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League Of Legends Detailed Evaluate And Advices For Learners
At this time I would like to introduce to you one of the profitable free to play - games: the double Golden Joystick - winner "League of Legends" by Riot Games!
League of Legends is a MOBA-Game (Multiplayer Online Battle Area), which is oriented in direction of the well-known Warcraft 3 - Map "Protection of the Ancients".
For many who by no means performed DotA (are there any?) and who do not know the game idea I will explain it in detail:
The start
League of Legends doesn't put high requirements in your PCs. You need at least:
- processor with 2 GHz - 1 GB RAM, - DirectX 9.zero capable video card, - 750 MB free exhausting disk area, - DSL or comparable
Create an account either on the server EU West, EU Nordic/East or US, relying on where you live. It's also possible to create an account on US whereas living in Europe but you will expertise higher pings then. I provide you with a hyperlink to create an account in my author's bio. Choose a reputation (all the time the toughest part) and a pleasant picture and off you go!
The Champions
There are 2 groups 5 players (there are more game modes, but they don't seem to be vital to start with because as a newbie it is best to begin with 5vs5 to study the gameplay). Before each match you all choose a "champion" who's the character you wish to use in battle. Dependant on your private preferendes it may be e.g. an undead mage, a large granite golem, a bit of boy riding on a Yeti, a courageous knight and lots of more.All in all there are more than 80 (!) different champions and every second week one is added.
Every champions has four completely different skills (3 normal and one further strong, the "Ultimate") and a passive, which he has because the beginning. You learn the talents by leveling up ingame and your max champion stage is 18 which means that you've got 5 points in each normal capacity and three in your ultimate.
You obtain expertise for levelling up by:
1. Being near when enemy minions or impartial monsters are killed by your troops (it is not essential to kill them your self!)
2. killing or assisting to kill enemy champions
At first you generally play whatever you want, later it is helpful to speak together with your teammembers before the match begins so that you have a balanced setup and never 5 champions of the identical kind.
The different kinds of champions are roughly:
1. Mages ("AP Carries": AP means means energy, they mainly deal magical injury with their skills)
2. Fighters ("AD Carries": AD means Attack Damage, they mainly deal physical harm with their autoattacks)
3. Tanks (They're exhausting to kill and shield their own carries, for example by gorgeous or taunting the enemies)
4. Supports (They've either buffs or heals to support their carries and keep them alive)
5. Junglers (They do not start within the lane however in the jungle and help their teammates by ganking and ambushing the enemies)
The interesting point is: Relying on the gadgets you equip on your champions they're often able to satisfy completely different roles!
At first you don't have own champions, however each week there are 10 free ones which everybody can use. After some matches you can buy more champions with affect points (IP) in the shop. I will come to this later.
The map
The map has three totally different lanes, which lead from your individual to the enemy base. On these lanes there are a number of Towers which you will need to destroy earlier than you can assault the bottom itself. As a help your most important constructing ("Nexus") spawns minion waves briefly intervals which assist you in fights. Between the lanes there's the "jungle", where neutral monsters are located. If you kill those you obtain gold and/or short-term buffs.
As quickly as the match begins everybody has a couple of minute to spend his starting capital on gadgets within the shop.
This does not take lengthy since you do not have much gold within the beginning. There are other ways to earn gold within the game:
1. Everyone receives gold over time
2. Killing enemy minions or neutral monsters (here it is important to give them the final blow, the so referred to as "lasthitting")
3. Killing or assisting to kill enemy champions
4. Destroying enemy buildings (towers and inhibitors -> destroying them makes your minions stronger)
5. There are a number of gadgets which grant you additional revenue (the so known as gold/5 objects -> they provide you 1 gold each 5 seconds)
The objective
When you destroy the enemy fundamental building (Nexus) your workforce wins. For being able to assault the Nexus, nonetheless, you must destroy all 3 towers and the inhibitor on a minimum of one lane and the two towers which shield the Nexus. So it is not the perfect idea to hunt the enemy champions 24/7 when you don't push the lanes at the similar time. An average match takes 30-45 minutes, hardly ever greater than an hour. As soon as the match reaches minute 20 it is also doable to surrender.
Extra game modes are a 3vs3 and a fairly new domination map ("Dominion") the place it's important to capture and defend sure points. As well as there are ranked modes for gamers with summoner stage 30 (explanation follows) in which you receive an Elo depend relying on your wins and losses. For freshmen I highly advocate the conventional 5vs5 map!
The summoners
league of legends shirt
of Legends also has an RPG part. You do not only choose a reputation and a picture for yourself (you're a so known as "summoner", do not combine it up with the "champions") however you are additionally able to stage up your self and buy small buffs with Influence Points (IP).
No events


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The Kati Roll Company Launches Happy Hour at Their Midtown NYC LocationJuly 28, 2011 - by City Guide
The Kati Roll Company (49 W. 39th St., 212-730-4280; www.thekatirollcompany.com) -- well-loved for introducing India's street-cart "kati" rolls to New York City -- has launched a Happy Hour at the midtown location. Well into the dog days of summer, and with long lines at all times of day, The Kati Roll Company presents this new offering to enhance their menu - the option of crisp, refreshing beers and wines to go with their spicy street food; the perfect complement to the savory spices of Indian cooking.
Every weekday from 4:30-6:30pm, The Kati Roll Company's Happy Hour features $2 off a beer and roll ordered as a combom and one rotating weekly special combo for $7.
The Kati Roll Company, known for consistent, mouthwatering Indian street food, has become a cult-favorite for many New Yorkers and Londoners. Served hot and devoured in the restaurant or easy to take on the go, The Kati Roll Company prepares all rolls from scratch, in-house using fresh and high-quality ingredients.
The simple menu of Kati Rolls contain a variety of ingredients that explode with layers of flavor from the proprietary blend of 22 hand-ground Indian spices that are used to marinate the fillings: beef, chicken, lamb, egg, cheese, chickpeas and potatoes. Cooked and wrapped in a fresh, house-made paratha or roti, these rolls are served almost identically to the rolls served at a pushcart in Calcutta, India, where they first originated. Reasonably priced at less than $7 each, The Kati Roll Company offers a variety of savory and wholesome rolls that are affordable and filling even for those on a tight budget.
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Halloween is a scary time for everyone
The last day of October – Halloween – is just around the corner. It's a frighteningly fun time for kids, but October is a scary month for cops too. In October of 2007, sixteen police officers died in the line of duty and as of October 26th of this year 12 have made the ultimate sacrifice. Of those 28 cops, two died by gunfire, one by vehicular assault, two by heart attack, and the rest by accidental means, primarily vehicle related, but also including a fall, drowning, and a ground-related aircraft accident. In fact, every October 2008 police death except one (again, as of October 26th) has been as the result of an accident.
October is by no means the deadliest month for cops, but just by the sheer volume of accident deaths, we are reminded that accidents account for far more law enforcement deaths than do felonious assaults. What are the best anecdotes for accidents? YOU!


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Cheap foreign TV coverage open to all, court rules
A pub landlady yesterday scored a victory for consumer choice after Europe's highest court ruled that British viewers could buy live English Premier League football matches from any pay-TV provider in the European Union.
The judgment from the European Court of Justice in Luxembourg means that people are free to buy foreign set-top boxes and cards, such as the Greek satellite system used by Karen Murphy at the Red, White and Blue pub in Southsea, Hampshire. It paves the way for a free-for-all, with consumers bypassing domestic providers such as Sky.
The attraction of buying English matches from foreign pay-TV providers is that they are allowed to show every Premier League match, including those kicking off at 3pm on a Saturday, which are off limits…


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Captain Sheppard McCloud, an American naval hero from the attack on Pearl Harbor, struggles to overcome both his physical and psychological injuries when he is selected for a new command on a vital mission. He must tackle the demons in his mind and the painful, lingering, injuries he suffered when Japan attacked on December 7. McCloud's been tapped to command the US Navy's latest capital ship, the Argonne, in the early phases of World War II. He needs to follow his new orders while keeping his fears secret.
A commander's life isn't easy; McCloud faces a host of challenges and decisions as he assumes total responsibility for the ship and crew. He's aware that his every move, behavior, and decision influences the men he leads in battle; for it is their performance as the sum total of the ship's character that is the weapon deciding outcomes. Carefully researched to accurately depict the US Navy during World War II, Sheppard of the Argonne follows the exploits of Sheppard McCloud during a hypothetical war at sea. It presents rare insight into the command of a capital ship at war, showing how it tests the captain's leadership as enemy submarines and aircraft attack, culminating in that rarest of historical actions, a gun duel between capital ships.
©2014 George W. Jackson (P)2015 George W. Jackson
"A captivating story of naval warfare!"
Yes, I enjoyed listening to the naval battles fought between the Americans, British and Germans.
The flashback to Sheppard in Command of the Shenandoah at the Battle of Pearl Harbor. The detail of the description of events and perspective from the main character felt better than seeing it play out on the big screen.
He provides excellent sound effects and good believable accents for the various character nationalities. The background music Lee Alan adds builds on the suspense, making you eager to listen to how the battles will unfold.
The Battle of Cape Vilan, the author's attention to detail and ability to keep the listener in suspense as to what the outcome would be are commendable.
This book is definitely worth listening to if you are a fan of military fiction or of flawed heroes/protagonists needing to rise to the occasion. This is no John Wayne or Robert Mitchum tough as nails action thriller, it is a story with characters that can easily play out in the real world.
"Fantastic music and sound effects!"
Yes, I would recommend this audiobook. The story is exciting and it is filled with characters that keep you wanting to listening.
This audiobook is in the same style as "The Hunt for Red October", with unfolding events from the different perspectives of the characters.
Lee Alan brings sound effects, music and different voices and accents. It feels as if you are listening to real events unfolding.
Sheppard was the most memorable character because of his complex struggles with PTSD and yet needing to lead his men in order to accomplish his mission.
This would be a great gift for a veteran or active duty sailor. Anyone who appreciates or wants to learn about World War II history at sea.
"Perhaps a true naval fan would appreciate..."
the story is good. the performance is, to me, overly excessive. the story moves very slow due to allowing for every form of naval protocol. a good story does not need all the minutiae, especially when it's fiction. if someone can appreciate protocol and ship board minutiae, then they would enjoy it.
lastly, the narrator's voice is too deep. it's a novel, not a Barry White song.
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Activision could pursue EA Access-like subscription plan once 'model is proven'
Activision has said they would consider pursuing an online subscription plan similar to the one Electronic Arts just rolled out with EA Access "once those models are proven."
Though the publisher didn't specify EA Access when answering the question about "creating an online subscription plan where players can access older catalog titles and get early access to new titles," the contents of the question basically alluded to EA's new service which has been met with mixed criticism.
"As you know, we have a very focused strategy as a company and we tend to focus our resources and our people on the biggest and best creative and commercial opportunities," said Activision CEO Eric Hirshberg. "And right now, I think, we have our strongest slate ever and we're broadening that slate so we have a lot of focus on and a lot to make sure we get right in the coming months to keep our tentpole franchises driving and establishing new ones as well. And we think everything we're working on has huge potential."
"So of course, we're always looking at new opportunities to better serve our players and our communities and we're always evaluating new business models. And once those models are proven, we'll pursue them if we think it makes sense for our players and for our business," he said.
So while it's possible that Activision could explore this subscription business model in the future, Hirshberg reiterated that Blizzard is focused on the business and monetization models that they think will deliver "the best experience for our fans and a great return for our shareholders."
EA Access was unveiled exclusively for Xbox One last week. The new service allows members to access EA's "Vault" -- catalog of games -- for just $4.99 a month or $29.99 for the year. Since the program is in beta right now, only four games are available: FIFA 14, Madden NFL 25, Battlefield 4 and Peggle 2, "with more to come in the future." Additionally, EA Access members enjoy other benefits including discounts on EA's digital purchases and early access to upcoming games.
Would you like to see Activision adopt a similar business model for its own catalog of games?


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Trust me, I was not looking for bad news. This was on the front page of Yahoo.(Credit: GameStop)Video game retailer GameStop saw its stock take a mighty tumble after Microsoft's Xbox One was announced earlier this week. Much of the stock's fall can be attributed to what some see as a sea change in the used game market, something that GameStop has dominated for years.
Investor concern appears to be due to a report published on MCV stating that Microsoft has negotiated a deal with retailers which sell used games. The deal would ensure that publishers -- and Microsoft itself -- will get a cut of the lucrative used game market, according to an earlier report from Yahoo! Games.
Under this plan, retailers would be forced to integrate Microsoft's cloud-based, pre-owned system into their catalog. Once a game is traded in, the previous owner will see it erased from his or her Xbox One account, since games will be installed on the system's hard drive.
This isnt as dire as some predicted. Many speculated that the Xbox One would cut out used games period, an act that would have really hurt GameStops bottom line (and alienated many a gamer). Sony has said the PlayStation 4 will allow used games, though it is being coy with the details. The Nintendo Wii U allows for used games.
But then there are the fees. From a gamer perspective, there is concern that owners of used games will have to pay a fee in order to play them on the Xbox One. If true (again, nothing is confirmed), this would essentially ruin the thing most folks love about used games: cheaper prices.
Used games are key part of GameStops business plan. In the most recent fiscal year, GameStop earned roughly 48% of its gross profits from used games, according to MarketWatch.
GameStop stock dropped roughly 10% on Friday on concerns about earnings. It's down 21% this week.
It isn't just the Xbox Ones new alleged profit sharing rules that have GameStop investors scared. Digital games continue to grow in popularity, a trend that cuts out retailers like GameStop.
And then there is the even larger trend of casual gaming. Many people play games on their mobile devices, often for cheap or even free. If people can get their gaming fix from their phone, the argument goes, why do they need an expensive console for their living room?
But this isn't the first time people have been saying that it's all over for the mighty retailer. And, even taking into account this week's news, the stock is still up a whopping 87% over the past year. For a company supposedly on its deathbed, it's doing pretty well.
Forbes recently spoke to GameStop President Tony Bartel. He's confident that the lack of backward compatibility on the Xbox One will also help with sales.
"As people upgraded to PS3 they traded in their old systems and libraries, which is why Sony made the move to not support backwards compatibility with later iterations of PS3," said Bartel. "That's why the 'buy, sell, trade' model works well. It enables people to purchase new games by trading in their old ones. We expect to see the same thing with this transition for PS4 and Xbox One. Trade-ins allow for a seamless transition."
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Results 1 to 9 of 9
05-26-2013 #1
GameStop stock plummets following Xbox One used game reports
05-26-2013 #2
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I don't see this as bad news. At least not for Microsoft. This is bad news that's been brewing for years as digital downloads have increased. Digital downloads cut out middle men like Gamestop....so I expect their stock to get worse over the years regardless.
Most traditional brick and mortar music stores are gone thanks to music digital downloads. I see Gamestop's days as numbered. Hell..... EA is trying to cut out the middle man that is Steam and Gamestop and made their own digital download service as well as the option to get the disc based version of their games shipped to the gamers too.
05-26-2013 #3
Walmart and best buy would lose out on used game sales too.
It could work out in a huge way for Sony if they don't follow MS path.
05-26-2013 #4
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So the ripples effects are occurring and nothing is going too stop themPlato and Aristotle, a detail of The School of Athens, a fresco by Raphael. Aristotle gestures to the earth, representing his belief in knowledge
05-26-2013 #5Flaw3d GeniusGuest
Games shops are doomed much like the Record shops
05-26-2013 #6
05-26-2013 #7
yup they do and that's why i don't buy it from gamestop.
05-26-2013 #8
05-26-2013 #9
Doesn't MS see the future of games as going purely digital this is probably there first step into getting the market for them up and closer to what they want,
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hemorrhage while pregnant...?
During my ultrasound the guy said I have a med size hemorrage. He told me he wanted to point it out and that there weas no ties to hemorrhages and the chance of miscarge. Is this something I should be worried about. My next doctor apt is next weeks. Has anyone had this happen?
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Wynn wants to stiffen animal abuse law
Rep. Evan Wynn, R-Whitewater, has unveiled �Casey�s Law,� a bill that would make it possible to charge a person with a felony for pet abuse that results in internal injuries.
The bill is named after a great Pyrenees dog shot with an arrow in May 2010 while walking with his owner along railroad tracks in Lima Township.
Dale A. Moore, 62, rural Milton, shot the dog with an arrow. He later was convicted in Rock County Court of misdemeanor mistreatment of animals, fined and ordered to serve a year of probation.
Casey survived after surgery, but Wynn said he�s learned from Casey�s owners that the dog now has trouble walking, running and jumping because of internal injuries from the arrow.
Wynn, who represents the 43rd Assembly District, said he heard from many who felt Moore�s punishment was too light.
�People felt it was such a severe case, it should have been bumped up,� said Wynn. �Look, if somebody hurts your pet to the point that it can�t jump or walk with its normal gait, it probably qualifies as more than a misdemeanor.�
Under Wynn�s bill, prosecutors could classify an act such as Moore�s as a possible felony with a punishment of up to 32 years in prison, or a fine of $10,000.
Wynn�s bill picks up the thread on a similar bill introduced in August 2010 by Kim Hixson who represented the 43rd Assembly District at the time.
Hixson�s bill sought to create a law that made felony charges possible in cases of unprovoked assaults on pets with a deadly weapon.
Wynn said Hixson�s bill never got past its introduction, probably because it was introduced late in a busy legislative session.
Wynn�s bill differs in that it only adds a section to state statutes covering animal cruelty.
Under current statutes, people can be charged with a felony only if they kill, maim or disfigure a pet. Wynn�s bill would add internal injuries to the list.
The law would apply only to pets, not farm animals or wild animals, and Wynn said it could not be used to target veterinarians, livestock farmers or others who work with animals.
Wynn has caught heat from people irritated by his animal abuse bill because they believe he should instead be working on boosting jobs and the economy.
Wynn, who owns a 10-year-old yellow Labrador, said he feels he�s able to split his efforts between jobs, the economy and other issues.
�I thought this was a common sense issue,� Wynn said. �I try to look at each situation on its own merit. There�s a lot of laws I�d like to change.�
Last updated: 7:00 pm Thursday, December 13, 2012


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Steve Davis
Jan-02-2007, 10:02am
I got a chance to play a Gibson Nouveau F-5-style mandolin and was quite impressed with it. Does anybody else have one or does anybody have any info about these? From what I can gather these were made in Japan and finished by Gibson. The label inside is orange and says Gibson. Model # is listed as C-7. Just curious as I have never seen one before or heard one mentioned. I guess they had a line of Nouveau guitars at the same time.


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3 March 1997 Vol. 2, No. 9 THE MATH FORUM INTERNET NEWS AP Statistics Courses | Proof by Induction | Snark Mailing List ADVANCED PLACEMENT STATISTICS COURSES Two courses designed to prepare students for the AP exam in Statistics: WOODWARD ACADEMY: AP STATISTICS ON THE WEB - Paul Myers http://www.mindspring.com/~waus2/apstat/ Comprehensive statistics resources include information on textbooks, reference materials, software, TI calculator programs, and the College Board. The site also features discussions on apstat-l and a selection of online tests. BB&N: AP STATISTICS - A MEASURE OF EXCELLENCE http://www.bbns.org/us/math/ap_stats/ Buckingham Browne & Nichols School's course emphasizes projects that require hands-on gathering and analysis of real world data. The site provides homework assignments and makes use of the popular "Workshop Statistics" text. -|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|- FROM THE MATHEDU ARCHIVE: PROOF BY INDUCTION http://mathforum.org/epigone/mathedu/blinblehhand Prof. Williams P. Wardlaw [email@example.com] writes: I like to introduce induction with a story about painting a chain. Given my institution, I prefer an anchor chain: A First Lieutenant (responsible for painting) orders a Seaman to paint the anchor chain. Later he asks the Seaman what color he painted the chain. The Seaman cannot remember, but is sure that whatever color he painted a given link, he used the same color for the next link. The First Lieutenant goes on deck and sees that the first link, just showing at the top of the hawse pipe, is chartreuse. What color is (every link of) the chain? The story is followed by a formal discussion of induction and several examples, such as a couple of summation formulas and a couple of inequalities... \-|-/ Lou Talman adds: Sonneborn's Horse Lemma states that all horses are the same color. Its power lies in its immediate applicability to proofs by contradiction, which assume the form "Suppose it were not so. Well, that would be a horse of another color, wouldn't it." \-|-/ This searchable thread from the MATHEDU archive cites useful articles and discusses examples of mathematical proof by induction at both the high school and the college level. -|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|- SNARK A SPANISH-ONLY MATH PUZZLE MAILING LIST LA LISTA SNARK engloba a la matemática recreativa, los problemas de lógica recreativa, juegos de tablero y problemas sobre ellos, rompecabezas geométricos (polióminos, policubos, tangrams, problemas de partir figuras, etc.), cuadrados mágicos, juegos con el lenguaje (palindromos, anagramas, textos monovocálicos, etc.), paradojas, y todo aquello que sorprenda, maraville y deje perpleja a la inteligencia. SNARK is an open, self-moderated mailing list devoted to puzzles, recreational mathematics, logic, word games, paradoxes, board and strategic games, geometry problems, mechanical puzzles, and other brain-teasers. CONTRIBUTIONS ARE ONLY IN SPANISH. To subscribe to Snark, send an e-mail to email@example.com In the BODY of the e-mail message write: SUBSCRIBE SNARK A searchable archive of the Snark list is now hosted by the Math Forum at: http://mathforum.org/epigone/snark -|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|-\-/-|- CHECK OUT OUR WEB SITE: The Math Forum http://mathforum.org/ Ask Dr. Math http://mathforum.org/dr.math/ Problem of the Week http://mathforum.org/geopow/ Internet Resources http://mathforum.org/~steve/ Join the Math Forum http://mathforum.org/join.forum.html Send comments to the Math Forum Internet Newsletter editors _o \o_ __| \ / |__ o _ o/ \o/ __|- __/ \__/o \o | o/ o/__ /\ /| | \ \ / \ / \ /o\ / \ | \ / | / \ / \
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Repurposing a Laptop for a Child's Toy
Q: I have a Dell Inspiron laptop that no longer works. However, rather than throwing it away, I'm curious whether any of your ingenious readers have repurposed such an item into a play latop for their kids? I've seen advertisements for the VTech toy laptop, and was wondering if anyone has made their own.
Sent by Ruthie
Editor: Ruthie, if your laptop has any functionality left you might consider installing a kid-friendly operating system. Readers - what other ideas do you have?
• Got a question? Email yours with pic attachments here (those with pics get answered first)


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Admit it. You've done it, and your silence is part of your shame. Statistics say you're still doing it, perhaps more than the once-a-week average; and statistics don't lie. We imagine you think you're doing it when no one is around, where no one will see you or catch you in the act. Perhaps on a particularly long, lonely weekend or a suffocating Monday night, you find that you just can't help it. You prop up the pillows in your bedroom--dark except for the fluctuating, colored light from the television. You settle in, under the covers, close your eyes for a second and let your hand slip beneath the blanket and glide along the cool sheet. There, you think. There! The remote is right there, touching your fingertips, and you drag it out from under the covers and sigh as you surf through 100 channels for which you pay at least $60 a month. Once again, there's nothing on. Once again, you put down the remote and begin to watch the Food Network.
Relax. You won't go blind, and you're not the only one tuning in, by default or on purpose, to the Food Network. More and more people are finding something interesting, or soothing, or comfortably numb about watching the cable channel's endless parade of cooking shows. Some of the Food Network's top talents are so popular, in fact, that NBC even made a run at putting one of them in prime time last season. Emeril Lagasse's infomercial-style delivery of spicy food prep didn't work on the network, though; still, he and his fellow foodies have quite a following on cable. Tanya Holland is one of the sought-after. Her penchant for African, Creole and Cajun recipes is regularly featured on the "Soul Kitchen" segments of the Food Network's Melting Pot series, and she's coming to Plano on Friday and Fort Worth on Thursday for two free evening cooking classes at HEB's Central Market.
Chef and author Holland, who's about to release a cookbook called New Soul Cooking, apprenticed in France to learn traditional French cooking. Her background, though, is Southern and African-American. Born in Shreveport, Holland says her grandmother was a big influence on her becoming a chef and Louisiana cuisine is still a favorite. "I like to explain the distinction between Creole cuisine and Cajun cuisine," Holland says. "Creole cuisine refers to a cooking style that was developed with French, Spanish and African influences. The ultimate Creole dish is gumbo, a seafood- or chicken-based stew served with rice on the side. Cajun cuisine is a blend of Southern and French cooking that is more dependent on animal fat, mostly pork, and spicy. The most well-known Cajun dish is jambalaya, where the seafood, vegetables and rice are mixed together."
Tanya Holland
Tanya Holland teaches her free classes from 6:30 p.m. to 9 p.m. at Central Market Fort Worth, 4651 West Freeway, on Thursday, and Central Market Plano, 320 Coit Road, on Friday. Call 817-989-4700 or 469-241-8300.
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For many of her Melting Pot segments, and for the recipes in her new cookbook, Holland says, she uses many of the traditional ingredients of "soul food" with new ingredients to create more global cuisine. "It's a tribute to the rich heritage and traditions found in African-American culture and cuisine," she says, "with newer, fresh, seasonal ingredients and flavors."


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Peru mountain glaciers 'receding rapidly' >>Source: Environmental News Network
Climate change-induced glacier melts have cost northern Peru's mountains 26% of their surface area in the past 33 years, satellite images have confirmed. The reduction is equivalent to 188 sq km of the Cordillera Blanca, the highest tropical mountain chain in the world. The mountain range is home to more than seven hundreds glaciers, with the glacier Huascaran declared a world heritage site by Unesco.
Cyprus investigates mass poisoning of pine trees >>Source: Reuters
Authorities in Cyprus are investigating the destruction by poisoning of hundreds of trees on the Mediterranean island. The forestry department called in police after finding evidence that pine trees lining two key motorways had been deliberately killed.
Climate change could hit Lebanon's dwindling cedars >>Source: Reuters
Sturdy cedars perched high in the mountains stand for many Lebanese as symbols of their fractured land's survival. But some environmentalists worry that the trees face a new threat from global warming.
Canadian Arctic sheds giant ice chunk >>Source: BBC News
A large chunk of an Arctic ice shelf has broken free of the northern Canadian coast, scientists say. Nearly 20 sq km (8 sq miles) of ice from the Ward Hunt shelf has split away from Ellesmere Island, according to satellite pictures.
80 seabirds found dead on Orkney >>Source: Telegraph.co.uk
An investigation has been launched after 80 dead seabirds were found in the centre of Kirkwall on Orkney. Tests for bird flu are being carried out, but experts said the black-backed gulls were not showing any symptoms of the disease.
Mediterranean climate moves bird population >>Source: Telegraph.co.uk
Northern species of birds in Britain are dwindling while southern species are breeding more because of Britain's increasingly "Mediterranean" climate, scientists said today. Population levels of some of the rarest birds in the country have changed considerably in the past 25 years, according to a study carried out by the RSPB and the universities of Durham and Cambridge.
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New 'Your Highness' Trailer Premieres!
Following the debut of Your Highness' red band trailer last month, a new trailer has hit the web — and yeah, even without f-bombs the medieval stoner flick still looks totally awesome.The film takes Danny McBride and James Franco on every man's fantasy: a quest, alongside Natalie Portman, to find Zooey Deschanel. Plus, the always funny Justin Theroux joins and from the look of the trailer, the group has all sorts of adventures together, featuring everything from swords, marijuana, and Ms. Portman in a bikini. Giddy-up!
Your Highness is set to hit theaters on April 8, 2011. Check out the new poster and watch the trailer below!


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Glen Arbor Holiday Marketplace
- This event has passed.
This annual event showcases local and visiting artists and merchants selling art, clothing, decor, ornaments, gourmet food and unique gift items. This is a wonderful opportunity to purchase one of a kind holiday gifts!
Then make your way up the road to the Empire Artisans Marketplace, also running from 10-4 on the 30th.
Food from Riverfront Pizza & Specialties is available for purchase at the Marketplace.


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The State Government has been forced to delay the launch of its controversial sex offender register.
The website, which will allow users to access details about sex offenders living in their area, was due to go live next Tuesday.
But the Police Minister Liza Harvey says she is concerned about technical issues that could have resulted in incorrect information being made public.
Ms Harvey says she is disappointed by the delay but has been assured it will be ready in the next few weeks.
Topics: child-abuse, sexual-offences, government-and-politics, wa


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|Very poor quality, The product wears off remarkably quick (used a brand new one today for a 50 km trip and it didn't make it until the end). This doesn't just make it an expensive brake to use but also dangerous if you don't know any other braking techniques. Tip: Rollerblade brakes also fit under the Powerslide frame (with a longer screw) and last longer.
|Stephan Sanders (Tilburg)
|First class customer focused staff, quick delivery. I live in Mallorca and they ship it all the way over. Super job in short time!! Breakpad is good value for money. No complaints. Keep going like this Skate Pro! Saludos Marleen Franklin Mallorca
|Peter Franklin (Nova Santa Ponsa Mallorca Illes)
|Quite good product for the purpose. Can be used only with Powerslides general brake kit. Doesn't last very long, so better to order several, because it should be checked and changed after few times usage, so that breaking power is assured for whole travel. Amazingly quick delivery, many thanks.
|Markku Hainari (Espoo)


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Plastic surgery is a booming business these days, with tabloids pinpointing every detail that a celeb has had fixed and customers lining up to get their (blank) done just like (fill in blank celeb)'s. While some people have plastic surgery to correct serious issues or boost self-esteem, others do it in a potentially endless persuit of what they consider perfection. With the rise in plastic surgery these days, are there unqualified doctors trying to cash in on the craze? Are too many patients scheduled per day?
"Plastic Disasters" is a one-hour documentary that looks into a few cases of people who went in for plastic surgery for various reasons and whose surgeries were botched. It's a very saddening piece and quite a troubling one at times. Anyone thinking about having plastic surgery - whether for cosmetic or health reasons or both - should certainly view this program before deciding whether or not to go through with it, or consider alternate treatments.
One of the first cases is Mona, seemingly a very nice, average older woman who saw an ad for a plastic surgeon and figured that it would be the best way to remove some excess weight. Although her husband was initially skeptical, when they thought it would be a way to help her diabetic condition, he agreed to it. After the surgery, Mona became increasingly ill and began to have trouble breathing. When the plastic surgeon, who kept telling her that "she'd be okay" finally told his nurse to tell her to go to the hospital, the area where the surgery had been done had become so infected that the doctors at the hospital worried if she'd be able to recover. Mona was devastated and eventually, due to lack of activity due to her injuries, one leg had to be removed. Shortly after, she lost the other.
Tony originally went in for a bit of a vanity reason: to fix his nose. He thought that it would be an in/out procedure that wouldn't be a big deal and increase his self-esteem. The first surgery was botched, then a revision went poorly and a third revision that included a silicon implant that was not inserted correctly, was a complete disaster. A fourth procedure? Further damage and now, not only was the appearance not correct, but Tony faced breathing problems. At that point, it became less about vanity and just trying to find someone who could get his nose to look normal again.
I found each one of these stories to be absolutely devastating to watch. These are people who went in to these surgeries with the hopes of improving their lives, but all of them were tragically harmed by what they thought were simple procedures. In Tony's case, follow-ups were botched and lead to worse issues. In the other cases, the patients didn't know where to turn or, such as in the case of Lucille, found no one willing to listen to their pain.
"Plastic Disasters" is, again, a must-view for anyone contemplating cosmetic surgery. As one doctor notes in the documentary, "Cosmetic surgery is still surgery." As this documentary certainly shows, severe problems can occur with procedures thought to be simple.
The DVD
VIDEO/AUDIO:: Clear, crisp 1.33:1 full-frame transfer, with only some slight shimmer and a couple of instances of artifacting. The stereo sound is documentary-style audio, with clear dialogue. There's not much else to it.
EXTRAS: Nothing.
Final Thoughts: This is a saddening, horrifying and troubling documentary that shows how dangerous "simple" cosmetic procedures can be. The DVD presents fine audio/video quality, but no extras. The documentary has fairly limited appeal aside from those considering cosmetic surgery, but anyone interested in the topic should definitely consider a rental or purchase.


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Use the tools below to refine your search by only displaying reviews with a certain number of star ratings or to only show reviews from a certain time period. Eg click on '1 star' to just display the reviews we have which received a 1 star rating click or 'Within the last month' to display just reviews posted over the last month.
Written on: 07/07/2008
Its a very good club someone that launches the ball low and long but not very consistent. (note that i did not try this club on the range or a course i only tried it on a golf simulator)
… Read Full Review
Written on: 04/07/2008 by golfprojim42 (5 reviews written)
Why do I like this driver?
Accuracy: It is really straight, even off-centre hits go very straight with minimal shape
Launch Angle: This club launches the ball very high with low spin. Consider trying a lower loft than you would usually try.
Looks: Many people may differ, but I love the square look. It feels to my like the square flat face encourages a nice sweeping driver swing
Shaft: I chose the standard fit Fujikura Speeder Stiff shaft and it has improved my accuracy dramatically. There are many… Read Full Review
Written on: 23/06/2008
I would recommend this driver to anyone any age great club!!!! 100%… Read Full Review
Written on: 11/06/2008 by 8sonny8 (1 review written)
The driver took some time to get used to. I brought it to the driving range for a couple of weeks, twice per week and used it on 2 Saturday's golf game. It was on the third week that I noticed an improvement in distance and target line, driving an average of 270 yards and was usually on the left center of the fairway. My driver is the tour 9.5 stiff… Read Full Review
Written on: 04/06/2008
I had read a number of reviews regarding this driver and thought I'd give it a go. Took it out for one round and then sent it back. It seems to be more of a novelty club than a class driver.
Might have just been my swing but it felt as though it was top heavy and so lost control through the swing.
… Read Full Review
Written on: 03/06/2008 by mcmillandarren (1 review written)
I have a ping g2 and was going to buy the g10.
My swing pushed the ball right and faded with the g2 and g10.
This surprised me, but he fti went straight this was the most important thing in a driver rather than distance and am off 8 handicap, play your second shot from the rough is not an option.
Oh by the way i have not played with the club yet just bought it… Read Full Review
Written on: 23/05/2008 by reid1976 (1 review written)
I bought the FT-i driver last summer ,when I took it out this year I noticed it had a crack in the head, so returned to the store I bought it at where it was sent away to Callaway they phoned me two days later to say they would not warranty my club because I had put in a new shaft,the shaft was done by a professional, but still voids the warranty they say,none of this was mentioned when I bought the club.(Way to back your product)… Read Full Review
Written on: 04/05/2008
Amazingly worth the price! I love the Calaway FT i drivers it get so much better control with it and it feels awesome… Read Full Review
Written on: 07/04/2008
Much straigher, not as long as G5 but in play. Play of 16 with swingspeed about 95mph. Bought the 586 9degree FTI neutral stiff, like playing with licqourice stick, no control or distance compared with old G5, Aldila NV75 stiff. Switched to 9.5 degree Stiff FTI TOUR, super, super long and straight. Headcover very annoying with magnetic fastener. Not sure it fits great… Read Full Review
Written on: 03/03/2008 by creese (1 review written)
I have been trying for some time to reduce the amount of slice on my drives and this club has done that in about three rounds. Getting off the tee with good distance and in the fairway takes a huge load off!! I am very happy with my Callaway FT i purchase… Read Full Review
Written on: 20/02/2008
I am an 18 handicap, was trying G10 at the heated launch range in toronto winter - getting about 210 carry, guy next to me a 8 handicap was making a lot of noise and blasting FTi neutral 11 degrees - we exchanged our clubs and I hit 10 shots with the FTi all straight with 220 - 240 carry amazing! - he in turn hit my G10 and he was hitting longer and straighter with G10.
Conclusion : if your handicap is 14 and above you can not go wrong with the FTi.
I bought the FTi neutral 11 degree and took… Read Full Review
Written on: 03/01/2008
The Callaway FT-iA is a large monetary investment but if you want to enjoy your golf and play it from the fairways you can't go wrong! The Draw version will cure all but the most terminal of slices. The magnetic head cover is a bit fiddly!… Read Full Review
Written on: 26/12/2007 by lloydus (1 review written)
I play off 15 and have a swing rate of 117 as on 2/12/07. I tended to slice the ball using my nike sumo on a regular flex shaft. Tried this callaway fti in a ten degree stiff shaft neutral bias and cant hit a ball wrong with it as yet... very long shots, very straight. Would suggest you get correctly fitted out for this kit to make it worth your while… Read Full Review
Written on: 27/10/2007 by kaan1992 (1 review written)
I play of 8.3, I have always struggled with my pld driver (ping g10) off the tee but since i got this Callaway I am hitting my ball straighter and longer nearly every time… Read Full Review
Written on: 15/10/2007 by 43guy (1 review written)
This driver is so simple to hit. Forgiveness is big, length is long, highly recommend!… Read Full Review
Written on: 18/07/2007 by GaryBoy100 (1 review written)
I am a 15 handicap player who has always struggled with consistency off the tee. Since I bought my Callaway FTi I am hitting the ball straighter and longer and getting the ball in play far more often. It has given me tremendous confidence off the tee and I am knocking 4-5 shots off each round. I even find that off center hits go much straighter and there is less of a tendency for the ball to 'slice'.
I have the 10 degree, stiff shaft, draw which I find I hit better than the regular shaft even… Read Full Review
Written on: 15/07/2007 by PtrJck (1 review written)
Do not worry about the shape of the Callaway FT-i… Read Full Review
Written on: 10/07/2007 by R3Wood (1 review written)
My index right now is 14. I am coming to the FT-i from the Great Big Bertha (GBB) (1995) version. There were little complaints about the 9 degree GBB besides low trajectory. I went to Demo days last week, and hit the FT-i Neutral and Draw. The 9 Degree Stiff, Draw version seemed to fit my swing better than the Neutral, which had a more consistent slice. The Draw version booms off the tee from straight to a nice high draw. I have not seen the distance loss as some people have seen. My tendency… Read Full Review
Written on: 07/05/2007 by jhgolf72 (1 review written)
Quick! Get one!… Read Full Review
Written on: 01/05/2007 by John J (1 review written)
I have been struggling with my R7 425 and decided to try another driver. Used a loaner FT-i neutral with a regular flex shaft. The results were consistency, 95% of my drives were 240-250 and straight. I plan on buying one as soon as I am able to sell my R7… Read Full Review
As rated by our community of reviewers
" Long " Read More
" Still a Great Club " Read More
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" Quality club " Read More
" Nice! " Read More
Written by Daa1969


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Kotsay expected out at least until May after back surgery
With the news coming today that Mark Kotsay had back surgery on Jan. 29 to remove a displaced disc fragment, the decision by the Red Sox to sign Brad Wilkerson (pending a physical) makes more sense. Wilkerson, a first baseman-outfielder, agreed to terms on a minor league deal, as reported yesterday.
Dr. Robert Watkins performed the arthroscopic surgery in Los Angeles. Kotsay is expected to miss at least the first month of the season, and could be back at some point in May, according to a source familiar with the situation.


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- Sicular, Terry; Olinto, Pedro; Ashwill, Maximillian; Ferreira, Francisco; Lopez-Calva, Luis-Felipe; Newman, John; Demombynes, Gabriel; Reva, Anna; Mulligan, Mary Anne;
- 2013/08/01
- Newsletter
- 82522
- 1
- 1
- China;
- East Asia and Pacific;
- 2013/11/07
- Disclosed
- Inequality in focus vol. 2 (no. 2)
Accountability, agricultural support, annual rate, average annual, average income, capital gains, child care, child-care, constant prices, death, Declining Inequality ... See More + Development Economics, discrimination, distributional outcomes, economic growth, economic indicators, Economic Research, educational services, empirical evidence, employment income, equal opportunities, evaluation, evaluators, falling poverty, financial crisis, financial markets, Foreign Policy, Gini coefficient, government policies, growth rate, health care, High Inequality, Household Income, Household per capita Income, household surveys, human capital, illiteracy, illiteracy rate, Income, income data, income differential, income differentials, income distribution, income gap, income groups, income growth, Income Inequality, increased inequality, InequalIty, infant, infant mortality, infant mortality rates, its, labor market, living standards, local economy, measures, middle class, migrant, mortality rates, PB, pensions, per capita incomes, place of residence, policy design, policy makers, policy making, policy measures, policy reforms, pollution, Poor, Poor Areas, poor communities, poor incomes, Poor People, population, positive growth, positive impact, poverty, poverty alleviation, poverty line, poverty rate, poverty rates, Poverty Reduction, power parity, private sector, Progress, property rights, public debate, public goods, Public Policy, public sector, public service, public services, public spending, public transportation, purchasing power, purchasing power parity, quality education, quality of services, quality services, rapid growth, rapid increase, redistributive policies, reducing inequality, reducing poverty, regional differences, rising inequality, rural, rural areas, rural differences, Rural Households, rural income, rural incomes, rural migrants, rural residents, social development, social policy, social programs, social services, social welfare, students, targeting, taxation, transfers, unemployment, urban areas, urban migration, urban population, urbanization, wages See Less -
- English
- Poverty Reduction; Health, Nutrition and Population;
- Inequality; Population Policies; Services & Transfers to Poor; Poverty Impact Evaluation; Rural Poverty Reduction;
- Poverty Reduction and Equity (PRMPR)
- Inequality in focus. -- Vol. 2, no. 2
- Final


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Nice women never wore makeup. Even the word was taboo in polite society—until Max Factor entered the scene. Born in Poland in 1877, Factor worked as a beautician for the Russian royal family, the Romanovs. In 1904, he fled to America, where he opened a cosmetics store in Los Angeles. Creating makeup originally for silent films, then the talkies, and, ultimately, color motion pictures, Factor designed looks for Katharine Hepburn, Rita Hayworth, Bette Davis, and countless other beauties of the day. Soon women everywhere wanted to look like their favorite glamorous stars, and Factor was there to help, bringing his innovative cosmetics to the general public.
He revolutionized the world of beauty by producing many firsts: false eyelashes, lip gloss, foundation, eye shadow, the eyebrow pencil, concealer, wand-applicator mascara, and water-resistant makeup. A true innovator, he also introduced the concept of color harmony and the celebrity-endorsed cosmetics advertising that forms the glamorous backbone of the modern industry. Max Factor was the father of modern makeup. This is his extraordinary story.
Fred Basten, many of whose books have featured Hollywood and the entertainment industry, explores the biography of the "father of modern makeup". Born in Poland, Max Factor worked on first Russian and then Hollywood royalty. With the friendliness and openness of a favorite cosmetician, Samantha Worthen reads the story of a cosmetics innovator who created the looks of Romanov women as well as stars such as Pola Negri, Katharine Hepburn, Rita Hayworth, and Bette Davis. Additionally, he proved himself a great salesman and only-in-America entrepreneur by bringing that glamour to the women of Main Street.
"Fascinating . . . you won't be able to put it down." (Glamour)
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Interesting, yet forgettable in all the good ways
Very interesting story about a very interesting man.
I would cast almost any human over Samantha Worthen, who sounds like a robot that doesn't understand how a sentence is supposed to be read for it to flow. Strange and unnecessary pauses, almost as if words were recorded independently of each other then strung together to make this recording. While this does improve over each individual chapter, the beginning of the next chapter is just as bad as the last
- Elizabeth Sutherland


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Kim Soo Hyun To Make Movie Comeback For The First Time Since 2014
Kim Soo Hyun is finally making his return to the big screen next month in his upcoming film Real.
Kim Soo Hyun is officially making his return the big screen after more than 3 years in the upcoming action film Real. The film that is expected to be released in June 2017, is about a troubleshooter that solves various requests for the underworld businesses that control the city.
Kim Soo Hyun made his acting debut in 2007 and had since then become a become a top Hallyu star. The actor was voted as Koreas Actor of the Year in 2014 by Gallup and was ranked in the top 5 of Forbes Korea Power Celebrity for three years.


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Health-systems efficiency in the Russian Federation: tuberculosis control
Efficacité des systèmes de santé en Fédération de Russie : la lutte antituberculeuse
Eficiencia de los sistemas de salud en la Federación de Rusia: control de la tuberculosis
Katherine FloydI; Raymond HutubessyI; Yevgeniy SamyshkinII; Alexei KorobitsynIII; Ivan FedorinIV; Gregory VolchenkovV; Boris KazeonnyVI; Richard CokerVII; Francis DrobniewskiVIII; Wieslaw JakubowiakIII; Margarita ShilovaIX; Rifat A AtunII, 1
IStop TB Department, World Health Organization, Geneva, Switzerland
IICentre for Health Management, Tanaka Business School, Imperial College London, South Kensington Campus, London SW7 2AZ, England
IIIWorld Health Organization, Moscow, Russian Federation
IVMinistry of Health, Samara, Russian Federation
VOblast TB dispensary, Vladimir, Russian Federation
VIOblast TB dispensary, Ivanovo, Russian Federation
VIIDepartment of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England
VIIIDepartment of Infectious Diseases, Guy's, King's and St Thomas' Medical School, London, England
IXResearch Institute of Phthisiopulmonology, Sechenov Moscow Medical Academy, Moscow, Russian Federation
OBJECTIVE: To conduct a comprehensive assessment of the case-mix of patients admitted to tuberculosis hospitals and the reasons for their admission in four Russian regions: Ivanovo, Orel, Samara and Vladimir. We also sought to quantify the extent to which efficiency could be improved by reducing hospitalization rates and re-profiling hospital beds available in the tuberculosis-control system.
METHODS: We used a standard questionnaire to determine how beds were being used and who was using the beds in tuberculosis facilities in four Russian regions. Data were collected to determine how 4306 tuberculosis beds were utilized as well as on the socioeconomic and demographic indicators, clinical parameters and reasons for hospitalization for 3352 patients.
FINDINGS: Of the 3352 patients surveyed about 70% were male; the average age was 40; and rates of unemployment, disability and alcohol misuse were high. About one-third of beds were occupied by smear-positive or culture-positive tuberculosis patients; 20% were occupied by tuberculosis patients who were smear-negative and/or culture-negative; 20% were occupied by patients who no longer had tuberculosis; and 20% were unoccupied. If clinical and public health admission criteria were applied then < 50% of admissions would be justified and < 50% of the current number of beds would be required. Up to 85% of admissions and beds were deemed to be necessary when social problems and poor access to outpatient care were considered along with clinical and public health admission criteria.
CONCLUSION: Much of the Russian Federation's large tuberculosis hospital infrastructure is unnecessary when clinical and public health criteria are used, but the large hospital infrastructure within the tuberculosis-control system has an important social support function. Improving the efficiency of the system will require the reform of health-system norms and regulations as they relate to resource allocation and clinical care and implementation of lower-cost approaches to case management for patients with social problems. Additionally, closer attention will need to be paid to the management of staff numbers in the tuberculosis system.
Keywords: Tuberculosis, Pulmonary/therapy; Hospitals, Special/utilization; Hospital costs; Hospital bed capacity; Bed occupancy; Hospitalization; Inpatients; Efficiency, Organizational; Health care surveys; Cross-sectional studies; Russian Federation (source: MeSH, NLM).
OBJECTIF: Conduire une évaluation globale d'un éventail de cas hospitalisés dans des établissements spécialisés dans la tuberculose et des raisons de leur admission dans quatre régions russes : Ivanovo, Orel, Samara et Vladimir. Nous avons également cherché à déterminer dans quelle mesure l'efficacité pourrait être améliorée en réduisant les taux d'hospitalisation et en restructurant les lits d'hôpitaux disponibles dans le système de lutte antituberculeuse.
MÉTHODES: Nous avons utilisé un questionnaire type pour déterminer de quelle façon les lits étaient utilisés et qui les utilisait dans les établissements spécialisés dans la tuberculose de quatre régions russes. Les données ont été recueillies afin de déterminer comment 4306 lits affectés à la tuberculose étaient utilisés et également concernant les indicateurs socio-économiques et démographiques, les paramètres cliniques et les raisons de l'hospitalisation de 3352 malades.
RÉSULTATS: Sur les 3352 patients étudiés, environ 70 % étaient des hommes ; l'âge moyen était de 40 ans et les taux de chômage, d'incapacité et d'alcoolisme étaient élevés. Près du tiers des lits étaient occupés par des patients tuberculeux à frottis positif ou à culture positive ; 20 % étaient occupés par des patients tuberculeux à frottis négatif et/ou culture négative ; 20 % étaient occupés par des patients qui n'avaient plus la tuberculose ; et 20 % étaient inoccupés. Si des critères d'admission cliniques et de santé publique étaient appliqués, moins de 50 % des admissions seraient justifiées et moins de 50 % du nombre actuel de lits s'avéreraient nécessaires. Jusqu'à 85 % des hospitalisations et des lits ont été jugés nécessaires lorsque les problèmes sociaux et d'accès aux soins ambulatoires étaient pris en compte au même titre que les critères cliniques et de santé publique.
CONCLUSION: Lorsque l'on utilise des critères cliniques et de santé publique, une grande partie de l'importante infrastructure hospitalières consacrée à la tuberculose en Fédération de Russie est superflue, mais cette infrastructure du système de lutte antituberculeuse joue un rôle de soutien social non négligeable. Il faudra, pour améliorer l'efficacité de la lutte antituberculeuse, entreprendre une réforme des normes et des réglementations du système de santé qui ont trait à l'allocation des ressources et aux soins cliniques et mettre en oeuvre des méthodes moins coûteuses de prise en charge des cas pour les patients présentant des problèmes sociaux. En outre, une attention accrue devra être portée à la gestion des effectifs dans le système de lutte antituberculeuse.
Mots clés: Tuberculose pulmonaire/thérapeutique; Hôpital spécialisé/utilisation; Coûts hôpital; Capacité lits hôpital; Occupation lit hôpital; Hospitalisation; Malade hospitalisé; Efficacité fonctionnement; Enquête système de santé; Etude section efficace; Fédération de Russie (source: MeSH, INSERM).
OBJETIVO: Realizar una evaluación integral de los casos de pacientes ingresados en hospitales de tuberculosis y de las razones de su ingreso en cuatro regiones de Rusia: Ivanovo, Orel, Samara y Vladimir. Decidimos además determinar en qué medida podía mejorarse la eficiencia reduciendo las tasas de hospitalización y reclasificando las camas de hospital disponibles en el sistema de control de la tuberculosis.
MÉTODOS: Utilizamos un cuestionario estándar para determinar cómo estaban utilizándose las camas y quiénes las ocupaban en los centros de tuberculosis de las cuatro regiones rusas mencionadas. Se reunieron datos para determinar cómo se utilizaban 4306 camas de tuberculosis, así como sobre los indicadores socioeconómicos y demográficos, los parámetros clínicos y los motivos de hospitalización de 3352 pacientes.
RESULTADOS: De los 3352 enfermos encuestados, alrededor del 70% eran hombres; su edad media era de 40 años; y las tasas de desempleo, discapacidad y consumo abusivo de alcohol eran altas. En torno a una tercera parte de las camas estaban ocupadas por enfermos de tuberculosis con baciloscopía positiva o cultivo positivo; el 20% lo estaban por tuberculosos con baciloscopía negativa y/o cultivo negativo; un 20% estaban ocupadas por pacientes que ya no sufrían tuberculosis; y el 20% estaban libres. Aplicando criterios de admisión clínicos y de salud pública, menos del 50% de los ingresos estarían justificados, y se necesitaría menos del 50% del número actual de camas. Cuando se tuvieron en cuenta los problemas sociales y el escaso acceso a la atención ambulatoria además de los criterios antes mencionados, se estimó que hasta un 85% de los ingresos y las camas eran realmente necesarios.
CONCLUSIÓN: Gran parte de la amplia infraestructura hospitalaria dedicada a la tuberculosis en la Federación de Rusia es innecesaria si nos atenemos a unos criterios clínicos y de salud pública, pero la infraestructura de hospitales en el contexto del sistema de control de la tuberculosis cumple una importante función de apoyo social. Para mejorar la eficiencia del sistema habrá que reformar las normas y disposiciones relativas a la asignación de recursos y la atención clínica, y aplicar enfoques de bajo costo a la gestión de los casos de pacientes con problemas sociales. Además, deberá potenciarse la gestión de los trabajadores empleados en el sistema de atención de la tuberculosis.
Palabras clave: Tuberculosis pulmonar/terapia/utilización; Costos de hospital; Hospitales especializados; Capacidad de camas en hospitales; Ocupación de camas; Hospitalización; Pacientes internos; Eficiencia organizacional; Encuestas de atención de la salud; Estudios transversales; Federación de Rusia (fuente: DeCS, BIREME).
The Russian Federation's health-care system is characterized by centralized planning and administration, government financing, and the provision of services to the public.1 There are several vertical programmes and related infrastructure for diseases deemed priorities, including tuberculosis (TB), sexually transmitted infections, diabetes, vaccine-preventable diseases and HIV/AIDS. In 2001, there were 9.1 hospital beds per 1000 population, compared with 2.4 per 1000 for the United Kingdom and 4.1 per 1000 in the European Union.2 An extensive primary care network comprising polyclinics, ambulatory care centres and feldsher stations also exists, but focuses on referral rather than gatekeeping and the management of patients. (Feldshers are medical/surgical practitioners who do not have full professional qualifications or status.)
Globally, the Russian Federation ranks twelfth in terms of the total number of new TB cases that occur each year.3 After a period of decline starting in the 1960s, the case-notification rate almost tripled during the 1990s, reaching 90.7 per 100 000 population in 2000.4 Similarly, the death rate from TB rose from 8 per 100 000 in 1991 to 20 per 100 000 in 2001.4 A large verticalized network of specialized institutes, dispensaries, hospitals, outpatient clinics, sanatoria and rural feldsher points exists to detect and treat cases; this network includes about 80 000 beds designated specifically for treating patients with TB. Box 1 provides further details of how TB control is implemented.5, 6
With support from international and bilateral agencies, new laws are being adopted to gradually implement standard international practices in TB control.79 Data from 2003 show that 25% of the population is covered by the internationally recommended control strategy known as DOTS.3 In 2003 a new regulation (prikaz) was implemented to enforce the use of standardized drug regimens; and in 2004 a prikaz was approved that introduced a recording and reporting system similar to that recommended in the DOTS strategy.10, 11
Despite these developments, there is considerable scope for improving efficiency in the extensive TB-control system. Studies have shown that implementation of the DOTS strategy could substantially lower treatment costs for new smear-positive patients,12 that inpatient care accounts for more than 50% of total TB-control costs,13 that health-system financing and provider-payment systems create perverse incentives for the use of lengthy and repeated hospitalizations (beyond those stipulated in the regulations),14 and that to compensate for inadequate social-support systems for TB patients, providers use sophisticated practices to enable lengthy admissions during winter.15 This contrasts with other countries that have a high burden of TB but where treatment is generally provided on an outpatient basis and it is unusual for patients to be hospitalized for long periods of time and large networks of TB hospitals do not exist.3
While these previous studies have identified frequent and lengthy hospitalizations and the factors that lead to these practices, they have not included a comprehensive assessment of the case-mix of patients admitted to TB hospitals and the reasons why patients are admitted: they have focused on new smear-positive or culture-positive patients in Group IA and not cases in Groups IB or IIVII (Box 1). Nor have they attempted to quantify the extent to which the existing number of beds and admissions could be reduced. To address these gaps, we conducted a detailed study of the utilization patterns of TB hospitals in four Russian regions. The study was designed to answer three questions. First: what kinds of patients are using the inpatient infrastructure of TB hospitals? Second: why are these patients being admitted? Third: what scope exists for reducing the use of the inpatient infrastructure in TB hospitals?
A cross-sectional bed census was conducted in TB facilities in four Russian regions: Ivanovo, Orel, Samara and Vladimir. These regions were chosen because collaborative links had been established among study investigators through projects funded by WHO, the United States Agency for International Development and the United Kingdom Department for International Development. The regions vary in terms of location, geographical size, population size, mean income level and number of TB-control facilities. Summary indicators for each region and the country as a whole are shown in Table 1.
A questionnaire was designed by a multidisciplinary study team; it was piloted in each of the four regions and refined through discussions with Russian and international experts (e.g., senior staff in specialist TB research institutes at federal level, chief TB doctors in each region where the survey was to be undertaken, WHO staff), including some that were bilingual. TB physicians in the four regions were trained to use the questionnaire. These physicians surveyed how all of the specialized TB beds were utilized on one day in Orel and Samara, and due to time and logistical constraints, collected data on large representative samples in Ivanovo (86% of all beds) and Vladimir (82% of all beds). The dates of the surveys varied for logistical reasons and to allow data to be collected for both summer and winter. Ivanovo was surveyed in September 2003 and the survey was repeated in March 2004; Orel was surveyed in September 2003; Samara was surveyed in November 2003; and Vladimir was surveyed in February 2004. The TB specialist in charge of each hospital ward was responsible for data collection. The patients' variables for which data were collected included socioeconomic and demographic indicators, clinical parameters, reasons for hospitalization and the classification of the case according to the Russian system in use in mid-2003 (Box 1).7
The cross-sectional study design required to understand the use of TB hospital beds is not compatible with collecting data on treatment outcomes; moreover such data were not necessary to answer our three study questions. Nonetheless, given the importance of treatment outcomes and the fact that they may vary according to whether treatment is provided on an inpatient or outpatient basis, this issue is addressed in the discussion section of the paper.
All data were entered into an Excel spreadsheet (version 7.0) and analysed in Excel and by using Stata software (version 8.0). Analysis was done in two stages. In the first, three major analyses were done: the socioeconomic and demographic data across regions were summarized and compared; bed utilization was quantified and compared across regions by identifying the percentage of beds occupied by each of the groups of patients in the Russian classification system and the percentage of beds that were unoccupied; and the frequency with which different reasons for hospitalization were reported were summarized and compared across regions.
In the second stage, we assessed the percentage of patients that would require admission, and the percentage of available beds that would be needed, for five sets of admission criteria. These admission criteria were defined in consultation with Russian experts and reflected clinical, public health, social and health-system justifications for admission. To assess the percentage of existing beds that would be required under each scenario, we assumed that the optimal average bed occupancy rate was 80%.16
A total of 3352 patients were surveyed, and the occupancy levels and reasons for utilization of 4306 beds were determined. Socioeconomic and demographic indicators for patients are summarized in Table 2. About 70% of patients were male; 1319% were children; and 510% were elderly. The average age was 40. There were high rates of alcohol misuse among patients (3249%), disability (1739%) and unemployment (2741%). In Ivanovo, 7% of patients were homeless. Rates of unemployment, disability, alcohol misuse, homelessness and the distribution of patients between rural and urban areas varied among the four study regions as did rates of multidrug-resistant TB.
The utilization of beds according to the Russian classification of cases is illustrated in Fig. 1. Around 2530% of beds were occupied by patients in Groups IA or IB and 57% of patients were smear-positive or culture-positive. Overall, about 20% of beds were occupied by patients in Groups IA or IB who were not smear-positive or culture-positive (i.e., bacteriologically negative, BK-) at the time of the study, but numbers varied across oblasts (range = 723%). Patients in Groups IIVII (patients who no longer had active TB or who had extrapulmonary TB) also occupied about 20% of beds, but again numbers varied among oblasts (range = 1832%). The numbers of patients with extrapulmonary TB within this group were small (data not shown). Overall, about 20% of beds were unoccupied (range = 837%). In every region at least one-third of beds were either unoccupied or occupied by patients who did not have active TB; in two regions (Orel and Ivanovo) the figure was > 50%.
When physicians were asked what was the single most important reason for hospitalizing a patient, the answers most frequently mentioned were that: the patient needed chemotherapy for TB, hospitalization was required according to existing regulations, the patient needed to be hospitalized to confirm or exclude the diagnosis of TB, the patient needed to be isolated to prevent transmission to others or to allow immunity to TB to develop, or the patient needed surgery (Table 3). Other reasons included on the questionnaire were rarely given as the main reason for admission (detailed data available from the authors).
The percentage of patients for whom admission would be required and the percentage of existing beds that would be needed according to different sets of clinical, public health, social and health-systems criteria are shown in Table 4. If clinical and public-health criteria were used, around 4050% of patients would need to be admitted, and 4050% of existing beds would be required (Table 4, scenario 1). If homeless patients were admitted to hospital in addition to those meeting clinical and public-health criteria (scenario 2) then about 50% of patients would require admission and 4050% of beds would be needed. When alcohol misuse is added as a justification for admission (scenario 3), approximately 60% of patients would need to be admitted and 4570% of beds would be required. When poor access to health services is added as a reason for admission (scenario 4), approximately 6580% of patients would need to be admitted and about 5080% of available beds would be needed. The averages across all regions are 77% of patients would need admission and 71% of existing beds would be needed. When clinical and public-health reasons, homelessness, lack of access to health facilities and an extended set of social reasons (patients with poor living conditions and/or no care at home) are all considered to justify admission, around 7580% of patients would need to be admitted and 6585% of existing beds would be needed. The average across all regions is 78% of patients would need admission and 76% of beds would be needed.
Our study suggests that much of the Russian Federation's TB hospital infrastructure (80 000 beds or about 1000 per region) is not used according to clinical and public-health criteria, and a large share of hospital beds are used for social reasons and because patients have difficulty in accessing outpatient care. In the four regions that we surveyed, about half of admissions were justified and half of the beds would be required if clinical and public-health criteria were applied but up to 81% of admissions would be justified and 85% of beds would be needed when clinical, public health, social and health-system factors are considered.
Despite some differences in the demographic, geographical and socioeconomic characteristics of the regions and patients studied, the broad similarity across regions was striking in terms of the percentage of patients who would need admission when different criteria were used. This is in line with previous studies of TB control in the Russian Federation that have identified consistency in case management, costs and average length of hospital admission across regions as well as the important social-support function played by TB hospitals.9, 1315 This consistency suggests that our results are likely to be applicable to the rest of the country's 88 regions.
If our results can be generalized, there is substantial potential for reallocating beds set aside for specialized TB care (that is, these beds could be used for other purposes or when this is not possible, fewer beds could be allocated for TB care), thus generating savings. In 1999, the cost of a bed-day for TB patients was consistently estimated at around US$ 3.00.13 If beds were used only for patients requiring admission for clinical and public-health reasons, more than half of the existing 80 000 beds set aside for specialized TB care (on average about 500 per oblast) could be reallocated, resulting in savings of around 15 million bed-days and US$ 45 million per year. For comparison, about US$ 245 million was spent on TB control in the Russian Federation in 2003,3 while in 2004 the government secured additional external funding from the World Bank and the Global Fund to fight AIDS, TB and Malaria (a combined worth of more than US$ 100 million over five years). Moreover, existing bed-day costs are part of a system in which salary levels are low (doctors' salaries are below the national average); there is inadequate funding for operating costs; and there is limited recent investment in buildings and equipment. Cost savings would be much higher if bed-day costs were more in line with the country's middle-income status and with the US$ 16.00 cost per day reported before the 1998 financial crisis.12
Of course, reallocation only makes sense if alternative services that both cost less and are at least as effective as the existing use of inpatient care can be developed for patients with social problems and poor access to health facilities and if cost-savings from the reallocation of specialist TB beds are available for reinvestment in such services. Evidence from other countries shows that outpatient care for TB patients is feasible, effective and costs less than inpatient care,1720 but in these settings social problems, such as alcohol misuse, are less common. Alternatives to inpatient care that have already been discussed in the Russian context include establishing shelter-type facilities that offer minimal clinical care, strengthening outpatient services and social support, and using isolation wards for treatment in general hospitals that have spare capacity.14, 21 Our findings suggest that assessing the costs and effectiveness of these alternatives and comparing them with existing care should be a priority. It is encouraging that data from recently introduced social-support programmes for TB patients in several Russian regions suggest that they can substantially improve treatment outcomes (from a treatment success rate of 65% to above the WHO target of 85%), with budgets of about US$ 20 000 per region per year (equivalent to the cost of operating 18 beds for one year).22
As noted in the Methods section, our study design did not allow us to compare treatment outcomes for inpatients and outpatients, and it would have been difficult to do this since almost all patients are treated as inpatients. Nonetheless, our study demonstrates that even if some patients are being hospitalized because physicians believe this is the best way to ensure a good treatment outcome, many beds are unoccupied or occupied by patients who have already completed treatment. Two further limitations of our study are that the reasons treating physicians gave for hospitalizing patients were based on their own observation and judgement and that the data illustrate bed-use at only one point in time and seasonal variation may exist. We tried to overcome these limitations by investing time in training doctors to use the questionnaire and by collecting data during both summer and winter.
The success of infectious disease-control programmes is often determined by the constraints posed by the health systems in which they operate.23, 24 In the Russian Federation, there are six major barriers to the rationalization of the TB control system. First: hospital funding is based on the number of beds and bed occupancy. This preserves existing structures and provides perverse incentives for providers to maintain the number of beds and to hospitalize patients with TB.9, 14 Reallocating beds requires making changes to mechanisms of resource allocation and provider-payment systems for both TB control and the health system as a whole.14 Second: previously, regulations stipulated long periods of hospitalization for patients with TB.8, 9, 2527 With the recent introduction of Ministry of Health Executive Order 109 these regulations have been formally abandoned but since the order does not explicitly specify new criteria for hospital admission previous regulations may still be used as a reference.10 Third: large numbers of staff are employed in TB-control facilities (17 860 doctors, 37 253 nurses, 18 515 hospital attendants and 18 500 ancillary staff). About one-third of the cost savings that could be made from reallocating beds is related to staff costs.13 Reducing or redistributing staff is politically difficult. Any reductions would need to be linked to improvements in pensions; current pension provision encourages staff to remain in their posts beyond retirement age. Fourth: outpatient services for TB care and social support for patients who are unemployed and/or misuse alcohol are poorly developed.9, 14, 15 Fifth: cost savings made from reallocating or reducing the number of beds would not necessarily be reinvested in TB control.14 Financing regulations (as in many other industrialized countries) prevent a shift of funds from health to social sectors and prevent a pooling of health-sector and social-sector budgets. For TB control to benefit from the reallocation of hospital infrastructure, and for such reallocation to be supported by existing stakeholders, it is essential that cost savings are reinvested in the TB-control system. For instance, funds could be used to provide incentives to staff to improve performance and outcomes and to strengthen weak outpatient and social-support services. The flexibility to reinvest savings would be facilitated by the introduction of global budgets for providers of TB services, which would provide flexibility to reallocate existing resources without a loss of income. Sixth: the prevailing experiences and attitudes of stakeholders (both staff and patients) may lead to strong resistance to change; this may be based on the view that inpatient care is necessary to ensure good outcomes and because patients expect to be hospitalized.28
In the short term, these constraints mean that significant improvements in the efficiency of TB-control programmes that are based on optimal use of beds are unrealistic. However, in the medium term it should be feasible to positively influence stakeholders' attitudes, revise existing approaches of resource allocation, introduce more efficient provider-payment systems, implement phased reductions in the number of hospital beds and staff, change existing regulations governing the management of patients with TB, and strengthen outpatient care and social-support services. Encouragingly, a two-day workshop in Vladimir in 2004 with stakeholders from the federal and local levels, which was held to discuss the findings presented in this paper, indicated that there was a broad consensus on the need to gradually reduce the reliance on inpatient care and the steps that would be needed to achieve this.21
Our findings have important policy implications for TB-control systems in the Russian Federation and other countries of the former Soviet Union, where similar systems exist and where TB hospitals shoulder not only the cost of extensive periods of clinical care but also a substantial burden of nonclinical social support. Improving the efficiency with which existing resources are used will require health-system norms and regulations to be reformed as they relate to planning, financing and clinical care; this will take time. National and international agencies need to focus on medium-term to long-term improvements in the health-care systems in general rather than on short-term change.
We thank Dr Elena Kiryanova and Olga Medvedeva (Orel Oblast), Dr Tatiana Petrova (Ivanovo Oblast), Dr Tatiana Somova (Vladimir Oblast), Dr Galina Gusarova and Dr Sergei Kuznetsov (Samara Oblast), Dr Irina Danilova (WHO/Moscow), Dr Lyudmila Rybka (WHO/Moscow) and Mr Vladimir Skorobogatov (Ministry of Economy, Moscow), who assisted with the collection of data and commented on the data and text.
Funding: This study was funded by an unrestricted grant from the United Kingdom Department for International Development.
Competing interests: none declared.
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8. Mawer C, Ignatenko N, Wares D, Strelis A, Golubchikova V, Yanova G, et al. Comparison of the effectiveness of WHO short-course chemotherapy and standard Russian antituberculous regimens in Tomsk, western Siberia. Lancet 2001;358:445-49.
9. Coker RJ, Dimitrova B, Drobniewski F, Samyshkin Y, Balabanova Y, Kuznetsov S, et al. Tuberculosis control in Samara Oblast, Russia: institutional and regulatory environment. Int J Tuberc Lung Dis 2003;7:920-32.
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13. Cost-effective TB control in the Russian Federation: report of the second project workshop, St Petersburg, Russian Federation, 1820 June 2002. Moscow: WHO TB control programme for the Russian Federation; 2002.
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19. Nganda B, Wang'ombe J, Floyd K. Cost and cost-effectiveness of increased community and primary care facility involvement in tuberculosis care in Machakos District, Kenya. Int J Tuberc Lung Dis 2003;7 Suppl 1:S14-20.
20. Okello D, Floyd K, Adatu F, Odeke R, Gargioni G. Cost and cost-effectiveness of community-based care in rural Uganda. Int J Tuberc Lung Dis 2003;7 Suppl 1:S72-9.
21. Improving the cost-effectiveness of TB control in the Russian Federation: the role of inpatient care. Geneva: WHO; 2005 (Policy Brief No. 2).
22. Jakubowiak W, Danilova I, Bogorodskaya E, Borisov S, Malakhov K. Reducing default rates in Russia requires support for providers and patients. In: International Union Against Tuberculosis and Lung Disease conference abstract book. Paris: IUAT LD; 2004. p. S24.
23. World Health Organization. The world health report 2003: shaping the future. Geneva: WHO; 2003.
24. Walt G. WHO's World health report 2003. BMJ 2004;328:6.
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28. Atun RA, Baeza J, Drobniewski F, Levicheva V, Coker RJ. Implementing WHO DOTS strategy in the Russian Federation: stakeholder attitudes. Health Policy 2005;74:122-32.
(Submitted: 9 October 2004 Final revised version received: 17 March 2005 Accepted: 25 July 2005)
1 Correspondence to Dr Atun (firstname.lastname@example.com).


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Peacock Décor
Peacock décor is attractive and suitable to be used as a theme especially for home interior design. Peacock decor includes outdoor ornaments and interior decorations, some of which contain genuine peacock feathers. Peacock decorative wreath is another type of peacock decoration. Peacock-inspired tablecloths and decorative vases and peacock motif can create a perfect peacock theme decoration as well.
Peacock décor is proud to be the niche theme compares to other interior design style and theme. Nevertheless there is still demand on it. As far as concern, peacock home décor is making green, probably dark green as the background color, and the room is designed with peacock murals, wall graphics as well as peacock accessories. Somehow these themes are pretty inviting and the most important point is they are supremely versatile and beautiful. The design theme is perfectly scaled to your comfort and also fulfilling the demand of your "peacock desire".
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For a formal dining room, some prefer to use peacock-inspired tablecloths and decorative vases. Place settings may also be designed with a peacock motif. For the true collector of peacock decor, porcelain dinnerware may complete the look.
Peacock designs are often found in ornamental wall decor. Asian-style fans with peacock designs may be depicted in a painting, or be hand crafted of silk and other fine materials. Fine art prints may consist of actual photographs of peacocks.
If you are going for an antique style of peacock décor, then you should select this old world peace. The item is numbered and made of hand signed limited edition of canvas. Thus to match with your peacock decorations, the artist-quality of canvas of this item is mounted on a sturdy wood stretching bar. The pavilion is made and come for peacock indeed, and they are clearly interpreting the message of your peacock décor theme. As far as concern, the item is weather resistant, water proof and scratch-free. You can wipe them with a damp cloth.


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I am a software engineer and entrepreneur living near North Carolina's Research Triangle Park where I dabble in all sorts of geekery. I am currently the Director of Engineering at MetaMetrics, Inc in Durham, NC. I also run the software consultancy Grandis Technologies.
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