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Many HIV-infected persons learn about their diagnosis years after initial infection. The extent to which missed opportunities for HIV testing occur in medical evaluations prior to one's HIV diagnosis is not known.
We performed a 10-year retrospective chart review of patients seen at an HIV intake clinic between January 1994 and June 2001 who 1) tested positive for HIV during the 12 months prior to their presentation at the intake clinic and 2) had at least one encounter recorded in the medical record prior to their HIV-positive status. Data collection included demographics, clinical presentation, and whether HIV testing was recommended to the patient or addressed in any way in the clinical note. Prespecified triggers for physicians to recommend HIV testing, such as specific patient characteristics, symptoms, and physical findings, were recorded for each visit. Multivariable logistic regression was used to identify factors associated with missed opportunities for discussion of HIV testing. Generalized estimating equations were used to account for multiple visits per subject.
Among the 221 patients meeting eligibility criteria, all had triggers for HIV testing found in an encounter note. Triggers were found in 50% (1,702/3,424) of these 221 patients' medical visits. The median number of visits per patient prior to HIV diagnosis to this single institution was 5; 40% of these visits were to either the emergency department or urgent care clinic. HIV was addressed in 27% of visits in which triggers were identified. The multivariable regression model indicated that patients were more likely to have testing addressed in urgent care clinic (39%), sexually transmitted disease clinic (78%), primary care clinics (32%), and during hospitalization (47%), compared to the emergency department (11%), obstetrics/gynecology (9%), and other specialty clinics (10%) (P < .0001). More recent clinical visits (1997–2001) were more likely to have HIV addressed than earlier visits (P < .0001). Women were offered testing less often than men (P = .07).
Missed opportunities for addressing HIV testing remain unacceptably high when patients seek medical care in the period before their HIV diagnosis. Despite improvement in recent years, variation by site of care remained important. In particular, the emergency department merits consideration for increased resource commitment to facilitate HIV testing. In order to detect HIV infection prior to advanced immunosuppression, clinicians must become more aware of clinical triggers that suggest a patient's increased risk for this infection and lower the threshold at which HIV testing is recommended.
Approximately 900,000 persons in the United States are infected with HIV, a national prevalence of 0.3%.1,2 Current Centers for Disease Control and Prevention estimates suggest that 30% of these individuals are unaware of their diagnosis; as many as 275,000 people are infected with HIV but do not know it.3 HIV infection has become a chronic and treatable disease, but in order to benefit from treatments, infected individuals must be tested for the virus and linked to medical care. This is a challenging goal, as the infection is often asymptomatic until the onset of opportunistic infections, and without treatment the median time between diagnosis and the development of clinical AIDS is 9 to 11 years.4,5 Patients frequently become aware of their HIV serostatus very late in the course of their disease, many years after seroconversion.6 In two different clinical studies at our institution assessing patients between 1990 and 1991, and again from 1994 to 1996, the median CD4 cell count at the time of presentation for medical care for HIV infection was 300 and 280 cells/µl, respectively.7,8 Although delays do occur between HIV testing and linking to care,9,10 the greatest delay occurs between initial infection and HIV testing.7 The value of HIV testing goes beyond enabling medical care for the infected individual. Some studies have demonstrated that knowledge of HIV serostatus, particularly when positive, decreases behavior that can result in HIV transmission.11–13 Over a decade has passed since an early call to action about HIV testing was prominently stated, "the nation's physicians and other health care providers should assume a much more active role in promoting HIV testing."14
In order to assess the clinical response to this call to action, we investigated the extent to which physicians in a variety of care settings within a single urban medical center adopted recommended approaches to HIV testing. We assessed 2 issues among recently tested HIV-infected patients: 1) whether prior to HIV diagnosis, clinical opportunities for health providers to recommend HIV testing had arisen; and 2) the clinician's response regarding HIV testing when a clinical opportunity occurred.
We performed a retrospective chart review of patients who initiated HIV-related medical care at Boston Medical Center in the HIV Diagnostic Evaluation Unit (DEU) between January 1994 and June 2001. The DEU is a weekly clinic designed for the initial assessment and triage of all nonpregnant patients presenting for primary care (PC) for their HIV infection, regardless of insurance status.15 Referrals to the DEU come from a wide variety of sources, including inpatient hospital services, hospital outpatient clinics, the emergency department (ED), the urgent care clinic (UCC), community health centers, drug treatment programs, HIV testing sites, local correctional institutions, as well as self-referrals.
Patients were eligible for this study if they were 18 years or older, had their initial positive HIV test within 1 year of their DEU visit, and had received medical care at Boston Medical Center prior to their first positive HIV test. We included clinic visits only after March 1985, when HIV testing became widely available.6 Medical care at Boston Medical Center was required as these were the medical records available for review. This study was approved by the Institutional Review Board of Boston Medical Center.
We requested medical records of patients who met inclusion criteria based on the DEU clinic's log, which contained date of initial HIV-positive test and the hospital's computerized records, which listed the dates and sites of prior clinic visits and hospitalizations. Information abstracted from medical records included the following: date of birth, gender, race/ethnicity, homelessness status prior to initial positive HIV test, date of positive HIV test, initial DEU visit date, total number of visits to Boston Medical Center in the 10 years prior to the patient's initial positive HIV test, and CD4 cell counts.16 If 2 initial CD4 counts were available from the first month of HIV-related care, then the mean number was recorded. If, in the encounter note, a patient was noted as homeless or living in a shelter, then the patient was considered homeless. When medical records were incomplete (e.g., missing certain volumes of a multivolume chart), whatever visit data were available were assessed. Each visit in the 10 years prior to the patient's initial positive HIV test, but none earlier than March 1985, was reviewed for patient characteristics or conditions considered as clinical triggers for HIV testing (Table 1). Three of the authors—two medical students (EM, RU) and a medical resident (RL)—performed all chart reviews and recorded if the patient had any of the listed characteristics or conditions. Charts were reviewed with a predetermined list of clinical conditions. Chart reviewers could list other conditions that they considered potential triggers for HIV testing; however, after review with study investigators, greater than 95% of triggers came from the predetermined list. The site of the clinical encounter was recorded.
Triggers were hierarchically categorized based on the level of clinical suspicion for HIV infection associated with each after review of the medical literature.16 For example, injection drug use (IDU) and men having sex with men (MSM) were defined as category 1 (unequivocable triggers), while homelessness and alcohol abuse were defined as category 4 (borderline triggers). Visits were categorized according to the highest (i.e., most unequivocable) category trigger present during that visit. For example, if a visit noted injection drug use, homelessness, lymphadenopathy, and gonorrhea, it was defined as a category 1 visit, due to the presence of IDU. We stratified triggers as either unequivocal, strongly suggestible, reasonable, or borderline for triggering HIV testing discussions; categories were identified as 1 to 4, respectively. If a trigger diagnosis was considered but not made definitively such as "tuberculosis versus bronchitis," then that was labeled borderline, category 4, even if the differential diagnosis included conditions listed in categories 1 to 3.
A "missed opportunity" for HIV testing was a visit in which HIV was not discussed yet contained at least 1 of the patient characteristics defined as "triggers." Visits with physicians, nurse practitioners, nurses, and dentists were reviewed for the presence of HIV trigger conditions recorded in the clinical note. Although clinician type was not possible to abstract in the chart review, physicians account for the overwhelming majority of clinical encounters with the exception that nurse and nurse practitioner encounters were most common in the sexually transmitted disease (STD) clinic. If a visit included 1 or more triggers, then additional information was collected about that visit assessing visit location, date, and other triggers, as well as whether HIV testing was considered or recommended to the patient. Examples of the "HIV considered" group were notes that stated "HIV negative 4 months ago" and "HIV a possibility." All potential HIV-associated conditions were recorded and categorized into the diagnoses in Table 1.
Prior to medical record review, we explicitly defined several patient characteristics. Alcohol abuse was recorded if "alcohol abuse" or "alcohol withdrawal" was noted or if the patient had a history of alcohol detoxification or was being admitted to alcohol detoxification. If a patient was recorded as drinking 12 or more beers or 1 pint of liquor/day, that was also recorded as alcohol abuse. Psychiatric diagnoses included depression and anxiety in addition to schizophrenia and psychosis. Abnormal Pap smears included histories and/or diagnoses of cervical dysplasia and cervical cancer. Substance abuse was checked if it was not specified which substances were being abused. Tuberculosis was not recorded if a patient had only a positive PPD in the absence of a positive chest radiograph. Lymphadenopathy included lymph node biopsy in addition to generalized and localized lymphadenopathy found on physical exam. Pregnancy included those patients admitted for spontaneous or induced abortion in addition to those that were receiving prenatal care or were admitted for delivery. Homelessness was recorded for persons living in shelters in addition to street dwellers. The time period of the clinical encounter was divided into 4-year intervals beginning with 1985 to 1988 and continuing through 1997 to 2001.
Simple proportions of patients who had a record of a clinician's recommending or considering HIV infection were calculated for each of the trigger conditions. We examined triggers associated with a provider's missed opportunity to consider HIV testing using generalized estimating equation (GEE)17,18 as implemented in SAS PROC GENMOD (SAS Institute, Cary, NC). These models accounted for the correlation between visits recorded for a given subject. An exchangeable working correlation matrix was assumed, and an empiric variance estimator was used to generate standard error estimates for the regression parameters. Potential confounding variables (gender, age of first diagnosis, race/ethnicity, homeless status, and time period of the clinical encounter) were included in the model, along with visit site and trigger category. In secondary analyses, the model was also fit excluding visits from 1985 to 1993, to assess the consistency of results only using more recent data, and also refit excluding category 4 (borderline triggers).
We performed additional secondary analyses with 10 selected triggers of particular clinical interest: men having sex with men, community-acquired pneumonia, hepatitis B and/or C, homelessness, sexually transmitted diseases, weight loss, zoster, injection drug use, cocaine use, and alcohol abuse. For the analyses of the 10 individual triggers, we used an extended GEE model considering whether use of a particular trigger will yield different associations. These methods are similar to fitting separate logistic regression models for each of these specified triggers. A limitation of fitting separate models has been the lack of a method for deciding whether regression coefficients are different in the separate models, and how to combine results if they are not. We used new techniques19–21 to fit models that allow different parameters for the association between trigger and outcome to appear in each of the equations. Using this model, it is possible to test whether there are different associations between each of these triggers and the outcome. Each subject contributes 10 observations to the data set (one for each trigger) for each visit, with an indicator as to whether that trigger was observed for that subject. An exchangeable working correlation structure was used, with subject as the clustering variable. For these models, using the previous results for guidance, a parsimonious regression was fit that dropped race/ethnicity, homelessness status, and used a 2 category period variable (1985 to 93 vs 1994 to 2001).
Between 1994 and 2001, 1,400 patients were seen at the DEU clinic and of those, 358 preliminarily met the study eligibility criteria based on DEU and administrative hospital computerized records: HIV tested in the previous 12 months and received prior care at Boston Medical Center. Of the eligible 358 patients, medical records of 256 (72%) were located by the hospital records department. After review of the individual medical records, 7% (19/256) of patients were excluded because they did not meet 1 of the 2 eligibility criteria. Among the 237 remaining patient charts, we reviewed a total of 3,742 clinic visits. An additional 16 medical records were excluded because they did not have visits after March 1985, the year that the HIV test became widely available.6 Among the remaining 221 patients' medical records, 5 were incomplete, but the available data were included in this study. There were 3,424 clinic visits for the 221 patients included in the final analyses.
All 221 patients had one or more triggers for HIV testing found in at least one encounter note. Triggers for HIV testing were noted in 50% (1,702/3,424) of the eligible visits reviewed among the 221 patients. HIV testing was recommended to the patient in 18% (299/1,702) of visits in which triggers were noted. HIV was considered in the note by the clinician without recommending testing in another 10% of visits (169/1,702). In total, HIV testing was recommended or considered in the provider note in 27% (468/1,702) of visits with triggers noted. The median number of visits per patient with a trigger was 5 (mean 7.7). The median number of triggers that a patient had per visit was 2.0 (mean 2.1).
Demographic characteristics of the 221 patients (Table 2) include the following: 66% male, 49% African-American, 23% immigrants from an HIV endemic country, and 22% homeless. The mean age at the time of a positive HIV test was 39 years. In 44% of patients (96/220), the initial CD4 count was less than 200 cells/µl when diagnosed with HIV. The mean CD4 count was 328 cells/µl, while the median was 256 cells/µl. Only 51% (113/221) of patients had any PC visit in the Boston Medical Center system prior to the date of their initial positive HIV test.
Thirty-nine percent (670) of the clinical visits (n = 1,702) with HIV triggers were to the ED (370) or UCC (300). Primary care was the second most common clinical site with 18% (306). Hospitalization accounted for 13% (218) of such visits and obstetrics/gynecology 7% (119). Although HIV was addressed in 28% of the 1,702 visits, the percentage of these visits varied widely by site (Table 3). While 32% of visits to PC clinic and 39% of visits to UCC addressed HIV, only 12% of ED visits considered HIV infection. The site that most routinely considered HIV was STD clinic (78%), followed by hospitalization (47%). Other sites with low percentages for addressing the issue of HIV testing were other specialists (10%), obstetrics/gynecology (9%), and dermatology (14%).
The multivariable model for missed opportunities for recommending testing or considering HIV found that gender was a borderline significant predictor, with women being more likely to have a missed opportunity (odds ratio [OR], 1.42; 95% confidence interval [CI], 0.98 to 2.07). There was no overall association between race/ethnicity and discussion (degrees of freedom [d.f.], 4; P = .44). Older age at first HIV diagnosis was associated with missed opportunities (OR, 1.26 for each additional decade of age; 95% CI, 1.02 to 1.55), while homelessness (P = .90) had no significant association with HIV discussion or testing.
The year of the visit had a significant association with addressing HIV, showing that more HIV testing occurred over time (d.f., 3; P < .001). Compared to visits during the periods 1997 to 2001, visits during 1985 to 1988 (OR, 12.0; 95% CI, 6.0 to 23.9), 1989 to 1992 (OR, 3.6; 95% CI, 2.4 to 5.3), and 1993 to 1996 (OR, 1.9; 95% CI, 1.4 to 2.6) had greater odds of missed opportunities. Site of visit was also a significant predictor of missed opportunities for discussion (d.f., 7; P < .0001). Compared to the UCC, visits to the ED (OR, 4.2; 95% CI, 2.6 to 6.7), obstetrics/gynecology clinic (OR, 2.0; 95% CI, 1.1 to 3.6), other specialty clinic (OR, 4.0; 95% CI, 2.3 to 6.9), and surgical clinic (OR, 10.3; 95% CI, 2.0 to 53.3) had greater odds of a missed opportunity. Visits to the PC clinic (OR, 1.0; 95% CI, 0.7 to 1.5) were not significantly different from the UCC, while the STD clinic had lower odds of a missed opportunity (OR, 0.07; 95% CI, 0.04 to 0.15).
Trigger category was significantly associated with missed opportunities for testing (d.f., 3; P < .0001). Table 4 shows the percentage of time that HIV was discussed in visits stratified by trigger category. Compared to category 4 (borderline triggers), category 1 had lower odds of missed opportunities (OR, 0.05; 95% CI, 0.03 to 0.08), as did category 2 (OR, 0.13; 95% CI, 0.08 to 0.21) and category 3 (OR, 0.27; 95% CI, 0.18 to 0.42). There were also statistically significant differences in missed opportunities among trigger categories 1 to 3. Compared to categories 2 and 3, respectively, category 1 had lower odds of missed opportunities (OR, 0.38, 95% CI, 0.25 to 0.58; OR, 0.18, 95% CI, 0.12 to 0.28). Category 2 had lower odds of missed opportunities than category 3 (OR, 0.49; 95% CI, 0.34 to 0.70).
In secondary analyses using only visit data from 1993 to 2001, the results were generally consistent, though women had significantly more missed opportunities for HIV testing (P = .01), and the age association was attenuated (P = .16). Results from the regression model were also similar when the category 4 trigger visits were excluded from the analysis.
When individual triggers were compared to one another, there was a significant difference between trigger type and whether HIV testing was recommended or considered (d.f., 9; P = .05), indicating that there were significant differences in clinicians' perceptions of the associations between the individual triggers and HIV discussion (while controlling for gender, age, location, and period). To help illustrate these differences, Table 5 lists the unadjusted percentage of visits with specific triggers where HIV was recommended or considered. Men having sex with men as a trigger was associated with the highest proportion of HIV testing being recommended or considered, 71%. When injection drug use was noted, HIV testing was recommended or considered 54% of the time. Zoster was the weakest trigger for HIV testing recommendation or consideration among the 10 individually assessed triggers.
More than 2 decades after AIDS was first described, patients continue to present for initial HIV-related medical care years after acquiring the virus. Although diagnosis of HIV infection at an asymptomatic stage is a challenge, it is a goal worth pursuing, as early testing to achieve this objective can benefit both the patient and society.13,22–25 Examination of the medical care of HIV-infected persons prior to an HIV diagnosis has received limited attention.
Demographic characteristics of the 221 patients in this study are similar to national averages for HIV-infected persons: 66% male and 49% African-American compared to 70% male and 54% African-American nationally;26 44% with CD4 counts below 200 cells/µl, similar to 36% found in several other urban centers.27 Our study found that in less than 1 of 5 encounters with a clinical trigger for HIV infection, documentation was found in the chart that HIV testing was recommended to the patient. Clinical documentation of "consideration" of HIV infection, a less stringent criterion, occurred in only 28% of encounters. In the case of category 1 and 2 visits, with triggers such as injection drug use, lymphadenopathy, and varicella zoster, testing was recommended or considered only 52% for category 1 and 33% for category 2 visits.
A large number of the visits with triggers for HIV testing (39%, 670/1,702) were found in patients presenting to the ED or UCC, while 18% of visits were to PC clinic. Only half of the 221 patients had even 1 PC visit. This finding indicates that successful early HIV diagnosis in medical settings requires outreach beyond the PC clinical arena.
The site of the encounter was highly associated with HIV testing's being recommended or considered. Hospitalized and STD clinic patients had a relatively high level of addressing HIV while the ED and obstetrics/gynecology and surgical clinics had lower levels. Barriers to testing at these sites may relate to time pressures and absence of a structured system to facilitate testing. The STD clinic routinely highlights HIV testing on patient forms as a physician reminder, while the ED did not have a reminder system or a staff member to encourage HIV testing. However, neither the UCC nor PC clinic had a system for HIV testing, yet the rates of recommending HIV testing, while still poor, were 3 times that of the ED. Several possible explanations may account for the discrepancy between testing in the UCC and ED: the level of medical acuity in the UCC is less than the ED setting, and ED staff have less training in preventive medicine as compared to internal medicine physicians in the UCC. Only 21% of TB clinic patients with triggers had a documented HIV test recommendation. Considering that 28% to 46% of adults with TB in the United States are HIV infected,28 21% is a very low percentage. However, the small number of TB clinic encounters (n = 33) makes conclusions in this setting difficult.
Missed opportunities for HIV testing may reflect the lack of adequate HIV services in the clinics and ED. Requiring patients to return to an unfamiliar clinical setting like the ED to receive HIV test results may be more likely to result in persons not returning for test results.29 It is also necessary for transient care sites to have effective systems for follow-up so that patients who test positive are able to engage in care.30
Our data indicate that even when triggers for HIV are present, clinicians either do not think of testing or do not document the consideration of this diagnosis. Developing systems whereby patients with selected "trigger" conditions presenting to EDs or other sites with high HIV prevalence are automatically offered HIV testing independent of the provider, would increase testing yet not add substantially to the burden of the provider. The Centers for Disease Control and Prevention has recommended that all high prevalence hospitals, those with greater than 1 new diagnosis of HIV per 1,000 inpatients, should implement testing for all inpatients. Implementation of such recommendations has yielded enhanced case findings of undiagnosed HIV-infected individuals.31 Expanding this recommendation to other high-risk clinical sites would enhance testing efforts.
In November 2002, the Food and Drug Administration approved OraQuick, a rapid fingerstick test with results in 20 minutes (sensitivity of 99.6%, specificity of 100%).32 Its utility may be particularly valuable in the UCC and ED setting in which patients are less likely to return for test results.29 If instituted in the ED and other high-volume sites, rapid testing might enhance testing and increase linkage to care.33,34
The lower proportion of testing for females (24%) compared to males (31%) has been shown previously.35 As the HIV epidemic becomes increasingly equally distributed between men and women, this past bias in provider risk perception for HIV needs to be eliminated.
Another potential barrier to expanded testing is the requirement of informed consent prior to testing. This requires a provider's time, which may decrease testing recommendation. If broader testing is to be implemented and explicit written informed consent continues to be considered essential prior to testing, then resources to enable this activity will be necessary.
A limitation of our study was dependence on chart review methodology to determine whether HIV testing had been considered or recommended between providers and patients. It is possible that discussions occurred but were not accurately documented. Another limitation is the need to make explicit and categorize the triggers for HIV testing derived from recently published reports. This is necessarily an approximation and differences of opinion may exist about the categorization of particular characteristics or diagnoses. In addition, category 4 triggers may have been less broadly appreciated in the earlier years assessed. Another limitation is that these data reflect a single urban northeastern U.S. hospital. Although representative of many clinical settings, generalization of these results may not be applicable to all hospitals. Patients were chosen based on the existence of documented clinical encounters at the study institution prior to their knowledge of HIV infection. Some patients may have been ineligible due to their receiving care at other institutions prior to a positive HIV test. These patients' encounters may have differed from study patients.
Missed opportunities for earlier HIV testing have been the norm for patients who received medical care prior to their HIV diagnoses. Recommendation or consideration of HIV testing was noted in the clinical record in less than a third of such opportunities. Many HIV-infected patients received their medical care prior to HIV diagnosis at transient sites, the emergency department, and urgent care clinic. These data indicate the need to initiate expansive HIV testing in transient sites with high volumes of HIV-infected individuals. It should be the responsibility of providers in all clinical sites to ensure that opportunities to address HIV testing are not missed.
We appreciate Jennifer Whiteley's assistance with the preparation of this manuscript and Colleen LaBelle for her selfless efforts to address patients' needs in the DEU clinic and with the preparation of this manuscript. We would also like to thank Ernesto Falcon and the Medical Records Department of Boston Medical Center for their assistance with this project. Dr. Horton was supported in part by NIH grant NIMH RO1-MH54693. Ms. Urban and Ms. Maier were supported by the Boston University Medical Student Summer Research Program and the General Clinical Research Center at Boston University School of Medicine (M01-RR00533).
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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State of New York Supreme Court, Appellate Division Third Judicial Department
June 2, 2011
GEORGE H. FRISBEE ET AL., APPELLANTS,v.156 RAILROAD AVENUE CORPORATION ET AL.,DEFENDANTS, AND J.M. RICH, LLC, ET AL., RESPONDENTS.
Appeal from an order of the Supreme Court (O'Connor, J.), entered April 14, 2010 in Albany County, which, among other things, granted a motion by defendants J.M. Rich, LLC and J.M. Rich Enterprises, Inc. for summary judgment dismissing the complaint against them.
Calendar Date: April 18, 2011
Before: Mercure, J.P., Rose, Lahtinen, Kavanagh and McCarthy, JJ.
Plaintiff George H. Frisbee (hereinafter plaintiff) was installing a security system at a building undergoing renovations when he allegedly slipped and fell on carpet glue recently applied to the cement floor by a subcontractor on the project. The building was owned by defendant 156 Railroad Avenue Corporation and the relevant portion had been leased to defendant Hanes Supply, Inc. and related defendant entities (hereinafter collectively referred to as Hanes Supply). 156 Railroad contracted to have defendant Landmark Flooring Concept, Inc. renovate the premises, and Landmark subcontracted the carpeting work to defendants J.M. Rich, LLC and J.M. Rich Enterprises, Inc. (hereinafter collectively referred to as J.M. Rich). Hanes Supply contracted with plaintiff's employer, Sonitrol Security, for installation of a security system. Employees of J.M. Rich applied glue to the floor in preparation for installing a new carpet, but before they placed the carpet, plaintiff entered the room and fell.
Plaintiff and his wife, derivatively, commenced this action alleging liability under common-law negligence, Labor Law § 200 and Labor Law § 241 (6). Following disclosure, the parties made various substantive and procedural motions. Prior to Supreme Court's decision, plaintiffs discontinued their action as to 156 Railroad, Hanes Supply and Landmark. Supreme Court then granted J.M. Rich's motion for summary judgment dismissing the complaint in its entirety. Plaintiffs appeal contending that there are factual issues as to their Labor Law § 200 and common-law negligence causes of action.
The Labor Law § 200 cause of action was properly dismissed. That statute is directed at owners and general contractors, and the "rare case" where a subcontractor may be liable under the statute must include a showing that the subcontractor had "authority and control over plaintiff's 'work'" (Ryder v Mount Loretto Nursing Home, 290 AD2d 892, 894 [2002]; see Bell v Bengomo Realty, Inc., 36 AD3d 479, 481 [2007]; Rice v City of Cortland, 262 AD2d 770, 772 [1999]; see generally Guclu v 900 Eighth Ave. Condominium, LLC, 81 AD3d 592, 593 [2011]; Walsh v Sweet Assoc., 172 AD2d 111, 113-114 [1991], lv denied 79 NY2d 755 [1992]). J.M. Rich was a subcontractor of the general contractor, who had been hired by the owner. Plaintiff was on the premises as an employee of a security firm retained by the lessee. There is no proof that J.M. Rich had any authority or control over plaintiff's work and, thus, Labor Law § 200 liability by J.M. Rich is not implicated on these facts.
We find merit, however, in plaintiffs' argument that they raised triable issues regarding negligence. Where a subcontractor creates a condition on the premises that results in an unreasonable risk of harm and that condition is a proximate cause of a worker's injuries, then common-law negligence may be implicated (see Bell v Bengomo Realty, Inc., 36 AD3d at 481; Ryder v Mount Loretto Nursing Home, 290 AD2d at 894). Here, there was testimony by one individual familiar with commercial carpeting who described the glue as being "like ice" when first applied. Plaintiff testified at his deposition that he did not know glue had been applied, there were no barriers or caution tape in the doorway and none of the carpet installers otherwise warned him. According to plaintiff, when he walked into the room to attend to his work, he could not see the glue because the room had no windows and it was dimly lit. J.M. Rich contested much of plaintiff's testimony and presented contrary proof regarding key facts. However, the evidence must be viewed in the light most favorable to the opponent of summary judgment (see e.g. Bailey v County of Tioga, 77 AD3d 1251, 1253 [2010]). Plaintiffs' proof presented a scenario of J.M. Rich leaving a dimly lit room with a slippery surface and no warnings while knowing that other workers were in the vicinity. This is sufficient to raise a triable issue as to common-law negligence.
Mercure, J.P., Rose, Kavanagh and McCarthy, JJ., concur.
ORDERED that the order is modified, on the law, without costs, by reversing so much thereof as granted the motion of defendants J.M. Rich, LLC and J.M. Rich Enterprises, Inc. for summary judgment dismissing the common-law negligence cause of action against them; motion denied to that extent; and, as so modified, affirmed.
Robert D. Mayberger Clerk of the Court
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School district consolidation has been a hot issue for years. During a board meeting late last week, Las Vegas City Schools board member Luis Ortiz revealed a rough draft resolution that could potentially be approved by the boards of both the Las Vegas Schools and West Las Vegas Schools. If both boards approve the measure, the idea of consolidation of districts would be sent to the voters.
Ortiz brought up the measure for information, but the board took no action during Thursday evening's meeting.
President Gloria Lovato- Pacheco, Ortiz and member Felix Alderete said they are in support of consolidation. Members Gabe Lucero and Ernesto Salazar did not attend the meeting.
Ortiz told the board he previously discussed the issue with Lucero, who asked Ortiz to draft a resolution that could potentially be passed by both boards.
"The idea behind it is to simply take this question to the voters," Ortiz said.
The resolution states if the schools become consolidated, Las Vegas will have one administration and one board instead of the current two boards and two administrations. The plan is similar to the organization of both Albuquerque and Santa Fe Public Schools.
Ortiz said the diminishing population has affected graduating classes for years. Both schools had roughly 100 graduates this past year, compared to prior years, when both Robertson High School and West Las Vegas High School each had roughly 200 graduates. Ortiz said consolidation would not mean both high schools would combine into one, but would fall under one district administration and board.
"We would face our problems together as one town," Ortiz said.
He said the question could be on a ballot in 2014 or 2015, but he is unsure if that will come to fruition since both school boards would need to take action.
"Whether we do and do not believe in consolidation doesn't matter because it really just needs to get to the voters … The resolution will respect the wishes of voting public," Ortiz said.
"It is no secret that I am pro consolidation," Lovato Pacheco said.
Lovato-Pacheco told Ortiz she would work to have the question placed on the school board election ballot in February 2015, but she is unsure of the exact wording of the question.
"With the consolidation of schools we need to look at what the economic impact would be: Would it be positive or negative? We need to look at many things," Lovato Pacheco said. "This district, for one, needs to have its finances in order. I don't know what things West Las Vegas needs… It is just like every corporation in consolidation; everything needs to come together … It needs to be well thought out, and we keep students the focus of whatever it is we are going to do."
She added that the matter would have to be addressed to two counties, both San Miguel and Mora as both school districts have students who attend from both counties.
Member Alderete thanked Ortiz for bringing the consolidation issue to the board as it is "long overdue."
Alderete said he participated in a meeting several years ago to discuss consolidation.
"In that meeting it was obvious that there was pro and cons on the positions; it was almost 50/50. I think it is a good idea to take it to the electorate as all voices that choose to be heard will be heard in that fashion," Alderete said.
He said that consolidation could take place only by legislative action or the action of both school boards. Alderete said the public would be concerned about having two high schools.
"Even with a unified school district, you can still have two high schools, and I think also we can do other things that neither school district can do right now," Alderete said. "I think those that heard me when I ran for office know that I have been in favor of some unification of the two school districts — the administrative functions."
It is unclear how many board members would sit on the board if consolidation of both school districts would take place.
Ortiz said the resolution is something for thought until the boards take action on what to do next.
"It wouldn't change anything in the schools … Let's just tackle our problems together, as one town, as one city, for the betterment — that's for sure," he said.
In other business, the board:
• Approved a budget adjustment request that moved more than $12,000 from the supplies and materials line item to athletics.
The board is scheduled to meet Thursday evening to discuss the recently submitted 2011-12 audit completed by Griego Professional Services as well as other items, including the status of the district request for emergency supplemental funding from the state Public Education Department.
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|Publication number
|Publication type
|Application number
|Publication date
|Oct 3, 2006
|Filing date
|Aug 2, 2004
|Priority date
|Aug 2, 2004
|Fee status
|Also published as
|Publication number
|Michael S. Kappes
|Original Assignee
|Broadcom Corporation
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (8), Referenced by (4), Classifications (12), Legal Events (7)
|External Links: USPTO, USPTO Assignment, Espacenet
1. Field of the Invention
The invention is related to the areas of buffers and buffer amplifiers, such as unity gain buffers and replica amplifiers.
2. Description of the Related Art
Buffer circuits are used to provide buffering between a first circuit and a second circuit. In other words, a buffer circuit is normally used to transfer voltage from a first circuit, having a high impedance level, to a second circuit with a lower impedance level. The interposed buffer circuit prevents the first circuit from unacceptably loading the second circuit and thus interfering with its desired operation.
If the voltage transferred is unchanged, the amplifier is known as a unity gain buffer. A simple unity gain buffer may be constructed by connecting the output of an operational amplifier to its inverting input, and using the non-inverting input. Other unity gain buffers may include an emitter follower, Darlington pair, or similar configurations using field effect transistors, vacuum tubes or other active devices.
Two preferred traits of a buffer amplifier are high input impedance and low output impedance. In addition, succeeding stages should be linear so as not to introduce distortion. As a result, there can be difficulty involved in designing a buffer stage that is linear and has sufficient bandwidth to process the signal with enough linearity such that distortions are not introduced. Feedback is typically used in this situation. However, there are limitations with respect to the amount of feedback that may be applied, the bandwidth of the feedback, and the loop gain that results.
In a related system, replica amplifiers may be used within a replica structure in order to predict a normal amplifier response and then couple the replica amplifier with a normal feedback amplifier such that the feedback system now only needs to do small corrective changes to the output. For example, if driving 1V into 1-ohm load, a replica amp may be used to supply the bulk of the current and the feedback amplifier can then operate with much lower currents.
Nevertheless, achieving both wide bandwidth and high linearity can be challenging. The previous topologies, discussed above, do not adequately address the need for wide bandwidth and high linearity within desirable power limitations. The claimed invention, however, is able to achieve higher linearity than previous solutions for a given power and area budget.
In one embodiment of the claimed invention, a buffer circuit is provided. The buffer circuit includes a first stage. The first stage includes a first amplifier and at least one device. The buffer circuit also includes a second stage. The second stage includes a second amplifier and at least two devices. The second stage forms an open loop between at least one of the devices and the second amplifier.
In another embodiment of the claimed invention, a buffer circuit is provided. The buffer circuit comprises a first amplifying means for receiving an input signal, and a first transistor means for receiving an input from a first amplifier and sending an output to the first amplifier, thereby forming a feedback loop. The circuit further includes a second transistor means for receiving an input from a first amplifier and a third transistor means for receiving an input from a second amplifier. The circuit also includes outputting means for outputting an output signal, wherein the output signal has low impedance.
In another embodiment of the claimed invention, a method of operating a buffer circuit is provided. The method includes the step of receiving an input signal at a first stage. The first stage includes a first amplifier and a first device. The method also includes the steps of sending a signal from the first amplifier to the first device and feeding back a signal from the first device to the first amplifier. The method further includes the step of sending a signal from the first stage to a second stage, the second stage including an open loop. The method also includes outputting, at the second stage, an output signal with low impedance.
For proper understanding of the invention, reference should be made to the accompanying drawings, wherein:
In one embodiment, the invention is intended for use as a buffer stage in a signal chain to drive low impedances or large capacitances with high linearity. The claimed invention may also be used as a reference voltage buffer where its wide bandwidth ensures power supply noise rejection at high frequencies.
One example of the invention can include amplifiers A1 and A2, as shown in
Referring to
The second stage, illustrated by
Therefore, in an embodiment of the invention, the linearity of the system is extended by applying two loops to the feedback around a source follower. A first loop makes the majority of the correction required to correct the non-linearity of the source follower stage and applies it in an open loop fashion. As a result, the secondary loop will not require as much loop gain because the source follower stage has already been linearized by the first loop. Consequently, the combination of the two loops will additively reduce distortion in the buffer stage.
Again referring to
The voltage developed by the replica stage is used in the second stage as an input to a wide-band amplifier A2. The solution provided in this example of the invention utilizes the first stage to approximate the signal required, and then uses the second amplifier to perform the remaining correction. Thus, if M1 receives a stable load and M2 receives a variable load, then A2 performs all of the correction with respect to the load, i.e. A2 handles the bulk of the load changes. The performance of the source follower is thereby augmented with an additional loop. The invention may allow M2 to provide a majority of current in signal transfer processing while M3 maintains access to the correction mechanism.
Utilizing this circuit configuration, the first amplifier dominates for moderate frequencies while the second amplifier takes over for high frequencies.
An advantage of the configuration provided by the embodiment illustrated in
Additionally, the claimed invention is not limited to a unity gain situation. For example, the resistor ratio may be changed in order to provide the system with gain.
Therefore, the circuit presented achieves higher linearity than other solutions for a given power and area budget. This is due, in part, to the complementary action of the two feedback loops. The primary loop reduces the burden of the secondary loop and thereby enhances the impact of the secondary loop's gain.
One having ordinary skill in the art will readily understand that the invention as discussed above may be practiced with steps in a different order, and/or with hardware elements in configurations which are different than those which are disclosed. Therefore, although the invention has been described based upon these preferred embodiments, it would be apparent to those of skill in the art that certain modifications, variations, and alternative constructions would be apparent, while remaining within the spirit and scope of the invention. In order to determine the metes and bounds of the invention, therefore, reference should be made to the appended claims.
|Cited Patent
|Filing date
|Publication date
|Jun 26, 1963
|May 3, 1966
|Beckman Instruments Inc
|A. c. coupled pulse amplifier with floating input and grounded output
|Oct 16, 1992
|Apr 5, 1994
|Suesserman Michael F
|Bootstrapped, AC-coupled differential amplifier
|May 23, 1995
|Apr 15, 1997
|Sgs-Thomson Microelectronics S.R.L.
|Class AB output amplifier stage
|Mar 6, 1996
|Mar 7, 2000
|Takeshi Ikeda
|Tuning amplifier
|Dec 19, 1997
|Nov 7, 2000
|Canon Kabushiki Kaisha
|Sample hold circuit and semiconductor device having the same
|Oct 28, 1999
|Aug 14, 2001
|Texas Instruments Incorporated
|Efficient microphone bias amplifier with high output voltage/current capability and excellent PSRR
|Jan 18, 2001
|Mar 19, 2002
|Texas Instruments Incorporated
|Slew rate boost circuitry and method
|Jul 12, 2002
|Nov 30, 2004
|Texas Instruments Incorporated
|Amplifier gain boost circuitry and method
|Citing Patent
|Filing date
|Publication date
|Feb 21, 2008
|Nov 15, 2011
|Mediatek Inc.
|Microphone bias circuits
|Feb 16, 2012
|Apr 23, 2013
|Acp Advanced Circuit Pursuit Ag
|Method and apparatus to linearize transconductors by predistortion
|Feb 21, 2008
|Aug 27, 2009
|Mediatek Inc.
|Microphone bias circuits
|Feb 16, 2012
|Aug 16, 2012
|Acp Advanced Circuit Pursuit Ag
|Method and apparatus to linearize transconductors by predistortion
|U.S. Classification
|330/69, 330/85
|International Classification
|Cooperative Classification
|European Classification
|May 12, 2004
Owner name: HEWLETT-PACKARD DEVELOPMENT COMPANY, L.P., TEXAS
Free format text: CHANGE OF NAME;ASSIGNOR:COMPAQ INFORMATION TECHNOLOGIES GROUP LP;REEL/FRAME:014628/0103
Effective date: 20021001
|Dec 21, 2004
Owner name: BROADCOM CORPORATION, CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:KAPPES, MICHAEL S.;REEL/FRAME:016095/0353
Effective date: 20041210
|Mar 23, 2010
|Fee payment
Year of fee payment: 4
|May 16, 2014
|Maintenance fee reminder mailed
|Oct 3, 2014
|Lapse for failure to pay maintenance fees
|Nov 25, 2014
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Effective date: 20141003
|Feb 11, 2016
Owner name: BANK OF AMERICA, N.A., AS COLLATERAL AGENT, NORTH
Free format text: PATENT SECURITY AGREEMENT;ASSIGNOR:BROADCOM CORPORATION;REEL/FRAME:037806/0001
Effective date: 20160201


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Enjoy the luxurious look and feel of genuine full- or top-grain leather in a look that is causal yet contemporary with the Omnia City Crafts sofa. The perfect choice for homes with kids, this leather sofa is durably constructed on a kiln-dried hardwood frame reinforced with corner blocking to allow it to stand up to hard daily use. With track arms, three simplified back cushions, and stout tapered block feet, the sofa has a rustic-chic style that will work with many decorative schemes. Both the color of the leather and the finish on the wood feet is customizable to suit your tastes.


text:
|By Derek Kol
Article Rating:
|February 22, 2014 02:00 PM EST
Author: Courtenay Troxel, Zetta.net
With the cloud in its sights as a fast-track strategy for growth, SHI International Corp. has partnered with Zetta.net to round out its expanding portfolio with an enterprise-grade cloud backup and disaster recovery (DR) solution.
SHI, which has transformed over the years from a $1 million "software-only" reseller into a $4 billion global provider of information technology products and services, says cloud offerings are crucial to attracting small- and medium-size businesses, which are constantly looking for ways to reduce cost, increase efficiency, and improve accessibility to mission-critical, enterprise IT systems.
Cloud backup, which fills a business need in SHI's cloud services lineup, is of particular interest to SMBs. They have been crying out for a secure, enterprise-grade solution that can address sophisticated backup and disaster recovery requirements without breaking the bank and without adding a layer of complexity that would discourage the use of technology.
"Zetta.net's service fills a business need for our customers' by providing an enterprise-grade cloud backup and disaster recovery solution at a price that small and medium businesses can afford," noted Rich Place, SHI's general manager of cloud solutions.
HIAS Ditches Error-Prone Tapes
SHI's new cloud service addition has been a boon for HIAS, a New York-based organization that helps protects the rights of refugees worldwide, and an SHI customer for 15 years. The company had historically used tape backup to safeguard between 1TB to 2TB of data, but its current solution was lacking in terms of both ease of use and cost. Specifically, it found the legacy tape drives to be error-prone, however it was far too costly and time consuming to replace the old tape backup equipment and the tapes themselves.
Enter SHI with Zetta.net's enterprise-grade cloud backup and DR solution. With Zetta.net, SHI helped HIAS overcome its backup challenges, allowing for faster and more efficient backups in their environment. And combined with the unique drive mounting capability for the cloud data, it ensures faster and easier recovery, HIAS IT Director Frank Rotondi said.
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For more on Zetta.net's partner program, go to www.zetta.net/partners.
Courtenay is Zetta's content creator, marketing strategist, and ninja in training.
Internet of @ThingsExpo has announced today that Chris Matthieu has been named tech chair of Internet of @ThingsExpo 2017 New York The 7th Internet of @ThingsExpo will take place on June 6-8, 2017, at the Javits Center in New York City, New York. Chris Matthieu is the co-founder and CTO of Octoblu, a revolutionary real-time IoT platform recently acquired by Citrix. Octoblu connects things, systems, people and clouds to a global mesh network allowing users to automate and control design flo...
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"We are an all-flash array storage provider but our focus has been on VM-aware storage specifically for virtualized applications," stated Dhiraj Sehgal of Tintri in this SYS-CON.tv interview at 19th Cloud Expo, held November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA.
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With 15% of enterprises adopting a hybrid IT strategy, you need to set a plan to integrate hybrid cloud throughout your infrastructure. In his session at 18th Cloud Expo, Steven Dreher, Director of Solutions Architecture at Green House Data, discussed how to plan for shifting resource requirements, overcome challenges, and implement hybrid IT alongside your existing data center assets. Highlights included anticipating workload, cost and resource calculations, integrating services on both sides...
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Unless your company can spend a lot of money on new technology, re-engineering your environment and hiring a comprehensive cybersecurity team, you will most likely move to the cloud or seek external service partnerships. In his session at 18th Cloud Expo, Darren Guccione, CEO of Keeper Security, revealed what you need to know when it comes to encryption in the cloud.
Dec. 8, 2016 04:00 AM EST Reads: 4,811
"We're a cybersecurity firm that specializes in engineering security solutions both at the software and hardware level. Security cannot be an after-the-fact afterthought, which is what it's become," stated Richard Blech, Chief Executive Officer at Secure Channels, in this SYS-CON.tv interview at @ThingsExpo, held November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA.
Dec. 8, 2016 04:00 AM EST Reads: 1,029
According to Forrester Research, every business will become either a digital predator or digital prey by 2020. To avoid demise, organizations must rapidly create new sources of value in their end-to-end customer experiences. True digital predators also must break down information and process silos and extend digital transformation initiatives to empower employees with the digital resources needed to win, serve, and retain customers.
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"We are the public cloud providers. We are currently providing 50% of the resources they need for doing e-commerce business in China and we are hosting about 60% of mobile gaming in China," explained Yi Zheng, CPO and VP of Engineering at CDS Global Cloud, in this SYS-CON.tv interview at 19th Cloud Expo, held November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA.
Dec. 8, 2016 02:30 AM EST Reads: 1,115
The WebRTC Summit New York, to be held June 6-8, 2017, at the Javits Center in New York City, NY, announces that its Call for Papers is now open. Topics include all aspects of improving IT delivery by eliminating waste through automated business models leveraging cloud technologies. WebRTC Summit is co-located with 20th International Cloud Expo and @ThingsExpo. WebRTC is the future of browser-to-browser communications, and continues to make inroads into the traditional, difficult, plug-in web co...
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Between 2005 and 2020, data volumes will grow by a factor of 300 – enough data to stack CDs from the earth to the moon 162 times. This has come to be known as the 'big data' phenomenon. Unfortunately, traditional approaches to handling, storing and analyzing data aren't adequate at this scale: they're too costly, slow and physically cumbersome to keep up. Fortunately, in response a new breed of technology has emerged that is cheaper, faster and more scalable. Yet, in meeting these new needs they...
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When it comes to cloud computing, the ability to turn massive amounts of compute cores on and off on demand sounds attractive to IT staff, who need to manage peaks and valleys in user activity. With cloud bursting, the majority of the data can stay on premises while tapping into compute from public cloud providers, reducing risk and minimizing need to move large files. In his session at 18th Cloud Expo, Scott Jeschonek, Director of Product Management at Avere Systems, discussed the IT and busin...
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In his general session at 19th Cloud Expo, Manish Dixit, VP of Product and Engineering at Dice, discussed how Dice leverages data insights and tools to help both tech professionals and recruiters better understand how skills relate to each other and which skills are in high demand using interactive visualizations and salary indicator tools to maximize earning potential. Manish Dixit is VP of Product and Engineering at Dice. As the leader of the Product, Engineering and Data Sciences team at D...
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The Internet of Things (IoT) promises to simplify and streamline our lives by automating routine tasks that distract us from our goals. This promise is based on the ubiquitous deployment of smart, connected devices that link everything from industrial control systems to automobiles to refrigerators. Unfortunately, comparatively few of the devices currently deployed have been developed with an eye toward security, and as the DDoS attacks of late October 2016 have demonstrated, this oversight can ...
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What happens when the different parts of a vehicle become smarter than the vehicle itself? As we move toward the era of smart everything, hundreds of entities in a vehicle that communicate with each other, the vehicle and external systems create a need for identity orchestration so that all entities work as a conglomerate. Much like an orchestra without a conductor, without the ability to secure, control, and connect the link between a vehicle's head unit, devices, and systems and to manage the ...
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Concerned that flight cutbacks and higher fares could negatively affect tourism, Caribbean leaders will discuss ways to handle the crunch at their annual Caricom summit. The Caribbean region attracted more than 15 million tourists to its beaches and cities last year and depends on tourism for its economic health. "We are poised at a very interesting period with some of the challenges that face us," said Harold Lovell, tourism minister for Antigua and Barbuda.
Full Story:MSNBC


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Where is the SNOW!!!
Items that do not fit the categories above.
- ajkagy
- Posts: 2654
- Joined: Sun Jan 07, 2007 8:34 pm
- Location: Crested Butte, CO
Re: Where is the SNOW!!!
17.5 in. reported at Monarch this morning...love it
- susanjoypaul
- Posts: 1999
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- Location: Colorado Springs
Re: Where is the SNOW!!!
JTOlson26 wrote:What kind of snowfall totals has everyone received so far? A friend who teaches at Cheyenne Mountain in Colorado Springs said they had school called off last night and I saw where Widefield had a good 6-8 inches.
Just over the tops of my down booties on the west side of Colorado Springs, so I guess that's about 8". Brrr... cold ankles!
- ameristrat
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Re: Where is the SNOW!!!
4-5" in DTC
You cannot stay on the summit forever; you have to come down again. So why bother in the first place? Just this: What is above knows what is below, but what is below does not know what is above. One climbs, one sees. One descends, one sees no longer, but one has seen. There is an art of conducting oneself in the lower regions by the memory of what one saw higher up. When one can no longer see, one can at least still know. - Rene Daumal
- TallGrass
- Posts: 1820
- Joined: Fri Jun 29, 2012 3:25 pm
Re: Where is the SNOW!!!
We got a foot of it here with 2' drifts common including some thundersnow throughout the morning. Bottom layer was powder with the top firmer letting one sweep out the bottom on your car and leave the top suspended. Planning on snayaking today or tomorrow.
Prairie Village, KS (KC)
Prairie Village, KS (KC)
Not sure if I'll do more 14ers. The trip reports are too tiring.
- kushrocks
- Posts: 759
- Joined: Tue Jun 22, 2010 8:38 am
- Location: Golden/Lakewood, Colorado
Re: Where is the SNOW!!!
Tallgrass where were those photos taken?
"The best climber in the world is the one who is having all the fun." – Alex Lowe
"To travel, to experience and learn, that is to live" - Sherpa Tensing Norgay (first person to Summit Mt. Everest)
"Wilderness is not a luxury but a necessity of the human spirit" - Edward Abbey
" Don't be afraid to move out of your comfort zone. Some of your best life experiences and opportunities will transpire only after you dare to loose."
"To travel, to experience and learn, that is to live" - Sherpa Tensing Norgay (first person to Summit Mt. Everest)
"Wilderness is not a luxury but a necessity of the human spirit" - Edward Abbey
" Don't be afraid to move out of your comfort zone. Some of your best life experiences and opportunities will transpire only after you dare to loose."
- PaliKona
- Posts: 921
- Joined: Wed Sep 24, 2008 3:04 pm
Re: Where is the SNOW!!!
Almost 3 feet at Monarch in the past 2 days
- TallGrass
- Posts: 1820
- Joined: Fri Jun 29, 2012 3:25 pm
Re: Where is the SNOW!!!
Locations to side of photos (news source). All from Kansas City area. Just got in from doing the second half of the drive way... TIRED Sidestreets are a rutted mess. One guy here was able to get out in his 4x4 with some spinning and a couple others got stuck in the street trying to get out. Taking the scooter out later for coffee -- I can drag it through/over any place I get stuck until I get to the main street which will be good enough. Snow Day! All the sledding kids (big ones too) and Xcountry skiers are eating it up!kushrocks wrote:Tallgrass where were those photos taken?
Wichita got 14.2"[/b], second only to the 1962 storm. Link has other storm impact data. It's not that we're not snow-prepared, it's that it came down so quick like 2" per hour at one point. Bulk came down 7am-12n so LOTS of cars got stuck or spun off trying to get home.
Not sure if I'll do more 14ers. The trip reports are too tiring.
- Presto
- Posts: 2009
- Joined: Tue Jun 26, 2007 8:04 am
- Location: Denver
Re: Where is the SNOW!!!
by PaliKona » Fri Feb 22, 2013 8:04 am
Almost 3 feet at Monarch in the past 2 days
Current webcam ... just beautiful.
- Attachments
- monarch_pass.jpg (36 KiB) Viewed 437 times
As if none of us have ever come back with a cool, quasi-epic story instead of being victim to tragic rockfall, a fatal stumble, a heart attack, an embolism, a lightning strike, a bear attack, collapsing cornice, some psycho with an axe, a falling tree, carbon monoxide, even falling asleep at the wheel getting to a mountain. If you can't accept the fact that sometimes "s**t happens", then you live with the illusion that your epic genius and profound wilderness intelligence has put you in total and complete control of yourself, your partners, and the mountain. How mystified you'll be when "s**t happens" to you! - FM
- Scott P
- Posts: 6421
- Joined: Wed May 04, 2005 10:46 am
- Location: Craig
Re: Where is the SNOW!!!
We got an inch. I don't think the mountains around here got that much either. According to the ski report, Steamboat got 6" at mid mountain from this storm, but I guess every little bit helps.
I'm slow and fat. Unfortunately, those are my good qualities.
- rijaca
- Posts: 2689
- Joined: Sat Jul 08, 2006 7:36 pm
- Location: Minglewood
Re: Where is the SNOW!!!
Monarch is reporting 12" in the past 24 hours, and 30" in the past 48 hours.
"Well a couple shots of whiskey, women `round here start looking good"
- mountaingoat-G
- Posts: 901
- Joined: Fri Sep 21, 2007 11:42 am
- Location: west metro suburbs
Re: Where is the SNOW!!!
- KyleS
- Posts: 180
- Joined: Mon Aug 15, 2011 12:22 pm
Re: Where is the SNOW!!!
Wolf Creek just broke 30" for the storm and it's still PUKING snow up here.
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Distances are calculated in a straight line and may not reflect actual travel distance.
A substantial apartment in a prestigious portered building on High Street Kensington. This apartment is situated on the first floor (with lift access) and comprises a large double reception room, eat in kitchen, four bedrooms, two bathrooms and guest WC. The property is flooded with natural light and further benefits include a long lease and use of a communal roof terrace. Situated moments from the many shops, restaurants and transport links of Kensington High Street and Kensington Church Street and the green open spaces of Kensington Gardens.
Four bedroom apartment
Prestigeous portered building
Two bathrooms
First floor
Wood floors throughout
EPC - Band D
High Street Kensington on your doorstep
Close to Kensington Gardens
Sorry, no pets
Closest station - High Street Kensington
Contact branch for relevant Energy Performance Certificate
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Paul Greer who teaches physics at St Peter the Apostle High School in Clydebank scooped the prize for innovation at the 2012 Scottish Qualifications Authority Star Awards for his series of Glesga Physics videos. Under the tutelage of the eminent 'Professor Valdo', Paul's videos complement students' learning with a uniquely Glaswegian approach to key components of the Higher Physics Course.
Over the past two years, the series had built up a loyal following on YouTube and has become extremely popular and widely-used by Higher Physics pupils across Scotland.
The videos have also gained a cult following from further afield as learners from around the world subscribe to hear Professor Valdo's take on topics just as semi-conductors, momentum and Newton's Laws of Motion.
Coatbridge College's student run campus healthcare programme and Cumbernauld College's annual course review tool were both highly commended.
Winner: St Peter the Apostle High School, West Dunbartonshire
Paul Greer with Kenneth Muir
Highly Commended
Highly Commended: Coatbridge College
Highly Commended: Cumbernauld College


text: Stores Dealer Profile MURPHYS FURNITURE Shaw believes in its people, products and mission. Purchasing flooring can be daunting, but we're committed to making easier for you every step of the way. Shaw creates a better future – for our customers, our people, our company and our communities. This attention to detail and extreme focus can be found in our beautiful, innovative products. Store Information GET DIRECTIONS 301-305 Main Street Caldwell, OH 43724 740-732-5700 Flooring CarpetResilient View all stores


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Description from the manager
Description from the manager
Bedrooms: 4/
Bathrooms: 3/
Sleeps: 9/
Type: Villa
Book this 4 bedroom, 3 bathroom villa in Argaka today! A total of 9 people can sleep here comfortably.
Guests can enjoy a outdoor grill, air conditioning, and parking space among other amenities offered by this rental.
No travelers have shared a review of this property yet.
The owner responds to 40% of inquiries, which is lower than average, and last updated the property's calendar today.
About the manager
About the manager
Agni Travel
Agni Travel
- Response rate: 40%
- Response time: Within a day
- Calendar updated: today
Overall rating:
4.1 / 5.0
Proximity to TripAdvisor's Top Argaka Attractions
Proximity to TripAdvisor's Top Argaka Attractions
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You are here
Manager/Senior Manager - Business Management, Private Banking
Hong Kong
Bullet points
- Reputable private bank
- Reasonable work-life balance
About Our Client
Our client is a top-tier bank with businesses across Investment Banking and Private Banking. To support its growing business, it is adding a new headcount to its Business Management team.
Job Description
Job responsibilities include:
- Provide oversight on daily operations of PWM, ensure service quality and consistency across front office
- Develop good knowledge on products and regulations around investments, interpret new regulations alongside with compliance and recommend relevant process changes
- Contribute to review and implementation of new products
- As first point of contract for issues and queries coming from Sales and Client Service Associates
- Supervise Client Service Assistants, responsible for transaction reviews and special trade approvals
- Handle and resolve customer complaints and any issues in trade booking, settlement and funding
- Participate in ad hoc projects in PWM
The Successful Applicant
Suitable candidates should have:
- Bachelor degree in Finance, Accounting, Business Administration or relevant disciplines
- At least 5 years of relevant experience in private banking
- Good understanding in PWM products and relevant regulations
- Ability to multi-task and work under pressure
- Good level of English, Mandarin and Cantonese
- Excellent communication skills
- HKMA/SFC Type 1 and 2 licenses
What's on Offer
Successful candidate will be offered competitive salary package, including annual leave and medical coverage.


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The 1940s Classic Ford Cars Channel covers popular antique Fords from the decade. Take a look under the hoods of 1940s classic Ford cars.
1949 Ford
The 1949 Ford was the result of an intense design competition with controversy over who gets credit for certain elements. This was the first modern Ford the company produced after the death of Henry Ford in 1947. Learn about the 1949 Ford.
The 1949-1951 Ford Mercury Woody was not the most reliable car, but they were popular nonetheless. Learn more about the 1949-1951 Ford Mercury Woody. See more »
The 1941-1948 Ford Super DeLuxe was a popular and attractive line that saved Ford Motor Company during the strife-filled World War II era. Read more. See more »
The 1949 Ford origins stretch all the way back to infighting between Henry and Edsel Ford in the early '40s. Learn about the origins of the 1949 Ford. See more »
A lesser-known jeep prototype -- the extremely rare 1944 Ford GWP Military Jeep -- was made for the Army by Ford during World War II. Learn more. See more »
1949 Ford Custom V-8 (exc. Sedans)
The 1949 Ford Custom V-8 (exc. Sedans) were good driver's cars and important historically. Learn more about the significance of this collectible car. See more »
1946-1948 Ford V-8 Super DeLuxe Sportsman
Ford's 1946-1948 V-8 Super DeLuxe Sportsman was an attractive car that's still coveted today. Learn about the Ford V-8 Super DeLuxe Sportsman. See more »


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Having unwanted fat in different locations of your body can have a substantial impact on your health and self-esteem. While traditional weight-loss through workout and diet is an excellent way to lose weight overall, even the best workouts can't target problem locations like the tummy, inner thighs, arms, and butts. Liposuction is a time tested treatment that is utilized to get rid of excess fat from specific locations of the body, permitting a specific to shape and contour their body to their preference. Is liposuction right for you? Discover now.
Pros of Liposuction
There are lots of benefits to this cosmetic treatment, consisting of:
• Immediately obvious changes. Unlike conventional weight loss, liposuction develops modifications that are immediately visible in the body. Some difference is noticeable right away, and the desired outcomes are generally achieved in simply a couple of days.
• Proven and safe. This cosmetic treatment has been carried out by experienced surgeons all over the world for many years and the strategy has actually been refined over and again to be safe and effective.
• Recovery time is usually fast. The downtime required after having this type of treatment is generally much less than what is required for other kinds of cosmetic treatments, including abdominoplasty, breast reduction, and more. People who have had the procedure can often go back to work much more rapidly than they expected and can return to living a healthy, active lifestyle.
• Weight loss can be permanent. With the right upkeep strategies, the fat that was removed during the liposuction procedure will not return.
• Complete control over your body. With liposuction, a person can have complete control over how they wish to look, beyond exactly what conventional diet plan and exercise can provide. Offering individuals this power over their bodies increases self-esteem and help individuals feel their very best.
While there countless benefits to liposuction, there are obviously a couple of caveats that need to be thought about prior to making the final decision to progress with the procedure.
Cons of Liposuction
Before having actually liposuction done, it's important to analyze the potential drawbacks of the procedure and identify if the benefits outweigh the dangers in your specific case. Your cosmetic surgeon can assist you find out more about the dangers related to the procedure and can assist you decide if moving on is the ideal thing for you.
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There are risks associated with liposuction, for many people, the advantages far surpass them. Inform yourself about the treatment by having extensive discussions with your cosmetic surgeon and think about how liposuction has the potential to impact you as a special person. Just you and your surgeon can figure out if liposuction will supply you with the results you are trying to find within your expectations.
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Occupy Denver dog leader, Shelby, only the latest real political animal in Colorado
Occupy Denver is the first of the Occupy Wall Street camps across the country to elect a leader: Shelby, a Border Collie mix seen here, who was anointed after a long meeting Sunday night, and has already requested a meeting with Governor John Hickenlooper.
Beyond that, Shelby doesn't have much to say, but we're certain she appreciates Colorado's long history of real political animals.
Among them: The tiny South Park town of Guffey elected as mayor a black cat, Monster, back in 1998.
Mayor Monster.
The 35 residents of Guffey also elected a golden retriever to the position. Technically, the office of mayor does not exist there, but then, neither do the two main political parties: "Democats" and "Repuplicans."
Upcoming Events
Denver Outlaws / Major League Lacrosse All Star Game
TicketsSat., Dec. 29, 6:00pm
Guffey's political animals may have taken their inspiration from Pirate the Dog, who used Denver as his base when he ran for president back in 1984, with owner Stoney Jackson (no, not that Stoney Jackson) managing the campaign. The pup's entry into the dog-eat-dog world of presidential politics earned Pirate the Best Local Candidate for President award in our initial Best of Denver issue . Jackson, a gentle, quixotic soul, has moved on.
No word on Pirate's whereabouts, but we wish he'd been at that debate in Michigan last night.
More from our Calhoun: Wake-Up Call archive: "DIA Art Master Plan calls for performances' return... and what about Blue Mustang's eyes?"
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Catch up on the day's news and stay informed with our daily digest of the most popular news, music, food and arts stories in Denver, delivered to your inbox Monday through Friday.
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They're here. One showed up as a slutty Crayola, and I think the other came as The Fat Friend.
the pic of her and her boyfriend fell off the wall as we were fucking.
he just came in and straightened the chair and left again
She called herself a train and then took off all her clothing. I forget everything after that.
I saw you two flinging Jello at the sidewalk if that helps jog your memory.
She always manages to outslut me. I can't keep up
Best. Handjob. Ever.
I'm guessing Kelly is over?
Nope. Home alone.
It was mandatory to shotgun a beer before we were allowed to eat dinner
her face looked like how i feel after Taco Bell
I don't even want to think what you did to boys being that drunk and horny.
Then I wouldn't suggest looking at the pictures from last night.
Now that world cup is done, funneling out of a vuvuzela has lost its fun
all nice guys are gay and all hot ones are assholes
You're fat. Stop making excuses
He keeps trying to sell me the forks from his kitchen drawer
oh ps. last night you kept telling me to calm down because everything was fine cause you were getting "arab money"...
My mom said I should get that 'not fucking anybody' problem fixed.


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Caesar Salad Dressing-No Raw Egg
Total Time
Prep 6 mins
Cook 0 mins
From Rick Bayless book "Rick and Lanie's Excellent Kitchen Adventures". I found the recipe posted on http://contessabare.proboards48.com/
Ingredients Nutrition
- 1 small garlic clove
- 1⁄2 cup mayonnaise, Hellman's
- 3 tablespoons fresh lemon juice
- 1 tablespoon olive oil
- salt
- 1 tablespoon cold water
- crush garlic into a 2 cup glass jar with a lid.
- Add remaining ingredients.
- Cover and shake well.
Most Helpful
This is a fantastic recipe!! I had all of the ingredients on hand and it whisked together in a flash. I did omit the salt, and added a sprinkle of salt and black pepper to the tops of our salads. If you are not fond of a strong lemon flavor, I would cut back a bit on the lemon juice--I used the entire amount and was quite happy with the tartness. Rae, thank you so much for sharing your recipe! It is a keeper!!!


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The Xiaomi Mi Band 2 that went on sale initially on the Mi.com website is now listed and available on Amazon.in for Rs. 1,999. This is a low cost fitness band that comes with heart rate sensor and an OLED display.
Fitbit Flex 2 and Charge 2 fitness wearable launched
Fitbit launched two new fitness tracker wearable devices in India, the Fitbit Flex 2 for Rs. 9,499 and the Fitbit Charge 2 for Rs. 14,999. Flex 2 is ultra Slim fitness band and the Charge 2 comes with large OLED screen.
GOQii launches new fitness band in India
GOQii today launched a new fitness band with GOQii Life programme subscription, pricing starts from Rs. 1999 for 3 months, Rs. 2999 for 6 months and Rs. 3,999 for 12 months.
No Android Wear 2.0 update for First Gen Moto 360 Smartwatch
The Motorola Moto 360 Smartwatch was first launched in 2014, the company has already launched the 2nd version the Moto 360 2nd Gen. Android Wear 2.0 update will not be rolled out on the first gen Moto 360.
Laforge Shima Alpha + Beta augmented reality eyewear pre-order for $590
Here is another smart eyewear the Laforge Alpha + Beta (Shima) that can display notifications in your field of vision. The concept is similar to what the Google Glass does but this device looks much better in terms of design and functionality.
Samsung Gear IconX cord free fitness earbuds unveiled
Samsung unveiled the Gear IconX a fitness device with no strings attached. The IconX fits in your ears and are designed to stay there. This device can track your fitness activities – you don't need to carry your phone.
Samsung Gear Fit2 fitness tracker launched for $179
Samsung launched their latest fitness tracker called the Samsung Gear Fit2, the next device in the Gear Fit series. Gear Fit2 is running Tizen OS and comes with a curved sAMOLED screen. This fitness tracker is priced at $179 (approx Rs. 12K).
Casio Unisex Smart Fitness watch STB-1000-1ADF listed for Rs. 6396
Another fitness watch from Casio – the Unisex STB-1000-1ADF got listed on Amazon for a price tag of Rs. 6,396. Now do note that Casio Unisex Smart Fitness watch STB-1000-1ADF is compatible with iOS platform and does not support Android.
Pebble Time Smartwatch available for Rs. 9999
Pebble Time Smartwatch has been launched in the Indian markets for Rs. 9,999. This Smartwatch is available on Amazon in Black, White and Red colour options. The Time Smartwatch is durable and water resistant up to 30m.
Kids Smartwatch Xiaomi Mi Bunny launched for RMB 299
Xiaomi Mi Bunny is a Smartwatch specially made for kids. This Smartwatch was launched in China for RMB 299 that comes to approx Rs. 3600. The key highlight about this kids watch is that it comes with Unicom SIM embedded and has a built in GPS.
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2nd hunger games
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The second hunger games was an interesting 1 as they find a map of the uk and USA the Capitol stop the games for 13 weeks of course only discret 12 trubites died in bloodbath Discert 9 male finds an ak47 in there base
U diasite the tubets