text:
Clinical officer
Occupation type
Activity sectors
Education required
A clinical officer (CO) is a licensed practitioner of medicine in East Africa and parts of Southern Africa who is trained and authorized to perform general or specialized medical duties such as diagnosis and treatment of disease and injury, ordering and interpreting medical tests, performing routine medical and surgical procedures, and referring patients to other practitioners.
Unlike nurses and physician assistants, a clinical officer is an independent practitioner who is trained in the medical model to practice the full scope of medicine and provides routine care in general medicine or within a medical specialty such as anesthesia and carries out treatment that is outside the nurses' scope. A clinical officer usually oversees a health center or a district hospital and is part of the medical team in bigger hospitals where one may head a department or work under a senior clinical officer or a physician.[6][7][8]
- 1 Overview
- 2 Kenya
- 3 Malawi
- 4 Sudan
- 5 Tanzania
- 6 Uganda
- 7 Zambia
- 8 Burkina Faso
- 9 Ethiopia
- 10 Ghana
- 11 Liberia
- 12 Mozambique
- 13 South Africa
- 14 International
- 15 See also
- 16 References
- 17 External links
To practice medicine and surgery or dentistry as a clinical officer one requires at least four years of full-time medical training, supervised clinical practice and internship at an accredited medical training institution and hospitals and registration with the relevant medical board in their country. After a prescribed number of years in active practice, one may complete a further one or two-year residency programme in order to specialize in any approved branch of clinical medicine and surgery such as anesthesia or pediatrics, or get an advanced medical qualification from the university. There are no pathways (post-basic or post-graduate entry-level conversion programs) for nurses and other health workers hence it takes at least eight years of specialised medical training and experience for a clinical officer to graduate with a post-basic qualification. It should be noted, however, that "clinical officer" in some countries such as Tanzania and Zambia refers to a different cadre of health workers, comparable to "medical assistants" in Malawi, who have less than three years of training but who may upgrade to a similar level by becoming Assistant Medical Officers (AMOs) or Medical Licentiates (MLs)."medical assistants/Sub Assistant Community Medical Officer" in Bangladesh,a Four Year medical diploma course conducting state medical faculty of Bangladesh under ministry of Health and family welfare.
No significant difference has been demonstrated in studies comparing treatment decisions, patient outcomes, quality of care provided and level of knowledge about diseases between a clinical officer and a medical officer (a non-specialist physician) except in countries where nurses were mistakenly assessed as clinical officers. However, because of the nature of practice, populations served and resources at ones disposal, a clinical officer is less likely to administer expensive treatment, prescribe expensive (but not necessarily better) drugs or engage in futile care.[9]
The success of HIV/AIDS prevention and treatment initiatives in Africa is mostly attributed to use of clinical officers to diagnose the disease and provide comprehensive medical care. Access to emergency obstetric care through greater deployment of the clinical officer is one way of attaining the Millennium Development Goals 4 (reducing child mortality) and 5 (improving maternal health).[10]
Worldwide, patients are seen by many other practitioners other than the traditional doctor such as:
- Osteopathic physicians, Podiatrists, Optometrists and Anesthesiologist assistants in the United States
- Emergency and Clinical Officer Pakistan
- Physician Assistants in the United States, United Kingdom, Liberia and Ghana
- Assistant Doctors in China,[11]
- Surgical Care and Emergency Care Practitioners in the UK,[12]
- Assistant Physicians in Saudi Arabia,[13]
- Health Extension Officers in Papua New Guinea[14]
- medical assistants/Sub Assistant Community Medical Officer in Bangladesh
- Medical Assistants in Fiji
- Assistant Medical Officers in Malaysia
- Surgical Technologists in Mozambique
- Clinical Associates in South Africa.[15]
Scope of practice[edit]
A clinical officer takes the Hippocratic oath and, depending on jurisdiction, may be registered by the same statutory board as physicians (in the southern countries such as Zambia and Malawi) or a separate board (in the eastern countries such as Kenya and Uganda). The broad nature of medical training prepares one to work at all levels of the health care system. Most work in primary care health centres and clinics, and casualty departments in hospitals where one will diagnose and treat all common diseases, including serious and life-threatening ones, in all age groups; and stabilise then admit, discharge or refer emergency cases. In smaller hospitals one may work as a hospitalist and one who has specialized in a clinical field provides advanced medical and surgical care and treatment such as administering anesthesia, performing general or specialised surgery, supervising other health workers and other administrative duties.
A clinical officer's scope of practice depends on one's training and experience, jurisdiction and workplace policies. In Malawi, for instance, a clinical officer performs all routine surgical and obstetric operations such as exploratory laparatomy, emergency orthopaedics and Caesarean section. However, in Kenya, Tanzania and Mozambique one has to undergo further specialized training in order to perform such major operations safely.
In rural and small urban health facilities a clinical officer is usually the highest medical care provider and works with minimal resources, relying on the traditional medical history and physical examination, often with little or no laboratory facilities, to make a diagnosis and provide treatment. In bigger and better equipped facilities a clinical officer generally acquires superior knowledge, experience and skills and provides high quality and a wider range of services in district, provincial and national hospitals, universities and colleges, research institutions and private medical facilities.
A clinical officer is usually the lowest entry-level cadre in the medical hierarchy but with years of experience and/or further training one can rise to the same or a higher grade than a physician. In most countries, however, wages are usually low compared to training and responsibilities and career progression is usually restricted by awarding terminal degrees and diplomas, training students who have not attained the minimum university entry grade and, in some countries, not awarding any degree or recognition for advanced training. In such countries, this usually results in a demotivated and low quality workforce and resulting poor health indicators.
The United States' Centers for Disease Control and Prevention and other international health and research institutions make extensive use of COs in their projects in Africa and clinical officers have been the backbone of HIV care and treatment enabling the rollout of ARVS to even the most rural hard to reach areas in Africa.
Research done by the University of Birmingham and published in the British Medical Journal concluded that the effectiveness and safety of caeserian sections carried out by clinical officers did not differ significantly compared with doctors.[10][16] Better health outcomes including lower maternal mortality rates were observed where COs had completed further specialised training particularly in anaesthesia.
In the multi-country study, poor outcomes were observed in Burkina Faso and Zaire - the only countries where the procedure was performed by trained nurses. Higher rates of wound infection and Wound dehiscence in these countries was thought to be due to the nurses' poor surgical technique and need for enhanced training. ≠
Kenya has a comprehensive framework of parallel laws and regulations that govern the medical practice of medical officers and clinical officers. The supreme health policy and medical authorities in the republic are the cabinet secretary of health and the director of medical services who oversee the registration and licensing of medical institutions and the training, registration and licensing of medical practitioners through the Medical Practitioners and Dentists Board and the Clinical Officers Council.
As a British colony in 1928, Kenya started training a select group of natives to practice medicine and care for the local population who were increasingly accepting and seeking western medicine. After independence from Britain in 1963, medical training in Kenya initially adopted the four-year medical school system used in the US rather than the six-year UK model. This was heavily influenced by The Kennedy Airlifts[17] which followed initial funding by the African-American Students Foundation (AASF) in 1959 and led to hundreds of young Kenyan students getting scholarships to study in American institutions: These students came back to Kenya after their studies and joined the civil service in the early post-independence Kenya. It was also around this time that the first DOs were accepted as medical officers by the US civil service and by 1967 the structure and duration of medical training in Kenya was similar to the US MD training. When the University of Nairobi split from the University of East Africa and became the first university in Kenya in 1970, it continued to teach the six-year British degree which led to the creation of two statutory bodies: the Kenya Medical Practitioners and Dentists Board in 1978 which had jurisdiction over medical officers and physicians, and the Clinical Officers Council in 1989 which had jurisdiction over clinical officers. Instead of residency for the clinical officer, the higher diploma in paediatrics, ophthalmology and other specializations was introduced in the late 1970s as a post-basic course for those who had worked for three or more years and, after ten years of service, one became a Senior Clinical Officer and qualified for a license to practice under his own name as a private medical practitioner. The BSc. Clinical Medicine and Surgery degree was later introduced in 2006.
Clinical officers play a central role in Kenya's medical sector today. There were 8,600 clinical officers on the register in 2010 compared to 7,100 medical officers.[18] They are trained by the universities, the Kenya Medical Training College (KMTC),[19] St. Mary's School of Clinical Medicine and other private institutions. The Ministry of Health, through the Clinical Officers Council (COC)[20] regulates their training and practice, accredits training institutions, and approves the syllabi of the universities and colleges. The Kenya Medical Training College (KMTC), also under the Ministry of Health, has campuses in regional teaching hospitals and trains the majority of clinical officers. St. Mary's School of Clinical Medicine and St. Mary's Mission Hospital in Mumias, owned by the Roman Catholic diocese of Kakamega, was the first private institution to train clinical officers. It admits students who got the minimum university entry grade in high school and have passed a written examination and oral interview. The students sit the same examination as their counterparts at the KMTC and are examined by consultants from the public service.
Legal status[edit]
Like the term doctor, the term clinical officer is a protected title whose use without the authority of the Clinical Officers Council is prohibited and a punishable offense under Kenyan laws. Court rulings uphold that a registration certificate or a license issued by the council automatically confers the status of a medical officer or a qualified medical practitioner to a clinician and the titles are used interchangeably in medico-legal documents because a qualified clinical officer has a recognized medical qualification and is eligible for registration as a medical practitioner under Section 11(1) of the Medical Practitioners and Dentists Act in addition to being expressly authorized to practice medicine, surgery or dentistry by Section 7(4) of the Clinical Officers Act[7][8][9][10][11].
From the Anatomy Act, the legal definition of a medical officer is any public officer who is entitled to be registered as a medical practitioner if he applied under any law in the country: Section 14(1) of the Medical Practitioners and Dentists Act and Section 7(4) of the Clinical Officers Act are the only two laws that can authorize one to practice medicine and render medical or dental services in the public sector if they hold a registration certificate or in the private sector if they hold a current license as well. The Public Health Act further defines a medical officer of health as a public officer who is responsible for health nationally (the Director of Medical Services and the Chief Clinical Officer) or regionally (the County or Sub-County Medical Officer of Health and the County or Sub-County Clinical Officer).
Like his counterparts in the public service, a clinical officer in the private sector has the same practice rights and privileges as a medical officer and both are authorized to work independently and specialize in any approved branch of general or specialised medicine. The Competition Act No.12 of 2010 directly prohibits and addresses multi-sectoral abuse of dominance, consumer welfare, exemptions, cartels and unwarranted concentration of economic power among practitioners.
A register of active clinical officers and medical institutions is available online on the Clinical Officers Council and Ministry of Health websites.
The Clinical Officers (Training, Registration and Licensing) Act Cap 260[edit]
The Clinical Officers (Training, Registration and Licensing) Act Cap 260 of 1988 is the law that governs the medical practice of a clinical Officer.[21] It establishes the Clinical Officers Council whose functions are:
- To assess the qualifications of Clinical officers
- To ensure the maintenance and improvement of the standards of practice by clinical officers and to supervise the professional conduct and practice of clinical officers
- To register and license clinical officers for the purposes of this act
- To collaborate with other bodies such as the medical practitioners and dentists board, the central board of health, the nursing council of Kenya, the pharmacy and poisons board, in the furtherance of the functions of the council and those bodies; and
- To consider and deal with any matter pertaining to clinical officers including prescribing badges, insignia or uniforms to be worn by clinical officers.
Before this act there were many sub-cadres within the profession such as registered clinical officer (RCO), certified clinical officer (CCO), medical assistant, etc., who had different kinds and levels of education. All these were abolished by the act in 1989, in favor of a uniform Clinical Officer (CO) cadre. However, the title Registered Clinical Officer (RCO), who were the creme of the profession at one time, has persisted even in official publications.
Although training programmes existed as early as 1928, the first university to train clinical officers was Egerton University[22] in 1999. Programs also exist at Jomo Kenyatta University of Agriculture and Technology,[23] Kenya Methodist University (KEMU)[24]Mt Kenya University.[25]and Presbyterian university of East Africa (PUEA).[26] The diploma in Clinical Medicine and Surgery is completed in nine 15-week trimesters over three calendar years (or 135 weeks which, notably, exceeds the minimum 130 weeks of instruction required to complete US MD programs).[27][28] The BSc. Clinical Medicine and Surgery is completed over 4 years.
Students study the biomedical and clinical sciences such as anatomy, physiology and pathology in the first year followed by the clinical subjects (medicine, surgery, pediatrics, obstetrics and gynecology) in the second year. The third and fourth year involves supervised clinical practice and internship in teaching hospitals where they rotate in all the departments, receive beside lectures, attend consultants' ward rounds, clerk patients and present medical histories, perform deliveries and first-assist in major surgery. They also attend clinical meetings and write prescriptions which at this stage must be counter-signed by a supervising clinician.
There is special emphasis on primary care with modules on community health taught throughout the course. Before starting their internship after the third year, clinical officers spend at least one month in a Provincial Rural Health Training Centre where they immunize children, examine pregnant women and offer family planning services in mother and child health clinics. They also treat in-patients and out-patients under the guidance of qualified Clinical officers and organise outreach services where they venture into remote rural villages, seeing patients and immunising children. During this time they complete a project in community diagnosis.
They also learn Health Service Management which prepares them for their management and leadership roles in health centers and other institutions.
Internship and registration[edit]
All clinical officers must work as full-time interns for one year without pay or any form of motivation at an approved public or mission hospital before getting a license to practice medicine, a situation that has resulted to major strikes by clinical officers in the past leading to operation standstills in public hospitals when these strikes occur. On passing the final qualifying examination, they take the hippocratic oath then apply for provisional registration by the Clinical Officers Council,[20] the statutory body that regulates the practice of clinical officers in the country. The internship involves supervised rotations in the major clinical departments namely casualty, medicine, paediatrics, surgery, obstetrics and gynecology. They are supervised by consultants in the respective fields. The consultants ensure that they can practice clinical medicine safely before signing them off for registration. An internship booklet signed by the consultants is required for registration. After registration one is required to apply for a license from the COC which allows them to practice medicine, surgery and dentistry legally in the country. This license is renewable every two years. Renewal requires evidence of having attained 60 Continuous Professional Development (CPD) points in the CPD diary by further training, research and publications, attending conferences and Continuing Medical Education (CME) sessions or major ward rounds and outreach activities.
An experienced clinical officer usually holds a senior clinical, administrative or teaching position within their organisation or establishes and manages his/her own private practice. One who holds the Diploma in Clinical Medicine and Surgery can upgrade his/her qualification to the BSc. Clinical Medicine and Surgery or undertake postgraduate training at the university. One may also enroll for the Higher Diploma programme at the Kenya Medical Training College.
The Higher Diploma in Clinical Medicine and Surgery requires at least three years of working experience and lasts twelve to eighteen months leading to a specialised qualification and re-designation as a specialised clinical officer in one of the medical specialties such as paediatrics, reproductive health, anaesthesia, ENT, ophthalmology and cataract surgery, orthopaedics, psychiatry/clinical psychology, skin and chest diseases, epidemiology, pathology and Community medicine. A specialised clinical officer provides advanced medical and surgical care including invasive procedures in their specialty such as caeserian section, cataract surgery, tonsillectomy, psychotherapy and administration of anaesthesia.
Medical care is generally provided by clinical officers who are even capable of providing surgical care. Clinical Officers are trained for 4 years, (3+1 year of clinical internship at designated teaching hospitals). One meta-analysis documented that the provision of caesarean section by clinical officers does not result in a significant increase in maternal or perinatal mortality. In other, words there was no difference whether the operation was done by clinical officers or medical doctor [29]
Southern Sudan separated from the Arab North (Sudan) in July 2011 after years of civil war that left much of the southern part in ruins. The healthcare system is almost non-existent. AMREF started training clinical officers by setting up the Maridi National Health Training Institute.[7]
The graduates supplement the efforts of COs trained in neighboring countries, e.g. Kenya, Uganda and Tanzania, most of who work for international humanitarian agencies.[citation needed]
In Tanzania, training is under the Ministry of Health. There are numerous clinical officer training schools and programs last three years. Internship is not required for registration.[6]
Experienced clinical officers may enrol for an advanced diploma in clinical medicine which takes two years to complete. This qualification is regarded as equivalent to a first degree in medicine by universities and the Ministry of Health in the country. The graduates are known as Assistant Medical Officers. A further two years training leads to a specialist qualification in anaesthesia, medicine, surgery and radiology etc.
Kampala International University has opened a campus in Dar es Salaam where it is now offering its Bachelor of Clinical Medicine and Community Health.
By 1918, Uganda was training clinical officers who were called medical assistants at the time. The training is under the Ministry of Education and takes place in clinical officer training schools.[30] Postsecondary programs last three years, focusing on medicine and hospice care, followed by a two-year internship.[6]
Kampala International University offers a Bachelor of Clinical Medicine and Community Health.[31] High school graduates take four-and-a-half years to complete this degree while practicing clinical officers take three years.
In Zambia, clinical officers who complete a two-year advanced diploma course are called medical licentiates. Medical licentiates have advanced skills in medicine and surgery and may be deployed interchangeably with physicians. Medical licentiates outnumber general physicians (with university degree) across all regions, with the ratio ranging from 3.8 COs per physician in Lusaka to 19.3 in the Northwestern provinces.[32] They perform routine surgical and obstetric operations as well as providing clinical care in hospitals. The College of Surgeons of East, Central and Southern Africa (COSECSA) is involved in their training to increase their surgical skills through the Clinical Officers Surgical Training (COST) programme.
Burkina Faso[edit]
In Burkina Faso, as elsewhere in sub-Saharan Africa, the use of non-physician clinicians began as a temporary measure while more doctors were trained, but has become a permanent strategy in the face of a crisis in health human resources. Different training alternatives have been used. Two-year advanced training programs in surgery were developed for registered nurses. Clinical officers (known as attachés de santé en chirurgie) were district medical officers trained with an additional six-month curriculum in emergency surgery.[33]
Many studies show that trained COs provide quality medical and surgical care with outcomes similar to physicians' providing similar care in the same setting. However, nurses re-trained to become COs have been associated with more adverse outcomes as shown in a study using 2004-2005 hospital data from six regions of Burkina Faso, which associated them with higher maternal and neonatal mortality when they performed caeserian sections.[33] The observed higher fatality rate pointed to a need for refresher courses and closer supervision of the nurses.
The first medical school in Ethiopia was initially a "health officer" training institution. The training of health officers started at Gonder University in 1954 due to the shortage of physicians.[8] Health officers hold bachelor's degrees and undergo a three-year training program plus one-year internship. Those who complete the master's degree provide advanced care (e.g. emergency surgery).[6]
In Ghana, Medical Assistants (MAs) have traditionally been experienced nurses who have undergone a one-year post-basic course to become MAs. High school graduates can now attend a three-year diploma course to become MAs.[34]
In Liberia, the Tubman National Institute of Medical Arts (TNIMA) was established in 1945. In 1965, the physician assistant (PA) programme was established as a joint venture between the Liberian government, WHO and UNICEF. Initially it was a one-year course, but currently it is a three-year diploma course accredited by the Liberia National Physician Assistant Association (LINPAA) and the Liberia Medical and Dental Association Board. In order to legally practice medicine as a PA one must sit and pass a state exam administered by the medical board.[35]
In Mozambique, tecnicos de cirurgia, or surgical technologists, are experienced Clinical Officers who undergo further residential training in surgery under the supervision of senior surgeons lasting two years at Maputo Central Hospital, and a one-year internship at a provincial hospital. They are trained to carry out emergency surgery, obstetrics and traumatology and are deployed to the district hospitals where they are usually the sole surgical care providers.[36]
South Africa[edit]
South Africa trains clinical associates for three years and awards them the Bachelor of Clinical Medical Practice degree. The first program was launched by the late Health Minister Tshabalala Msimang on 18 August 2008 at the Walter Sisulu University in Mthatha. The first class graduated in December 2010.[37] Programs also exist at the University of Pretoria and the University of the Witwatersrand.
The specialised nature of medical training in the developed world has created a shortage of general practitioners and runaway expenditure on healthcare by governments. primary care is increasingly being provided by non-physician providers such as physician assistants.
United States[edit]
Physician assistants in the United States train for at least two years at the postsecondary level and can hold an associate, bachelors or master's degree. Most PAs have earned a master's degree. Some institutions offer a Doctor of Science degree in the same. According to Money magazine, this is currently one of the best careers in the US.[38] The profession is represented by the American Academy of Physician Assistants.
United Kingdom[edit]
The United Kingdom has in recent years employed physician assistants from the United States on a trial basis as it plans to introduce this cadre into their health care system.[citation needed] Several UK universities are already offering a post-graduate diploma in Physician Assistant studies. The PAs of the UK are represented by the Association of UK PAs.
The University of Queensland offers a one-and-a-half-year Master of Physician Assistant Studies to those with a bachelor's degree. Those with a post-secondary healthcare qualification such as registered nurses and paramedics can access the programme via a Graduate Certificate in Physician Assistant Studies; as long as they have at least five years full-time working experience.[39] It has been announced that PAs will be allowed to work in Queensland as fully licensed practitioners in 2014.
China has about 880,000 Rural Doctors and 110,000 assistant doctors who provide primary care to rural populations where they are also known as barefoot doctors. They typically have about one year of training; those who sit and pass government examinations qualify to be rural doctors. Those who fail become community health workers. However, there is a government move to have all rural doctors complete three years training.[citation needed]
Africa and the rest of the world are perhaps following a well trode path. In 1879, a group of Indians arrived in Fiji by ship having survived cholera and smallpox en route. During a period of crew quarantine, a small group was trained in vaccination. The experience was considered so successful that a few years later, in 1885, a group of young Fijian men started a three-year training program at the Suva Medical School, now known as the Fiji School of Medicine.[40] The title given to the professional practice has had many names over the years, including Native Medical Practitioner, Assistant Medical Practitioner, Assistant Medical Officer, and Primary Care Practitioner (PCP). By 1987, the PCPs were training for three years before going back to their communities to serve one-year internship, followed by another two years of study after which they were awarded a MBBS degree.
Under British rule, India trained licenciate doctors for three years. They were then registered with the General Medical Council of Britain. Most of them worked among the rural population providing medical care.
After independence, and on the recommendation of the bhore committee in 1946, the training of licentiate doctors was stopped and their qualifications converted to MBBS degrees. They were then grandfathered into the Medical Council of India.
The plan was to train enough doctors who would serve the whole country. However, the plan has not borne fruit and doctors generally leave their rural posts after their internship for more lucrative and glamorous careers in the big cities.
As of 2009, the Indian government plans to introduce a three-and-a-half-year Bachelor of Rural Medicine and Surgery (BRMS) degree to train doctors who will work in remote Indian villages. On graduation they will undergo a one-year internship period at a regional hospital before being licensed. Those with five years' experience will qualify for post-graduate studies on equal standing with their MBBS counterparts.[41]
In India, the Madras Medical Mission in Chennai, collaborating with Birla Institute of Technology and Frontier Lifeline has since 1992 offered a bachelor of science degree in Physician Assistant studies. The program duration is four years, comprising three years classroom and laboratory coursework then one year compulsory internship. Several other universities offer similar courses in partnership with US universities. PAs in India can pursue masters and doctor of science degrees.[42][43][44]
|This section may need to be rewritten entirely to comply with Wikipedia's quality standards. (July 2015)
Mid-label Medical Care Health Human Resources of Bangladesh are Medical Assistant product of Medical Assistant Training School(MATS).3 year Medical Assistant Course Started 1976. See Also Medical Assistant
Bangladesh was part of British India until independence, and then spent a quarter of a century as East Pakistan before Bangladesh seceded and became an independent nation.
British India[edit]
Modern Bangladesh was mostly part of Bengal in British India.
In 1914 the State medical Faculty of Bengal was established to conduct trained licentiate of medical Faculty doctors(LMF Doctor) for four years Mid-Label Diploma Physician. They were then registered with the General Medical Council of Britain. Most of them worked among the rural population providing medical care. At independence East Pakistan had five medical schools 1. Mitford medical school,Dhaka(1875-1957) 2. Lytton Medical school, Mymensingh (1924-1962) 3. Chittagong Medical School (1927-1957) 4. Sylhet Medical School (1948-1962) 5.Rajshahi Medical School(1954-1958)
East Pakistan[edit]
After independence from Britain, the training of licentiate doctors was continued in East Pakistan and on the recommendation of the bhore committee in 1946, started MBBS Degree. They were then grandfathered into the Medical Council of India & Pakistan. In 1962 Health Minister Monem khan introduced Condensed MBBS Course for LMF Doctor at Sir Salimullah Medical College, Dhaka from 1963 to 1972.
After independence from Pakistan,the training of licentiate doctors(LMF Doctor) course was stopped. All Medical School Converted Medical College & Course Started MBBS. The First Five year plan[1973] of the Father of Nations sheik Mujibur Rahman Government planned to create new health cadre namely "Medical Assistant" & institution name "Medical Assistant Training School(MATS)". In 1976 started Medical Assistant training course under State Medical Faculty of Bangladesh & Ministry of health & family welfare. In 1980 1st Batch Medical Assistant student enter government service. In 1983 Medical Assistant get Bangladesh Medical & Dental Council Registration 1st time. In 1996 Medical Assistant Post of DGHS & DGFP Converted Sub-Assistant Community Medical Officer(SACMO) prime minister Sheike Hasina government, DGFP Implement it but DGHS no implement. In 2011 by the court order implement SACMO in DGHS Bangladesh.
From 2009 session Medical Assistant Course developed 4-year course(3 year Institution + 1 year Internee ship). Nowadays Medical Assistant Course conducted in 8 public institution & 146 private institution.
About 65% rural population receive primary medical treatment from Sub-Assistant medical officer(medical assistant). Medical Assistant no scope of Higher education & promotion. But Bongobondu sheike mujibur rahman government The First Five year plan[1973] page 520 & 521 brief details on Medical Assistant (After passing medical assistant course & 3 year service rural area in national service entering qualification of medical college for MBBS course).[45]
Now 8 Government Medical Assistant Training School.They are---- 1.Tangail Medical Assistant Training School(Tangail MATS) 2.Sirajgonj Medical Assistant Training School(Sirajgonj MATS) 3.Kustia Medical Assistant Training School(Kustia MATS) 4.Bagerhat Medical Assistant Training School(Bagerhat MATS) 5.Noakhali Medical Assistant Training School(Noakhali MATS) 6.Faridpur Medical Assistant Training School(Faridpur MATS) 7.Jhenaidah Medical Assistant Training School(Jhenaidah MATS) 8.Comilla Medical Assistant Training School(Comilla MATS)
Other hand 146 Private Medical Assistant Training School.They are----
Malaysia started training Medical Assistant in the early 1900s after independence from Britain. Also known as Assistant Medical Officers, they are trained for three and a half year in an undergraduate academic program recognized by the Malaysian Qualifications Agency in order to practice. They are mainly deployed in public hospitals, parastatal institutions (e.g. military, prisons), rural health centres, aged care centres, or private specialist hospitals.[46]
See also[edit]
- Allied health professions
- Healthcare in Kenya
- Paramedics
- Surgical technologists
- Clinical associates in South Africa
- Feldsher in countries of the former Soviet Union
- ^ http://www.mchsmau.ac.mw/?q=node/23
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- ^ http://www.mku.ac.ke/index.php/our-facilities/118-programmes/628-master-of-clinical-medicine
- ^ http://www.ox.ac.uk/admissions/graduate/courses/dphil-clinical-medicine
- ^ a b c d Mullan F, Frehywot S. Non-physician clinicians in 47 sub-Saharan African countries. Lancet; 2007, 370: 2158–63.
- ^ a b AMREF. Clinical Officers. Accessed 6 April 2011.
- ^ a b Kruk ME et al. Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey. PLoS Medicine; 2010 http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000242
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- ^ a b University of Birmingham. Major analysis shows value of non-physician clinicians for maternal health in sub-Saharan Africa. Posted on 20 May 2011.
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- ^ Jomo Kenyatta University of Agriculture and Technology, Kenya
- ^ Kenya Methodist University,
- ^ Mt. Kenya University,
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- ^ "A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies". BMJ. 342: d2600. doi:10.1136/bmj.d2600.
- ^ Health Training Institutions in Uganda Information Portal. Accessed 6 April 2011.
- ^ Kampala International University, Uganda
- ^ Ferrinho P et al. "The human resource for health situation in Zambia: deficit and maldistribution." Human Resources for Health 2011, 9:30 (19 December 2011)
- ^ a b Hounton SH; et al. "A cost-effectiveness study of caesarean-section deliveries by clinical officers, general practitioners and obstetricians in Burkina Faso". Human Resources for Health. 2009 (7): 34. doi:10.1186/1478-4491-7-34.
- ^ Narhbita College. The Medical Assistant Course.
- ^ Tubman National Institute of Medical Arts, Liberia
- ^ Cumbi A; et al. (2007). "Major surgery delegation to mid-level health practitioners in Mozambique: health professionals' perceptions". Hum Resour Health. 5: 27. doi:10.1186/1478-4491-5-27. PMC 2235883. PMID 18062808.
- ^ Walter Sisulu University. First South African Clinical Associates take their pledge at WSU.
- ^ CNNMoney.com. Best Jobs in America: #2. Physician Assistant
- ^ University of Queensland, Australia
- ^ Fiji School of Medicine. History. Accessed 6 April 2011.
- ^ "Account Suspended". Retrieved 13 July 2016.
- ^ "BITS Pilani Has Collaborations With Top Healthcare Institutions in India Today". Retrieved 13 July 2016.
- ^ "Page Not Found". Retrieved 13 July 2016.
- ^ "Welcome to Indian Association of Physician Assistants". Retrieved 13 July 2016.
- ^ "নীড় পাতা". Retrieved 13 July 2016.
- ^ Management and Science University, Malaysia
External links[edit]
- Presbyterian university of East Africa]
- Kenya Medical Training College - Clinical Medicine Department
- Kilimanjaro Christian Medical College- Tanzania
- Egerton University (Kenya) - Diploma in Clinical Medicine and Surgery
- Kenya Methodist University - Department of Clinical Medicine
- Mt. Kenya University
- Malawi College of Health Sciences
- Maridi National Health Training Institute- Maridi
- Indian Association of Physician Assistants
- The Clinical Officers Council


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Go "inside" Broadway with us. We want to invite you into our world, show you its cast of characters and have you feel the drama (and sometimes comedy) that unfolds right here on Broadway. We are professional actors and singers with New York City tour guide licenses. Don't be surprised if we belt out a tune on the tour.
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Hazen Star News
'Not in my backyard'
Rezoning, permit approved for anhydrous tank By April Baumgarten Farmers may be in trouble next year if Hazen doesn't approve plans for an anhydrous tank near Riverside Park, officials said. But residents echoed one phrase last week at City Hall: Not in my backyard. "I find it very disrespectful that anyone would even consider building a plant of hazardous material in my backyard, in somebody's backyard," Mel Gutknecht said. "I have a lot of friends that are farmers and I am not in opposition (of the center). I am in opposition of the location." More than 50 residents attended the Hazen Planning and Zoning meeting Oct. 16. Proponents and opponents spoke for two hours on Enerbase Agronomy's requests to build an agronomy center. The board voted 3-2 to change nine acres of land east of the Hazen Elevator from agricultural to industrial. "We have a tendency to want to have a perfect world," board member Clayton Hoffman said. "We look at what the ag community has done for this area. The elevator is gone. We need to support this community of farmers in the best way possible."
Posted 10/21/13 (Mon) read more »
Water board continues work on Lake Shore
After surveying the land that holds Lake Shore Estates, the Mercer County Water Resource Board has determined water flows into the development.
Posted 10/16/13 (Wed) read more »
County approves final budget
Mercer County employees are set to get a 10 percent increase By April Baumgarten The County Commission unanimously approved the 2014 budget, giving department heads the option to give workers up to a 10 percent increase.
Posted 10/09/13 (Wed) read more »
Knife River Indian Villages closed
Shutdown impacts local entities By April Baumgarten Once again the Knife River Indian Villages is empty, but it's not because its residents left freely or tried to avoid an epidemic.
Posted 10/09/13 (Wed) read more »
Little town talent, big time success
Tigirlily hits 1.1 million views on YouTube
Posted 10/07/13 (Mon) read more »
From Dubai to Hazen
Joy Dental Design welcomes Maveli
Posted 10/02/13 (Wed) read more »
Stanton council looks at four-wheeler state law
City plans to annex 45 acres east of tracks
Posted 10/02/13 (Wed) read more »
No-use policy fails after second reading
By Chris Erickson After months of discussions and rewrites, a contentious policy will have to go back to the drawing board after a motion for its approval failed last week. The Mercer County Commission voted 2-2 on the no-use policy after Commissioner Gary Murray and Commission Chairman Frank Bitterman had motioned to adopt it during last Wednesday's meeting. Commisioners Duane Scheurer and Wayne Entze voted against adopting the policy. Commissioner Bill Tveit was not present.
Posted 9/25/13 (Wed) read more »
City mulls water, sewer policy
The Hazen City Commission is one step closer to deciding whether it should allow residents to hookup to outside water sources. Commissioners discussed a policy Monday during a meeting at Hazen City Hall that could require residents who wish to connect to rural water pay a fee to the city. The government would also be able to assess costs for projects even if the landowner does not connect to city water.
Posted 9/25/13 (Wed) read more »
Water board finds maps for Lake Shore
Mercer County Water Resource board members have obtained maps that could help prevent flooding at Lake Shore Estates. But the development is still in deep waters. "The key to draining is showing the natural flow of a drain," said Greg Lange, board secretary and treasurer, adding the board will have to show how much drains.
Posted 9/19/13 (Thu) read more »


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He got his start in the group Soofy & the Walrus. But now, Ryan Howell is a solo act known as Michigan Jackson. Link to his Facebook page here.
Music Monday: Michigan Jackson
Posted: 8:24 AM EDT Apr 21, 2014 Updated: 11:03 AM EDT Apr 24, 2014
Copyright 2014 WFMZ. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
The views expressed are not those of this company or its affiliated companies. Please note by clicking on "Post" you acknowledge that you have read and agree to the TERMS OF USE and the comment you are posting is in compliance with such terms. Your comments may be used on air. Please be polite. Inappropriate posts and those containing links to other sites may be removed by the moderator. Desktop and mobile versions of this site use independent comment threads.


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All hotels in Tarbes, France
1 room, 2 adults
Route de Lourdes, ZI de Bastillac, Tarbes, Hautes-Pyrenees, 65000, France, 1-877-214-4288
Campanile Tarbes Bastillac - Tarbes
Lowest price$45
Campanile Tarbes Bastillac offers 3-star Tarbes hotel accommodations 1.8 mi (3 km) from Stade Maurice Trelut and 2.1 mi (3.4 km) from Nouveautes Theater. Jardin Massey and Golf de Tumulus Tarbes are also within 3 mi (5 km).
This hotel has its own restaurant serving breakfast, lunch and dinner where you'll find a selection of items to try. Free WiFi is available.
This hotel has its own restaurant serving breakfast, lunch and dinner where you'll find a selection of items to try. Free WiFi is available.
See all 47 Venere.com reviews
Great location
Tasty breakfast
Vibe is not too good
TripAdvisor Traveller Rating: 3
From 128 reviews
Campanile Tarbes Bastillac - Tarbes
Hotel Info: 1-877-214-4288from $45
- Triple Room with double bed & extra bed
- Twin Room
- Triple Room with 3 single beds
- Double Room
Also popular with travelers from the USA
At a glance
Key facts
Hotel size
- This hotel has 54 rooms
- This hotel is arranged over 2 floors
- 24-hour check-in
- Check-out time is noon
Reception is available until 11 PM. Guests who require after-hours check-in must make arrangement in advance using the telephone number provided on the confirmation notice.
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
Travelling with others
- Up to 2 children (10 years old and younger) stay free when occupying the parent or guardian's room, using existing bedding
- No cribs (infant beds)
- Pets allowed *
- Up to 10 kg
- Free WiFi in public areas
- Free WiFi in rooms
- Free self parking
Other information
- Smoke-free property
- Resort fee included
In the hotel
Food and drink
- Buffet breakfast daily (surcharge)
- Restaurant
- Coffee shop/café
Things to do
- Golfing nearby
Working away
- Conference space size (feet) - 581
- Conference space size (meters) - 54
- One meeting room
- Front desk (limited hours)
- Free newspapers in lobby
- Multilingual staff
- Number of buildings/towers - 2
- Year Built 1990
- Garden
- Terrace
- Television in common areas
- Accessible bathroom
- In-room accessibility
In the room
Home comforts
- Air conditioning
- Coffee/tea maker
Sleep well
- Premium bedding
Freshen up
- Private bathroom
- Bathtub only
- Free toiletries
- Hair dryer (on request)
Be entertained
- Digital TV channels
Stay connected
- Desk
- Free WiFi
- Phone
- Daily housekeeping
- Access via exterior corridors
Special features
DiningLe Restaurant - This restaurant specializes in French cuisine and serves breakfast, lunch, and dinner. A children's menu is available.
Campanile Tarbes Bastillac - Tarbes's small print
Also known as
- Campanile Tarbes Bastillac Hotel
- Campanile Bastillac Hotel Tarbes
- Campanile Tarbes Bastillac
Mandatory fees
You'll be asked to pay the following charges at check in or check out:
- A tax is imposed by the city: EUR 0.80 per person, per night
- Tourism fee: EUR 0.80 per person, per night
The charges below are included in the total price displayed:
- Resort fee
Optional extras
Buffet breakfast is offered for an extra charge of EUR 9.90 for adults and EUR 4.95 for children (approximately)
Pets are allowed for an extra charge of EUR 5.00 per pet, per night
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.


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Click here to learn more about the municipality of Greenstone, including the community of Longlac.
To ensure authentic Catholic education to all through a commitment to gospel values, active partnerships and the celebration of excellence.
Contact InformationOur Lady of Fatima
113 Indian Road P.O. Box 670Longlac, ONP0T 2A0 Phone: (807) 876-2213Fax: (807) 876-2902
Additional InformationMonthly Newsletters and calendarsFacebook PageBias-Free Progressive Discipline & Bullying Prevention and Intervention PolicySubscribe
To ensure authentic Catholic education for all with a commitment to gospel values in a culture of leading and learning through: inquiry, illumination, inclusion, inspiration, and integrity.
Busing of students is provided by the East of Thunder Bay Transportation Consortium. Click here for up to date route information: http://etbtc.on.ca
We are thrilled to announce Destination: Renewal, our multi-year strategic plan. The plan is about system renewal, and more importantly, student achievement and well-being ... read more


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California Series - Books Two - Four
Promises, Promise; James; A Quickstep to RomancePromises, Promises - They met at a wild party and neither forgot the experience. Each came away with completely different perceptions of what happened when Judith Reid, an ill at ease seventeen-year-old college student, captured Dev McAllister's attention and he succeeded in breaking through her icy demeanor. The minute things heated up, she ran. He chased and tried everything he could think of
Christmas Wishes Lead to Valentine Kisses
California Series (Book 5)War is hell, especially for those left behind. When an IED explosion devastates the lives of Roberto 'Cam' Camareno and Nicole Murphy, both believe their promise of tomorrow has been shattered. Field medic Cam helplessly watches his fatally wounded friend die in his arms, wishing he could take his place. Cam is the one who should have died, not his friend with a fiancée waiting back home. Instead
(Formerly Dancing with an Angel)
California Series (Book 4)Kyle Davidson is flirty, fun, and sexy. Can he lead Mary Ann Murphy astray, even though she has become overly picky about dating since her break-up with the person she thought was the one? Mary Ann has no intentions of making the same mistake again, especially when the man in question is one of her mother's set-ups. To return a favor to a wily matchmaker, Kyle unwittingly agrees to be Mary Ann's
Paul Farmer Speaks to the Next Generation
California Series in Public Anthropology (Book 29)Here, for the first time, is a collection of short speeches by the charismatic doctor and social activist Paul Farmer. One of the most passionate and influential voices for global health equity and social justice, Farmer encourages young people to tackle the greatest challenges of our times. Engaging, often humorous, and always inspiring, these speeches bring to light the brilliance and force of
Migrant Farmworkers in the United States
California Series in Public Anthropology (Book 27)Fresh Fruit, Broken Bodies provides an intimate examination of the everyday lives and suffering of Mexican migrants in our contemporary food system. An anthropologist and MD in the mold of Paul Farmer and Didier Fassin, Holmes shows how market forces, anti-immigrant sentiment, and racism undermine health and health care. Holmes's material is visceral and powerful. He trekked with his companions
California Series in Public Anthropology (Book 23)For nearly thirty years, anthropologist and physician Paul Farmer has traveled to some of the most impoverished places on earth to bring comfort and the best possible medical care to the poorest of the poor. Driven by his stated intent to "make human rights substantial," Farmer has treated patients—and worked to address the root causes of their disease—in Haiti, Boston, Peru, Rwanda, and elsewhere
California Series in Public Anthropology (Book 26)Bringing together the experience, perspective and expertise of Paul Farmer, Jim Yong Kim, and Arthur Kleinman, Reimagining Global Health provides an original, compelling introduction to the field of global health. Drawn from a Harvard course developed by their student Matthew Basilico, this work provides an accessible and engaging framework for the study of global health. Insisting on an approach


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Lakewood Lions Renaissance Faire
The Lakewood Lions Club
Multiple Dates
Event Details
The Renaissance Faire will take you back in time to the 16th century where nobility, chivalry and romance abound. Enter the world where Knights in full combat armor joust on their "War Horses". Witness Knights fighting in hand to hand combat. Have your young ones learn the art of sword fighting and seek the Black Knight.
Find yourself in a country village amongst the many artisans, strolling musicians, storytellers, jugglers, magicians, and wizards. Sit back and enjoy the belly dancers, tribal and gypsy dancers. See archers using the English long bow.
Revel in the scents and smells of the foods. Feast like royalty on juicy roasted turkey legs, fish 'n chips, steak-on-a-stick, dragon dogs, cheese steaks or funnel cakes.
Be witness to the crowning of the Faire's King and Queen chosen from children ages 10 and under dressed in period garb.
Visit www.lakewoodrenfair.com for more information.
Pine Park
500 Country Club Dr
Lakewood Township,
Multiple Dates
Add to my calendar
The Lakewood Lions Club
The Lakewood Lions Club is a men and women's volunteer service organiztion. It's dedicated to helping those with vision and hearing impairments as well as local and national charities. Visit our website for more detail information www.lakewoodrenfair.com


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53 Nanny Jobs Found
Part time nanny to care for infant
Posted by Jenny S. on 10/20/2016
- 24 miles away (Portland, OR)
- $11/hr
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We are looking for a loving, energetic person to come nanny for us 2 days a week. This would be in home care for our 7 months old daughter. Daily responsibilities would be playing, feeding, putting her down for naps and going to the park when nice outside. Additional duties would be cleaning up... More
morning routine help
Posted by Mica G. on 10/18/2016
- 19 miles away (Tigard, OR)
- $13/hr
- 2 children
Need a dependable person to get my girls off to school with a great start. Job includes 2hours of care Tues-Friday during regular school days. I leave for work at 6 a.m. The girls wake up at 7 and on the bus near our house at 8:05. You will have 1 hour to hang out before they wake up. They can do... More
Post Pre-School Care
Posted by Keely M. on 10/18/2016
- 17 miles away (Portland, OR)
- $10–15/hr
- 2 children
We are looking for a part time nanny to start ASAP. You would be picking our youngest up from pre-school at 12:30, then our older son at 2:30pm from Kindergarten (same school) and caring for them until mom or dad arrive home from work (between 5:30 – 6:00 PM). Tasks include making their dinner, and... More
Infant care in Foster-Powell
Posted by Ekatrina S. on 10/19/2016
- 17 miles away (Portland, OR)
- $9–10/hr
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We have a newborn we are looking for in home care or a nanny share situation starting in November. Our child will be 2 months old at that point. For the last half of November we'll need someone Sundays (11-5) only. In December we'll need someone Sundays and Wednesdays (9-6). Beginning in January... More
After school nanny
Posted by Suzie M. on 10/17/2016
- 23 miles away (Portland, OR)
- $12/hr
- 3 children
I am looking for someone to pick up our children from school a couple days a week and drive them home. (Twin 11 year old daughters and 6 year old son.) Our dog will need to be let out and walked or played with for a bit also. The kids can help with this. When they get home, the kids like to have... More
Nanny for big family in Gresham
Posted by Christine H. on 10/18/2016
- 16 miles away (Gresham, OR)
- $14–20/hr
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We are a blended family of Birth, Adopted and Foster children. Our girls are 6-9 and love crafts, coloring, swimming, cooking. Our boys are 6 and 10-15. They like to play video games, build Lego's, swim, roller skate and draw. 5 of our kids go to swimming 2x a week and they all like to roller skate... More
Nanny Needed
Posted by Rachel W. on 10/16/2016
- 19 miles away (Portland, OR)
- $14/hr
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We are looking for a loving, energetic person to come nanny for us 3 days a week. My kids are 15 months, 3.5 and 6 years old. We Would like you to do preschool geared activities with the kids and pick up my oldest off the bus after school. My kids love books, art, music and playing outside. if you... More
Two Cuties need child care
Posted by Alyssa B. on 10/16/2016
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- $40/hr
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I am looking for someone with nanny experience to come in one day a week, Thursday, to watch my kiddies while I'm at work and my husband is at school. They're well behaved and kind. My daughter is homeschooled so there would be some worksheets I'd love if she did that day. Sitter would need to... More
Watch 10 month old twins
Posted by Duane N. on 10/15/2016
- 21 miles away (Portland, OR)
- $15–25/hr
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10 month old twins need care starting Sunday 16 oct for 5 hours. Boy and girl twins are crawling. Need formula and diaper changes. Experience with multiples extremely helpful. Regular sitting opportunities are available going forward.thanks. We live in the NW near Japanese Garden. Please... More
Live in Nanny
Posted by Melinda S. on 10/13/2016
- 17 miles away (Gresham, OR)
- $15/hr
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I work 12 hour night shifts and go to school. My husband will be away for the weekend and I need someone to watch my kids while I go to school this Friday from 9-1 pm and 3-6 pm and also when i go to work from 6 pm to 7 am in the morning on Friday and Saturday, which becomes Sunday when I get home.... More
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Posted by Stephanie K. on 10/12/2016
- 14 miles away (Wilsonville, OR)
- $10–13/hr
- 1 child
Looking For Someone Who Can Be Interactive, Engaging, And Fun! Need after school care for our first-grade son. Looking for a firm commitment for 2016-2017 school year. Spanish speaker is a bonus. Monday-Friday 2-5:30 PM A typical day would involve: ⁃ Walking son home from school ⁃ Snack... More
Part Time Nanny Needed
Posted by Carolyn K. on 10/12/2016
- 16 miles away (Portland, OR)
- $13/hr
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Looking for part-time nanny for 1 day a week (Wednesdays) during School Year. Will also need coverage Winter Break (M, W & F) and some holidays. During Wednesdays, hours would be 8am-10am and 3:15pm-6:15pm and will need to drive children to & from school. Children are ages 12, 10 and 7, also have... More
Twin care,house keeping (food preparation]
Posted by Phiona V. on 10/13/2016
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Hi Mother of two new born twins looking for help with them and some light house keeping,meal preparation from 7am to 2.30pm Monday to Thursday or tuesday to Friday . Plz have yr own transportation,have experience with multiples,be open to food preparation , we want an addition to the... More
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Posted by Catalina A. on 10/11/2016
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I need someone that is able to be in my home from when I leave around 620 am until 830am. My son needs to be woken up at 730, given breakfast and walked to the bus stop by 830am!
Part time nanny for one to three children...
Posted by Gina C. on 10/12/2016
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We're looking for someone who is fun, outgoing, active and loving to help us care for our kids. We are a family of 2 bio children, Clara age 4 and Eli age 7, and also do foster care for one child at a time under four years old. Currently we do not have a foster placement because our last child... More


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- The Stenian (from Greek stenos, "narrow") is the final geologic period in the ... Instead of being based on stratigraphy, these dates are defined chronometrically.
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- 0.55–0.8 Ga), Tonian–Stenian.
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- Stenian - Wikipedia, the free encyclopedia
- The Stenian (from Greek stenos, "narrow") is the final geologic period in the Mesoproterozoic Era and lasted from 1200 Mya to 1000 Mya (million years ago).
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- Palaeos Proterozoic: The Stenian Period
- Most of the important events we mentioned in the Mesoproterozoic actually occurred in the Stenian, the last Period of the Mesoproterozoic Era. These include ...
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- Stenian (1.2–1.0 Ga) - Plant Evolution & Paleobotany - Sites - Google
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- Feb 24, 2013 Artist: The Ocean Title: Stenian Album: Precambrian (Proterozoic) Year: 2007 no copyright infringement intended.
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- A brief description explaining many facts about the Stenian period.
- www.dinosaurfact.net
Stenian is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, Stenian books and related discussion.
Suggested Pdf Resources
Suggested News Resources
Suggested Web Resources
Great care has been taken to prepare the information on this page. Elements of the content come from factual and lexical knowledge databases, realmagick.com library and third-party sources. We appreciate your suggestions and comments on further improvements of the site.
Stenian Topics
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The Answer Center is your place to ask fellow eBay Community members questions about buying and selling on eBay, and for you to share your best information, tips, and insights to help other members get answers to their own questions.
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i bought item from ebay but my purchase History said your payment is being processed through paypal after i check with my paypal it's says payment is completed. several time i conntact with seller but still seller not responding me i dont know why... i cant contact with ebay also... how can i solve the my problem ??
plz help me for this..


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Chosen Valley High School Alumni
Chosen Valley Alumni Photos
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Click on the Yearbooks below to view a copy Online at Classmates.com®. If you don't see your class's yearbook, check out our yearbook page.
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- James Wilhelm
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- Class of 2002 Stephanie Jergenson
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- Class of 1956 Donald Mundell
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Even if alumni from Chosen Valley High School have moved away from Chatfield, Minnesota, they can use this site to find and contact high school friends. For former Chosen Valley HS students from MN, you can view the class reunion information that has been posted by other site visitors. In addition, we encourage you to post your profile in the alumni directory, share information about the school activities you were involved with and reconnect with Chosen Valley High School alumni. If you haven't already, we also encourage you to register for free on this site. You may also want to check out the latest news and school memories.
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People heavily overrate the MP40. Was it an awesome gun? Yes. It wasn't like it was the only viable gun in that game though. I personally perform better with quite a few other guns.People act like it was the only usable weapon in that game which is very wrong.
MP40 - WaW.
You are not allowed to request a sticky.


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After being beaten down more than a third....the last trade for 2657 shares was for $16.70...the same as the closing price. I bet the shorts will be bailing out tomorrow as fast as they piled on tonight.
That was a trade made during regular hours that was posted in the after hours. This is a common occurrence with all stocks. If you trade the after hours regularly, you'll see this happen over and over again.
Strange, but I like it!


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Reviewed By Glenn K (Athens, NY) Reviewed for a 2015 Ford F-350 —10/15/2016 1:29 PM
Fit well and built well. Easy to put on and took about 1hr by myself. Installed on brand new truck to save light colored seats from hunting season.
Reviewed By Patrick P (Atoka, TN) Reviewed for a 2015 Ford Expedition —9/30/2016 6:04 PM
These are very nice seat covers for my Expedition. Just got the second row to protect the seats from the kids. Fit is very good, nice and tight and look very nice. Wasn't too terribly difficult to put on. Covers were very nice but the extra pieces on them used for pulling through seats and connecting with the velcro were sewed on fairly cheaply with some bad stitching. Still would buy again though.


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Do K&N induction kits work on C20XE engines?
Do any induction kits work??
If so what ones are best??
Do K&N induction kits work on C20XE engines?
Do any induction kits work??
If so what ones are best??
They will work but you MAY need to do the breather modification as shown in this Forum under the technical section - Breather Mod for 20XE engine
If you are going to fit one then make up some ducting to let more air into the filter. A perfect example is Sho_offs new Cav GSi -
The Cav-Turbo Resource:
Click Me
Hehe.. cheers Richie, I don't know what to say. Wayne certainly did a fine job with the 57i. You have to remember that my car is also running Piper fast road cams so you would expect it to be more lumpy than badly made gravy. However, partly thanks to a superchip and that excellent breather mod everything is very very good. The kit itself sounds awesome and due to the removed heat protection under the bonnet it really does roar or more to the point... thwarrrrrrp!
Get one, copy this breather mod (running from directly behind the front grill) and reap the benefits.
Else fit a panel filter and have a smoother responsive drive with the option to later drill your airbox and replicate the induction howl.
Although you may want to experiment with how close the end of the ducting it to the filter, as if it is too close there is the risk of the air flowing too fast over the surface of the filter causing air to be drawn away from it instead of to it. Sounds strange I know, but it is true.
K&N advise the pipe be at least 4 inches away from the filter for that reason.
Shhh.... that is 4 inches (well that's what i told Miss SHO_off!!)


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The Pacific Northwest—unlike, say, Lebanon—is not particularly known for its brushes with the world's great armies. Thus, you might be tempted at first blush to think of local author Kurt R. Nelson's Fighting for Paradise: A Military History of the Pacific Northwest (Westholme Publishing, 308 pages, $35) as a catalog of historical sidebars, a molehill mountain for local enthusiasts.
But there is much here that's often overlooked, even by your average Portland native, well-schooled by the Oregon Trail computer game. Nelson ably narrates, for example, the time we almost went to war with Great Britain on account of the heartless murder of a farmer's errant pig on the San Juan Islands. Likewise, the Japanese submarines and naval shelling off our coast—as well as their military's charming habit of sending bombs down the jetstream via hot-air balloon—aren't often commented on, even though they were the only attacks by a foreign nation on U.S. soil since the War of 1812. Most likely, this is because pretty much all of Japan's efforts in that regard were sorry, awkward failures.
The meat of Nelson's book, however, is devoted not to transoceanic intrigue but to the very local and very personal disputes among Oregon settlers, various Native American tribes and the U.S. Army between about 1840 and 1870. This is where the whole thing gets interesting.
Even though the temptation is understandable, Nelson doesn't idealize two sides in an epic struggle: evil U.S. versus peaceful tribes, aggressor versus victim, big bad bully versus you in the third grade. Instead, he leaves out much of the editorial, and seeks to humanize the history by showing the long chain of small disputes, misunderstandings and treacheries on all sides that led to the Northwest's share in one of our country's greatest tragedies—the near-depeopling of a continent.
In fact, the picture painted by Nelson is dishearteningly familiar to watchers of recent news reports from Iraq (right down to the occasional belated rebuke from the New York Times ). The history of the Oregon country involves no small amount of good intentions and peaceable instincts on the part of the settlers and army that were overridden, more than anything, by the absolute chaos and greed and nervousness of individual people—miners, militia volunteers, panicky settlers, politicking governors, tribal sell-outs, betrayed chiefs—and by the common inability of settlers to see the native tribes as anything but some threatening Other.
When you look at it this way, the literal decimation of the Native American people seems less like an inhuman, unrepeatable atrocity and more like a series of mistakes, betrayals, misunderstandings and outright criminal acts that seem eminently human and very possible even today. In fact, we're probably doing it again right now. .
Fighting for Paradise: A Military History of the Pacific Northwest


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Temptalia Asks You
October 22, 2013
Weekly Feature
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Alumni Services
Do you need help with your resume, need interviewing tips or have general questions? One of our Career Development Specialists is happy to help. You can obtain assistance by calling (330) 966-5459.
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Student allegedly smokes pot in dorm
MANSFIELD – Mansfield University student Adam L. Welch, 18, of 305 Dewald Lane, Hughesville, is accused by university police of possessing a controlled substance and drug paraphernalia.
The charges were filed after police were dispatched for an odor of marijuana in a hallway of Hickory Hall on Dec. 12. According to documents filed at District Judge James Carlson's office, another student was exiting Room 450 when police arrived, and that student told police Welch and another student were smoking pot in the room.
Welch invited police into the room when they knocked and allegedly admitted to smoking pot and then turned over a copper colored marijuana grinder with about 0.1 gram of the drug, as well as a homemade bong made from two plastic bottles and a socket wrench.
He was issued a summons for a Feb. 6 preliminary hearing.


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About Me
I've been spinning for nearly 30 years and my passion – teaching spinning, weaving and supplying 'woolly' things is my fast becoming a full-time job. I like my life to be filled with good things and appreciate quality – in crafts this is even more important as it's where one spends quality time – so give me the finest fibres (from Jacob to cashmere), best wheels – best of everything please.
My forte is long draw spinning and I'm a woman with a mission to teach it.
It's fun, fast, very satisfying. Projects get finished in timescales to suit today's busy lifestyle. Spinning arm lengths of yarn at a time is not only very productive, it's extremely relaxing too. There is always a place that is peaceful – at my wheel – or at my knitting.
I'm a discerning person; do my best and like the best. I don't charge silly money but instead aim to be accessible and offer the very best tuition, products and services I can. You will find I am generous with my time and pupils receive valuable discounts on new products and help with trade-ups. But what other people say about me, says more than anything I can say…..
….For example:
Wow, I was impressed by what was happening at Loddington this morning, lots of wonderful creativity going on, I think you have a great set-up there!
I'm so glad I was able to grab an hour to see how it all works, and College commitments allowing, I hope to call in again.
Thanks Pam. I had a wonderful day. I live in quite an isolated place and sometimes get very lonely so to be able to come and be amongst a group of women who enjoy doing what I do and are all so lovely and friendly is food for my soul. I can't tell you how pleased I am that I found you and your lovely ladies and every opportunity I get I shall be there!
Colour in spinning
Colour in Spinning and weaving was the theme for Wednesday's Summer School this year. I love colour. If I'm feeling a bit low I turn to my dye box - its far healthier than popping [...]
Jenny raises >£500 for Cancer Research
Jenny raises > £500 for Cancer Research when she completed a 26 mile overnight walk recently. I'm very proud of her. My grandsons Nathan - who lives in London, and Ben - at uni in [...]
Gotland pullover – pupil news
Gotland pullover - pupil news from Jane who completed this cosy pullover for her husband. Jane learned to weave this time last year and subsequently learned to spin - so she has not been spinning [...]
Beginner spinner news:
This is a BIG THANK YOU to you all at Summer School! Val and I found these beautiful feathers in one of my fields = inspiration! We acquired a Jacob fleece at the Summer School [...]


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Hockey Great Reg Fleming was the first hockey player known to have CTE. This discovery was announced in December 2009, six months after Fleming's death.
Here is an explainer about CTE -- the progressive brain disease that is at the center of a debate between retired athletes and multiple sports leagues.


text: Marley and LennonThese two cuties came to us at around 5 weeks old having been rescued from a commercial turkey farm. They were both painfully debeaked as babies and were understandably skittish of humans upon arrival at the sanctuary. They soon learned, though, that they are safe here. Marley and Lennon like to snuggle up together in the sun on the soft green grass–something they'd never have been allowed in their short life at the factory. Here they will be given every chance to live long and happy life.2016 UPDATEDespite the love and care that we gave while he was here, Lennon passed away suddenly from a heart attack in late 2015. Turkeys are have been so selectively bred and genetically manipulated over the years that their internal organs have a hard time supporting their large size. All of our animals are on special diets and we give them the utmost care to have the best lives while here at the sanctuary. Lennon will be sorely missed and forever in our hearts.Marley has become quite close with her fellow female turkeys Beatrice, Jean, and Loren.


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realmagick.com The shrine of knowledge.
The Worlds Most Northern
A selection of articles related to the worlds most northern.
Original articles from our library related to the The Worlds Most Northern. See Table of Contents for further available material (downloadable resources) on The Worlds Most Northern.
- The Aeonic Perspective of the Enochian Temples
- The initiatory system of the Enochian Temples divides the path of initiation into four major stages, distinguished primarily by the types and sources of the influences they are sensitive to. Briefly, these stages are: 1. Lunar-planetary, focused in Yesod and...
Magick >> Enochian
- Bringing it Down to Earth: A Fractal Approach
- 'Clouds are not spheres, mountains are not cones, coastlines are not circles, and bark is not smooth, nor does lightning travel in a straight line.' B. Mandelbrot W e want to think about the future - it's our nature. Unlike other creatures, humans possess an...
Mystic Sciences >> Astrology
- What is hypnotic trance? Does it provide unusual physical or mental capacities?
- 2.1 'Trance;' descriptive or misleading? Most of the classical notions of hypnosis have long held that hypnosis was special in some way from other types of interpersonal communication and that an induction (preparatory process considered by some to be...
Parapsychology >> Hypnosis
- Mother Of The Gods And The Father Of The Gael
- There is no surviving, or as yet translated, Creation story within Irish mythology. We learn from the Lebor Gabala Erenn, a text from the Christian Middle Ages, of the Tuatha De Danann, or "People of the Goddess Danu", who came to Ireland either...
Deities & Heros >> Celtic, Welsh, Irish & Brittish
- The Celtic Vedic Connection, Part I
- Of all the great ancient cultures perhaps no two share more parallels than those of the Celtic and Vedic peoples. A deep rooted affinity runs between them, what is present in one is mirrored in the other. Myths, Gods, Goddesses, even fairy tales bear a...
Religions >> Druidism
The Worlds Most Northern is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, The Worlds Most Northern books and related discussion.
Suggested News Resources
- Harland & Wolff Headquarters set to become 'world's most authentic Titanic
- Kerrie Sweeney, Chief Executive of Titanic Foundation, said: "The Harland & Wolff Drawing Offices are one of Northern Ireland's most significant and important historical buildings.
- How George Martin Changed the World
- He let them play their own instruments and keep their working-class Northern accents. No other producer in the business would have been insane enough to just put the Beatles in front of their amps ... The Beatles called him "Mr.
- Nuechterlein: The world doesn't wait while America elects a president
- Our press and television, preoccupied with domestic politics this year, provide only limited reporting on dangerous situations around the world — among them Syria, Ukraine, Yemen and Libya.
- Peter Falconio case: parole plan raises hopes British backpacker's body will
- "The phrase that captures the notion is 'No body no parole'." A similar law has been in place in South Australia since July last year and last week police revealed they would seek to use it with one of the state's most notorious killers.
Great care has been taken to prepare the information on this page. Elements of the content come from factual and lexical knowledge databases, realmagick.com library and third-party sources. We appreciate your suggestions and comments on further improvements of the site.
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