Capitol Hill Hotel
200 C St., SE
Washington DC, 20003
The secured room block at the Capitol Hill Hotel is now full. Below are some alternative hotels near the Reserve Officers Association.
**A room block has not been secured at any of the below hotels; therefore, room reservations are based on individual hotel availability.**
Hyatt Regency400 New Jersey Ave NWWashington, DC 20001202-737-1234http://washingtonregency.hyatt.com/en/hotel/home.html.5 miles from ROA
Hotel George15 E St NWWashington, DC 20001202-347-4200http://www.hotelgeorge.com/.5 miles from ROA
The Liaison Capitol Hill Hotel415 New Jersey Ave NWWashington, DC 20001202-638-1616http://www.jdvhotels.com/hotels/washington-dc/washington-dc-hotels/the-liaison-capitol-hill-dc/.5 miles from ROA
Washington Court Hotel525 New Jersey Ave NWWashington, DC 2000202-628-2100http://www.washingtoncourthotel.com/.6 miles from ROAFollow this event on social media: Twitter: @GlobalBTA, #GBTALegislative16Facebook: https://www.facebook.com/GBTAonFB/ LinkedIn: Global Business Travel AssociationFor more information, please contact:Shane DowneyDirector, Public Policy GBTA Global Business Travel Association Main: +1 703 684 0836 ext 131 Direct: +1 703 236 1131 gbta.org
Click here to see the Importance of Advocacy
Have your voice heard. GBTA advocates for the travel industry every day but we can't do it on our own; these issues have impacts on a global scale as well as a local level and its the impact of you a constituent that will help us win these debates. Come to be educated, but also to educate lawmakers on the issues that impact our industry May 9-11 in Washington D.C. at GBTA Legislative Symposium 2016.
©2016 Global Business Travel Association (GBTA). All rights reserved. Unauthorized use prohibited.


text:
Natalya In Prime Condition
Natalya Out For A Run In Spain
Natalya Loves Paris
Natalya's Ripped Mirror Selfie
Zack Ryder And Cody Rhodes At Universal Studios
Nikki Bella Looking Gorgeous For Her Media Day In NYC
Torrie Wilson Jumping Topless
The Bella Twins With Tyler Henry Of Medium On E!
More On WWE Buying TNA, Brandi Rhodes On Chaos During WWE Shows, Matt Hardy Has RAW Premonition?
WWE Releases NXT Talent
John Cena On If Vince McMahon Would Bring CM Punk Back To WWE, Wants 'Live With Kelly' Co-Host Gig
Dixie Carter Comments On Speculation, BFG And TNA TV Tapings Proceeding As Scheduled?
Nikki Bella Reveals "Massive Fight" With Daniel Bryan, Brie Bella Says She Didn't Want To Retire
More On TNA Sale Negotiations, Dixie Carter Being Blamed For The Mess, WWE Out Of The Picture Again?
Matt And Jeff Hardy On TNA Sale Reports, Billy Corgan, WWE Return Rumors, Wrestling Evolving, More
Billy Corgan On TNA Sale Negotiations, Drew Galloway Injury Note, Matt Hardy On Being Electrocuted


text:
Creeping landslide devouring part of Wyoming town
JACKSON, Wyo. -- A slow-motion disaster continued unfolding in the Wyoming resort town of Jackson on Saturday, as a creeping landslide that split a hillside home threatened to swallow up more houses and businesses.
The ground beneath the 100-foot hillside had been slowly giving way for almost two weeks before the downward movement accelerated in recent days.
With rocks and dirt tumbling down, officials suspended efforts to shore up the slope and said they were uncertain what else could be done.
"When is it going to go? How long is it going to last? These are the questions we just can't answer and they're what everyone wants to know," town spokeswoman Charlotte Reynolds said.
Authorities said there could be a variety of causes for the slide, including prior construction at the site, warmer weather and a wet winter that put more water into the ground where it acts as a lubricant for unstable rocks and soil.
Experts say the hillside is unlikely to suddenly collapse like the March 22 landslide in Oso, Wash., that killed 39 people. More likely, large blocks of earth would tumble down piece by piece.
But the threat is real and authorities are enforcing an evacuation order in hopes of avoiding injuries. Town officials first noticed significant hill movement April 4. They evacuated 42 homes and apartment units April 9.
By Saturday morning, the shifting earth had bulged a road and a parking lot at the foot of the hill by as much as 10 feet. The groundswell pushed a small town water pump building 15 feet toward West Broadway, the town's main drag.
The ground had been moving at a rate of an inch a day but is expected to move increasingly faster as time goes on, said George Machan, a landslide specialist consulting for the town.
Rockslides are common in the Rocky Mountains in spring, as melting snow and warm weather unleash the region's dynamic geology.
In the early 1900s, a massive slide caused by heavy rains north of Jackson formed a natural dam across a small river. The dam gave way two years later, unleashing a flood that killed six people.
The area of the landslide has been graded for roads and businesses in recent years. That could have weakened the hillside and set the stage for the landslide, although the precise trigger remains under investigation.


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DistributionRead full entry
Range DescriptionThis species inhabits Dominica, Martinique, St. Lucia, and both of the Maria Islands (Schwartz and Henderson 1991). The Maria Islands are a short distance east of the southern end of St. Lucia (Thomas 1965).
Three subspecies exist, with distributional information as follows (Thomas 1965):
- G. pleii pleii: Martinique
- G. p. luetkeni: St. Lucia
- G. p. nesydrion: southern most of the Maria Islands
The area of the five islands combined is 1,837 km. This species is found between sea level and 400 m above sea level.


text:
Receive Our Updates
About Friends of the Family
Programs & Services
How You Can Help
Public Policy
News & Media
Contact Us
Print Page
We want to begin and end this message with
Thank you to all those who made the
2016 Families Matter Benefit
a great success – event sponsors, donors, auction donors, event committee, volunteers, staff, Blue Room Events, and most especially, our indefatigable Event Chair, Jane Francis and Auction Co-Chairs, Sue Johenning & Melissa Joan Hart! Thank you so much!
This year's event was held on Wednesday, June 8, at the SmogShoppe in Culver City, a new venue for us and one that drew rave reviews from attendees. 200 guests enjoyed a lovely evening in support of Friends of the Family's work to change the trajectory of the lives of struggling children, families, and communities right here in Los Angeles.
Read more...
The Family Wellness Institute provides a range of classes, activities and special events that address all dimensions of wellness - social, emotional, spiritual, environmental, occupational, intellectual, and physical.
Come join in the fun and free activities!
Please click on the link below for 2016 Summer Session Schedule!
2016 FWI Summer Session Schedule
FOF is Melissa Joan Hart's "Favorite" Charity
Melissa Joan Hart has found a new way to support Friends of the Family in an ongoing way! It's CHIDEO – a new website that offers celebrities a way to connect with their fans AND make money for their favorite charities at the same time. FOF is so very honored to be Melissa's favorite charity! Check it out
and spread the word to all your friends!
Please Join us on Facebook!
like us
and learn more about upcoming events!
Friends of the Family
is among the most highly regarded family resource centers in Southern California. The organization provides a safety net of support for families as they struggle to care for their children in the face of multiple challenges including poverty, community violence, isolation, language barriers, and inadequate schools.
Read more
Our organization
serves more than 5,000 family members each year with a range of programs that result in improved family and community health, educational readiness and achievement, family economic self-sufficiency, and community unity.
Learn more
Our vision
is the creation of vibrant communities where all children and families thrive and succeed. We work to help families foster resilient and joyful children who will be able to realize whatever unique potential of mind, body, and spirit he or she possesses.
See more
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text:
Advanced Organic Chemistry
This survey of advanced chemistry covers virtually all the useful reactions--600 all told--with the scope, limitations, and mechanism of each described in detail. Extensive general sections on the mechanisms of the important reaction types, and five chapters on the structure and stereochemistry of organic compounds and reactive intermediates are included as well. Of the more than 10,000 references included, 5,000 are new in this edition.
Please visit Help Page for Questions
regarding ISBN / ISBN-10 / ISBN10, ISBN-13 / ISBN13, EAN / EAN-13, and Amazon
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Copyright © 2003-2014 AllDiscountBooks.net All rights reserved.


text:
Popular Californication Quotes
Nobody likes you. You're ugly and your mother dresses you funny. Now smile, you f--cking douche!Hank Moody
Hey. You know, it's not fair to say BRB and then never actually BRB.Hank Moody
You can't snort a line of coke off a woman's ass and not wonder about her hopes and dreams, it's not gentlemanly.Hank Moody
Radio Show Host: What's your latest obsession?
Hank Moody: Just the fact that people seem to be getting dumber and dumber. You know, I mean we have all this amazing technology and yet computers have turned into basically four figure wank machines. The internet was supposed to set us free, democratize us, but all it's really given us is Howard Dean's aborted candidacy and 24 hour a day access to kiddie porn. People... they don't write anymore, they blog. Instead of talking, they text, no punctuation, no grammar: LOL this and LMFAO that. You know, it just seems to me it's just a bunch of stupid people pseudo-communicating with a bunch of other stupid people at a proto-language that resembles more what cavemen used to speak than the King's English.
Marcy Runkle: You can have the ass if you want.
Charlie Runkle: You can keep it.
To quote The Clash, should I stay or should I rock the casbah?Hank Moody
Hank Moody: 'B' to the 'I' to the double 'L'. What's up, my nig nog?
Bill Lewis: I need to talk to you.
Hank Moody: Well, you should have called. I wouldn't have answered, but you could've left a message, which I would have quickly erased.
She's got a nose ring, too. You know what that means.Hank Moody
Hank Moody: Oh, look at the time: The big hand says F**k, and the little hand says Off. Good thing there's not a second hand. I'm going in.
I just get so lonely sometimes. I need a hug for a moment and the moment passes. I'm good. Smell you later.Hank Moody
I won't go down in history, but I will go down on your sister.Hank Moody
Try not to forget all the times I brought you to fruition. 33 to be exact.Hank Moody


text:
Interior Modern-classic
This project received 19 bids from talented freelancers with an average bid price of $458 USD.Get free quotes for a project like this
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Project BudgetN/A
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Project Description
Create with Sketcup Vray...Modeling for Mr. S at Jakarta, Indonesia. Hope you like it. Living room with mini-bar area
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The diagnostic likelihood ratio function, DLR, is a statistical measure used to evaluate risk prediction markers. The goal of this paper is to develop new methods to estimate the DLR function. Furthermore, we show how risk prediction markers can be compared using rank-invariant DLR functions. Various estimators are proposed that accommodate cohort or case–control study designs. Performances of the estimators are compared using simulation studies. The methods are illustrated by comparing a lung function measure and a nutritional status measure for predicting subsequent onset of major pulmonary infection in children suffering from cystic fibrosis. For continuous markers, the DLR function is mathematically related to the slope of the receiver operating characteristic (ROC) curve, an entity used to evaluate diagnostic markers. We show that our methodology can be used to estimate the slope of the ROC curve and illustrate use of the estimated ROC derivative in variance and sample size calculations for a diagnostic biomarker study.
Accurate diagnosis of disease is a prerequisite for treating symptomatic patients. The development of new and better diagnostic tests is a major focus of medical research. The goal in using a diagnostic or screening test is to accurately classify individuals as either diseased or nondiseased. A good diagnostic test or marker should be able to separate subjects with and without the disease. There are 2 sorts of errors that can occur: The first error is to classify a diseased subject as nondiseased and is called a false-negative error and the second is to falsely classify a nondiseased subject as diseased and is known as a false-positive error. Ideally, both error rates are small. Continuous diagnostic markers are typically evaluated using the receiver operating characteristic (ROC) curve (Baker, 2003; Hanley, 1989; Begg, 1991; Zhou and others, 2002; Pepe, 2003). The ROC curve is a plot of true positive rate (sensitivity = 1 − false-negative error rate) versus false-positive error rate (1 − specificity), associated with rules that classify an individual as "positive" if his marker value is above a threshold c, for all possible thresholds.
Prognostic markers, on the other hand, are used to predict an individual's risk of having a future event, such as 10-year risk of a cardiovascular event or 5-year risk of developing breast cancer. Therefore, the evaluation of these markers requires a different approach. In this context, the key issue is to identify subjects at high or at low risk for the event and to quantify the information in the marker that is pertinent to such prediction. As an example, in this paper, we consider occurrence of a major pulmonary infection in children with cystic fibrosis (CF). The task is to quantify and compare how well forced expiratory volume in 1 second (FEV1), a measure of lung function, and weight, a measure of nutritional status, predict occurrence of major pulmonary infection in the subsequent year. Data for 12 802 patients in 1995 and 1996 are available.
Here, we consider evaluating and comparing prognostic markers using the diagnostic likelihood ratio (DLR) function. We develop new methods for estimating and comparing the DLRs of markers. Interestingly, the DLR function is mathematically related to the derivative of the ROC curve and we exploit this result in developing and applying the methods.
We use the following notation to encompass both prognostic and diagnostic applications: Let D be a binary outcome variable, where D = 1 denotes the event occurs or the disease is present. Let Y be a marker or test. We use subscripts D and for the case (D = 1) and control (D = 0) populations, respectively. Thus, YD and Y are marker measurements from case and control populations, FD and F are their cumulative distribution functions, fD and f are the corresponding density functions, and nD and n are the numbers of observations available for analysis from the 2 populations. We write n = nD + n.
The DLR function, DLR(y), is the ratio of the likelihoods of observing Y = y conditional on disease or event status, D = 1 versus D = 0,
where P is a probability density function if Y is continuous and a probability mass if Y is discrete.
However, an alternative and maybe more appealing interpretation for DLR(y) is as a Bayes factor. In particular, Bayes theorem implies that
In other words, by use of DLR(y), one can calculate a subject's risk given knowledge of Y = y, P(D = 1 | Y = y), from his risk in the absence of Y, P(D = 1). The DLR function quantifies the information in Y pertinent to prediction in the sense that it provides the update to the pretest risk, P(D = 1), that is incurred with knowledge of the marker value or test result.
The value of the DLR function is well appreciated in clinical medicine. See, for example the series on "The Rational Clinical Exam" in the Journal of the American Medical Association. Specifically, the DLR is appealing because it relates to medical decision making (Boyko, 1994), (Giard and Hermans, 1993). Patients make decisions on the basis of their risk, opting perhaps for a treatment if the risk is sufficiently high and opting against the treatment if not. The DLR function helps determine if ascertaining Y is likely to be worthwhile in the sense of potentially changing the patient's medical decision about intervention. For example, if the pretest risk, P(D = 1), is above the treatment threshold and the DLR(y) function is such that the posttest risk, P(D = 1 | Y = y), is likely to remain above the threshold, then ascertaining the patient's marker value Y is not worthwhile.
If the marker is binary with value either positive (+) or negative (−), the corresponding DLR function is
Estimation of DLR(y) follows by plugging in estimators for true positive rates (TPR) and false positive rates (FPR). However, since most markers are measured on a continuous scale, having an algorithm available to estimate continuous DLR functions is critical. We develop a variety of algorithms in this paper.
We assume that data are derived from a case–control study. Case–control studies are most common in diagnostic research (Pepe and others, 2008) due in part to their cost efficiency. The methods are equally valid for cohort studies where the total sample size, n, is fixed but the number of cases, nD, is random. In Section 7, we make some remarks that pertain specifically to cohort studies.
From (2.1), we can write DLR(y) = fD(y)/f(y). Therefore, a natural way to estimate DLR(y) is to substitute estimates for the density functions:
where the subscript DE denotes "density estimation." Here, we adopt nonparametric Gaussian kernel estimators for fD and f with bandwidth defined by Scott (1992), × n−1/5, where IQR is the "interquartile range."
An alternative approach to estimating DLR(y) is with logistic regression (LR). The motivation for using LR arises from the fact that from (2.2), the DLR function can be written as follows:
If estimates for logitP(D = 1) and for logitP(D = 1 | Y = y) are available, their difference yields an estimator for logDLR(y).
Let S indicate that data are sampled using a case–control design. The probability, P(D = 1 | S), is therefore fixed by design as nD/n. We model P(D = 1 | Y,S) using LR,
where g is some function of the marker, Y, that is parameterized by β. This is a very general formulation. In the simplest form, logit{P(D = 1 | Y,S)} is the ordinary linear logistic model, α + βY with β > 0, since we assume that larger values of Y are associated with increasing risk. In practice, one must use goodness-of-fit procedures to assess the validity of the model.
We now note the classic result from epidemiology that the difference between the posttest risk and the pretest risk (on the logit scale) is the same in a case–control study as that calculated for a cohort study in the same population. The result follows from Bayes theorem:
Therefore, based on (3.1–3.3), an estimator for DLR(y) can be obtained by plugging in estimates of model parameters, and , and the case–control ratio:
The subscript LR is used to denote "logistic regression."
The following result concerning the asymptotic distribution of follows from asymptotic theory for (,) and the delta method.
Result: converges to a mean 0 normal distribution with variance
where A−1 is the asymptotic variance of
The LR approach has previously been used by Janssens and others (2005) to estimate covariate-specific DLR functions for binary Y. Here, we extend the approach to continuous markers, and for simplicity, we only consider scenarios without covariates. Gu and Pepe (2009) previously used LR to estimate covariate-specific DLR functions for continuous markers but did not study its properties or make comparisons with other methods.
We now propose methods that are rank invariant allowing estimates of DLR(y) to be independent of the original scale for Y. The approach is to transform markers to a common scale that only depends on ranks. This has the additional advantage that markers can be compared on this common scale. In particular, comparing the predictive capacities of different risk prediction markers can be based on their rank-invariant DLR functions.
There are various ways to transform or standardize Y. In this paper, we use the notion of placement values (Pepe, 2003), (Huang and Pepe, 2009), (Pepe and Longton, 2005), which standardizes values of Y by using the controls as a reference population. The placement value, U(Y), is defined as
U(y) (0, 1) is the proportion of controls with marker measurements at least as large as y. It is straightforward to see that U U(Y) follows a uniform (0,1) distribution:
An empirical estimate of U(Y) is , where is the empirical cumulative distribution function of Y in the controls.
Next, we describe 3 approaches that yield rank-invariant estimators for DLR each using (Y) to standardize markers as a preliminary step.
Let fUD and fU be the density functions for U in the case and control populations, respectively. We can write
since fU = 1. A rank-invariant density estimator therefore is
where the subscript RIDE indicates "rank-invariant density estimation." In our applications, a nonparametric Gaussian kernel estimate is adopted to estimate fD.
Observe that the only difference between rank-invariant and nonrank-invariant density estimation is that the estimated density function is based on {Di, i = 1,…,nD}. The procedure is rank invariant because the placement values depend only on the ranks of the observed marker values for cases relative to the ranks of the control marker values.
The LR approach is similarly extended to a rank-invariant approach. We model the posttest risk probability as a function of the placement value U(Y) instead of as a function of the original marker value Y,
where h is an appropriate function of U parameterized by βU. We use αU and βU for the regression parameters to distinguish them from the parameters α and β in the ordinary LR model (3.2). The values for αU and βU are not affected by monotone increasing transformations of Y.
This LR model is fit using (Y) as predictors to yield and . The corresponding rank-invariant estimate of DLR(y) is
We use the subscript RILR to indicate "rank-invariant logistic regression."
The ROC curve, ROC(t), where t denotes the false-positive rate, is mathematically related to the DLR function. In particular, the ROC derivative can be written as
(Pepe, 2003), and since DLR(y) = fD(y)/f(y), we have
Therefore, rank-invariant methods for estimating the ROC curve can be adapted for estimating the DLR function. Here, we adapt receiver operating characteristic-generalized linear modeling (ROC-GLM) (Pepe, 1997), which models the ROC curve as
where r is a link function and l = {l1,…,ls} are specified functions. A natural estimator for ROC′(t) is to take the derivative of the parametric ROC curve (3.6) and plug in estimates for θ.
There are many ways to estimate θ, including the binary regression algorithm proposed by Alonzo and Pepe (2002), the LABROC approach by Metz and others (1998), and the pseudolikelihood approach proposed by Pepe and Cai (2004). In this paper, we use the binary regression algorithm, which is available in Stata (Pepe and others, 2009).
To illustrate, let us use the classic binormal model, where r = Φ−1, l1(t) = 1, and l2(t) = Φ−1(t):
with derivative given by
Since we write the corresponding estimator of (y) as follows:
We simulated case–control data to illustrate our proposed methodology and to compare the performances of different approaches. We generated independent normally distributed marker observations, YD and Y, for random samples from the case and control population with YD having mean 2 and variance 1 and Y having mean 0 and variance 1. Therefore, we have log{DLR(y)} = 2y − 2. We fit the correct model forms to the data.
In Table 1, we report results for 3 different values of y = −0.20,0.50, and 1.31, which are approximately the first, second, and third quartiles of the pooled distributions for YD and Y. For each simulated case–control data set, estimates of DLR were calculated and their corresponding variances were estimated using bootstrap resampling. Equal numbers of cases and controls were employed and total sample sizes, n = nD + n, ranged from n = 200 to 2000. For each scenario, 1000 simulations are conducted.
Results of simulations to estimate the log DLR function using DE, LR, RIDE, RILR, and ROC–GLM estimators. The study design employs case–control sampling with equal numbers of cases and controls, n = nD + n. Marker data for controls are ...
Density and rank-invariant density estimators for DLR(y) are much more biased than corresponding LR and ROC–GLM estimators. Biases for all approaches decrease as sample size increases. Overall the magnitudes of bias for LR and ROC–GLM estimators are comparable, particularly, when sample size is large. It also appears that LR and ROC–GLM estimators are much more efficient than density-based estimators as is evidenced by their smaller standard deviations (SDs) and mean square errors (MSEs). We therefore recommend against using density-based estimators for DLR(y).
The ROC–GLM approach appears to be somewhat less efficient than LR-based estimators. Their SDs and MSEs were generally larger than those of the rank-invariant LR estimators. Among the LR estimators, we found that the rank-invariant estimator, RILR(y), was less efficient than LR(y). This is not surprising since LR(y) is the maximum likelihood estimator under correct specification of the LR model. The advantage of RILR(y) may be in its robustness.
Coverages of 95% confidence intervals (CIs) using percentiles of the bootstrap distribution are also summarized in Table 1. DE yielded coverage that was too small, while the LR and ROC–GLM estimators have much better coverage probabilities.
CF is an inherited chronic disease that affects the lungs and digestive system of people. A defective gene and its protein product cause the body to produce unusually thick sticky mucus that clogs the lungs and leads to life-threatening lung infections and also obstructs the pancreas and stops natural enzymes from helping the body break down and absorb food. The main culminating event that leads to death is acute pulmonary exacerbation, that is lung infection requiring intravenous antibiotics.
The data for analysis are from the CF Registry, a database maintained by the CF Foundation, containing annually updated information on over 20 000 people diagnosed with CF and living in the United States. We are interested in the predictive information provided by knowing FEV1, a measure of lung function, measured in 1995 to predict the occurrence of pulmonary exacerbation in 1996. There are 12 802 unique subjects in the data and 5245 (41%) had at least 1 pulmonary exacerbation. Patients younger than 6 years are excluded. FEV1 is standardized for age, gender, and height (Knudson and others, 1983) by converting it to a percentage of predicted for healthy children, and it is negated to satisfy our assumption that increasing values are associated with increasing risk (see Moskowitz and Pepe, 2004 for more details). In order to apply our methodology, we simulated a nested case–control sample from the entire cohort by randomly selecting 500 individuals with and 500 individuals without pulmonary exacerbation in 1996.
Figure 1 displays the estimated log DLR curves for FEV1. Since the density ratio estimates performed so poorly in the simulation, we do not present them here. Observe that log DLR estimated using nonrank-invariant LR is linear in Y = FEV1 because we let Y enter the model as a linear term. The estimated placement value, , entered the rank-invariant LR model as . The binormal ROC–GLM model was employed. We see that the estimators are close and that their CIs are also similar (Figure 2).
Estimates of the DLR function for FEV1, a measure of lung function, in the CF Study.
95% pointwise CIs for log DLR using percentiles of the bootstrap distribution based on 1000 resampled data sets.
Table 2 shows the log DLR values estimated at FEV1 = 100 and 40, approximately the first and third quartiles of the population distribution of FEV1. The estimates derived using all 3 methods appear to be similar. Since the probability of having a pulmonary exacerbation is approximately 0.4 in the population, if a subject's FEV1 was measured and was equal to 100, the revised event probability would be calculated as logit−1(logit 0.4 − 1.263) = 0.16 (95% CI = (0.13, 0.18)) using LR. Rank-invariant LR yielded a similar posttest risk probability of 0.15, with 95% CI (0.13, 0.18), while the ROC–GLM estimator yielded 0.17 (95% CI = (0.14, 0.19)). These estimates and their associated CIs are almost identical. It appears that the chances are fairly low that a subject with FEV1 equal to 100 will have a pulmonary exacerbation in the following year.
Estimates of the log DLR function at FEV1 equal to 100 and 40 in the CF Study. Shown in the table are the estimates and associated 95% bootstrap percentile CIs according to different estimation approaches
Now, let us consider FEV1 = 40, which is approximately the 25th percentile of the population distribution of FEV1. The LR estimate of log DLR is 1.347 (95% CI = (1.152, 1.536)). The corresponding posttest disease probability is logit−1 (logit 0.4 + 1.347) = 0.72 (95% CI = (0.68, 0.76)). Under rank-invariant estimation approaches, estimates of log DLR are 1.199 (95% CI = (1.022, 1.430)) and 1.246 (95% CI = (1.025, 1.537)) for LR and ROC–GLM methods, respectively. Modified risk probabilities are therefore 0.69 (95% CI = (0.65, 0.74)) and 0.70 (95% CI = (0.65, 0.76)). Overall, estimates of posttest risks are quite similar, and we conclude that for a patient whose FEV1 is 40, the chance that he will have a pulmonary exacerbation in the following year is fairly high.
We now turn to use of the DLR functions for making comparisons between risk prediction markers, FEV1, and weight. We have argued that the DLR function quantifies the predictive information in a marker since it quantifies how much the risk should be modified from baseline by knowing the marker value. A better marker should lead to a larger revision in the risk probability.
The issue in making DLR comparisons between markers is that the DLR is a function of the marker value but raw values for one marker are not comparable with those for another. For example, should the DLR associated with an FEV1 value of 100 be compared with the DLR associated with a weight percentile of 50? Our proposal is to first standardize both markers using placement value standardization and to then make comparisons between the DLR functions. That is, we propose that comparisons between risk prediction markers can be based on DLR(U(Y)), the rank-invariant DLR function. By transforming Y into U(Y), we are essentially saying that marker values are comparable when they are at the same quantile in their respective control distributions. For example, if we consider U(Y) ≤ 0.10 and find that DLR is substantially higher for FEV1 than it is for weight in this risk range, we would conclude that the FEV1 values at or worse than the 90th percentile of controls are more predictive than weight values at or worse than the 90th percentile of controls. In particular, if subjects are candidates for intervention if their predictor values are in the worst decile (relative to controls), the ordering of DLR(U) functions for FEV1 versus weight in the range u < 0.10 indicates that FEV1 identifies a group at greater risk than does weight.
Turning now to the data, estimates of the rank-invariant DLR functions are shown in Figure 3. These curves were estimated using the rank-invariant LR method with placement values, U, for FEV1 and weight entered into separate LR models as terms of the form Φ−1(1 − U). We can read from the plot the DLR of a marker value Y which is at the 100(1 − u)th percentile of the marker distribution in controls, that is in subjects who did not suffer an event in 1996.
Rank-invariant log DLR functions for FEV1 and weight. Estimation of log DLR is based on rank-invariant LR. At u = 0.1, log DLR is 0.73 based on FEV1 and 0.23 based on weight.
The rank-invariant DLR function is substantially higher for FEV1 than for weight when u is small but substantially lower for FEV1 than for weight when u is large. Observe in particular that when logDLR(u) > 0, so that the predictors are in ranges where risk modification yields increased risk over baseline, we see that FEV1 values increase the risk more than do comparable weight values. Conversely, when logDLR(u) < 0, so that the predictors are in ranges where risk modification yields reduced risk relative to baseline, we see that FEV1 values decrease the risk more than comparable weight values. This indicates that FEV1 is a better marker for predicting risk than is weight.
As suggested earlier, suppose that it has been decided to treat subjects whose FEV1 or weight measurement are in the worst 10% of values measured for controls. We see that DLR(0.1) is 2.08 (95% CI = (1.91, 2.24)) for FEV1 as opposed to 1.26 (95% CI = (1.16, 1.38)) for weight. The corresponding posttest risks are logit−1 (log2.08 + logit0.4) = 0.58 (95% CI = (0.56, 0.60)) and logit−1 (log1.26 + logit0.4) = 0.46 (95% CI = (0.44, 0.48)), respectively. Therefore, using FEV1 to select the subpopulation to receive treatment ensures that these subjects are at greater risk of an event, risk >0.58 as opposed to risk > 0.46.
We noted earlier that ROC′(t) = DLR(y) for t = 1 − F(y). This implies that estimators of the DLR function give rise to estimators of the ROC derivative function. Estimating the ROC derivative is an important component of ROC analysis of continuous diagnostic biomarkers. Specifically, the empirical ROC curve, , is typically used for estimation, and the asymptotic distribution of − ROC(t)) is normal with mean 0 and variance
Therefore, CIs based on this asymptotic theory require an estimate of ROC′(t). We have previously used the ratio of kernel density estimators. However, results of our simulation studies in Table 1 suggest that estimators with better performance may be based on LR or ROC–GLM. It would be interesting to determine if this leads to better performing CIs for ROC(t) based on . Our current practice for CI construction, however, uses bootstrap resampling, thereby avoiding the need to estimate ROC′(t) (Pepe and others, 2009). More compelling motivation for estimating ROC′(t) derives from its key role in study design. In order to calculate sample size for a study based on the variance expression (6.1), an estimate of ROC′(t) must be made from pilot data. Moreover, the optimal choice of case–control ratio, λ =nD/n, is also a function of the estimated value for ROC′(t). In particular, Janes and Pepe (2006) showed that by choosing the ratio as
the overall sample size is minimized. Having an estimate of ROC′(t) available from pilot data allows one to choose an appropriate case–control ratio for a future study.
When pilot data are available, one can estimate ROC′(t) as , where (y) is any of the 5 proposed estimators of the DLR function: DE, LR, RIDE, RILR, and ROC–GLM. We focus on the 3 rank-invariant estimators because a fundamental attribute of ROC analysis is that it is rank invariant.
We use a pancreatic cancer data set (Wieand and others, 1989) for illustration. This was a case–control study with 90 subjects having pancreatic cancer and 51 controls who did not have cancer but had pancreatitis. Serum samples from each patient were assayed for CA-19-9, a carbohydrate antigen, which is a biomarker for cancer. We are particularly interested in the ROC curve at false-positive rate 0.2, ROC(0.2). We applied rank-invariant estimators of ROC′ to the data. Both the logistic and the ROC–GLM models were fit including linear and quadratic terms in Φ−1(1 − U).
Figure 4 displays estimates of ROC′. LR and ROC–GLM produced very similar results: The estimated ROC′ curves and their CIs are almost identical. However, the nonparametric density estimator is substantially different from the other two. Observe that the magnitude of fluctuation in the estimated curve is large and that the corresponding confidence bands are extremely wide. This agrees with poor performance of density-based estimation of DLR(y) observed in the simulations summarized in Table 1.
Rank-invariant estimation of the derivative of the ROC curve for marker CA-19-9 in a pancreatic cancer study. (a) ROC′ curves and (b) 95% pointwise CIs using percentiles of the 1000 bootstrap resampled data sets. Also shown in (a) are the corresponding ...
Table 3 shows the estimated slope values at the false-positive rate t = 0.2. The density ratio estimator is 0.404 (95% CI = (0, 1.052)), which is substantially different from the LR and ROC–GLM estimators, 0.464 (95% CI = (0.259, 0.707)), and 0.466 (95% CI = (0.254, 0.698)), respectively. Moreover, the CI based on the rank-invariant density estimator is extremely wide compared to the other estimators. The empirical estimate of ROC(0.2) is = 0.778. This along with the estimate of ROC′(0.2) gives rise to an estimate of the SD of and a CI for ROC(0.2) using the expression for σ2. SDs and CIs for ROC(0.2) are also shown in Table 3.
Estimates of ROC′(0.2) with corresponding 95% CIs calculated as percentiles of their bootstrap distributions. Shown also are λopt, the estimated optimal case–control ratio for a future study of CA-19-9; (), the estimated SD of ...
Suppose we want to conduct a definitive case–control study to evaluate the diagnostic accuracy of CA-19-9 with FPR fixed at 0.2 and we have the current study of 141 observations as pilot data. The optimal case–control ratio, λopt, is estimated as 2.57, 2.24, and 2.23 based on the 3 rank-invariant methods. It appears that about 2.5 cases should be enrolled for each case in the definitive study. This is quite different from the case–control ratio of 1.76 used in the pilot study.
This paper presents some new statistical methods to estimate the DLR function. New approaches include rank-invariant DE and rank-invariant LR. Although using densities to estimate the slope of the ROC curve and using LR to estimate the DLR function are relatively standard, their rank-invariant counterparts have not been defined previously. An advantage of rank-invariant estimators over nonrank-invariant estimators is that they can be used to compare markers.
Our methods were developed for case–control studies. However, all approaches apply to cohort studies too. Estimation methods condition on case–control status. We note that a case–control study and a cohort study with the same observations yield exactly the same DLR estimates. However, the variances of the estimates will depend on the design because the case–control ratio is subject to sampling variability in a cohort study. Therefore, when using bootstrap resampling to estimate variances, it is important to resample data sets according to the study design employed.
We adopted Gaussian kernels in applying DE methods because they are commonly used in practice. However, other kernel functions might be used, including uniform, triangle, quartic, and cosine kernels. We investigated the nonrank-invariant DE of DLR and ROC′ functions using quartic and cosine kernels for the same simulation models described here and observed that both quartic and cosine kernels yield much smaller biases but larger variances and MSEs than the Gaussian kernel (data not shown). Our overall conclusion did not change in regard to the best approach for estimating DLR and ROC′ functions: LR and ROC–GLM are much better than DE methods no matter which kernel is employed.
We have shown that the risk prediction capacity of markers can be compared using the rank-invariant DLR function, DLR(u), where u = U(Y). We did not specifically relate this to ROC curves, but there is a relationship. In particular, a marker Y1 that is more predictive than Y2 has higher DLR when the markers are at the high end of their scales (U(Y) low) and lower DLR when the markers are at the low end of their scales (U(Y) high). This implies that ROC1′(u) > ROC2′(u) when u is large, where u is the false positive rate. Since the ROC curves for Y1 and Y2 are tied down at 0 and 1, and are concave, this implies that the area under the ROC curve for Y1 is greater than that for Y2.
National Institutes of Health (RO1 GM054438, UO1 CA086368) to M.S.P.
Conflict of Interest: None declared.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Simple Arrangement: Hydrangea, Cranberries, & Apples
how to keep holiday decorations subtle and simple. Thus, I found it fitting to show one of my favorite floral arrangements that recalls traditional arrangements like a few stems of hydrangea but updated with some pops of red in winter appropriate cranberries and apples. The key is to begin with a simple vessel (I actually used a glass hurricane from Crate & Barrel) and let the flowers do the talking. 1. Pour in the cranberries (I used two bags but could have probably gone with a third) and fill with water. 2. Cut the hydrangeas to the right height. The cranberries will float and actually help hold the stems in place so no need to worry about cutting the stems too short. 3. Then take some wood skewers, stab some apples, and drop in the hydrangeas: instant Christmas spirit. If you replace the water after three days this should last just over a week (the cranberries and apples will last longer so you can continue to just replace the hydrangeas). The best part about clean and subtle arrangements is their ability to transition throughout the year. Try replacing the cranberries and apples with lemons and tangerines and you have a perfect summer arrangement. Images: Timothy Ragan


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11 comments
Don't see how getting rid of the monarchy would do much good. Seems like the princess, herself a member of the royal family however unimportant her position, has progressive ideas. If it were a democracy, the majority would likely elect a religious fundamentalist, who they then couldn't get rid of anyway because he'd fake the votes every election (probably the first one too), and would only loot the country from the inside. A monarchy at least has a greater sense of responsibility and patriotism, no need to loot anything because they don't have humble beginnings, and are overall less likely to act against their country. Its main flaw is corruption, and a democracy would certainly not solve that.
No, this is about the belief that people anywhere should not trust democracy at face value.
My point was that elected leaders tend to be more flawed than monarchs. Populations are easily manipulated, like Hitler and Stalin and Bush showed. And once someone is in office, they can modify the constitution to lengthen their stay, or just ignore it - example: Putin, though lots of others have done what he did. Monarchies, in particular constitutional monarchies - which isn't quite the case for Saudi Arabia, but still - function differently. Parliament is overseen by the monarchy, and the monarchy is more likely to be incorruptible. Monarchs are raised in luxury, so it's harder to tempt them with money, and they are more likely to be well educated, and raised with a love of country. Also, they are in their position for life. If a president is at his last mandate and doesn't want to rule any more, he can do whatever he likes with the country, knowing he won't see a re-election anyway. This is happening now where I live, with the president and his cronies acting like they have nothing to lose (which is true).
This is why people are happier and have a higher standard of living under constitutional monarchies, like in Scandinavian countries, as opposed to people living under democracies.
This is why people are happier and have a higher standard of living under constitutional monarchies, like in Scandinavian countries, as opposed to people living under democracies.
+Matt Mullin, you asked what my point had been, I just told you. I'm not going to tell other people how to rule themselves. I just explained to you why one system is better than another.
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