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CME credit systems in three developing countries: China, India and Indonesia
Lewis A. Miller1, Xuejun Chen2, Vaibhav Srivastava3, Lisa Sullivan4, Weiguang Yang2 and Charity Yii4
1WentzMiller Global Services, New York, NY, USA
2China Continuing Medical Education, Beijing, China
3Insignia Communications, Mumbai, India
4InVivo Communications, Singapore
Introduction. Two of the largest countries in the world, still developing nations, China and Indonesia, have now created national credit systems for continuing medical education (CME). A third, India, has tried but succeeded only on a state-by-state basis. This study tracks the development of CME/continuing professional development (CPD) credit systems in these three major Asian countries, analyses the related administrative backgrounds and points to strengths and weaknesses of each system in terms of serving the goals of CME/CPD in impacting medical care systems. Methods. The authors researched national- and state-level government records to identify legal and regulatory data affecting CME in China, India and Indonesia. Information on current and future activities was gained from media reports. Results. In all three countries, CME/CPD systems evaluate physician continuing competence by counting credits or credit hours. Central health authorities in China and Indonesia have established national systems applying to all health professionals. In Indonesia, CME/CPD is mandatory for re-licensure; in China, it is necessary for career advancement and re-registration. An effort to develop mandatory CME requirements in India, for physicians only, failed because the central agency underwent a major overhaul. Nevertheless, 9 of 28 states in India have developed systems, all tied to re-registration. Discussion. A comparison of systems in the three countries shows that little attention has been paid to physician performance improvement or improved patient health outcomes. Needs assessments and outcomes measures are not regularly carried out. We did not find any evidence of programmes to train administrators or faculty in CME/CPD principles, with the possible exception of Indonesia. Suggestions are offered to CME system leaders and providers to help their counterparts in developing nations.
Keywords: continuing medical education, continuing professional development, mandatory credit requirements, needs assessment, programme planning, performance improvement, outcomes measures, China CME, India CME, Indonesia CPD
Received: 27 January 2015 Accepted: 16 March 2015 Published online: 21 April 2015
Journal of European CME (JECME) 2015. © 2015 Lewis A. Miller et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
Citation: Journal of European CME 2015, 4: 27411 - http://dx.doi.org/10.3402/jecme.v4.27411
Although the medical profession has grappled with the need for continuous learning for physicians since ancient times, formal credit systems for continuing medical education (CME) began first in North America and then extended to Europe. Only recently did attention focus on principles of lifelong learning for physicians and other health professionals for the purpose of enhancing the ability to provide up-to-date care to their patients. Systems of continuing education for health professionals (CEHP) with mandates for participation now exist widely in the Western world. How is this concept spreading to the developing nations that are home to the largest populations in the world?
The terms CME and continuing professional development (CPD) are used according to country preference in this article. An early definition of CME from the American Medical Association stated:
"CME consists of educational activities to maintain, develop, or increase the knowledge, skills and professional performance and relationships that a physician uses to provide services for patients, the public or the profession."1
In the past 20 years, a number of medical organisations around the world have felt that the term CME is too limiting, and that CPD more accurately describes efforts to enable physicians to continuously pursue "personal and professional development resulting in the transformation of the health-care system towards the delivery of patient-centered, humanistic, cost-effective health care."2
Organised medicine (medical professional organisations and national/state health ministries) has been known to use both terms to fit any system of continuing education. In the case of China and India, CME is generally favoured; in Indonesia, CPD is preferred. But as we shall see, the terms are defined in each country's requirements rather than in codified definitions.
One significant element of consistency in the systems described in China, India and Indonesia, not reflected in formal CME or CPD definitions, is the role of commercial interests, specifically pharmaceutical and medical device companies. In all three countries, such entities are not permitted to be providers of CME or CPD and providers have a responsibility to limit perception of commercial bias in content (though without stringent review or enforcement).
Organised medicine leaders in other developing countries may find this information of value as they seek to develop national or local CME credit systems. CME leaders in North America and Europe, perhaps working through organised medicine, may find the information useful for future networking. CME professionals may also find opportunities to collaborate with providers in these developing countries to provide content, delivery and measurement systems. Table 1 provides a list of publicly available contacts in CME administration in the three countries for those who wish to engage their international colleagues.
|Institute name
|China National CME Commission
|NO.1, Xizhimen Wai south road, west district, Beijing, 100044
|+86 010 68792114
|Goa Medical College
|Dr. Jayant Bhandare, Pres.
|+91 0832 2458723
|Gujarat Medical Council
|Dr. Nitin Vora, Pres.
|+91 079 22680534
|State Medical Council
|Dr. Chikkananjappa
|+91 080 26620293
|T.C. Medical Council
|Dr. Rema M. N., Pres.
|+91 0471 2302756
|Maharashtra Medical Council
|Dr. Kishir Taori, Admin.
|Off. 0647 2402847
|Punjab Medical Council
|Dr. Manmohan Singh, Pres.
|+91 0172 2266913, 2265104
|Rajasthan Medical Council
|Dr. O. P. Gupta, Pres.
|India/Tamil Nadu
|State Medical Council
|Dr. M. S. Ashaf, Pres.
|+91 044 26265678
|India/Uttar Pradesh
|Uttar Pradesh Medical Council
|Dr. M. C. Sharma, Pres.
|+91 0522 2387653
|Indonesia Medical Council
|Dr. Ihsan Oetama (International Relations)
|+62 818 834466
The research methodology for this article was not based on existing criteria for measurement of effectiveness of a CME system. No data are available in the three countries for this form of measurement. Instead, the authors obtained official documents from national and organisational websites in each country to identify legal and regulatory objectives and requirements for continuing education of health professionals. The authors particularly focused on the goals of the CME systems, the mandatory requirements, penalties for non-compliance, the responsible agencies and providers, the details of the process (e.g. needs assessment, programme planning, delivery and evaluation) and funding.
In addition, medical societies and regional medical authorities were queried to determine current levels of activity and implementation of standards such as accreditation of programmes and/or providers, independence from bias and benefits to participating health professionals. Each author (except for Miller), referred to as "colleague" in the text that follows, is involved in producing CME programmes in one or more of the three countries, and his/her comments reflect knowledge of legal and organisational requirements as well as cultural differences in these countries.
Based on the methodology described above, the authors examined recent efforts in three major developing Asian countries, China, India and Indonesia, to establish their CME credit systems in the 21st century – and where applicable, extension of requirements to other health professionals. (For a comparison of the demographics of the three countries, see Table 2.)
|CME start
|April 2011
|December 2006
The time frame to establish national systems was compressed into a relatively short period in China and Indonesia, where these systems are up and running: starting in 1996 in China (but not truly implemented until 2001) and starting in 2006 in Indonesia. In India, the concept of a national CME system was introduced in 2002 but is still a work in progress. At the time of this writing, the Indian system is developing along state lines, because of the failure of a national impetus by the Medical Council of India (MCI) to form a mandatory CME system.
The Chinese and Indonesian systems established legal and accreditation requirements on a national-government-controlled basis. Clearly, the shortened time frame for system development and implementation has led to unresolved issues of quality and compliance that will be explored further in this paper.
For comparison purposes, tabulated below are the results we found in the seven principal areas we reviewed.
Goals of the CME systems
According to the National Health and Family Planning Commission (formerly Ministry of Health) of the People's Republic of China, the goals of the CME system are3:
- To keep the high professional morals of physicians
- To improve their practice skills
- To upgrade the quality of health-care service
- To meet the needs of the development of public health and disease management
A national system does not exist. But since nine states have moved to legislate requirements, we will focus on one such state in an effort to provide some information about the thinking in India. According to the Maharashtra Medical Council, the stated purpose of instituting a mandatory CME credit system is4:
- Tremendous advances are taking place in the field of medical sciences, continuously changing the concept, approach to management and the outcome of several diseases. The rapid pace of these advances makes it mandatory for doctors to keep themselves updated so that they may apply this information to their practice and thus fortify their competence and knowledge by keeping abreast with the latest developments in the field. Importance of credit hours and updating the knowledge of doctors have been globally accepted and have also been approved by all the state medical councils in February 2012, and have already been endorsed by MCI.
According to the Indonesia Medical Association, the objectives of CPD are5:
- To maintain and promote the professionalism of doctors, upholding quality and ethics, according to global standards of competence
- To guarantee the existence of quality medical services through a programme of certification of doctors
Additional goals specified for general practitioners (GPs) are:
- To improve GP professionalism by a self-assessment programme based on accumulation of a minimum number of CPD credits
- To improve GP professional performance
- To improve GP knowledge and skills
- To ensure ethical conduct in providing medical services and care
Mandatory requirements
Each of the three countries expresses its requirements differently in terms of credits or credit hours. No equivalency exists between the two terms across the countries.
A national mandate requires physicians to have 25 CE credits per year6,7:
- 5–10 credits must be Category 1 credits achieved by attending CE programmes approved by a national-, provincial- or municipal-level agency.
- Physicians can achieve 1 CME credit by attending a learning course of 2–3 hours.
- The balance, 15–20 Category II credits, may be achieved by self-learning, archives study, a research project or hospital-based learning activities.
Nurses must also earn 25 credits per year. Pharmacists are required to have 15 credits per year.
The Medical Council of India, a quasi-government body, was unsuccessful in promoting national legislation for mandatory CME but proposed in 2011 that all physicians be required to have 30 hours of CME every 5 years, to be enacted through state medical councils, which are formed through MCI by election. To date, 9 of 28 state medical councils have made re-registration of the licence to practise mandatory, based on reporting CME credit hours. The trend for adoption of the MCI recommendation has moved swiftly in the past year; more states are expected to adopt similar measures in the next 3 years. While seven of the nine state councils followed the MCI recommendations, two declined, to increase to 50 and 150 hours. No reasons for the difference have been stated publicly–nor did the MCI provide a rationale for the 30 credit-hour recommendation.
- Goa Medical Council: 30 credit hours every 5 years8
- Gujarat Medical Council: 30 credit hours per year for a total of 150 credit hours every 5 years9
- Karnataka Medical Council: 30 credit hours every 5 years10
- Kerala Medical Council: 30 credit hours every 5 years11
- Maharashtra Medical Council: 30 credit hours every 5 years4
- Punjab Medical Council: 50 credit hours every 5 years (10 per year)12
- Rajasthan Medical Council: 30 credit hours every 5 years13
- Tamil Nadu Medical Council: 30 credit hours every 5 years14
- Uttar Pradesh: 30 credit hours every 5 years15
A tenth state council, Delhi, is planning to act this year on a similar mandate. Neither nurses nor pharmacists will have any mandatory CE requirements, although the Delhi Nursing Council recommends re-registration for nurses in the state of Delhi every 5 years with 150 credit hours.
A mandatory national requirement for CPD is in place.3,16 Every physician in practice must complete 250 credits every 5 years to achieve a certificate of competence and must pass a competency test to have his/her license renewed.17
Nurses must also have a certificate of competence renewed every 5 years with a minimum of 25 CPD credits. Pharmacists must also renew their certificate of competence with CPD credits, the number varying by the determination of individual branches of the Indonesian Pharmacists Association, in general from 150–200 credits every 5 years.
Penalties for non-compliance
While the penalties for non-compliance are spelled out in regulations in each country or state, and vary considerably, it remains to be seen how effectively they will be enforced. Health ministries in many Western countries face the same problem, and have not yet resolved it with any consistency. In China, failure to comply can mean that the career path of a physician (or pharmacist or nurse) is limited. In India and Indonesia, the threat is loss of licence to practise. Is that too strong a punishment for a physician who fails to accumulate or record enough CME credits – especially when CME is not related to performance?
Completion of CE requirements serves as evidence for annual performance review and is a prerequisite for credentialing and promotions. For example, if an assistant chief physician fails to complete the CE requirements, he/she will not be promoted as the chief physician.
While regulations specify that failure to meet mandatory credit requirements can lead to cancellation of registration (licensure) for practice, this has not yet been enforced, but may be enforced in 2015. There is a minor monetary penalty in each of the nine state councils for delay in completing requirements.
The competence of a doctor is measured in terms of credit units earned after completing 1 hour of activity recognised as an education activity in a CPD scheme. However, the value of these credits depends on the various formats of CPD activities. (Table 3 shows the percentages expected to be derived from various formats.) Physicians who fail to accumulate 250 credits every 5 years, of which 10% must originate from non-clinical activities, for example, education, research and community service, will not be able to renew their certificate of competence and hence their licence to practise.
|Points proportion (%)
|Professional performance
|Community/professional dedication
|Scientific publication
|Science and education
Responsible agencies
The National CME Commission and CME commissions in each province are responsible for guidance, coordination and quality control of CME activities.
The state medical councils in the nine states that mandate CME are responsible for oversight.
The Indonesian Medical Association and its district agencies are responsible for managing and monitoring CME programmes.
Providers of CME
Providers are medical associations/societies, hospitals and other CME agencies approved by the National Health and Family Planning Commission.18
The following providers can organise CME activities:
- All recognised medical colleges
- Indian Medical Association and its state chapters
- National Academy of Medical Sciences
- National or state chapters of medical specialty associations
- All recognised postgraduate medical institutions
- Central, state and district government hospitals and training centres
- International conferences of professional bodies
- Professional bodies of repute at a district, city or state level
CPD programmes can be organised by:
- Indonesian Medical Association (IMA)
- The Association of Specialist Doctors
- The Association of Primary Services of Medical Doctors
Other organisations accredited by IMA, including:
- Ministry of Health and its directorate of specialist medical services
- Academic institutions, including faculties of medicine
- Hospitals and other service providers
- CPD organisers
- Insurance companies
Needs assessment
CME facilities, including government agencies, determine the needs, in some cases based on problems in clinical practice as identified by the course organisers. Most providers do not follow a needs assessment process, either based on healthcare data or on perceived needs of practitioners.
There is no structured needs assessment process. Needs assessment is performed by governing bodies, department heads in institutions and scientific committees, which organise conferences based on their perception of the needs of the target audience.
Learning needs can be identified through formal tests, evaluation by superiors and colleagues, medical audit and self-reflection, according to the CPD implementation manual of the IMA. The individual physician then draws up a personal development plan.
Programmes planning and delivery
CME providers select the topics and develop the courses, according to the experts' experience and identified clinical problems. Large lectures are the primary delivery method, followed by hospital lectures, small training classes, print and CD materials. Online courses are increasing, but still account only for a small part of CME activities. Recognising the gap in health-care in underdeveloped, rural regions, the National Health and Family Planning Commission has put considerable effort into developing online education programmes.
For the most part, professional societies plan and develop live CME, the only format recognised for credit. By far the most common delivery method is the lecture. For example, the General Practitioners Association, Greater Bombay, arranges six or seven accredited CME sessions of 3 hours each per week. So far, efforts to accredit print or online courses have been unsuccessful.
Programme planning and delivery is highly organised. Credits can be earned through three types of CPD activities:
- Personal education activities: individual activities performed by one person alone, giving him/her additional scientific knowledge and skill
- Internal education activities: activities performed jointly with fellow workers, that is, being structured activities in the workplace
- External education activities: activities performed by some other group outside the workplace concerned – local/regional, national as well as international
From the professional point of view, the activities can be divided into five types, as shown in Table 3:
Learning activities, namely activities that allow a person to learn a theme:
- reading a journal article
- tracking information/evidence-based medicine
- partaking in a training exercise
Professional activities performed in connection with a person's position as a medical doctor and giving him/her an opportunity to study:
- handling of patients
- presentation of paper
- instructing in workshops
- moderating seminars
Community-centred activities intended as a service to the general public or professional community:
- offering health-care information
- partaking in disaster relief operations
- sitting as a member in a professional organisation
- sitting in the management of medical doctors professional organisation
Publication activities:
- publishing a paper
- writing a book (with ISBN reference)
- translating a book in one's scientific discipline (with ISBN reference)
- writing a book review published in an accredited journal
Scientific and education development activities relating to developments in the sector or a person's discipline:
- conducting research in his/her scientific discipline
- educating/teaching
- drawing up tests
- supervising or providing guidance in his/her scientific discipline
CME programmes are not evaluated by outcome measures such as physician performance, patient care or population health. National providers are evaluated and reaccredited every 3 years, though the process of evaluation is not carried out on a regular basis. Each provincial department of health and CME commission can determine its own policy in terms of provider performance review.
There is no standard practice of evaluation of CME programmes by providers or regulators related to outcome measures such as physician performance, patient care or population health. In some cases, organisers ask participants for feedback on the quality of the programmes and their outcomes. State councils set their own policies regarding review of providers.
To evaluate the effectiveness of a CPD activity, organisers may use pre- and post-tests to measure changes in the knowledge and skills of the participants. Questionnaires are given out to participants after each programme to enable feedback about the organisation of the CPD activity and to gather suggestions for improving future CPD activities. But so far no effort has been initiated to relate CME to physician performance or patient health status.
According to recommendations of the Ministry of Health (released before the ministry name change), funding of CME programmes should be a combination of provider budgeting, programme registration fees and other appropriate sponsorships. No breakdown of data are available, but it is estimated that a majority of funding comes from industry sponsorship. Pharmaceutical and medical devices companies may not be providers; education is supposed to be free of commercial bias. There are, however, no detailed regulations on commercial support. Parenthetically, a large proportion of physician registration fees comes indirectly from industry, because many physicians receive rebates from industry for their prescribing volume. This practice is currently undergoing change as the government intends to reduce corruption.
For physician education, most funding comes from industry. Pharmaceutical and device companies cannot provide accredited programmes, nor can they use funds to promote their products directly in CME content. Grants to professional societies may not influence choice of topics or faculty. The MCI, concerned about complaints of unethical practice, has issued new restrictions on physicians. These prohibit acceptance of cash or gifts from industry or its representatives, and of hotel or travel funds to attend courses in or outside of India.19
The operational and administrative costs for conducting CPD programmes are covered by individual medical professional associations, which derive their funds from membership fees. Industry provides substantial support through grants to associations. As with China and India, there appear to be no clear regulations governing elimination of commercial bias.
Variations and progress towards goals
All three developing nations stress the importance of maintaining the professionalism of physicians, as well as improving their practice skills. China and Indonesia desire to maintain or upgrade the quality of health-care services, while India seeks to have its CME system lead to improved patient care. These goals, while compatible, are not identical. What is lacking is a clear definition of quality of service related to public health. Is the end goal improved care of patients, improved patient outcomes in terms of longevity and quality of life and/or improved population health?
Both China and Indonesia also address high physician morals or ethics as important objectives, particularly interesting in light of recent corruption scandals in China in which pharmaceutical companies were accused of bribing physicians and hospitals. India, which has also addressed issues of eliminating bribery by industry, fails to mention this as a goal for funding of CME systems.
Finally, there is little or no effort to evaluate the CME systems in India and China in relation to the goals. As our Indian co-author notes, "Indian CME is in a very primitive stage. This will change only when Indian CME gets synchronised with International CME standards." One Chinese co-author adds, "Now there is no specific way to progress toward the goals. Particularly there is no CME evaluation system based on outcome measures such as changes in patient care or population health." Is China's decision to limit a physician's career path due to failure to comply with CME requirements a sufficient incentive? Our co-author reports on Indonesia, however, that the "Indonesian Medical Association is working toward setting up a web-based centralised system to track CPD performances. Now participants are required to submit their self-assessment forms and personal development plans either online or manually to their respective medical professional associations."
Variations in mandatory credit systems
Clearly, no relationship exists between the goals of the three countries for CME and their credit requirements, nor is there any clear basis for the number of credits required.
How does one explain the wide variation from country to country? In Indonesia, physicians are required to complete 250 credits (usually one credit equals 1 hour) in 5 years; in China, 25 credits (usually one credit equals 2–3 hours) per year (or 125 in 5 years); and in India, 30 credit hours in 5 years, except in Gujarat, where the requirement is 30 credit hours per year or 150 credit hours in 5 years, and Punjab, where it is 50 credit hours in 5 years.
India and Indonesia put their professional societies in charge of the systems, working through state or regional agencies. In China, the system is under the control of a national government commission working through provincial agencies. All three nations propose that non-compliance will lead to loss of licence or credentialing. Since all systems are relatively new, no data are available to indicate the extent to which this mandate is being carried out.
Variations in providers and programmes
The three countries agree in principle that CME providers should be legitimate professional schools or organisations, and do not permit providers from industry. The accreditation process in each country appears to be more or less automatic, with little review of how providers carry out the CME process.
Indonesia has the only system that makes an effort to assess needs from learners. China and India rely on the perceptions of programme organisers or health-care authorities. Indonesia is also the only country in which physicians have their personal development plans on which to base a selection of CME programming, which includes a wide variety of activities going beyond organised lectures or online presentations. Live lectures are the primary mode of education in China and India, in fact, the only source of accredited CME in India. Online learning is growing slowly.
Once again, only the CME system of Indonesia makes a strong effort to evaluate effectiveness of activities, through pre and post-tests of knowledge. However, none of the three nations has embarked on outcomes measures such as physician performance, patient health and population health.
One of the major gaps in the CME systems in all three countries is the lack of professionals in the field of CME. No formal training programmes exist for administrators or educators. Presenters are expected to be experts in their fields and free of conflicts of interest, and they often lack the tools to engage learners in effective education.
Opportunities for assistance
The CME organisations in China, India and Indonesia are all eager for help from Western organisations with more experience and expertise. Our Chinese colleague notes: "International CME expertise is welcome in China to build CME guidelines and standards, provide new learning models, provide online support and help set up evaluation systems." Our Indian colleague adds: "Established CME players from the Western world can help the Indian CME ecosystem take shape quickly by collaborating with Indian medical associations and CME providers." Our Indonesian colleague urges creation of "a taskforce to develop CPD curricula which can be translated, reproduced or adapted to regional/local needs" and also suggests that international CME professionals can "organise conferences and workshops for CPD educators."
A list of current contacts appears in Table 1.
Finally, the pharmaceutical and device companies that are the primary source of CME funding (theoretically limited to funding without influencing content or speakers) can encourage improved methods of needs assessment, programme planning and evaluation by making funds available for these specific purposes.
A word of caution: Cultural, social, ethical and economic differences may limit the opportunities to help CME leaders in developing nations. It is important to take a low-key collegial approach to sharing and learning from one another, and to recognise that no CME/CPD system has yet achieved perfection, much less proof of widespread improvement in health-care outcomes.
Three of the largest countries in the world – all still considered developing countries – deserve credit for the speed with which they have set up viable systems of CME, in two cases including education of all health professionals. While there is still far to go, especially in India, governments and medical associations have taken seriously the responsibility for helping doctors maintain and improve knowledge and skills consistent with professional behaviour and the health-care needs of their countries.
The CME system in Indonesia, in particular, stands out for its clarity of vision, standards of learning and efforts to evaluate results. China, with the force of national planning behind its CME system, recognises the need to rapidly upgrade the health services in underserved rural areas, and the role of CME in accomplishing this objective. India, meanwhile, struggles with the same problems that the United States once had, being forced to move state by state rather than on a national level.
We would encourage leaders of organised CME in North America and Europe to offer consultation and assistance to help leaders in China, India, Indonesia and other developing countries build and improve their national or regional systems.
The authors report none.
- American Medical Association. Council on Medical Education Report A, House of Delegates Policy 300.988. Chicago: American Medical Association; 1982.
- Price D, Havens C, Bell M. Continuing professional development and improvement to meet current and future continuing medical education needs of physicians. In: Wentz D (Ed.), Continuing medical education: looking back, planning ahead. Hanover, NH: Dartmouth College Press; 2011.
- Peoples Republic of China Health Ministry. (, 2000). [Continuing medical education regulation of Ministry of Health (trial, 2000)].
- Maharashtra Medical Council. New policy for holding the CMEs & Credit Points. Available at: http://www.maharashtramedicalcouncil.in/CME/CMENotice/New CME Guidelines.pdf, accessed June 24, 2014.
- Central Executive Board, Indonesian Medical Association. Implementation manual. continuing professional development program. Indonesian Medical Association; 2007.
- Peking University School of Distance Learning for Medical Education. Available at: http://cme1.91huayi.com/pages/news_article.aspx?info_id=3021d47+d-26f0-4ad6-b702-0ca91f3e8038&&KeyLink=zcfg, accessed June 16, 2014.
- , 2001. [Conferring regulation of continuing medical education credits, China Ministry of Health, 2001].
- Goa Medical Council. Extract from The Goa Medical Council guidelines for Cme accreditation. IMA News Goa State Branch 2013;XXI(4):32–35.
- Patel V. Credit hours for doctors: guidelines by Gujarat Medical Council. Natl J Med Res 2012;2(4):399.
- Karnataka Medical Council. Guidelines for continuing medical education. Available at: http://karnatakamedicalcouncil.com/cme_wing.php, accessed June 16, 2014.
- Kerala Medical Council. Available at: http://www.medicalcouncil.kerala.gov.in/pdf/cmeguidelines.pdf, accessed in India June 20, 2014 (access difficult in US).
- Punjab Medical Council. Guidelines for CME. Available at: http://www.punjabmedicalcouncil.com/GUIDELINES FOR CME.pdf, accessed June 16, 2014.
- Rajasthan Medical Council. Continuing medical education. Accreditation of Continuing Medical Education (CME). Available at: http://rmcjaipur.org/cme.aspx, accessed June 24, 2014.
- Tamil Nadu Medical Council. Guidelines for CME programme for getting accreditation. Available at: http://www.tnmedicalcouncil.org/REVISEDCMEGUIDELINES-1.pdf, accessed June 24, 2014.
- Uttar Pradesh Medical Council. Accreditation of CME programme as approved by Governing Body of U P Medical Council, Lucknow on 11 April 2012. Available at: http://upsmfac.org/UploadedFiles/ImageLatestUpdates/Cme-08octe4195d6b-7e50-48f4-a87b-6ae60fa24f5b.pdf, accessed June 14, 2014.
- Regulation of the Health Minister of the Republic of Indonesia. #1796/MENKES/PER/VIII/2011. Article 5.
- Regulation of the Health Minister of the Republic of Indonesia. #889/MENKES/PER/V/2011. Article 9.
- Division of Science and Education. National Health and Family Planning Commission. Available at: http://www.nhfpc.gov.cn, accessed December 19, 2013.
- Gupta MC. Guidelines regarding sponsorship of medical conferences by pharma industry. India Medical Times, July 26, 2013. Available at: http://www.indiamedicaltimes.com/2013/07/26/guidelines-regarding-sponsorship-of-medical-conferences-by-pharma-industry, accessed June 25, 2014.
Correspondence: Lewis A. Miller, WentzMiller Global Services, 303 East 57th St., Apt. 28F, New York, NY 10022, USA. E-mail: firstname.lastname@example.com
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Walk For Haiti
WEST HARTFORD — The 8th annual CT Walks for Haiti walk-a-thon and Haitian Festival will take place on Saturday, April 1, at St. Peter Claver, 47 Pleasant St.
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text: 11/23/16 1/28/13 POPSUGAR Beauty Makeup Best Drugstore Lip Glosses Under $10 10 Best Lip Glosses Under $10 January 28, 2013 by Kaitlyn Dreyling 58 Shares Chat with us on Facebook Messenger. Learn what's trending across POPSUGAR. Whether you're going for a full-on glamour or just a casual, fuss-free look, lip gloss is a makeup essential. You can find hundreds of varieties, but we're sifting through the tubes to find the best options that are also wallet-friendly. Click through, and swipe one on. Shop Brands Forever 21 · L'Oreal · Burt's Bees · Wet n Wild Image Source: Corbis Images Pretty in Pink Image Source: Corbis Images Drew Barrymore's latest venture into makeup has been on the lips of everyone. Fall in love with her new line with Flower Shine On Lip Gloss in Iris I Could Fly ($7). This flattering shade of pink looks great on everyone, and the packaging is just as gorgeous. Flower Shine On Lip Gloss in Iris I Could Fly $7 from walmart.com Buy Now Crystal Clear Image Source: Corbis Images Wet 'n' Wild Glassy Gloss Lip Gel ($3) gives your natural lips a layer of high shine, while it's also the perfect way to add some gloss to any lip color. Think of it like a top coat for your lips. Wet n Wild Glassy Gloss Lip Gel, Glass Confusion 311A $2 from drugstore.com Buy Now See more Wet n Wild Lip Gloss Fine Wine Image Source: Corbis Images The rich color of the Revlon Colorburst Lip Gloss in Bordeaux ($7) imparts a stunning berry hue on your pout. Revlon Colorburst Lip Gloss in Bordeaux $7 from ulta.com Buy Now Go Nude Image Source: Corbis Images Play down the pinkish tones in your lips or lipstick with Yes to Carrots C Me Shine Lip Gloss in Playful Nude ($6). Best of all, the neutral hue is an optimal shade to pair with a smoky eye. Yes to Carrots C Me Shine Lip Gloss in Playful Nude $6 from drugstore.com Buy Now Go Bold Image Source: Corbis Images The new CoverGirl LipPerfection Jumbo Gloss Balm in Haute Pink Twist ($7) features a glossy balm in the form of a lip crayon. This shocking pink hue is a far cry from your traditional pink gloss. Target Lip Gloss CoverGirl Lip Perfection Jumbo Gloss Balm $5.99 from Target Buy Now See more Target Lip Gloss Three Times the Charm Image Source: Corbis Images Your wallet will rejoice over the E.L.F. Lip Gloss Set ($3), while your lips will enjoy all three of these classic shades. E.L.F. Lip Gloss Set $3 from target.com Buy Now Lovely Lavender Image Source: Corbis Images The richly pigmented L'Oréal Colour Riche Colour Caresse in Lilac Ever After ($10) swipes on a high-impact layer of color. Plus, this mauve hue is a naturally flattering shade for the lips. L'Oreal Colour Riche Caresse Wet Shine Stain, Pink Resistance 183 (Pink) $9 from drugstore.com Buy Now See more L'Oreal Nail Polish Take Two Image Source: Corbis Images Don't just settle for a gloss only. With the Love & Beauty Perfect Lip Duo in Pink ($4), you get a coordinating lipstick to give your lips an ideal balance of color and shine. Forever 21 Sparkling Perfect Lip Duo $3 from Forever 21 Buy Now See more Forever 21 Lip Products Tropi-Coral Image Source: Corbis Images Warm up your complexion with the radiant Maybelline Color Sensational High Shine Gloss in Captivating Coral ($7). The highly pigmented gloss gives you a flush of warmth and a dose of vibrant color, all topped off with a brilliant finish. Maybelline Color Sensational High Shine Gloss in Captivating Coral $7 from drugstore.com Buy Now Natural Flush Image Source: Corbis Images Give your lips a wash of glossy red color with Burt's Bees Super Shiny Lip Gloss in Zesty Red ($7). The natural formula boasts almond and citrus oils to hydrate and soften your pout. Burt's Bees Super Shiny Lip Gloss - Zesty Red $6 from DERMSTORE Buy Now See more Burt's Bees Lip Gloss Share this post 10 Under $10Drugstore BeautyMakeupLip Gloss


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Rolls-Royce Shuffles Executive Ranks as Aerospace Head QuitsRobert Wall
Rolls-Royce Holdings Plc, Europe's largest maker of aircraft engines, announced the surprise departure of aerospace chief Mark King just four months after handing the 26-year company veteran a larger portfolio.
King, 48, "has decided to resign" and will go in June, replaced by Tony Wood, head of the ship-engine business, Rolls-Royce said in a statement. Lawrie Haynes takes on responsibility for the marine unit while remaining head of nuclear energy.
King joined London-based Rolls in 1986 and became head of the newly combined commercial and military aerospace business only in January after previously heading civil activities. His replacement Wood was hired from landing-gear maker Messier-Dowty in 2001 and has had stints in both aircraft-engine units.
"King's leaving is a surprise given his recent promotion, but it seems to be for personal reasons," said Oliver Sleath, a London-based analyst at Credit Suisse. "Those below him running day-to-day operations are remaining so it should not be disruptive to Rolls-Royce."
Rolls-Royce declined as much as 19 pence, or 1.7 percent, to 1,114 pence in London. The stock has gained 28 percent so far this year, valuing the company at 21 billion pounds ($33 billion).
U.S. Purchase
Rolls-Royce reiterated its guidance today for "good growth" in underlying profit for 2013 after first-quarter trading matched expectations. The company commented ahead of an annual investor meeting at which Ian Davis, senior adviser at private equity firm Apax Partners LLP, succeeds Simon Robertson as chairman.
The management shuffle comes as Rolls continues a review of anti-corruption practices after last year alerting the U.K. Serious Fraud Office to potential wrongdoing in activities in Asia. The company plans to tighten controls over sales agents. Rolls-Royce today named Iain Conn chairman of the ethics committee, taking over from Ian Strachan, who has stood down.
Chief Executive Officer John Rishton has broadened the product portfolio with the acquisition yesterday of closely held Hyper-Therm High Temperature Composites Inc. of California for an undisclosed sum. Rolls also said April 23 it would sell its half of the RTM322 helicopter-engine venture to partner Safran SA for 293 million euros ($385 million) by the year's end.
Hyper-Therm specializes in materials such as ceramic matrix composites, one-third the density of nickel super alloys and able to withstand higher temperatures, which Rolls plans to use in applications spanning aircraft engines to energy turbines.


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The Weather Channel
12,445pages onAdd New Page
this wiki
this wiki
but was removed on December 10, 2008,
a day of forgiveness declared by Dr. Stephen T. Colbert, D.F.A.
~ Dr. Stephen T. Colbert, D.F.A.
The Colbert Report June 18, 2007
The Weather Channel is a group of America Haters, who attempt to distract us from the important wars.


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Popular property highlights
Located in Rome Historic Centre within a short walk of Teatro dell'Opera di Roma, Castelfidardo is within a mile (2 km) of other popular sights such as Borghese Gallery. This 14-room hotel welcomes guests with conveniences like free in-room WiFi and express check-in. In the historical district, it's also near St. Peter's Basilica and Basilica di Santa Maria Maggiore.
Start each morning with cooked-to-order breakfast, available for a fee from 8 AM to 10:30 AM.
All 14 soundproofed rooms feature safes. Guests can stay connected with free WiFi.
At Castelfidardo, guests have access to free WiFi in public areas and express check-in. For transportation, you can make use of a shuttle from the hotel to the airport (available on request) for EUR 50 per vehicle, as well as an airport shuttle. Front-desk staff can help with luggage storage, and provide local restaurant recommendations.
Property features
- Walking distance to Teatro dell'Opera di Roma
- Free WiFi in rooms and public areas
HighlightsInformation missing or incorrect? Tell us!Opens in a new window
Hotel Amenities
Hotel Amenities
Castelfidardo features express check-in and an elevator (lift). Wireless Internet access is complimentary. For a surcharge, a shuttle from the hotel to the airport (available on request) is offered to guests.
- Free WiFi
- Total number of rooms - 14
- Number of floors - 3
- Airport transportation - drop-off (surcharge)
- Front desk (limited hours)
- Breakfast available (surcharge)
- Airport transportation
- Luggage storage
- Elevator/lift
- Express check-in
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Room Amenities
Castelfidardo offers 14 air-conditioned accommodations with safes. Guests can surf the web using the complimentary wireless Internet access. Rooms have partially open bathrooms. Bathrooms include showers.
- Air conditioning
- Shower only
- Free WiFi
- Soundproofed rooms
- In-room safe
- In-room climate control (air conditioning)
- Partially open bathroom
Where to Eat
Cooked-to-order breakfasts are available for a surcharge and are served each morning between 8 AM and 10:30 AM.
Hotel Policies
Check-in time ends at midnight
Check-in time starts at 1 PM
Special check-in instructions:
Check-out time is 10:30 AM
Payment types
Children and extra beds
- Children are welcome.
- Pets not allowed
You need to know
Extra-person charges may apply and vary depending on property policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
- No onsite parking is available.
No rollaway/extra beds available
No cribs (infant beds) available
- A tax is imposed by the city: EUR 3 per person, per night, up to 10 nights. This tax does not apply to children under 10 years of age.
Optional extras
Hotel Name
- Castelfidardo
- Castelfidardo Hotel
- Castelfidardo Hotel Rome
- Castelfidardo Rome
We should mention
All guests, including children, must be present at check-in and show their government-issued photo ID card or passport. Cash transactions at this property cannot exceed EUR 2999.99, due to national regulations. For further details, please contact the property using information in the booking confirmation.


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Arnold Coogle
Arnold Coogle, 72, of Louisville, passed away Wednesday Dec. 22, 2010, at Audubon Hospital in Louisville.
He was a Hardin County native and a truck driver. He was preceded in death by his parents, Park and Essie (Givans); a brother, Bluford Coogle; and a sister, Noma Hay.
He is survived by a son, Arnold Craig Coogle of Eastview; a brother, Hershel Coogle of Eastview; three sisters, Jeanetta Corley of Louisville, Loretta Siewert of Sellersburg, Ind. and Dorothy Keton of Wichita, Kan.; two granddaughters; and four great-grandchildren.
The funeral is at 11 a.m. Tuesday at Manakee Funeral Home in Elizabethtown, with the Rev. Shelby "Sonny" Haire officiating. Burial is in Needham-Smith Chapel Cemetery.
Visitation is from 5 p.m. to 8 p.m. Monday and 9 a.m. to 11 a.m. Tuesday at the funeral home.
Condolences may be expressed online at www.manakeefuneralhome.com.
Michael James Cronin
Michael James Cronin, 34, of Radcliff, died Thursday, Dec. 23, 2010, as the result of an automobile crash.
He was a graduate of North Hardin High School.
Survivors include his mother, Eugenia Cronin of Radcliff; his father, Timothy W. Cronin of Chicago; three children, Mikaela Cronin, Gabriel Cronin and Nyema Cronin; a brother, Timothy Kenji Cronin of Grave City, Pa.; two sisters, Teruko T. Cronin and Meiko T. Cronin, both of Radcliff; his grandparents, Teruko Sullivan and Michael Sullivan of Chicago, and Jane Scarborough of Kileen, Texas; and his aunts and uncles, Tijuana Bosley of Kileen, Texas, Tira Scarborough and Tiann Scarborough of San Diego, Sean Scarborough of Los Angeles, and Janie and Carl Cook of St. Paul, Minn.
A memorial service is at 4 p.m. Thursday at Nelson-Edelen-Bennett Funeral Home in Radcliff.
Visitation begins at 2 p.m. Thursday at the funeral home.
Condolences may be expressed online at www.nebfh.com.
Laine Lindsey
Laine Lindsey, 34, of Radcliff, died Thursday, Dec. 23, 2010, as the result of an automobile crash.
Survivors include his wife, Teara Lindsey; four children, Liyah Lynn, Logan Lynn, Brandon Lindsey and Nia Lindsey; his mother, Merrye Lindsey; and his father, William Lindsey.
A memorial service is at 2 p.m. on Tuesday at Nelson-Edelen-Bennett Funeral Home in Radcliff.
Visitation begins at noon Tuesday at the funeral home.
Marcellus Morton Jr.
Marcellus Morton Jr., 71, of Radcliff, died Friday, Dec. 24, 2010, at Elizabethtown Nursing & Rehabilitation Center.
Arrangements are incomplete at this time.
Condolences can be expressed online at www.coffeyandchism.com.
Eugene 'Pop' Ragland
Eugene "Pop" Ragland, 85, of Magnolia, passed away Friday, Dec. 24, 2010, at the Hardin Memorial Hospital in Elizabethtown.
He was retired from LG&E in Magnolia.
He was preceded in death by his wife, Margaret Perkins Ragland; a son, Ronnie Gene Ragland; his parents, Robert Beckham and Beulah Ann Turner Ragland; and a brother, Dash Ragland.
Survivors include two daughters, Wanda (Quay) Skaggs of Magnolia and Deborah (Carrell) Mathis of Hodgenville; a son, Ricky Ragland of Magnolia; a grandson, Terry Mathis; a great-granddaughter, Ashley Mathis; and a sister, Ruby Benningfield of Magnolia.
The funeral is at 11 a.m. Monday at Dixon-Rogers Funeral Home in Magnolia, with the Rev. Darrell Hensley and the Rev. Matthew Murrill officiating. Burial will follow in the Magnolia Cemetery.
Visitation is from 2 p.m. to 8 p.m. today and after 9 a.m. Monday at the funeral home.
Condolences may also be expressed at www.dixon-rogers.com.
Harold Ray Wager Sr.
Harold Ray Wager Sr., 77, of Radcliff died Thursday, Dec. 23, 2010, at Hardin Memorial Hospital in Elizabethtown.
Major Wager retired from the U.S. Army. He was past president of the Radcliff Lions Club, life member and president of MOAA and lifetime member of American Legion Post No. 1 in Paris, France.
He was preceded in death by his daughter, Kathryn L. Wager.
Survivors include his wife, Altha Wager; a son, Harold R. Wager Jr. of Radcliff; a sister, Donna Wager Doom of Springfield, Ill.; and two grandchildren, Airel K. Wager and Evan M. Wager of Harrisburg, Ill.
A memorial service is at 7 p.m. Thursday at Nelson-Edelen-Bennett Funeral Home in Radcliff. Burial will be at a later date in Tennessee.
Visitation begins at 6 p.m. Thursday at the funeral home.
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Orthodontic Treatment for Tongue Thrust
Orthodontists can use orthodontics to treat myo-functional problems, such as tongue thrust, to prevent additional problems in the future.
"There are no specific causes for tongue thrust, but we suspect many things may contribute to the habit," says Dr. Aly Kanani, a Surrey orthodontist "Thumbsucking, bottle use by infants, mouth breathing and a large tongue could be to blame. Additionally, patients who are tongue tied, those with a short lingual frenum, as well as the angle of the jaw line, and muscular, neurological and other abnormalities could be to blame."
Orthodontists see patients presenting with variations of tongue thrust that each result in different orthodontic issues. An anterior open bite is the most common. The lips will not close properly, and typically a child will have their mouth open and the tongue protruding. The most common culprit is a large tongue.
Anterior thrust occurs when the lower lip pulls in the lower incisors, leaving the upper incisors severely protruded. Anterior thrust is usually accompanied by a strong chin muscle.
A unilateral thrust can leave the bite open on either side, while a bilateral thrust will have the anterior bite closed, but the posterior teeth will be open. This is the most difficult case to treat.
In a bilateral anterior open bite, the only teeth in the mouth that touch are the molars. A closed bite thrust occurs when the upper and lower teeth are spread apart and flared out.
In the United States, some 20-80 percent of orthodontic patients may exhibit some form of tongue thrust. Some believe that 67-95 percent of all children ages five to eight may exhibit some level of tongue thrust that can contribute to either orthodontic or speech problems.
Malocclusions, or bad bites, result from the force of the tongue against the teeth. If the tongue thrusting habit isn't rectified before or during orthodontic treatment, the continued habit will undo all of the work that was done.
Tongue thrusting is an infantile swallowing pattern that is normal until around the age of four. Most children outgrow this and will not develop any problems. However, if the habit isn't naturally outgrow, patients will require training to stop it before they cause damage to their mouths. In most cases, tongue thrust won't be diagnosed until a child is under orthodontic care because the issue can go unnoticed by parents and caregivers. Diagnosis usually isn't made until there is a problem that needs correction.
"Correction is possible in most cases, but it takes commitment from the child and parent," says Dr. Kanani. "There are typically two ways tongue thrust is handled by an orthodontist, through either myo-functional therapy or through the use of an appliance."
Myo-functional therapy, or tongue therapy, are exercise techniques to retrain the tongue muscles. It's basically physical therapy for the tongue and requires the patient to dedicate time to the therapy. In other cases, an appliance will be placed in a patient's mouth that prevents the tongue from thrusting.
Once the issue tongue thrusting has been resolved, patients may then undergo orthodontic treatment, such as braces, to repair the damage. It is very important that patients have the necessary work done to properly align their teeth in order to avoid more serious oral health issues in the future. Crooked teeth aren't just unsightly, they can cause issues that lead to periodontal disease and eventual tooth loss if not corrected.
Learn More
To learn more about BC Orthodontics Group (http://www.bcorthodonticsgroup.com/
About Us
BC Orthodontics Group and Dr. Aly Kanani provide excellent orthodontic care at a fair price and pride themselves on their exceptional patient care. To learn more, visit http://www.bcorthodonticsgroup.com/
© 2014 BC Orthodontics Group, Millionairium and Invisalign Vancouver. Authorization to post is granted, with the stipulation that Millionairium and Invisible Orthodontics are credited as sole source. Linking to other sites from this document is strictly prohibited, with the exception of herein imbedded links.
Dr. Aly Kanani
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Page Updated Last on: Jun 17, 2014


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If you want to know why the promoters of Lennox Lewis's world heavyweight defence in Los Angeles tomorrow are expressing little sympathy for Kirk Johnson, the original challenger who was forced to pull out through injury?
The talk is that when Johnson tore a muscle earlier this month, less than 1,000 tickets had been sold for the 19,000-capacity Staples Center. However, since the more dangerous Vitali Klitschko was promoted from the undercard to a share of the top-of-the-bill, another 9,000 seats have been snapped up and the prediction is for close on a full house.
Harrison calls the tune
Scott Harrison should be tuned up for his world championship defence in Glasgow next month because his fiancee has helped record a song to herald the featherweight's entrance to the ring against Mexican Manuel Medina.
Jackie Reoch sings the final verse of "The Lion of the Cathkin" on a CD recorded by Scottish band The Vagabonds. It will be played for the first time when Harrison enters the Braehead Arena on 12 July and will then go on sale for charity.
King is another Holy row
Is Don King boxing's most successful but controversial promoter, finally reeling on the ropes?
King, who has survived so many past assaults upon his company and his reputation, is already facing lawsuits issued on behalf of Lennox Lewis and Mike Tyson which could leave him financially crippled.
Now Talk hears that he of the electric hair has fallen out with one of his most loyal heavyweights, Evander Holyfield. A rift between the two men is delaying plans for a November match between Holyfield and WBA title-holder Roy Jones Jr in New York.
Talk hears that South Africa's WBO world champion Corrie Sanders wants to come to London for sparring practice, if any British heavyweight can be persuaded to share a training ring with the man who cut down the giant Wladimir Klitschko inside two rounds earlier
Big-hearted Brodie bash
Michael Brodie is as hard as they come inside the ring. But outside the ropes it's a different matter.
Brodie has fallen for Kirsty Howard, the little girl with a terminal heart condition befriended by David Beckham and his wife Victoria.
Now the Manchester featherweight has pledged 10 per cent of the gate takings from his world title fight with Argentina's Juan Cabrera at the MEN Arena tomorrow to Kirsty's £5 million fund-raising effort on behalf of the Francis House Hospice.
- More about:
- Boxing
- Glasgow
- Lennox Lewis
- Mexico


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Check out all of the posts tagged with 'alberta' below. If you still can't find what you are looking for, try using the search box.
ClearStream staff were kept hopping at two major industry events this month
Effective September 17, two more of our operating companies have officially changed names.
Members of our North Region Industrial Services team took the lead in representing ClearStream and our operating company BVL Construction at a tradeshow in Wabasca September 22-23.
A job fair in Fredericton hosted by 11 oilsands companies drew a bigger crowd than organizers imagined.
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Daystar Shelter Ltd was established as a Mass Housing Firm under the Corporate Affairs Commission Act of 1990. The firm has over the years increased her scope of services, capacity and performance in meeting virtually all the shelter demands of the Nigerian economy. The firm has two offices in Nigeria located at Lagos with field offices scattered across the country on project sites.Daystar Shelter Ltd is an independent organization providing building construction, facility maintenance and property development among others. We have well qualified engineers and technicians who have considerable expertise in both traditional and high-tech engineering.Through its key personnel, Daystar Shelter Ltd provides a personal and unbiased service to every individual client and deals with every project, large or small, with a high degree of engineering quality and efficiency.The Company is capable of handling a wide variety of projects including Residential, Industrial and Commercial Estates.
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Les Airelles
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
TripAdvisor Reviews Les Airelles Neufchatel en Bray
Travel Blogs from Neufchatel en Bray
Day 18 Friday 6th November
We awoke t be in Avignon and low and behold once again we had a vessel attach to outside our window. River cruising has become so popular that mown the river boats have to moor to each other at times and then the guests walk through the vessel closest to the dock to get to land, the first time this happened it was ,a bit off putting but we have adjusted to it. Avignon also dates back ...
Day 17 Thursday 5th November
... up guests who had been on a truffle tour. The scenery as we sailed all afternoon was once again breathtaking. I really loved this small quite village, I think because there are few shops, is what makes it so appealing. Tonight we were n tied by two other guests from New Orleans to join them to have a special dinner in the Leopard room. This meal is like having a degustation meal and was most enjoyable . Into bed around 11pm after many ...
To Neufchatel-en-Bray
Amusing little scene this morning as we sat eating our breakfast at about 8:30.
A "council" pickup truck arrived, towing an industrial shredder.
Three workmen emerged.
First, they asked the lone German lady campervaner to move her van, they clearly planned to trim the trees behind her van.
I expected this to be the end of peace and quiet, chain saws, hedge trimmers, ...
To Neufchatel-en-Bray
Thursday, on to Neufchatel-en-Bray, our old favourite, Camping St Claire. Still as well kept as ever, this ACSI site is only two hours south of Calais. Not that it concerns us, since we are "pet free", but, I told there is a good English speaking Vet in the Town, who can do all of the Pet formalities far cheaper than the Calais based ...
Ablutions at St Claire
... than men, to make of for the time they spend "doing" their hair, and other such tasks.
For example, washing my hair takes 2 minutes maximum, and, is incorporated with taking a shower. No drying / straightening is required, a quick comb, and that is that for the day. If by chance, I have worn my cycle helmet, or motorcycle helmet in the course of ...
Other places to stay in Neufchatel en Bray
Hotel Du Grand Cerf9 Grande rue Fausse Porte, Neufchatel en Bray | Hotelfrom $86


text:
"Are you hungry?" Amelia asked, "There's lots of food around here."
Will shook his head because all the food in the house was as old as Amelia. It was old, rotten, and it smelled terrible! Will decided that someday he would clean up the house. He would dust all the furniture and throw out all the old food and try to make the place look nice.
"Oh, how I miss eating!" Cried Amelia, "I haven't tasted anything in thirty years! I am so hungry!"
"I can't imagine what that would be like." Will said. "I've never missed a meal in my life."
"Well, sometimes I pretend I'm eating food again. It may not seem like it, but sometimes I am eating."


text: Review For Final (Summer 2010) © Abdou Illia 1 Computer Hardware 2 The Core Computer Components Four subsystems in a computer system: 1. Input subsystem 2. Processing subsystem 3. Output subsystem 4. I/O (Storage) subsystem Input/Output (storage) Input Process Output 3 Output Devices Monitors Cathode ray tube (CRTs) Liquid crystal displays (LCDs) Quality of display Resolution (width and height in pixels); e.g. 640 x 480) Dot pitch in millimeters (e.g. .25, .26) Active-Matrix vs. Passive-Matrix display Touch screens Input and output via display device Video Card Common resolution Color Graphics Adapter CGA (1981) 640×200 Hercules (1984) 720×348 Extended Graphics Array XGA (1990) 1024×768 Super XGA 1280×1024 Ultra XGA 1600×1200 4 Printers Speed and resolution Pages per minute (PPM) Dots per inch (DPI) Impact printers Number of ink dots to fill a square inch Higher DPI = greater page clarity Create image by striking paper and ribbon Dot-matrix printers = most common impact printers Non-impact printers Create image by spraying or rolling ink on the page 5 I/O or Secondary Storage devices Secondary compared to the main primary memory called RAM Nonvolatile1 storage of digital data Could be Magnetic or Optical Magnetic storage (i.e. data stored on magnetically coated surface) Examples: Magnetic tape, Hard disk, floppy disk Sequential access (e.g. tape) or direct access (e.g. HDD) Hard disk disks many standards: Parallel ATA (PATA) or IDE (Integrated Drive Electronics) Serial ATA (SATA)2 SCSI (Small Computer System Interface) SCSI provides disk fault-tolerance by using RAID – Redundant Array of Inexpensive Disks; that is multiple disks set together to provide continued service in case one disk fails. Disk speed: Transfer rate in MBps (Megabytes per second) Average Read Time (in milliseconds or ms) Platter rotation speed in RPM (5400/7200/10,000/15,000) 1. Means that the stored data wouldn't disappear (or be deleted) in case of power shortage 2. In SATA and PATA, ATA stands for Advanced Technology Attachment 6 Measuring Storage Capacity 7 Processing subsystem Motherboard: chipset that all components connect to Two major components in processing subsys. CPU (Central Processing Unit) or Processor(s) Primary Storage: Random Access Memory (RAM) Read Only Memory (ROM) Other components on the Motherboard CPU Busses that transfer data Primary Storage 8 Central Processing Unit Processor Clock: generate time that synchronize other components ICU: Fetches instructions from RAM ALU: Execute instructions (arithmetic & logic operations) Registers: Store control information, data, intermediate results Clock Instruction Control Unit Arithmetic Logic Unit Registers 9 CPU speed Speed measured in hertz Hertz = # of instructions executed per second Megahertz = 1 million of instructions per second Gigahertz = 1 billion of instructions per second Speed is also measured in FLOPS* … especially in fields of scientific calculations where long divisions called Floating point divisions are used. Intel - Major Processor manufacturers Celeron - Pentium 3, Pentium 4, Pentium 4 Xeon, Dual Core Advanced Micro Devices (AMD) - K6 series processors (which compete with Intel Pentium 3) - Athlon series (which compete with Intel Pentium 4) IBM - PowerPC 740, 750, 750FX, 750GL, 750GX *FLoating point Operations Per Second 10 Primary Storage Computer's memory stored on semiconductor chips Two categories: RAM (Random Access Memory) which is volatile Synchronous Dynamic RAM (SDRAM) Double Data Rate SDRAM or DDR SDRAM ROM (Read-Only Memory) which is non-volatile Capacity in Megabytes (MB) or Gigabytes (GB) Primary Storage RAM Program RAM holds running programs and the data they use ROM contains critical programs such as those that boot the computer Data ROM 11 Summary Questions Book Notes 1) Name two devices that could be used for both input and output. 2) What is the difference between: (a) a Kilobyte and a Gigabyte? (b) a Megabyte and a byte? 3) What is the function of the Instruction Control Unit or ICU found in the processing subsystem? 4) Explain the difference between RAM and ROM. 5) What is pixel? What is dot pitch 6) What is a byte? 7) What is a Hertz? 12 Network Technology 13 Computer Network Once connected to the network, the computer (or another device) becomes a network node An interconnection of computers and computing equipment using either wires or radio waves over small or large geographic distances GHI DEF ABC MNO "Connect to GHI" JKL 14 Physical Transmission Media Physical media Wireless Transmission media used to physically connect nodes in to the network Transmits electrical or optical signals Could be cooper wire or fiber optic cable 15 Transmission Media (Continued) Twisted Pair Category Use Signal Data rate Distance Problem Category 1 Telephone Analog/Digital <100Kbps 3-4 miles Security, noise Category 2 T1, ISDN Digital <2 Mbps 3-4 miles Security, noise Category 3 LANs Digital 10 Mbps 100 m Security, noise Category 4 LANs Digital 20 Mbps 100 m Security, noise Category 5 LANs Digital 100 Mhz 100 m Security, noise Category 6 LANs Digital 250 Mhz 100 m Security, noise Category 7 LANs Digital 600 Mhz 100 m Security, noise 16 Wireless Media Uses electromagnetic waves or electromagnetic radiation for data transmission Propagation through space, and indirectly, through solid objects Two kinds of wireless media used Radio waves (radio Frequency) Infrared light Affected by Multipath interference Highly vulnerable to snooping Limited distance Blocked by thick objects Close proximity and "line of sight" location required Laptop Comm. Tower 17 Network Topologies The configurations of network components How physically the network looks like How logically data is transferred on the network Widely used network topologies: Bus Star Ring 18 Bus Network Topology Most simple network topology All devices connected to a common central cable called a "bus" Inexpensive If cable fails, the entire network will shut down 19 Star Network Topology Centered around central device called a hub or a switch All network nodes connect to the hub/switch Easy to install and update If hub fails, network fails 20 Ring Topology Node connected to a logical ring in a central device called MAU More reliable than bus or star Only one node sends at a time (no collisions) Expensive and limited speed 21 Network Architecture Defines how the processing takes place on the network Two primary types Client-server Peer-to-peer (P2P) 22 Summary Questions Malaga Notes 1) What is a node? 2) Name physical and wireless media used in networking 3) What transmission media is used for the telephone? 4) What are the main network topology? What are the differences between them? 5) Distinguish between Client-server and P2P networks 23 The Internet and eBusiness 24 Brief history of the Internet Make sure you know what DNS is used for. 1969 The Defense Advanced Research Projects developed ARPANET, the precursor of the Internet 1971 Ray Tomlison invents e-mail 1979 USENET newsgroups created at Duke University and the University of North Carolina 1984 Domain Name System (DNS) established 1991 Tim Berners-Lee creates the World Wide Web 1994 First online shopping mall, first spam email, first pizza ordered online, first advertisement banner 2000 A major denial of service attack brings down websites such as Yahoo!, Amazon.com, and eBay 2002 Denial of service attack knocks out 8/15 root DNS 25 servers Accessing the Internet (www) Web Browser Network Packet Webserver Software Packet Route Router User PC needs: - Workstation Operating System - TCP/IP - Web browser (e.g. Internet Explorer) - Internet access (e.g. thru an ISP) - IP Address (e.g. 18.104.22.168) Webserver needs: - Network (or Server) Operating System - TCP/IP - Domain name (e.g. eiu.edu) - Internet access 26 - IP Address (e.g. 22.214.171.124) Internet applications/services E-Mail File transfers Instant messaging (IM) Newsgroups Streaming audio and video Internet telephony World Wide Web (WWW) Portal 27 Intranets and Extranets Intranet Internal company network that uses Internet and WWW technologies. Typical Use: Finding and sharing work documents Collaboration between employees to work in teams Communication tool Typically, only internal employees can get access Extranet Web site that allows customers and business partners limited access to organizational intranet Uses Internet and WWW technologies Add additional security through the use of a Virtual Private Network (VPN) 28 Portal Portal Web site that offers a broad array of resources and services; such as email newsgroup Serach engines Online shopping malls Example: yahoo!, msn, aol 29 Summary Questions Book 1) (a) Name some Internet applications/services (b) What is Instant Messaging? 2) (a) What does a user PC needs for accessing the World Wide Web? (b) What is needed on the webserver side? 3) Name some Internet connection options available for residential users and businesses. 4) (a) What is an intranet? (b) an extranet? Refers to the slide # in class posted notes Notes 9,14, 7 5-6 18,19 30 Managing Security 31 Best way to prepare Review the ppt notes or chapter 7, 12 in the book to make sure you can answer the following questions Security Review Questions available in the Final Review section of course web site Security Questions in Quiz 1 32 Managing the Development and Purchase of IS 33 Systems Development Methodology? The process companies go through to develop and maintain an information system Framework for successful IS development A System Development Methodology is used For building a new system Or for modifying an existing system Examples of SDM: System Development Life Cycle ■ Prototyping Joint Application Development ■ Rapid Application Development 34 Questions Which of the following is true about SDM? 1) They provide guidelines for developing IS and maintaining them which includes upgrading and improving them. 2) SDM are needed when a brand new IS has to be developed, but you don't need to use a SDM when it comes to modifying an existing IS. 3) When a company is engaged in developing an IS, the process involves the company's employees who would be the future users of the IS, and IS professionals like system analysts and programmers. But it doesn't involve the company's management 4) All of the above 35 Traditional Systems Development Planning Life Cycle (SDLC) Analysis Seven phases 1) 2) 3) 4) Planning Systems Analysis Systems Design Development Design 5) Testing 6) Implementation 7) Maintenance Development Testing Implementation Typically one phase needs to be completed before beginning the next Problem in later phase may require return to previous phase Maintenance 36 Question In SDLC, the 7 phases are typically followed in a sequential order, which means we don't return to a previous phase in any circumstances True False 37 Feasibility Analyses Planning Feasibility analyses Technical Analysis Can the organization afford the system? Will it provide an adequate Benefit? Operational Analysis (i.e. assessing the human element of the proposed system) Resistance to change Organizational politics System development schedule Do the technologies exist to develop the system? Economic Analysis System Development Schedule Is the proposed development time line realistic? Is the programming team available during Programming step? Planning performed by Project Manager using Search and investigation (e.g. for technical analysis step) Total Cost of Ownership analysis 38 Project Management software Systems Analysis Analyze current system Define new system requirement Systems analyst works with company to understand the problem fully and to detail the requirements of the proposed system Step 1: Analyze current system Objectives: Understand what things are done and how (business processes) Identify any problems associated w/ current business processes Techniques: Observe employees at work Talk to employees (potential users) Conducting interviews 39 Systems Analysis Analyze current system Define new system requirements Step 2: Define new system's requirements Main Objective: To be defined: Specify What need to be done (not how to do it) Input requirements (nature of data, source, etc.) Processing requirements Output requirements (Types of reports, content, etc.) Storage requirements Tools and techniques Data flow diagrams (DFD) Start with high level process Add more levels with increased levels of detail Computer-Aided Software Engineering (CASE) tools Software that eases the systems development process 40 Data Flow Diagrams (DFD) Process . Symbolized by a rectangle or a curved rectangle. . Action performed by people of organizational units in order to transform input into output OR Action performed by people in the organizational units to help the units achieve their objectives Data flow . Symbolized by an arrow. . Shows data being passed from or to a process External Entity Symbolized by a square, an external entity is something (person, group, department, etc.) outside the system that interacts with the system by providing input or receiving information. Data storage Used to store data in the system. Represents a file, a database, etc. 41 Systems Design Using the requirements from Systems Analysis phase to design the new or modified system. Logical systems design Physical systems design Specifies all of the actual components (hardware, network, etc) used to implement the logical design The design must be frozen at end of this phase to prevent the to system grow indefinitely in terms of its scope and features Details the system's functionality (what it should do?) Uses Structure charts to create top-down representation of system's modules Uses System flowcharts to show relationships between modules Scope creep Feature creep Performed by system designer or (system analyst in 42 some case) Development Programming process is usually the most difficult and time consuming in the Development process. Development performed by programmers, database developers, and network engineers Programmers use Program Development Cycle 1) 2) 3) 4) 5) Review the input, processing, output, and storage requirements Develop the logic of the programs (using Flowcharts and Pseudo code) Write the programs using code generators & programming languages Test and debug the programs Complete the programs documentation 43 Development tools Program Flowchart: Graphical illustration of the problem-solving logic within a program Pseudocode: English-language statements that describe the processing steps of a program in paragraph form. Code generators: Software that generate programs that programmers could modify. Programming languages: -Java -C++ -Visual Basic -Etc. 44 Testing Programmers test modules Development team do unit testing Do they return proper outputs? Do they handle incorrect data appropriately? i.e. testing how modules work together System testing (software along with database and network component) Verification: Testing system in simulated environment with simulated data Validation: Testing system in real working environment with real data 45 Implementation Implementation strategies Direct cutover: Quick change to new system Parallel conversion: Old and new systems used in parallel for a while. Pilot testing: New system installed at only one location or one department Staged conversion: Only one part of the system installed, then another part is installed. User training 46 Maintenance Maintenance counts for as much as 80% of the total cost of an information system Tasks Correct errors found during implementation System enhancements Incremental upgrades Addition of major new features 47 Summary Questions Book Notes 1) What is a System Development Methodology? What is it used for? 2) What are the 7 phases of the SDLC methodology? 3) What kind of Feasibility analyses need to be performed during the Planning phase? Why is the system development schedule important? 4) What are the two steps in the Systems Analysis phase? What techniques and tools are used during the Systems Analysis phase? 5) What tools do programmers usually use during the Development phase? 6) What is the difference between the Verification and the Validation tests performed during systems testing? 48 Questions During what SDLC phase software programs like Microsoft Project could be used? a) b) c) d) e) f) Maintenance Implementation Development System Analysis Planning None of the above Which of the following tools or techniques could be used during the System Analysis phase of the SDLC? (Choose all correct answers) a) b) c) d) e) Interviews Observing future users doing their job Using pseudocode Using software programs to draw data flow diagrams All of the above 49 Questions What kind of feasibility analysis seeks to determine if an organization can afford the new information system and if the system will provide the adequate benefits? a) b) c) d) e) Operational Feasibility Financial Feasibility Economic Feasibility Beneficial Feasibility None of the above During the Development phase of a new medical IS, the development team finds out that most of the technologies needed to develop and implement the system are not yet available on the market. At what step of the SDLC that kind of problem should have been identified? a) b) c) d) e) f) Maintenance Implementation Development System Analysis Planning None of the above 50 Questions During what phase of the SDLC the Database component of a new system is created? a) b) c) d) e) f) Maintenance Implementation Development System Analysis Planning None of the above During what phase of the SDLC code generators could be used? a) b) c) d) e) f) Maintenance Implementation Development System Analysis Planning None of the above 51 Questions The implementation strategy in which the old system is immediately replaced by the new one is called: a) b) c) d) Staged conversion Direct cutover Systematic testing None of the above Validation testing performed during the Testing phase of the SDLC ensures that the system is working properly in the real working environment using real data. a) True b) False 52 SDLC: Recap Steps Key actors Tools/Techniques 1. Planning Project Manager Project Management software, Total Cost Ownership analysis, etc. 2. System Analysis System Analyst, Users. Interviews, observing users at work, DFD 3. System Design System analyst (or system designer) System Flowchart, Structure chart 4. Development Programmers, database developers, network engineers Program Flowchart, Pseudo code, programming languages, DBMS 5. Testing Development team, Users Unit testing, verification, validation 6. Implementation Development team, Users Direct cutover, parallel conversion, pilot testing, staged conversion 7. Maintenance internal IS staff, external consultant Make sure you can answer questions about System Development (see SDM Quest link in Review section) 53


text:
Get Your Own Chi Gul BBM Stickers
Did someone just say 'amaze-balls'? Because that is what it is. So we had the Mavin crew killing it with their stickers, mostly Don Jazzy and his famous slang 'It's Don Jazzy Again' and Korede Bello's 'God Win'. We love her expressions, and it would make chatting so much fun. Guess the sticker that saysContinue reading


text:
Scene 5
Young Gabrielle is curled up in a little cupboard.
Narrator(s): 28th November. Grannie's cupboard. New diary.
Dear diary,
I'm hiding in Grannie's cupboard. She didn't mind me being in her when she was alive so I guessed she wouldn't mind now. The time? Well let's just say it's not the twenty-eighth any more.
Young Gabrielle: (points at a china dove a china dove) I used to covet these. Now I can't touch them. It's like it's her soul preserved, like in the diary. It's because her name was Dovie. Dovie Dorethea Lyle, nee Byrde.
Narrator(s): She was beautiful. (Grannie enters and kneels beside Young Gabrielle) She had long grey hair, always in a bun except at night when she let it down. Her blue twinkling eyes. She always wore silky nighties and floaty dresses.
Young Gabrielle: Then her hair was messy and left loose. Her floaty dresses disappeared into the cupboard. She never played in the garden anymore. I write this so the diary knows what became of its owner, who disappeared. Then a starnge new one with similar hands starts. Poor confused diary. (Gabrielle starts sobbing and Grannie comforts her)
Narrator(s): I got lost in town today and made a new friend. He's very poor but I'm going to help him. He looked starved. Mum and Dianna wouldn't be impressed. Mum would be worried about me going to the slums. Dianna would scorn me for making such poor friends.
Dianna doesn't understand anything about being kind and thoughtful. She's naive and thinks that if her hair is okay, then everything is. She'll just trot along behind Ebony-Rai and do anything like a willing little puppy.
Young Gabrielle: (to Grannie) So you see? Only you can know this.
(Grannie smiles and nods)
Oh how I wish you weren't just a figment of imagination now!


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Summer School 2017
Get details for this year's event at Camp Dawson in Kingwood, WV.More
AFT-WV members from all over the state traveled to Charleston on April 1st to attend a rally in support of the United Mine Workers of America battle to save health care benefits for their retirees.
Congratulations AFT-WV member Whitney Stead from Cabell County, this year's winner of the Milken Award! Watch the video of the suprise announcement during a school assembly on Jan. 24th!
Charleston, WV – At today's PEIA Finance Board meeting, employees were saved from the benefit cuts that were proposed for the next fiscal year. Only moments prior to the meeting, Governor Tomblin committed an additional $4 million to prevent these benefit reductions, which included huge increases on specialty drugs and additional out of pocket costs, penalizing the sickest and most vulnerable people in the plan.
During the 2012 AFT-WV Legislative Retreat, AFT members from across the state gathered in Charleston to prioritize the union's legislative agenda. The recommendations from the retreat are compiled and prepared for final approval during the AFT-WV Convention.
Check out AFT-WV's new Flickr site, accessible at the bottom right of this webpage. View hundreds of photos from AFT-WV events and meetings!
Congratulations to the newly-elected AFT-WV officers and executive board members! Convention delegates elected the following leaders on October 20, 2012:
Judy Hale, President
Christine Campbell, President-elect (Pocahontas Co.)
Stacey Strawderman, Vice-president (Marion Co.)
Beth Kitzmiller, Secretary (Webster Co.) ; and
Greg Merritt, Treasurer (Wood Co.)
Elected as Executive Board Members-at-Large were:


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Apple has bought another machine learning startup as part of its effort to boost its AI prowesses for features like intelligent search and Siri.
The company that was acquired this time is India/US-based Tuplejump. The startup's old website has already been taken down, but it appears that it specialized in big-data technologies for businesses.