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Follow-up of abnormal outpatient laboratory test results is a major patient safety concern. Electronic medical records can potentially address this concern through automated notification. We examined whether automated notifications of abnormal laboratory results (alerts) in an integrated electronic medical record resulted in timely follow-up actions.
We studied four alerts: hemoglobin A1c (HbA1c) ≥15%, positive hepatitis C antibody (HCV), prostate specific antigen (PSA) ≥15 ng/mL, and thyroid stimulating hormone (TSH) ≥ 15 mIU/L. An alert tracking system determined whether the alert was acknowledged (i.e. provider clicked on and opened the message) within two weeks of transmission; acknowledged alerts were considered read. Within 30 days of result transmission, record review and provider contact determined follow-up actions (e.g. patient contact, treatment etc.). Multivariable logistic regression models analyzed predictors for lack of timely follow-up.
Between May 2008 and December 2008, 78,158 tests (HbA1c, HCV, TSH and PSA) were performed, of which 1163 (1.48%) were transmitted as alerts; 10.2% of these (119/1163) were unacknowledged. Timely follow-up was lacking in 79 (6.8%) and was statistically not different for acknowledged and unacknowledged alerts (6.4% vs. 10.1%; p =.13). Two-hundred two alerts (17.4% of 1163) arose from unnecessarily ordered (redundant) tests. Alerts for a new versus known diagnosis were more likely to lack timely follow-up (OR: 7.35; 95% CI: 4.16-12.97) whereas alerts related to redundant tests were less likely to lack timely follow-up (OR: 0.24; 95% CI: 0.07-0.84).
Safety concerns related to timely patient follow-up remain despite automated notification of non-life threatening abnormal laboratory results in the outpatient setting.
Outpatient care is often busy and fragmented, and therefore follow-up of abnormal laboratory test results is prone to error. 1-10 Moreover, many laboratory test results in the outpatient setting may not be immediately life threatening and hence not verbally reported to the ordering provider. Therefore, missed laboratory results or delayed recognition of results leads to a significant potential for outpatient diagnostic errors, adverse events and liability claims.4;9;11-17
Most paper-based methods of communication between laboratories and ordering physicians are especially vulnerable to failures. Automated systems notifying providers about abnormal test results in integrated electronic medical record systems offer a potential solution.18 These systems usually communicate through "alerts" (computerized notifications of abnormal clinical information) transmitted directly to the provider's desktop, facilitating a rapid review of patient information.15 The integrated electronic medical record used at all Veterans Affairs (VA) facilities [the Computerized Patient Record System (CPRS)] uses the View Alert system for automated notification of abnormal laboratory test results.
Abnormal result follow-up, however, will occur only if electronic communication of test results (either through alerts or direct access of test result) is reviewed and acted upon by providers. In previous work, we found abnormal diagnostic imaging alerts may not always be reviewed by ordering practitioners, and practitioners who review them may not always act upon the transmitted results in a timely manner.19 We thus hypothesized that a similar phenomenon would exist for abnormal laboratory results. In this study we evaluated follow-up actions on abnormal diagnostic laboratory tests transmitted as high-priority automated notifications to ordering providers in an integrated electronic medical record. We also determined predictors of lack of timely follow-up of these tests.
The study was conducted in a large multispecialty ambulatory clinic of the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) and its five satellite clinics located in Southeast Texas from May 2008 to December 2008. To reliably assess follow-up actions on outpatient test alerts, we only focused on abnormal tests that generated a "high-priority" mandatory automated notification to a specified ordering provider without a concomitant verbal notification. Hence we excluded abnormal tests which:
Four tests met our inclusion criteria: hemoglobin A1c (HbA1c) at a level ≥15%, positive hepatitis C antibody (HCV), prostate specific antigen (PSA) at a level ≥15 ng/mL, and thyroid stimulating hormone (TSH) at a level ≥ 15mIU/L.
While some site specific configurations exist, many automated notification processes in CPRS are similar within the VA system. All VA health care providers receive important clinical information in a "View Alert" window of the electronic medical record screen and life-threatening findings are communicated by telephone. As their only "inbox" for all types of CPRS notifications, providers are very dependent on the View Alert system. Providers see all of their alerts when they first log on and again when they switch between patient records. New alerts remain active in the window for two weeks unless acknowledged, after which they disappear. Providers are expected to click on and open the alert to review the report (considered acknowledged), after which the alert disappears from the window. The provider also may become aware of an abnormal result without clicking on the alert if they were reviewing the medical record for other purposes, hence directly accessing the result. Primary care providers assign surrogate covering providers to receive their alerts when they are out of office.
On a daily basis we queried an Alert Tracking File of the electronic medical record to identify outpatient alerts transmitted two weeks earlier. We tracked acknowledgement status of alerts and extracted additional information such as patient identifiers, names of providers to whom the alert was sent, the date and type of laboratory study. Within a week of data query, a reviewer blinded to acknowledgement status evaluated the medical record using a standardized pre-tested data collection instrument to determine any follow-up actions such as ordering a follow-up test or referral, prescribing or changing treatment, contacting the patient, or patient refusal of additional work-up. Based upon our pilot work, we unexpectedly found a fair number of abnormal tests that were clinically determined to be unnecessary. For instance, we found some tests to be redundant based on the frequency of being ordered i.e., ordered too soon after a previous test or, in cases of hepatitis C, the ELISA was repeated unnecessarily despite a previous positive value. We used objective pre-defined explicit criteria to determine redundancy of tests (criteria specified in Table 3).20
In cases of no documented follow-up, a second study investigator evaluated the medical record to confirm the findings and contacted the provider by telephone to obtain any additional evidence of undocumented follow-up or a decision to not pursue follow-up. If we could not contact any of the patient's providers or if the provider offered no additional information about follow-up, we considered the alert to lack timely follow-up. This determination was made approximately 30 days after alert transmission. In certain cases, we determined calling the provider would be unnecessary or make no impact on outcome either because the alert offered no new information over what was previously documented, the patient was already receiving appropriate care for the condition, or the patient had died. These were considered as timely follow-up; however, categorized as "no-impact". Not all redundant tests were automatically considered to be of no impact. For example, a redundant positive HCV would still need follow-up if there was none documented for either the new or the previously positive test. Hence, follow-up actions on a redundant test did not make it any less redundant.
In addition to descriptive data, we identified two groups of alerts corresponding to the two outcome variables in our study: 1) alerts lacking electronic acknowledgment versus acknowledged alerts; 2) alerts lacking timely follow-up versus those receiving timely follow-up. We compared the distribution (as proportions) of several independent variables within each group including: ordering provider specialty (primary care, medicine subspecialties, surgery etc.), ordering provider type (physician, trainee, and allied health professionals), redundant tests and alerts signifying a new versus known diagnosis. To assess significance, chi-square test was used for categorical variables and Fisher's exact test was used when chi-square assumptions were not met. Hierarchical multivariable logistic regression models accounting for clustering of laboratory tests by providers were used to identify factors associated with the outcome variables, lack of acknowledgment and lack of timely follow-up. Covariates with p values <0.2 in univariate testing were tested as predictor variables. For multivariable testing, we combined specialties from univariate analysis into three groups: primary care, specialty care and mental health care. The models were fit using maximum likelihood estimation and odds ratios (OR) and 95% confidence intervals (CI) were calculated. We also described the frequencies and types of redundant test alerts.
Between May 2008 and December 2008, 27,092 HbA1c, 22,837 PSA, 6271 HCV and 21,958 TSH tests were performed. A total of 1163 (1.49%) results were electronically transmitted as mandatory high-priority alerts (including 29 HbA1c ≥15%, 448 PSA ≥15 ng/mL, 433 positive HCV, and 253 TSH ≥15 mIU/L.). Acknowledged alerts constituted 89.8% of the total high-priority alerts (1163). Figure 1 illustrates the outcomes of these 1163 alerts. No evidence of documented follow-up action was found in 307 (26.4%) of the alerts, however 213 (18.3% of 1163) cases were categorized as no-impact alerts. In the remaining 94 cases, we called providers to determine if for some reason follow-up had occurred but was not documented or if they had additional knowledge that would affect outcome including patient or provider decision not to pursue follow-up. Of these, 79 alerts (6.8% of total) were determined to lack timely follow-up. Two-hundred two alerts (17.4% of 1163) were considered redundant of which 159 were considered redundant based on repetition (recent or previous test).
Table 1 shows the distribution of the four laboratory tests between the acknowledged and unacknowledged groups. We also show a comparison of several independent variables between the two groups using univariate testing. Ordering provider type and specialty were significantly different across the two groups. Trainees were less likely to acknowledge alerts compared to attending/staff physicians and allied health providers (physician assistants and nurse practitioners) whereas specialty services (including mental health) were less likely to acknowledge alerts compared to primary care providers (p<.0001 for both). In a nested logistic regression model (data not shown in Table 1), the following variables were significantly associated with lack of acknowledgment of the alert, compared to attending physicians: allied health care providers as ordering providers (OR, 4.32; 95% CI: 1.21-15.52) and trainees as ordering providers (OR, 8.39, 95% CI: 2.97-23.68).
Table 2 shows the distribution of the four laboratory tests between the timely follow-up versus lack of timely follow-up groups. We show results of a univariate analysis comparing the several independent variables between the 79 alerts determined to lack timely follow-up versus 1084 that received timely follow-up: Statistically, there was no significant difference in rates of lack of timely follow-up between acknowledged and unacknowledged laboratory alerts (6.4% vs. 10.1%; p=.13). There was no significant difference in provider type but specialty differences were significant. Redundant tests were more likely to receive follow-up (p<.01). Alerts for conditions signifying new diagnoses were more likely to lack timely follow-up than alerts for pre-existing conditions (p<.0001).
In a nested logistic regression model the following were significantly associated with lack of timely follow-up (data not shown in Table 2): redundant tests (OR: 0.24; 95% CI: 0.074-0.84) with appropriately ordered tests as referent; alerts for conditions newly diagnosed i.e., diagnosis was not made until the lab was done (OR: 7.35; 95% CI: 4.16-12.97) with previously known diagnosis as referent and mental health as a specialty (OR: 2.82; 95% CI: 1.06-7.54) with primary care as referent.
In Table 3 we list criteria to determine if an alert was related to a redundant laboratory tests and their respective frequencies (total n=202). Because the VA's electronic medical record has a reminder system that prompts the ordering provider about recent orders of the same test, we further evaluated the subcategory of 159 alerts deemed redundant based on repetition. Overall, we found 28 cases where the provider ordered the test too soon after the last PSA, TSH or HbA1c and in 131 cases a second HCV ELISA test was ordered despite the presence of a previous positive test. In our institution the reminder is set to prompt the ordering provider about repetition when the new test is being ordered within 60 days from last TSH or PSA order or within 90 days from last HCV or HbA1c order. However, in only 11 (7%) of these 159 cases would the provider have received a computerized reminder prompting them of potential redundancy based on repetition.
We tested whether certain abnormal outpatient laboratory tests were followed-up in a timely manner in a multi-specialty clinic that used an integrated electronic medical record for automated notification. We found 6.8% of alerts lacked follow-up at 30 days, suggesting that follow-up of abnormal outpatient test results is not fail-safe even when providers are alerted about abnormal results through the electronic medical record. Of concern was the finding that there was lack of timely follow-up even when providers acknowledged notifications through the electronic medical record, which was comparable to when they did not acknowledge them. These findings are similar to our previous findings of follow-up on abnormal imaging alerts in the same electronic medical record suggesting that this phenomenon may exist for all alerts of abnormal diagnostic test results. Unexpectedly, we found 17% of abnormal test alerts were related to tests that we deemed redundant based on pre-determined criteria. Alerts related to these tests were less likely to lack timely follow-up.
Our findings have several significant implications for electronic medical record use in the future. One, it cannot be assumed that automated notification of abnormal lab results within an electronic medical record and the resultant acknowledgement will translate into timely actions to address these alerts. Two, notifications of abnormal redundant tests appear to be a distracting influence on providers who are missing essential alerts for newly diagnosed conditions. Three, high-reliability tracking systems to monitor potential patient harm and outcomes are needed, which also should account for follow-up actions by providers. Currently, the only way to track follow-up actions on abnormal alerts is through medical record review, a time-consuming and expensive procedure. However, individual-level tracking of follow-up actions taken in response to abnormal test result notifications could be designed within the electronic medical record. Thus, when providers process an alert, they could be provided order sets of appropriate follow-up actions in a separate "pop-up" window (such as having a nurse call the patient, setting up a return appointment, ordering a consultation or follow-up test, or an option indicating no further action is required such as when a patient is already in hospice care). These actions could be tracked through the electronic medical record and a reporting process could be created for clinic administrators to review and identify patients who may have truly "slipped through the cracks" without performing extensive record reviews. For instance, in cases of inaction on an abnormal lab at 2 weeks, the ordering provider or their surrogates could be informed.
We previously determined rate of lack of timely follow-up for abnormal imaging alerts in the same system and setting and found comparable results. Future work needs to confirm the extent to which these findings exist in other electronic medical record systems. Because there could be many potential reasons why busy providers in the front lines of health care delivery miss abnormal test results, a multidisciplinary approach is needed to address test result follow-up in future. For instance, an approach involving human computer interaction and informatics3;21 that accounts for issues related to usability, organizational characteristics, technology, work-flow and provider factors could be useful to explain why providers are unable to follow-up results despite reading them and hence improve safety in this area. 22;23
Computerized reminders have been shown to reduce redundant tests in the inpatient setting.24 However, our computerized reminder system would have prompted the ordering provider only 7% of the time. Notably, in 131 cases where a positive Hepatitis C test previously existed in the electronic medical record, the reminder logic was not set to prompt providers that they were ordering a repeat, redundant test. Current computerized reminder systems could be better designed to reduce test redundancy. For instance, these reminders are designed to prompt providers based only on the date of test order and not the date of the result of the last test. If the system had been configured as giving off a prompt based on both these dates, all 28 providers who unnecessarily ordered a PSA, Hba1c or a TSH would have received a prompt. Future work is essential to better document whether the use of information technology can reduce the enormous costs associated with redundant tests especially in the outpatient setting. 25;26
Our study had several limitations. Because of the study population (e.g. predominantly male veterans) and the unique VA setting, our findings may not be generalizable outside the VA. However, with increasing emphasis on electronic medical records the potential relevance of these findings is significant. We also lack comparable data from non-electronic medical record based systems and cannot comment on the effectiveness of automated notification compared to these systems. Due to the lack of similar tracking and documentation capabilities, such an evaluation study would be very difficult to carry out. Conversely, many factors including a large sample size, multiple clinics, large number of providers (over 500 from different specialties), rigorous methods to determine follow-up, explicit criteria for determination of redundant tests, various types of abnormal lab alerts and an advanced integrated electronic medical record used in VA facilities throughout the US, all add several unique strengths to our study.
In conclusion, current systems of mandatory automated notification of abnormal lab results do not guarantee timely follow-up on the abnormality in the outpatient setting. Additionally, provider acknowledgment of receipt of the test result also does not automatically result in timely follow-up. Multidisciplinary interventions involving human-computer interaction 3;21 and high-reliability tracking systems to monitor test result notification outcomes, such as follow-up actions by providers on these tests, are needed to alleviate these safety concerns.
Funding Source
The study was supported by an NIH K23 career development award (K23CA125585) to Dr. Singh, the VA National Center of Patient Safety, Agency for Health Care Research and Quality and in part by the Houston VA HSR&D Center of Excellence (HFP90-020).
These sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Dr. Mark and Linda Jacobson, ELCA Missionaries sponsored by Christ the King, will join us on Sunday, July 16, to share their work in Arusha, Tanzania during the worship services and through a special luncheon following the 10:30am service.
Dr. Mark is founder and director of the Arusha Lutheran Medical Center (ALMC). He and Linda developed several medical care facilities and a nursing school in conjunction with the ALMC hospital. Dr. Mark will be preaching that Sunday to talk about their work in the Arusha area. The Global Mission Team has arranged a luncheon in the Fireside Room with Dr. Mark and Linda following the 10:30 service.
RSVP for July 16 Luncheon
You are invited to the luncheon to visit with them and learn more about their mission work at the medical center and other facilities. Dr. Mark and Linda will do a slide presentation illustrating more specific details of their work. There will be a free will offering for the luncheon. Please register for the luncheon via email or calling the CtK Office at (651-633-4674) by July 12, 2017.

subset: commoncrawl


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The Highlands
Amazing North
Amazing North is a small family run tour operator that offers private tours all around North Iceland in highly modified super jeeps. Amazing North is based at Lake Myvatn but tours can also start from Akureyri.
We offer tours to Askja and Holuhraun, around Myvatn, Waterfalls Special, Northern Lights, Diamond Circle, Dettifoss Tours, gourmet tours, activity tours and Amazing Custom Tours were you decide where to go and what to do.
Our knowledge of the land, nature and nation and the fact that we really love doing what we do, make our tours both fun and educating.
We like children, they are welcome on most of our tours.
"Eagle Lake moors" is a larg green, lake-studded landscape in the highland, south of Húnaflói. The area extends for 80km or so south to the glaciers of Eiriksjokul and Langjokul. It´s a popular trout fishing venue in a wild, lonely nature. 4WD track.
Askja is a 50 km2 caldera in the Dyngjufjoll mountains. The mountains emerged in eruptions under an Ice Age glacier cap. Askja itself was formed, for the most part, at the end of the Ice Age in a major ash eruption which caused the roof of the magma chamber at the heart of the central volcano to subside.
Askja is a part of Vatnajökull National Park.
The caldera contains several volcanoes, including Víti (explosive volcanic crater). Water has accumulated in the crater, its temperature is variable - it is around 30°C on average. Víti is a popular bathing site, but if you intend taking a dip, please be aware that the sloping path is very slippery in wet weather.
The road to Askja goes from road 1 to road 901 and onto mountain road F905. Onward to F910 to Drekagil. On this route there are two fords to cross, usually small. From Drekagil goes mountain road F894 (8 km) to the car park at Vikraborgir.
Another option is to go from road 1 to mountain road F88 via Herðubreiðarlindir to Drekagil. On this road ther are fords on the rivers Grafarlandsá and Lindá that need to be crossed. The fords can be difficult or even impassable for small jeeps.
Bárðarbunga, is a stratovolcano located under Vatnajökull, Iceland's most extensive glacier. The second highest mountain in Iceland, 2,009 metres (6,591 ft) above sea level, Bárðarbunga is also part of a volcanic system that is approximately 200 kilometres (120 mi) long and 25 kilometres (16 mi) wide.
Mt. Herdubreid on the Oskjuleið Route is a 1682m high table mountain. It is the national mountain of Iceland and often called the "Queen of Icelandic mountains". There is a hiking trail to the top of the mountain, but due to loose rock it´s difficult and steep.
At the foot of Herðubreið are the Herðubreiðarlindir Springs, a spot with magnificent views and diverse natural attributes - which is probably why so many people consider this to be one of the most beautiful places in the country's wilderness. The road to Herðubreiðarlindir is only passable in summer.
The "hub" of the Kjolur Route, is a geothermal area of fumaroles, and multicoloured hot pools. There are two mountain huts with kitchen facilities and a nice hot pool just outside the hut.
The Kverkfjöll mountain range, Iceland's third highest mountain group, is a cluster of peaks formed by a large central volcano on the northern edge of the ice cap.One of Iceland's most active high-temperature geothermal areas is located in the western Kverkfjöll Mountains. Its existence is due to a fault scarp. An area of hot springs 3 km long and nearly 1km wide can be found at an altitude of 1600-1700 m.
More information about the National Park is at the webpage: www.vatnajokullnationalpark.is
An oasis in the barren land between the glacier Hofsjokull and Vatnajokull. The site is about 25km to the west of the best known highland route "Sprengisandur". On the north-western slopes of the mountain Laugafell, there are geothermal hot springs bubbling and three mountain huts open in summer, with kitchen facilities and a nice geothermal nature pool outside.
At an altitude of 469 m, Möðrudalur farm lies higher than any other Icelandic farm. The remarkable, tiny church was built by the farmer himself, Jón Stefánsson, in 1949. The tourist services here operate year-round. Various trails have been marked through the area, which prides itself on wide panoramas and amazing silence. The majestic Mount Herðubreið, looming in the near distance, has long been referred to as the Queen of Icelandic Mountains, but its image was further cultivated in the last century by a self-made painter from Möðrudalur farm, Stefán Jónsson (Stórval).


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Akali Build Guide by KST Midnight
This build has been archived and is for historical display only.
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Middle Lane
Akali Build
Starting Items
Boots of Choice
Core Items - Offensive
Core Items - Defensive
Viable Offensive Items
Viable Defensive Items
Ability Sequence
Not Updated For Current Season
The masteries shown here are not yet updated for the current season, the guide author needs to set up the new masteries. As such, they will be different than the masteries you see in-game.
|Hey guys! This is Midnight and welcome to my Akali guide. It took me some time to make this guide so I would appreciate if you guys would read this completely and give me some decent feedback!
Akali is // Explanation.
+ // Pros.
// Explanation.
- // Cons.
|// Explanation.
- Greater Mark of Magic Penetration: 7-8 bonus MPen is decent -- especially for burst/nuke mages like Akali -- so you don't wanna skip this out.
- Greater Seal of Armor: 12-13 bonus armor is pretty good. Not to mention this is the standard seals used by most champions.
- Greater Glyph of Magic Resist: 12 bonus MR is also good especially since you're probably against an AP Mid. If not, then your seals will do the thing.
- Greater Quintessence of Ability Power: Who doesn't want 14-15 free AP? It helps with your early game damage greatly.
Ignite: A really good summoner spell for a lot of reasons. Mainly for kill securing but it can also help shut down those nasty healing/regenerating maniacs. (e.g. Aatrox, Dr. Mundo, Garen, etc.)
Flash: Probably the mostly used spell in the game for high leveled summoners. This is probably because it can help in chasing/escaping or even to combo it up with Shadow Dance.
- Twin Disciplines: // Explanation.
TIP: // Tip.
- Mark of the Assassin (Q): // Explanation.
TIP: // Tip.
- Twilight Shroud (W): // Explanation.
TIP: // Tip.
- Crescent Slash (E): // Explanation.
TIP: // Tip.
- Shadow Dance (R): // Explanation.
TIP: // Tip.
Starting Items
|It gives you a slight amount of AP and HP that will surely help early game and have extra mana sustain.
|Even if you have Essence Theft, you'd still need more of these to help prolong your sustain in lane. This should be bought AFTER buying a Doran's Ring until your gold runs out.
|Take this trinket because... why not?
Boots of Choice
|This is what you'll mostly end up with since, Magic Penetration.
|I don't usually go for this but I advise you only take this if the enemy team has tons of Hard CC or even atleast your enemy mid laner has a hard CC.
Core Items - Offensive
|This item's active, makes the enemy carries cry like Amumu. Aside from the AP that it gives that'll obviously increase your damage output, but if you use Deathfire Grasp before your Charm combo, it'll literally disintegrate them in a matter of seconds.
|The whole point of this item, which is probably applicable to every AP Carry right there, is the HUGE amount of AP that it gives. Which in favor, allows you to deal tons of damage.
Core Items - Defensive
|A really decent item for AP Carries, because this saves them from sticky situations. This might be a good idea to rush when against AD Mids. Oh and this item's pretty useful when negating strong ults like Ace in the Hole.
|This item allows you to cast spells continuously without the need of the blue buff. The CDR and MR that it gives is pretty decent too.
Viable Offensive items
|There's nothing better than Void Staff when countering someone who is stacking magic resist. Get this after your core items and you'll shred them! (and their MR)
|Don't get this that often. Unless your against someone with a low range (preferably melee) which will allow you to harass them even more. Do note that you can cast up to 6 times which (obviously) grants you 6 times to trigger Lich Bane.
|I don't really take this most of the time, and I feel like it's only useful to counter champions who can regenerate quickly when they're on low health (e.g. Tryndamere, Dr. Mundo)
Viable Defensive Items
|Provides a decent amount of AP and MR. The MR is great for reducing the damage taken from the enemy AP Carry AND the aura helps you deal slightly more damage to them.
|This is very useful for Ahri, no kidding. It allows you to survive longer in lengthy fights/teamfights AND applies a slow on all your skills which will greatly benefit your entire team.
|Pretty straightforward if you ask me. Gives you extra MR, HP and a decent passive that'll help you block CCs.
|Provides decent armor and magic resist. Straightforward still -- basically you enter a fight, deal some sick amount of damage, die & revive, fight again (but be careful).
- 03/23/13 - Guide Created
- 03/23/13 - Completed Runes Chapter.
- 03/23/13 - Completed Summoner Spells Chapter.
- 03/23/13 - Completed Summary Chapter.


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Physician retention in Norway's northernmost county : How effective has the tailored internship strategy been ?. Margrete Gaski National Centre of R ural Medicine University of Tromsø – The Arctic University of Norway. Internship in Norway → 1. M arch 2014 .
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
Margrete Gaski
National Centre of Rural Medicine
University of Tromsø – The Arctic University of Norway
Medical education in Norway:
6 years
Internshipin Norway
1.5 years of training after completing medical education:
1 year in hospital
+ ½ year in primary health care
Regular internship:
Allocation by raffle
Tailored internship strategy:
Students in 10th term can sign up for internship in Finnmark,
in advance of raffle:
Intension: to recruit and retain more doctors to Finnmark
Period of tailored internship strategy:
1. August 2009 – 1. March 2014
Comparison area:
Another vulnerable area (Sogn og Fjordane county),
Comparison area
Employment today:
Figure: Share of doctors still working in and outside their "internship county" (N=388)
Doctors completing tailored internship
► 75 % chose the 4 major municipalities
Internship in primary health care 1. August 2009-1. March 2014:
* internship in primary health care 1. August 2009-1. March 2014
The tailored internship strategy is effective
- The rural background effect
Other possible explanations of the results:
What about the significance of local affiliation as a qualification?


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Join Mofos Network! Download full-length 25min 45sec movie now!
The horny guy ran into slutty Alice on the Czech streets. The crazy brunette showed him her lovely boobs right in the middle of the street... Click to watch her undressing and sucking dick for more money. Enjoy the inciting hardcore scenes!
- dtr76ed
- : 7min
- : 15 Jul 2015
- Exclusive video


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obvious shoulder peeker
obvious shoulder peeker
obvious noob is obviously a noob
obvious noob farm
random: we cant fram in ca, fgt
i dont know how to shoulder peek, but i peek a box
Camper, photoshop, asked to some1 to let him self die or hacks, LOL.
If I helped you In any way, Please press thanks.
He uses Rez Chams, so not 100% Legit.
erm is erm...
who cares
probably bug user :\
I'm glad that's banable in europe!
u lpayed with noob + afk botters


text:
Fat parents to blame for childhood obesity epidemic by over-feeding under-fives, stud
Discussion in 'News' started by Jim, 1 February 2010 Social URL.
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text:
Ms. Krista Betts receives the Senate 150 Anniversary Medal
Posted: November 20, 2017
Ms. Krista Betts educator at EWG Middle School in Rexton was recently awarded the Senate 150 Anniversary Medal from Senator Rose May Poirier. In photo l. to r. Mr. Greg Theriault, Principal of EWG Middle School, Kevin Scully mentor and former coach, Ms. Betts, Ms. Poirier, Mr. Dean Mutch, Director of Schools for ASD-N Miramichi/Rexton.
The Senate 150th Anniversary Medal commemorates the first time senators came to Ottawa to sit in Parliament, on November 6, 1867.Read more


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Fresh Aloe by Coats Aloe Aloe Soothing Masque 2 oz
Product DescriptionFresh Aloe Aloe Soothing Masque made by Coats Aloe is a deep soothing gel, based on plant extracts, and is specially formulated for gentle care of sensitive skin. The combination of Aloe and Azulene effectively soothes and calms. Ideal to use after waxing, microdermabrasion, extractions, and professional glycolic treatments. 2 oz
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The 1 per cent surcharge on 'super-rich' having income above Rs 1 crore in a year, and the 5 per cent surcharge on corporates imposed last year, has been allowed to lapse with the Finance Minister saying, "In keeping with the conventions I do not propose to make any announcements regarding changes to the tax laws." The Budget document does not give figures of the indirect tax concessions, which are valid up to June 30, 2014 and could be reviewed later. They will be notified later in the day. He justified the excise duty reliefs saying, "However, the current economic situation demands some interventions that cannot wait for the regular Budget.
In particular, the manufacturing sector needs an immediate boost." To encourage domestic production of mobile handsets, he restructured the excise duty for all categories fixing it at 6 per cent with CENVAT credit or 1 per cent without CENVAT credit. Customs duty structure on non-edible grade industrial oils and its fractions, fatty acids and fatty alcohols has been pegged at 7.5 per cent to encourage to domestic production of soaps and oleo chemicals. Similarly, a concessional customs duty of 5 per cent on capital goods imported by Bank Note Paper Mill India Pvt Ltd has been provided to encourage to indigenous production of security paper for printing currency notes.
Giving Budget estimates, the Minister said the current financial year will end on a satisfactory note with the fiscal deficit at 4.6 per cent, below the redline of 4.8 per cent, and the revenue deficit at 3.3 per cent. The fiscal deficit for 2014-15 has been pegged at 4.1 per cent, which will be below the target of 4.2 per cent set by the new fiscal consolidation path. Revenue deficit is estimated at 3 per cent. Plan expenditure for the coming fiscal has been fixed at Rs 555,322 crore, unchanged from current year, and non-Plan expenditure at Rs 12,07,892 crore, marginally higher than 2013-14. (MORE) PTI TEAM ANZ VSC SMI


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Anne Perry, that incomparable novelist of life in Victorian England, has once again surpassed herself with this 21st installment of her New York Times best-selling William Monk series. In Corridors of the Night, nurse Hester Monk and her husband, William, commander of the Thames River Police, do desperate battle with two obsessed scientists who, in the name of healing, have turned to homicide. The monomaniacal Rand brothers - Magnus, a cunning doctor, and Hamilton, a genius chemist - are utterly ruthless in their pursuit of a cure for the fatal "white-blood disease". In London's Royal Naval Hospital annex, Hester is tending one of the brothers' dying patients - wealthy Bryson Radnor - when she stumbles upon three weak, terrified young children and learns, to her horror, that they've been secretly purchased and imprisoned by the Rands for experimental purposes. But the Rand brothers are too close to a miracle cure to allow their experiments to be exposed. Before Hester can reveal the truth, she, too, becomes a prisoner. As Monk and his faithful friends - distinguished lawyer Oliver Rathbone and reformed brothel keeper Squeaky Robinson among them - scour London's grimy streets and the beautiful English countryside searching for her, Hester's time, as well as the children's, is quickly draining away. Taut with intrigue and laced with white-knuckled terror, Corridors of the Night is Anne Perry at her magnificent, unforgettable best.
©2015 Anne Perry (P)2015 Recorded Books
"Brilliantly written"
This is book 21 of the Monk series. The books are historical fiction based in the 1850's London. This book features my favorite character Hester. Hester is a nurse who was one of Nightingales' team of nurses in the Crimean War. In this story Hester is filling in for a friend on the night shift at the Greenwich Hospital. Hester discovers research is being conducted on indigent men, women and children without their knowledge. If you have read other books in this series you know that Hester's ethics are of the highest caliber. She sets out to correct the situation and suddenly disappears. Monk and all their friends are hunting for Hester.
Perry again exposes the rotten underbelly of 19th Century London, with its huge disparity between the wealthy elite and the impoverished lower working classes. (Sound familiar.) Perry is a fantastic writer of historical fiction, her characters are alive, complex; their personalities are real and the speech reflects their status and upbringing in the Victorian era. Perry provides a nuance and strong layer of moral questions which elevate the story. The story also demonstrates how far the criminal justice system has advanced with crime scene investigation and forensics. I was particularly interested in the status of nursing and medicine Perry revealed in the story; also found the information on blood transfusions fascinating. Perry not only tells a good story but educates the reader about the history of the Victorian era. David Colacci does a good job narrating the story; he is one of my favorite narrators.
"Love her writing, characters, and plot twists"
I like both. I usually consult the Kindle version for the spelling of names and places.
I love the ongoing involvement of secondary characters from previous books in addition to Hester and Monk: Rathbone, Scuff, Work, Squeaky, Sgt Orme). This doesn't really answer the question, but that would give away surprises in the plot.
I very much enjoy all the books that he has read in the Monk series. I know when I see his name as the reader that the story is in good hands. Fortunately, this series has had several top notch readers.
I can't say without giving away several plot twists. But the plot and character development are extremely well done, and there are times when I yell out loud when something unexpected happens.
This is one of my very favorite series. It's one of the few audio series that I've listened to several times. I look forward to each new release and download it as soon as it's available. I'll have to read her WWI series and resume listening to the Charlotte & Thomas Pitt series while I'm waiting for the next Monk book. Thanks, Audible, for making these Anne Perry series available!
"might be better with a different narrator"
Perry has written a melodramatic narrative that is not up to her usual standard. I began to notice excessive redundancy in the last Perry book I read (Death on Blackheath) and it is even worse in Corridors of the Night. The same information is presented and the same phrases are used over and over again within a few pages of each other. The book needs editing to remove what is essentially filler material.
There is interesting background information about treating leukemia in the 19th century and the callous way in which children were treated.
I will not buy another book narrated by David Collacci. His speech pattern emphasizes words almost randomly and it's very distracting. And annoying. And unnatural. A good narrator fades into the story and you don't even notice the voice or mannerisms. Not so in this book.
I would welcome another Thomas Monk book with better narrative flow and a different narrator.
"Not Really A Mystery"
This is basically a book about the early attempts at blood transfusion. It centers around a chemists who is attempting to save a wealthy patient who has white cell disease (I presume it was Leukemia). The doctor is using the blood of children whom he purchased from their parents.
Hester is filling in for a sick friend doing night duty at the hospital. She finds the children, being used to draw blood, who are near death due to dehydration. She save them by giving them water and beef tea. When she goes looking for the doctor who has caused this, she is kidnapped and taken with the children to a lonely farm
At the farm she not only nurses the patient but also makes sure that the children kidnapped with her are kept alive and well fed. Monk and other go looking for her and release her from her imprisonment along with the children. They explore the farm and find graves of children and adults in the orchard.
The daughter of the patient is there helping with the cleaning and cooking.
There is a trial of the doctor for kidnapping which they lose when the sick patient walks in announcing that he is cured. Trial end in chaos and doctor is hailed as a miracle worker. The the daughter is found murdered, the doctor is accused and found guilty of the murder and hung. The sick patient has a relapse and goes to the hospital for treatment and dies. I will let you enjoy finding out how he dies.
Basically this is one of the least interesting books Anne Perry has ever written. It is not really a mystery - the only thing approaching a mystery is the murder of a daughter and that is barely mentioned. The emphasis is more about the efforts to develop blood transfusion and what little mystery there is, has been pasted on top of medical story.
It was not my cup of tea. I have always enjoyed Monk less than Pitt and more or less skimmed thru the books. There was no murder, nothing to solve - hardly what I would call a mystery.
"Starting to get kind of predictable"
Another good series that I will continue to listen to for now. The plots are becoming very predictable but I still like the characters.
"awesome ending!!!"
great ending...edge of seat the whole way! I would suggest this book most definitely. Everyone got what was due!
"Loved it!"
Anne Perry is a lovely writer. You can always expect that twist in the end. And Hester could never be replaced.
"not her best"
quite slow moving, for me, & a whole lot of detail that became tedious. I didn't finish it. But I would like to put in a plug for Anne Perry's World War 1 series of five books. It is incomparable.
"Interesting story not as harrowing as some"
Either I have gotten used to Anne Perry's storytelling, or she has slacked off a little in this one. Or possibly it's the way David Colacci reads it. This was an involving tale of a medical and criminal mystery, but there were elements of it that were not entirely satisfying. Even so, it's far more entertaining than a lot of what gets published and recorded.
I will say this – Colacci's English accent is distracting, far more so than if he had just read it without trying. He's a wonderful narrator – I enjoy him in other audiobooks - but for some reason, for these, he has developed a speech pattern that features an odd emphasis and rhythm, which I think he thinks makes him sound grave and British. It doesn't. It just sounds sort of, I don't know, pompous?
I am a little puzzled why the gig wasn't given to an actual Brit. Even so, an involving mystery, with hints at future developments, which seems to be the norm for series writers these days.
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Can't stop, won't stop the beat! NBC released the first teaser on Friday, August 19, for its upcoming special Hairspray Live! and it's positively sparkling with star power.
The 30-second spot, set to debut during the network's Olympics coverage on Friday, shows the cast in costume for the first time, dressed to the nines in colorful (and, in some cases, bedazzled) suits and dresses.
"From the network that ushered in live TV musicals comes the next big thing!" a voice says over clips from The Sound of Music Live! and Peter Pan Live!, NBC's first two specials. Then, as if summoned, Harvey Fierstein appears in all his glory as Edna Turnblad, glares at the camera and says in a raspy baritone, "Excuse me?"
Brief glimpses of other characters follow: Jennifer Hudson as Motormouth Maybelle, Ariana Grande as Penny Pingleton, Martin Short as Wilbur Turnblad, Derek Hough as Corny Collins, Kristin Chenoweth as Velma Von Tussle, Dove Cameron as Amber Von Tussle, and Garrett Clayton as Link Larkin. Last, but not least, newcomer Maddie Baillio makes her debut as the show's leading lady, Tracy Turnblad.
All the while, the musical's closing number, "You Can't Stop the Beat," plays in the background.
Hairspray Live! is NBC's fourth live musical. The Sound of Music Live!, starring Carrie Underwood as Maria, premiered on December 5, 2013, followed by the Allison Williams–led Peter Pan Live! in December 2014. Most recently, Common, Amber Riley, Uzo Aduba, Ne-Yo, Mary J. Blige, Queen Latifah and Shanice Williams performed in 2015's The Wiz Live!.
Hairspray Live! airs on NBC Wednesday, December 7, at 8 p.m. ET.
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The phlebotomy training is a 160-hour course designed to prepare students for entry level competencies as phlebotomists. Phlebotomists are skilled health care professionals who have been trained to handle and process blood and other specimens for laboratory analysis using venipuncture and micro collection techniques. Upon completion of the course, students will be prepared to work as a phlebotomist and be eligible to take the ASCP certification exam.
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Manama, June 12 (IANS) Bahrain's High Criminal Court on Thursday ordered stripping of citizenship of 56 suspects in connection with a terrorist plot.
Head of the terror crimes at the public prosecution Ahmed Al Hamadi in a statement said that four people were acquitted in the case and 56 were found guilty, Xinhua reported.
The case involved a total of 61 suspects of which 33 were arrested while others charged in absentia.
"The accused have been charged sentences ranging from life term to three years in prison," he said.
It was reported that the suspects were allegedly part of a terror cell that aimed to target vital facilities including the King Fahd Causeway.
Al Hamadi said the court in its verdict ordered nationalities revoked of 56 suspects, adding they have the right to appeal.


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Web banners x5
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Experience Level: Intermediate
To create 5 banners (varying sizes) max file size flash 50K from imagery and concept supplied. Creative input welcome, however we would need to discuss requirements etc. Timescale within next two weeks.
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When I left the studio last night, I looked back at the lit signs and the murals and thought, "How cool.." I feel like I have another family now and they are very dear to me! I got in the car and checked my phone. There were 2 texts, one from Gwyn pretty much summing up what I just said with the addition that there are kids still outside talking about the evening and how cool that was, then the other was from Ryan with this photo for us… yup, Y@A is going to be really magical!
This is Ryan Parker and Paige Ryler, our featured poet last night.
More photos from the evening. This was probably the most diverse and talented group yet. We had a full band inside, duets and trios, plus all the poetry the room could handle! Once again, thanks to Ryan for his electricity and positivity!


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Sololá, town, southwestern Guatemala. It lies in the central highlands at 6,932 feet (2,113 metres) above sea level. Sololá overlooks spectacular Lake Atitlán, a few miles to the south. Cakchiquel Maya make up the majority of the town's population. Sololá is known for its Friday markets, for which hundreds of Indians come in from surrounding villages to trade or to worship at the 16th-century church, which was rebuilt after the 1902 earthquake. Coffee, fruit, grains, onions, and garlic are the principal products of the area; there is flour milling in the vicinity. Sololá lies 5 miles (8 km) north of the Inter-American Highway and 75 miles (120 km) from Guatemala City. Pop. (2002) 30,155.
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Spoken Word curators and producers, opening up new spaces for spoken word, and its links to music, performance and visual expression.
Since 2004, we have produced events featuring talents such as Mike Ladd, Ursula Rucker, Sophie Woolley, Brian Patten and Patience Agbabi. We have hosted UK Tours and events for Amiri Baraka, Jamaican dub poet and reggae artist Mutabaruka, poet and rock star Jessica Care Moore and the Guardian journalist Gary Younge. We host the acclaimed 'Liming' events which fuse spoken word with a carnival sensibility and our Patron is the acclaimed poet John Agard
Tilt is the sister company to Renaissance One. Renaissance one works with the full range of literature - offering events, touring, project management and mentoring to writers and emerging producers.


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March 20, 2017
Monday Service – For the Conversion of the Heart of the World
Jesus is here with His Heart exposed. He says: "I am your Jesus, born Incarnate."
"My brothers and sisters, My Message to you this evening is simple. It is life-giving and salvific. Live in the Truth of Holy Love in every present moment."
"Tonight, I'm imparting to you My Blessing of Divine Love."


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n-tech Research Predicts Smart Structures in the Aerospace Industry to Reach $2.1 billion by 2021
Details about the report, including a downloadable excerpt are available at: http://ntechresearch.com/market_reports/smart-structures-in-aerospace-market-opportunities-2016-20251
About the report:
Related Reports
Smart Structures in Aerospace: Market Opportunities: 2016-2025
Smart structures play a growing role in the aerospace industry in four different areas: monitoring of composites, suppression of structural vibration, noise suppression, and surface morphing. A related area is the use of photovoltaics in aircraft of various types. This report identifies where the commercial opportunities are for smart...Learn more


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PMForum named Media Partner for EVM World 2009 Conference in Florida
Media entity PMForum to provide news coverage for Earned Value Program Management Conference to be held in Naples, Florida in May 2009
According to David Pells, PMForum President and Managing Editor of the PM World Today eJournal, "The PMI College of Performance Management's annual conference is one of the biggest EVM events in the world each year. As US government civilian agencies and other organizations have embraced earned value in recent years, this conference has become a more important opportunity to study earned value, see the latest tools and meet the experts. I look forward to attending myself."
EVM World 2009 will be one of the best opportunities in the world this year to learn more about project performance management techniques, including EVM. The conference will provide training classes, presentations on current topics, access to world leaders in project performance management, networking and the latest in software and consulting services. If you are involved with earned value, performance management or governmental programs, don't miss this opportunity to learn from the best, meet world leaders in this field, and advance your careers. Participants can also earn PDUs for PMP recertification. For information or to register, visit www.pmi-cpm.org
As a PMForum media partner, the conference will receive visibility on PMForum websites including listing in PMForum's global Events Calendar, pre-event news coverage, media coverage during the event, and post-event reporting. Examples of PMForum media coverage of major events can be found at http://www.pmforum.org/
About the PMI College of Performance Management
The PMI College of Performance Management (PMI-CPM) is a knowledge-based component of the Project Management Institute (PMI®), the world's largest professional organization for project management. PMI-CPM was originally established as the Performance Management Association, but became the first college of PMI in 1999. PMI-CPM is an international, non-profit professional organization dedicated to the disciplines of project management and performance measurement. The organization assists earned value professionals and project managers with professional growth, and promotes the application of earned value management globally. PMI-CPM is a growing body of professionals dedicated to managing projects on time and on budget. Visit www.pmi-cpm.org
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About PMForum
PMForum operates www.pmforum.org, the world's oldest project management website and one of the world's best known sources of project management news and information. PMForum also publishes the monthly online PM World Today e-Journal, where articles, papers and stories by leading project management authorities and leaders from around the world can be found. Free subscriptions available at www.pmworldtoday.net.
SOURCE: PMForum, Inc.
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Alternative Titles
Synonyms: Anata no Omocha
Type: Manga
Volumes: 1
Chapters: 5
Status: Finished
Published: Not available
Genres: Shoujo
Authors: Nagae, Tomomi (Story & Art)
Serialization: None
Score: 6.661 (scored by 262 users)
1 indicates a weighted score. Please note that 'Not yet published' titles are excluded.
Ranked: #122442
2 based on the top manga page. Please note that 'R18+' titles are excluded.
Popularity: #11196
Members: 507
Favorites: 1


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Talstar P (Talstar One)
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Lisa from Ada, Michigan writes,
My Talstar from last year was ineffectual due to serious freezing last winter. I have 1/2 tank of mixed and don't now where to dump it. How and where do I dispose?
We recommend that you contact your local sanitation department for correct disposal instructions in your area as they can vary.
Answer last updated on: 08/08/2014
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Traveling Luck for Laughing Whitefish Falls Scenic Site, Michigan, United States
Where is Laughing Whitefish Falls Scenic Site?What's around Laughing Whitefish Falls Scenic Site?
Wikipedia near Laughing Whitefish Falls Scenic Site
Where to stay near Laughing Whitefish Falls Scenic Site
The timezone in Laughing Whitefish Falls Scenic Site is America/Iqaluit
Sunrise at 08:57 and Sunset at 18:09. It's Dark
Latitude. 46.3833°, Longitude. -87.0725° , Elevation. 316m
Weather near Laughing Whitefish Falls Scenic Site; Report from Marquette, Sawyer International Airport, MI 28.9km away
Weather : light snow
Temperature: -6°C / 21°F
Wind: 9.2km/h West/Northwest
Cloud: Solid Overcast at 2300ft
Weather : light snow
Temperature: -6°C / 21°F
Wind: 9.2km/h West/Northwest
Cloud: Solid Overcast at 2300ft
Satellite map around Laughing Whitefish Falls Scenic Site
Loading map of Laughing Whitefish Falls Scenic Site and it's surroudings
Geographic features & Photographs around Laughing Whitefish Falls Scenic Site, in Michigan, United States
- populated place;
- a city, town, village, or other agglomeration of buildings where people live and work.
- Sundell (4.7km)
- Dorsey (5.7km)
- Rumely (5.7km)
- Dukes (8.8km)
- Lawson (8.9km)
- Eben Junction (9.8km)
- Selma (10.1km)
- Vick (10.7km)
- New Dalton (11.3km)
- Deerton (12km)
- Skandia Station (12.3km)
- Maple Grove (12.6km)
- Ladoga (13.1km)
- Onota (13.1km)
- Chatham (13.5km)
- Sand River (14.3km)
- stream;
- a body of running water moving to a lower level in a channel on land.
- Dorsey Creek (1.8km)
- East Branch Sand River (8.8km)
- South Branch Slapneck Creek (9.3km)
- West Branch Laughing Whitefish River (10.4km)
- McMaster Creek (10.5km)
- North Branch Slapneck Creek (11km)
- Silver Creek (13.3km)
- East Branch LeVasseur Creek (14.2km)
- West Branch Nelson Creek (14.7km)
- Sand River (14.8km)
- lake;
- a large inland body of standing water.
- Silver Lake (4.4km)
- Laughing Whitefish Lake (5.2km)
- Howe Lake (6.3km)
- Dorsey Lake (6.4km)
- Laakso Lake (8.5km)
- Ginpole Lake (11.6km)
- Abraham Lake (12.8km)
- Sand Lake (13.8km)
- Local Feature;
- A Nearby feature worthy of being marked on a map..
- Laughing Whitefish Falls Scenic Site (0km)
- Rock River Canyon Wilderness (10.2km)
- Upper Peninsula Experimental Forest Headquarters (12.1km)
- Yalmar Station (12.7km)
- Michigan State University UP Research Station (13km)
- CCC Camp (14.3km)
- Chatham Corners (14.3km)
- administrative division;
- an administrative division of a country, undifferentiated as to administrative level.
- Rock River, Township of (8.4km)
- Skandia, Township of (11km)
- Onota, Township of (13km)
Accommodation around Laughing Whitefish Falls Scenic Site
- tower;
- a high conspicuous structure, typically much higher than its diameter.
- Dukes Lookout Tower (6.7km)
- Johnson Lake Lookout Tower (11.1km)
- Skandia Lookout Tower (13.6km)
- overfalls;
- an area of breaking waves caused by the meeting of currents or by waves moving against the current.
- Laughing Whitefish Falls (0.4km)
- Rock River Falls (9.3km)
- Silver Falls (12.6km)
- school;
- building(s) where instruction in one or more branches of knowledge takes place.
- Eben High School (9.8km)
- Skandia School (13.5km)
- cemetery;
- a burial place or ground.
- Deerton Cemetery (12.9km)
- Haglund Cemetery (14km)
- reservoir(s);
- an artificial pond or lake.
- James D Jeske Flooding (13.4km)
- James D Jeske Flooding (13.4km)
- park;
- an area, often of forested land, maintained as a place of beauty, or for recreation.
- Rock River Township Recreation Area (12.8km)
- Chatham Park (14.1km)
- post office;
- a public building in which mail is received, sorted and distributed.
- Sand River Post Office (historical) (14.3km)
- church;
- a building for public Christian worship.
- Emmanuel Church (13.7km)
- forest(s);
- an area dominated by tree vegetation.
- Escanaba River State Forest (9.5km)
Wikipedia entries close to
Laughing Whitefish Falls Scenic Site
- Rock River Township, Michigan city o
- Onota Township, Michigan city o
- Chatham, Michigan city o
- Laughing Whitefish River river
- Au Train, Michigan city o
- Limestone Township, Michigan city o
- Mathias Township, Michigan city o
- Sawyer International Airport airport airport
- Marquette Underwater Preserve park
- Au Train Township, Michigan city o
- Mud Lake (Michigan) lake
- Onota, Michigan city city o
- Christmas, Michigan city o
- Indian River (Michigan) river
- Gwinn, Michigan archaeologic
- Marquette, Michigan city city o
Airports close to Laughing Whitefish Falls Scenic Site
Sawyer international(MQT), Marquette, Usa (47.4km)
Menominee marinette twin co(MNM), Macon, Usa (169.6km)
Yalinga(AIG), Yalinga, Central african rep. (242.3km)
Airfields or small airports close to Laughing Whitefish Falls Scenic Site
Sawyer international, Gwinn, Usa (28.9km)
Photos provided by Panoramio are under the copyright of their owners.


text:
See E.
Melbourne, Australia, 3134
Joined on November, 2012
Gender: Male
Average Rating:
Weekends at any time
Friday after 9AM
Friday after 9AM
Lives Near:
Can Meet:
Up to 30 minutes away for no additional charge
Education2012- Current Master of Creative Media
RMIT, Australia (Melbourne)
Major in Film & TV Production
2008-2009 Bachelor of Creative Industries
Edith Cowan University, Australia (Perth)
1st Major in Film & Video
2nd Major in Advertising
2005-2007 Diploma in Mass Communication
Han Chiang College, Malaysia (Penang)
Major in Broadcasting
ExperienceHave one and half year lecture experiences in Private College, Malaysia. (Han Chiang College)
Becoming a lecture or tutor able to let me share my knowledge, creativity, fun and wisdom to the student. I believe lecturer or tutor somehow have huge influences among the student in their future career,to guide and support them what they love to do and then contribute to the society.
Won a several short film awards from my college, university and short film festivals. Had been nominee as best lecturer in Malaysia Private college.
HobbiesPhotography, Videography, Reading, Writing script
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The tutor will respond if they are available/interested.


text: I'm in the Denver area for a few weeks and I'm having a challenging time finding organic, grass-fed meat. I'm hoping to making a leg of lamb for New Year's Eve. At this point, forget locally-raised. I'll be happy with New Zealand if I have to, as long as it's organic and hopefully grass-fed. Can anyone recommend someplace that I can go to for such things out here?


text:
There's always a lot that goes into winning a championship, but one of the most important factors to Pittsburgh's Stanley Cup run last season was how well the team's unheralded young players performed. Matt Murray, Bryan Rust, and Conor Sheary all took their turn playing hero on the way to the 2016 title.
They are all regular "NHLers" now, but that doesn't mean Pittsburgh is done bringing up impactful youngsters from the AHL.
Impressively, the Penguins still have a couple young players performing at a high level in the AHL that could potentially make an impact this season; the first of which is wing Jake Guentzel. He's spent only one week in Pittsburgh, but he's already making his case for why he should permanently stay with the Penguins.
With both Patric Hornqvist and Chris Kunitz out due to injuries, coach Mike Sullivan needed to fill two spots on the top six and elected the rookie to make his debut alongside Evgeni Malkin and Phil Kessel last Monday against the Rangers.
It didn't take long for Guentzel to make an impact, as he scored a goal on his first NHL shift, and then he added a second one in the first period. His first came off the rush, where Guentzel has done some of his best work in the minors, and the second was on a loose rebound in the slot.
The 22-year-old was done scoring in that game, but not for the week. He added another goal in Saturday's game against New Jersey on another loose puck close to the net.
Now, Guentzel won't continue to score on 50 percent of his shots, but his presence should be a breath of fresh air for a team that actually hasn't seen much secondary scoring yet this season.
Despite the fact secondary scoring was a bedrock for this team last spring, Sidney Crosby and Evgeni Malkin have combined to score about 35.0 percent of the team's goals at even strength. Interestingly, that number is down 5.0 percent since Guentzel's arrival, and he's a big reason why.
The 22-year-old hasn't even played a full season at the AHL level, so it's tough to determine what type of goal production to expect from him, but in 16 games at Wilkes-Barre Scranton to begin this season, he had seven goals and 17 points.
During his final season at Nebraska-Omaha, he had 19 goals and 46 points in 36 games. Alongside Malkin and Kessel, there are reasons to believe Guentzel could score 15-20 goals.
If he continues to play on the second line, he isn't technically a secondary scorer because Guentzel would be on the top six, but he is another scoring option at even strength.
The Guentzel play from his first NHL week that stood out the most was Friday versus Minnesota. On a simple dump into the offensive zone, the 22-year-old got on his horse and bore down hard on the Wild defense, creating a loose puck.
Malkin quickly corralled it and found an open Kessel on the opposite side of the net for a score.
Those kinds of puck battle wins were just as important to Pittsburgh's formula last season as team speed. Without Hornqvist and Kunitz, there's a lot less grit in the Penguins' lineup, but Guentzel at least proved on that play, and on two of his goals, he isn't afraid to go to the dirty areas. Pittsburgh could use more of that even when Hornqvist and Kunitz return.
Now, the biggest question, though, will be if Guentzel stays, who leaves? Once healthy, Hornqvist deserves a top-line role and Kunitz should assume a spot in the top-nine.
That's much trickier, and there's no logical answer. Forwards Nick Bonino and Tom Kuhmhackl have struggled the most to score and own the worst possession numbers on the team, but they play valuable roles on the penalty kill. The same can basically be said for Eric Fehr.
That might mean Rust or fellow 2015 call-up Scott Wilson could be in line for reduced playing time. Both have scored within the last week but have just three goals each to match the production from Guentzel's first NHL week.
The solution will not be easy, but as always, this is a good problem to have. Based on Pittsburgh's recent history, this team is going to go through more injuries, and they will need all their young players at some point over the course of 60 more games.
Having said that, should Guentzel continue to score and display the same youth and energy that sparked their Stanley Cup run last season, Pittsburgh must ride his hot streak and keep him in the lineup.


text:
Introducing a brand-new podcast about "The 'Nam," Marvel Comics' Vietnam War comic book that ran from 1986-1993. Over the course of the next 100 episodes, I will cover every single issue of the series as well as some unpublished stories and other pop culture featuring the Vietnam War.
This episode features issue #1 of "The 'Nam," where Doug Murray and Michael Golden introduce us to Ed Marks, a newly drafted G.I. who is about to start serving in the Vietnam War in 1966. I'll take you through the issue's events, give my opinion/critique and will also provide some historical and cultural context for the month when the story takes place (in this case, February 1966). I'll also cover the issue's lettercolumn as well as ads. So join me as I take my first step into … The 'Nam.
You can subscribe through iTunes, 0r you can listen to the episode here: In Country, Episode 1


text:
Worcester 23 Leicester 19
Worcester, having won at high-flying Sale the previous weekend, took another illustrious scalp on Saturday, deservedly defeating Leicester, scoring three tries to one and, in the process, doing much to secure their Premiership survival.
The game was error-strewn but intense throughout, Worcester's backs looking livelier but their pack having to strain every sinew to withstand Leicester's powerful eight.
Shane Drahm, who scored 17 points in the defeat of Sale, was again influential. If his place-kicking was fallible, he compensated with his pace and vision, instigating two of Worcester's tries. Worcester also had quality performers in Thinus Delport, Marcel Garvey and scrum-half Matt Powell.
Leicester, by contrast, stuttered behind the scrum and the potentially lethal wing Tom Varndell hardly received a pass all afternoon.
Yet Worcester had suffered an instant setback. Andy Goode kicked off long to Drahm, whose kick was charged down by Harry Ellis, Brett Deacon touching down after only 21 seconds.
Goode's conversion compounded Worcester's woes, but they went diligently to work and were rewarded with two long-range penalty goals from Drahm. Goode landed a penalty for offside, but then Powell sent Greg Rawlinson over.
Goode's second penalty edged Leicester ahead at the interval, but the visitors suffered two body blows soon after the restart. First, their defence laid off Drahm, who shot through a gap to send Garvey over, Drahm converting. Four minutes later, Drahm fielded Goode's long kick in his own half and kicked ahead. Dale Rasmussen regathered and, though he was stopped just short, Miles Benjamin was on hand to touch down.
Leicester, with 33 minutes in which to overturn a 10-point deficit, exerted immense pressure but Worcester held on, limiting Leicester to two more penalty goals from Goode.
| Match details Worcester: T Delport; M Garvey, D Rasmussen, S Tuitupou, M Benjamin; S Drahm, M Powell (R Powell 67); T Windo (M Mullan 70), A Lutui, T Taumoepeau, G Rawlinson (W Bowley 70), C Gillies, T Wood (D Hickey 63), P Sanderson (capt), K Horstmann.
Tries: Rawlinson, Garvey, Benjamin.
Con/Pens: Drahm 1/2.
Sin bin: Hickey 77.
Leicester Tigers: S Vesty; T Varndell, O Smith, T Youngs, A Tuilagi; A Goode, H Ellis (F Murphy 52); B Stankovic (M Ayerza 61), M Davies (B Kayser 61), J White, M Corry (capt), L Deacon, B Deacon, B Pienaar, J Crane.
Try: Ellis.
Con: Goode.
Pens: Goode 4.
Referee: C White (Cheltenham).
Att: 10,047.


text:
With our Sixth Form being one of the newest in Bolton, we have lots of information that we want to share!
Sixth Form Overview
We are an inclusive 6th form and can offer courses at Levels 1, 2 and 3. For more details please see the "Our Courses" page. It is essential that students are on the right Level of course so that they can progress during their time in 6th form. We offer a range of choices for Level 2 and 3 to help people choose courses that will get them to where they want to be. This also includes GCSE Maths and English resits for those student who did not gain a grade C or higher at GCSE, Advanced GCE qualifications and vocational equivalents that are all coursework. If you are not sure what courses you should take we have a team of people who are able to help you to find the right courses for you based on your prior attainment and your aspirations.
Although we are growing quickly we will still be a relatively small 6th form. This will provide you with high levels of support from the 6th form team and your subject teachers. This will also provide lots of opportunities for you to involve yourself in Student Voice, leadership activities and work experience opportunities that will help support your applications to higher education, apprenticeships or employment.
The Sixth Form Day
The 6th form day starts at 9 o'clock and lesson 5 finishes at 3.10pm. Lessons are 1 hour long and each Level 2 and Level 3 subject has 5 hours of lessons per week. It is likely that 6th form students will have some study sessions on their timetable. If these are at the start or end of the school day students can come in late or go home early. If the study sessions are in the middle of the day students should remain on site and can situate themselves in a variety of places. We have lots of areas that students can work in to complement the work they do in lessons. It is recommended that all Level 3 students complete at least 4 hours of independent study per week per subject.
Dress Code
The dress code for 6th form is to dress in a manner which is appropriate to a working environment. In this working environment there will be a range of people from the Principal to Year 7 students. A list of examples of clothes that are acceptable in 6th form is found below. If you are unsure, just ask a member of the 6th form team.
- Smart jeans, skirt, leggings
- Smart t-shirt, jumper, sweatshirt
- Trainers, shoes


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Gobhi Chili
Panner Chilli
Mashroom Chilli
Gulaab Jamun
Gajar Ka Halwa
Ice Cream (Vanilla) 1 Scoop
Veg. Biryani
Veg. Pulao
Steam Rice
Mix Raita
Green Salad
Plain Dahi
Dahi Balla
Mix Achar Complimentary
Tandoori Roti
Plain Naan
Lachedar Naan
Garlic Naan
Paneer Kulcha
Onion Kulcha
Palak Naan
Tawa Roti
Makki Di Roti
Halwa Poori Sunday Special
Aloo Tikki
Papri Chat
Vegitable Pakora
Paneer Pakora
Amritsari Kulcha
Gobhi Paratha
Aloo Partha
Channa Bhatura
Two Puri With Channa
Gol Gappa
Shahi Paneer
Methi Chaman
Mix Vegetable
Dal Makhani
Punjab Dal Tadka
Palak Channa
Palak Panner
Aloo Gobhi
Matar Paneer
Kadahi Paneer
Kadahi Paneer
Malai Kofta
Jeera Aloo
Chilli Paneer
Chana Masala
Kadhi Pakora
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Calgary sweet's Sunday Halwa Puri Brunch is great. It's best value for money around $6-7 per person including tea. Buffet style set up for Sunday brunch with hot and fresh puris served at the table excellent. Their mithaie and other food like chicken qoruma and karaahi, kabas and rass mallaie is really tasty. Owner really puts his heart and soul in his product. I myself, my family, especialy my daughter likes their mithaie and other stuff.
Calgary Sweets is the best sweet shop in Canada! They have a Sunday special of puri halwa which is unbelievable. It is only for 2 hours from 11 to 1 00 and the line ups are usually very long but the wait is definately worth it. They really aren t a restaurant they mostly sell sweets but the food they do sell is amazing!. I suggest you all go check this store out.
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text:
2016 Annual Report (PDF)
Quarterly Earnings
For more information, contact:
Gross margin for the second quarter was 40.1% versus 43.6% in the second quarter of 2007 due to lower sales and the related overhead absorption. Sequentially, gross margins were fractionally down from 40.3% in the first quarter of 2008.
Net income for the second quarter of 2008 was $5.9 million, or $0.14 per diluted share, as cost reduction efforts controlled our operating expenses, compared to $11.7 million, or $0.25 per diluted share in the second quarter of 2007. Net income decreased sequentially from $6.0 million in the first quarter of 2008, but earnings per diluted share for the second quarter of 2008 were slightly higher due to shares repurchased during the quarter.
"We executed on our diversification strategy, growing non-semiconductor revenue to record levels this quarter. Sales in each of our major non-semiconductor markets demonstrated strong growth, and demand for our products in the solar market reached its highest level yet," said Dr. Hans Betz, president and chief executive officer of Advanced Energy. "Further, we believe our ability to address these emerging markets will serve us well as we develop new applications for our technology and navigate through this cycle in the semiconductor market."
Management will host a conference call today, Wednesday, July 23, 2008 at 5:00 pm Eastern Daylight Time to discuss Advanced Energy's financial results. Domestic callers may access this conference call by dialing 877-627-6511 and International callers may access the call by dialing 719-325-4916. Participants will need to provide the conference passcode 9067934. For a replay of this teleconference, please call 888-203-1112, or 719-457-0820 and enter the passcode 9067934. The replay will be available through 12:00 a.m. Eastern Daylight Time, July 25, 2008. A webcast will also be available on the Investor Relations webpage at http://ir.advanced-energy.com.
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text:
Electric City Presents
Keef Mountain, Boreas
Czar Bar
1531 Grand Blvd.
Kansas City, MO, 64108
This event is all ages
A two piece bringing the smoke filled fury.
We were kicking it hard one day and though it would be in our best interests if we jammed. We jammed, wrote songs, Jake almost died, awoke from a coma, relearned the songs, and now here we are. Smoke a couple.
Formed in winter of 2010/2011 as a 3 piece with two guitarists and a drummer.
Recorded our self titled cassette in winter of 2011 in a cold, disgusting basement where nothing was sacred and no one was safe.
Also contributed the track "Serpent Slayer" to the Troost DIY Comp, a collection of tracks by Kansas City's DIY artists, put out by XO Press.
Performed as a 2-piece from Sept 2012 to the end of the year.
Currently adding a bassist, and writing our 2-song Parabellum EP,
to be self released Spring of 2013 on cassette.
$5.00 - $7.00
Upcoming Events
Czar Bar
- Sorry, there are currently no upcoming events.


text:
Neal Riley gets more then he bargains for when he takes a leave of absence from his job to tend bar for his brother at The Swollen Pussy Club. His life is turned upside down when librarian and would-be erotic novelist Jennifer Logan, takes a job as a stripper to - "research" - her next book. Jennifer's ex-boyfriend Steve, and hostile erotic dancer Cameo, bring danger to the mix and threaten Neal and Jennifer's on-again-off-again torrid romance. Only time will tell if her research will bring more than just a great story for her book - and a happy-ever-after ending for herself?
©2008 Jodi Olson (P)2013 Jodi Olson
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text:
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Its 2017: what case can be made for the Government to be in the broadcasting business, competing unfairly with the private sector? The CBC receives advertising and cable/satellite fees-fees greater than CTV and Global but this is not enough for the greedy CBC who also receive more than a billion dollars of your tax money. And now the new Trudeau Government has promised at least an additional $150 million dollars a year to this biased, wasteful government broadcaster. As is, Taxpayers continue to be hosed to the tune of about $100,000,000 (yes, 100 MILLION) of our taxes every 30 days with no CBC accountability to taxpayers as they continue with their biased news service serving only the extreme socialists and anti-Semitics. Wake up Canada!
cbcExposed continues to hear from confidential sources inside the CBC about the "scandal du jour" and we will continue to expose their reports of waste, abuse and bias while we protect our sources. We take joy in knowing CBC-HQ visits us daily to research our stories such as the CBC Sunshine List, ongoing scandals including the epic Dr. Leenen case against The Fifth Estate (the largest libel case ever awarded against the media in Canadian history) where no one at CBC was fired and taxpayers paid the award and legal costs for this CBC Libel action. Writers and filmmakers take note-this is a Perfect story for a Documentary!
cbcExposed continues to enjoy substantial visitors coming from Universities and Colleges across Canada who use us for research in debates, exams, etc. We ask students to please join us in this mission; you have the power to make a difference! And so can private broadcasters who we know are hurting from the dwindling Advertising revenue pool and the CBC taking money from that pool while also unfairly getting Tax subsidies money. It's time to stop being silent and start speaking up.
Our cbcExposed Twitter followers and frequent visitors to cbcExposed continue to motivate us to expose CBC's abuse and waste of tax money as well as exposing their ongoing left wing bully-like news bias. Polls meanwhile show that Canadians favour selling the wasteful government owned media giant and to put our tax money to better use for all Canadians. The Liberals privatized Petro Canada and Air Canada; it's time for the Trudeau Liberals to privatize the CBC, not give them more tax money.
What does it take for real change at the CBC? You! Our blog now contains a link to the Politicians contact info for you to make your voice heard. Act now and contact your MP, the Cabinet and Prime Minister ... tell them to stop wasting your money, and ... sell the CBC.
Thursday, July 11, 2013
CBC was ordered to pay close to $1 million in damages to medical scientist Dr. Frans Leenen
Two years ago, the CBC was ordered to pay close to $1 million in damages to medical scientist Dr. Frans Leenen of the University of Ottawa because of a story that ran on the investigative program the fifth estate.
It was also told to pay another $200,000 in damages to a Toronto cardiologist, Dr. Martin Myers.
The two doctors had sued the CBC over a story about the safety of heart medication that had been broadcast in 1996.
They accused the investigative report of being malicious, unfair, defamatory and sensationalized.
The CBC said it respects the court's decision, but expressed concern that important guidelines about investigative journalism will not be reviewed by the top justices.
It's not clear how much the CBC will have to pay in the end, because the corporation is still adding up court-ordered damages, legal fees, and other costs. The total is expected to be several million dollars.
Read the full story.


text:
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text:
'Croods' Star Nicolas Cage Says The Sequel Should Be Like 'Star Trek'
The Croods may be about a family discovering new worlds in their stone-age setting — places in which whales walk on land and tigers are rainbow-colored — but the voice of head caveman Grug, Nicolas Cage, is ready to move his family on to the final frontier: Space. When he sat down with Hollywood.com (video below), Cage told us all about how the cro-magnon crew could boldly go where no caveman has gone before.
RELATED: 'Croods' Star Emma Stone Teaches Ryan Reynolds About GIFs -VIDEO
"I want to see the Croods in space so that way we have all the Jetsons and the Flintstones all rolled into one," he says. But it's not just about circumstance, The Croods employs a wild sense of imagination, taking us and the caveman clan (comprised of characters voiced by Emma Stone, Cloris Leachman, Catherine Keener, and Clark Duke) into spectacular landscapes full of exotic vegetation and even more exotic animals, something that could be even more fantastical in space. "You could take it to the next level in terms of landscapes. You could Star Trek it, there could be an entire planet that is purple," says Cage.
But Cage's character Grug might not actually be up for that kind of adventure. His mode of operation is hiding from anything new or unknown, something his daughter Eep (Stone) rebels against rather vehemently when she meets a new friend, Guy (Ryan Reynolds). Cage says Grug's anti-exploration position couldn't be further from his style.
RELATED: 'The Croods' Think Ideas Are For Weaklings – CLIP
"I don't relate to Grug, I really dont… I'd even cringe when I had lines like 'New is bad' and 'Never not be a afraid,'" he says. "I want to face the unknown, I want to go on road trips and go to wild places and explore," adds Cage with the caveat that as a father himself, he does understand the want to protect one's children.
And even with all of Grug's safety at all costs rhetoric, the film still makes sure to give even the youngest children the benefit of the doubt. "[The movie] doesn't talk down to kids, it knows how intelligent they are," says Cage.
The intelligent, creative, visually-stunning film and Cage's vocal stylings will hit movie screens March 22.
Follow Kelsea on Twitter @KelseaStahler
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Young Jack Black Is Totally Unrecognizable


text:
Late Cenozoic Volcanic Evolution Of The Northeastern Aegean Region
From Open Energy Information
OpenEI Reference LibraryAdd to library
Journal Article: Late Cenozoic Volcanic Evolution Of The Northeastern Aegean Region
AbstractLate Cenozoic volcanism occurred in an extensional tectonic regime in the northeastern Aegean Activity commenced in northeastern Greece during the Early Oligocene, and in northwestern Turkey during the Late Oligocene-Early Miocene. The beginning of activity was characterized by calc-alkaline intermediate-acid volcanism; however, alkaline intermediate-basic volcanism became dominant from the Late Miocene until the Pleistocene. This change in nature of volcanism is not related to a change of regional tectonic regime, as previously thought. Instead, we propose that the volcanic evolution reflects an increasing asthenospheric contribution, facilitated by a thinned, extended lithosphere arising from the regional extensional tectonics.
- Authors
- Gurol Seyitoglu and Barry C. Scott
- Published Journal
- Journal of Volcanology and Geothermal Research, 1992
- Not Provided
Check for DOI availability: http://crossref.org
Gurol Seyitoglu,Barry C. Scott. 1992. Late Cenozoic Volcanic Evolution Of The Northeastern Aegean Region. Journal of Volcanology and Geothermal Research. (!) .