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Reverse Brain Drain
By Abigail Paris | February 13, 2008
Ever since humans set a dusty foot outside Olduvai Gorge they have been migrating vast distances. Yet with new technologies, a modified form of migration has emerged.
Brain drain, also known as human capital flight, tends to occur in developing countries where skilled and educated workers are lured to prosperous nations abroad. The temptation of greater wealth, better living conditions, political stability, and intellectual freedom strips many poor economies of their best and brightest.
At a lecture recently hosted by Policy Innovations, Marcus Noland of the Peterson Institute for International Economics and Michele Wucker of the World Policy Institute discussed this problem vis-a-vis the Middle East.
In The Arab Economies in a Changing World, coauthors Marcus Noland and Howard Pack estimate that 5 percent economic growth rates are needed to adequately employ the region's rapidly growing labor force. But with the exception of tourism and natural resource extraction, the Middle East tends to be weakly linked to the world economy. Although foreign direct investment has risen along with the recent surge in energy prices, much of that investment has gone into internationally nontraded sectors such as real estate. Even the recent increase in manufactured exports has been confined largely to energy-intensive products such as petrochemicals, which do not generate large numbers of new jobs.
With nearly all recent growth reliant on high oil prices, the production potential of these countries is low given their lack of infrastructure and weak "synaptic link" to the outside world, said Noland. He discussed ways to combat these problems, including an increase in local entrepreneurship, foreign investors, and returnees. Trade agreements and foreign investment stimulus could spark development in the region, but they are not a substitute for internal reforms that would promote the return of entrepreneurs and educated workers. The focus of Noland and Wucker's discussion was how to reverse brain drain for the Arab economies.
Brain drain is widespread. In the Philippines, healthcare professionals sometimes seek foreign jobs below their level of education and training. Faced with poor working conditions, Kenyan doctors and nurses also leave for better prospects. Healthcare brain drain is particularly devastating when it occurs concurrently with HIV/AIDS and endemic diseases like measles and malaria.
Meanwhile, the International Monetary Fund cites Iran as having the highest rate of brain drain among countries it measured. Lebanon is also experiencing brain drain, due partly to the 2006 war with Israel. In Egypt, human capital may even be one of the biggest exports, Noland said.
According to the Arab League, unemployment in the region could rise from 15 million to 50 million in the next 15 years. The unemployment rate in the Middle East and North Africa is estimated above 13 percent, regionally the highest in the world. Thailand exports more manufactures to the rest of the world than the Arab countries combined, Noland said, despite having only one quarter the population.
In the United States, the education level and economic status of Arab Americans is higher than the national level. "Median Arab American income is roughly $52,000, compared with the national average of $50,000," Noland noted. Earning power is typically linked to educational achievement, and in Canada, where the share of Arabs with a bachelor's degree (30 percent) is more than twice the national rate (12 percent), Arab Canadians are doing disproportionately well, Noland continued.
The consequences of brain drain have attracted the attention of international agencies, legislators, and academics. For countries on the receiving end, it is partly a question of whether to limit the migration of educated and skilled workers. The United States, Canada, and the United Kingdom actively seek educated and skilled professionals to improve international competitiveness.
To reverse brain drain, countries must reduce the incentives gap between them and the industrialized nations, and provide adequate well-paying jobs to move their economies forward. One disincentive to returning is fear. Noland argued that "brain drain will not be reversed unless returnees are confident that they will not be subject to economic predation and that their families will be safe."
Wucker, the author of Lockout: Why America Keeps Getting Immigration Wrong When Our Prosperity Depends on Getting It Right, added that better overall standards of living must be achieved in countries of origin before brain drain can be reversed. "Countries must make themselves more attractive," she said, by improving property rights, political stability, and living conditions.
The reversal of brain drain in most cases is beneficial to the countries of origin, but what about to the individuals involved?
Noland addressed the notion of happiness in the context of brain drain. He indicated that self-reported well-being is strongly correlated with personal health status, employment status, which provides a sense of self-respect and dignity, and a sense of voice or influence in decision-making and governance. When asked about what restrictions should be placed on outward migration, he argued that "an individual has a right to do as well as they can do." When migrants no longer fear predation or repression, Noland argued, brain drain reversal will be advantageous for the individual as well as for the nation.
Noland said that Egypt is less repressive today than Taiwan and South Korea were in the 1970s when they attempted to reverse brain drain with some success.
Wucker continued by asking how it would be possible to develop a system that allows for people to return home at the best time in terms of their own development, benefiting both host and sending countries. She described polices that provide incentives for returnees. In India, rules of citizenship have been changed, creating a new class of overseas citizens. The Chinese government has created venture capital funds to finance returning entrepreneurs who launch businesses. A program has been developed and implemented in Mexico in which the Mexican government provides 3-to-1 matching funds for donations raised by American hometown associations to support social projects in Mexico.
Once brain drain begins to reverse, according to Noland, the link between the Arab countries and the rest of the world will begin to open. Returnees will not only bring back their experience, education, and skills, but also their international connections or "social capital." The timely reversal of brain drain may help countries escape a downward cycle of reduced growth, rising unemployment, low foreign investment, and political instability.
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CQ Law Firm
- Alamat Kantor
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Improving provider performance is central to strengthening health services in developing countries. Because of critical shortages of physicians, many clinics in sub-Saharan Africa are led by nurses. In addition to clinical skills, nurse managers need practical managerial skills and adequate resources to ensure procurement of essential supplies, quality assurance implementation, and productive work environment. Giving nurses more autonomy in their work empowers them in the workplace and has shown to create positive influence on work attitudes and behaviors. The Infectious Disease Institute, an affiliate of Makerere University College of Health Science, in an effort to expand the needed HIV services in the Ugandan capital, established a community-university partnership with the Ministry of Health to implement an innovative model to build capacity in HIV service delivery. This paper evaluates the impact on the nurses from this innovative program to provide more health care in six nurse managed Kampala City Council (KCC) Clinics.
A mixed method approach was used. The descriptive study collected key informant interviews from the six nurse managers, and administered a questionnaire to 20 staff nurses between September and December 2009. Key themes were manually identified from the interviews, and the questionnaire data were analyzed using SPSS.
Introducing new HIV services into six KCC clinics was positive for the nurses. They identified the project as successful because of perceived improved environment, increase in useful in-service training, new competence to manage patients and staff, improved physical infrastructure, provision of more direct patient care, motivation to improve the clinic because the project acted on their suggestions, and involvement in role expansion. All of these helped empower the nurses, improving quality of care and increasing job satisfaction.
This community-university HIV innovative model was successful from the point of view of the nurses and nurse managers. This model shows promise in increasing effective, quality health service; HIV and other programs can build capacity and empower nurses and nurse managers to directly implement such services. It also demonstrates how MakCHS can be instrumental through partnerships in designing and testing effective strategies, building human health resources and improving Ugandan health outcomes.
The global deficit of trained health workers in Africa is estimated to be more than 4 million, and the Global Health Worker Force Alliance estimates that 1.5 million new workers need to be trained to address the current shortfall in Africa's health systems [1]. With this deficit much interest has recently surrounded how to streamline HIV care, both to offer high quality care to patients and expand access to care with fewer workers. In countries severely affected by HIV/AIDS, shortages of health workers including qualified health care professionals present a major obstacle to scaling-up HIV services. Health services, as a labor intensive activity, depend ultimately on the performance of the workers, and improving their performance is central to the building of health capacity and should receive high priority.
Nurses are the largest group of health care providers, and it is essential that these nurses feel engaged in their work, have a satisfying work environment and thus experience job satisfaction. Giving nurses more autonomy in their work empowers them in the workplace and has shown to create a positive influence on work attitudes and behaviors [2,3]. Laschinger and colleague, using a model of structural empowerment, argue that for nurses, access to information, access to support, access to resources needed on the job, and the opportunities to learn and grow will increase job satisfaction, commitment, and productivity, with fewer adverse patient events [2]. Empowering nurses will make them more effective health providers.
Makerere University College of Health Sciences (MakCHS) in Uganda is undergoing a major organizational transformation to more effectively impact the health sector in Uganda and internationally. The improvement of health provider performance has emerged as a high priority. As a center of learning the University provides an environment where new ideas and new models of health care can be generated to meet the health worker crisis [4]. As part of meeting the grander challenge of building innovative systems to sustain better health in Uganda, a community-university partnership was created to demonstrate how to better serve the HIV needs of the disadvantaged population of Kampala City.
In the Ugandan capital, the Kampala City Council (KCC) health division is mandated by the Ministry of Health (MoH) to be the local provider of services, including primary health care to local city residents. The council administers a total of eight nurse managed health centers (HCs) distributed throughout the city to meet this mandate. Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) in 2005 received supplemental funding to pilot a program to provide comprehensive HIV treatment in two of the KCC clinics. By expanding these two clinics they had the potential to deliver HIV services closer to the community, and to improve access to care. At the same time, this enabled referral centers like Mulago National Referral Hospital and its associated clinics to decongest and actually operate as referral units and not as a primary health care site. The pilot program consisted of providing supplies and equipment, training, and trained physicians that would assist in the clinics once weekly.
With the success of the pilot program, the potential of using all the clinics to deliver PEPFAR funded HIV prevention, care, and treatment was discussed between the Infectious Disease Institute (IDI), an affiliate of the Makerere University College of Health Sciences, and the responsible government authorities. In 2006, IDI and MJAP partnered with the MoH to build the capacity of the six KCC clinics to deliver HIV/AIDS care.
In the development of this program IDI adapted and exported their best practice model of HIV care delivery to the KCC clinics which included: routine HIV testing and counseling (RTC), HIV basic care and psychological support, TB diagnosis and treatment, antiretroviral therapy (ART), and expanded laboratories. IDI also implemented capacity building activities in these six nurse managed KCC urban health centers, including training and technical assistance to staff for clinic and pharmacy management, strengthening clinic management capacity to monitor patients on ART, and providing the nurse managers the skills in procurement and supply chain for drugs and supplies. Over 25,000 individuals in the six KCC clinics received HIV counseling, testing, and treatment as needed between 2006 and 2009. The program was a success from the PEPFAR viewpoint having achieved expansion of RTC services and HIV treatment via community-based care.
One of the objectives of a MakCHS and Johns Hopkins University (JHU) learning grant was to develop and test effective strategies for the University and the community partners to use to improve health services and outcomes related to national health priorities [4]. The grant provided an opportunity to evaluate the KCC project from the point of view of the University mission, to demonstrate how MakCHS could play a critical role within the Ugandan health system. This paper presents the impact of introducing HIV PEPFAR clinical services into local, nurse-managed, urban, government clinics in Kampala, Uganda. The study was initially designed to evaluate the influence of this community-university partnership on the KCC nurse managers and staff that work at these clinics. The evaluation framework asked the nurses about their knowledge of the key project initiatives, partner involvements at their clinic, capacity building, job satisfaction, effect on services and the challenges of the new program. This paper provides information on this new model of care, and examines the model's effectiveness as perceived by the nurses in this low resource setting.
A mixed method approach was used. The study was descriptive, collecting both qualitative and quantitative data between September and December, 2009. Key informant interviews were conducted on site in English by two of the authors with the nurse managers of each of the six KCC clinics (Kisenyi, Kiruddu, Komamboga, Kiswa, Kitebi and Kawaala) in Kampala. In addition a structured questionnaire in English was administered by a research assistant to all the staff nurses working at the six clinics on the same day as the key informant interview. In total data was collected from 20 staff nurses (all the nurses who qualified consented) and the 6 nurse managers.
The Key Informant (KI) interviews followed a semi-structured guide to explore the experiences of the nurse as a manager, their roles in the clinic, the challenges, and the opportunities as a result of the PEPFAR program being placed in their clinic. The KI interviews were audio recorded with the permission of the nurses and detailed notes were taken at the time of the interview.
Each KI interview lasted about one hour. All interviews were transcribed, providing a full record of each of the interviews. The transcripts were reviewed by the recorder (interviewer) for accuracy. The interviews were then read by two member of the research team, manually analyzed and jointly summarized. During the analysis, key themes were identified in the transcripts, focusing on issues that were mentioned frequently or consistently, that received particular emphasis, or for which KI views expressed in the interviews diverged in a systematic way. The textual data was structured in matrices, with column for different thematic areas, and rows that illustrated the themes. This approach facilitated comparison across and within groups. The other members of the research team reviewed the themes identified and provided comments.
Based on the information in the KI interviews, the themes of empowerment and leadership emerged (see figure figure1).1). Empowerment was defined as facilitating the nurses to think, take action and control work and autonomous decision-making. The areas that facilitated empowerment included access to information, access to support, access to resources needed on the job, the opportunities to learn and grow, and increased in confidence and autonomous nursing practice [5]. Under the theme of leadership and management the tasks of planning, providing staff direction, monitoring of the operations and representation with administration were included as nurse manager skills [6]. This framework was then used to analyze the data.
After receiving written consent the staff nurse questionnaire was administered by a trained research assistant and supervised by the researchers doing the KI interviews. The questions asked the nurses about their work experience at the KCC clinics, the shift in work load, impact of new services on the other clinic services, any training they received as part of the new project, the current perception of their new work experience and their perception of the IDI team working at the clinic. This questionnaire was created for assessment purposes and followed a similar framework as the KI interviews. The 45 question survey took about 30 minutes to complete. The data were reviewed for completeness, entered into windows excel program and analyzed using SPSS version 15.
The research was approved by the Institutional Review Boards of the College of Health Sciences Makerere University and Uganda National Council of Science and Technology. Johns Hopkins School of Public Health IRB also assessed the project and determined that no additional approval was required.
The six nurse managers that participated in the key informant interviews were all women between the ages of 35 and 45 years and were double trained with diplomas in both nursing and midwifery. The duration of their service as clinic manager ranged from six months to six years. Their designated role as clinic manager included supervision and coordination of the different clinic activities, ensuring the cleanliness of the clinic, attendance at monthly administrative meetings, report writing, and requisitions of the essential supplies (including pharmacy) and equipment for the clinic. The managers also collaborated with different partners interested in working with the clinic. In addition, several of the nurse managers supervised nursing and other health science students in research and community-based education. The nurse managers were responsible for supervising the clinical staff and were also involved in provision of in-service education and skills training for nurses and other health care providers. The number of clinic staff (including all health care providers and support staff) at each clinic varied with a range of 24 to 40 staff with a mean of 32.
Clinic managers were asked what they knew of the key initiatives of the project. The majority understood the project and recognized the over-arching goals of reducing patient congestion at Mulago, decentralizing HIV care services, and equipping other persons/health care providers in HIV care through knowledge and support. The managers also recognized and implemented the need for expansion of the Voluntary Counseling and Testing (VCT) services, tuberculosis (TB) care, and offering ART and treatment for opportunistic infections. They utilized improved infrastructure, equipment, and clinical support, and key initiatives of the project to improve clinic services. The managers expressed on several occasions that the partners valued their managerial skills as the sister-in-charge, gave them respect, listen and acted on their contributions, but also put more administrative demand on them in supporting the new clinic.
With the increase in patient numbers there were more administrative duties, more supplies to order, new clinic budgets to consider, the accountability of more funds received, and allocation of these funds to specific projects/ clinics. The nurse managers also had new IDI/KCC project duties. As the clinical administrator for the project, they needed to ensure there were adequate stocks of medicines and sundries, patients were seen on the specific project days, data for clinic services was collected, and information was compiled into a monthly report. The nurses said that although there was more work it didn't substantially increase their work load because they were equipped with new knowledge, skills training, and the logistical system to do the tasks.
A nurse manager described the leadership the nurses took in developing a community program.
"The nurses motivated the Princess Club, and they got 4 active members from the HIV positive patients and they trained them as peer counselors, and these people can go to the community, they can follow up at the clients within the community, they can train, they can counsel and they are also given allowances, they are paid. It has also led to behavior change, when they come here they are counseled, they are taught how to behave."
The stock-out of non-HIV drugs to treat malaria and infections was a big challenge. One nurse took on a leadership role and went to the district MoH and persuaded them to increase the funding for the medications. She was able to get more drugs, but some stock-outs persisted.
The nurse managers had not been stakeholders in the initial partnership and planning by IDI and the MoH. However, as the partnership developed the nurse managers were actively involved in the new clinic collaboration. The nurses saw this as an opportunity to participate in better planning for health care services and outcomes for the entire clinic due to the availability of a greater quantity and quality of supplies and equipment.
The nurse managers mentioned the following as part of the project objectives and planning components in which they participated:
"We can plan how to move medications that are about to expire from one clinic to another or to Mulago to avoid drug wastage with the help of our partners."
"We have with the grant, planned for improved space and new infrastructure to improve waiting areas for patients, increase the number of consultation rooms, and have more bathrooms."
As a result of actively participating in the planning the nurses noted that
"We can provide more comprehensive care to HIV patients: expansion of voluntary testing and counseling services, provide community-based care and at the same time decongesting Mulago IDI, expansion and improvement of TB care, support ARV home care, and the treatment of opportunistic infections."
"I purchase drugs and do the accountability," one nurse manger reported. "We have more consistent supply of medication."
Another nurse manager stated, "We have more equipment to better exam HIV patients, for example laboratory equipment, BP machines."
"We can have continuous HIV in-service education to teach staff how to treat, identify cases, and counsel clients."
The managers stated that with improved infrastructure patient care services by the nurses and laboratory technicians had improved significantly. This made it easier for the nurse managers to monitor and improve the operations. They were able to collaborate with partners to hand out basic care kits to HIV patients that included tuberculosis drugs and drugs for opportunistic infections. They were able to use test kits to screen the community, and then provide service to the HIV positive clients. With the improvements of supplies and management of drugs and other daily consumables they stated they provided better service. The managers pointed out that the partners were even conscious of making the operation run smoothly by making sure there were such things as tea, sugar and toilet paper for the MoH staff.
The mangers reported having regular staff meetings and they also attended health facility management at the district level. They were very happy that they were always included in all the meetings occurring within the project, and that their opinion was valued. They were included in the decision making of their own clinics and were consulted on issues like staffing, supplies, changes in infrastructure, and inservice education.
"The system of working with the partnership is good. When there is a challenge it is discussed and they [the partners] look immediately for a solution or an alternative."
Before the partnership the large patient numbers and lack of equipment was a challenge that had been impossible to address with overcrowding, no space for consultation, having to refer for laboratory work, and lack of medicine. The managers said that at the beginning of the partnership their space was even more limited due to the large influx of HIV patients. Before the renovations were completed and the clinics reorganized, the KCC clinics with the larger patient populations were not physically able to provide all of the previous services (e.g. immunizations, and antenatal services). With the completion of the improved infrastructure all the nurses reported that they could now provide these services. The improvement of infrastructure included patient and staff toilet facilities, pharmacy storage, increased consultation rooms, laboratory upgrading with equipment (CD4 machine, HIV testing kits, sterilizing equipment), and increased supplies (e.g. needles, gloves).
The nurse mangers commented:
"They[MJAP-IDI]recently constructed a big shelter where the client can sit, while waiting for the doctors, and can be counseled from there, they constructed a counseling rooms, doctor's rooms, they provided chairs, tables, TV screens, exam table and many other things".
"With City Council we couldn't, but with IDI, we usually sit in a meeting and then present our problems, so they managed to provide the necessary infrastructure and human resources."
The managers also mentioned that their operations could also now extend directly into the community. With support from the partners they now had the resources.
The managers stated that nurses at the clinics benefited from several rewards. They reported that all the nurses received an additional allowance as a motivation for the project work or the extra regular clinical work done; this significantly improved everyone's morale. A few of the nurse managers pointed out that although everyone received an additional allowance not everyone had project responsibilities, creating some job dissatisfaction for those with the additional project work. For example, the nurses in the HIV clinic stated they had new project work and they wanted more money than their colleagues not working in the HIV clinics received. Likewise, a few of the staff nurses said they didn't understand why all nurses got additional money, although the managers understood completely. However, most of the staff was happy with the additional income, agreeing that they all had additional work. The nurse managers reported that none of the staff were de-motivated, but everyone was concerned with what would happen if/when MJAP/IDI pulled out of the project.
The managers recognized that human resources were an essential input in the delivery of better health services. The managers were pleased that the staff received new training in HIV care, service provision, and logistics management. This led, according to the managers, to increased patient services, better HIV counseling, and increased opportunity for patient behavioral change. The managers listed several inservice trainings as a result of the partnership: staff management workshop, ART care and medications, prevention of mother-to-child transmission (PMTCT), pediatric HIV management, palliative care, data management, counseling, multidisciplinary workshop on HIV care, and human resource management. Many of these topics were particularly relevant to the nurse managers in their extended roles as a result of task expansion in the clinic. The managers said an additional benefit of the training was that at the continuing education programs they developed collegial relationship across the clinics allowing them to share different challenges and solutions.
Expanded tasks of both the nurse managers and the nurses included: review and management of HIV patients on their clinic days, management of opportunistic infections in these patients, and referral for patients with complications. They also provided initial medical care to the patients with newly diagnosed HIV.
"We no longer send away HIV patients even if it is not a clinic day, we are able to manage them.'' Nurse Manager
The nurse managers stated:
"The training was beyond the HIV clinical care. Provided information in data management"
"Have had several training: human resource management, effective management, logistic management, malaria management, taught them about HIV drug management (nurse can now prescribe), nearly all staff received training at IDI, trained in mother to child transmission prevention, palliative care"
"The training has really done good because a mere single registered nurse and midwife, if they don't go for these workshops; you never know what to do. For example I can now start a patient on ARV's… and how to manage side effect. In case we are to operate alone you know what to do"
The managers were especially cognizant of the increase in clinic capacity because of the increase in knowledge among the staff.
"We have the skill to now manage HIV patients even if it is not the project day. We don't turn the patients away." Nurse manager
"I must say that they have really built capacity in this clinic, we are able to at least do good work, I must appreciate that the coming in of this project, I think we have become better people now." Nurse manager
"Maybe for antenatal, we didn't have the PMTCT services but we initiated the PMTCT services, this was because people were not trained in provision of the PMTCT services but later on midwives were taken for training and we started the service." Nurse manager
The nurse managers reported that there was not much change in their work load or role, and actually they were now better equipped to meet the challenges of a busy clinic. One nurse manger reported that the project collaboration runs very smoothly and needs little of her time.
"I do not just relate now to KCC but also I am the clinic administrator for this project, I was given management training and a multidisciplinary HIV workshop."
Some managers reported added responsibility: increased paperwork in monthly reports, more accountability for medicine, spending more time in management, supervising of staff and patients, and more work with data entry. However, another nurse noted that with increased self reliance among the staff,
"I have to spend less time in general OPD on the day of the clinic"
When asked: Is the role harder with the new clinics? The nurses replied:
"No, it is not harder, but a little heavier because of the additional work."
"No, not really. You feel you are engaged from time to time, am busier than I was."
"No, my work is easier. There has been many staff trained, so I am not working alone but have a team. We integrate and work together."
The challenges identified from introducing the project included: limited space, client overload, clinic understaffing, poor hygiene, lack of skills in handling large number and different patients, and stock outs for drugs such as antibiotics and anti-malarials.
"Client overload means everything must be doubled but you find that despite the increasing numbers, certain things have remained constant so meeting the gap is still a big challenge." Nurse manager
The challenge of space is one of the biggest.
"Client congestion is a problem, cleanliness of the compound. So at the end of the day you find the compound full of papers, full of empties of drugs, but we try our level best to clean at the end of the day. We are also overwhelmed because the temporary closing of a clinic to restructure the old clinic." Nurse manager
Too small a pharmacy and poor space for distribution were complaints in one clinic. The new program worked with the staff to change the infrastructure, and the nurse reported they now had new areas for drug storage, a redesigned pharmacy distribution to one location, and an increased patient flow which at the same time reduced stigma of HIV medication being given in a different location. Additional challenges included inadequate staff in one clinic.
Interviews were carried out with the clinical staff nurses to explore the impact of the HIV PEPFAR services on their work experience, job satisfaction, workload, views on other clinic services and their in-service training. Twenty nurses were interviewed from the six different clinics (Kiruddu, Kisenyi, Kiswa, Kitebi, Komamboga and Kawaala). They described their current job as including counseling, drug dispensing, general clinic nursing care, and specific HIV and TB care.
Of the 20 staff nurses interviewed 70% had worked at the clinic for more than 1 year, and they liked the job because of opportunities to improve their skills with additional training (Table (Table1).1). The majority of the nurses reported that after the project started they had spent more time with the patients; job satisfaction had improved as a result of the project initiation.
Eighty percent (n=16) of nurses reported having more work to do after the initiation of the project, with only 5% (n=1) reported having the same amount of work before and after the project started. Over half of the nurses (n=11, 55%) reported having more time to spend with the patients after the restructuring of the clinic. Four of the nurses (20%) stated that they now spent less time with patient, three nurses (15%) the same amount of time, and 2 nurses (10%) were not sure if they spent more or less time with the patients.
The nurses reported that all services had improved with the exception, in some of the clinics, of pediatric care (Table (Table2).2). Of the nurse respondents, 35 % stated there was a decrease in pediatric services. This could in part reflect the initiation of a new pediatric HIV center sponsored by Baylor College of Medicine providing care to the same population near the KCC clinics, decreasing the utilization of the KCC services.
Ninety percent of the nursing staff that was included in this study had received training from IDI in HIV and non-HIV areas. As summarized in Table Table3,3, 95% of those that received this training felt that the training had been useful to their current work, and that through this training they had acquired both clinical (70%) and non clinical knowledge and skills (55%). The training also allowed 60% of the nurses to refresh knowledge and skills previously learned.
Table Table33 presents the perception of the nurses about their work experience using a 5 point Likert scale were 1 indicated the lowest level of agreement and 5 indicated the highest level of agreement with a given statement. The nurses responded positively about the effect of the clinic restructuring on their work experiences, especially in the areas of their confidence in carrying out their work, feeling valued, having received adequate training, and providing quality care. The lower rating had to do with lack of the best environment to provide the care. They did not find the clinic highly stressful.
Like much of Africa, provision of more universal HIV services in Uganda created extraordinary health systems demand that could not be met using traditional physician dependent models. In the context of this PEPFAR-funded community-university partnership emphasis was placed on utilizing every available human resource to its full potential. The three-pronged approach of training, provision of necessary resources, and continued support allowed the rapid integration of services and care despite some notable human resource constraints. Both the nurse managers and the staff nurses found that the training and support to the nurse cadre helped to improve the services delivered to patients under this newly structured program. Our data agree with others who found that good health outcomes can be achieved by enhancing the role of the nurse [8,9].
The primary intent of this study was to evaluate the impact of introducing PEPFAR clinical services into the local KCC urban government clinics. In actuality it identified the effectiveness of empowering nurse in their role of providing primary care as they scale up the quality of care provided HIV patients as well as other services provided. Two of the largest dilemmas experienced universally by nurse managers are having problems that appear impossible to solve due to a lack of adequate resources, and individual staff apathy [10]. Effective provision of resources is key to the empowerment of staff and essential for work effectiveness, for nurses to function autonomously, for patient's safety and quality care, and to promote collaborative/collegial relationships. According to the nurses, this project provided those resources in a well-managed approach that helped solve some of the insoluable problems and immediately engaged staff interest.
With triangulation of the data from the nurse managers and staff nurse, the responses reflected similar views and perceptions. All of the nurses agreed that the increase in training provided new skills and knowledge that could be immediately implemented in the direct service to the patients at the clinic. Immediate implementation of the new information is likely to increase the trainees' interests and efforts [11]. The nurses also agreed that the care was improved and that specifically the staff nurses had more time to spend with the individual patient. The improvement in infrastructure and particularly increased lab capabilities, more space, and reliable sources of medications with no stock outs were also named as important developments under the project. Improvement in the nurse's work environments in health centers has the potential to empower the nurses, simultaneously reduce high level of job burnout and decrease the risk of turnover [2,12]. It also increases job satisfaction [13] and there has been increased patient satisfaction with care at the KCC clinic [14]. The staff nurses, however, were in agreement that they had more work with the restructuring, even though the nurse managers felt the work load had not increased. Although, in general, the nurses were very satisfied with the collaboration, there was some concern that pediatric care decreased in a few of the clinics; an issue that warrants further exploration.
A skilled nurse manager can be a huge asset to the effective functioning of a clinic, and actions that can be taken to enhance any of the components of an effective manager will be reflected in the provision of better health care. According to Tappen there are seven components to an effective nurse manager: leadership, planning, providing staff direction, monitoring the operations, distributing fair rewards, staff development, and representation with administration [6]. The nurse managers in their interviews volunteered all seven of these components as actions that were enhanced as part of the partnership, and the nurses considered each component as an important part of a successful improvement of the clinic nurse manager role. They were appreciative of the extensive management training that they received that equipped them with the skills, knowledge, and competencies to carry out their roles. The nurse managers by participating in the partner meetings had knowledge of organizational decisions giving them the ability to make decisions that contributed to the organizational goals.
Research indicates that low levels of job satisfaction are prevalent among nurses and this poor satisfaction leads to job turnover. Sources of low satisfaction are associated with factors that interfere with patient care, feeling overloaded with work responsibilities, poor relations with co-workers, personal factors, organizational factors, and a lack of power in the job setting. Nurses' ability to moderate aspects of the work environment correlates with job satisfaction [15,2], and in this project, the nurses repeatedly talked about how they modified and improved their environment through provision of necessary drugs and supplies on top of the training received.
The difference in satisfaction levels is also directly related to resource availability (e.g. working equipments, medication, examination facilitates) [16]. This partnership was important because it demonstrated that you can empower nurses in a public, local government facility. This partnership translated into more efficient, effective health care in a comfortable environment which ensured that the patients were a priority, their needs were better met, and they were satisfied with the services.
In this study, we found that the nurses were dissatisfied working in the public clinics because the salary was low. This is a big contributor to job dissatisfaction [16]. The issue of nurse remuneration in public sectors in Uganda has been an enduring one and needs to be addressed by the MoH. To guarantee that increased remuneration produces a better product, the MoH could link portions of the salary to performance that includes measuring quality of care, resource conservation and patient satisfaction, as well as to consider non financial rewards (e.g. career development, gratitude, and recognition). The nurses in these clinics received a small additional remuneration and this may partially account for their increased satisfaction.
Burn out and intentions to leave the job are associated with increased work load as a result of a nursing shortage and a larger demand for health care [13]. Excess work load has been shown to significantly contribute to lower morale and productivity of nurses. In addition to training the staff in better time utilization this project allocated extra nurses that were deployed on project days to decreases the stress to the system. This may also account in part for the increased job satisfaction.
The knowledge and skills the nurses acquire, in part, increased their ability to provide good
nursing care. These finding agree with those of Pillay [16] who found that career opportunities and training afford individuals recognition, the prospect of further developing themselves, and growing within the ranks of their career. Nurses have more motivation and stay on the job when the environment is challenging. The nurses were also appreciative of the quality of the training they received and, in particular, noted that the training was conducted by reputable and knowledgeable people, was current information, and was structured to allow immediate implementation. For nurses in Uganda additional education is highly regarded within the context of their culture.
This study was limited by the small sample of nurses, all working in KCC clinics in an urban environment. It is difficult to clearly determine which factor or combination of factors had the largest impact and contributed to increased job satisfaction with the partnership. It could have been the small increase in salary, the increased valuing of their work, the additional education, or the better work environment. They also may have felt empowered by a broader role in the clinic, or a clearer understanding of the goals of the clinic.
This community-university HIV services program was successful from the point of view of the nurses and nurse managers in improving all clinic services, and all the nurses felt successful in utilizing this opportunity for their professional advancement. This model show promise in increasing effective, quality health service; HIV and other programs can build capacity of nurses and nurse managers to directly implement such services through leadership and empowerment. The IDI has now incorporated nurse-in-charge empowerment and leadership training as key components of other PEPFAR funded HIV prevention care and treatment programs. MakCHS in their Department of Nursing has recognized the importance of educating nurses to be good managers and to be leaders in health care in Uganda and nurses in the Bachelor's track receive specific management training. This study supports the importance of these skills to provide quality health care.
Nurses are pivotal to the effective and efficient delivery of health care in Uganda. The chronic shortages of nurses impose a real threat to the future. It therefore becomes imperative for nurse managers to identify and address those factors which are the stumbling blocks, and improve the work environment to provide a context congruent with the aspirations and value systems of nurses. This is likely to have a positive effect on individual, organizational, and population health outcomes. It also demonstrates how MakCHS can be instrumental through partnerships in designing and testing effective strategies, building human health resources and improving health outcomes in Uganda.
MakCHS: Makerere University College of Health Sciences; IDI: Infectious Disease Institute; KCC: Kampala City Council; MJAP: Mulago-Mbarara Teaching Hospitals' Joint AIDS Program; HC: health center; MoH: Ministry of Health; RTC: routine HIV testing and counseling; ART: antiretroviral therapy; JHU: Johns Hopkins University; KI: key informant; VCT: Voluntary Counseling and Testing; TB: tuberculosis; PMTCT: prevention of mother-to-child transmission.
The authors declare that they have no competing interests.
NJ was involved in the conception of this paper, data analysis, and drafted the manuscript. SG was involved in the qualitative data analysis and drafting the manuscript. EL and YM contributed to the review and writing of the manuscript. NK was involved in the design of the data collection tools, ethics submissions, and contributed to the review of the manuscript.
All authors have read and approved the manuscript.
The team is grateful for the support of the Bill and Melinda Gates Foundation for funding this work through the "Partnership for Building the Capacity of Makerere University to Improve Health Outcomes in Uganda", a Collaborative Learning Initiative with Johns Hopkins University (Grant # 49504). The team also extends their appreciation to the nurse managers of these local government urban clinics and their nursing staff, and all others who contributed to the success of this research.
This article has been published as part of BMC International Health and Human Right Volume 11 Supplement 1, 2011: An innovative approach to building capacity at an African university to improve health outcomes. The full contents of the supplement are available online at http://www.biomedcentral.com/1472-698X/11?issue=S1.
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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Can't get scanner/printer to scan; any help?
Do you get an error message when attempting to scan?As for the laptop, if the printer works then the laptop is not too old.
Why cant i scan/?
This might seem like a silly question but did you install the driver; yes, yes I know you said you downloaded it but did you actually run it?Without a more detailed description of what you tried, m...
Read More »
I cant scan to my computer.?
Did you remember to completely close the lid/door when you put the new cartridges in?This has happened in the past on some printers/all in ones
Why cant i scan money ...?
It is not illegal to scan money. It's fair use to make a t-shirt using an image of money, it's not illegal at all. What's illegal is scanning money and then printing that money out in a way that ...
Read More »
Why cant I scan money!?
Yep, it's not good you can't use images of ca$h, but there are so many images already out there on the net, why do you need to scan it anyway? - Just do a Google search for "money images" or someth...
Read More »


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817 Meadow Circle, Belle Plaine, MN 56011
About the Listing
Must see! Nice 5 bedroom, 3 bath home is located on a quiet street. Vaulted ceilings, eat-in kitchen with a patio door leading to large deck and private back yard. Separate dining room. 2 bedrooms and family room in lower level.
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Property Details for 817 Meadow Circle, Belle Plaine, MN 56011
Bedrooms: 5
Bathrooms: 1 Full | 2 Three-Qtr
Lot Size: 0.28 Acres
Lot Dimensions: 85x145
Year Built: 2000
Garage Dimensions: 3 car
Garage: Attached Garage
Style: (SF) Split Entry (Bi-Level)
Water: City Water/Connected
Sewer: City Sewer/Connected
Square Feet: 2277
Above Ground Sq Ft: 1375
Below Ground Sq Ft: 902 (approx)
Room Information for 817 Meadow Circle, Belle Plaine, MN 56011
Main Floor
Living Room: 15x14
Dining Room: 10x9
Kitchen: 11x15
Bedroom 1: 11x15
Bedroom 2: 11x10
Bedroom 3: 10x8
Lower Floor
Family Room: 19x28
Bedroom 4: 10x11
Fifth (5th) Bedroom: 11x13
Dining Room Description: Separate/Formal Dining Room
Family Room Characteristics: Lower Level
School Information for 817 Meadow Circle, Belle Plaine, MN 56011
School District: Belle Plaine
School District Phone: 952-873-2400
Interior Features for 817 Meadow Circle, Belle Plaine, MN 56011
Appliances: Range, Microwave, Dishwasher, Refrigerator, Washer, Dryer, Water Softener - Owned, Disposal
Air Cond: Central
Heating: Forced Air
Fireplaces: No
Basement: (902 sq Finished) Full, Finished (Livable), Egress Windows
Exterior Features for 817 Meadow Circle, Belle Plaine, MN 56011
Lot Description: Tree Coverage - Light
Lot Dimensions: 85x145
Roof: Asphalt Shingles
Zoning: Residential-Single
Financial Considerations for 817 Meadow Circle, Belle Plaine, MN 56011
Tax Amount: $2,941
Taxes w/Assessments: $2,952
Tax/Property ID: 200470600
Tax Year: 2016
Monthly Payment = $0
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Volume 606 of the series Advances in Experimental Medicine and Biology pp 271-294
Protective Effect of Milk Peptides: Antibacterial and Antitumor Properties
- Iván López-Expósito
- , Isidra RecioAffiliated withInstituto de Fermentaciones Industriales (CSIC)
* Final gross prices may vary according to local VAT.Get Access
There is no doubt that milk proteins provide excellent nutrition for the suckling. However, apart from that, milk proteins can also exert numerous physiological activities benefiting the suckling in a variety ofways. These activities include enhancement of immune function, defense against pathogenic bacteria, viruses, and yeasts, and development of the gut and its functions. Besides the naturally occurring, biologically active proteins present in milk, a variety of bioactive peptides are encrypted within the sequence of milk proteins that are released upon suitable hydrolysis of the precursor protein. A large range of bioactivities has been reported for milk protein components, with some showing more than one kind of biological activity (Korhonen&Pihlanto, 2006). This chapter reviews the most important antimicrobial and antitumor peptides derived from milk proteins, especially those that may have a physiological significance to the suckling neonate. Antimicrobial peptides present in milk that are not derived frommilk proteins are also considered. Special attention is given to the generation of these peptides by the action of different proteolytic enzymes and the origin of these enzymes since, if present in the digestive tract, it is likely that the peptides might play a role in the host defense system. Finally, the most relevant in vivo studies carried out with this kind of bioactive peptides are discussed.
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- Title
- Protective Effect of Milk Peptides: Antibacterial and Antitumor Properties
- Book Title
- Bioactive Components of Milk
- Book Part
- Pages
- pp 271-294
- Copyright
- 2008
- 10.1007/978-0-387-74087-4_11
- Print ISBN
- 978-0-387-74086-7
- Online ISBN
- 978-0-387-74087-4
- Series Title
- Advances in Experimental Medicine and Biology
- Series Volume
- 606
- Series ISSN
- 0065-2598
- Publisher
- Springer New York
- Copyright Holder
- Springer Science+Business Media, LLC
- Additional Links
- Topics
- Industry Sectors
- eBook Packages
- Editors
- Zsuzsanna Bösze (6)
- Editor Affiliations
- 6. Agricultural Biotechnology Center
- Authors
- Author Affiliations
- 7. Instituto de Fermentaciones Industriales (CSIC), Juan de la Cierva 3, 28006 Madrid, Spain
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To view the rest of this content please follow the download PDF link above.


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Controversial! Fun And Also Games! First Comic Book related blog to be featured in the Australian National Library's Pandora archive. 2016 Rondo Award nominee. Pop culture, music, film and comic book expert. Would be willing to write for biscuits.
Logo and banner designed by the amazing Michael Netzer.
Friday, December 07, 2007
King Size Comic, An Australian Classic
I'll freely admit that my knowledge of these books is fairly limited, but here's what I do know. According to Kevin Patrick's excellent article on Buck Rogers, King Size Comic was "a giant 2/- (two shilling) magazine, produced by the Cleveland Publishing Company of Sydney under its Apache Comics imprint. Apart from Buck Rogers, King Size Comic featured reprints of various American and Australian comic book features, ranging from crime (T-Man) to westerns (El Lobo, Tim Holt) and science-fiction (Silver Starr), before it, too, ceased publication in 1959."*
Not much is it? However the best information about Cleveland Publishing comes from John Ryan's excellent and invaluable book, Panel By Panel. On page 207 of that book Ryan discusses Cleveland briefly, and I again quote;
"Cleveland Press were publishers of western, detective, and romance paperbacks when they decided to enter the comic publishing field late in 1955. Against the advice of his fellow publishers the owner of Cleveland Press, Jack Atkins, was determined to have a comic on the market bearing his company's name. He acquired the rights to a radio serial, The Twilight Ranger, which had been written by Michael Noonan and then asked Chatto to illustrate it. The first issue of the comic appeared in October bearing a full-colour half tone cover illustration and costing 9d. The comic was tied in with a series of competitions that offered such prizes as interstate air trips, bicycles, cameras and tennis racquets. It was an impressive debut for the masked cowboy who was derivative of a number of US comics. Because of the high overheads, the comic did not make money and Atkins gambled with the seventh issue by increasing the price to 1s. and making it full-colour throughout. The comic failed, though an eighth story was published at a later date.
"Determined to stay in the comics field, Atkins asked Chatto to create another character which resulted in another cowboy comic, El Lobo - The Man from Nowhere. Again with a full-colour half tone cover, El Lobo first appeared late in 1956 and ran through 23 issues. The comic was also responsible for introducing the Cleveland trademark, King Size Comics. Also in the late 'sixties Cleveland published Clancy of the Overflow drawn by Hal English. Although the lively outback adventures of Clancy showed English at his best, the title lasted less than half a dozen issues. Deciding to use reprint material, Cleveland introduced their 100-page King Size Comics in 1956. As well as reprinting such material as Frank Frazetta's Johnny Comet, there were comics from the E. C. New Direction list, Yager's Buck Rogers and a number of local comics. New Silver Starr comics were drawn to add to the reprints of those that had been previously published by Young's Merchandising as well as a mixture of new stories and reprints of Twilight Ranger, Clancy, and El Lobo. King Size Comics lasted until late in 1959.
"Cleveland Press also published a pocketbook-size Silhouette series of western, romance and war comics. Many of the covers were drawn by Pitt and the bulk of the comics were drawn by Chatto, English and Wilkinson. One of the last major publishers to attempt to foster original comics, the odds were against Cleveland Press from the beginning. They entered the field just prior to the advent of television and only a few years before the lifting of Import Restrictions would see the market swamped with US comic books."**
So there you have it. Both books sport lovely covers and some very impressive Keith Chatto and Stanley Pitt artwork, along with the reprints. My own research leads me to believe that issue #23 is actually the first issue (and if you can work that out then you're doing well) and that seventeen issues in total were released. That also makes #28 the sixth issue in reality, a decent enough find for a mere $5.00 each (yep, that's what I paid). The King Size Annual would be a definite prize, clocking in at a total of 340 pages, you could be assured that it'd be value for money, even if it did reprint previously published material (the Annual merely combined previously published issues). The main thing that these comics show is that the local talent of the time, Stanley Pitt, Keith Chatto and Hal English in particular, was just as good, and in a lot of cases better, than their more commonly known American counterparts. This is very evident in issue #28 where at least one Matt Baker Phantom Lady story, Satan's Seal, exists (other Phantom Lady stories in this volume, Television Spies and The Old Shell Game, are probably also Matt Baker). As good as it is the Baker material looks pedestrian when compared to Stanley Pitt at his best in the lead off Silver Starr story, The Flame World.
Issue #23 showcases a magnificent Keith Chatto splash page (I know, I know, I'm going backwards), and the resulting story virtually overshadows the rest of the issue, and that includes a vintage Al Williamson 'sandal epic' dated 1954 and a Wally Wood Sir Geoffrey story. Add to those another Stanley Pitt Silver Starr and a Hal English Clancy story and you can easily see why these would have been considered to be the pick of the bunch at the time of publication. With Chatto, Pitt and English representing the Australian side of things, and Williamson and Wood flying the flag for the Americans this makes for one of the most impressive Australian comics I've seen in many a moon from an art perspective. Plus that painted cover only tops it all off. I doubt anyone could have ever asked for a better first issue in a comic book anywhere.
So how hard are these puppies to find? Damn good question. Not that long ago Keven Patrick quoted from a Stanley Pitt interview where Pitt claimed that Cleveland Publishing had printed 125,000 copies of a full-colour edition of Silver Starr in the late 1950s, but only released 50,000 copies into the marketplace***. This makes sense as one thing I've discovered by speaking to people is that more often than not Australian publishers printed more than they could ever hope to sell, resulting in issues being run out as showbag fillers. In the case of King Size Comics I would hazard a guess and say that they'd have cost too much to given away, so the bulk of the unsold returns would have been either pulped or 'rebadged'. There is evidence of this with the existence of the King Size Annual, which, as previously noted, was a combination of previous issues of unsold King Size Comics. I've had a quick peek on the internet and can't find a single copy for sale, however they do surface on eBay from time to time, so if you see one at a good price then pick it up. I doubt you'll be disappointed.
* Buck Rogers Australian Orbit by Kevin Patrick, 15/10/2007, OzComics.com
** Panel By Panel, by John Ryan, published 1979 Cassell Australia Ltd, page 207
*** Australian Comics – A 1960 Snapshot by Kevin Patrick, 02/11/2007
1 comment:
- Kevin Patrick said...
Daniel - As I said in my email to you, I'm green with envy that you scored these 'King Size Comic' beauties - and at an unbelievable price, to boot!
Roger Morrison's 1997 price guide states that the series did begin with issue #23, as you state, while issues #23-32, 36 & 39 contain Australian-drawn material. However, I'm not sure if there were issues released after #39 (something which Morrison fails to clarify in his 'bare-bones' title listings)
Hal English apparently drew the cover to King Size #26, and may have done others in the series.
I can't prove this categorically, but the cover for #23 looks as if it could be the work of Carl Lyons, an Australian comics artist who also worked as a freelance cover artist for Cleveland's line of western pulp novelettes.
Other covers in the series could well have been drawn by Cleveland's other freelance illustrators, esp. those working on their line of war/western pulp novels. Oddly enough, given that Stanley Pitt was already producing some knock-out painted covers for the American Science Fiction magazine/booklet series at this time (published by Malian Press, Sydney), it's strange he never got the chance to do painted covers depicting his own SF hero, Silver Starr, on the King Size Comic. They would've been stunning, no doubt!
And, yes, Chatto did some gorgeous work on the Twilight Ranger series - the painted covers he did for the solo TR comic from Cleveland are just amazing to look at. Only surpassed by his work on El Lobo - The Man from Nowhere, which has to be one of my all-time favourite Australian comics from that era.
- Tuesday, December 11, 2007 10:10:00 pm


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This post was not written in response to the comments on this blog in latest round of arguments about miracles. It's been up on my website for several years on my miracle pages. But it answers certain basic issues brought up recently.
In the discussions of miracles several atheists have made some big misconceptions.
(1) mistaken assumptions about my knowledge of correlation and cause.
some assume that since they are clever enough to know the very basic information, the difference in correlation and causality, that I must not know that because I'm a Christian and Christians are stupid, and they are so very clever to know some basic fact that all high school kids should get, correlation is not causality.
But what they don't get is that just becasue I argue inductively that correlation is indicative of a cause if certain conditions obtain, that doesn't mean I don't know the difference.
(2) What these very clever atheist don't get is that correlation is indicative of cause.
Part of the problem is that certain people don't seem to know what indicative means. Be that as it may, there is an epistemological gap in our knowledge that is a problem at the most fundamental philosophical level. We can only establish causality in one way, buy making very tight correlations and eliminating alternate causes. This is the only way there is, and that's what Hume really proved with the billiard balls.
science can't prove causes. We can only prove correlations. When I assume causes on miracles, it's the only way we ever establish cause. Hans (HRG on CARM) says "only if we eliminate the alternate causes." Yes, that's true, but it also leads to recursion of the original problem. Because if we can't observe causality and it must be inferred from correlation, then you can't say "I have eliminated an alternate cause by showing causality and eliminating it." That's just a repeat of the same problem. The alternate causes are only possibilities, they are not proven either. What it boils down to is in the final analysis is a really tight correlation is the only way to determine cause. Although it is important to eliminate the alternative possible causes, essential in fact. What this means is I am right to assume causes from correlations, given that I can eliminate alternatives, and I usually can, and given the very tight correlation.
All of this means that medical evidence showing the disease went away, when examined by scientific medicos is good evidence for miracles. It's not absolute, there is no absolute. There will always be a gap in our epistemology. We will always have to make epistemic judgment.
(3) Don't need to show hit rate
The argument is made we must show the percentage of those healed vs not healed.
That's ridiculous. The reason is because we do not know the reason when someone is not healed. We cannot assume "O not being healed means there's no ;god, because some are healed." Knowing the hit rate is important in many cases. such as prophesy, "so and so is a true prophet he predicted x," but how many predictions did the make that did not come true?
Knowing the hist rate is not true in terms of empirical evidence of healing because:
......(a) We don't know if the not healing is the result of no god, or God just didn't want to heal. Because a will is on the other end of the prayer we cannot treat it like a natural process and expect it to behave like a drug in a field trial.
......(b) Miracles are supposed to be impossible. they violate natural law. that's the whole theory of naturalism in a nut shell; nothing happens apart form natural law.
Thus if one miracle happens that proves miracles and all it takes is one. proving that x% are not healed doesn't prove anything. miracles are supposed to be impossible and can't happen, if one of them happens, or we can assume it happened, then that proves they do happen. We don't know the rate because God is not a drug. Divine healing is a matter of God's will.
(4) God's action in healing is not indicative of God's feelings about those healed or not healed.
This is the whole fallacy of the God hates amputees thing. You might as well say God hates breakfast because not once in my Christian walk has God ever made me scrambled eggs in the morning.
St. Augustine proved that there is no correlation between worldly prosperity or success and God's love. Rome was sacked by the vandals and everyone was saying "this disproves Christianity." but Augie said "no it doesn't, divine favor is not based worldly success. Stuff happens to Christians too, God causes it rain on the just and unjust."
(5) No double blind
Lourdes evidence does not need to be double blind. First of all these are not "studies." They are not set up as a longitudinal study to see if healing works. These are real people and their journey to Lourdes is part of their journey in life in a search to be healed, they are not white lab mice plotting world conquest.
Secondly, double blind is used as a means of control so we know data is not contaminated by the subjects knowledge of the test. People suffering from an incurable disease cannot cure themselves. So it doesn't matter if they know. If the data shows the condition went away immediately and it can be documented that all traces are gone, the of course can assume healing, provided there is no counter cause such as he took a wonder drug before he left for Lourdes; they do certainly screen for that. That is controlled for in the Lourdes rules.
Of course there are still epistemological problems. There will always be such problems. That's why you can't prove you exist. But just as the answer to that problem is "Make epistemic judgment based upon regularity and inconsistency of data," so it goes with miracles, proving smoking causes cancer or anything else.
Thomas Reid got it right, we are justified in assuming empirical evidence provided it's strong evidence.
One more problem. When I say "correlation" this invites the question "how can you find a correlation if you don't know the hit rate? A correlation implies X and Y are seen together a lot, not just in one instance. But we can't go around giving people cancer and praying for them over and over to see if they ar always healed. We have to let multiple cases stand for correlation. But since we can't say why healing didn't take place we have to use empirical means to assert on a case by case basis. That's why it makes sense to go by a case by case study rather than try to establish a hit rate for miracles.
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Lately, I have been listening to a series of lectures by Hubert Dreyfus, Ph.D., a Philosophy professor at U.C. Berekley, concerning the writ...
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May 6, 2009
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I have an either sex Antelope tag this year. Why do I have to leave evidence of sex attached? Isn't it evident that with the tag attached to the meat that I am in compliance with the rules of my hunt? This rule seems to be seems to be a little bit of overkill. It could easily be corrected by adding the following wording in the regulations: "In the case of an either sex hunt this requirement is waived".
Several years ago, evidence of sex rules were specific to the hunt. In other words, in an either-sex hunt there was no requirement for evidence of sex; while in sex-specific hunts there was the requirement. Depending on the year, and the hunting season, the evidence-of-sex requirement did or did not apply - even in the same unit. This created confusion among hunters. In an effort to simplify the regulation and make it easier to comply with, the Idaho Fish and Game Commission changed the rule to standardize it's application for all big game hunting.
Fortunately, there are some very simple and uncomplicated ways of leaving evidence-of-sex. For females, leaving 1 teat attached to the carcass will suffice. For males, leaving a small section of the penil ligament (white cord entering the rectal canal) attached to 1 hind quarter is all that is needed.


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mikegl様は99designsで ロゴ デザインコンペを開催しました。
Logo must incorporate the "Trollbeads" manufacturer's design as found on http://www.trollbeadsUS.com. Plus include our name of TotallyTrollbeads.com. The logo must say "Totally Trollbeads.com" (the name of our store).
We are asked to keep in the same style as the manufacturer's design found at: http://www.trollbeads.com. ...that is the Trollbeads name.
Our site is http://totallytrollbeads.com
- Item 1:
Colors will need to match the necklace found on our home page of http://www.totallytrollbeads.com.
- Item 2:
The logo needs to have "Totally Trollbeads" on it.
- Item 3: The Logo must be on one line.
- Item 1...


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Terça-feira 10 de Julho de 2012 às 20h30m
World Cafe Live at the Queen
500 North Market St., Wilmington, DE, 19801, United States
Web: http://queen.worldcafelive.com/
Comprar ingressosSeatGeek
Formed in early 60s London, John Mayall's Bluesbreakers are well known for cultivating new talent. Starting with Eric Clapton and Jack Bruce (formed Cream), followed by Peter Green, John McVie and Mick Fleetwood (started Fleetwood Mac), the perpetual succession of great musicians also featured Andy Fraser (co-founded Free), Mick Taylor (who joined The Stones) and Coco Montoya and Walter Trout.
As for the man himself, the father of six and grandfather of six, John Mayall was awarded an OBE in the Queens Honours list and, as usual, shows no signs of slowing down. He has released of several solo albums that have set new standards in rock blues and he plans to keep the blues alive for many more years to come.


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Marvel Spotlight Vol 1 3
180,794pages onAdd New Page
this wiki
this wiki
Appearing in "The Thing in the Cellar!"Edit
Featured Characters:
Supporting Characters:
- Agatha Timly (Only Appearance)[1]
- Kraig (Only appearance; dies)[1]
Other Characters:
- Nathan Timly (Only appearance; dies)[1]
- Philip Russell
- Darkhold (Mentioned)
Solicit Synopsis:Edit
A teenager by day - a "Werewolf By Night"! Yet, can even a man-beast survive against the steel claw of - Kraig?
- No special notes.
- No trivia.
Related Articles
See AlsoEdit
Recommended ReadingEdit
- Werewolf by Night (Volume 1) #1-43
- Werewolf by Night (Volume 2) #1-6
- Giant-Size Werewolf #1-4
- Marvel Spotlight #2-4
- Moon Knight (Volume 1) #29-30
- Spider-Woman (Volume 1) #6, 48-50
Links and ReferencesEdit
- Werewolf by Night series article at Wikipedia
- Werewolf by Night series review at Photon Torpedoes
- Werewolf article at the Marvel Universe
- Werewolf by Night article at the Marvel Appendix
|Like this? Let us know!


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Syfy Channel will move its Friday night dramas to Tuesdays starting in October, the network announced this week.
Stargate Universe, Sanctuary and Caprica will air on Tuesday nights, where the network has had great success in the summer months with Eureka and Warehouse 13, its two highest rated original series. SGU and Sanctuary air in the fall months, Caprica in the winter. SGU then returns for the second half of its season during the spring.
The reason? Syfy has picked up … wait for it … WWE Friday Night SmackDown, one of the many professional wrestling shows that seem to draw big viewership for cable networks, particularly among the coveted young male demographics.
That series will debut October 1 at 8 p.m. Eastern and Pacific, and run two hours in length. Rather than pairing Stargate and its other scripted dramas with wrestling, Syfy is opting to maintain SmackDown's Friday night presence and give its dramas — which have seen sliding ratings on Friday nights for several years — a try on another night of the week.
SmackDown is a veteran 10-year-old series that has been airing on Friday nights since 2005. It comes to Syfy from the MyNetworkTV syndication group, having originally aired on UPN and then The CW. The series launched in 1999 and averages more than 3.4 million viewers each week.
Stargate Universe, the current Friday night leader for Syfy during the fall, draws about half that.
"With Tuesday night, a proven winner for our original drama series including Warehouse 13, there is bigger opportunity for series such as Stargate Universe, Sanctuary and Caprica to thrive on a night with a significantly larger number of viewers available to watch live," Syfy president Dave Howe said.
The move to Tuesdays makes a premiere of either September 28 or October 5 likely. The latter would follow Syfy's pattern of starting off the quarter with new series; but it would also cede a bigger jump on the new fall season to the broadcast networks.
Scheduling Strategy
What seems like a minor shift in scheduling strategy could actually have big ramifications for Stargate and the cable network — hopefully for the better.
Friday night is notorious for being one of the least-watched nights of television, earning the "graveyard" moniker for the big networks. Because science fiction genre shows struggle with finding a general audience by their very nature, networks and cable channels have typically relegated them to the Friday time slots anyway — where there are lower expectations to perform.
Add the fact that sci-fi fans are statistically more likely to be early adopters of DVR technology and watch their favorite Friday night shows later, and you begin to see why series like Stargate see some of the biggest ratings boosts when the DVR-delayed viewing is factored in. For shows like Stargate and Battlestar Galactica, those viewership increases have been upwards of 45 to 50 percent.
Taking SGU and other dramas to Tuesdays — a highly-watched night of the week — could pay off in spades for Syfy. But the competition with bigger network shows, of course, also increases the risk. The networks' new fall season is expected to premiere in late September. And Tuesdays boasts some of television's biggest juggernauts, including FOX's American Idol in the springtime.
Syfy Channel previously experimented with Galactica on Sunday nights, but didn't see much improvement in the ratings for the critically acclaimed series. It moved back to Friday nights for its final run of episodes.
Syfy is following its sister network USA in taking its scripted series off Friday nights. USA has seen great success for such shows as Burn Notice, In Plain Sight, and Royal Pains on other weeknights. It also airs WWE's other weekly series, WWE Raw, on Mondays.
Whether or not the gamble will pay off for Syfy and Stargate Universe is anyone's guess. We'll certainly be watching the numbers very closely when Season Two begins this fall!
What do you think? Is it a good move for the network and the shows to go to Tuesday? Sound off below!
(Thanks to Ryan, Morjana, Gary, Madwelshboy, Tanith, Brandon, Justin, Diogo, Jonno, Robert, Meh, Jim, and Jeff for the tip)
NEXT: The press release
What they ARE putting on Fridays makes me lol hard, but this might actually be good for SGU. Here's hoping more viewers tune in live on Tuesday.
i'm a fan of sanctuary, and i'm very concerned. BUT, this might be a good thing for it (and sgu and caprica), so…
the other popular shows of tues night, i don't watch. :p
I'm cautiously optimistic about it. Although SciFi Fridays having been a staple of existence for the duration of this century, I'll have to retrain people on what night of the week to leave me alone. :)
I still fail to see the reason why SyFy show WWE, especially since WWE isn't sci-fi at all. It's just mediocre 'play fighting' by adults who don't have real careers.
Okay, so maybe a move to Tuesday will do SGU some good, but it should be for a legitimate reason, like reserving Fridays for cr*p SyFy produced TV movies, or less american sci-fi, like Red Dwarf or something like that.
SyFy hasn't a clue about what it's doing. Fans complained about the presence of wrestling…so it added MORE wrestling.
Brilliant job, SyFy. Bravo.
In the age of DVR's it does make sense to move it away from Friday. I think they should of picked Monday though. Going up against American Idol is bad idea IMO.
Another thing to consider about the move to Tuesdays…
FOX: American Idol
Being that both American Idol and NCIS draw around 20 million viewers each every week, it's VERY hard to get viewers on that day. I for one will most likely be recording SGU, so I can watch NCIS/NCISLA.
I just find it weird because there getting rid of WWE NXT on tuesday's to move the Syfy shows to tuesday because there getting another WWE show. Why not just put Smackdown in the NXT slot is news to me but they are the network. But SYFY's rationale has always been that WWE fits into the "imagine greater" slogan. And add to that the fact that Vince Mcmahon and Dick Ebersol (Head of NBC, SYFY's parent company) are best buddies plays a role. Still I beleive that they should have some loyalty to their programming but I guess that's why they're no longer Sci-Fi
Good job on the time slot change, failure in the replacement. Wrestling does not belong on their channel.
Insanity has hit the programmers or management or both at SYFY. No, not because they are moving those series to Tuesday (though after having established Friday night as the SCI-FI (not SYFY) night of the week, you would think that would remain as a real statement), rather because of the totally irritating, stupid annoying addition of, who cares a fig about fake wrestling, not me, WWE on Friday night. What is any wrestling or boxing doing on the Scifi channel, now called SYFY, at all. I have to pay Comcast around $30 extra per month just to have the SYFY channel included in my "package". The only way I can see that channel is to purchase a larger package of channels, not one of which I care about other than SYFY, and I absolutely do not spend that $30 per month so I can watch Wrestling on a station supposedly devoted to Science fiction or close shows. I am insulted that the SYFY network would actually make an agreement to show Wrestling on the night previously only scheduling new Sci-Fi series. It makes me consider cancelling my agreement with Comcast and then just using Torrents to download episodes of the series I want to see and screw SYFY.
Most likely they are hoping to capture the Tuesday night audience that watches Lost after that show sees its finally.
Great job – SeeFee!
I being moved over for Wrestling is better than being cancelled and being replaced by a "re-imagined" Flash Gordon (*rolls eyes*)
TV Schedules are meaningless to me, I DVR my shows and watch at my leasure. The networks need to realize thats what alot of people are doing now.
People still watch 'Lost'???
Only show I like on tuesdays was 'Lie to Me', and it's not back yet… so … oh well. No biggie for me.
Well since Lost is ending :( SGU wont have to compete with it. I might still have to compete with V that is if it gets picked up for a 2nd season.
I'm gonna have to DVR Sanctuary now. That was the only show that I made an effort to watch live. But I work late most weekdays, so DVR it is.
O yes we must make space for "wrestling"
Next they will go from tuesday to wednesday and put Oprah and Emeril live on tuesdays…
SyFy honestly sucks on *any* and all decisions for programming on that network. A trained monkey could possibly make more effective decisions. I work second shift, and I have Fridays off it's the one thing I like looking forward to on Friday nights. Honestly, Syfy makes just completely makes terrible decisions all the dang time since as far as I can remember. Ugh.
I suppose being moved because of Wrestling is better than cancellation and replacement by a re-imagined FG, but…remember, just last year they had something far worse – that completely unfunny embarrassing Outer Space Astronauts. So, you're absolutely correct, it could be much worse. They could make that series the "centerpiece" of Tuesday nights.
About USA's shows – not true that the move to Weds. was a great success for In Plain Sight: 3.2 mil. and 0.8 demo this week and still a drop from last week's ratings.
So far, the move to Tues. and Weds. worked well for White Collar, so-so for Psych and barely at all for L&O:CI and In Plain Sight.
Tues. would have worked for SyFy during summer. But throughout the regular season? I think that the shows will either drop or stay level. Let's face it, ratings prove that SGU's fans DVR the show anyway. I don't see them jumping on the "live" wagon when it moves to Tues.
Im a huge Stargate and WWE fan and in the UK we have Smackdown on a Friday and SGU on a Tuesday. They both get great ratings on these days. So i think its a good thing for SGU that its moving to a Tuesday. It might get better raitings in the US to
wwe on syfy is wrong it just doesnt belong there
Part of the problem is that the Sci-Fi executives…wait for it…hate science fiction. They see it as geeky and niche, and have been trying to move away from it for over a decade. They see it as a detriment to their brand and profitability.
They won't actually stop acting like m***** until the fans organize a collective letter writing campaign or something similar.
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Lana Addison Bridal offers brides the perfect mix of Southern charm and modern style! The gorgeous salon is located in Historic Downtown Cary on the National Registry of Historic Homes and is owned by bridal industry pros Alexia and Michael Joyce.
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By Sarah Skidmore, AP Business Writer
PORTLAND, Ore. BJ's Wholesale Club Inc. posted a slightly higher second-quarter profit on Wednesday and raised its full-year earnings forecast as frugal shoppers look for deals at discounters.
But shares in the nation's third-biggest warehouse club dropped more than 7 percent, or $2.97, to close at $37.71, possibly on investor concerns about pricing and the economy.
The Natick, Mass.-based retailer earned $36.5 million, or 61 cents per share, in the three months ended Aug. 2. That's up from $36.3 million, or 55 cents per share, a year earlier.
This year's second quarter included a benefit of 3 cents a share related to state income tax audit settlements. Last year's results included gains of 4 cents a share related to the disposition of a lease as well as 5 cents per share from state income tax audit settlements.
Sales rose almost 18 percent to $2.65 billion, from $2.25 billion in the same period last year. Shoppers focused on gas, groceries and necessary items.
The company said products like coffee, dairy, fresh meat and salty snacks fared well but discretionary items like electronics, furniture and best-seller books did not.
Same-store sales, or sales at stores open at least a year, rose 15.5 percent, including a contribution from sales of gasoline of 8.1 percent. Same-store sales are considered a key indicator of a retailer's health.
Analysts surveyed by Thomson Reuters were expecting BJ's to earn 57 cents per share on revenue of $2.67 billion.
The company said traffic increased by 5 percent for the quarter, excluding the sales of gasoline, its strongest growth since 2004.
"I believe that our value proposition will continue to attract more members as well as to deliver increased frequency," said BJ's President Laura Sen. "Because the majority of BJ's sales are derived from non-discretionary items we have been able to generate strong top line growth in a challenging macro environment."
The company said it expects sales of general merchandise other than groceries to remain flat in the immediate future. BJ's also said that it is, like most retailers, struggling to find the right balance on where to pass cost increases on the consumer. But it continues to expand the company, adding four new stores during the year.
Standard & Poor's Equity Research reiterated its "hold" recommendation on BJ's, saying in a note Wednesday that the sharp drop in the stock price reflects concern about spending on discretionary items during the holiday season. But it added that in the months ahead, it expects BJ's market share to grow as a result of price-sensitive consumers.
BJ's raised its full-year profit forecast, the second upgrade in a matter of months. The company now expects earnings for the year of $2.10 to $2.20 per share, up from its May guidance of $2.04 to $2.14 per share. The May forecast was 6 cents per share above the company's previous expectations offered in March.
Analysts surveyed by Thomson Reuters expect earnings of $2.14 per share for the year.
The company also announced that its board has authorized an additional $200 million for share repurchases. During the second quarter, BJ's purchased about 1.4 million shares of its own common stock at an average cost of $37.45 each, or approximately $54 million total.
During the half-year ended Aug. 2, BJ's purchased about 2.4 million shares of its own common stock at an average cost of $35.30 each, or about $83 million. Including the $200 million authorization announced Wednesday, the company has about $291 million available for share repurchase.
Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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We can help you to get a mortgage on favourable terms. A residence permit can be obtained with the purchase of this property. Please ask our team for more information.


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