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Glory Invasion: Walking Under an Open HeavenIs there something beyond your current Christian experience that seems to be lacking? Is God calling you to the next level of His Glory?God will reveal to you how to activate the prophetic destiny over your life that seems dormant. He is waiting for you to realize that your dream, prophecy, desire, or miracle is not dead only sleeping! God is ready to awaken those promises as you open yourself to
Mysteries of the Glory UnveiledFifty years after the last great miracle revival, believers of every Christian denomination are experiencing a restoration. As foretold by the prophets, this rain is resulting in the greatest harvest of souls the world has ever known. What took centuries to understand and accomplish, God is doing in an instant in this present glory. Mysteries are being unveiled now to those who seek the knowledge
$9.89You can find the spiritual gateways of supernatural power! Author David Herzog has accessed gateways of the supernatural. His life and ministry have accelerated as a result of tapping these incredible portals. Living in the Glory Every Day shares astounding and practical biblical truths that can function in your everyday life. Ministering in and traveling extensively to Israel and other Middle
Unleashing Ancient secrets to Power, Blessing and HarvestIn the midst of worldwide shaking and global anxiety, nations search for strategies. People struggle, desperate for answers. Maybe this describes you. This timely repackaged edition of The Ancient Portals of Heaven reminds believers that they are citizens of another world—Heaven. Your life and your world need Heaven's solutions! Ministering in and traveling extensively to Israel and other
The Ancient Portals of Heaven: Glory, Favor, and BlessingWhat are the ancient pathways that opened up the supernatural for the ancients like Moses, Elijah and Solomon. What ancient wisdom did the wisest man in the world possess allowing him to be an king, inventor, writer, scientist, psalmist, businessman, and see the glory cloud first hand as well as allowed Israel to even travel worldwide including ancient America. Where are the geographical and
Your Way to Healthy Living With the Miracle of Superfoods, New Weight-Loss Discoveries, Antiaging Techniques & MoreA step-by-step plan to supercharge every area of your health Everybody wants to look and feel their best. Jumpstart! takes a multipronged approach to heath and wellness that provides impressive results quickly. Emphasizing the connection between mind, body and spirit, the author shows you how to: · Reset your weight to its optimal level · Reprogram your mind for success ·
Desperate for New Wine: The Doorway into your HarvestAre you satisfied with "church as usual," or are you desperately thirsty for more and ready to move from renewal to revival to harvest!? Desperate for New Wine excites, challenges, and encourages all who genuinely want more of God. Believers worldwide are being overcome by the Spirit of God. The current move of the Spirit is escalating towards what may be the greatest harvest that the world has
Unlocking the Mysteries of Eating Disorders: A Life-Saving Guide to Your Child's Treatment and RecoveryThe answers you need to help your child survive an eating disorder You've noticed a change in your child's eating habits and want to help, but you don't know what to say. Perhaps you're not sure if your child has an eating disorder or is at risk of developing one, and you don't know what to do. Written by experts in the field, Unlocking the Mysteries of Eating Disorders will guide you through
$28.79A practical, skill-based introduction to data analysis and literacy We are swimming in a world of data, and this handy guide will keep you afloat while you learn to make sense of it all. In Data Literacy: A User's Guide, David Herzog, a journalist with a decade of experience using data analysis to transform information into captivating storytelling, introduces students and professionals to the
CliffsNotes Algebra II Quick Review, 2nd EditionInside the book:Linear Sentences in One VariableSegments, Lines, and InequalitiesLinear Sentences in Two VariablesLinear Equations in Three VariablesPolynomial ArithmeticFactoring PolynomialsRational ExpressionsRelations and FunctionsPolynomial FunctionsRadicals and Complex NumbersQuadratics in One Variable<L...
Creating a Realm for Miracles & SuccessSharing from years of experience in the supernatural, Joshua Mills will show you the significance of your atmosphere and how it affects you in a powerful way. In this fascinating book you will learn how to develop an atmosphere for miracles and success to abound in your life! This book Includes the following topics: - 20 Things You Need To Know About Your Atmosphere - Learn The Difference Between
$12.79Get ready for a spiritual explosion!Experience the release of spiritual power through the age-old wonders of fasting and prayer! When it comes to Fasting and Prayer, author Steven Brooks has lived his message. In this book, he shares the ups and downs of his experiences with fasting—and the explosive power the Holy Spirit has released in his ministry as a result. Visions, healings, and miracles


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Gentiva Health Services
Gentiva Health Services was recognized and certified in 1993 by Centers for Medicare & Medicaid Services (CMS) as one of modern home-health care agencies which are scientifically measured and assessed to have high-quality home-health care services for promoting health and improving the quality of life. Gentiva Health Services is located at 39 12th Street Parkersburg, WV 26101 and can be contacted via phone number (304) 424-7172. Home Health Services being offerred by Gentiva Health Services includes nursing, physical therapy, occupational therapy, speech pathology, medical social, home health aide.
- Nursing
- Physical Therapy
- Occupational Therapy
- Speech Pathology
- Medical Social
- Home Health Aide
- Monday - Friday: 8:00 AM - 5:00 PM
- Saturday - Sunday: Closed
Quality Measures
Center for Medicare & Medicaid Services (CMS) regularly surveys the quality of home health services basing on different metrics which more or less reflect the overall patients' health conditions after receving the services. This quality measures report is provided in order to help patients understand the home health services being offerred by Gentiva Health Services and to help the facilities improve their service quality for promoting health. The following quality measures are collected, compiled and publicized on Oct 19th, 2016 by CMS
Patient Experiences
Center for Medicare & Medicaid Services (CMS) regularly gathers feedback information from patients (and their family or friends) about their experiences with a certain home health agency. In the survey, the patients shares their feelings about services they received, and whether they would recommend the agency to someone else. This information is also very helpful to the agency, telling the agency where to focus their improvement efforts for better health care and services.
This home-health data was updated by using the dataset publicized on Oct 19th, 2016 by the Centers for Medicare and Medicaid Services (CMS). If you found out anything that is incorrect and want to change it, please follow this Update Data guide.
Related Providers
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Housecalls Home Health
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Amedisys Home Health Of West Virginia
2345 Chesterfield Avenue, Suite 201

subset: commoncrawl


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World Bulletin/News Desk
More than 100 Bulgarian judges protested on Friday against the dismissal of a judge and government critic, accusing the top legal body of bias and double standards.
The Supreme Judicial Council sacked Miroslava Todorova, a chair of the judicial professional body, the Union of Judges, for taking too long over judging three cases.
"Todorova is one of the most prominent critics of the Supreme Judicial Council. Obviously she was inconvenient and was sacked in an unclear procedure," said judge Neli Kutskova at the demonstration in front of the council's offices in Sofia.
Rightist groups and professional organisations of magistrates also condemned the decision and called it an attempt to intimidate reformist judges and stifle change in the inefficient and graft-prone judiciary.
The centre-right government of Prime Minister Boiko Borisov, which came to office three years ago promising to end a climate of impunity in the European Union's poorest state, rushed to distance itself from the dismissal of Todorova.
"The decision of the Supreme Judicial Council, whose reputation I can call controversial, is a provocation aimed against the government," the prime minister said in a statement.
Borisov said other judges had been given lighter punishments or none for similar delays to cases and urged the council, an independent body which administers the legal system, to reconsider its decision.
Brussels has repeatedly urged its newest member to overhaul its justice system. It is to issue a report next week on Bulgaria's progress in fighting corruption and organised crime.
On Thursday, European leaders reprimanded neighbouring Romania, which also is under Brussels monitoring, for failing to protect the rule of law, sending a signal that the independence of judges should be respected.
Todorova said her dismissal was "humiliating and unfair" and she would appeal it. She called on judges not to be intimidated by the council.
"I may be a subject of repression but I do not feel a victim ... There is no need for the colleagues to be afraid," Todorova told a news conference.
Todorova has criticised the government for not going far enough in its reforms and called for changes to the way members of the Supreme Judicial Council are chosen.
A survey carried out by the independent Centre for the Study of Democracy in May showed more than 50 percent of Bulgarians did not trust the courts and 72 percent believed magistrates could be easily bribed.
More than 60 percent believe the judges are susceptible to political influence.
More than 240 Palestinians have been killed since an uptick in Israeli-Palestinian violence since October
'We must give a chance to dialogue,' a senior official of the International Criminal Court says in Senegal
Beijing has implemented strict rules in Xinjiang forbidding anyone under the age of 18 from following a religion, levying hefty fines against families whose children study the Quran or fast during Ramadan.
GREECE has received yet another bailout worth billions from EU money chiefs
Located about 20 kilometers (13 miles) southeast of Mosul, Qaraqosh considered main entrance to ISIL-held city
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12 people killed in an attack after suspected Al-Shabaab gunmen attacked a lodge with explosives
Ex-Bosnian Serb leader Karadzic, convicted war criminal, awarded certificate of appreciation by Republika Srpska parliament
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Civil rights group demands federal probe in wake of incident in Mississippi


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Two Monsters
Written by David McKee
Illustrated by
Lovereading4kids Price £5.59
£6.99 saving £1.40 (20%)
The Lovereading4Kids comment
Delightfully witty, Two Monsters is a classic picture book with a strong message about understanding other people's point of view. The Two Monsters live on different sides of the mountain and so see the world from different angles. Communicating through a hole in the mass that lies between them, the Two Monsters argue about what they can see and exchange insults. "You're just a stupid old wind-filled prune!" one yells at the other bringing the quick response, "And you're a bandy-legged, soggy cornflake!" But as the argument escalates into rock throwing, the Two Monsters bring the mountain down and find that they actually like each other's company…
Two Monsters by David McKee
Two monsters live on either side of a huge mountain and talk to each other through a hole in the middle. But when the sun sets one evening an argument starts that eventually brings the mountain down. This is a story about friendship and understanding others' points of view.
About the Author
Other Formats
Book Info
28 pages
Interest Age: From 2
David McKee
More books by David McKee
Author's Website
Publication date
1st January 2009
It's really exciting to read and review new books, thrilling to see my reviews online and I love finding the final published copies on sale.Sam Harper – age 10
Writing reviews help the children with their literacy skills and we always read the books together which gives us good quality family time!Cat Bisland (on behalf of the Bi
A great way to introduce kids to great books, authors & genres. Parents can find age-appropriate books to share with their children.Judi Davies – Aberdare Girls Sch
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Has anyone had to use annual leave instead of sick leave because your sick leave balance is low?
Free e-mail watchdog
Answer this question
Has anyone had to use annual leave instead of sick leave because your sick leave balance is low?
Answer for question:
Your name:
Answer #1
| 19/12 2013 10:26
you mean vacation?
98 %
Answer #2
| 19/12 2013 11:46
No because luckily I am hardly ever ill. Some people look on sick leave as extra paid vacation and use up the their sick leave when they are not ill at all so have none left when they really are ill.
92 %
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Employees may use the paid sick leave to care ... annual use of paid sick leave to ... employer already has a sick leave or PTO policy ...
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Tip: Click / touch once to select each option. Click / touch again to deselect.
Time to get to work! LRS Consulting Services is seeking a Senior Automation Engineer for one of our clients. This is a 6-month contract opportunity that could lead to permanent employment for the right person. The selected candidate can be located in either Dallas, TX or San Diego, CA. If you're that person, if you have Testing Architecture expertise that we need, submit your resume now! LRS Consulting Services has been delivering IT excellence for over three decades. Our reputation for quality, flexibility, and strong relationships with our clients keeps them turning to us to meet their IT consulting needs. Our contacts combined with your technical expertise equals career possibilities for you. So let's get to work! The Senior Automation Engineer will:- Participate in day-to-day QA activities.- Maintain, enhance and expand the automation framework and associated tools.- Create and execute automated functional tests.- Have experience with utilizing and maintining virutal environments.- Assist with expanding and maintaining existing suite of internal load and performance testing tools.- Assist with creation and execution of load and performance tests and results analysis.- Work closely with development on any identified areas of improvement based on load test results.- Assist DevOps team with Continuous Integration.- Perform some manual test creation and execution as required.- Participate in code reviews.- Exercise good judgment in selecting methods, techniques and evaluation criteria for obtaining solutions.- Work with product managers, development, business analysts and manual QA teams. - Analyze test results and create test reports.- Communicate test reports to stakeholders.- Track, analyze and resolve defects. To apply, please submit your resume to firstname.lastname@example.com. Visit us online at www.LRS.com.LRS is an equal opportunity employer. Applicants for employment will receive consideration without unlawful discrimination based on race, color, religion, creed, national origin, sex, age, disability, marital status, gender identity, domestic partner status, sexual orientation, genetic information, citizenship status or protected veteran status.
- 4+ years of experience with testing in a C# / .NET environment- 1+ years of manual testing experience- 1+ years of experience with the following: Continuous integration, experience with repositories such as TFS, Visual Studio Coded UI experience, Load and Performance testing, database testing- Candidate must have ability to effectively communicate in English (written and verbal)- Candidate must have permanent authorization to work in the USA for any employer
This position is not eligible for benefits.This position is: Right to Hire
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Pavtube DVD Copy
Pavtube DVD Copy is a professional DVD to DVD copy tool with one click for all, the output file can be saved as ISO file for DVD backup. The powerful function enables users copy most DVD movies.
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As such, links may appear that were valid originally, but no longer are.
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after serveral weeks. You can still click on the link to see if the original image is still available.
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- Show newest for...
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Today's Date Display Pack
Languages / Countries
OSN2002 Aug 23rd
would really like the matching days of the week to go with this set
Lucy.B@Twinkl Aug 23rd
Hi OSN2002,
I'll see what we can do for you! Thanks for commenting :)
Joe.M@Twinkl Aug 24th
Hi there,
We have a similar resource that includes the days of the week available here - http://www.twinkl.co.uk/resource/t-c-1279-todays-day-and-date-display-pack
I hope you find it useful!
- Lucy.B@Twinkl Aug 23rd
bspteacher Dec 21st
Is the banner page in this correct? Not sure if there should be another page so that the day,month and date can be added?
Kathy.S@Twinkl Dec 21st
Hi bspteacher,
Thank you so much for letting us know about this one. I'll ask our resource team to look at this right away!
Joe.M@Twinkl Dec 22nd
Hi there bspteacher,
Thanks for spotting this mistake! We have now corrected it and emailed you the amended resource, I hope you find it useful. It will also be updated on the website within 48 hours, and you can find it either as a main resource, or under 'Alternative versions' above.
- Kathy.S@Twinkl Dec 21st
senoredwards Oct 10th
Days of the week, please. [3]
karensheerin Apr 14th
I agree, days of the week would be great!
chuckles76 Apr 8th
Needs to include days of the week too.
Today's Date Display Pack - This pack is a brilliant way to get the children actively remembering what the date is - with a banner to stick on your wall and date and month cards included, this pack is a brilliant way to reinforce the months of the year and the number of days in each!
This zip file contains:
- Todays Date Display Pack Banner [PDF]
- Todays Date Display Pack Dates [PDF]
- Todays Date Display Pack Months [PDF]
- Todays Date Display Pack Seasons [PDF]
This resource is available in Precursive, Dyslexic, Cursive, Editable and Standard.
- Twinkl added Dyslexic Version on May 12th
- Twinkl added Precursive Version on May 12th
- Twinkl updated the Main Version on May 11th
- Twinkl added Cursive Version on Oct 24th
- Twinkl added Editable Version on Oct 15th


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Do you know the coach of this team?
Send us the coach name and contact information.
The Douglas Eagles football team is at their home non-conference game vs. Pennington.
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I am from eastern Europe.
But don't take my word about P society since I am not measure, since I am quite asymmetrical in P/J.
Through my entire life I have this tendencies it is just that MBTI made it clear for me.
On my first test I was answering in a way that makes me more friendly towards environment. Since all my life I am hidding myself. (not just a J)
But when I have started to connect the dots it is clear what I am.
Chronic lateness is something totally P for sure. But if you manage to move the entire process 10 minutes so that you come 5 minutes earlier you will be in business.
You need to do exactly the same thing, you just have to start 10 earlier.
I am never late unless something trully drastic happens.


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|By Mark R. Hinkle
Article Rating:
|June 15, 2004 12:00 AM EDT
Many people feel that if they get something for free there is no real value in it, but that's not always the case. Free doesn't always equate to low quality or "cheap." Especially when it comes to open source and free software.
I am often fascinated by the caliber of the many open source and royalty-free applications available and useful to a variety of organizations, from business to government to education. In homage to those people who develop and donate their applications to the community, I am focusing on a collection of tools from the open source community that can be used to solve common PC problems. These solutions are not only without licensing fees, they are adaptable to different needs of various classifications of users. I chose to focus on Linux-bootable CD distributions and the utilities included with them for a range of applications from bioinformatics to rescuing PCs destined for the scrap heap or ailing due to viruses.
The best way for the new Linux user to take advantage of these tools is by virtue of a bootable Linux distribution because it won't require you to install Linux and will allow you to use an existing PC that may already have an operating system on it. Also, in many instances having a portable operating system is the key to solving your problems.
KNOPPIX: Free Operating System, Big Savings
I have mentioned on occasion the KNOPPIX Linux Distribution (www.knoppix.com), which runs from a bootable CD on a wide variety of PCs with or without all the working parts. KNOPPIX is particularly attractive because it includes a working operating system and thousands of applications, and is as easy to obtain over a broadband connection. Not only is the KNOPPIX downloadable from numerous Web sites but via the Bit Torrent (http://bitconjurer.org/BitTorrent) peer-to-peer file sharing network, an excellent and legitimate use of p2p technology. I am using for the purpose of this article the latest release, version 3.4, of KNOPPIX. (You can find out more about KNOPPIX at www.knopper.net/knoppix-info/index-en.html#description
Repurposing Workstations
In many businesses PCs are taken out of service as part of scheduled upgrade plans. Frequently these machines are decommissioned due to age and for purposes of standardization or because the burden of keeping them maintained is too great. What if you could turn these perfectly good though aging PCs into useful workstations for visitors or workers with relatively modest computing needs? There are many variations of how this could be useful; following are two scenarios that may be appealing.
Aging PC into a Thin-Client Machine
Imagine a company that has 20 PCs that are at the end of their useful Windows life, with the following specifications: 200MHz processor, 32MB of RAM, 2-4GB hard drives. They are constantly breaking down or needing software updates, and you're contemplating an upgrade to new hardware and the latest Windows operating system. The conventional solution is to buy 20 replacement PCs with Microsoft Windows at an average cost of $600-$800 or a total of $12,000-$16,000, and additional applications can quickly raise those figures.
An alternative Linux solution allows you to keep your existing PCs but to burn copies of the KNOPPIX CD, setting the PCs to boot from the CD. The total cost for materials for this solution is about $ .25 per PC, or $5 plus the time to complete the conversion. Then you can invest $2,000 in a file server that can save all the files and if necessary serve applications through a terminal server model, which can extend the useful life of the hardware for a number of years. This solution has limitations, but it does provide a couple of advantages. First, there are fewer moving parts at the user's desktop so there are fewer things that can break. Second, because the system is read-only users have significant protection from viruses as well as other undesirable changes that result from conventional PC configurations. Third, new applications can be pushed out to users from your central terminal server or via a Web services model that no longer requires changes on the client machine. For more information on thin-client computing, see my story in the January 2004 issue of LinuxWorld Magazine, "Desktop Linux: Think Thin" (Vol. 2, issue 1, www.linuxworld.com/story/38281.htm).
Kiosk for Web Browsing and Internet Access or Training Labs
There is an old saying, "One man's trash in another man's treasure." In the day and age when PCs are selling for less than $400, there is little incentive to keep old PCs in service and many organizations refresh their workstations often. Just because your workstations are being replaced doesn't mean you can't find new uses for your older PCs. One such use is to create kiosks for visitors to access the Web and check their e-mail when visiting your facility, or perhaps to outfit a training room that does Web-based training. These PCs, once configured to boot from CD, are impervious to most software failures. Since the file system on the PC is read-only, any problems can be fixed with a simple reboot. Because of this virtually bulletproof configuration, Linux distributions that run from a live file system CD lend themselves to a multi-user situation. Another alternative is to demonstrate this solution to a local charitable organization and donate the PCs to them - a local school will understand the value of the donation and potentially provide a tax write-off. Also, before you donate them you can use the SHRED utility mentioned later in this article to ensure that all data has been removed.
Traveling Desktop
Many people today have laptops, but it's not always convenient to carry one. Often when we visit friends they have a computer that we may borrow. These computers usually have an Internet connection and some core applications, but they don't usually have the data we need. One solution is to use KNOPPIX in conjunction with a USB memory stick. The memory stick can hold all your critical data, such as your address book and documents, and maybe a calendar or other information that you want to make sure travels with you. One way to accomplish this is to use the "persistent Knoppix home directory." To do this you can allow Knoppix to boot from your USB thumb drive and make your computing environment both lightweight and highly portable. The following recipe will give you a blueprint to accomplish this type of solution:
- Boot into Knoppix and insert your USB storage drive.
- Choose "Create a persistent KNOPPIX Home directory" by going to your K Menu > Configure.
- When asked if you want to create a persistent home directory, choose "Yes."
- Now you choose to create the partition on your USB key; usually these drives will register as /dev/sda or /dev/sda1.
- Next you will be offered the choice to use the ENTIRE Partition, if you are only using your USB thumb drive for Knoppix this should be fine. If you choose the FAT32 format you can access the thumb drive from both Linux and Windows.
Now you can take this CD and thumb drive to another computer and your data and settings will travel with you. Knoppix.net has a Persistent Home How-To on their Web site (www.knoppix.net/docs/index.php/PersistentHomeHowTo); their forums offer additional information for this type of configuration.
Rescue Utilities
There are tons of commercial solutions for reviving "dead" Windows PCs by numerous reputable software makers. However, the Knoppix live CD distribution includes utilities that can solve many common problems that these often-expensive solutions address.
Windows Installation Won't Boot
Sometimes Windows installations run into errors that won't boot. In these cases you have a couple of options; the first is to try your rescue disk from the operating system you have installed. If that doesn't work you can boot from your Knoppix disk to install files, edit configurations, and access your data. Sometimes it may be necessary for you to download a file and overwrite one that is corrupt so that your installation can still boot. You can use Knoppix to boot and edit your windows.sys or other system files that might prevent Windows from booting.
Rescuing Files and Moving Them to a Windows File Server
A couple of months ago a friend of mine brought me his laptop that was running Windows 98; no matter what he tried he could not get Windows to boot. After considerable time spent investigating his problem I was unable to boot Windows either. This was a huge problem for him as he had a presentation (for his son's wedding) held hostage by his laptop. I told him not to worry and pulled out my Knoppix CD. I then proceeded to successfully boot his four-year-old Gateway laptop via Knoppix. Since the presentation he needed was in PowerPoint I booted up in Windows PC and copied the files over from one PC to the other. I did this through the handy LinNeighborhood application (www.bnro.de/~schmidjo), a front end for Samba (www.samba.org) that allows Linux users to access Windows files and print services using the Server Message Block (SMB) protocol.
To solve my friend's dilemma I launched LinNeighborhood, which allowed me to browse the Windows PCs on my network. Then I entered my information for the machine I wanted to connect to (in this case it was called Hinkle-Top and I entered the IP address and the Hinkle-Top entry showed up in the LinNeighborhood window). Then I right-clicked the associated icon and chose to scan as user. The scan as user function allowed me to enter my Windows username and password. This then allowed me to see all the shared directories on that Windows PC. The next step was to right click on the share I wanted to access (in this case it was called Data) and choose mount. The directory then showed up in the lower window with the mount point (in this case /root/mnt/HINKLE-TOP/Data/); then since my friend needed to browse his drive I chose to set up Konqueror (a graphical file manager and Web browser like Windows explorer). To make sure I had full permissions to read and write to the partition I went to a command prompt and launched Konqueror by typing "su" to gain super user access, then I typed konqueror to run the graphical utility with the permissions I needed. To move the files I dragged them from one Window to another. Figure 1 shows both the local disk and the remote Windows PC. In conjunction with Konqueror file manager, this solution offers an easy way to drag and drop files from one PC to another.
Manipulating a Hard Drive (Formatting, Partitioning, Erasing)
Knoppix includes many disk utilities for manipulating hard drives, including partitioning tools and utilities to securely delete data from the hard drive before it is thrown out or repurposed. The following tools are well suited to these types of tasks.
QTParted (http://qtparted.sourceforge.net) is a graphical clone of the popular disk utility Partition Magic. It's written using the QT toolkit and the command line tool "parted," hence the name. What it I find it useful for in my Windows to Linux migration is to resize Windows partitions so that I can install Linux in a dual boot setup (see Figure 2).
Many Windows users will recognize the term fdisk, which is a menu-driven program for creation and manipulation of partition tables. Partitions are logical disks on a physical device. These logical disks can be formatted with a variety of file systems. Also, fdisk can create or delete partitions and rewrite the master boot record. To use fdisk from Knoppix just launch a command prompt and make sure to su to root, then to access your disk type fdisk /dev/hda where hda is the name of your hard drive (usually this will be /dev/hda but if you have two hard drives you may see it as /dev/hdb). For more information on how to use fdisk you can type m for help at the Command: prompt. Also, you may find it useful to read the fdisk manual by typing info fdisk at a command prompt. This will bring up extended data on the fdisk partition table manipulator (see Figure 3).
Securely Deleting Data from a PC
SHRED - (Click Here !) - When you delete files from your operating system what normally happens is that you are only deleting an entry in the index of files that tells where that data is stored. Though the data is no longer visible it still exists until new data overwrites the old data. An unscrupulous user could use utilities to recover this data since files that you thought were deleted may still exist on the hard drive. That's where a utility like SHRED comes in handy. SHRED actually overwrites that data with new data so that there is little chance of recovery. By default shred will overwrite your hard drive 25 times with data and greatly reduce the risk of old data being recovered. To "shred" a hard drive with Knoppix you would simply go to a command line and type:
shred -verbose /dev/hda
where /dev/hda is the name of the hard drive you want to shred or delete all data from. In cases where sensitive data is stored on PCs it's very important to delete this data completely before repurposing or disposing of PCs and shred would be a useful means to securely wipe this data whether this be for patient data in a doctor's office or a government office that has standards for secure destruction of computer data.
Various Bootable Linux CD Distributions
There are many customized live CD Linux distributions that are useful and specialized for different purposes. The following are a few examples of special-use live CD Linux distributions.
Damn Small Linux
Damn Small Linux (www.damnsmalllinux.org) is a bootable CD Linux distribution that can fit on a 50MB CD about the size of a business card that you can carry in your wallet. Damn Small Linux doesn't have as many applications as Knoppix but it does include some critical applications including a mail client, Web browser, spreadsheet program, PDF viewer, and more.
INSERT (INside SEcurity REscue Toolkit)
INSERT (www.inside-security.de/INSERT_en.html) is a small footprint bootable Linux system that like Damn Small Linux can fit on a business card sized CD. However, INSERT includes tools that would be most useful for repairing and diagnosing computer problems.
Morphix (www.morphix.org) is a distribution that can be "morphed" into a bootable Linux CD with your specifications. So in the likelihood that you have specific requirements for your own bootable Linux distribution you can roll your own Live CD distribution with the aid of the Morphix TROM (Total Remastering of Morphix - www.morphix.org/trom) utility.
These are a few of the specialized bootable Linux distributions that I have used in the past. For a more comprehensive list you can visit www.knoppix.net/docs/index.php/KnoppixCustomizations.
I hope you find these tips valuable in your everyday computing life. All these solutions are useful to average IT users. Users with modest knowledge of Linux can execute every one of the solutions mentioned here; with a little research and creativity you can solve these and many other inconveniences. Best of all, these applications are unencumbered by licensing fees and can be freely obtained from the Internet. The fact that they are almost all developed under an open source licenses means that it's easy for other community members to improve upon software and redistribute their improvements. It also makes it possible for unrelated parties to continue the work of the previous parties should they decide to stop developing their solution. This type of model makes a lot of sense, especially when it enables the widest possible involvement of developers and companies globally.
|Arnold L. Johnson 01/20/08 09:10:49 AM EST
Your article is right on the money. I so much enjoy not being tethered to a Microsoft machine. Many friends have older PC's with borrowed copies of MS windows on them and can not get upgrades. I try to interest them in live-CD Linux, they fear not being compatible with MS business software. A live-CD says "don't take my word on this, but look here". I am so impressed.
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text:
I too have my doubts about the JSF - sounds like an international Collins Class to me.
Brendon Nelson (SP) when he was defence minister said in an interview on 60 mins that the main reason Aust was involved in the JSF was due to the 5 percent of the project he couldn't talk about - stealth.
Maybe they have something brewing, maybe not.


text:
From the Clinic of Respiratory Medicine (Drs Scherr and Tamm), Clinic of Internal Medicine (Drs Scherr, Schafroth Török, Jochmann, Miedinger, Chhajed, and Leuppi and Ms Maier), and Clinic of Clinical Pharmacology and Toxicology (Dr Taegtmeyer), University Hospital Basel, Basel, Switzerland.
Correspondence to: Joerg D. Leuppi, MD, PhD, Clinic of Internal Medicine, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland; e-mail: email@example.com
Drs Scherr and Schafroth Török contributed equally.
Funding/Support: The study was supported financially by a grant from Boehringer Ingelheim GmbH, Switzerland, who also provided tiotropium for study use, and Pharmaxis Ltd, Australia provided the mannitol tests.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
The use of inhaled corticosteroids in mild to moderate COPD is controversial. The aim of this study was to determine whether airway hyperresponsiveness to mannitol might identify patients who are likely to respond to add-on inhaled corticosteroids.
Ninety subjects with mild to moderate COPD were recruited and 68 subsequently randomized in a double-blind manner to receive inhaled budesonide (1,600 μg/d, n = 31) or placebo (n = 37) for 3 months. Thirty-eight subjects had airway hyperresponsiveness to mannitol (17 received budesonide, 21 placebo). All subjects received tiotropium throughout the study, including 4 weeks before randomization. Spirometry, quality of life (St. George Respiratory Questionnaire), degree of dyspnea, airway responsiveness to mannitol, and exhaled nitric oxide were assessed at week 0 (recruitment), week 4 (baseline prior to randomization), and week 16 (posttreatment).
Compared with placebo, budesonide was associated with improved quality of life in subjects showing airway hyperresponsiveness to mannitol (difference of changes in quality of life score between randomization and study completion, −9.1; 95% CI, −15.8 to −2.3; P < .01). Treatment with inhaled budesonide also led to a reduction in airway responsiveness to mannitol compared with placebo (difference in log10 response-dose ratio, −0.3; 95% CI, −0.6 to −0.04; P < .01). However, postrandomization changes in FEV1 % predicted, quality of life, and exhaled nitric oxide showed no difference between budesonide and placebo.
In subjects with mild to moderate COPD and airway hyperresponsiveness to mannitol, quality of life and airway responsiveness improved after treatment with inhaled corticosteroids added to long-acting bronchodilator therapy.
Trial registry:
ClinicalTrials.gov; No.: NCT00860938; URL: www.clinicaltrials.gov
COPD is characterized by chronic airflow limitation that is not fully reversible and usually leads to a progressive decline in lung function over time.1 Clinical and functional presentations vary greatly among patients, even when degrees of airflow limitation are similar.
The development of COPD is associated with both chronic airway and systemic inflammation.2 Although inhaled corticosteroids (ICSs) are very effective in controlling symptoms in patients with asthma of all ages and disease severity, the antiinflammatory properties of ICSs in COPD remain controversial.3 Based on current guidelines, patients with severe airway obstruction and frequent exacerbations seem to gain from ICS treatment.4 Although widely prescribed, the role of ICSs in mild to moderate COPD has been less intensively evaluated than in patients with asthma.5 Continued treatment at high doses of ICSs is expensive and carries the risk of reduced bone density and other side effects, including pneumonia; therefore, the identification of subgroups likely to benefit from ICS treatment would be helpful.6 To date, there are no established factors that predict response to ICS in patients with mild or moderate COPD. Airway hyperresponsiveness (AHR) to mannitol may be one such predictive factor because it has been shown to be associated with the presence of inflammatory cells and the release of mediators in the airways.7 In our previous proof-of-concept study in which 30 steroid-naive subjects with mild to moderate COPD were challenged with mannitol, AHR to mannitol was present in seven subjects (23%), five of whom showed both a reduction in AHR to mannitol and a significant improvement in FEV1 and quality of life after ICS treatment.8 Spirometry, however, remained unchanged in the absence of AHR.8 To further investigate the potential predictive value of AHR to mannitol and response to ICS in mild to moderate COPD, we performed a double-blind, double-dummy, placebo-controlled trial of 3 months treatment with ICS in subjects already receiving tiotropium.
Ninety current or former smokers with mild to moderate COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] classes I and II) aged > 35 years were recruited for the study from the general public between 2007 and 2010. The diagnosis of COPD GOLD I and II was based on an initial screening of lung function and reversibility testing at recruitment. All subjects had a measured postbronchodilator FEV1/FVC ratio of < 0.7 and a bronchodilator reversibility of < 12% or 200 mL and were naive for any class of COPD medication at screening (e-Appendix 1).
The study was performed in accordance with the Good Clinical Practice guidelines recommended by the International Conference on Harmonisation of Technical Requirements and the Declaration of Helsinki.9,10 The study was approved by the institutional Ethics Committee (EKBB 148/06) and registered with the current controlled trials database. Written informed consent was obtained from each subject prior to participation in the study.
The study was an investigator-driven, monocentric, randomized, double-blind, double-dummy intervention trial (Fig 1). It consisted of a 4-week run-in phase (tiotropium 18 μg once daily only) and an intervention period of 3 months duration (tiotropium plus either dry-powder budesonide 800 μg bid or placebo). COPD GOLD guidelines recommend initial treatment with a long-acting bronchodilator prior to any introduction of an ICS.4 In keeping with these guidelines, tiotropium was commenced prior to randomization and continued throughout the whole study period. High-dose inhaled dry-powder budesonide (Miflonide 400 μg capsules; Novartis Pharma Switzerland AG) is licensed for the treatment of COPD in Switzerland and was chosen for the study to be in keeping with ICS doses used in other COPD trials.11
The primary outcome measure was the change in FEV1 % predicted after 12 weeks of ICS treatment in subjects who showed AHR to mannitol at baseline compared with those who did not. Secondary outcome measures were changes in quality of life (St. George Respiratory Questionnaire [SGRQ]), airway responsiveness to mannitol, exhaled nitric oxide (eno), Medical Research Council (MRC) dypsnea scale, and respiratory symptoms (cough, sputum production).
Subjects underwent spirometry, assessment of quality of life (SGRQ), bronchoprovocation testing with mannitol, and measurement of eno at recruitment (week 0), baseline (week 4, randomization), and posttreatment (week 16). Assessment of outcome-relevant parameters was performed at each on-site visit on 2 consecutive days. Clinical data, questionnaire, and postbronchodilator spirometry data were collected on the first day, and eno was measured prior to bronchoprovocation testing on the second day. Intake of any short-acting bronchodilators and tiotropium was not allowed for at least 6 and 24 h, respectively, prior to bronchoprovocation testing. Subjects also underwent skin prick testing to six common aeroallergens on the first day of the recruitment visit. The protocol used for the mannitol challenge test was originally described by Anderson et al.12 AHR was defined as a 15% fall in FEV1 on exposure to 635 mg or less of mannitol (provocation dose to cause a fall in FEV1 > 15% [PD15]). Response-dose ratio (RDR) was calculated as the final percent fall in FEV1 divided by the cumulative dose of mannitol to cause this fall for all subjects.13 The degree of dyspnea was assessed with the MRC dyspnea scale, and current respiratory symptoms were recorded. Additional details on the methods for performing these tests are provided in e-Appendix 1.
Based on the results of our pilot study,8 we expected to observe an improvement in FEV1 % predicted of 12% in the mannitol-positive group compared to the mannitol-negative group. A sample size of at least 10 subjects in each group was required to complete the study. This calculation was based on an unpaired t test with a 5% significance level and 80% power.
Randomization of subjects after 4 weeks of pretreatment with tiotropium was stratified according to their current smoking status. Smokers and former smokers were represented in the same proportions in both the treatment and the placebo groups.
The predictor variable was the study group, and dependent variables were postintervention baseline-subtracted study variables. Results are expressed as differences in means or medians (with 95% CIs and P values) of postintervention baseline-subtracted outcome variables between the placebo and the intervention groups or between subjects with or without AHR to mannitol. Calculations of PD15 mannitol and RDR were carried out on log10-transformed data to reach normal distribution for parametric analysis. All outcome variables were analyzed on a per-protocol basis. P < .05 was considered significant.
The subjects in the budesonide and placebo groups were well matched in terms of sex, age, smoking pack-years, and GOLD classification (Table 1).
Data are presented as No. (%) or median (interquartile range). P < .05 is significant (two-sided unpaired t test for continuous variables, χ2 test for discontinuous variables). GOLD = Global Initiative for Chronic Obstructive Lung Disease.
During the run-in phase between recruitment and baseline, 11 subjects dropped out (Fig 1). No significant changes occurred in FEV1 % predicted, quality of life, reactivity to mannitol (log10 RDR), and eno after 4 weeks of treatment with tiotropium (e-Table 1).
There were no differences in spirometry, quality of life, and airway responsiveness to mannitol as measured by log10 RDR, eno, MRC dyspnea scale, and respiratory symptoms at baseline (Table 2). After randomization, a further 11 subjects were unable to complete the study (Fig 1). The dropout rate did not differ between treatment groups. Sixty-eight subjects completed the final visit (posttreatment).
Data are presented as No. (%), mean ± SD, or median (interquartile range). P < .05 is significant (two-sided unpaired t test for continuous variables, χ2 test for discontinuous variables). eno = exhaled nitric oxide; MRC = Medical Research Council; PD15 = provocation dose to cause a fall in FEV1 > 15%; RDR = response-dose ratio (fall in FEV1 divided by cumulative mannitol dose given to cause this fall); SGRQ = St. George Respiratory Questionnaire.
Adherence calculated from the number of used tiotropium and study medication capsules (for method details, see e-Appendix 1).
Changes and differences in outcome measurements are shown for both the budesonide and the placebo groups in Table 3. There were no changes in FEV1, quality of life (SGRQ), MRC dyspnea scale, and chronic sputum production between randomization and study completion in either the budesonide or the placebo groups. Responsiveness to mannitol improved in the ICS group wherein changes in log10 RDR after 3 months of budesonide treatment were significantly greater than in the placebo group (difference in change between the budesonide and the placebo groups, −0.2; 95% CI, −0.5 to −0.03; P = .03). Current smoking status had no influence on outcome (e-Table 2).
Data are presented as mean ± SD or No. (%), unless otherwise indicated. ΔBudesonide − Δplacebo = difference from baseline changes after 12 wk of treatment in the budesonide and placebo groups. P < .05 is significant. See Table 2 legend for expansion of abbreviations.
At randomization, 38 subjects (56%) showed AHR to mannitol. Of these, 17 were randomized to receive budesonide and 21 to receive placebo. To investigate the role of airway responsiveness to mannitol and response to ICS treatment, a subgroup analysis of AHR was performed (Table 4, e-Table 3). Differences between baseline changes in FEV1 % predicted were greater in subjects treated with ICS with AHR to mannitol than in subjects treated with placebo with AHR (4.8%; 95% CI, 0.3%-9.4%; P = .04). However, within the budesonide-treated group, subjects with positive results for AHR did not show a significantly greater improvement in FEV1 % predicted compared to those with AHR-negative results (0.6%, 95% CI, −5.0% to 5.1%; P = .99) (Table 4).
Data are presented as mean ± SD, unless otherwise indicated. ΔMannitol positive − Δmannitol negative = difference from baseline changes after 12 wk of budesonide treatment in subjects with mannitol-positive and mannitol-negative results. P < .05 is significant. See Table 2 legend for expansion of abbreviations.
Changes over time in quality of life (SGRQ) in the budesonide group were correlated with the presence of AHR to mannitol and were significantly different compared with subjects without AHR (difference in SGRQ change between the AHR-positive and the AHR-negative groups, −8.6; 95% CI, −16.1 to −1.2; P = .02). Accordingly, a similar difference between baseline changes was also found compared with the placebo-treated subjects with AHR (−9.1; 95% CI, −15.8 to −2.3; P < .01). In contrast, this effect was not present in placebo-treated subjects without AHR (−4.9; 95% CI, −1.92 to 11.8; P = .16) (Fig 2).
Airway responsiveness to mannitol, as measured by log10 RDR, decreased under ICS treatment compared with both placebo subgroups (with AHR, −0.3; 95% CI, −0.6 to −0.04; P = .03; without AHR, −0.4; 95% CI, −0.7 to −0.1; P < .01). Seven of 17 patients (41%) lost AHR to mannitol after budesonide treatment (PD15 was not reached after treatment), whereas AHR in the placebo group (n = 21) remained stable over time. Smoking status was not associated with changes in airway responsiveness to mannitol after budesonide treatment (three current smokers compared with four former smokers lost AHR, and four current smokers compared with six former smokers showed ongoing AHR).
This well-matched, randomized, placebo-controlled trial investigated the effect of ICSs in steroid-naive subjects with mild to moderate COPD and AHR to mannitol challenge. The results suggest that AHR often is present in patients with COPD and that treatment with ICS is associated with a significant improvement in quality of life and reduction in airway responsiveness to mannitol.
Three months of high-dose ICS treatment was well-tolerated but had no relevant impact on FEV1 % predicted, quality of life, eno, subjective degree of dyspnea, or respiratory symptoms in the group as a whole. These results are in line with previous trials with regard to FEV1 % predicted, quality of life (SGRQ), respiratory symptoms, and eno.14‐17 There was also no significant improvement in FEV1 % predicted in patients with AHR to mannitol and receiving ICS, which contradicts the results of our previous pilot study, possibly because of the earlier study's small sample size and lack of placebo control.8 Also in contrast to our previous investigation, subjects with AHR to mannitol in the present study had mainly mild airway obstruction, so a large improvement in lung function might not be expected in such a population.
Current COPD GOLD guidelines recommend initiating treatment with long-acting bronchodilators prior to commencing add-on ICS, and the study aim was to investigate whether airway responsiveness to mannitol predicts response to add-on ICS treatment. Monotherapy with ICS alone is not recommended and would be of little interest to study. Furthermore, because of their differing pharmacologic actions, it is unlikely that tiotropium (a long-acting anticholinergic) masked steroid-induced (antiinflammatory) effects.
Several large trials examining the effects of ICS in patients with moderate to severe COPD have shown an association with ICS use and improvement in quality of life.16,18‐20 The Inhaled Steroids in Obstructive Lung Disease in Europe (ISOLDE) trial, for instance, showed a significant reduction in health status deterioration among patients receiving high-dose ICS compared with placebo.11 In the present subjects with mild to moderate COPD, only those with AHR to mannitol showed a significant improvement in quality of life after 3 months of ICS treatment, likely because of the concomitant reduction in airway responsiveness to mannitol. Of note is that improvement in quality of life occurred despite the relative paucity of symptoms reported at randomization.
The Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) demonstrated that asymptomatic, or silent, AHR measured by direct bronchoprovocation testing with methacholine was an increased risk factor not only for developing COPD but also for experiencing a new onset of symptoms, such as shortness of breath and cough.21 Therefore, it can be argued that by treating AHR, symptoms and, therefore, quality of life can also be improved. Because it has been shown that AHR to mannitol is associated with sputum eosinophilia, it can be further hypothesized that ICS reduces an underlying eosinophilic inflammation and, therefore, improves quality of life.21 The level of eno was considered to predict airflow reversibility and steroid responsiveness in COPD.22 In the present population, levels of eno showed no differences based on AHR to mannitol and were in a normal range at baseline.21,23 However, most of the subjects were active smokers, resulting in false-low values of eno.24 It has been shown that smoking cessation can reduce airway responsiveness to mannitol in smokers.25 Therefore, we also looked for outcome differences based on current smoking status. Smoking status was regularly assessed and was stable over time. We could not find any significant differences in outcome parameters between current smokers and former smokers who were treated with ICS. However, the present study was not originally designed or powered to compare outcomes between current smokers and former smokers.
The present study has some limitations. The dropout rate of 24% was relatively high. Medical reasons were, however, not the main cause. The majority of patients who dropped out had few symptoms and did not feel inclined to continue using medication. Although the dropout rate was relatively high, it did not introduce bias because it was equal in both study arms. Additionally, despite dropout, the study power was maintained. A further limitation of the study might be the lack of data for sputum eosinophilia. It should be mentioned that therapeutic response in patients with asthma was also observed for a paucigranulocytic phenotype of airway inflammation.26 Mast cells are considered to both infiltrate the bronchial epithelium in COPD and to play an important role in the airway response to mannitol.27 However, sputum analysis might not be the ideal method for detecting mast cells in bronchial airways.28
Although the reproducibility of mannitol challenge testing in COPD is sparse, it is known to be good in patients with asthma.12 Whereas this may be considered a limitation, we do not expect the mannitol test to perform differently in COPD compared with asthma.
In conclusion, subjects with mild to moderate COPD who demonstrated AHR to mannitol experienced an improvement in quality of life and reduction of airway responsiveness to mannitol after 3 months treatment with ICS. Therefore, the present study provides evidence that the presence of AHR to mannitol identifies patients with mild to moderate COPD who are likely to respond to antiinflammatory medication, and mannitol testing in mild to moderate COPD might be useful in selecting patients for ICS treatment. The connection between AHR to mannitol and specific inflammatory processes in this subgroup needs further investigation.
Author contributions: Drs Scherr and Schafroth Török had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Scherr: contributed to the data acquisition, analysis, and interpretation; drafting of the manuscript; and critical revision of the manuscript for important intellectual content.
Dr Schafroth Török: contributed to the study conception and design, data acquisition, and critical revision of the manuscript for important intellectual content.
Dr Jochmann: contributed to the data acquisition and critical revision of the manuscript for important intellectual content.
Dr Miedinger: contributed to the data analysis and interpretation and critical revision of the manuscript for important intellectual content.
Ms Maier: contributed to the data acquisition and critical revision of the manuscript for important intellectual content.
Dr Taegtmeyer: contributed to the data analysis and interpretation, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.
Dr Chhajed: contributed to the data analysis and interpretation and critical revision of the manuscript for important intellectual content.
Dr Tamm: contributed to the study conception and design and critical revision of the manuscript for important intellectual content.
Dr Leuppi: contributed to the study conception and design, data analysis and interpretation, and critical revision of the manuscript for important intellectual content.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Miedinger has received grant money from the following organizations: University of Montréal, University Hospital Basel (2009), Swiss National Science Foundation (2008), Swiss Allergy Foundation (2011), Canadian Institutes of Health Research (2011), and Centre asthme et travail (2009). He also received in-kind support from Trimedal Switzerland for a study not related to this article. Dr Leuppi has received speakers fees from Boehringer Ingelheim GmbH, Switzerland; Merck Sharpe & Dohme-Chibret AG, Switzerland; Nycomed AG, Switzerland; and Pharmaxis Ltd, French Forest, NSW, Australia. Drs Scherr, Schafroth Török, Jochmann, Taegtmeyer, Chhajed, and Tamm and Ms Maier have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Role of sponsors: The sponsors had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.
Other contributions: The use application for mannitol described in this study is covered by US Patent No. 5817028 and internationally by PCT/AU95/000086. The patent is owned by Central Sydney Area Health Service, NSW, Australia, and is licensed to Pharmaxis Ltd, French Forest, NSW, Australia. We thank Schötzau & Simmen (Basel, Switzerland) for statistical support.
Additional information: The e-Appendix and e-Tables can be found in the "Supplemental Materials" area of the online article.
airway hyperresponsiveness
exhaled nitric oxide
Global Initiative for Chronic Obstructive Lung Disease
inhaled corticosteroid
Medical Research Council
provocation dose to cause a fall in FEV1 > 15%
response-dose ratio
St. George Respiratory Questionnaire
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Charm Communications Stock Charts (NASDAQ:CHRM)
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