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EGD, Training and Credentialing of Family Physicians In (Position Paper)
Esophagogastroduodenoscopy (EGD) is a useful procedure for the diagnosis of conditions of the upper gastrointestinal (GI) tract. For all upper GI problems except esophageal and gastric motility abnormalities, EGD can often be substituted for radiologic studies. The sensitivity and specificity of EGD are higher than those of radiographs for the diagnosis of upper GI tract inflammation, ulcers and neoplasm.
Becoming competent to perform EGD increases the family physician's knowledge of upper GI pathology and normal physiology and anatomy. The ability to detect significant pathology earlier enhances the quality of care family physicians provide.
Family physicians who perform EGD find it can increase patient satisfaction because patients often prefer to stay with their primary care physician. Patients may be pleased that their family physician is able to do this procedure and may appreciate having their physician with them during a somewhat intimidating diagnostic procedure. The patient-physician bond is strengthened, and the patient's confidence in the physician is increased.
Benefits for Family Physicians
Family physicians are under pressure today to make accurate diagnoses and efficacious treatment plans as efficiently and cost-effectively as possible. In this environment especiallly, EGD is a useful tool in the physician's armamentarium.
Furthermore, family physicians who do upper GI endoscopy invariably note an enhanced relationship with patients, a better working relationship with their gastroenterologist colleagues, a better understanding of the pathology in individual cases, and a much greater comfort level with the chosen treatment as a direct result of having done the procedure themselves.
In a review of 793 EGDs performed by a family physician, 451 biopsies were taken during 385 EGDs.1 546 pathologic dianoses were provided as a result of the biopsies. No major complications occurred -- only one minor complication (a rash from meperidine). The complication rate in this family medicine study was 0.13%. A series of 1,949 endoscopies, including 667 gastroscopies, performed by a Canadian family physician reported two complications for the series as a whole, neither of which arose from a gastroscopy. 2 Such complication rates compare favorably with others in the GI literature. In what is still probably the largest series published to date, a 1976 survey of more than 210,000 esophagogastroduodenoscopies reported an overall complication rate of 0.13% with a 0.008% death rate.3
Office Versus Hospital GI Lab
Each family physician must assess the appropriateness of outpatient EGD in his or her office. The physician should consider his or her competence and comfort with the procedure, the expertise of staff, the set-up of the office, the local standards of care, the economic implications, and, in some cases, the local political climate surrounding procedures and privileges. The physician must also consider specific patient factors such as the urgency and timing of the procedure, and the patient's wishes regarding outpatient EGD.
Currently, economics favor the GI lab setting over the office setting for many family physicians. The scope, video and photography equipment, intravenous (IV) medications and supplies, and nursing staff are provided without additional charge to the physician. Physician payment today is generally provided at the same rate regardless of where the procedure is performed. Many insurance companies do not pay for supplies when procedures are performed in the office, which provides another economic incentive for physicians to do the procedure in the hospital outpatient area. The overall cost to the patient and payer, however, is considerably higher when the procedure is performed outside of the family physician's office.
EGD is safe and rarely causes significant physical stress for the patient. However, IV sedation does carry a measurable risk and thus significant post-procedure observation is required. Physicians who perform procedures requiring IV sedation in their offices should provide the same level of care as is available in an EGD lab in the hospital or out-patient setting. This would include appropriate personnel for assistance and observation and may include oximetry monitoring and telemetry for appropriate patients.
Not all patients are candidates for office EGD, particularly when the physician is first gaining experience with the procedure. For the beginning endoscopist, the following patient characteristics may preclude office EGD:
- Age > 70 years
- Age < 12 years
- Angina
- Aortic stenosis, post cardiac bypass
- Chronic Obstructive Pulmonary Disease (COPD)
- Cerebrovascular Accident (CVA)
Of course, these are guidelines and may be altered depending on the geographic area, available facilities, and experience of the endoscopist.
The Trend in Family Medicine and Support of EGD
The first national course in EGD for family physicians was sponsored by the American Academy of Family Physicians (AAFP) in 1989. Before that, state chapters provided accredited continuing medical education (CME) in EGD. Today, the AAFP and state chapters have expanded CME opportunities for EGD and other procedures.
Family physicians have gained hospital privileges for EGD in all 50 states, and the number of family physicians performing EGD continues to grow. According to a 2006 AAFP survey.4 3.8% of family physicians surveyed had hospital privileges to perform EGD alone or under supervision or with consultation. By 2011, while the percentage with privileges to perform EGD alone dropped from 3.4% to 2.4%, the total percentage had risen to 6.8%.5
Accoring to a 2003 study, 32% of family medicine residency programs offered training in colonoscopy, and 13% reported actually training one or more residents in the procedure.6
EGD has multiple indications. The most common in a study1 of 793 procedures performed by a family physician were these:
- Abdominal pain, dyspepsia
- Gastrointestinal bleeding
- Dysphagia
- Heartburn
- Anemia
- Abnormal upper GI radiograph
- Gastritis follow-up
- Barrett's esophagus follow-up
- Nausea/vomiting
A complete list is quite extensive. Indications include several pre-existing conditions, signs, and symptoms (depending on factors such as severity, response to treatment, length of symptoms, etc.):
- Cancer surveillance in high risk patient conditions (Barrett's esophagus, Menetrier disease, polyposis, pernicious anemia)
- Crohn's disease of the upper GI tract (pre-existing or suspected)
- Duodenitis, chronic
- Esophageal stricture
- Chronic esophagitis
- Failed medical therapy, for instance for Helicobacter--pylori
- Gastric retention
- Gastric ulcer monitoring
- Chronic gastritis
- Hiatal hernia
- Chronic peptic ulcer disease
- Pyloroduodenal stenosis
- Varices
- Abdominal mass in the upper-mid abdomen (when other diagnostic tests point to the stomach as the origin)
- Unexplained anemia
- Chest pain when the etiology is uncertain
- Sever dyspepsia
- Gross, but not massive GI bleeding
- Occult GI bleeding
- Severe heartburn
- Severe indigestion
- Chronic loss of appetite
- Chronic nausea (vomiting)
- Severe reflux
- Severe weight loss
- X-ray abnormality
The American Society for Gastrointestinal Endoscopy (ASGE) has published a list of indications for GI endoscopy in general (including EGD, colonoscopy, and other modalities) and for EGD specifically.7 That list appears in Table 1 below.
Table 1
ASGE Guidelines for GI Endoscopy and for EGD
GI endoscopy is generally indicated:
1. If a change in management is probable based on results of endoscopy.
2. After an empirical trial of therapy for a suspected benign digestive disorder has been unsuccessful.
3. As the initial method of evaluation as an alternative to radiographic studies.
4. When a primary therapeutic procedure is contemplated.
GI endoscopy is generally not indicated:
1. When the results will not contribute to a management choice.
2. For periodic follow-up of healed benign disease unless surveillance of a premalignant condition is
GI endoscopy is generally contraindicated:
1. When the risks to patient health or life are judged to outweigh the most favorable benefits of the
2. When adequate patient cooperation or consent cannot be obtained.
3. When a perforated viscus is known or suspected.
EGD is generally indicated for evaluating:
A. Upper abdominal symptoms that persist despite an appropriate trial of therapy.
B. Upper abdominal symptoms associated with other symptoms or signs suggesting structural
disease (e.g., anorexia and weight loss) or new-onset symptoms in patients older than 50 years of
C. Dysphagia or odynophagia.
D. Esophageal reflux symptoms that persist or recur despite appropriate therapy.
E. Persistent vomiting of unknown cause.
F. Other diseases in which the presence of upper GI pathology might modify other planned
management. Examples include patients who have a history of ulcer or GI bleeding who are
scheduled for organ transplantation, long-term anticoagulation or nonsteroidal anti-inflammatory
drug therapy for arthritis, and those with cancer of the head and neck.
G. Familial adenomatous polyposis syndromes.
H. For confirmation and specific histologic diagnosis of radiologically demonstrated lesions:
1. Suspected neoplastic lesion.
2. Gastric or esophageal ulcer.
3. Upper tract stricture or obstruction.
I. GI bleeding:
1. In patients with active or recent bleeding.
2. For presumed chronic blood loss and for iron deficiency anemia when the clinical situation
suggests an upper GI source or when colonoscopy does not provide an explanation.
J. When sampling of tissue or fluid is indicated.
K. Selected patients with suspected portal hypertension to document or treat esophageal varices.
L. To assess acute injury after caustic ingestion.
M. To assess diarrhea in patients suspected of having small-bowel disease (e.g., celiac disease).
N. Treatment of bleeding lesions such as ulcers, tumors, vascular abnormalities (e.g.,
electrocoagulation, heater probe, laser photocoagulation, or injection therapy).
O. Removal of foreign bodies.
P. Removal of selected lesions.
Q. Placement of feeding or drainage tubes (e.g., peroral, percutaneous endoscopic gastrostomy,
percutaneous endoscopic jejunostomy).
R. Dilation and stenting of stenotic lesions (e.g., with transendoscopic balloon dilators or dilation
systems using guide wires).
S. Management of achalasia (e.g., botulinum toxin, balloon dilation).
T. Palliative treatment of stenosing neoplasms (e.g., laser, multipolar electrocoagulation, stent
U. Endoscopic therapy of intestinal metaplasia.
V. Intraoperative evaluation of anatomic reconstructions typical of modern foregut surgery (e.g.,
evaluation of anastomotic leak and patency, fundoplication formation, pouch configuration during
bariatric surgery).
W. Management of operative complications (e.g., dilation of anastomotic strictures, stenting of
anastomotic disruption, fistula, or leak in selected circumstances).
EGD is generally not indicated for evaluating:
A. Symptoms that are considered functional in origin (there are exceptions in which an endoscopic
examination may be done once to rule out organic disease, especially if symptoms are
unresponsive to therapy or symptoms recur that are different in nature from the original symptoms).
B. Metastatic adenocarcinoma of unknown primary site when the results will not alter management.
C. Radiographic findings of:
1. Asymptomatic or uncomplicated sliding hiatal hernia.
2. Uncomplicated duodenal ulcer that has responded to therapy.
3. Deformed duodenal bulb when symptoms are absent or respond adequately to ulcer therapy.
Sequential or periodic EGD may be indicated for:
A. Surveillance for malignancy in patients with premalignant conditions (e.g., Barrett's esophagus,
polyposis syndromes, gastric adenomas, tylosis, or previous caustic ingestion).
Sequential or periodic EGD is generally not indicated for:
A. Surveillance for malignancy in patients with gastric atrophy, pernicious anemia, fundic gland or
hyperplastic polyps, gastric intestinal metaplasia, or previous gastric operations for benign
B. Surveillance of healed benign disease, such as esophagitis and gastric or duodenal ulcer.
Reprinted with permission from Early DS, Ben-Menachem T, Decker GA, et al; ASGE Standards of Practice Committee. Appropriate use of GI endoscopy. Gastrointest Endosc. 2012;75(6):1127-31.
The physician interested in learning EGD can obtain training through a medical school, residency, post-residency fellowships, CME conferences, preceptors, or any of a variety of self-study sources, including atlases, articles, videotapes, audio tapes, and computer-assisted programs. Related endoscopy skills include rigid and flexible sigmoidoscopy, colonoscopy, and nasopharyngolaryngoscopy.
The AAFP outlined requirements for demonstration of proficiency and documentation in 19998. Those requirements are reproduced in Table 2, below.
Table 2
Demonstration of Proficiency and Documentation for EGD
The learner shall demonstrate adequate clinical knowledge regarding the following:
- Indications
- Patient selection and contraindications (relative & absolute)
- Informed consent
- Preparation of patient
- Limitations of procedure
- Complications and their management
- Electrosurgical principles
- Indications and contraindications for simple biopsy, electrosurgical biopsy, ablation, and polypectomy
- Complications and management of biopsy
- Familiarity with disinfection, preparation of equipment, and Occupational Safety & Health Administration (OSHA) regulations regarding this procedure
The learner shall demonstrate technical and clinical skills as he or she does the following. (Since the procedure cannot be completed without all of these steps, possession of the entire skill set is required.)
- Identifies the parts of the scope and explains their use.
- Explains the equipment setup.
- Performs an oral examination on the patient.
- Inserts the scope into the patient's mouth using either the manual or the visual technique.
- Places the bite block between the patient's teeth.
- Advances the scope to the cricopharyngeus and demonstrates how it is traversed.
- Explains (or demonstrates) how he or she would handle a tracheal intubation.
- Demonstrates the passage of the scope through the esophagus.
- Discusses the decision whether or not to biopsy the distal esophagus.
- Demonstrates passage through the lower esophagus sphincter.
- Explains how the gastric pool would be aspirated upon entry into the stomach.
- Passes the scope through the stomach and demonstrates orientation and landmarks as he or she progresses.
- Demonstrates the approach to and passage through the pylorus.
- Demonstrates passage of the scope into the duodenum.
- Discusses orientation within the duodenum and the location of the papilla of Vater.
- Begins to withdraw the scope and demonstrates visualization of the duodenal bulb.
- Withdraws the scope into the stomach and identifies returning past the pylorus.
- Demonstrates the "J" or retroflexion maneuver and visualizes the cardia and the lower aspect of the gastroesophageal junction.
- At this point, or earlier when in the lower esophagus, explains how the diaphragmatic level can be identified on the esophagus or stomach.
- Straightens the scope and adequately visualizes the lining of the stomach, maintaining orientation.
- Shows/explains how a biopsy will be done.
- Correctly removes the scope from the stomach, correctly visualizing the esophagus and vocal cords.
If administering conscious sedation, the learner shall demonstrate that he or she has performed conscious sedation during the past 24 months with cases reviewed for choice of drug, interval, dosage, and outcome.
The learner shall demonstrate proficiency in post-procedure steps through the following:
- Appropriate aftercare of patient, including use of reversal medications if appropriate, orders, medications, and instructions.
- Preparation of endoscopic report.
- Appropriate post-procedure follow-up.
After the completion of upper GI endoscopy, appropriate documentation of the procedure is necessary for continuing care of the patient, medicolegal reasons, and billing.
Documentation can be performed by dictating a complete report or by using an endoscopy report form that allows notation of findings by circling the appropriate indications, medications, findings, and pathology. This type of documentation is also helpful when further clinical privileges are being requested and in clinical studies on EGD. A sample endoscopic report form is included as Appendix A.
Adapted from American Academy of Family Physicians. Esophagogastroduodenoscopy: a syllabus for the family physician interested in performing this technique. Leawood, KS: American Academy of Family Physicians 1999.
The Hospital Accreditation Standards 20139 published by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) states Credentialing involves the collection, verification, and assessment of information regarding three critical parameters: current licensure; education and relevant training; and experience, ability, and current competence to perform the requested privilege(s)," (MS.06.01.03) and "The decision to grant or deny a privilege(s), and/or to renew an existing privilege(s), is an objective, evidence-based process." (MS.06.01.05)
The Joint Commission's standards create no barriers to granting privileges for a given activity to more than one clinical specialty (for example, privileges to perform endoscopy granted to both surgeons and gastroenterologists). The overriding concern is that the physician demonstrate the appropriate education, training, and current competence to perform the procedure in question. The specific criteria regarding education, training, and current competence should be developed by the individual departments and, as specified in standard MS.06.01.05, "All of the criteria used are consistently evaluated for all practitioners holding that privilege."
The American Association for Primary Care Endoscopy (AAPCE) recommends, "that "credentialing for gastrointestinal endoscopy be based primarily upon documentation of prior and/or current proficiency in a clinical setting. Competency should be substantiated by documentation provided by the applicant from prior mentors and/or supervisors. Alternatively, the applicant may be observed performing actual cases by an unbiased proctor (agreed upon by applicant and hospital) who then renders an opinion to the hospital regarding the applicant's competency. The required number of proctored cases should usually be less than 10. For hospitals that choose to specify required numbers of procedures during training, these requirements should not exceed 50 colonoscopies or 35 esophagogastroduodenoscopies (EGD). No competent primary care physician should be denied privileges based on having been trained in primary care or on a specific number of required procedures during training.10
Physician candidates may be required to provide written documentation of additional training beyond the core curriculum of family medicine residency. This training can include, but is not necessarily limited, to the following:
- Special selective training within a family medicine residency.
- Accredited continuing medical education.
- Verified preceptorship with a licensed physician.
The department may request written information regarding the number of cases performed and the presence of any complications related to the procedure.
Privileges for invasive procedures are usually granted a provisionally with the requirement that the physician submit progress reports at designated intervals (for example, three, six, and 12 months). The family medicine department would monitor these progress reports for department members and make recommendations for advancement from provisional privileges to active privileges.
During the provisional period, the family medicine department should assign a physician for to proctor the family physician monitored.
To ensure continuous monitoring of quality, physicians may be required to submit an annual census of all invasive procedures, listing many or all complications should they arise. This list should be reviewed by the department chair or his or her designee. Active privileges are renewed every one to two years by the authority of the department chair.
Applying for GI Endoscopy Privileges
The family physician wishing to apply for privileges to perform EGD should follow a several-step process as instructed below:
1. Prepare a brief resume that describes your educational background including college, medical school, residency, board certification, and recertification.
2. Include your affiliations with hospitals and, state and national medical societies, including the duration of these affiliations. Include any professional honors, elected offices, or committee chair positions.
3. Describe the accredited CME courses you have taken that pertain to GI endoscopy. Include CME and/or self study of gastrointestinal illness (atlases, articles, etc).
4. Describe your years of practice and your record in providing high-quality care for a variety of complicated cases. The physician with a record of exemplary service can point to these experiences as evidence of professional excellence.
5. Include a summary letter from your residency or state AAFP chapter that supports these privileges as being within the scope of the specialty of family practice.
6. Describe the number of rigid sigmoidoscopies, flexible sigmoidoscopies, colonoscopies, and/or upper GI endoscopies that you have performed. Include an inventory that lists the patients by name, age, sex, and indication. Provide diagnostic findings and prominently highlight your lack of complications.
7. Describe hands-on proctorship experiences and/or identify someone who is willing to do cases with you. A hands-on proctorship is not necessarily a prerequisite if you have equivalent training and/or experience.
8. Be prepared, if necessary, to discuss the criteria for EGD credentialing suggested by the ASGE and the AAFP's position that the ASGE's stance is not supported by current clinical evidence, and may reasonably be interpreted as more aligned with competitive marketplace concerns than patient access to quality care.
9. Describe your plan for quality assurance. This should involve tracking your cases, and providing these data to your department chair after a period of six to 12 months.
10. Provide evidence of your ability to obtain malpractice insurance coverage.
11. Be able to demonstrate an ongoing commitment to GI-related CME.
12. Be cooperative yet persistent during the privileging process. Become thoroughly familiar with your hospital's bylaws and processes related to credentialing and privileging. Review and understand the privileging materials available from the Academy (see www.aafp.org/online/en/home/practicemgt/privileges/assistancepriv.html. Accessed January 28, 2013.).
Public Health Implications
Unfortunately, little is known concerning the public health implications of family physicians performing EGDs. However, it is known that patients, particularly in rural areas, often have more ready access to family physicians than other specialists. Thus, when family physicians can offer EGD, it increases patients' access to the procedure. Improved access should lead to earlier diagnosis and treatment as well as greater patient convenience.
Current Research Agenda
Research concerning EGD in primary care has been limited primarily to case series and descriptive studies. These investigations suggest that family physicians can safely, accurately, and effectively perform EGD compared with other specialists or established criteria.
Although findings from case series, descriptive series, and literature reviews are helpful, evidence from randomized, controlled trials or other more powerful study designs is needed. The AAFP supports the need for such research. Clearly, further research is needed in every area of procedural training, performance, and health services. The need to document benefits and harms of procedures, patient preferences, economic costs and savings, and utilization and alternatives will assume greater importance as time goes on.
Several measures might help facilitate needed research:
- Target research support from existing sources, such as the AAFP and AAFP Foundation (AAFP/F).
- Develop alliances with equipment or pharmaceutical manufacturers or other proprietary entities.
- Develop grant funding via the AAFP/F for procedural skills research.
- Work with HMOs, insurance corporations or health systems to develop funding.
- Work with the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH) or other federal granting agencies to develop requests for proposals centering on procedural skills.
- Approach foundations for funding.
- Explore opportunities to publish results of procedural skills research and experiences.
Relationship Between the AAFP and Other Physician Organizations
In an ideal world, the specialty societies would work together to improve patient care by disseminating technology and educating all physicians. Unfortunately, groups such as the ASGE have, in the past, been unwilling to work cooperatively with the AAFP on endoscopy issues. In such situations, the AAFP has had no choice but to develop its own educational programs. In situations where other specialty organizations are willing to partner with the AAFP, the AAFP welcomes the chance to work toward improved patient care by increasing the education of its members.
Informed Consent
An example of an informed consent form used by a family medicine program follows as Appendix B.
1. Pierzchajlo PJ, Ackerman RJ & Vogel RL. Esophagogastroduodenoscopy performed by a family physician: a case series of 793 procedures. J Fam Pract 1998;46(1):41-6.
2. Kolber M, Szafran O, Suwal J, et al. Outcomes of 1949 endoscopic procedures: performed by a Canadian rural family physician. Can Fam Physician. 2009;55(2):170-5.
3. Silvis SE, Nebel O, Rogers G, et al. complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA. 1976;235(9):928-30.
4. American Academy of Family Physicians. Facts About Family Practice. Leawood, KS: American Academy of Family Physicians 2006.
5. American Academy of Family Physicians. Provision of selected services and procedures in hospital practices of family physicians (as of April 2011). In Facts About Family Medicine. Kansas City, MO: American Academy of Family Physicians; 2008. www.aafp.org/online/en/home/aboutus/specialty/facts/17.html. Accessed January 30, 2013.
6. Wilkins T, Hardy H. The current state of esophagogastroduodenoscopy training in family practice residency programs. Fam Med. 2003;35(4):269-72.
7. Early DS, Ben-Menachem T, Decker GA, et al ASGE Standards of Practice Committee. Appropriate use of GI endoscopy. Gastrointest Endosc. 2012;75(6):1127-31.
8. American Academy of Family Physicians. Esophagogastroduodenoscopy: A Syllabus for the Family Physician Interested in Performing This Technique. Leawood, KS: American Academy of Family Physicians 1999.
9. Joint Commission on Accreditation of Healthcare Organizations. Hospital Accreditation Standards 2013. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations 2012.
10. American Association for Primary Care Endoscopy. AAPCE Policy on Credentialing for Gastrointestinal Endoscopy. Leawood, KS; 2009.
Appendix A
Patient's Name: _______________________ Location: ______________________
Date: _____________ Age: _______ Sex: M or F
Race: _____________ Physician:______________________
Office/Hospital ID# (if any): ______________ Assistant(s): ___________________
Pertinent Patient History (e.g., illnesses, medicines, surgery, allergies, duration of problem):
Has the patient completed 7-10 days of medical therapy ? Yes No
Circle the categories of drugs used and indicate the drug, dosage and duration of therapy, if known:
Antacid / Antibiotic / Cytotec / Bismuth / Carafate
PPI:_______________ H2 blocker:_______________ Other:________________
Has the patient been using over the counter or prescription NSAIDs or other known gastric irritants?
If so, please list:____________________________________________________
What are the indications for these procedures? (Circle the numbers of those that apply.)
|ICD 9 Codes
|ICD 9 Codes
|Pre-existing Conditions
|1. Abdominal Mass
|17. Cancer Surveillance
|2. Anemia, Unexplained
|in High Risk Patients
|3. GI Bleeding, Acute
|(e.g., Barrett's Esophagus, Menetrier
|4. GI Bleeding, Occult
|Disease, Polyposis)
|5. X-Ray Abnormality
|18. Esophageal Stricture
|19. Gastric Retention
|20. History of Duodenitis
|6. Dyspepsia, Severe
|21. History of Esophagitis
|7. Dysphagia/Odynophagia
|22. History of Gastritis
|8. Early Satiety
|23. History of Hiatal Hernia
|9. Epigastric Pain
|24. Monitoring a Gastric Ulcer
|10. Food Slicking
|25. Peptic Ulcer Disease
|11. Heartburn, Meal Related
|26. Pyloroduodenal Stenosis
|12. Indigestion, Severe
|27. Varices
|13. Nausea, Chronic (Vomiting)
|14. Pain (Substernal/Paraxiphold)
|Any Other Indications (please describe):
|15. Reflux of Food (Regurgitation)
|16. Weight Loss, Severe
Medications Used: (Circle drugs used and indicate total dosage.)
|Conscious Sedation
|Topical Anesthetic
|1. Morphine
|1. Cetacaine
|1. Naloxone
|1. Atropine
|2. Fentanyl
|2. Lidocaine
|2. Romazicon
|2. Simethicone
|3. Demerol
|3. Other
|3. Glucagon
|4. Nubain
|4. Other
|5. Versed
|6. Valium
Findings: (Circle one for each question)
|1. Was esophagus well visualized?
|2. Was pylorus well visualized?
|3. Was duodenum entered?
|4. Was Papilla of Vater seen?
|5. Did you do a turnaround maneuver to see cardia/fundus?
Pathology Codes: (Codes apply immediately below.)
1. Mild erythema, patchy, no ulcers
2. Moderate erythema, diffuse in area, some petechiae, no ulcers
3. Severe erythema, limited focal mucosal degeneration (i.e., 1-3 ulcers are seen)
4. Severe erythema with diffuse mucosal degeneration (more than 3 ulcers)
5. Other (polyps, cancer, atrophy, or miscellaneous)
Circle one inflammation code for each area: (See above.)
|None 1 2 3 4 5
|None 1 2 3 4 5
|Gastric Area
|None 1 2 3 4 5
|None 1 2 3 4 5
|Number of biopsies: (Circle one.)
|0 1 2 3 4 5 6 7 8 9 10 More
|Pathology: (location, size)
|Did you biopsy an area that appeared normal as a control)?
|Will you be requesting confirmation for the presence of the H. pylori?
What is your post-endoscopy working diagnosis? (Circle those that apply.)
|ICD 9 Code
|ICD 9 Code
|Hiatal Hernia
|Tumor Growth
|AV Malformation
|Other (describe)
Will you or did you order upper GI x-rays or barium swallow to confirm and/or complement your endoscopy findings? (Circle one.) Yes No
Were there any complications? (Circle one.) Yes No
Did this procedure change your management plan? (Circle one.) Yes No
Comments - Circle how your management plan or diagnosis changed: (Circle all that apply.)
|1. New diagnosis
|6. Suspected diagnosis now confirmed
|2. Medication added/deleted
|7. Previous diagnosis deleted
|3. Medication will be continued
|8. Diagnostic tests added or deleted
|4. Consultation will be requested
|9. Other (describe)
|5. Endoscopy consult not necessary now
Exam performed as above,
Please check to see that all items have been completed. Complete information strengthens our ability to document a high quality of care.
Appendix B
EGD is a way for your family doctor to look into your stomach or intestine with a flexible tube and possibly remove a small sample of tissue called a biopsy. The sample of tissue is sent to a lab for testing. EGD is also called by other names such as endoscopy or upper GI endoscopy.
What are the benefits of EGD?
EGD can help your family doctor find out what is causing your symptoms and find the cause. For example, your doctor may find that an ulcer has been causing your pain. The doctor can then recommend medicine or other treatments. EGD can also find early signs of cancer. With some cancers, early diagnosis increases the chances of a cure.
What are the risks of EGD?
EGD is a generally safe. It causes few complications. But, as with all medical tests or procedures, EGD does have some risks. Your doctor thinks the likely benefits are greater than the risks. Still, you need to understand the risks before you decide to have an EGD. Please read and understand the following:
1. Infection can occur, although this is rare. You might need medications after the procedure.
2. Bleeding can occur, but it is also rare. You could have some spotting or even enough bleeding to need a transfusion. This is not common, but it is possible.
3. Perforation (putting a hole in the intestine) is a serious complication, but it is uncommon. If a perforation occurs, you would need to go to the hospital and might need an operation.
4. You will be given some medicines during EGD. The medicines may have side effects, but your doctor will take steps to lower the risk. The medications your doctor will give you to prevent pain can cause a reaction. One rare side effect is a swelling and redness in the arm. Another might be a severe allergic reaction to the medications. Your doctor will take precautions to minimize this risk.
What are my choices?
You can choose to have EGD or choose not to. This sheet is designed to help you make that decision after talking with your doctor about it. You have several choices:
1. If you feel your questions have been answered and you understand and accept the risks and benefits, you can agree to have EGD by signing the bottom of this sheet.
2. If you are not yet ready to decide to have an EGD, you can ask for more time to think about it and discuss it with your doctor.
3. You can refuse to have EGD, but keep in mind that not having the procedure may also involve some risk. For example, your doctor may not be able to find the cause of your problem, or the cause may take longer to find. In the case of cancer, delaying could mean that treatment isn't started soon enough to cure the cancer.
4. In some cases, other tests could be done instead of an EGD. You can ask your doctor about alternatives to EGD. If there are alternatives that your family, friends, or other doctors have discussed with you, tell your family doctor about them so you can discuss whether they would be right for you.
Informed Consent
I have read and understood the above. I believe that the benefits of this procedure outweigh its risks. I agree to allow Dr. to perform the procedure.
Signature Date
(August Board 2002) (2013 COD)
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August 24, 2003:
Full Results from the Special August 9, 2003 Elections
To see the Full Election Results of the Special Tribal Council Election and Pictures of the proceedings, Go to the Election 2003 Page.
Latest TRIBAL COUNCIL REPORT:
See the current Little Shell Tribal Newsletter located on the Little Shell Community webpage for all the latest news from the Little Shell Tribal Council.
Little Shell Tribal Council Monthly Meetings:
Monthly Meeting Schedule:
(2nd Saturday of each month)
October 11, 2003
November 8, 2003
December 13, 2003
January 10, 2004
February 14, 2004
March 13, 2004
April 10, 2004
May 8, 2004
June 12, 2004
August 2003 Minutes:
HTML Version: August 2003 minutes
PDF Version: August 2003 Minutes
WordPerfect Version: August 2003 Minutes
September 2003 Minutes:
Coming soon
Little Shell Tribal Council Members
John Sinclair
1stVice Chairman
Darrell Koke
2nd Vice Chairman
Larry Salois
Caroline Fleury
Council Members
Alvina Allen
Bob Van Guten
Ed Lavenger
Bulletin Board Little Shell Tribe Contacts Home News Council Committee Recognition Legal History Genealogy Pictures Resources Culture Our Community
The Little Shell Tribe Newsletter is FREE to all Enrolled Tribal Members. It is published 12 months a year and is supported by particle funding by the Little Shell Tobacco Abuse Prevention Program. To place your name on the list for the newsletter, Click Here to get the Address/phone number to request your name and address be placed on the newsletter subscription list. The Contact is Toni Jo Atchison, Tobacco Abuse Prevention Specialist
By the LittleShellTribe.com Webmaster:
Toni Jo Atchison, Little Shell Tobacco Abuse Prevention Specialist Announces Tribal Newsletter is FREE to Tribal Members
Toni Jo Atchison, Little Shell Tribal Tobacco Abuse Prevention Specialist has announced that the Tribal newsletter is FREE to all Enrolled Tribal Members. Previously, a subscription of $10 was required for the newsletter and was published quartely. The subscription cost covered monies that funded the creation, mailing of the newsletter, along with helping with office expenses. Now, with funding provided in part under a contract with the Montana Department of Public Health and Human Services, Montana Tobacco Use Prevention Program, and the Little Shell Tobacco Abuse Prevention Program, the Newsletter will be published 12 months a year. To place your name on the List for the newsletter (if you do not currently receive it), contact Toni Jo at the main office or write a letter requesting your name to be placed on it. Tribal and Non-Tribal members are still welcome and are encourgaged to send donations to the Office to help with tribal expenses.
To view the Little Shell Tribal Tobacco Prevention Program, Click Here
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subset: commoncrawl


text:
How to include MathJax in an epub3 file to work with iBooks (and possibly others)13 Jan 2013
At the Joint Mathematics Meetings Present and Future of Mathematics on the Web session, Lila Roberts presented an excellent demo of the good stuff you can do with iBooks author. The demo included MathJax and jsxgraph, and combined both with iBooks Author's easy, pretty layout tools. Of course, the drawback is that iBooks Author is
- a proprietary format
- restricted to iPads (not just iOS)
- you're not allowed to sell an iBooks Author file except through iTunes.
- iBooks Author is not transparent about how its formula editor produces SVGs out of TeX but pastes MathML directly into a page, leading to inconsistent renderings of equivalent mathematics
- MathML support of iBooks on iOS5 devices is severly broken (and will likely never be fixed) thanks to a mobile Safari bug that screws up the use of STIX fonts.
Let's get started!
If you're lazy, grab the file at the end of the post and hack from there. But I'll walk you through it.
- If you want to learn something, grab a copy of MathJax
- slim it down as described here
- I went all the way and restricted output to SVG – to minimize things and to make it work. HTML output should work on iOS5, but last I checked Apple changed something on iOS6 that I couldn't track down for lack of devices.
Alright, that's the basics. You now have a copy of MathJax that works on any reasonably recent webkit browser, including most Android and iOS versions.
You have all inputs (LaTeX, asciimath, MathML) available but only SVG output (well, and native MathML but if that worked we wouldn't be here…).
What's next?
Create your document. That's actually hard if you don't have a workflow already and don't want to afford InDesign, Blue Griffon etc.
Personally, I will always try pandoc first. It's the most versatile tool there is and John McFarlane is just fantastic. Its TeX implementation is enough if you are writing TeX with HTML/epub output in mind, I'm sure you won't run into trouble.
If you can, consider to go through the Haskell-cabal-pain of installing the current development version – see the instructions at the pandoc github wiki. That will get you the new epub3 writer and things should be easy.
Of course, you can hack the example file below and just use a current version of pandoc or whatever you like to generate some xHTML5 (yes, xhtml, not html if you want your file to validate). You'll have to modify the manifest etc by hand.
Anyway, let's daringly assume you have an epub3 with your xhtml+mathml content.
Adding MathJax.
- add the slim down version of MathJax to your epub file using your favoriate tool for adding content to a zip file. (Don't unzip/rezip unless you know what epub needs when zipping…)
- Assuming you're using the copy as in the attachement, add the following to your manifest (modify paths and id's if needed)
- To each xhtml file that contains MathML, add

- I have not activated automatic linebreaking because there's currently a bug in MathJax on iOS6. If MathJax detects the need to break the line, you'll get Math Processing errors instead.
- For each xhtml file with the above we'll have to modify the
properties-part in the manifest to have both
mathml scripted, e.g., in the sample file you'll see
<item id="c3" media-type="application/xhtml+xml" href="xhtml/ch1.html" properties="mathml scripted"/>
- And then you can include wonderful MathML and even webkit deficiencies or the horrible iOS5 Safari+STIX bug will be meaningless to your epub file and you can actually publish a mathematical epub file to be read on iBooks.
This text is available as an epub3 file which includes MathJax and should run on iOS devices.
- Lila Roberts, 2013/01/15
I'd like to try to create an epub file–I must admit the opf file is quite intimidating. pandoc looks nice; but I do have inDesign and BlueGriffon. I'll keep you posted. Thanks, Peter!
- Peter, 2013/01/15 yes, creating opf files is a pain. For experiments, you can just hack the sample file from the post. iBooks doesn't complain if the opf is incomplete, so you can just add jsxgraph etc to the file, too.
- AndrewMcDermott, 2013/01/25
Hi Peter
Great post, I'll give this a go in the next week or so hopefully, if things calm down a little on our project. Will let you know how I get on!
- Peter, 2013/01/25 great! let me know how it goes.
- Peter, 2013/02/14 Hi Andrew. I think this was caught in moderation — sorry. Great to hear it works for you. I hope we can get HTML output running again since that behaves better wrt to CSS. You can of course include both images and MathML and have MathJax replace the images with its rendering. That way you can support all systems using the same file.
- Johannes Wilm, 2013/05/04
nice one! We have included this in our javascript based epub generator at http://www.fiduswriter.com. I must admit though that I haven't found any ereaders that can make use of this. Is there a list somewhere of what readers support javascript? I noticed thatyou guys are really against prerendering things, but I wonder if maybe thatis needed anyway. So at first I tried looking at the style declarations that are being included in the -section by mathjax. The most important thing missing there seems to be the font-face declarations. I haven'tlooked too much into whether they can be recreated some way.
The other way one could go would be to try to convert the rendered SVG to a canvas element and from there to an img, which could be saved within the epub. I haven't tried it, but was thinking of something like https://code.google.com/p/canvg/.
Are there any other recommentations you have?
- Peter, 2013/05/05 Hi Johannes, sorry that this was stuck in the moderation queue. Somehow I didn't get the notification… This warrants a longer reply, as your comment is hitting on many problems and misconceptions at once 😀 (not you personal, just the way the comment can be misunderstood).
- Johannes Wilm, 2013/05/05
I see. The epub with mathjax in it worked fine in IBooks, while in Adobe Digital Editings (installed via Wine) and my Nook Glow Light, it just doesn't run the Javascript. It seems to crash the ebook reading app that comes with Calibre.
Epubs themselves may have a limited lifespan, as ebook readers will get fullblown browsers with time, and once there is MathML support everywhere, we may just need a smaller script of some kind to translate Tex-based maths to MathML… The point is that the landscape is changing rapidly and that one needs to adjust one's solutions quite a lot over the next few years.
So, I was thinking: To get smething that is working with today's devices, instead of this:
$X=Y^2$which is rendered fine on only some devices, have something like this: Then the ebook readers that cannot run jaascript will show the image and those that can (IBooks) can calculate the mathjax formula. Of course, mathjax has to be run manually with some javascript, as it cannot find the equation it should render as easily, but I'm sure this can be done. As for SVG vs. IMG – I didn't look enough at the svg-canvas library, but assuming that it permits me to copy an already rendered SVG to a canvas, that should mean that I should be able to create a canvas which easily can be converted to an IMG and then saved inside the epub. But you would maybe argue that it is preferable to just include the SVG directly? For that I assume I would copy the SVG code from the DOM, copy the extra style information that has been added to the header, and find the fonts that have been added through some other trick (cannot find them in hte header) and add those to the mix as well. Right?
- Johannes Wilm, 2013/05/05
Ah, this system ate most of my code examples. let me try again:
So, I was thinking: To get something that is working with today's devices, instead of this:
<MATH>X=Y^2</MATH>which is rendered fine on only some devices, have something like this:

- Peter, 2013/05/05 As I wrote, ideally, you would produce some kind of image fallback and use the epub-switch element. Unfortunately, very few epub3 reading systems support it. Even worse, they often react the wrong way to it: using MahtML instead of the image :( Unfortunately, your "once there's MathML support everywhere" makes me cry a little as I just replied to https://groups.google.com/forum/?fromgroups=#!topic/mozilla.dev.platform/96dZw1jXTvM. There's currently zero development going into browsers. I hope we can change that, but this will be a while. Anyway, yes, MathJax can easily replace images by rendering embedded code. Case in point: bookmarklets for doing that on Wordpress.com and Wikipedia https://gist.github.com/pkra You can use SVG – both canvas and SVG are part of epub3. Grabbing MathJax output is certainly possible, but with constraints. Making MathJax work also outside the DOM (with those constraints) is in our backlog, but has been for a while. You might find https://github.com/agrbin/svgtex interesting.


text: I haven't been sharing the Tribune's Hook Shot feature nearly as often as I should in recent months. I was motivated to do so with the two most recent pictures. One of a 5-year-old that obviously just became hooked on the sport and the other of a 95-year-old still getting a kick out of hooking up. That, my friends, is what it is all about. If you have a picture from your fishing experiences send it to me at email@example.com Be creative, have fun. While there is nothing wrong with the traditional "grip and grin", there are plenty of other ways to catch the awesome benefits of fishing.


text:
I'm not going to go on and on about how much i love this perfect malibu home michael s. smith designed, after all i have done two posts on it- a master creating a masterpiece! need i add this particular home was featured on the cover of elle decors 2oth anniversary issue a few years ago.
what i will go on and on about is the auction christie's is having this week, palladium villa by michael s. smith, to sell off items from this spectacular project and home (see video about sale here). this home is truly one of my favorite residences ever, and i can't believe we all get a chance to have a piece of it- a piece of a masterpiece! i have my list- i can't wait to bid!
if that's not enough, or if you don't get a chance to take part in the auction, you can get more of this amazing home in a few weeks when michael's new book building beauty- the alchemy of design arrives. the book is all about the conception and creation of this masterpiece.
something else you can count on is this won't be the last you will hear about all of this, especially here! much more to come!
photographs by francois halard and simon upton.


text:
Valerie Harper Targeted By $2 Million Lawsuit from Broadway Producer
She's celebrating her progress in fighting off inoperable brain cancer these days, but Valerie Harper's joy may be short-lived as her former Broadway producer is looking to loot her to the tune of two million dollars!
"Looped" honcho Matthew Lombardo filed a lawsuit against the 74-year-old actress for "intentionally failing to notify him that her cancer had returned, forcing him to have to find a last-minute replacement."
Due to Harper's delay in divulging her diagnosis, Lombardo claims it cost him $500,000 to find a suitable actress to fill in for her.
Meanwhile, Valerie made sure to mention that rather than the previous 'cancer-free' claim, she's merely been able to stop her disease from taking her life- "I want to thank Closer Weekly for giving me a chance to clarify my story and, more importantly, to address the headline which states that I am cancer free. I am not cancer free."
"As I have stated on many occasions, I have Leptomeningeal Carcinomatosis (Lepto), lung cancer that has traveled to the meninges around my brain. While speaking to the reporter for Closer Weekly, I was relaying a story where my doctor had told me that in his 30 year practice, I was the only Lepto patient he has seen without other cancers already present."
"I had just had my yearly full-body scan to determine if this sneaky cancer had migrated to other parts of my body. Therefore, in completing that part of the story, I told the reporter with excitement that I was cancer-free, but what I meant to say was that my full body scan revealed that I was still thankfully cancer free."
"What all parties want to be made clear now is that while the Lepto has not spread, I am still not cured. I am a cancer patient, and I continue to fight with the hope that a cure may be just around the corner," she added.


text:
When the cannery boats arrived the albacore quit biting and took to other waters.
His pre-war clothes had served nicely to wear about the cannery.
We must get everything up to the level of the cannery buildings.
Hope it's from the fleet, saying they arrived at the cannery all right.
And the cannery was notified of the safe arrival of the boats at the island.
The message was to be forwarded to Farnsworth from the cannery.
Mr. Dunlap: I have never been in the cannery business, I could not tell.
While they talked one of the night men from the cannery hurried on to the scene.
In the summer she had worked for a few weeks in a cannery, pasting labels on fruit cans.
"The cannery doesn't seem to be running," observed Mr. Bradford.
A jail (1920s+)


text:
Informacije in možnosti za mlade v Evropi.
Do you have the opportunity to travel abroad? Here's a few reasons you should grab it with both hands!
"I haven't been everywhere but it's on my list." – Susan Sontag. Isn't it time you discovered the world? Find out more about how you can study, work and volunteer outside of Europe.
Curious as to the origins of this pearl of wisdom? Is your knowledge of Chinese culture limited to the menu of the local Chinese restaurant, and do you want to change that? Find out more about China through the Confucius Institutes.
It's easier to change the world as a group than by yourself. The Global Youth Network (GYAN) pulls together the power of young people and the youth organisations they represent to achieve that goal!


text:
Drunken Four Year-Old Almost Ruins Christmas (VIDEO)
Best part of this story: A 4-year-old boy gets wasted, puts on a dress, and stumbles across the block to steal Christmas presents from a neighbor.
Heartbreaking part of the story: "He runs away trying to find his father," the mom says. "He wants to get in trouble so he can go to jail because that's where his daddy is."
This is, um… hilariousad?
"We're Going crossdressing!! Up through the street and into the schoolyard! Come on everybody, come on! Snoop, Snoop-a-loop! No, it's cool, it's cool, I'm cool. I'm four."


text:
STARmeterSEE RANK
Up 38,184 this week
Regula Grauwiller
Regula Grauwiller was born on December 10, 1970 in Liestal BL, Switzerland. She is an actress, known for Cargo (2009), Short Sharp Shock (1998) and Cascadeur (1998). She is married to Jophi Ries. They have three children. See full bio »
Born:in Liestal BL, Switzerland
More at IMDbPro » Contact Info: View agent


text:
Ohio State coach Urban Meyer is pretty high on his quarterback Braxton Miller.
How high?
Meyer decided to compare the sophomore to another former college prodigy of Meyer's: Tim Tebow.
"Very similar guys," Meyer said. "They're both competitive human beings. They're both very talented people. Braxton has more talent. Tim is probably more of a grinder."
Meyer made the comments during his call-in show on 97.1 The Fan, according to Fear the Hat.
It's safe to say Meyer doesn't believe Miller already to be a better quarterback than Tebow, who once upon a time was the 2007 Heisman Trophy winner before he was topless in Vogue. But Miller is quietly ascending to Tebow-like college stats.
Through the first three games of Tebow's sophomore campaign, he had amassed 13 touchdowns and 1,037 yards combined rushing and passing. Miller had 12 touchdowns and 988 all-around yards through his first three games (stat tip: CBSsports.com).
It will be tough for Miller to match Tebow's college trophy case. Ohio State isn't eligible for the postseason this year, so Miller has two years to match Tebow's two BCS championships and conference titles.
Reid Cherner has been with USA TODAY since 1982 and written Game On! since March 2008.
He has covered everything from high schools to horse racing to the college and the pros. The only thing he likes more than his own voice is the sound of readers telling him when he's right and wrong.
Michael Hiestand has covered sports media and marketing for USA TODAY, tackling the sports biz ranging from what's behind mega-events such as the Olympics and Super Bowl to the sometimes-hidden numbers behind the sports world's bottom line.


text:
George Rickey
American, 1907-2002
Cluster of Four Cubes, 1992
stainless steel
Gift of George Rickey and Patrons' Permanent Fund 1992.79.1
George Rickey began to produce kinetic sculpture in the late 1940s. Intrigued by both the history of constructivist art and by the example of Calder's mobiles, he developed systems of motion that made his works respond to the slightest variations in the flow of air currents. Rickey's kinetic sculpture provides a dialogue between ordered geometric shapes and random motion.
The massive element of Cluster of Four Cubes is appended by ball bearings to slender arms that branch from a central post. Each cube is precisely weighted and balanced, engineered to turn effortlessly in the lightest breeze; they glide, nearly brushing one another in an intricate and graceful dance that belies their apparent bulk.(16 of 17)


text:
Antarctic Convergence
Photographs from the Peninsula
by Evan Anderman
About the Book
When the opportunity to go to Antarctica came up, I jumped at the chance to visit this mysterious place. I saw Antarctica as the one of the last frontiers on the planet, a place that few people have the opportunity to visit. I also had the romanticized view of Antarctica as a land of ice and snow and extreme weather. I imagined it as the place that invited the tragic survival stories of Shackleton and the other explorers. I knew, of course, that our expedition would be more comfortable and safe, but somehow I expected adventure.
Features & Details
- Category Fine Art Photography
Standard Landscape, 10×8 in, 25×20 cm
80 Pages
- Publish Date Jan 05, 2012
- Tags adventure travel, photography
About the Creator
Evan Anderman is a social-landscape photographer based in his hometown of Denver, Colorado who shoots mostly from his airplane. In his youth Anderman spent a great deal of time in the mountains and plains of Colorado and the Western United States. This love of the land eventually led Anderman to pursue the earth sciences as a career and he obtained several degrees in Geological Engineering. After working nearly two decades in the field, Anderman took his love for the landscape and pursued his passion for photography to become a full-time artist in 2005. Anderman is especially attracted to less-traveled, and often barren, areas such as Eastern Colorado, the high deserts and forests of the Western United States, Antarctica, Iceland and the Arctic. He finds peace in the solitude that these places offer, and is empowered to rise to the challenge of portraying these landscapes with optimism.
Log in or create an account to post a comment.


text:
For some, the thought of sitting anywhere for more than 30 minutes makes the hands sweat and the mind spin. The good news, however, is that one can receive benefit from meditation in a relatively short amount of time. Sure, you're going to have to turn that focus inward and yes, you'll probably encounter some uncomfortable feelings, sensations, and thoughts before finding that sweet spot within. But the truth is, the payoff might just save your life.
Checkout this recent Sydney Morning Herald post on meditation teacher Andy Puddicombe and his 10 minute meditation practice. According to Puddicombe, the purpose of meditation is to recognize what's already there within oneself. Using the analogy of clouds blocking a blue sky to symbolize your thoughts and feelings blocking awareness of your essence, Puddicombe offers how meditation helps to part the clouds to see the blue sky of one's being. Below is his 10 minute meditation instruction.
Practice for meditation
Getting ready:
1) Find a place to sit down comfortably, keeping a straight back.
2) Ensure you'll be left undisturbed (switch off your mobile).
3) Set the timer for 10 minutes.
Checking in:
1) Take five deep breaths, breathing in through the nose and out through the mouth and gently close your eyes.
2) Focus on the physical sensation of the body on the chair and the feet on the floor.
3) Scan down through the body and notice which parts feel comfortable and relaxed, and which parts feel uncomfortable and tense.
4) Notice how you're feeling – that is, what sort of mood you're in right now.
Focusing the mind:
1) Notice where you feel the rising and falling sensation of the breath most strongly.
2) Notice how each breath feels, the rhythm of it – whether it's long or short, deep or shallow, rough or smooth.
3) Gently count the breaths as you focus on the rising and falling sensation – one with the rise and two with the fall, upwards to a count of 10.
4) Repeat this cycle between five and 10 times, or for as long as you have time available.
Finishing off:
1) Let go of any focus at all, allowing the mind to be as busy or as still as it wants to be for 20 seconds.
2) Bring the mind back to the sensation of the body on the chair and the feet on the floor.
3) Gently open your eyes and stand up when you feel ready.
Read more on Puddicombe and his 10 minute meditation practice here.


text:
Himatnagar.com is promoted by Reflect Media, a Full Service Advertising/Media house operating in Himatnagar. Reflect Media is also the Sole Outdoor Advertising Agent of the Himatnagar Nagar Palika offering the following services
Reflect Media also provides a broad spectrum of Marketing Communication & Advertising Services which are as the followings:
For Further Details Contact:
4, Basement, Vpayar Bhavan,
Nyaymandir, Himmatnagar-383001.
Dist: S.K, Gujarat .
Ph: +91 2772 241595
Shihab Sheikh (Founder Director)
Reflect Media M. +91 9724674364
Email: firstname.lastname@example.com
Free Listing


text:
Sponsor Animal Update: Xena
« Back to Xena's page
2nd Quarter 2013
Xena is as active as always. Although her adoptive family were told she has a heart murmur, it is not compromising her present medical conditions or health in anyway. All is well now with Xena. Now that the warmer weather is here, she can spend more time outdoors, playing and running with the family. There is a very special story about Xena meeting with her young sponsor Emily at http://www.animalleague.org/adopt-a-pet/happy-adoption-stories/adoption-tale-xena.html. A very touching story of Xena and a very caring young lady.
More Updates on Xena
Animal League: Sponsor profile for 2nd Quarter 2013 | The world's largest no-kill animal rescue and adoption shelter


text:
LEBANON -- Funeral services have been set for 11 a.m. Friday, April 23 at the Ligon & Bobo Funeral Home for Mrs. Locke, 86, of Lebanon. A 1943 graduate of Lebanon High School and a member of the College Hills Church of Christ, Mrs. Locke died Tuesday, Apr. 20 at her residence.
The widow of the late Nick M. Locke, Jr., she was a graduate of the Oak Ridge School of Cosmetology.
Visitation Friday after 10 a.m. Services will be conducted by Dr. Larry Locke and Tom Arnold. Entombment will follow at the Hermitage Memories Mausoleum.
Survivors include children Gayle Locke Kennedy of Franklin and Nick C. (Diane) Locke of Lake Wylie, SC and step-son Harold Locke of Quinlan, TX.
Also surviving are siblings Shirley (Tony) Dematteo and Frank (Dimple) Laine Jr. -- both of Lebanon and Linda (Bobby) Yarbrough of Clarksville; grandchildren Stacy (Stan) Watson, Cindy (Rob) Brown, Nikki (Oliver) Schwendeler, Lee (Lyn Lee) Kennedy, Wes (Nancy) Kennedy and Toby (Karen) Locke.
In addition to her late husband, she is preceded in death by parents Frank and Laura Hastings Laine; siblings Frances Vanhook, Iva Dell McMinn, Martha Bell, Ralph and David Laine.
Pallbearers: Lee and Wes Kennedy, Jack Bell, Stan Watson, Toby Locke and Rob Brown.
Memorials may be made to the American Cancer Society or College Hills Church of Christ Building Fund.
Ligon & Bobo Funeral Home is in charge of arrangements.


text:
Hostelworld anbefaler
Vi elsker dette vandrerhjemmet! Vi gir tommelen opp for gjennomgående gode kundekarakterer og utmerkede kvalitetsvurderinger.
Sammenlign resultater
Når vil du være i Cairns?
Angi datoer for å sjekke tilgjengelighet
- Søk etter tilgjengelighet og priser
- 24 Jul 2017, 3 Netter
- 2 Gjester
- Endre Søk
Beste pris-garanti
Hvis du finner lavere pris på en bestilling på et annet nettsted, refunderer vi mellomlegget.
Vandrerhjem du vil elske
8 millioner vurderinger fra vårt nettsamfunn med reisende.
Øyeblikkelig bekreftelse
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Mad Monkey Backpackers Cairns100 Sheridan Street,... 0.4kmUS$19.85
Nomads Cairns Hostel & Serpent Bar341 Lake St, Cairns... 2.7kmUS$12.71
The Jack Backpackers
The Jack Backpackers is a newly refurbished pub-style backpacker accommodation. The Jack offers all guests FREE WiFi as well as a FREE good quality evening meals!
The hostel has a range of 8, 6 and... Mer...
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Calypso Inn Backpackers Resort
Svaiende palmer, glatte låter, gratis WiFi på fellesområdene, og svingende hengekøyer, er at Calypso måte!
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Globetrotters International
Free unlimited NBN WiFi in rooms, free breakfast every morning - pancakes cereal, toast, cappuccino or tea. Free BBQ every wednesday and sunday.
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Mad Monkey Backpackers Cairns
Mad Monkey Cairns offers affordable upmarket hostel accommodation right in the centre of Cairns City. We are often referred to as the "Flash Packers" of Cairns due to our designer kitchen/... Mer...
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Nomads Cairns Hostel & Serpent Bar
Nomads Cairns Backpackers Resort er den ultimate tropiske backpackers hostel ligger kun minutter fra store transport og attraksjonen er som Esplanade Lagoon.
Nomads Cairns Resort har en rekke rom... Mer...
Gilligan's Backpacker Hotel & Resort Cairns
Gilligan's is Australia's leading youth hostel resort, located in the heart of Cairns. Offering a blend of traditional backpacker dorm accommodation and hotel rooms. All room types are fully aircondit... Mer...
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Travellers Oasis
Welcome to Travellers Oasis Backpackers in Cairns.
We offer comfortable and clean facilities to budget-conscious travelers in a relaxed and friendly environment.
Our premises are newly renovated... Mer...
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Caravella Central Backpackers is situated in the heart of Cairns city, close to all amenities and attractions. We are 2 minutes from the shopping center and Woolworths, and a hop, skip and a jump from... Mer...
Castaways Backpackers Cairns
Enjoy free WiFi and access to a swimming pool and a communal kitchen at Castaways Backpackers Cairns. It is located 10 minutes walk from the popular Esplanade.
We are a small family owned hostel th... Mer...
Tropic Days Backpackers
Home Sweet Home... Tropic Days is a charming little guest house set in tropical landscaped gardens and a relaxed environment.
Offering free Internet, 24h unlimited free WiFi and free tea & coff... Mer...
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***NEWSFLASH--UNDER NEW MANAGEMENT*** Inn the Tropics Cairns Backpacker Hostel appeals to international and domestic travellers alike. Families, Individual travellers, couples and small groups all enj... Mer...
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Cairns Central YHA
Cairns is a backpackers' mecca and Cairns Central YHA Hostel has everything a backpacker needs for a comfortable stay.
Located right in the centre of Cairns, our hostel has a large internal courty... Mer...
Dreamtime Travellers Rest
Dreamtime Travellers Rest an award winning small Independent hostel just got better , guests now enjoy free WiFi and desk top computers, call for a free pick ups from the bus terminal.
This unique... Mer...
Jazz Cairns
Jazz Cairns brings class and convenience to the budget accommodation scene in Cairns. Located on the iconic Cairns Esplanade, you will be only steps away from the best attractions in Cairns such as th... Mer...
- Pris Romtype
Caravella Backpackers Cairns City Waterfront
Waterfront location in Cairns City Center. Free airport pick up, nightly meal deal every night, free wifi in public areas, free information and discounted tour bookings, free luggage storage, free air... Mer...
- Pris Romtype
The Northern Greenhouse
The Northern Greenhouse is a resort style hostel, centrally located in the heart of Cairns and is only a short walk to all the major attractions. Featuring FREE daily breakfast and FREE unlimited WIFI... Mer...
- Pris Romtype
Reef Backpackers
Free WiFi and a relaxed atmosphere!
In the heart of the town, you'll find a real hostel hidden from view and with a great backyard, BBQ, Pool area, hammocks, large communal kitchen and pool table.
... Mer...
Asylum Cairns
At Asylum Cairns, you're free to chill out by the pool and our front gardens, or party hard! We provide free airport pickups, free high-speed WiFi, USB power to every bed (in selected dorms) and we ar... Mer...
- Pris Romtype
Hides Hotel
Hides Hotel Cairns offers affordable accommodation right in the heart of Cairns.
It is surrounded by restaurants, pubs and shops and is only a short walk to the Casino, Reef Fleet Terminal, Esp... Mer...
- Pris Romtype
Waterfront Backpackers Cairns
Free WiFi, Free airport shuttle pickup available 8:00am - 8:00pm, and the best location!
Only metres from the beautiful City Swimming Lagoon and Sun-baking Park, and walking distance to 24hr eateri... Mer...
Global Central
Global Central is situated right in the heart of town, one block from the Esplanade waterfront lagoon.
One of Cairns' classier hostels, Global Central resides in a converted cinema building and bo... Mer...
- Pris Romtype
Cairns City Backpackers
We provide a 24 hour check-in service but you need to let us know in advance if you are going to arrive outside reception hours so we can organize your key (if you are arriving by flight after midnigh... Mer...
Lazy Duck Backpackers
People come back, again and again or have heard of us through their friends. We're run by friendly, helpful and efficient staff who will make you feel right at home from the moment you walk in. We wil... Mer...
Cairns Beaches Flashpackers
The look and feel of a beach house in an unbeatable location, you will instantly feel relaxed and at home. We are a family owned and operated boutique hostel with only 5 rooms all on 1 level with easy... Mer...
- Pris Romtype
Koala Beach Resort Cairns
Great Hotel located in the city centre of Cairns. We offer modern hotel rooms with AC and private bathrooms. 2 minutes to Greyhound bustop, 15 min to Airport. Tours to Great barrier Reef and the Daint... Mer...
- Pris Romtype
JJ's Backpackers
Tildelt 'Beste ansatte 2012 & 2013 ', er JJ sin Backpackers en av de få gjenværende små vandrerhjem i Cairns. Denne eieren / opererte hostel er kjent for sin vennlige, hjelpsomme... Mer...
- Pris Romtype
Flying Monkey Backpackers
Recently under new management, the Flying Monkey Backpackers is located right in the centre of Cairns and opposite the famous Esplanade Lagoon where you can throw down a towel and enjoy the sun or go... Mer...
Cairns Girls Hostel
Stay in an historic 'Queenslander'located in Cairns City Centre.
1930's residence built for the founder of Cairns first Department store.
Home to travelling women from all over the world.
Voted 'C... Mer...
- Pris Romtype
Golden Sands Beach Front Resort
Golden Sands Resort Cairns ligger rett på Yorkeys Knob stranden med bare åpne plener og hager skille leilighet din fra den lange strekningen av gyllen sand som er Yorkeys Knob stranden.
... Mer...
- Pris Romtype
Cairns City Motel
With our quiet and convenient location and our friendly and knowledgeable staff, we hope to make your time in Cairns pleasurable.
If you are looking for a relaxing, unpretentious and economical acc... Mer...
- Pris Romtype
Hostelworld mobilapper
Bestill mens du er på farten med de nye mobilappene til Hostelworld.


text:
By default perl looks for modules in the standard library path and the current directory. Sometimes you need to use some modules that are installed in non standard locations; there are several ways to deal with this situation:
-- Install the module somewhere in the standard library path
If you have administrator privileges, then the best solution is to install the modules in any of the system defined library paths (you can get the paths executing perl -le 'print foreach @INC').
-- Set the environment variable PERL5LIB
Perl will look for modules in the directories specified in PERL5LIB environment variable before looking in the standard library and current directory, so you can set this variable to locate your modules.
The syntax is the same you use for the PATH environment variables, so you separate the directories with colons on unix and with a semicolon on Windows.
# unix, bourne shell
PERL5LIB=/home/path/lib:/usr/another/path/lib; export PERL5LIB
Be aware that scripts running with -T option (taint checks) don't use that variable, so in those cases this option won't work.
-- Use '-I' command line parameter
The syntax should be something like:
perl -I /home/path/lib -I /usr/another/lib script.pl
-- Add the library path in your script
The command for including the path in your script is: use lib "path".
Notice that this statement prepends "path" to the @INC array, so it's basically the same as unshift @INC, "path"
use lib "/home/path/lib";
use lib "/usr/another/lib";
use MyCustomModule;


text:
A New Year! I hope 2013 brings you exciting and meaningful success, vibrant health and lots of laughter!
As you ease into the New Year, here are a few essential oil recipes that might help you get through the holiday celebrations–all that food and late night partying can really take its toll!
Do you have any favorite essential oil recipes you want to share? Please add your comment below! If you have a blog post with recipes, you can add the URL in the comment section (we're using the plugin CommentLuv that directs readers to your blog–it is so cool!)
- Essential Oils for Digestion (Great recipe for your belly!)
- Saro Essential Oil (Try using Saro to prevent a cold or flu from settling in, or to reduce the symptoms once you're already sick.)
- 8 Hours of Sleep (Oh, the healing power of a deep sleep . . .)
Related Posts:
Andrea Butje
Latest posts by Andrea Butje (see all)
- How To Know Exactly Which Oils To Use In Your Blends! - July 17, 2017
- A Vanilla Orange Lavender Lip Balm Recipe - July 10, 2017
- Soothe Sunburn with Aloe and Essential Oils - June 26, 2017


text:
Replacing exhaust manifold?
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bob lindquist
A Clean Windshield
Location: Florida
Join Date: Jul 2002
Posts: 2,192
Mein Auto: 2000 Imola M Coupe
View My Garage
S52 engine install of Turner Shorty Headers
Just wanted to be clear on the install of the Turner shorty headers on a S52 engine (2000 Mcoupe).
O2 sensors reinstall in the headers (threaded fittings on headers)
The air pump. Is there a fitting to install on the Turner shorties?
If so there are no engine management fault codes resulting from the headers.
2000 Imola Red M Coupe
Dinan suspension, M rotors /Axxis pads
Eurosport Cam Kit 1, touch lane change
Zaino polish, Beach Sand
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"life's to short to drink cheap beer"
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text: NRF Launches Get-Out-The-Vote Initiative AAFA member poll favors Obama. By Kristi Ellis on October 3, 2012 WASHINGTON — The National Retail Federation launched a get-out-the-vote initiative and Web site on Wednesday, while the American Apparel & Footwear Association revealed results from its most recent straw poll, as the industry's trade and lobbying organizations gear up for the final leg of the presidential race. The outcome of the presidential and congressional elections could have a major impact on policies critical to the fashion industry, ranging from trade and job growth to taxes and health care. WWD logo To Read the Full Article SUBSCRIBE NOW Already a Subscriber? Log in. Tap into our Global Network Of Industry Leaders and Designers load comments blog comments powered by Disqus


text:
I was reading the examples of intergammu
and I have some doubts before practice
excuse me by my spelling errors i know speak spanish, little english
maybe we could discuss an interesting topic....
when I'm using Daemon gammu.
this syntax could be:
gammu-smsd -c smsdrc
I can't get to use the command to send sms gammu because this modem port is occupied by the daemon jaja...
eg when using these commands:
gammu --identify or send sms eg: echo "hello test" | gammu sendsms TEXT number
I get this error:Error opening device. Unknown, busy or no permissions.
This means, i can receive sms but can not send.
The obvious question would be mine. How to use two command at a time?
how to send and receive sms linked at mysql whithout daemon perhaps?
żCan I send and receive sms without a database attached to a deamon??
my mail is: firstname.lastname@example.com
This is all thanks ..
A tool for securing DNS communications between a client and a DNS resolver.
A polyhedral extraction tool (PET).


text:
Audit-Ready Financials -- Best Practices to Avoid Common Pitfalls
Date: Tue, Mar 25, 2014
Time: 02:00 P.M. ET
Duration: 1 hour
Cost: FREE
Independent external audits of GAAP financial statements are an increasingly inescapable reality for finance professionals. External audits are, of course, required by statute for public companies -- but growing demands for transparency from regulators, investors, and other stakeholders mean that external audits are also becoming the norm among private companies.
Ultimately, every audit carries the risk of exposing a material misstatement. The consequences of such a misstatement can be grave for companies and for individuals, calling into question a company's internal controls and the soundness of its management. Cloud accounting software can help finance teams to mitigate audit-related risks by streamlining and automating the organization of source materials; the documentation of accounting treatments; the calculation and reconciliation of figures; consolidation and close; and, ultimately, the preparation of financial statements.
From this Webcast, you will learn:
- How to improve your process for preparing audit-ready financials;
- Key steps for audit preparation;
- How to employ cloud technology for financial reporting and audit preparation effectively; and
- How to ensure that the information you present -- and the way you present it -- helps your company earn a "clean" opinion from your auditor.
About the Presenters
Matthew Perreault, Audit Partner, Armanino LLP
Matthew is the partner in charge of Armanino's technology and SEC audit practice group. He has more than 25 years of experience auditing public and private companies in a variety of industries. He is a recognized subject matter expert and frequently consults in the areas of revenue recognition, equity accounting and M&A/IPO activities.
Mark Gervase, Cloud Financials Strategist, Intacct
Mark is responsible for Intacct's product positioning, messaging and go-to-market strategies, with a focus on the software and SaaS industry. Prior to joining Intacct, he marketed mobile collaboration applications for Cisco Systems, specializing in areas that include cloud, BYOD, mobile devices and applications and wireless technologies. Earlier in his career, he worked as a CPA at a large public accounting firm.
Matthew Perreault
Audit Partner
Mark Gervase
Cloud Financials Strategist


text:
Cast: Allie Haze, Beverly Hills, Chasity Lynn, Mckenzee Miles
Ever fantasize about what it would be like to have a young, eager massage girl work the knots out of your back before she curls your toes? Here comes a massage-themed DVD with four gorgeous young girls to show you there's nothing like a kinky massage to melt away the tension!Jim Powers brings you four more wonderfully decadent vignettes with "Massage School Girls" from Powersville. These fresh-out-of-massage-school girls are eager-to-please teens who give more than a happy ending… they make their clients happy from start to finish when they put their new skills to work!Chastity Lynn finds that a well oiled-massage can really calm the nerves, and a hard cock really works out the stiff spots, when her masseuse works his hands and cock to take care of his client's every need. Her slick, glistening body titillates, all covered in oil, all lithe and wanton.Allie Haze adapts quickly to eastern massage techniques and learns that giving a good massage can be as good for her as it is for the client. Her guy reaps the benefit of her training when she gets into her work and her client gets into her! Allie makes more than the ending happy! She's cute and innocent until you realize she isn't wearing any panties! When she gets into the massage she turns into a nasty slut!Beverly Hills is a good masseuse who will use every tool at her disposal to satisfy her client — including his tool in her asshole — to relieve all his stress. The long-haired busty brunette takes his cock in her ass and gives him his happy ending in her mouth!McKenzie Miles starts with a tugjob and finds happy endings are second nature. The client for this overachieving massage school graduate ramps it up once he sees her piercing blue eyes, mane of blonde hair and tight smoking hot body. She climbs on top and massages her body all over his. The view is as phenomenal as her technique!Reviewer Denny Wall says… "If you've ever had a massage from a beautiful young girl, or even wanted one, you need to watch this movie! These young fresh-out-of-school masseuses… are all fresh and hot!" — Denny Wall


text:
Your shopping cart is empty!
Umbro Glasgow Celtic 2001 away Authentic player's shirt in gold and forest green.Umbro Vapa Tech fabric with mesh panels on both sides,Embroidered team badge and logo with sponsor in front.100% polyester.
Note:All of our Products are offiical, brand new with its original tags.
Soccerplus first opened in 1994. We were one of the first soccer websites to hit the webView more
Address: 1640 E. Washington Blvd.
Pasadena, Ca 91104, USA
Phone: 1-800-945-7291
Get Direct


text:
Im fascinated by consciousness. In painting, I actually see how my own consciousness plays out as the recursive process of building a surface creates the work. In video, the time-based nature of thought mirrors that quality in video. In social practice, I get to see how consciousness requires a social context in order to simply operate.
My research into consciousness has taken me into the uses of machine learning in order to better understand mental processes. Current models based on Bayesian inference, e.g. Markov blankets, Kalman filters and the like, illustrate how induction and learning happen. I am especially excited by the convergence of machine learning and neuropsychiatry. Freuds original dream to map the activity of the human mind according to the organic processes of the body, a bottom-up approach, finally seems realizable.
I intend in my practice to engage the models that best capture the complexity of consciousness in play. I think a multi-disciplinary approach is the best way to manage this, as no one discipline has all the necessary features to fully reflect the processes at work. All art is illusion, and there is no greater work of art than the conscious self.
All rights reserved
Hovey Brock, February 2nd, 2016 ©


text:
Return to ads
All categories Services Miscellaneous Dating
Air Ticket Booking In Bangalore
Air Ticket Booking In Bangalore
Posted by lalbabu
Posting ads for 7 years
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Air tickets booking of all the leading airlines in India to all the leading destinations in the world. Book your air ticket now with us.
Contact PRIYA Ph.080-42049895/8095611572Posted by- SiSD02102
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text:
Branson Royal Vista's Condos are available in 2, 3, or 4 bedroom plans. Each condo for sale has features and amenities that are normally reserved for high-end custom homes such as stainless steel appliances, solid granite counter tops, Italian stone tile and remote controlled fireplaces. Homeowners have exclusive access to the clubhouse which features an in-ground heated pool, gas grill, fully furnished community room with fireplace, kitchen and a fully outfitted exercise room.
The new building #6 is ready to close with 2 units already sold and 10 units available.
For more information, please contact:
Southwest Missouri Real Estate
Ali Coleman (417) 337-4322
Email: firstname.lastname@example.com
Website: http://www.sellingbranson.com
Branson Royal Vista
130 Royal Vista Dr
Branson, MO 65616


text:
March Maddness..Not Only For Basketball…
I was driving down the road today, just listening to an unnamed radio station, and when the news came on all I heard was…"Vacectomy Maddness." A study has shown that during the NCAA tournament in March, men have another kind of Maddness…."Vacectomy Maddness."
According to the USA today,
"The idea: Men time the surgery so that they can combine recovery with a little quality TV sports time. Or, as one Virginia clinic puts it in promotional materials: "Spend three days on the couch watching hoops with your wife's approval"
Clinics around the United States are catching on to this new craze and doing their promotions accordingly, with special recovery kits in Oregon they hand out t-shirts, a cooler, Sports Illustrated and more just for doing their surgery during the March Maddness season.
Ladies you want to know why your guy wanted to snip his Sh*t??? He wants to watch basketball!
Here's to the snip and March Maddness!!!!!


text:
Because we all know there aren't enough ironic (and non-ironic) mustaches floating around on our faces... there should be more on our stuff. Get your very own Handlebars sticker and be not ashamed! Facial hair, not attached to faces, is all the rage. (3" x 0.72")
New: As per popular request, now available with or without a white outline! See photos for details.
A percentage of profits from the sale of Handlebars merchandise are used to fund the continued development and support of the Handlebars project.
Our friends at Sticker Mule are the official producer of DevSwag stickers; a huge thank you for their continued support of the open-source community.


text:
The nominees in five CMA Awards categories were announced this morning on Good Morning America.
Jason Aldean and Luke Bryan read out the names. Lady Antebellum was supposed to be on hand for the announcement, but the group was delayed by bad weather. Here's what they revealed:
Female vocalist of the year: Kelly Clarkson, Miranda Lambert, Taylor Swift, Martina McBride and Carrie Underwood
Vocal group of the year: Eli Young Band, Lady Antebellum, Little Big Town, The Band Perry, Zac Brown Band
Male vocalist of the year: Jason Aldean, Luke Bryan, Eric Church, Blake Shelton ("Mr. Lambert" they said), Keith Urban
Entertainer of the year: Jason Aldean, Kenny Chesney, Blake Shelton, Taylor Swift, Brad Paisley
Album of the year: Eric Church, Chief; Miranda Lambert, Four the Record; Dierks Bentley, Home; Lady Antebellum, Own the Night; Luke Bryan, Tailgates and Tanlines
"It's just been an amazing year," said Bryan after the announcement, happy to be among the nominees.
Eric Church tops the list of final nominees with five. The reigning CMA Female and Male Vocalist of the Year husband-and-wife Miranda Lambert and Blake Shelton each received four nominations. Jason Aldean, Dierks Bentley, Kenny Chesney, Little Big Town and Taylor Swift each received three nominations.
Following the announcement, Aldean and Bryan were slated to head over to B.B. King Blues Club and Grill to announce the finalists in the remaining seven categories.
Hosted for the fifth time by Brad Paisley and Carrie Underwood, The 46th Annual CMA Awards will air live on Nov. 1 (8-11 p.m. ET) from the Bridgestone Arena in Nashville on ABC.
Sign up for Lifeline Live e-mail alerts


text:
- Lan Kwai Fong is one of Hong Kong's most popular nightlife hotspots and home to over 90 restaurants and bars. The atmosphere ranges from stylish wine pairings to jelly shots and the food on offer is as diverse as the clientele.
- Experience Hong Kong's vibrant nightlife at Knustford Terrance – where you'll find bars, clubs and a lively nightlife scene. Step out of hectic Tsim Sha Tsui into Knutsford Terrace for a choice of more than 30 restaurants with cuisines spanning the globe.


text:
NORWAY-L ArchivesArchiver > NORWAY > 1999-03 > 0921192977
From: <>
Subject: Fylke for Gudbrandsdalen?
Date: Thu, 11 Mar 1999 17:56:17 EST
Dear Listers,
Gudbrandsdalen valley is located north of Lillehammer. I cannot access the
electronic www maps today, they keep timing out on me! What Fylke is
Lillehammer in, that will solve the problem of what fylke Gudbrandsdalen is
Mange Takk
This thread:
|Fylke for Gudbrandsdalen? by <>


text:
The Office of Academic Services works to ensure that all educational programs are equally accessible to qualified students. Students with physical, learning, and other disabilities are encouraged to contact the Office for Academic Services for specific information and assistance regarding potential special needs.
St. Mary's College of Maryland provides services for students under the American with Disabilities Act of 1990 (ADA) and the Rehabilitation Act of 1973.
Accommodations & Services
Procedures for Registering
Making the Transition
Course Substitutions
Temporary Accommodations & Assistance
Testing Sites for Psychological Evaluation


text:
Plant Propagation ItemsMore than 100 items were found
List Price:$49.95
RentList Price:$30.00
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Propagation of Plants - With Chapters on Propagation by Seed, Bulbs, Runners, Cuttings and Other MethodsList Price:$6.95
Seashore Plants of South Florida and the Caribbean: A Guide to Identification and Propagation of Xeriscape PlantsList Price:$16.95
The Gardener's Guide to Propagation: Step-by-step instructions for creating plants for free, from propagating seeds and cuttings to dividing, layering and grafting
List Price:$15.75
BookRenter.com's 5-Star Satisfaction Guarantee
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As always, you have access to over 5 million titles. Plus, you can choose from 5 rental periods, so you only pay for what you'll use. And if you ever run into trouble, our top-notch U.S. based Customer Service team is ready to help by email, chat or phone.
* Free shipping excludes HI, AK and PR.
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Order now and we'll cover you through the end of the semester!
We're automatically extending 125-day rental orders toMay 21, 2012*. It's our way of giving those of you who plan ahead a special "Thank You."
For all your procrastinators, the Semester Guarantee program lasts through January 11, 2012, so get going!
*It can take up to 24 hours for the extension to appear in your account.
**BookRenter reserves the right to terminate this promotion at any time.
BookRenter.com's Fast Shipping Both Ways
With Standard Shipping for the continental U.S., you'll receive your order in 3-7 business days.
Need it faster? Our shipping page details our Express & Express Plus options.
Shipping for rental returns is free. Simply print your prepaid shipping label available from the returns page under My Account. For more information see the How to Return page.


text:
Please use this identifier to cite or link to this item: http://hdl.handle.net/1811/6056
|Audio Part 1 (mp3 download)
|Audio Part 2 (mp3 download)
|Audio Part 1 (mp3 streaming)
|Audio Part 2 (mp3 streaming)
|Beebe, LLoyd FinalTranscript.pdf
|Interview of Lloyd Beebe by Brian Shoemaker
|Beebe, Lloyd, 1916-
|Shoemaker, Brian
Little America
Marie Byrd Land
Walt Disney Studios
|Subjects (LCSH):
International Geophysical Year, 1957-1958 -- Interviews
Photography -- Antarctica -- Interviews
Antarctica -- Discovery and exploration -- Interviews
|Issue Date:
|Byrd Polar Research Center Archival Program
|Series/Report no.:
|Polar Oral History Program
|Lloyd Beebe, the celebrated wildlife photographer, was born in 1916 in British Columbia, Canada, less than a mile from the American border. In later years, after some hesitation, he opted for American over Canadian citizenship. He grew up in Forks, Washington, a logging town, in the difficult years of the Great Depression. Money was scarce. Beebe dropped out of high school, and helped his father through logging, trapping, shooting cougars for the bounty, raising mink, and, after 1940, farming in Sequim, Washington. In time, this farm became the Olympic Game Farm. On the farm Beebe learned to appreciate and work with various animals, including elk, cougar, mink, bears, and others. As visitors came to photograph the animals, Beebe decided he might like to do the same. Thus, a career was born. Many of his early pictures were shots of a cougar in the wild. Actually it was a tame cougar that rode with Beebe in the front seat of his car. The cat stuck his head out the window like a dog, and got car sick like people. The success of the cougar pictures enabled the purchase of better equipment, and shots of wild elk and bear. In 1949 Beebe contacted the Walt Disney studio and he, and his wife, Catherine, were invited to visit. Some of his cougar pictures were used in the classic film, Vanishing Prairie, but more shots were needed for the film, so Beebe trained other cougars for additional scenes. After working five months on his first film, he started on White Wilderness. This called for a much more difficult assignment than taming cougars - taming wolverines, animals well known for vicious behavior. For several months he lived and slept day and night near the cage of four wolverines. Gradually they came to accept him; one would even gently lick a cracked egg off his fingers. Park rangers and others were truly amazed. Once tamed, Beebe moved his four wolverines to wilderness camp for filming. The animals would climb trees, pick berries, chase a fox, and then, on command, return to the cages to be fed. Beebe also filmed caribou and polar bears in the wild. By now Beebe was enjoying a growing reputation as a wildlife photographer. He had become a close personal friend of Walt Disney, and in 1955 he was invited to take part, at double his previous salary of $700 a month, in an eighteen-month project in Antarctica. Beebe was asked to represent the Walt Disney studio on a new expedition to Antarctica commanded by Admiral Richard E. Byrd. He boarded the Glacier in Portsmouth, New Hampshire, traveled through the Panama Canal, crossed the Equator, and stopped for a time in Lyttelton, New Zealand, where Admiral Byrd invited Beebe to his room for a private dinner. Such invitations would be repeated in Antarctica. Beebe thought the Admiral was lonely since few of the Navy personnel dared to approach him unless it was on official business. The send-off from New Zealand was outstanding, and the trip south was fascinating as Beebe saw icebergs, flying fish, and got a clear look at the stars. Once in Antarctica, the icebreaker Edisto cleared a path for a landing at Cannon Bay. Accommodations were primitive; Beebe slept in a tent although some men slept on the ship. Penguins were common, and they were not afraid of humans. Once Beebe hiked three miles over ice and filmed for two hours at a penguin rookery at Cape Crozier. These were the first photographs ever taken at Cape Crozier. He was given free reign of the base, and Disney had provided him all of the equipment he needed. Over time, he photographed the entire building of Little America V, and accompanied Admiral Byrd to visit and photograph the four earlier versions of Little America, or what was left of them under thirty feet of snow. Sometimes Seabees aided Beebe in his photographic assignments, especially after he would offer them a case of beer. Some filming was done in ice caves and in crevasses, up to 80 or 100 feet deep, which required cables of 200 feet. The views were said to be "really spectacular." Once, however, inside a crevasse, there was a partial collapse of an ice wall, and Beebe was fortunate that he escaped the crashing chunks of ice. He and his two Seabee companions escaped with their lives, but none wanted to go there again. Still, it was worth it, because Beebe got some spectacular photographs. Most of these were color motion films, but he also took many still pictures using a Bolex camera. Beebe did not recall filming any sun halos while in Antarctica, but he did film arcs, also known as sun dogs, and got several spectacular shots of the rising moon. Beebe also spent the winter season in Antarctica. He made several flights with Bob Stretch, the pilot. Once they nearly ran out of gas and barely made it safely back to base. He also accompanied several of the traverses to Byrd Land. On one three-week excursion, a tractor train fell into a crevasse. Max Keel could not be rescued in time, and his funeral was held in Antarctica. Beebe photographed the scene of the dead man wedged deep in the crevasse, and in so doing fell himself into another, shallow crevasse. Another dangerous assignment he accepted was to drop bamboo trail stakes, or crevasse markers, from outside the open door of a tilted helicopter while secured with nothing more than a narrow belt with a single snap. Beebe took part in four lengthy tractor train overland excursions, using Weasels and Snow Cats, to Byrd Land. He filmed the entire construction of the base at Marie Byrd Land. Many of his pictures later were used in the three Disney movies of Operation Deepfreeze. After completing his fourth tractor train expedition to Byrd Land, Beebe prepared to return home. He was flown out to the Curtis, and the ship stopped at McMurdo Sound and Australia on the way home. On reflection so many years after the trip to Antarctica, Beebe expressed no regrets over having gone there. Beebe returned to his original interest in animals, and operated an animal park in Washington State. One of his endeavors involved training three polar bears he had purchased. In sixty years of working with wild animals Beebe had never had an accident. He continued working from time to time for the Disney studio for another 28 years.
|Erwin Verady, production manager for Walt Disney studio, pp. 11, 20 Walt Disney, filmmaker, p. 21 Roy Disney, filmmaker, pp. 21, 70 Admiral Richard E. Byrd, explorer, p. 27, George J. Dufek, pp. 31 Ches Wombley, weather forecaster for the Byrd Expedition, p. 37 Dr. Elrick, team physician, p. 45. Bob Stretch, Otter pilot, pp. 47-48, 52, 55 Max Keel, died in Antarctica, pp. 48-51, 53 Elmo Jones, Antarctic photographer for the Coast Guard, pp. 71-73
|Restrictions: This item is not restricted.
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