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Contagious Disease EpidemiologyBY: Muniba Safdar | Category: Healthcare | Submitted: 2010-07-15 11:02:50
Article Summary: "Epidemiology is the branch of medical science dealing with the transmission and control of disease. In other words, the study of spreading of disease with an effect to tracing down the cause..."
Epidemiology is the branch of medical science dealing with the transmission and control of disease. In other words, the study of spreading of disease with an effect to tracing down the cause. Epidemiology deals with only one population while infectious disease epidemiology refers to two or more populations which include human, infectious agents, vectors (mosquitoes are vectors of malaria), and animal population.
Infection is caused by an infectious agent it can be helminthes, bacteria, fungi, protozoa, viruses, prions. Infectivity in one person can be transmitted to others. A case can be an exposure (skin, sexual intercourse, water contact etc) and contact patterns. The cause is often known in infectious disease epidemiology. If an infectious agent is a necessary cause what is infectious epidemiology disease then used for?
• Identification of causes of new, emerging infections, e.g. HIV.
• Monitoring the behavior of persons that are infected.
• Identification of source of eruptions.
• Identification of routes of transmission.
• Study of natural history infections
• Identification of new innovations.
There are some terms that are used to classify infectious diseases.
Acute disease: a disease in which symptoms develop quickly.
Chronic disease: a disease with mild symptoms that develop slowly and last a long time.
Subacute disease: a disease with time line and symptoms between acute and chronic.
Communicable disease: disease transfer from one person to another.
Noncommunicable disease: disease originating from opportunistic pathogen.
Primary infection: initial infection within a given patient.
Secondary infection: infections that follow primary infection often by opportunistic pathogens.
We are incessantly being bare to infectious agents. Our immune system that protects our body against infections or foreign substances. The fortes for the safety from infectious disease are to cover up our coughs and sneezes while communicating with poeple which is the mainsail cause of cold, flu, tuberculosis. As routes of transmission are direct or indirect. A direct contact of skin to skin causes herpes type I, an indirect contact of food-borne cause food poisoning. Other factors also influence transmission of disease age, sex, genotype, behavior, nutritional status, health status, air quality, weather, food etc. We should conceal ourselves from these ambush snipes so that one may live healthy live.
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The Islander Eastern Settlement Act is a law passed in Long Island.
Long Island can be roughly divided into two parts: the western 20% being home to three quarters of the total population, and the eastern 80% being sparsley populated. Under rule from Britain, immigrants were forced to live on 1/4 of the land, while the citizens could have the other 3/4 with a bloodline restriction. Things worked out pretty well, as citizens made the predominant group. However, when New England became independent immigrants made 45% of the population. The highly congested area brought diseases. The government had to find a solution.
Density in the west cooled from a high 68,900 to 23,700 persons per square mile over the first 15 years of effect.

subset: commoncrawl


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Phil Lewis
L.A. Guns: The Hollywood Years: Cocked & Loaded
Original L.A. Guns members Tracii Gunn, Phil Lewis, Steve Riley, Mick Cripps and Kelly Nickels demonstrate why they ruled the Los Angeles metal scene during the 1980s and beyond with adrenaline-fueled performances of some of their best-loved tunes. Songs include "Show No Mercy," "Bitch Is Back," "Hollywood Tease" and more. Also included are interviews with the band members and a photo slideshow.


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(A) The Ohio air quality development authority may, with the approval of its executive director and the affirmative vote of a majority of its members, request the issuance of bonds under section 166.08 of the Revised Code for the purpose of providing loans and grants for acquiring, manufacturing, constructing, reconstructing, expanding, improving, or equipping facilities or facility components by business and industry in this state, entities and agencies of state and local government, educational institutions, research organizations and institutions, or any combination thereof, for energy production, delivery, storage, conservation, and efficiency through advanced energy projects. The authority may, with the approval of its executive director and the affirmative vote of a majority of its members, make such loans and provide such grants in the manner provided for in section 166.30 of the Revised Code.
(B) The issuance of bonds for the purpose described in this section is subject to the limitation established in division (A) of section 166.11 of the Revised Code.
Effective Date: 2008 HB554 09-12-2008.


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Perfect little gift for your Valentine or BFF with a heart of gold! Pressed into foil and inserted into a gorgeous lucite tray. Our trinket trays keep all your favorite things nice and tidy, plus look cute on your nightstand or coffee table.
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text: More Morrow is a 1921 collection of cartoons by George Morrow. This article is a stub. You can help the Irish Comics Wiki by expanding it. Retrieved from "http://irishcomics.wikia.com/wiki/More_Morrow?oldid=24169" Ad blocker interference detected! Wikia is a free-to-use site that makes money from advertising. We have a modified experience for viewers using ad blockers Wikia is not accessible if you've made further modifications. Remove the custom ad blocker rule(s) and the page will load as expected. Categories: Article stubs Comics M Cartoon collections 1921 Add category Cancel Save


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The Mitsubishi Shogun Pinin is a compact SUV whose design borders on the cute as rather than rugged. But, don't let this suggest that it is in any way unable to live up to its 4X4 billing. It is, after all, a member of the Shogun clan, whose abilities are well known to lie on the capable, raw side of SUVs. The five door model offers more practicality than the compact three door, but both offer the same talented off road ability. On road the drive is a bit more crude - body roll and substandard refinement limit its genuine cruising ability. There may be more able road SUVs which appeal to the sensible, but for those looking for a genuine off roader with city style, the Shogun Pinin is just the ticket.


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I'm so excited for this contest!! Tomb Raider is my favorite thing ever I am happy to post my finished piece! I hope you guys like it!!!
I wanted to portray Lara with her vulnerability and strength.
I'm selling prints and portraits for the first time ever!! Check out my ETSY shop to order a prints and your own custom artwork!!
I wanted to portray Lara with her vulnerability and strength.
I'm selling prints and portraits for the first time ever!! Check out my ETSY shop to order a prints and your own custom artwork!!
This one looks AMAZING!!
great work
Sigh... i can't praise this one enough.
you are a beast! I can't wait to see more of your work as you continue learning either. good show.
Ohhh Thank you!!! I cannot tell you how much this comment means to me!!! sepecially on Lara!! Glad you enjoy!!
WOW *-* looks really great!
Did you know the one in charge of writing Reborn was Rihanna Pratchett, daugther of the famed fantasy comedy author?
i love that you incorperated the anniversary outfit in the reflection! it is somthing that even for the person who is just getting into tomb raider might wonder, why her reflection was different. and this would link to the elder games. good luck and keep posting art!
I didnt even notice that her reflection was different at first. I like how subtle that was!
Good luck ^^
Good luck ^^
Very nice work!
Awesome job >v<
I like her face
Good one
Very nice vibrant colours and a nice pose and expression. My only crit is that youve painted her with a bow but no quiver, that poor girl only has one arrow! you're not the only one to do this, by the way.
Have you got time to paint one in?
Have you got time to paint one in?
Thanks!! I tried to put one in, but it looked like it wasn't going to show very much. Kind like a "whats that" lol But I think you are right. If I position one in right, it could look cool! Thank you so much for the comment!!!
Really well thought out composition and storytelling in this piece. Makes a nice change from the standard shots of Lara just sort of standing somewhere with no real purpose. You've captured a sense of her character and her story as well as just her look, that sets it apart from the other entries in my opinion. Very nice work.
Thank you so much! You don't know how much that means to me! I really wanted to do that with this piece. I'm glad you saw all of those qualities in it. So that is extremely great to hear! Thank you!! Very happy you like it!
Fantastic, wow!!
Excellent stuff - I like the reflection of the past/future, subtle and very good. Clocked something different with the reflection and then it made sense - Bravo.
Oh Thank you!! I love hearing that! I want it to be something people could discover!!
Wow this is amazing!!
Excellent work and overall mood!
Thanks you! I'm glad to hear that ..and so happy you like it!
Very welcome!. It's a really fine interpretation of such a well known character, and forgot to add the convincing way you made her hold the bow and arrow too.
Oh Thank you so much! That means so much to me ..to hear you say that! I really appreciate the comment so much!
Very welcome indeed. I tend to look at an artwork overall and in detail. And you seem to have a very good attention to detail. This is very important and says a lot about your talents. Hope you keep on improving as the sky is your limit!
the pose, the atmosphere, the everything about this piece is on the right side of epic.
straight up boss, skilled deviant
straight up boss, skilled deviant
Ohh Thank you so much!!! I appreciate the comment! I'm glad to hear that!!!!
Wow! It's really beautiful. I love how blue and green it is. Feels so lush.
love how you did the water, it looks great!!
Thank you!! Glad to hear it, I spent a little extra time figuring out the ripple and referencing water
WOW--this is fantastic!


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Author | Source: The Economic Times | Wednesday, Dec 28,2005 7:13 AM
It takes two to tango. And no one agrees more than malls and multiplexes. In a bid to woo customers and generate footfalls, multiplex and malls have come out with the winning formula.
So in the next one year, almost all multiplexes that will dot the country will be sitting on the top of a mall. And nearly 50% of the upcoming malls will have multiplex as one of their anchor tenants.
While malls try to cash in on the movie goers, multiplexes make the most of the impulsive urge of a customer to watch a movie after shopping.
"Mall and multiplexes complement each other perfectly," says Alok Tandon, COO, Inox Leisure," Multiplexes are the anchor tenants of the mall and built on the top floor.
So, besides the impulse-ticket buying of the consumer, the movie-goer also does window shopping which might convert into actual sales. "Tandon estimates that increase in footfalls might be nearly 40-50% in the mall and multiplex duo.
Says, Ajjay Bijli, MD, PVR Cinemas, "Multiplexes and malls are a perfect fit as both are two different entertainment formats and act as support systems for each other."
Market research too shows that footfalls of retail consumers drop dramatically beyond the first two floors. "Most retails do not want to put up shop in the third or fourth floor. That is where multiplexes come in handy," said a Delhi-based mall developer.
One of the key drivers why mall developers prefer to have a multiplex as part of the complex is that former are bulk users of property, taking up as much as 20% of the covered space.
"Malls are actually fuelling the growth of multiplexes for the simple reason that most modern multiplexes are being built in malls," says Atul Goel, chief executive officer, E-city Entertainment. "For instance, in the NCR region, of the 100 upcoming malls, nearly 60 have multiplexes as anchor tenants," he added.
But one cannot forget that there have been cases of standalone multiplexes and malls doing well on their own in Delhi, Mumbai and Bangalore.
For instance, Ansal Plaza in Delhi, one of the early birds in the mall boom that struck NCR, has been able to stand on its feet - without any prop from a multiplex theatre - despite being so close to popular markets like South Extension and Lajpat Nagar. In fact, as per initial plans, a cineplex was supposed to be part of the Ansal Plaza complex.
Says Shravan Shroff, director, Shringar Cinemas, "I think the increase in footfalls is only around 15-20%. Footfalls depend on the location. If the location is good, they will generate footfalls irrespective of whether they are in a retail format or a standalone."
Though almost all future multiplexes may be coming up in malls, Abhijit Das, head, Ansal Plaza Mall Management Company, does not feel that not having a multiplex or cineplex within the complex has been a disadvantage.


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Metal: 18K yellow gold Marked/Tested B. KIESELSTEIN CORD, 1991, 18K Gemstones/Diamonds None Clarity: N/A Color: N/A Measurements: Cufflinks 11mm x 35mm ( 1 inch= 25mm) Weight 27.8g Description: Pre-owned, excellent condition.
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CardBus Host Card for 32-bit PCI Expansion Systems for Laptop.
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- Home
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Follow the latest goings-on in your community through the blog links below. Click "Subscribe" to be notified when a new blog post hits.
4/6/2017Registration is Open!
7/24/2017Idaho publishes its July 2017 newsletter.
7/21/2017Kentucky issues bulletin summarizing its legislative changes in 2017.
7/21/2017Illinois declares suspension of cancellation, non-renewal & premium payments for disaster areas.
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7/14/2017Colorado Division of Securities implements Cybersecurity rules effective Monday, July 17, 2017.


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Join our ecoactive.travel network
Mobility and Bikes - read about our Afribike initiatives hereunder . . whether primary school scholars in rural South Africa or an anti-poaching unit, bicycles can make a huge difference. (watch the video hereunder for an appreciation of how a bicycle can change economic and other factors in our communities)
Project Links:
Afribike USA
Books on Bikes
Afribike History:
The Afribike name originated in 1999 with a South-African based non-governmental organization (NGO) that, under the Afribike moniker, began providing free bikes and bike repairs to rural poor residents as a means of transportation to access jobs and other opportunities inside and outside their local area.
Soon the program rapidly expanded from its base in South Africa to projects under the World Bank's Rural Travel and Transport program. The program's reach covered Guinea Conakry, Ghana, Senegal, Swaziland and Lesotho. In 2002 the successful effort evolved into a National Department of Transport program and became a thriving new project under the 'Shova Kalula' program of Government.
Although the immensely impactful Afribike South Africa project soon phased down, through a partnership with one of the founding members of Afribike, Bike & Saddle and GivingSpirit.Org have been given rights to the use of the Afribike name in Africa and the USA respectively.
The goal of the partnership is to breathe new life into the Afribike name, while continuing the brand's tradition of uplifting the people of South Africa. Through the semi-annual Detroit AFRIBIKE ride, Giving Spirit aims to raise awareness for their work while energizing the friendship between the local community in the USA and South Africa. Similarly, Bike & Saddle through it's semi-anual 'Books on Bikes' ride in Cape Town, aims to raise funding for and awareness of educaction and bicycle transport priorities, crucial to a healthy society.


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Do u have any sugar free or no sugar added products?
Roberta W. asked on Dec 9, 2012
Hi Roberta
I'm very sorry that we were unable to get to your question! Since this Groupon is only available for purchase until midnight tonight, I suggest contacting the merchant directly at (501) 868-8194. Thanks for your interest!
Kelsey W. from Groupon replied on Dec 12, 2012


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RE "Speed crackdown catches 24 drivers'"
(The Bolton News, April 21).
We are asked: "What do we think?" I think a licence to drive isn't a licence to kill and, if you think you just might, then don't drive.
Those who infringe the rules, however slight, should be hammered again for their sheer arrogance, crass stupidity, disrespect for the law and general indifference for the environment and public wellbeing — that's what I think.
The obscenity of "killing by car'"should result in a heavy custodial sentence and licence revoked for life. "A life for a life", no excuses, no compromises.
That's what I think.
Name and address supplied


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7.7 acres in Cochise County, Arizona
Gorgeous panoramic views on this rare 7.7 acre property within Tombstone city limits. This land is a patented mining claim and is located just a short distance to town near Allen St. and Charleston Rd. Property can be split for added investment value.
From Allen St. Take Charleston Rd. towards Sierra Vista. Turn right on Louis Rd. (at the Lucky Hills sign). Property is on the right.
Tax Data (Show Tax Data)
Tax data is not available for this listing.
Contact the Seller for more information.
Contact Seller
Fill out this form to contact Seller about this property
Linda D'Ambrose
Tombstone Real Estate
P.O. Box 965, 204 E. Fremont, Tombstone, AZ 85638
Tombstone, AZ
Other Land for Sale in Cochise County
- Properties for Sale in Nearby Counties
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NOTE: The information contained herein is provided as general information only and has been obtained from sources deemed reliable. It is provided without any guaranty, warranty or representation, expressed or implied, made by Lands of America, or any related entity, as to the accuracy or completeness of the information. The information is presented subject to errors, omissions, change of price or conditions, prior sale or withdrawal without notice. Prospective purchasers should make their own investigations, projections and conclusions concerning the information.


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Fabulous Fudge Pie
Be the first to review
READY IN: 1hr 10mins
Recipe by looneytunesfan
Everyone will think this fudgy pie is fancy, but it goes together so easily!
See Discussion:
Ingredients Nutrition
- 1 pillsbury pet-ritz frozen deep dish pie shell
- 1⁄2 cup butter or 1⁄2 cup margarine, softened
- 3⁄4 cup packed brown sugar
- 3 eggs
- 1 (12 ounce) package semi-sweet chocolate chips, melted
- 2 teaspoons instant coffee (dry)
- 1 teaspoon vanilla
- 1⁄2 cup all-purpose flour
- 1 cup coarsely chopped walnuts
Directions See How It's Made
- Heat oven to 375°F Partially bake crust 5 to 7 minutes.
- Meanwhile, in large bowl, beat butter and brown sugar on medium speed until light and fluffy. Beat in eggs, one at a time, beating well after each addition. Add melted chocolate, dry coffee and vanilla; mix well. Stir in flour and walnuts.
- Pour mixture into partially baked crust. Bake 25 to 30 minutes or until set. Serve warm with whipped cream or ice cream, if desired.


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Saturday, June 23, 2012
For Whom the Bell Tolls
Just ask St. Pete attorney Frank Louderback who is defending Jerry Alan Bottorff in a federal criminal murder-for-hire case. A self-described "perennial contestant in the Ernest Hemingway Look-alike contest," Louderback moved Judge Merryday to recess the specially set federal death penalty case in Tampa so he could make it on time to Sloppy Joe's Bar in Key West.
Come on, kids! Lighten up! I understand a person's life is in the balance, but who wants to miss all this fun?
Let's see what Judge Merryday had to say.
"At his most robust, Hemingway exemplified the intrepid defense lawyer:
'He works like hell, and through it... He has the most profound bravery...He has had pain[] and the kind of poverty that you don't believe[;] he has had about eight times the normal allotment of responsibilities. And he has never once compromised. He has never once turned off on an easier path than the one he staked himself.'
Perhaps a lawyer who evokes Hemingway can resist relaxing frolic in favor of solemn duty.
Or at least, 'Isn't it pretty to think so?'
Good luck in next year's contest. DENIED."
Spanky, spanky.
Order Denying Louderback Time Off
N.B. I'd much rather see a Margaux, Mariel, or Dree contest
8 comments:
- AnonymousJune 23, 2012 at 6:50 PM
Some of them could pass for Santa Claus look-a-likes.ReplyDelete
- AnonymousJune 23, 2012 at 8:18 PM
Bell should toll for the arrogant Sara Soto, now with Bressler, Amery & Ross. Sara Soto will defame and talk crap about anyone, especially those she does not know. She is an overweight nightmare and all should beware of this carzy, scorned woman. The lawyers at Bressler should watch out and be careful - she will soon start talking crap about them each.ReplyDelete
- AnonymousJune 23, 2012 at 11:27 PM
nice quote characterizing defense lawyers.ReplyDelete
surprised rumpole has never borrowed it.
but then again, rumpole is a ticket lawyer not a real criminal defense trial lawyer, and he likely knows zilch about hemingway.
no page ese ticket , bunghole
I enjoyed the video! Thank you for sharing! This totally made my day.ReplyDelete
- AnonymousJuly 25, 2012 at 10:53 PM
.thanks for sharingReplyDelete
- tatic hadicAugust 10, 2012 at 8:59 PM
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- AnonymousAugust 30, 2012 at 12:10 AM
thanks for sharing.ReplyDelete
There are always problems present.ReplyDelete


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Just like the television series, the drama never seems to end in the race to be crowned Sydney's top apprentice.
Through blow-ups with masters, blues with stewards and self-imposed sabbaticals, it seems this season's leading contenders could have easily slipped into the role of their television namesakes.
Brodie Loy might be the exception rather than the rule. He has chipped away, largely without fuss, to establish himself in the ultra-competitive Sydney riding ranks.
His first Saturday metropolitan double at Randwick on Anzac Day suggests that process is underway.
"It's good to finally start getting opportunities and to make the most of them," Loy said.
"I'm more professional [now] and I'm really happy with my circumstances now. You've just got to learn from your mistakes and make the best of them. Don't make the same mistake twice."
The mistake the 18-year-old refers to was his publicised referral to the riding skills panel when bowling along at breakneck speed on cult hero The Cleaner - long before the Tasmanian burst into the public conscience - when the raw-boned apprentice had a short stint in Melbourne.
Suffice to say Loy's preference was there for all to see in his race-to-race double at Randwick, which was achieved on a pair of backmarkers allowed to build into the race.
The numbers suggest Loy is going to have to pull something remarkable out of the hat over the final few months of the season to eat into Winona Costin's (31) lead for the apprentice title.
But after chalking up his 11th city win for the term he is at least talking a big game as Costin later responded with victory on Dowdstown Charlie for David Payne.
Her tally has idled in recent months after a spat with master Gai Waterhouse before the pair patched things up. Samantha Clenton (12) fell foul of the stewards and Taylor Marshall (10) has only just returned from a break.
"Obviously Winona's out in front and she's going to be hard to beat, but nothing beats confidence and I'm full of it at the moment," said Loy, just four winners shy of losing his three-kilogram claim.
The same can be said of trainer John Sargent, who handed Loy his second winner - Swift Lady, another fit horse backing up on rain-affected ground who ambled to victory.
Sargent has trained winners of the Victoria Oaks, Australian Oaks, Queensland Oaks and New Zealand Oaks in recent seasons and isn't ruling out the grey following Quintessential's footsteps during the Brisbane winter carnival.
"We're starting to hit our straps now," Sargent said. "This filly is starting to hit her peak and I'm lucky enough to have bought the full brother at the ready-to-run sale this year. The owners have got another full brother getting broken in in New Zealand, so I've got the whole family.
"She's run a strong mile today and [this year's Queensland Oaks] is at Doomben and is only 2200 [metres]."
Loy painted a target on Tommy Berry and the easing Sadler's Lake in the run, quickly gobbling up the deficit in the going and pouncing for a 2½-length win. Swing Sensation was well back in third.
On Swift Lady's standing against this season's Oaks-winning filly Gust Of Wind and the VRC Oaks-placed Thunder Lady, Sargent said: "She's probably got a bit more brilliance than them as they're more staying types.
"She's a similar type of filly [to Quintessential] and she handled the wet as well. We'll see how she comes through it and whether we move onto Brisbane or she goes for a break as she's going to be a nice horse next year, but she can handle the wet and that's a big help up there."


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Im doing good, though im less active now :3
Hey Reppy how are you?
Hi there. I just noticed you used to be a moderator. I was wondering what made you stop o: if you don't mind answering.
enjoy your vacation and have a safe trip back!
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Understanding Australian healthcare workers' uptake of influenza vaccination: examination of public hospital policies and procedures
Organization, structure and delivery of healthcare
In Australia, whether to provide free influenza vaccine to health care workers (HCWs) is a policy decision for each hospital or jurisdiction, and is therefore not uniform across the country. This study explored hospital policies and practices regarding occupational influenza vaccination of HCWs in Australia.
A study using qualitative methodology, which included semi-structured interviews, was undertaken with hospital staff involved with the delivery of occupational influenza vaccination from three states in Australia.
The 29 participants were responsible for vaccinating staff in 82 hospitals. Major themes in the responses were the lack of resources and the difficulties participants faced in procuring any additional support or funding from their institutions. All study sites provided vaccine free of charge to employees via on-site clinics or mobile carts, and used multiple strategies to inform and educate their staff. In some instances, declination forms had been adopted, however their use was associated with resourcing issues, animosity, and other problems. Participants who were responsible for multiple sites were more likely to recount lower vaccination coverage figures at their hospitals.
From these interviews, it is clear that hospitals are implementing multiple strategies to educate, promote, and deliver the vaccine to staff. However, resources and support are not always available to assist with the vaccination campaign. The reality for many hospitals is that there is limited capacity to implement the vaccination campaigns at the levels high enough to raise compliance rates. Further research needs to be conducted to quantify the factors contributing to higher uptake in the Australian hospital setting.
As documented in the
Although the vaccination of HCWs is a high priority everywhere, previous studies have shown that there are substantial variations in rates of influenza vaccine use between different countries
In Australia, provision of influenza vaccination to HCWs is a policy decision for each hospital or jurisdiction, and is therefore not uniform across the country. There have been individual studies of influenza vaccination policies and practices, but no clear snapshot of the policies and practices in the Australian hospital sector as a whole. From a previous survey of hospital based infection control and occupational health coordinators, it was reported that 76% (138 of 182) of the public hospitals surveyed, and 46% (36 of 79) of the private hospitals surveyed, provided annual influenza vaccination to their staff
Study design
Twenty-nine semi-structured interviews were completed with staff involved with the delivery of occupational influenza vaccination in public hospitals in three Australian states between June and August 2011. This approach was selected so that we could explore the processes and practices in place in these hospital settings along with the experiences of the staff responsible for vaccinating hospital employees. The study was approved by the Human Research Ethics Committee at the University of New South Wales (Reference: 2011-7-13).
The study was open to all metropolitan public hospitals (including tertiary, principal referral, specialist women and children's hospitals) from three states of Australia: New South Wales (NSW), Victoria (VIC), and South Australia (SA). Ninety-two public hospitals were identified as being eligible, based on information freely available on the websites of the state health departments (52 hospitals in NSW, 16 in SA, and 24 in VIC). The median numbers of overnight admissions for the hospitals represented in the study included were 8520 for NSW, 3914 for VIC, and 4824 for SA.
At each site, we identified a staff member (infection control coordinator, clinical nurse consultant, or nurse manager) who was responsible for coordinating the staff influenza vaccination campaign. The rationale for selecting these staff members to interview was that we believed they were in the best position to comment on the process, barriers, and problems associated with the campaigns. An invitation letter, consent form, and copy of the interview guide were sent to these stakeholders at each of the hospitals. Informed consent was collected from every participant prior to the interview. In some settings, one participant had responsibility for vaccinating staff at multiple hospitals.
Data collection
Semi-structured, one-on-one interviews were conducted with the aim of exploring current occupational vaccination policies and the measures used to promote and distribute the influenza vaccine. Two of the investigators (HS and RK) collaboratively developed an interview guide. A conceptual or theoretical framework was not used in this study.
Questions were shaped to cover the key areas of interest, which included: (a) descriptive information (size of hospital, population served etc.); (b) hospital policies on annual influenza vaccinations for employees; (c) implementation practices (use of clinics, mobile carts, etc., the use of signed declination forms for those refusing vaccination; consequences for not following the requirements); (d) activities taken to encourage immunizations (incentives, promotion and education); and (e) modes of storing data on HCW vaccinations (use of software, databases, etc.). Participants were also asked to comment on levels of staff vaccination. Last, we explored the potential barriers to employee vaccinations and institutional and staff support for a policy of mandatory annual influenza vaccinations. Pre-designed prompts were employed throughout the interview to trigger interviewees' thoughts. Interviews were conducted by HS and RK and lasted up to 45 minutes. Each facility was called up to five times before it was considered a non-respondent.
Data analysis
The interviews were digitally recorded, transcribed verbatim, and analysed thematically. Two investigators (HS and RK) developed a list of themes after one quarter of the transcripts had been analysed. An agreed framework was then applied to another subsample of transcripts and modified further. Using this final framework, all of the transcripts were analysed and coded. Text was organised within the identified themes of the developed framework without the use of any software. No formal testing of the reliability of the coding was undertaken, although discussions with colleagues about the analysis and the meanings and patterns derived from it were extensively undertaken. Data on the number of hospital beds at each site was extracted from the Australian federal government's my hospitals website (
Overall, 29 of the 34 invited stakeholders (85.3%) participated in the study. Three identified stakeholders refused to participate and another two could not be contacted. The remaining 29 participants were responsible for or involved with the delivery of occupational influenza vaccination in 82 responding hospitals out of 92 hospitals of interest from the three states. These hospitals were classified, as per the Australian government's myhospitals website, into the following categories: 54 general, 25 tertiary, and 3 specialist. Sixteen participants represented single sites, 8 represented 2–5 sites, 3 represented 6–9 sites, and 2 represented more than 9 sites. The vaccine was provided freely to employees at all sites.
Structure and resources associated with the campaigns
When asked about the existence of a formal written policy regarding employee influenza vaccination, a reference was generally made to a policy published by the state health department, which states that the uptake of the influenza vaccine by HCWs is "highly recommended." Only one participant reported that influenza vaccination of the staff at their site is "essential," and that their site requires employees who refuse vaccination for any reason to discuss with their manager the risk of being unvaccinated and of possible exposure to a patient with influenza. At this site, any staff member who declines to receive the influenza vaccine (because of an allergy, illness, or non-medical reason) is required to complete a declination form.
In order to make the influenza vaccine easily accessible at their hospitals, numerous strategies to deliver the vaccine have been utilised. These range from having permanent "drop in" staff health clinics to temporary clinics (within wards or the staff cafeteria) and using mobile carts. However, not all sites have the capacity to run a fixed clinic; those that do not rely on mobile carts to deliver the vaccine. At one hospital, the wards are responsible for vaccinating their own staff, while at other sites, temporary vaccine clinics are set up to vaccinate staff
In most instances, the vaccine campaigns also target non-clinical staff such as volunteers, students, laboratory staff, ancillary staff, and the health service childcare centre staff.
Staffing and resource issues
The need for surge staff to assist with the initial weeks of the campaign was not uncommon, while in other instances staff had to be "rationed" so that all sites were serviced. The capacity to increase the number of clinics run or the hours they are open for was deemed to be limited because of these staffing constraints.
Aside from being responsible for organising general staff health activities, staffing the vaccine clinics, and promoting and educating, participants are also involved in other infection control activities, such as exposure management. The vastness or relentlessness of the "task" each year was often mentioned, while the lack of support or resources available from within the hospital setting was highlighted. One participant went as far as to say that during "the six weeks of the flu campaign, all of our other work goes on hold."
It was not uncommon for participants to spread their time over multiple sites, with one participant even reporting that they are responsible for staff vaccination at 19 sites. Participants who estimated that their coverage rates were above 50% were generally only responsible for a single site, and often commented on the considerable amount of resources available to them.
Informing and educating staff
The need to continually promote the importance of getting vaccinated at every opportunity was a common theme, with many participants relying on the resources produced by the drug companies to promote the vaccine. A wide range of methods were utilised to inform staff about the availability and need for influenza vaccination, with multiple strategies often being adopted. Emails were the most common method, followed by newsletters or flyers. Other approaches mentioned included posters, payslips, pop-up screen reminders, letters from hospital directors, and setting up booths in the cafeteria. Some indicated that they provided information and education at orientation days and at grand rounds (medical and nursing).
Less common approaches included providing an eight-minute DVD to staff, produced by one of the main vaccine distributors, which challenges staff to consider whether "they can afford the flu." Last, one group highlighted that they had instigated an "ask the expert" helpline so that staff members could get their questions about the disease and the vaccine answered by a medical staff member located at the hospital.
Motivators driving vaccination
The use of incentives was a common factor, with many relying on the products provided by the vaccine manufacturer (often a lollipop). Participants highlighted that it was common for staff not to turn up at the vaccine clinic if they found out the incentives were not available or had run out. Not all incentives were targeted at the individual, with some sites awarding a monetary prize (partly donated by the vaccine manufacturer) to the ward that had the highest overall levels of influenza coverage. However, the ability to routinely provide this type of incentive was not ubiquitous. In many instances the hospitals were unable or reluctant to provide any incentives, with one participant saying that they had used gifts donated by volunteers, and unwanted "Christmas" presents, to make up raffle prizes, or had dipped into their own department budget to buy chocolates as incentives. Due to funding issues, most of the perks (such as morning teas for staff during the vaccine clinics) had ceased.
The positive effect of having champions within the hospital system actively promoting the need for staff to get vaccinated, or "rolling up their sleeve" and getting vaccinated as an example, was spoken about. On the flipside, others commented on the negative impact of having managers or senior hospital staff who did not support influenza vaccination.
While declination forms had been implemented in some sites, the practice was deemed to be resource intensive and associated with staff animosity and other problems. Participants believed that the problems stemmed from the fact that receiving the vaccine was not "mandatory," so there was no governance behind the action. They could not "force" the staff members to complete the form, and too many thought it was a "pointless activity in the end," and had abandoned the use at most sites within a season.
Difficulties of keeping vaccination records
While some form of record keeping was done at most sites to document on-site staff influenza vaccination, not all hospitals had the capacity to maintain electronic databases and instead relied on hard copy consent forms as evidence of uptake. Many commented on the enormity of the task of manual entry for the coverage data each year. Generally, there were no organised mechanisms for recording off-site vaccination or for keeping records for personnel not directly employed by the hospital (agency staff, volunteers, students, etc.) due to resource constraints and feasibility issues.
The problems associated with not having databases ranged from not being to track staff members who were unvaccinated through to not being able to identify wards and departments with overall low uptake rates. Participants spoke of the frustration of not being able to appropriately target areas with low uptake with the appropriate resources or education.
While the available vaccine coverage data (or estimates) were conveyed back to either the ward managers or the hospital board, the information was neither being strategically utilised as patient safety indicators nor being made available to staff.
Future directions: need for a culture change
When asked to comment on whether they felt their hospital and/or staff would support a mandatory influenza vaccination policy, the response was extremely mixed. For the participants who stated that there would be outright hospital support, the main reason provided was that the policy would promote patient protection and would reduce personal risk and sick leave among staff. One participant felt that it was the only way to increase coverage figures among their staff. Others felt that it would be supported if the policy or directive came from the state health department. However, numerous comments were made about the problems associated with implementing this type of policy, with most remarking that the difficulties lay in not having enough infrastructure and resources to provide a vaccine that needs to be administered on a yearly basis. One participant stated that there needed to be a "culture change" around vaccination support before they could implement a mandatory vaccination policy.
When asked to comment on whether staff would support a mandatory vaccination policy, it was felt that there would be little support among staff. Some stated that they felt their staff would see it as a violation of their rights. However on the flipside, others felt that if there were consequences associated with not complying, or if the policy were instigated from the state or national health department, then it would be accepted and complied with.
Using qualitative methods, this study explored the occupational influenza vaccination policies and practices currently in place in public hospitals in three states of Australia. In every interview, the central issue participants highlighted was the enormity of the task of promoting and delivering the vaccine annually, sometimes in an environment with extremely low staff support. The difficulty in procuring any resources or funding or extra staff members was also mentioned, and was perceived to affect the ability to sufficiently promote and deliver the vaccine to increase compliance rates. In some instances, participants were responsible for overseeing the delivery of the influenza vaccine to staff over a large number of sites (19 in one instance), or sites that are located in different parts of a city (separated by 50 km or more). Last, many sites did not have the capacity to properly document and maintain databases and track coverage.
The need to continually promote the importance of getting the influenza vaccine at every possible opportunity was a common theme in our study. Most sites employed multiple strategies to educate staff about the importance of getting vaccinated and to deliver the vaccine to staff. Mobile carts, out of hours clinics, and peer-to-peer vaccination were just some of the methods recounted.
Non-mandatory campaigns using these measures have previously been shown to be successful at increasing influenza vaccination among HCWs
The use of incentives was common factor among the interviews. In most instances, the incentives were merely a lollipop that had been provided by the vaccine manufacturer. On some occasions, raffles or competitions had been used to encourage staff to get vaccinated. In these cases, sites had to use their own budgets or rely on gifts from other members of the hospital community to use as prizes, and hence were not able to maintain the practice. In 2005, Kimura et al. reported on the interventions used to increase influenza vaccination of HCWs in California and Minnesota
While there are mixed reports about the impact of incentives on occupational vaccination, in other areas of employee health and safety the evidence is strong that incentives and rewards work better than punishments
While the use of "opt out" declination forms was reported by a number of our respondents, most found the practice resource intensive and problematic, and had abandoned using them. The intent of a declination statement is to ensure that HCWs are appropriately informed of the rationale for influenza vaccination, to promote the message of patient safety, and to dispel commonly held misconceptions about influenza and influenza vaccination. The major benefit associated with using these forms is that, unlike the introduction of mandatory vaccination policies, they allow HCWs to retain their autonomy and their right to refuse treatment: they can simply choose to opt out if they do not wish to be vaccinated. However, to date most studies have failed to show any real or substantial benefit associated with their use
What has been established is that the use of declination forms is associated with increased resources to track compliance (as noted by a number of our participants), the risk of negatively affecting the employer–employee relationship, and the need for institutions to determine the punitive consequences for HCWs who refuse to sign the document. In the concluding statement of a recent review examining the use and impact of declination statements the authors emphasised that there may be increases in vaccination coverage, and a decrease in staff misconceptions about the influenza vaccine, if the declination statements were bundled with other measures that emphasised the rationale for and importance of vaccination, and decreased barriers to receipt of the vaccine
The difficulty in maintaining databases and tracking staff vaccination was often highlighted during the interviews. Some sites did not have the capacity to follow up with staff members who were vaccinated off-site, whiles others did not keep records for non-payroll hospital workers (volunteers, ancillary staff, and agency staff). At the extreme, some sites relied on hard copy consent forms as evidence of staff vaccination because they did not have the capacity to enter the information into a computerised system. As a result of this, participants spoke of the frustration of not being able to appropriately target areas with low uptake with resources and/or education.
Previous studies have recognised the benefits associated with the ability to build computer programs to calculate vaccination rates. These include: (1) easy identification of noncompliant staff members and the provision of information back to ward managers, (2) calculation of and feedback about rates throughout the influenza season, and (3) mobilising of resources or interventions to target groups within the hospital that continue to have low levels of uptake
When respondents were asked whether their hospital and staff would support a mandatory influenza vaccination policy, a mixed response was received. It was felt that institutions would not independently introduce a policy, and that currently there was no support for it among staff. The perceived lack of support for a mandatory influenza vaccination policy correlates well with the findings from a survey of Australian HCWs
The high response rate and the use of in-depth interviews to elicit a greater depth in the information are two key strengths of the present study. Limitations include that (1) member checking of themes was not undertaken; and (2) interviews were only undertaken with a select group of hospital staff, so the possibility of other important themes emerging cannot be ruled out. Specific details regarding the participants' role at the hospital was also not included. This was a small, qualitative study, and the findings should be explored further in larger, quantitative studies.
From these interviews, it is clear that hospitals implement multiple strategies to educate, promote and deliver the vaccine to staff. However, resources and support are not always available to the campaigns. The reality for many hospitals is that there is limited capacity to implement these strategies more intensively to drive compliance rates higher. Further research needs to be conducted to identify the factors contributing to higher uptake in the Australian hospital setting.
Competing interests
Dr Seale has received lecture fees from CSL and Sanofi Pasteur. Prof. C. Raina MacIntyre receives funding from influenza vaccine manufacturers GSK and CSL Biotherapies, for investigator-driven research. These payments were not associated with this study. Rajneesh Kaur declares that she has no competing interests.
Authors' contributions
HS and RK participated in the design of the study and interview guide, undertook the interviews, performed the analysis and drafted the manuscript. CRM reviewed the manuscript. All authors read and approved the final manuscript. The corresponding author had full access to all the data in the study, and had final responsibility for the decision to submit for publication.
The authors would like to thank all the hospital staff who participated in our study. We would like to acknowledge the Influenza Specialist Group (ISG) for supporting the work undertaken in this paper. Dr Holly Seale holds an NHMRC Australian-based Public Health Training Fellowship (1012631).
Recommendations of the Immunisation Practices Advisory Committee (ACIP): Prevention and control of Influenza
Influenza vaccination in 2000: recommendations and vaccine use in 50 developed and rapidly developing countries
Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs
Influenza vaccination among healthcare workers in a multidisciplinary University hospital in Italy
Prevention and control of influenza. Recommendations of the advisory committee on immunization practices (ACIP)
Influenza immunization policies in Europe and the United States
Parents' decision-making regarding vaccinating their children against influenza: A web-based survey
A survey of children's preferences for influenza vaccine attributes
Why do older people not get immunised against influenza? A community survey
A review of the factors involved in older people's decision making with regard to influenza vaccination: a literature review
Influenza vaccination of health care workers in hospitals–a review of studies on attitudes and predictors
Do we practice what we preach? Health care worker screening and vaccination
Use of a mobile cart influenza program for vaccination of hospital employees
Do declination statements increase health care worker influenza vaccination rates?
Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP).[erratum appears in MMWR Recomm Rep. 2006 Mar 10;55(9):252]
Voluntary to mandatory: evolution of strategies and attitudes toward influenza vaccination of healthcare personnel
Interventions to increase influenza vaccination of health-care workers: California and Minnesota
Requiring influenza vaccination for health care workers
Relationship of influenza vaccination declination statements and influenza vaccination rates for healthcare workers in 22 US hospitals
Development of a flexible, computerized database to prioritize, record, and report influenza vaccination rates for healthcare personnel
Awareness, attitudes and behavior of hospital healthcare workers towards a mandatory vaccination directive: Two years on
Pre-publication history
The pre-publication history for this paper can be accessed here:


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Mush (Amberly ©3/12/13) - Poem by Amberly Orlando
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Have you ever had one of those moments where you tune out, only to be snapped out of it and realize someone had been trying to talk to you? Yeah it's kinda like this...
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Langston Hughes
Annabel Lee
Edgar Allan Poe
Caged Bird
Maya Angelou
Rudyard Kipling
Stopping By Woods On A Snowy Evening
Robert Frost
A Dream Within A Dream
Edgar Allan Poe


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Need Food Allergy Testing in Shawnee, OK? Simply order online 24/7 and get fast, affordable Food Allergy Testing at a lab near you (Find More Locations):
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Food Allergy Testing is useful for people in Shawnee, OK who suffer from symptoms such as unexplained rashes, bloating, itching or runny noses that may be caused by exposure to foods.
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- 2017
- Removal of sensor tilt noise in fluxgate gradiometer survey data by applying one-dimensional wavelet filtering
- 2016
- The Archaeology of World War I in Comines-Warneton (Belgium) through Aerial Photographs and Proximal Soil Sensing
- Historical aerial photography and multi-receiver EMI soil sensing, complementing techniques for the study of a Great War conflict landscape
- EMI as a non-invasive survey technique to account for the interaction between WW I relicts and the soil environment at the Western front
The characterization of a former World War I battlefield by integrating multiple signals from a multireceiver EMI soil sensor
2016) GEOARCHAEOLOGY-AN INTERNATIONAL JOURNAL. 31(4). p.267-281 Mark(
- Identifying relations between the dynamic military landscape and network of linear features throughout the Great War
The First World War from above and below: historical aerial photographs and mine craters in the Ypres Salient
2016) APPLIED GEOGRAPHY. 66. p.64-72 Mark(
- 2013
An interdisciplinary non-invasive approach to landscape archaeology of the Great War
2013) ARCHAEOLOGICAL PROSPECTION. 20(1). p.39-44 Mark(
A multidisciplinary approach to reconstructing Late Glacial and Early Holocene landscapes
2013) JOURNAL OF ARCHAEOLOGICAL SCIENCE. 40(2). p.1260-1267 Mark(
- 2011
Reconstructing palaeochannel morphology with a mobile multicoil electromagnetic induction sensor
2011) GEOMORPHOLOGY. 130(3-4). p.136-141 Mark(


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Filigree Heart Locket Watch
Keep your lover close, but keep time even closer with this Filigree Heart Locket that opens up to a watch face. Throw this on to keep track of how many times you say "I Love You" in a minute, Or just wear it b/c you think it's cute.
Handmade with agate gemstones and honey jade with lots of bronze accents and delicate added bits, this handmade necklace is made with a pocket watch pendant at it's end with an owl on the face. Adjustable length.Tags: jewelry, bronze, necklaces, beaded, lockets, time pieces, gemstones, pocket watch, watch necklaceAdded 7 Years Ago from Artfire
Alright, so I did find a locket that will not hold a picture. It will, however, tell you the time, and this funky L.A.M.B. piece was too fun to leave out.Tags: watches, silver, necklaces, celebrity, lockets, time, Gwen Stefani, LAMB, watch necklaceAdded 10 Years Ago from eLuxury


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Tit-Alicious OrgasmsFavorites [+]
Pay-Per-Minute Viewing
You can now enjoy this movie on your iPhone®, iPad®, or compatible Smart TV & Android devices.
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DRM-free downloads offer content that is not limited by standard Digital Rights Management (DRM) access technologies. These technologies allow hardware manufacturers, publishers, copyright holders and individuals to limit the usage of digital content.
When you purchase DRM-free downloadable content, that content is available for you to download on any computer and save to a disk whenever you like. You can also download to multiple computers. There is no timeframe associated with your purchase and the content will not expire.
Running Time: 125 minutes
Released: 11/2014
Studio Name: Gothic Media Sunset Media Explicit Empire
Categories: Big Tits Euro International All Sex Big Natural Breasts High Definition
Description: When you have tits that big and juicy of course you want someone to fuck them.
5 Scenes from Tit-Alicious Orgasms
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Sex Acts: Oral Sex, Tittie Fucking, Breast Play, Vaginal Sex
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9 Bedroom Terraced For Sale
Portland Street, Lincoln, Lincolnshire, LN5
Currently used as offices to a total of over 2600 Sq. Ft., this property has been granted planning permission for conversion to a residential dwelling - see photos for a draft plan for the conversion.The plot accommodates two separate buildings both currently being...
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The Lamar family was recently interviewed about how they balance family and work life by having a live/work arrangement in their Agritopia® home. Our community does have special zoning allowing expanded home-based business opportunities not offered elsewhere in the Valley. Lamar Studios is located just north of the Community Center. The complete Arizona Republic article is here: Lamar Studios.
Finding the perfect balance
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Researchers created a membrane to prevent heart attacks
Researchers again made new innovations in the medical field. This time they made an external membrane that lines the heart using 3-D printers. This membrane serves to digitally control the heart rate and is claimed to prevent the occurrence of heart attacks.
The thin membrane that is very elastic and can be stretched, is designed to correspond with the movement of the heart. In addition, the membrane is also equipped with electrodes that are used to monitor heart function. The membrane is known to be able to function properly when tested in rabbits.
Researchers from the University of Illinois and Washington University announced the results of their innovations in the Nature journal. They hope that this innovation could someday help humans maintain their heart health and prevent heart attacks, as reported by the Daily Mail.
Even so , the cardiac membrane can not immediately be used in humans. Researchers estimate that they require 10-15 years before the membrane is available for humans. However, they believe that this revolutionary tool will be a long-term solution to prevent sudden heart attacks.
The researcher also explained that the tool can adapt well to the heart in different ways. Sensors in the device will capture the movement of the heart and sends a signal to the nervous system. This method makes the tool can help keep the heart beating during a heart attack.
"When this tool detects a heart attack or arrhythmia, the device will immediately provide necessary treatment to keep the heart beating and prevent heart attacks," said Igor Efimox.
Electrical stimulation of this tool will keep the heart beating, the blood will continue to be pumped and ??flow throughout the body, so that it will prevent people to die suddenly from a heart attack.
Related Articles:
- People Are More Prone to Heart Attacks During Winter
- 5 Symptoms of a heart attack that occurs during sleep
- Cheerful people are more immune to heart attacks
- 25 Percent of people experience trauma after heart attack
- Can holidays really can trigger a heart attack?


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So I've been wanting to get liposuction on my stomach as long as I can remember. But I had issues being that I had cardiac surgery in the past but now I'm all clear and ready to give this a shot. I've been to a few consultations so far and decided to go with Dr John Hamel in Nebo NC. I live on NYC BTW. I wanted to do just liposuction but being that they are taking away the fat I say why not transfer it to my butt. My goals are to have the flattest stomach possible and a nice round ass. I'm scheduled for later this month and getting anxious as the days are going by. I'm praying that everything goes well. I will update measurements that I'm currently at soon.
32 Yr Old Tired of Being Skinny Fat. Nebo, NC
So I've been wanting to get liposuction on my...
Made it!!! Now waiting for magic to happen
Hello guys so I went through with Dr Hamel this past Saturday and so far so good. I'm very sore and uncomfortable. I can't really see much because of the swelling and bruising.
So far loving my results
So its been since Saturday that I had my bbl done by Dr Hamel which was 4 days ago. I've been mainly sore and uncomfortable not much sleep at night. I'm also itchy but I keep my compression garment on always except when taking a shower although last night I needed rest so I slept in a spanx. I'm too swollen to know exactly if all fat was taken but I do know he put 1100 CCS in each buttuck
So far I do not know much besides Dr Hamel has great reviews on his beside manner and work. I've spoke wit him over the phone it was brief. His assistant Jennifer seems to be busy but will make sure she gets back to you on any questions you may have.
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Home > Product Categories > Digital CATV & RF Distribution > RF Modulators > HDB2840
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Go HERE to read the full article.
|photo courtesy of District Dig
By Bill Myers and Jeffrey Anderson
Chroniclers of local politics may have noted two rival clans competing for the wanting throne that presides over the District of Columbia. One house dwells mostly east of the Anacostia River and marks its descent from the Civil Rights era and its principle dynast, Marion Barry. The other unfurls its standards in Ward 4 and is embodied in Mayor Muriel Bowser, heir to the Green Team, a political and fundraising crusade left to her by her mentor, former Mayor Adrian Fenty.But in the figure of Ward 8 Council Member LaRuby May, the flags of the rival houses have united under a single banner. May recites heroic verses about growth, transparency and accountability, but she and her privy councilor—businessman and longtime ward fixture Phinis Jones—have quietly built an empire on which the sun never sets. It's also an empire on which the sun has never shined.
Poring over hundreds of pages of public records, District Dig has charted a complex political and business alliance with grand claims to D.C.'s political capital—an alliance that promises its subjects cradle-to-grave service, all the while blurring the lines between public and private money.
May embodies and synthesizes the traditions of both political houses. Raised in Pensacola, Fla., she is the youngest (of seven) of the Right Rev. Theophalis May, a domestic Colossus—a self-made construction mogul who answered his call to public service through economic revitalization and historic preservation, and whose name adorns a public resource center. Yet she has risen to her prominence as a champion of the self-described progressive Green Team by campaigning for Bowser in Ward 8 and desperately trying to lend the Mayor credibility East-of-the-River.


text: To get from Teramo to Gela by train you can catch one of the 5 trains that everyday travel between these two cities. The first train to Gela leaves from Teramo at 12:00 and the last train departs at 20:39. If you choose a local train the trip lasts on average 01:26 hours. For your trip from Teramo to Gela by train you can choose to leave from one of Teramo main stations: Teramo On Wanderio you can compare all schedules, fares and railway companies to Gela and book the best itinerary starting from Teramo.


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$525,000 22 acres 2616 Creekside Lane, Morris, IL 60450 - Grundy County
22 Acres - Clubhouse - Lake - Buildable Site
Beautiful landscaped 22 acres with a Large (32x56) Year-Round Clubhouse. 28x32 Great Room w/18' Fireplace, Fully-Equipped Kitchen & Full Bath. There is a 2 Acre Stocked Lake w/private beach. Wooded, Open Area with potential to build new homes overlooking lake. Also, a second 1/2 acre Lake. West of the creek has bow hunting. Two Food Plots. Horses Welcome. One-of-a-kind property. List Price: $525,000
Richard A. Olson Richard A. Olson & Associates


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By Jennifer Clampet, WBAMC Public AffairsMay 30, 2012
"Should we save the leg?"
Without hesitation, most will jump to the affirmative. A Soldier laid out on a stretcher, surrounded by the debris of war, will beg for it to be saved.
But will he make the same plea 10 months later as surgeries fail to bring back to life a dying limb?
A technology currently used mostly in plastic surgery can help orthopaedic surgeons determine if a limb's soft tissue is healthy enough to produce a living limb after trauma.
This was just one research finding unveiled during the 2012 William Beaumont Army Medical Center Research Day.
Captain Andrew Cleveland III, with WBAMC orthopaedics department, earned first place for his poster presentation on "Use of indocynanine green fluorescent dye video angiography in orthopaedic lower extremity trauma."
The use of the dye and video technology is commonly used by plastic surgeons. The technology helps physicians to recognize healthy tissue -- tissue displaying perfusion or delivery of blood to a capillary bed in biological tissue -- capable of surviving trauma and reattachment.
Cleveland's research project delves into the first recorded and researched use of the technology in orthopaedics. His poster displayed four cases of lower extremity trauma handled at Texas Tech University Health Science Center in El Paso, Texas, -- a Level 1 trauma center where Cleveland is also working during his residency.
"This may provide an objective variable tool to make decisions on tissue that is not going to survive," Cleveland told a panel of judges.
"It helps to answer the question 'should we amputate this leg of not.'"
Cleveland plans to submit his findings to medical journals for publication.
Captain Brian Waterman, also with WBAMC orthopaedics department, earned first place for his podium presentation on "Surgical Treatment of Chronic Exertional Compartment Syndrome of the Leg: Failure rates and postoperative disability in an active patient population."
CECS is a condition caused by exercise which results in increase tissue pressure within a limited fibro-osseous compartment. The research included 611 patients -- who underwent 754 surgeries. The average age was 28 years old and males comprised 91.8 percent of the cases studied.
Waterman's research project found that CECS is a significant contributor to lower extremity disability in the military population. Waterman was also named the WBAMC Resident Investigator of the Year.
The WBAMC Research Day featured nine research presentations and 11 poster presentations all demonstrating research pursued by staff and residents at WBAMC.
"Military medicine system still has many untapped resources that can be used to fascilitate research," said Maj. Andrew Schoenfeld, keynote speaker at Research Day.
Schoenfeld is the director of orthopaedic research, chair of the investigation review board and chief of the protocol development committee at WBAMC.
Schoenfeld, who completed his fellowship at Harvard Medical School, has been involved in research since 2004 having published or had approved for publication 77 research articles.
"Our resident research productivity is as good, or better, than most other teaching programs across the country," Schoenfeld said of the orthopeadic department at WBAMC -- which has 10 surgeons.
Schoenfeld -- who was named the 2012 WBAMC Staff/ Faculty Investigator of the Year pushed for more research by residents noting the unique setting that a military installation offers.
The military operates as a model for a closed American healthcare system. The active duty military represents a young and high-demand population. Whereas a majority of orthopaedic surgeries occur on older patients in civilian healthcare -- medical research may not be applicable to the younger demographics of military orthopaedic patients.
Conditions with high incidence in active duty populations can be rare in civilian settings.


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Although the primary responsibility of nurses is to provide medical care to patients, their role doesn't end there. Thanks to their constant interaction, patients often view nurses as the human face of an otherwise impersonal hospital atmosphere. When interacting with patients, it is important for nurses to follow a few guidelines to avoid hitting roadblocks that hamper effective communication.
Being Judgmental
To encourage patients to disclose what is on their mind, it is important to provide an atmosphere where they don't feel someone is judging them. Many times, patients who are in pain express a feeling that touches a chord deep within you. Instead of jumping in with a response about how it is right or wrong, it is vital to listen patiently until the patient completes what he is saying. Rather than agreeing or disagreeing with those sentiments, draw the patient's attention to exploring the topic further.
Although it is important to ask questions to gauge the physical condition of the patient, it is unprofessional to ask personal questions that are irrelevant to the situation. In circumstances when such information is necessary, it is important to word questions in such a way that they don't sound accusing. The easiest way to do this is to avoid questions beginning with "why." For example, saying, "You seem out of sorts today. Is there something bothering you?" is better than asking, "Why are you so grumpy?"
Expressing Personal Opinions
When interacting with a patient, avoid saying, "If I were you..." or "I think you should do....." One of the major blocks to communication is shifting focus from the patient towards you. Expressing a personal opinion is an unnecessary intrusion on the patient's personal space. In some cases, when a nurse tries to express sympathy, the patient may perceive it as a feeling of pity. A better approach is to encourage the patient to express her opinions, act as a sounding board, and help her arrive at her own decisions.
Providing False Reassurances
A patient who is ill wants to know exactly what he is up against. When such a patient asks the nurse for input, responding with a cliché such as, "Don't worry, everything is going to be fine" is of absolutely no value to the patient. In fact, providing such false assurances only makes it more difficult for the patient to come to terms with his health situation. Rather, nurses should recognize the patient's anxiety, empathize with this, and encourage him to speak about his fears.
Lack of Listening
When patients complain, it is tempting to change the topic to something else. When nurses do this, patients perceive them as rude, and tend to stop communicating. Other ways of not listening include reacting defensively when patients criticize something at the hospital, or responding with generalizations. For example, if a patient is complaining about her insurance problems, and how the administrative staff is doing nothing to help, the nurse should listen and avoid saying, "The admin staff would never do that," or "What will you do -- that's the way things are."
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