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Let's face it. Two Worlds sucked. So it's safe to say that we were skeptical when checking out Two Worlds II at PAX this year. The concept was always solid, but TopWare, Reality Pump and SouthPeak had yet to deliver the single player and multiplayer RPG experience that once looked so promising.
Nobody was more aware of the fact that the original Two Worlds sucked more than SouthPeak themselves. In fact, you may have seen this series of videos in which they make fun of how bad the game was. Behold, Sordahon's Journey.
I'm willing to give any developer that is able to make fun of themselves for their own shortcomings a second chance, so it was with reckless abandon that I demanded answers about Two Worlds II, and why it shalt not sucketh!!
The first thing I asked when speaking with them at PAX? "Give me five reasons why Two Worlds II won't suck!" Well, low and behold . . . they did.
Reason #1 – A brand new game engine specifically designed for multi-platform gameplay.
There are no ports. There was simultaneous development for all three major gaming platforms. A big problem with the first game was that it was developed for PC and then ported to consoles. They had never done a console port before!! This time around, they've got the bases covered. That being said, the game now looks and plays better than the original, watch the E3 Trailer as proof.
Reason #2 – DEEP Customization.
There are no classes in TW II, you build your own. You can also build up and break down nearly any materials in the game to create better armor and weapons. The crafting system is enormous and the spell system is currently being considered by the Guiness Book of World Records for the most player activated spells or abilities in a videogame . . .ever.
Now, I know what you're saying, "Oh great, a really complicated spell building system? No thanks." But alas! Not only is this system easy and intuitive, but it's also easy and intuitive!! You simply stack and arrange cards to upgrade and change spells!! Want a lightning spell? Done. Want an AOE lightning spell? Done. Want an AOE lightning spell that shoots 5 bolts instead of 3? Done. Want an AOE Lightning spell that shoots 5 bolts instead of 3 and ricochets off the environment? DONE. See what I'm getting at here?
The possibilities are endless, and for roleplayers, this is very very cool. You can also name your own spells. I call this one Uber Fire Face Pwnage IV!!
You can also do things like bind different sets of armor to your keys and change them on the fly!! (Not realistic, but very cool) Go from tank, to rogue, to battlemage with the push of a button!! Watch this short off-screen video I recorded at PAX.
Reason #3 – The huge and diverse game world.
There is not much to say here, except for the fact that it is. From lush jungles to barren plains, Two Worlds II covers the entire spectrum of RPG environments. Don't believe me? Check out this map of Antaloor and the following video in which it is detailed:
Reason #4 – The Storyline.
The story was localized in multiple languages and written by a multinational team. German, English, Spanish and Polish writers working together to make a story with flavors from all these different cultures. The game will also feature voicework with over 200 unique voices. Remember how many different voices Oblivion had? Of course you do, and you're probably laughing just thinking about it. The entire game is voice acted (for those of you with a fear of reading) and the voicework is clearly superior to that of the first game. The in-game cutscenes have much better direction this time around, yet unfortunately I've no footage of them. You'll have to just take my word for it and know that they are definitely better than this:
Reason #5 – The Multiplayer.
Stepped up across the board. Not just PvP, Not Just PvE. There is now a unique co-op campaign with nearly 10 hours of gameplay that is completely different from single player campaign. SouthPeak promises some great multiplayer footage soon!!
Also, All modes are 2-8 players and are completely drop in / drop out.
So there you have it. 5 solid reasons why Two Worlds II won't suck. This is the sort of game real RPGamers want to play. Hell, so was the first one, but as we know, it was riddled with issues that made it hard to enjoy. SouthPeak, Topware and Reality Pump seemed to have addressed all of those issues and are proud to bring us the epic roleplaying experience we have all been waiting for.
Look for our full HD Video review of Two Worlds II when it launches on October 5th.


text: Thousands of ringtones on Audiko.net! All you need is to download a free Asaf Avidan ringtones for your iPhone or mobile. Cut your favorite episode from your favorite composition - Asaf Avidan - One day -, ASAF AVIDAN - ONE DAY *FREE DOWNLOA, Asaf Avidan - One Day Full download, or any other track. Then download the prepared Asaf Avidan ringtones to your iPhone, and enjoy Israeli music by Asaf Avidan every time your phone rings. If you enjoy Israeli or maybe Rock and Folk Rock music, then you will probably like Tom Rosenthal, , or as well. For all who want a free Asaf Avidan ringtone, we also recommend listening to Folk-Rock, Magic, and Classic Rock. We provide you with an option to gain your tune both in the MP3 and m4a formats, compatible with both mobile phones and iPhones. Just select a track, and choose free Asaf Avidan ringtones download option.

subset: commoncrawl


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Thomas Garcia
A Logan High senior has received a scholarship bestowed on just 104 students across the country.
Holly Raines-Baxter, 18, a senior at Logan high school said she was excited to be notified she had received the Horatio Alger National Scholarship, good for $20,000 at any four-year institution.
"This is the first scholarship that I have received," Raines-Baxter said. "It's a relief to know that I will have help in paying for my higher education."
Raines-Baxter said she has a 4.23 grade point average, which has been difficult to maintain since she has been in and out of foster care since she was 14 years-old. She said it only got more difficult when her mother, Diana Liard, passed away when she was 16.
"It took a lot of effort to continue pushing myself and maintain my grades," Raines-Baxter.
Students selected for the scholarship, according to the association, demonstrated how they overcame personal obstacles to attain academic success.
"The Association is proud to help these talented individuals find continued success through their pursuit of higher education," said Tony Novelly, President and CEO of the Horatio Alger Association, "We know they will continue to represent the Horatio Alger ideals of achievement through perseverance and integrity in facing life's challenges."
She will be honored at the Horatio Alger Awards Ceremonies in Washington D.C, in April.
Every year, the Association disburses over $7 million in scholarships to deserving high school students all over North America through its various scholarship programs. The National Scholarship recipients are invited on an all-expense paid trip to Washington, D.C. this April to attend the National Scholars Conference. During the trip, they will have the opportunity to meet fellow scholar and association members, and attend college preparatory sessions.
Raines-Baxter said it took her two weeks to complete the application for the scholarship. She said some of the requirements included writing four essays.
She plans to attend the University of New Mexico, where she will double major in business and political science.
The scholarship is distributed $4,000 annually over five years, with the remaining balance paid to Raines-Baxter in her final seemster if she completes her education sooner.


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Taken from Bon Appetit, December 2006
- 1/2 cup honey
- 1/2 cup fresh chopped cilantro
- 6 Tablespoons tomato paste
- 2 Tablespoons water
- 2 Tablespoons minced chipotle chiles (with adobo sauce)
- 1 lb Yukon Gold potatoes (peeled-cut into 1" cubes)
- 6 oz. brie trimmed and cut into 1" pieces
- 8 - 8 inch flour tortillas
- 1 medium sized red onion
- Olive Oil
- Puree honey, cilantro, tomato paste, 2 tablespoons water and chipotle in a blender or food processor until smooth. Season with salt and pepper to taste. Boil the potatoes until tender (about 12 min.) Drain. Mash in a pot until smooth and then season well to taste with salt and pepper, Now spread the potato mixture evenly and at about a 1/4 inch on the 8 tortillas. Then, on top of this spoon the chiptole puree, folding the quesadillas over. Heat large skillet over medium high hear; brush lightly with olive oil. Working in batches, cook quesadillas until golden brown, about 2 minutes per side. Serve, passing chpotle honey alongside.
Nutritional Info
- Calories255
- Carbohydrates37 g(12%)
- Fat9 g(14%)
- Protein7 g(15%)
- Saturated Fat4 g(18%)
- Sodium438 mg(18%)
- Polyunsaturated Fat1 g
- Fiber2 g(9%)
- Monounsaturated Fat4 g
- Cholesterol17 mg(6%)


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I finally get to tell you a secret that has been super hard to keep to myself!!
Do you remember my piCture pOlish Blogfest post from July?
Well because of that I was chosen (with many others) to help make a nail polish with piCture pOlish!
I got to work with the wonderful ladies from piCture pOlish to help create a Limited Edition collaboration shade with them!
Unfortunately I missed the package today so I didn't take my swatches with bottle pictures.
I do have a bottle atm but it isn't labelled but I did use it for some pretty macros later in this post!
I love my collaboration polish so much! It is very difficult to photograph though!
|A single coat of Atomic over various polishes
First lets talk inspiration. Of course my first thought was the element Samarium!
Which my blog is named after. Samarium is a silvery white metal, named from the mineral samarskite.
Samarium oxidizes in the air, forming a grayish-yellow powder. Which is the reasoning for the gold shimmer sparkle in it! It is more visible when layering. But enough chit chat!
I wish I could even begin to describe this polish. I will c&p the Picture Polish description when it is posted.
But trust me that this polish is beautiful and very intricate, I hope dearly that some fellow amazing bloggers will get their hands on it and help show it off!
I used three thin coats for opacity. Two coats is great coverage but there was a tiny but of VNL.
I love that this polish is versatile, not only does it build up beautifully- it can also be layered!
Granted it;s a little thick for layering so be sure to apply a nice even coat when doing so!
Here is one coat vs three.
This picture have a single coat of Atomic over Illamasqua Poke, and Nails Inc Baker Street.
One coat over Gray, Black, Purple and on it's own.
Single coat over black!
Here are two macro bottle shots for you! Seriously click them! So pretty!
It will also be available via the piCture pOlish Network!
This polish is Limited Edition if it does well it may be added to their line so if you like it please buy it sooner rather than later :D
It will launch shortly and I will include a link to it directly when I can!
Click HERE to purchase Atomic from piCture pOlish.com!
Also make sure to checkout my fellow bloggers shades!
Jen The Polishaholic's shade - Mallard
Sheila from Pointlesscafe - Focus
Sahrish from Sahrishadeel - Majesty
Cathy at More Nail Polish has swatches up now, go look here!
I have never once thought that one day my name could be on a nail polish! I can't even explain the excitement I have!!
Sorry for the amount of pictures!
Thank you so much for looking, and for following my blog!
This never would have happened if it weren't for each and every one of you!


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Okay, this is an optimization problem.
The first thing you are going to want to do is draw a picture - it really helps you visualize it. I set the length equal to y and the width equal to x. From the picture, you should be able to see that the length is equal to y-8 (eight being the size of the margins). You should also realize that the width is equal to x-4.
Put this into the equation for area, A=x*y and you should get A=(y-8)(x-4)
This doesn't help yet, but remember that A=x*y, and we want the printed area to be 200 sq inches. So, plug 200 in for A, and you get 200=x*y. Solve this for y, and you get y=200/x.
Now plug that into your first area equation, and you get A=((200/x)-8)(x-4).
From there, you should be able to simplify it and take the derivative. Once you have the derivative, it's simply a matter of optimizing the problem. Look for the critical points on the graph, and find the local maximum. Once you have a value for the local max, you should be able to return to the equation y=200/x. Just plug in the value of the relative maximum you found for x, and solve for y. From there, you should get your dimensions!
Good luck!


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Ningin | GirlyBubble | ZiggyTek | Wirebot | FlauntMe | SwanDiary | Rekuru | CrazySingleLife | HTCYou | OMGHaute | Reelwire.com | Funsauce.com
What I love about Davichi is just how powerful and emotional that both their songs and music videos can be. The duo has come back with their third mini-album, Love Delight, and with the new mini-album comes their brand new MV for "Don't Say Goodbye".
The music video. Davichi's music videos have always been beautifully made and this MV here is no exception. The MV begins with a young man who seems to be interested in astronomy as he peers into his telescope. As he steps out of his house, he is startled by something moving in a black trash can. He opens it up, revealing Kang Minkyung inside, who seems to have been beaten up and discarded. The two enjoy being in each other's presence and have fun together until the guy receives a call from a mysterious man. It turns out that he had a previous girlfriend, who went missing five years ago and resurfaced recently. Torn between the two, he goes to the meet with an unsuspecting Minkyung, who recognizes the man and begs the guy not to leave her. But in the end, he chooses his girlfriend, leaving a screaming and crying Minkyung in the grasps of the mysterious man. It sends out a poignant message that most of the time, when confronted in a situation, a guy will always go for his true love, even if it means abandoning someone else.
The dance/choreography. As with most of Davichi's music videos, there is no dance or choreography shown. Their music videos have always had some sort of storyline and it makes the song all that much better. Speaking of the song…
The song. At first, when I heard the song, it has bits and pieces of sad emotion, but with such strong, loud voices singing, I thought it was more of a cheerful song. Boy was I wrong. It's more of a pop ballad with a sad story and message of not wanting someone to leave you and say goodbye. The song pulls at your heartstrings and the music video even more.
Thoughts. I've always loved Davichi's songs and music videos ever since I heard them two years ago with their '8282′ song. That was such a nice and beautiful song. Davichi's talents are seriously no joke and I really do wish they would earn more awards. But that's wishful thinking. Someone needs to recognize talents such as these young ladies and they honestly should be recognized more. I really do love this MV and I hope there's a part 2! Like how Minkyung ended up there.
Overall Rating. 5/5
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08/31/11 9:06 pm
yeah I agree too
5/5 from me
08/30/11 7:29 pm
i agree!! 5/5!!
08/30/11 2:02 pm
thanks for the review !
08/30/11 2:24 am
thanks for the review ! agree, not just the song, but the MV also good, i'll also give it 5/5 <333 ~
08/30/11 12:17 am
Thanks for the review!
08/29/11 9:52 pm
I agree with basically every bit of this review. The powerful vocals and the sad emotion is just such an epic combination, and Davichi had definitely done that effortlessly. The MV is totally beautiful but with such a sad story line.
All in all, I love this Music Video. <3
08/29/11 9:51 pm
i like the song, very nice & the mv is good too
thanks for the review
08/29/11 9:48 pm
thanks for sharing!
08/29/11 9:47 pm
Definitely agree! I've always loved Davichi for having beautiful songs with powerful vocals and sad and emotional MVs, and this MV is no different.


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Frank Hall, an assistant football coach at Chardon High School, says that when he chased a shooter who had killed three students there in February, he was just doing his job — protecting kids.
This past summer, Hall took his family on a much-needed vacation to New York City and learned that he can't leave Chardon behind, and that Chardon will never leave him.
"We went to the Intrepid Museum," he said, referring to the retired U.S. aircraft carrier. "They had a display that talked about the kamikaze attacks, and the ship's worst day was when a kamikaze attack killed 44 men. And they said it also was the ship's best day, because they saved the ship and were able to get back in the fight."
Read the full story from The Cleveland Plain Dealer.


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Ohio University Dining Services got 123 freshman students to upgrade their meal plans—a nearly $90,000 bump in meal plan sales—thanks to an upgrade promotion held during the pre-college orientation before the beginning of the school year. Freshmen who agreed to upgrade from a traditional to a super meal plan were entered into a drawing to win the upgrade free of charge for the first term. The department gave away 10 free upgrades at a total cost of $2,630, reports Dining Services Director ...
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24 Oct 2011 06:30:33 AM
Movember Gallery: The Greatest Facial Hair in MMA History
(You can make fun of your opponent's voice, and you can trash his fighting style. But mock a man's sideburns, and you're asking for the worst beating of your life.)
Start sharpening your razors, folks: We're just eight days away from the official start of Movember! To help get you in the moustache-growing spirit, we've put together a photo gallery of our favorite facial hair arrangements in MMA history, which you can check out after the jump.Read More DIGG THIS


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If the U.S. Supreme Court's Citizens United ruling stands, we will not have representation by the people, but representation by corporations.
We cannot give up this right to have our say in government, so we must all pressure our government representatives to put this issue up for a decision by the people through a constitutional amendment.
Our leaders should approve Senate Joint Resolution 19 to amend the U.S. Constitution to reverse Citizens United.


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The ISIS militants who've terrorized Iraq appear to have killed their first American victim.
The group released a horrifying video showing the execution of James Foley - a journalist kidnapped in Syria back in 2012.
James Foley's whereabouts were unknown until this video was released.
(NBC News) Islamist militants have released a photo along with a graphic video of the apparent beheading of American photojournalist and threatened to kill another kidnapped American newsman unless the United States pulls out of Iraq.
James Foley disappeared in Syria on Thanksgiving 2012.
The United States says it won't give in to terrorist demands.
"Most immediately they want to halt the airstrikes, but that simply is not going to happen," says Rep. Adam Schiff, of California.
Copyright 2016 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.


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They came together on fields throughout North Texas months ago — boys and girls of all ages, each skilled in the game of soccer, and each with one goal in mind … a North Texas State Cup.
Earlier this month, those dreams were realized for several teams, as this year's State Cup came to an exciting conclusion, and 17 teams were crowned State Champions!
To see photos of all of the winning teams, CLICK HERE.


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Abbotsford Cycles is as close to an old fashioned bike shop as you get these days, without the pressure of selling bikes.
We do bicycle servicing and repairs, are expert spoked wheel builders, and stock a wide range of parts and accessories.
We love our bikes, and we can take good care of yours!
Our hours are long during the week so you can drop off before work and pick up after work. Train, tram and bus are at our door for easy access, or we can do a courtesy bike.
Online service and repair booking is available, same day turn around in most cases. We have a massive catalogue of items for your bicycle online, in our shop and at the warehouse.
Melbourne is a great city for riding a bicycle, and we are proud to contribute to it's liveability.
Oh, and unfortunately we may not have the answer to all your questions on our websites, but perhaps we do in our memory banks, which predate computers. You can access those by phone, email, or face to face in the shop.


text: Programs of Study Home | Programs of Study | Early Childhood Education | ECED-1475 - Professional In-Home Care ECED-1475 - Professional In-Home Care Skills and requirements specifically for the person working in a home setting as a professional nanny or a family child care provider. Discussion of business plans, development of a parent handbook, selection of employment agencies, contract negotiations and interviewing of prospective clients and employers. Activity planning and scheduling for children of diverse ages and abilities. Academic Level Undergraduate Subject ECED-Early Childhood Educ Department Early Childhood Education Credits 4.5 Prerequisites None Corequisites None Return to Early Childhood Education


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I remember, many years ago in our early days of home schooling, teaching my little boy Science. Something in one lesson came as a big surprise to him. In his young perspective he thought the sun went around the earth. In his thinking, the sun's rising and setting was a result of it going around the earth. He was surprised to learn that the sun was not circling the earth as he thought but it is instead the sun that is at the center and the earth is actually the one going around the sun. I could understand his confusion. The Earth seemed so big and the sun so small and far away. The Earth seemed so important and the sun seemed only like one of its accoutrements. But as his perspective was broadened he began to see reality. And his view of the sun grew.
We can be like this; diminutive in our thinking. We can have a narrow view of life and believe it is all about ourselves. Ultimately thinking things are about us and our comfort, our happiness, our goals, our dreams, our success. But this is up-side-down thinking in reality and our view needs to be broadened. This life is not about us but about the one who made us. Does this bother you? It is probably because you are basing things on a false perspective.
So why is this so important? Because if we get this wrong then our view of God is not just too small but our view of ourselves is too big. And when this happens then we will begin to questions why things aren't turning out the way we want. When things become about us then we will be angry when we experience difficulties and things that don't go as planned. We will question if God is good because our expectations are not being met. We will get weighed down in wondering why God is not promoting our aspirations. Yet here is the reality:
"God ultimately is about God. Yes He loves you, yes He provides for you and yes He cares for you, but the motivation behind that provision, care and love is the glory of His name and the worship of His perfection. So ultimately, you are not the center of the universe; God is. And although that offends our modern sensibilities, our greatest hope in the world is wrapped up in God being about God and about the praise of His glorious grace." (From God Saves, Matt Chandler sermon)
If this is true then is it just some kind of divine ego trip? Not at all, because if God were to be anything less then the center, anything less then the ultimate, if he were to share his glory with anyone or anything then he would cease to be God. The fact that he is supreme and that all things are centered around him is what affirms to us that he is God. Just as my son's view had to be broadened to understand the Earth's dependence on the sun so our view must be broadened to understand our dependence on an all sovereign God. Ego trip or Divine Supremacy? The answer depends on your perspective. Make sure you have your facts straight.


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Mahaffie will host an All American Celebration on Thursday, July 11 where we will incorporate our planned Cowboy night and firework activities. The Olathe Civic Band will play a concert at 7:30 p.m. Thursday July 11th.
www.mahaffie.org for the latest details and schedule of activities for Kansas Cowboys and 19th Century Fireworks.


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Boy's Under Armour 'Flow' Athletic Sneaker, Size 5
Breathable knit mesh ventilates the toe box while lacing overlays and an external heel counter help lock down the foot in this lightweight, responsive athletic shoe. The nonmarking cupsole features a curving waffle tread for added traction. Color(s): black/ white, graphite/ steel/ orange, white/ lime. Brand: UNDER ARMOUR. Style Name:Under ... Learn More


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Treatments for iron-deficiency anaemia in pregnancy
Although the best method of treating anaemia has not been clarified in this review, in theory oral treatment is the most feasible option, and therefore it is likely to remain the most widely used approach. Intravenous iron administration was associated with a higher risk of venous thrombosis than intramuscular administration.
RHL Commentary by Walraven G
This review examines the effectiveness on maternal and neonatal morbidity and mortality, haematological parameters and side-effects of different treatments for iron-deficiency anaemia in pregnancy. Hundred-and-one trials of treatment for this condition were identified. Seventeen of these, involving 2578 women in total, met the reviewers' inclusion criteria. Most of the remaining trials were excluded because they were not truly randomized or had other methodological shortcomings.
The review was complicated by the lack of common definitions of iron-deficiency anaemia, lack of agreement on the tests to be used in diagnosing the condition and the cut-off points for diagnosing iron-deficiency in pregnancy, especially in the presence of other causes of anaemia and a co-existing infection. Few of the studies assessed clinical outcomes, and these randomized controlled trials (RCTs) were too small to estimate important clinical effects.
In one trial (n=125) conducted in West Java, Indonesia, oral iron supplementation for anaemia in pregnancy was compared with a placebo (1). This trial showed a reduction in anaemia and higher mean haemoglobin and serum ferritin levels in the iron supplementation group. The addition of vitamin A to iron supplementation improved the results of the therapy. Unfortunately, the study evaluated the outcome at the end of treatment during the second trimester of pregnancy, and not at term (or at least the third trimester), which would have been more appropriate.
Comparison of different treatments showed that intravenous (IV) iron administration was associated with a higher risk of venous thrombosis than intramuscular (IM) administration, but the IM route resulted in pain at the injection site more frequently. Skin coloration was more frequently observed in people receiving IM iron-dextran compared with IM iron-sorbitol. As expected, women taking oral iron preparations complained of nausea and constipation more frequently than those receiving IV preparations. Pooled estimates (two RCTs, 137 women) for haemoglobin levels at four weeks favoured IV iron treatments compared with oral iron (2,3).
On the basis of this review, no recommendation can be made regarding how to treat iron-deficiency anaemia in pregnancy.
Both the search strategy and the strategy for extracting the data were appropriate.
2.1. Magnitude of the problem
The prevalence of anaemia in pregnancy (haemoglobin below 11 g/dL) in many developing countries is high, with reported rates of 35–75% (4). A United Nations expert panel considered severe anaemia (<7 g/dL) an associated cause in up to half of maternal deaths worldwide (5). At least half of all anaemia cases have been attributed to iron deficiency (6). In many developing countries endemic problems such as malaria and helminth infections, together with the problem of poor nutrition make anaemia one of the most common pathologies in pregnancy.
2.2. Feasibility of the intervention
In order to identify anaemia in pregnancy, an accurate method for measuring haemoglobin levels is needed. Many clinics in developing countries, especially those in sub-Saharan Africa, rely only on conjunctival inspection. The WHO Colour Scale might still be useful, especially at the primary health care level as a screening tool despite observed limitations in accuracy (7, 8). The routine measurement of serum ferritin—a better indicator of body iron stores than haemoglobin concentration—is unrealistic for most of the low-income countries.
Although the best method of treating anaemia has not been clarified in this review, oral treatment is in theory the most feasible and therefore likely to remain the most widely used. The side-effects of oral iron administration or women's dislike of the tablets owing to smell or taste have often been blamed for treatment failure, although a literature review found that side-effects accounted for only 10% of non-compliance. Rather, in most cases, women did not take their tablets because they never received them or received inadequate quantities (9).
Mostly anecdotal evidence suggests that IV and IM iron administration is associated with allergic reactions and allergic shock. Compared with IM iron sucrose, IV iron sucrose significantly increased haematological indices, but it is unclear what the effects are on maternal and neonatal morbidity. In addition, there is uncertainty whether IV iron sucrose may increase the incidence of serious adverse effects such as venous thromosis, which were frequent in the studies (9/41; 22%). The use of non-sterile injection equipment and blood transfusion are associated with the risk of transmission of parasites and viruses such as HIV and hepatitis.
2.3. Applicability of the results of the Cochrane Review
On the basis of this review no recommendation can be made regarding the treatment of iron-deficiency anaemia in pregnancy in developing countries and therefore the applicability of the results cannot be considered.
2.4. Implementation of the intervention
The need to avoid blood transfusions to treat severe anaemia makes the prevention and treatment of mild-to-moderate anaemia of utmost importance. The Cochrane Review on routine iron supplementation in pregnancy concludes that the available data from controlled trials provide evidence of an improvement in haematological indices in women receiving preventative iron supplementation, but also here there is not enough information available on clinical maternal and infant outcomes and this will need further assessment (10). Unpleasant side-effects of iron supplementation, inadequate availability of tablets, a misguided perception among health workers that anaemia is not a serious problem, and insufficient supplementation owing to late consultation for antenatal care are all obstacles to running a successful programme. The impact of community- or clinic-based supplementation can be improved by counselling on why, how, and when to take iron tablets and by supplying sufficient tablets in a timely manner (11).
2.5. Research
The causes of anaemia will vary from region to region and these are in general, more or less documented. There is, however, a need for consensus on the cut-off points for mild, moderate, and severe iron-deficiency anaemia.
Good quality clinical trials need to be done urgently, especially to study interventions for severe iron-deficiency anaemia in pregnant women (haemoglobin levels less than < 7 g/dL without signs of imminent heart failure). In such trials different treatments and routes of administration should be compared for well-defined laboratory values, side-effects, and especially the effects on maternal and neonatal morbidity and mortality.
- Suharno D, West CE, Muhalil, Karyadi D, Hautvast JG. Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia. The lancet 1993;342:1325-1328.
- Al RA, Unlubilgin E, Kandemir O, Yalvac S, Cakir L, Haberal A. Intravenous versus oral iron for treatment of anemia in pregnancy: a randomized trial. Obstetrics & Gynecology 2005; 106: 1335-40.
- Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier-Barbarino P, Laxenaire MC. Iron therapy in iron-deficiency anemia in pregnancy : intravenous route versus oral route. American Journal of Obstetrics and Gynecology 2002; 186:518-22.
- World Health Organization. The prevalence of anaemia in women: a tabulation of available information. Geneva, WHO 1992; (WHO/MCH/MSM/92.2):119-124.
- Controlling iron deficiency. A report based on an Administrative Committee on Coordination/Subcommittee on Nutrition workshop. Nutrition-State-of-the-Art Series. Nutrition Policy Discussion Paper No 9. Geneva, United Nations. 1991.
- Van den Broek NR, Letsky EA, White SA, Shenkin A. Iron status in pregnant women: which measurements are valid. British Journal of Haematology 1998;103:817-824.
- World Health Organization. Haemoglobin colour scale: a practical answer to a vital need. WHO Department of blood safety and clinical technology, Geneva, 2001.
- Gies S, Brabin BJ, Yassin MA, Cuevas LE. Comparison of screening methods for anaemia in pregnant women in Awassa, Ethiopia. Tropical Medicine and International Health 2003;8:301-9.
- Galloway R, McGuire J. Determinants of compliance with iron supplementation: supplies, side effects, or psychology. Social science and medicine 1994;39:381-390.
- Pena-Rosas JP, Viteri FE. Effects of routine oral iron supplementation with or without folic acid for women during pregnancy (Cochrane Review). In: The Cochrane Database Syst Rev, 2006;3:CD004736.
- Menendez C, Todd J, Alonso PL et al . The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Transactions of the royal society of tropical medicine and hygiene 1994;88:590-593.
This document should be cited as: Walraven G. Treatments for iron-deficiency anaemia in pregnancy: RHL commentary (last revised: 20 June 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.


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Intellon Corporation, the world leader in powerline communications, today announced the introduction of its next generation powerline networking chipset. The INT5500CS, an 85Mbps powerline networking chipset, is fully compliant with the 14 Mbps HomePlug 1.0 specification and offers the higher bandwidth performance necessary to drive next-generation home entertainment applications such as standard definition video and whole house audio.
The INT5500CS complements Intellon's highly successful and broadly deployed INT51X1 and INT5200 products, which implement the 14Mbps HomePlug 1.0 specification. The INT5500CS enables additional applications requiring higher bandwidth, including standard definition video distribution, TV over IP (IPTV), digital video recorder (DVR) networking and media center PCs. Other applications include whole house audio, extension and bridging of higher speed wireless technologies such as 802.11x and UWB, and higher data-rate broadband sharing based on technologies such as ADSL2 and fiber to the home.
The new solution is comprised of the INT5500 baseband (MAC/PHY) processor and the INT1200 analog front end (AFE). The INT5500 chipset will begin sampling in the first quarter of 2005, with production volumes following in the second quarter.
"The introduction of the INT5500CS is a significant milestone in Intellon's product roadmap strategy," said Ron Glibbery, president of Intellon. "Working with our customers worldwide, Intellon continues to advance the performance envelope of powerline communications technology. We recognize the aggressive requirements for whole house distribution of data and multimedia content. The INT5500CS enables reliable whole house distribution of a new set of audio and video applications."
"The INT5500CS is the second step in a three-tier product strategy designed to meet the increasing bandwidth needs of the evolving digital home," said Andreas Melder, senior vice president of sales, marketing and business development at Intellon. "Continuing our powerline industry leadership, our 14Mbps INT51X1 and INT5200 products and our new 85Mbps INT5500CS will be joined next year by our 200Mbps HomePlugAV-compliant product line, which will enable distribution of multiple high definition video streams over home powerlines."
HomePlug powerline communications is recognized as a key technology in the home networking ecosystem. High reliability, resistance to interference, simplicity of setup and use, and strong Quality of Service (QoS) make powerline ideal for real-time entertainment content delivery, particularly whole-house audio and networked video.


text:
Because this is a Cauchy sequence, you know that for some N, if n,m> N, then . In particular, if , we have so that . So is an upper bound for all terms with n> N.
The part you are asking about, where they look at , up to is the easy part- those together with the bound form a finite set. And a finite set of numbers always contains a "largest member" which must be an upper bound on the entire sequence.


text:
When 25 American tennis players landed in Paris earlier this month, they readied themselves for singles competition at Stade Roland Garros.
In total, 15 women and 10 men laced up their sneakers to do battle on clay. When the red dust settled early on Wednesday, four men and 10 women survived to fight on during the second round.
Last year, 13 from the U.S. advanced to Round 2. This year, only one more American made it through, but still, 14 is the most Americans in a decade to survive the opening round in Paris.
Traditionally, Week 2 begins with the Round of 16. Now, the important question: Which Americans will make it through the next two rounds, assuming the weather holds?
These players must possess the talent in addition to a favorable draw in order to be left standing as the second Sunday's action gets underway in Paris.


text:
Using quality indicators to improve hospital care: a review of the literature
Purpose To review the literature concerning strategies for implementing quality indicators in hospital care, and their effectiveness in improving the quality of care.
Data sources A systematic literature study was carried out using MEDLINE and the Cochrane Library (January 1994 to January 2008).
Study selection Hospital-based trials studying the effects of using quality indicators as a tool to improve quality of care.
Data extraction Two reviewers independently assessed studies for inclusion, and extracted information from the studies included regarding the health care setting, type of implementation strategy and their effectiveness as a tool to improve quality of hospital care.
Results A total of 21 studies were included. The most frequently used implementation strategies were audit and feedback. The majority of these studies focused on care processes rather than patient outcomes. Six studies evaluated the effects of the implementation of quality indicators on patient outcomes. In four studies, quality indicator implementation was found to be ineffective, in one partially effective and in one it was found to be effective. Twenty studies focused on care processes, and most reported significant improvement with respect to part of the measured process indicators. The implementation of quality indicators in hospitals is most effective if feedback reports are given in combination with an educational implementation strategy and/or the development of a quality improvement plan.
Conclusion Effective strategies to implement quality indicators in daily practice in order to improve hospital care do exist, but there is considerable variation in the methods used and the level of change achieved. Feedback reports combined with another implementation strategy seem to be most effective.
- quality indicators
- quality improvement
- quality measurement
- implementation strategy
- hospital care
With increasing frequency, hospitals in various countries report and monitor indicator data in order to improve the quality of care [1–4]. Quality indicators aim to detect sub-optimal care either in structure, process or outcome, and can be used as a tool to guide the process of quality improvement in health care [5]. Monitoring the health care quality makes hospital care more transparent for physicians, hospitals and patients. Furthermore, it provides information to target quality improvement initiatives. However, collection of indicator data also implies an administrative burden for physicians and hospitals; therefore, the use of this information should be optimized. It is unclear which implementation strategy for quality indicators is optimal, and what effects can be achieved when quality improvement is guided by indicator information.
The implementation of quality indicators as a tool to assist quality improvement requires effective communication strategies and the removal of hindrances [6]. Evidence suggests that audit and feedback based on indicator data can be effective in changing health care professional practice [7, 8]. Monitoring the indicator data may also help to target specific quality improvement initiatives such as educational programs and development of protocols.
The effect of monitoring indicator data to promote quality improvement, and ultimately patient care, has been demonstrated in specific situations. For example, in the Bradford Teaching Hospital in the United Kingdom, feedback of mortality rates resulted in the reduction of the standardized mortality rate from 0.95 to 0.75 [9].
At present, no clear overview is available about strategies for implementing indicators and the effects on quality of care in hospitals. Some reviews do address the issue of implementation of indicators, but do not focus on hospital care [10, 11]. Another review of the literature has a limited focus on audit and feedback as implementation strategies [8]. With respect to the effectiveness of using indicators to promote quality improvement, previous reviews have focused on specific diseases or medical disciplines, e.g. pneumonia or cardiac surgery [12, 13]. In our review, we focus on hospital care in general, and take into account all possible implementation strategies described in the literature. The purpose of our study is firstly to review the literature concerning strategies for implementing quality indicators, and secondly to examine their effectiveness in improving the quality of hospital care.
Data source
A systematic literature search was conducted in MEDLINE and the Cochrane Library for the period from January 1994 to January 2008. We searched all articles published in the English and Dutch languages. The search was limited to randomized controlled trials (RCTs), controlled clinical trials (CCTs) and controlled before–after studies (CBAs), as categorized in MEDLINE. A RCT is the most robust study design to show the effect of quality improvement strategies [14]. However, as some strategies are not amenable to randomization, we also included non-randomized trials.
The search strategy in MEDLINE combined a truncated search for 'quality indi*' with the text words 'hospital care' or 'quality improvement'. In addition, we searched the Cochrane Library, based on the Medical Subject Heading: 'quality indicators, health care'. The reference lists of all retrieved articles were searched for additional relevant references.
Two reviewers independently assessed the studies for inclusion. In case of disagreement between the two researchers, a third researcher was consulted.
Study selection
Firstly, we selected studies based on the relevance of the focus of the study. Studies reporting the use of quality indicators as a tool to improve hospital care were included. Studies that measured care processes or patient outcomes were also included, if the focus was on inpatient care at the hospital level, ward, or individual specialist. Studies concerned with primary care, e.g. general practitioners, chronic health, mental health and dental care were excluded because the delivery of care may differ considerably in these care settings from the hospital care setting.
Secondly, we selected studies based on study design and quality of the study. Studies had to report a baseline and follow-up measurement, and include a control and an intervention group. The effects of the implementation strategy had to be quantified, and studies had to be carried out in two or more hospitals because of generalization of the results.
For those studies that met the inclusion criteria, we classified the implementation strategies in which the information on quality indicators was used directly into the following categories (see Table 1): (1) educational meeting, (2) educational outreach, (3) audit and feedback, (4) development of a quality improvement plan and (5) financial incentives.
|Implementation strategies in which the information on quality indicators was directly used
|Educational meeting
|Participation in conferences, seminars, lectures, workshops or training sessions. During these meetings, feedback of quality indicators was presented, and study participants discussed how to improve performance.
|Educational outreach
|A trained independent person or investigator who met with health professionals or managers in their practice setting to provide information (e.g. feedback of quality indicators).
|Audit and feedback
|Report including a summary of clinical performance over a specified period of time had to be given.
|Development of a quality improvement plan
|A plan based on indicator data was used to improve the quality of care.
|Financial incentive
|Rewarding individual health professionals or institutions with higher payments when they improve performance.
|Supporting activities
|Distribution of educational material
|Distribution of educational material was used if published or printed recommendations for clinical care or quality improvement were used.
|Local opinion leader
|Professionals named by their colleagues as influential with emphasis on acting as authority locally.
|Quality improvement facilities
|An implementation process organized by a quality improvement team or organizations to improve the quality of care and implementing system support methods (support by phone or e-mail for quality improvement).
Implementation strategies that did not directly use the information on quality indicators, but support the implementation, were categorized in 'distribution of educational material', 'local opinion leaders' and 'quality improvement facilities' (see Table 1). Educational meeting was regarded as a supporting activity if the meeting focused on quality improvement techniques instead of presenting feedback on quality indicators.
Common to all studies on which we focus in this review is the use of key information of structure, process and outcome of care, and the systematic use of this information to improve quality of care. Central to the use of quality indicators is the feedback of information. Therefore, in order to summarize the implementation strategies that were used, we categorized the contribution of feedback to the implementation strategy in 'receiving no feedback report', 'receiving a feedback report only' and 'receiving a feedback report combined with another strategy, which also used quality indicators as part of the implementation strategy.'
For the studies included, information was collected concerning the healthcare setting, methods used to implement quality indicators in hospitals, and their effectiveness in improving the quality of hospital care. The effectiveness of these strategies may be explained by the fact that they are capable of dealing with different barriers simultaneously [15]. We have summarized the barriers reported in some of the studies.
Selection of articles
As a result of the search, 516 studies were identified (see Fig. 1). Of these, 465 were excluded, because these studies did not aim to measure the effect of the use of quality indicators. Four additional new articles were obtained from the reference lists. A total of 55 articles was evaluated by two reviewers, based on the quality of the studies. Finally, 21 studies were included.
Study characteristics
We included nine RCTs [16–24], two CCTs [25, 26] and ten CBAs [27–36].
The majority of the trials were conducted in the United States (17 studies); the others were carried out in Canada [17], Australia [33], Sweden [16] and Laos [21]. Furthermore, quality indicators were in a wide range of medical disciplines within hospital care. The majority of studies focused on the use of quality indicators in cardiovascular care (67%) [16, 17, 19, 20, 22–24, 27, 29, 32–36]. Most studies (81%) aimed at improving quality of care in one specific medical discipline. The sample size showed great variation, from one to 379 hospitals in the intervention group (see Table 2).
|First author, year
|Study design
|Clinical area
|Methods to implement quality indicators
|Effects on care processes
|Effects on patient outcome
|Pandey et al., 2006 [27]
|Cardiovascular care
|Educ. outreach and educ. meeting vs. chart audit only
|No sign. improvement in 6 out of 7 process indicators, except for lipid screening (adj. OR 19.93; 90% CI 2.99–36.86)
|Not measured
|Carlhed et al., 2006 [16]
|Cardiovascular care
|Real-time feedback report, educ. meetings and QI plan vs. no intervention Supporting activities (QI facilities, incl. QI team and ongoing support by phone and on request site visits)
|Sign. improvement in 4 out of 5 process indicators: use of ACE inhibitor 1.4% vs. 12.6% (P = 0.002), use of lip. low. 2.3% vs. 7.2% (P = 0.065), use of heparin 5.3% vs. 16.3% (P = 0.010) and use of Cor-Angio 6.2% vs. 18.8% (P = 0.027)
|Not measured
|Grossbart, 2006 [28]
|Cardiovascular care, pneumonia, hip/ knee
|Feedback report and rewarding hospitals with an incentive bonus vs. no intervention
|Sign. improvement in composite process indicator scores of 6.7 % vs. 9.3% (P < 0.001)
|Not measured
|Moscucci et al., 2006 [29]
|Cardiovascular care
|Quarterly + annual feedback reports, educ. outreach, educ. meeting, distribution educ. material and QI plan vs. no intervention
|Sign. improvement in all 6 process indicators
|Sign. improvement in 4 out of 6 outcome indicators; contrast nephropathy (adj. OR 0.59; 95% CI 0.44–0.77), emergency CABG (adj. OR 0.54; 95% CI 0.32–0.90), stroke (adj. OR 0.33; 95% CI 0.16–0.65) and death (adj. OR 0.57; 95% CI 0.40–0.82).
|Rosenthal et al., 2005 [30]
|Cancer screening, mammography, hemoglobin testing
|Rewarding health care professionals with an incentive bonus vs. no intervention
|No sign. improvement in 2 out of 3 process indicators, except for cervical cancer screening (3.6% improvement, P = 0.02)
|Not measured
|Beck et al., 2005 [17]
|Cardiovascular care
|Rapid feedback report vs. delayed feedback report
|No sign. improvement in any of the 12 process indicators
|No sign. improvement in mortality at 30 days after discharge (adj. OR 0.6; 95% CI –0.70–1.8)
|Snyder and Anderson 2005 [31]
|Cardiovascular care, pneumonia
|Feedback report vs. no intervention Supporting activities (distribution educ. material and QI facilities, incl. assisting implementing system change)
|No sign. improvement in 14 out of 15 process indicators, except for pneumonia immunization (P = 0.005).
|Not measured
|Landon et al., 2004 [25]
|HIV infection
|Monthly feedback reports, educ. meetings and QI plan vs. no intervention Supporting activities (QI facilities, incl. QI team and monthly conference calls)
|No sign. improvement in 7 out of 8 process indicators, except for screening and prophylaxis papanicolaou smear (P = 0.06)
|Not measured
|Horbar et al., 2004 [18]
|Surfactant preterm infants
|Feedback report vs. no intervention Supporting activities (educ. meeting for QI techniques and QI facilities incl. ongoing support by quarterly conference calls and mail discussion list)
|Sign. improvement in all 3 process indicators: proportion receiving surfactant in delivery room (adj. OR 5.38; 95% CI 2.84–10.20), proportion receiving first surfactant >2 h after birth (adj. OR 0.35; 95% CI 0.24–0.53) and median time from birth to first dose surfactant (P < 0.0001)
|No sign. improvement in rate of death before discharge
|Berner et al., 2003 [19]
|Cardiovascular care
|Educ. meeting and QI plan (IG1) vs. no intervention Supporting activities (distribution educ. material and IG2 added opinion leader)
|No sign. improvement in 4 out of 5 process indicators, except for antiplatet medication within 24 h for IG2 vs. CG (adj. OR 1.92; 95% CI 1.19–3.12) and antiplatet medication within 24 h for IG1 vs. IG2 (adj. OR 1.79; 95% CI 1.09–2.94)
|Not measured
|Chu et al., 2003 [26]
|CCT (CG = 16 (crossover) IG = 20)
|Feedback report, educ. outreach and QI plan Supporting activities (distribution educ. material and QI facilities incl. support QI training and site visits)
|Sign. improvement in 2 out of 4 process indicators: antibiotics given emergency department (adj. OR 10.72; 95% CI 3.56–32.30) and blood culture obtained in 4 h (adj. OR 2.48; 95% CI 1.17–5.25)
|No sign. improvement in LOS and unadjusted mortality
|Ferguson et al., 2003 [20]
|Cardiovascular care
|Feedback report, QI plan and distribution educ. material (one arm received educ. beta-blockade (IG1), other arm received educ. IMA grafting (IG2)) vs. no intervention Supporting activities (local opinion leader)
|Sign. improvement in 1 out of 2 process indicators: use of preoperative beta-blockade (IG1 group vs. CG (P < 0.001)) and (IG2 vs. CG (P = 0.02))
|Not measured
|Wahlström et al., 2003 [21]
|Malaria, diarrhea and pneumonia
|Educ. meetings vs. no intervention Supporting activities (educ. meeting incl. QI and QI facilities, incl. QI team)
|Sign. improvement in overall mean process indicator scores for malaria, diarrhea and pneumonia together (OR 0.63; 95% CI 0.16–1.112)
|Not measured
|Hayes et al., 2002 [22]
|Cardiovascular care
|Educ. outreach vs. feedback report and educ. material Supporting activities (opinion leader, educ. meeting)
|No sign. improvement in 4 out of 5 process indicators, except for discharge counseling for daily weights (OR 2.63; 95% CI 1.14–6.07)
|Not measured
|Mehta et al., 2002 [32]
|Cardiovascular care
|Educ. outreach, feedback report and QI plan vs. no intervention Supporting activities (opinion leader (outside hospital), distribution educ. material)
|Sign. improvement in 4 out of 8 process indicators: use of aspirin on admission (81% vs. 87%; P= 0.02), use of beta-blockers on admission (65% vs. 74%; P= 0.04), use of aspirin after discharge (84% vs. 92%; P= 0.002) and smoking counseling at discharge (53% vs. 65%; P= 0.02)
|Not measured
|Scott et al., 2001 [33]
|Cardiovascular care
|Feedback reports and educ. meeting vs. no intervention Supporting activities (distribution educ. material)
|Not measured
|Sign. improvement in inpatient mortality (adj. OR, 0.59; 95% CI 0.45–0.77)
|Hayes et al., 2001 [23]
|Cardiovascular care
|Educ. meeting and QI plan vs. feedback report Supporting activities (opinion leader and distribution educ. material)
|No sign. improvement in any of the 5 process indicators
|Not measured
|Sauaia et al., 2000 [34]
|Cardiovascular care
|Educ. outreach and QI plan vs. mailed feedback report Supporting activities (opinion leader)
|No sign. improvement in any of the 7 process indicators
|Not measured
|Ellerbeck et al., 2000 [35]
|Cardiovascular care
|QI plan based on feedback vs. no QI plan based on feedback
|Sign. improvement in 3 out of 8 process indicators: aspirin during hospitalization (6% vs. 13%) and at discharge (6% vs. 15%) and use of beta-blockers (14% vs. 22%).
|Not measured
|Marciniak et al., 1998 [36]
|CBA (CG = not given, IG= 379)
|Cardiovascular care
|Feedback report and QI plan vs. no intervention
|Sign. improvement in 3 out of 7 process indicators: use of aspirin at discharge (OR, 5.6; 95% CI 2.6–8.7), use of beta-blockers (OR, 8.0; 95% CI 1.4–14.6) and smoking counseling (OR, 8.5; 95% CI 1.6–15.5)
|No sign. improvement in hospital mortality
|Soumerai et al., 1998 [24]
|Cardiovascular care
|Educ. meeting vs. mailed feedback report Supporting activities (local opinion leader and distribution educ. material)
|Sign. improvement in 2 out of 4 process indicators: use of oral aspirin (P < 0.04) and use of beta-blockers (P < 0.02)
|Not measured
CG, number of hospitals in control group; IG, number of hospitals intervention group; QI, quality improvement; OR, odds ratio; CI, confidence interval; sign., significant; adj., adjusted; incl., including; educ.,educational; lip.low, lipid-lowering therapy; Cor-Angio, coronary angiography; IMA, internal mammary artery; LOS, length of stay.
Types of implementation strategies
The methods used to implement quality indicators were classified into implementation strategies in which the information on quality indicators was used directly, or that did not use the information on quality indicators directly, but only supported the implementation, such as the involvement of a quality improvement team.
Table 2 shows the implementation strategies used. The most frequently used implementation strategies in which the information on quality indicators was used directly were audit and feedback (12 studies), followed by the development of a quality improvement plan based on quality indicator data (10 studies), 57% and 48%, respectively. The combination of these strategies was used in seven studies, and often supplemented by educational meetings and/or educational outreach [16, 25, 26, 29, 32]. The most frequently used supporting activity was distribution of educational material (9 studies). Other supporting activities were the use of a local opinion leader and the development of a quality improvement team.
In most studies (86%), multiple implementation strategies were used. In 14 studies, implementation strategies that related directly to quality indicators were combined with supporting activities. In four studies, strategies that related directly to quality indicators alone were used [27–29, 36].
Three studies reported a single implementation strategy in which the information on quality indicators was used directly. The single implementation strategies described were as follows: providing external feedback with an incentive bonus [30], providing immediate feedback [17] and using a quality improvement plan [35].
Most follow-up measurements of process and outcome indicators were performed 6 months after the strategy was implemented [16–18, 20, 21, 23, 25, 32].
Effects of quality indicator use
Different designs, implementation strategies and outcome measurements to measure the effect of quality indicators were described. In Table 2, the results are summarized as per study.
Most studies measured several outcomes, e.g. the change in several process indicators. In an attempt to summarize the results of the studies, we divided them into three categories: effective, partly effective and ineffective. We categorized the studies as 'effective' if more than half of all the outcome measures improved significantly. Studies were considered 'partly effective' if approximately half of the outcomes improved significantly, and 'ineffective' if there was significant improvement in less than half of all the outcomes.
Nine RCTs, two CCTs and ten CBAs were included. There was no clear relationship between the study design used and the effectiveness. Four out of nine RCTs showed the implementation to be ineffective [17, 19, 22, 23], one CCT was ineffective [25] and four out of ten CBAs did not show clear positive effects [27, 30, 31, 34]. The results of the studies included are reported in three different types of outcomes: overall composite score, patient outcomes and care processes, e.g. hospital mortality and prescribing medication. In two studies, an overall indicator score was measured. These studies showed a statistically significant improvement in the composite process indicator score [21, 28]. Five studies reported patient outcomes as well as care processes [17, 18, 26, 29, 36]. One study measured patient outcomes only [33]. In total, six studies evaluated whether or not quality indicator implementation improved patient outcomes. Four studies were found to be ineffective, one was partly effective and one was categorized as effective (see Table 2). Five studies reported inpatient mortality as endpoint. Two studies found significant improvements in patient outcomes: reduction in inpatient mortality [29, 33], stroke or transient ischemic attack [29], emergency coronary artery bypass graft (CABG) [29] and contrast nephropathy [29].
In 20 studies, process indicators were used to measure care processes (see Table 2). In each of these studies, more than one process indicator was measured. In three studies, there was no significant improvement in all the process indicators measured [17, 23, 34]. Two studies reported significant improvements in all process indicators [18, 29]. Most studies reported significant improvements in part of the measured process indicators. Of these studies, seven studies seemed to be effective or partly effective. These studies reported mostly on higher rates of prescribing drugs: inhibitors of angiotensin-converting enzyme (ACE) [16], heparin [16], antibiotics at emergency department [26], beta-blockers [20, 24, 32] and aspirin [24, 32]. In addition, these studies also reported on treatments given: lipid-lowering therapy [16], coronary angiography [16], blood culture obtained in 4 h [26] and higher rates of smoking counseling [32].
Not all studies adjusted the analyses for differences in distributions of other determinants when comparing the effect in the intervention group with that of the control group. Fourteen of the studies reported adjusted outcome measurements at patient level (age, co-morbidity) and/or hospital level (teaching status/ volume). Of these studies eight were found to be ineffective [17, 19, 22, 23, 25, 27, 31, 34], four were partly effective [18, 20, 26, 32] and only two were categorized as effective [29, 33]. Looking at the studies using unadjusted outcome measurements, three studies were found to be effective [16, 21, 28], three were partly effective [24, 35, 36] and one was ineffective [30].
The follow-up measurement period varied from 4 months [27, 35, 36] to 4 years [33]. Studies with a follow-up measurement period of less than 6 months showed less significant improvement and functioning of the hospital outcome measures [27, 34–36].
Types of implementation strategies and their effects
In order to summarize the prevailing implementation strategies, we divided them into three categories: receiving no feedback report, a feedback report only and receiving a feedback report combined with another implementation strategy (see Table 3). There seemed to be a relation between implementation strategies used and the effectiveness of the study (Kruskal–Wallis χ2 = 6,720, P = 0.035).
|Implementation strategies in which indicator scores were used directly
|Partly effectiveb
|No feedback report
|Feedback report only
|Feedback report combined with another implementation strategy
aEffective, if more than half of all outcomes improved significantly.
bPartly effective, if approximately half of the outcomes improved significantly.
cIneffective, if less than half of all outcomes improved significantly.
Effective or partly effective studies appear to use feedback reports combined with other implementation strategies. For example, feedback reports in combination with education and the use of a quality improvement plan seemed to be effective [16, 20, 26, 29, 32]. Studies that did not use feedback reports systematically seemed to be less effective [19, 22–24, 27, 30, 34, 35]. Studies using a feedback report only also seemed to be less effective [17, 31].
From the studies describing an implementation strategy in which the information on quality indicators was used directly, eight studies reported a single implementation strategy, with additional supporting activities in five of these. Only one out of eight studies was effective [21]. This study used monthly educational meetings, including feedback and discussion on performance improvement. Thirteen studies used multifaceted implementation strategies, and of these four were effective [16, 28, 29, 33].
Reported barriers
Analyses of barriers to changing practice, such as a review of 76 studies on doctors, have shown that obstacles to change can arise at different levels at the health care system, such as at the level of the patient, the individual professional, the health care team, the health care organization, or the wider environment [37].
In our study, we identified reported barriers to implementation. In seven of the studies included, perceived barriers to change were reported. In these studies, we also identified barriers at different levels of the health care system (see Table 4): knowledge and cognitions (not convinced of the evidence) of the individual health care professional; interaction within the team (no mutual accountability and control, no leadership) and functioning of the hospital (facilities).
|Barriers at different levels
|Focus of factors
|Lack of credible data
|[17, 21]
|Team or unit
|Social influence and leadership
|No support management/physicians
|[17, 22]
|Lack of resources
|[20, 22, 23, 30]
Four studies reported a lack of resources, e.g. time investment and lack of administrative support (see Table 4). Several facilitating factors were reported, such as the availability of supportive/collaborative management, administration support, using detailed and credible data feedback to evaluate effects and the ability of persons receiving feedback to act on it.
The two main objectives of this review were to explore the best implementation strategy for quality indicators, and to quantify the effectiveness of using quality indicators as a tool to improve quality of hospital care. Our results show that the majority of the studies included reported combinations of implementation strategies in which audit and feedback were most frequently used. Few studies showed significant improvements in the outcomes measured. Most of them focused on process measures, and reported significant improvements in part of the measured process indicators. Only few studies focused on the improvement of patient outcomes.
We recognize that significant improvements in patient outcomes are difficult to achieve. In our review, studies with a follow-up measurement period of less than 6 months showed less significant improvements in outcome measures. Short follow up on the effects of the implementation strategies may have contributed to the lack of effectiveness in some studies.
Looking at the type of implementation strategies used and their effects, there does seem to be a link between how quality indicators are used and the effectiveness of the study. Although this relationship was statistically significant (Kruskal–Wallis χ2 = 6,720, P = 0.035), we should be cautious in interpreting this partly arbitrary data. Effective or partly effective studies appeared to use feedback reports combined with other implementation strategies. Receiving a feedback report combined with education and the use of a quality improvement plan seemed to be effective. Less effective were those implementation strategies in which health care providers or managers did not receive a feedback report of quality indicator data. To improve patient outcomes or provider performance, health care providers should receive feedback on their performance in order to change practice and improve patient outcomes.
It has been suggested that multifaceted implementation strategies are more effective than single implementation strategies [10, 38]. In this review, we also found combinations of implementation strategies to be most effective. However, we could not really confirm these results because only few studies involved single implementation strategies.
The prevailing view on implementation of strategies to improve quality of care is that they should be tailored to potential barriers [39]. Ideally, possible barriers should be analyzed before the quality improvement implementation strategies are developed in order to influence both type and content of the implementation strategy [39]. Remarkably, none of the studies included reported translation of a priori identified barriers into tailor-made implementation strategies, but only reported barriers after the strategy was implemented. This may have affected the effectiveness.
The studies included in this review showed a great diversity in outcomes measured. Therefore, in an attempt to summarize the results of these studies, we categorized studies as 'effective', 'partly effective' and 'ineffective'. However, the results of this aggregation have to be interpreted with caution. All outcomes were included on an equal basis, but outcomes may be valued differently for their relevance for quality of care. For example, one measure for patient outcome may be of more value than a process measure.
The implications of the findings reported in the present review must be considered within the context of the limits of the study. Firstly, we used strict selection criteria and as a result, the studies included are limited. Studies without a control group were excluded and, consequently, interrupted time series were excluded as well.
Due to our inclusion criteria, we report only on studies with primary quantitative outcome measurements. As a result, insights from qualitative studies fall outside the scope of this paper.
We noted the relatively narrow range of clinical areas studied. While cardiovascular care is an important clinical topic, other important areas, such as intensive care and obstetrics, were not covered in the studies. As a result, it is difficult to make generalized conclusions about hospital care as a whole.
Secondly, there is a great variation in quality of the studies. The availability of well-designed studies on this topic is limited. In the results section, we reported that adjustments for differences in distributions of other determinants varied when comparing the effects in the intervention group with the control group. Studies using unadjusted outcome measurements seemed to be more effective than studies using adjusted outcomes. In addition, most studies describe a combination of implementation strategies, which hampers a quantification of the effects of separate implementation strategies. Finally, implementation strategies used in the studies were often poorly described; therefore, we checked them against a standardized list of strategies.
In conclusion, there are many different implementation strategies in which the information on quality indicators was used directly, focusing on feedback, education, etc. Often, these strategies were combined with supporting activities. Receiving a feedback report, combined with education, and the development of a quality improvement plan seemed to be most effective. Effective strategies to implement quality indicators in daily practice in order to improve hospital care do exist, but there is considerable variation in methods used and the level of change achieved. Based on the present review, receiving a feedback report combined with another implementation strategy is recommended. There is a need for thoroughly designed studies on the implementation of quality indicators to further guide future implementation.
- © The Author 2009. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved


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Quote:the triangular base of the seated posture provides 3 points (knees and feet) and 2 edges (shins) of contact with the ground. Force acting on the structure is directed to the ground and bounced back - internally - thru your structure into their structure. Changing the vector of the GRF is what causes the other person to uproot...all by themselves.
Quote:ie. 'leveraging'.
Quote:if someone can hold their breath and do this as you say - then an equal argument is saying someone can do this technique without concepts such as 'ki'....but if it's conveinent to do so, why not.
Quote:receive/inhale/float - whatever term you like for softening or redirecting the attackers incoming momentum (or vectors). transmit/exhale/sink - or whichever term for projecting your momentum or vectors. Both using angles, timing, 'loose' structure, and a host of subtlties that are impossible to get with words and only can be understood by feel. all of those things aren't separate.
Quote: Ki is the balanced manipulation of momentum and force vectors....one part of doing that is with breathing - along with a thousand other things that don't amount to much just reading about it.
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Book presents photo tour of the Trans-Allegany Lunatic Asylum. A must if you're going to take a ghost tour!


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Based on a 2,000 calorie dietSee full nutrition
Ready In
Although I prefer the Herbed Corn recipe from AR, this was a nice side dish. I used about half frozen and half canned corn because that's what I had; rice vinegar in lieu of white wine vinegar; ...
This is really good if you like cold corn! Very simple and easy to put together. I didn't have tarragon so I used parsley, but didn't make any other changes.. Thanks for the new recipe to try.


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Jail Is Totally "In" This Season
This past Friday, Nicole Richie was charged with a misdemeanor DUI and faces mandatory jail time from ninety days up to one year. This comes as a result of her December 11th vehicular mishap in which Richie found herself heading down the wrong way on the 134 freeway in Burbank, CA. Richie's admission of driving under the influence of Viocodin and marijuana was partnered with the excuse that she was suffering from menstrual cramps.
Her arraignment is set to happen February 21st and personally, I think she should just try to figure out a way to capitalize on that shit with a new television show of her own. Maybe it could be a reality TV version of "Prison Break," in which she plots her escape by slipping unnoticed between the bars.


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1) As he made a 22% profit, the total amount he sold them for was 122%.
Now if you let the price he bought the items for be x:
How would you rearrange this formula to find x?
2) You are correct as the profit
3) Using the updated answer for a, have another attempt at c. I'll review your answer afterwards


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VY: Safety could slip, but within fed limitsBy Susan Smallheer Herald Staff | November 16,2005BRATTLEBORO Entergy Nuclear acknowledged Tuesday that a proposed power increase at the Vermont Yankee nuclear power plant would reduce safety margins but not below federal standards.
Entergy project manager Craig Nichols made that statement Tuesday during a daylong hearing before the Advisory Committee on Reactor Safeguards. The independent advisory group is examining several technical issues raised by Entergy's plans to increase power production by 110 megawatts, or 20 percent.
The morning was devoted to technical aspects of the project and the afternoon was set aside for public comment. Today, the state Department of Public Service will present its technical concerns with the power boost, which it says will reduce the margin of safety for the emergency core cooling pumps.
Graham Wallis, chairman of the advisory committee and a professor at Dartmouth College's Thayer School of Engineering, agreed the reactor would still be within federal operating standards but the safety margin would be smaller.
"You haven't maintained the margin, but you haven't crossed the limit," Wallis told Nichols.
The Nuclear Regulatory Commission's own Web site identifies corrosion, vibration, cracking and over-pressure concerns as problems associated with power boosts, and the advisory committee has earlier raised questions of its own on the pressure issue.
More than 50 residents from Vermont, New Hampshire and Massachusetts testified Tuesday afternoon. All urged the committee to reject the power increase.
At times during the afternoon session, more than 100 people filtered into the ballroom at the Quality Inn in Brattleboro to listen to the testimony.
Residents said the 33-year-old Vermont Yankee reactor in Vernon was unsafe at any level, but that the increased pressures of the increased production would make their lives less safe.
Most residents asked the technical advisory group for an independent, in-depth review of several safety systems at the plant similar to the inspection at Maine Yankee, which discovered costly problems ultimately leading to the plant's closure.
"Why not give us an independent safety assessment and make everybody happy?" asked Cole Simanson of Wilmington.
Jill Neitlich of Wardsboro said she was a psychotherapist and that many of her clients lived in "terror" something going wrong at Vermont Yankee.
"Would you put your child on a school bus that hadn't been inspected for 30 years?" she asked.
"We feel we are talking to the walls. You are our last resort," said Phil Allard of Deerfield, Mass., not far from Vermont Yankee.
Residents asked whether any of the committee members lived near a nuclear power plant or within the 10-mile evacuation zone.
Members of the nine-member board said they did live near a reactor, but not within the 10-mile zone.
Many residents raised perennial concerns about the disposal of high-level radioactive waste and the problems associated with evacuating thousands of residents in the event of an accident.
During the entire public session, only two people spoke in favor of the power boost former Gov. Thomas Salmon of Rockingham and an Entergy Nuclear engineer.
Salmon, who at one time was chairman of Green Mountain Power, formerly one of Vermont Yankee's owners, said the reactor was one of the few sources of locally produced power and valuable to the state.
John Daugherty of Chesterfield, N.H., an Entergy engineer, said he was able to change his Dutch relatives' minds last year when he pointed out that nuclear power didn't add to the toxic effects of greenhouse gases.
Entergy spokesman Robert Williams said the renovations and retrofitting at Vermont Yankee had increased the safety margins in some areas of the reactor's operation, but said it was true that in some areas the margins were smaller.
Williams said that, even with the reduction, "that's perfectly OK to operate."
NRC spokesman Neil Sheehan said that while the margin was reduced, the plant would still be able to operate safely. He said he didn't know exactly how much the safety margins had been reduced.
Contact Susan Smallheer at email@example.com IN NewsNarration and audio production by RH Alcott Full StoryNarration and audio production by RH Alcott Full Story
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|Spoilers for the week of June 9th; *updated 6/1 *
|Tweet Topic Started: May 28 2014, 04:13 PM (32,181 Views)
|May 28 2014, 05:58 PM Post #21
|Team Nicole
|May 28 2014, 06:00 PM Post #22
Regardless of what anyone thinks of daniel and jen,looking at it objectively, she was willing to throw a friend under the bus because she had to cover what she did to Eric with every lie she could think of. Then she has the unmitigating gall to lash out at them on top of that.
I can' t take Nicole anymore. The writers shifted her worst qualities into overdrive for this story.
|May 28 2014, 06:16 PM Post #23
Many seem to want to pen Jack's death on Gabi. The gas leak combined with the sparks from the fuse box in the tunnel caused the explosion, not Gabi. I could just as easily say Abby was somewhat complicit in Jack's death. Had she not been in the elevator at the time of the explosion, Jack wouldn't have tried to rescue her and subsequently fallen to his death. Gabi is guilty of the events that led to Melanie's kidnapping, but she did not cause Jack's death.
|May 28 2014, 06:23 PM Post #24
I still think Gabi will confess to the whole Melanie thing as her motive for killing Nick. He WAS holding it over her head to control her choices. Some of Gabi's final scenes are supposed to be intense, emotional ones with Abigail. I always assumed that Gabi's role in DAYSASTER will be revealed and Abigail will confront Gabi before she's sent to prison.
|May 28 2014, 06:26 PM Post #25
|Wrong or not, I'm still in Nicole's corner and will take anything that removes her from Dannifer's orbit. :mellow:
|May 28 2014, 06:27 PM Post #26
Wasn't it Andrew who caused the first explosion which lead to the subsequent explosions? If yes, it was Gabi's actions that lead to Andrew dragging Melanie into the tunnels and setting everything in motion. Is Gabi directly responsible for Jack's death? No, but there were consequences to her actions, and that includes the accidental deaths of 2 innocent people because Gabi was too busy trying to cover her ass instead of doing the right thing.
|May 28 2014, 06:28 PM Post #27
Gabi's emotional scenes with Abby could also be Gabi saying goodbye to her best friend and asking her to take care of her daughter for her since Abby is Ari's godmother.
|May 28 2014, 06:30 PM Post #28
I'm sure the "take care of my daughter since you're her godmother" will be a part of it. But I still think Abigail deserves to know what happened and to confront Gabi about it.
|May 28 2014, 06:32 PM Post #29
The fuse blew and it was a dark in the tunnel. Andrew initially opened a cigarette lighter to see and it caused the first small explosion. He was beating/shaking the fuse box trying to get the light back on. Had they not been in the tunnels that fuse box would still have short circuited and caused those explosions. I'm not defending Gabi hiring Andrew but seriously how can one blame her for that explosion. Had Ciara been in the tunnels using it as her secret hideout, would some blame her for the explosions and Jack's death.
Edited by cryin4days, May 28 2014, 06:41 PM.
|May 28 2014, 06:38 PM Post #30
|Is this the week Nicole threatens to kill Daniel? I hope Ari plays Nicole as a drunken badass and not the sappy, emotional wreck that Nicole has been for months now. #FreeNicoleFromDaniel
|May 28 2014, 07:04 PM Post #31
Yeah but that's not it. If Andrew and the others hadn't been at the tunnels at those times, the explosion might not have happened at the time when it did, when those people were gathered in the ballroom. Sure, it might have happened at another time, but by then the police or other residents could have been protected. And yes, Andrew shaked the fuse box and lit the match that set out the first explosion that probably was a catalyst to the later ones.
|May 28 2014, 07:06 PM Post #32
:applause: :rockon: Thank u Nicole!!! Lash'em and slash'em the hell out of your storyline. If Dannifer wants or needs some angst, they can go bark up another tree somewhere on the other side of Salem. As for Salem, I don't get this town :shame: there are enough mofo hypocrites running around in it that it's not even funny. But, FINALLY, the "shitty that never shoulda happened in the first damn place plot point" is over and for that alone, I'm ecstatic. :rockon:
As for it being Nicole's fault, of course it is. And it's something that she/Eric need to work through without the rest of the sanctimonious hypocrites of Salem throwing their cents in that won't even amount to a half-a-damn dollar.
As for the mess that happened with Gabi/Melanie/Chad, its all water under the bridge for me. And again, there are people that have committed far worse crimes that are still marching around in Salem USA. Again, the little town is filled with nothing but hypocrites. Surprised that glass houses aren't shattered every millisecond there.
|May 28 2014, 07:30 PM Post #33
Love To Love
:cheers: :hug:
|May 28 2014, 07:41 PM Post #34
Nicole doesn' t want to work through anything. She just wants to continue to lie to Eric. If not for her lies being exposed she would have been perfectly happy to continue to deceive Eric . Thats not love. Its a sick obssession . Eric needs to shed her like a bad habit and Nicole deserves to be all alone.
|May 28 2014, 07:46 PM Post #35
Surely if Gabi is responsible for killing Jack and Madison....
can't we blame Eric not being able to be a priest on Kristen.
|May 28 2014, 07:47 PM Post #36
|or Marlena and Brady .
|May 28 2014, 07:57 PM Post #37
Depends on how they write it in the future.
|May 28 2014, 08:08 PM Post #38
Always. Only because of AZ, though. If any other actress was playing Nicole, I don't think I would've lasted this long.
|May 28 2014, 08:10 PM Post #39
Oh I buy Marlena being mad at them after all I sure that she probably blames them for everything Nick did to Wilson and Arianna with his games and attempts (through the started before that) to keep Will & Sonny from Will's daughter, Sonny's step daughter and Gabi's daughter. But clearly here Gabi is the killer because I don't see else Marlena learns of what Kate & Sami did unless Gabi confesses to the successful attempt at murder and the attempt Nick survived months earlier.
|May 28 2014, 08:13 PM Post #40
Yes, it is Daniel and Jennifer's fault. They ruined the Ericole story with their epic suckage. They're like a black hole for creativity, every character associated with them gets destroyed at their altar.
I hope Nicole kills them.
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Chocolate Cream Pie
November 22, 2012 | Print | E-mail | Filed under chocolate, pie
Happy Thanksgiving! As promised, today I'm back with a pie for dessert, just in case you're looking for some last-minute inspiration. Although I do have recipes for twists on both apple and pumpkin pies, today I'm posting a recipe using something that my sister and I feel is often overlooked on Thanksgiving dessert tables: chocolate. This chocolate cream pie comes together as easily as my chocolate banana cream pie, especially if you already have a pie crust in your freezer that you can pull out the morning of or even the day before Thanksgiving if you want to blind bake the crust beforehand to save on oven space. Without further ado, here is the recipe. Have a wonderful day with family and friends, and enjoy the holiday!
For the pie: 1 pie crust
For the chocolate filling:
- 5 ounces semisweet chocolate, chopped
- 2 Tbsp unsalted butter
- 2/3 cup sugar
- 3 Tbsp cornstarch
- 1 1/2 Tbsp dark cocoa powder
- 1/4 tsp salt
- 3 egg yolks
- 1 cup heavy cream, divided
- 2 cups milk
For the whipped cream topping:
- 1 cup heavy cream
- 1/4 cup powdered sugar
- 1/2 tsp vanilla extract
Roll out the pie crust to 1/8? thick. Place in a pie dish and crimp the edges, if desired.
Preheat the oven to 425 degrees. Place a piece of parchment paper on the crust, and then fill the crust with pie weights, dried beans, or dried rice. Blind bake the crust for 30 minutes or until lightly browned. Let cool completely before filling.
Place the the chocolate and butter in a large mixing bowl.
Then, in a medium sauce pan, whisk together the sugar, cornstarch, cocoa, and salt. Stir in 1/2 cup of cream until smooth, and then whisk in the egg yolks. Gradually whisk in the remaining cream and milk and cook, stirring constantly, until the mixture thickens. Remove the pan from the heat and pour the cream mixture over the chocolate mixture. Strain to remove any lumps, if desired (I didn't).
Pour the filling into the pie crust and then press plastic wrap directly to the surface of the filling to prevent a film from forming on the top. Refrigerate at least two hours or until set.
In a medium bowl, beat the whipping cream until stiff peaks form. Pipe the whipped cream on top and chill until ready to serve. Garnish with mini chocolate chips, if desired.
14 Responses to "Chocolate Cream Pie"
Amanda @ Once Upon a Recipe Says:
November 22nd, 2012 at 1:47 pm
What a gorgeous pie! I adore chocolate, so I wouldn't mind a slice of this any time of year! I have a potentially dumb question, mostly because I rarely (ever) make pies. When you blind bake a crust, what do you do with the rice/beans afterwards. Can they still be used/cooked?
Happy Thanksgiving Tracy!
Katrina @ Warm Vanilla Sugar Says:
November 22nd, 2012 at 3:04 pm
I've never made a chocolate pie and they look so fabulous! Great recipe
Liz (Little Bitty Bakes) Says:
November 22nd, 2012 at 3:51 pm
This looks so good! I was just saying last night I think I'll make a chocolate cream pie soon (not today, too late!). I will have to tuck away your recipe.
Marie Says:
November 22nd, 2012 at 5:51 pm
Happy Thanksgiving, lady! This looks fabulous… might have to be a last-minute addition to our dinner tomorrow. Hope all is well with you!
Becca - Cookie Jar Treats Says:
November 23rd, 2012 at 10:06 am
This looks great!
I hope you had a wonderful thanksgiving
Jessica@AKitchenAddiction Says:
November 23rd, 2012 at 10:51 am
What a beautiful pie! Love how easy it is! Definitely will be keeping this in mind for upcoming Christmas parties!
Jen @ Savory Simple Says:
November 24th, 2012 at 12:00 am
I always like a bit of chocolate at Thanksgiving. You can never go wrong.
Tracy Says:
November 24th, 2012 at 3:32 pm
Amanda – Not a dumb question at all! I wouldn't eat the rice or beans once used, but I do keep using the same ones over and over again for pie weights – it's a cheap and easy solution!
Kristen Says:
November 26th, 2012 at 7:02 pm
Chocolate cream pie is a favorite of mine. Yours looks delicious!
Colleen @ What's Baking in the Barbershop?! Says:
November 26th, 2012 at 8:58 pm
This pie is gorgeous! That chocolate cream layer looks absolutely perfect!
Amber | Bluebonnets & Brownies Says:
November 27th, 2012 at 1:43 pm
Mmmm chocolate pie! Yes, yes yes.
Loretta | A Finn In The Kitchen Says:
November 27th, 2012 at 10:37 pm
I love what you did with the topping! The last time I made chocolate cream pie I figured the weighting wasn't that big of a deal. Big mistake. I'm using beans for sure next time!
Avanika {Yumsilicious Bakes} Says:
December 2nd, 2012 at 3:01 pm
This pie looks amazing. I love chocolate pies, though I haven't ever tasted a pumpkin pie yet. Need to make one someday soon.
shelly (cookies and cups) Says:
December 4th, 2012 at 9:23 am
Oh my word…this pie needs to happen. That filling!!


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Hi all.
Following NonCommAlgs example, I have decided to post a fun algebra (group theory) problem of my own on this forum.
Let where is an abelian group and is a cyclic group of order 2, and suppose contains an element with Find a binary operation on such that is a nonabelian group.
To NonCommAlg: If you know the answer to this one (and I have a feeling you do) please dont be too quick to reveal the answer. Let others have a chance to do the problem first.
Yes, that was what I had in mind.
For those who don't understand NonCommAlg's proof:Spoiler:The binary operation is this: For
Comments:Spoiler:You can verify that all the group axioms are satisfied for the operation defined above, but checking associativity directly can be rather time consuming. Fortunately, we have a theorem.
Let be any group, a cyclic group of order and an automorphism of such that is the identity automorphism. Then is a group with respect to the operation where
for all and
is known as the cyclic extension of by induced by the automorphism For a proof of the theorem (and more on cyclic extensions) see Chapter 21 of John F. Humphreys, A Course in Group Theory, Oxford University Press, 1996.
In our example, is the mapping which is an automorphism because is Abelian. And is not Abelian because whereas the two are not equal if