text: A Modification of the Injury Severity Score That Both Improves Accuracy and Simplifies ScoringOsler, Turner MD; Baker, Susan P. MPH; Long, William MDJournal of Trauma-Injury Infection & Critical Care: December 1997 - Volume 43 - Issue 6 - pp 922-926 Article Abstract Author Information Article Outline Objectives: The Injury Severity Score (ISS) has served as the standard summary measure of anatomic injury for more than 20 years. Nevertheless, the ISS has an idiosyncrasy that both impairs its predictive power and complicates its calculation. We present here a simple modification of the ISS called the New Injury Severity Score (NISS), which significantly outperforms the venerable but dated ISS as a predictor of mortality. Design: Retrospective calculation of NISS and comparison of NISS with prospectively calculated ISS. Materials and Methods: The NISS is defined as the sum of the squares of the Abbreviated Injury Scale scores of each of a patient's three most severe Abbreviated Injury Scale injuries regardless of the body region in which they occur. NISS values were calculated for every patient in two large independent data sets: 3,136 patients treated during a 4-year period at the American College of Surgeons' Level I trauma center in Albuquerque, New Mexico, and 3,449 patients treated during a 4-year period at the American College of Surgeons' Level I trauma center at the Emanuel Hospital in Portland, Oregon. The power of NISS to predict mortality was then compared with previously calculated ISS values for the same patients in each of the two data sets. Measurements and Main Results: We find that NISS is not only simple to calculate but more predictive of survival as well (Albuquerque: receiver operating characteristic (ROC) ISS = 0.869, ROC NISS = 0.896, p < 0.001; Portland: ROC ISS = 0.896, ROC NISS = 0.907, p < 0.004). Moreover, NISS provides a better fit throughout its entire range of prediction (Hosmer Lemeshow statistic for Albuquerque ISS = 29.12, NISS = 8.88; Hosmer Lemeshow statistic for Portland ISS = 83.48, NISS = 19.86). Conclusion: NISS should replace ISS as the standard summary measure of human trauma. From the Department of Surgery (T.O.), University of Vermont, Burlington, Vermont; the Department of Health Policy and Management (S.P.B.), Center for Injury Research and Policy, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; and The Emanuel Hospital and Health Center, Portland, Oregon. This research was supported in part by Grant R49/CCR302486 from the Centers for Disease Control and Prevention to the Johns Hopkins Injury Prevention Center. Presented at the 10th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 15-18, 1997, Sanibel, Florida. Address for reprints: Turner Osler, MD, University of Vermont, Department of Surgery, Given Building E-309, Burlington, VT 05405; e-mail: email@example.com. Abstract MATERIALS AND METHODS RESULTS DISCUSSION CONCLUSION Acknowledgments DISCUSSION REFERENCES Cited By From the dawn of human record-keeping, humans have shown a penchant for prognostication in trauma. The great Egyptian physician and architect Imhotep published a listing of injuries and illnesses in 2000 BC, a listing that notably included an expected outcome for each injury. [1] One thousand years later, Homer carefully cataloged 147 injuries among his legendary combatants and noted an overall mortality of 77%, a mortality that climbed to 100% for heroes with head injuries. [2] The modern scientific era of injury measurement began in 1952, when De Haven proposed a rudimentary classification of human injury to facilitate his study of light plane crashes. [3] In 1971, the Committee on Automotive Safety published the Abbreviated Injury Scale (AIS). [4] This listing of 73 different injuries referred only to blunt trauma and made no attempt to provide a comprehensive listing of all possible injuries. It did assign a severity to each injury, however, on a scale from 1 (minor injury) to 6 (fatal within 24 hours). Although the AIS provided a rudimentary dictionary of possible injuries, it failed to provide a mechanism to summarize a single patient's multiple injuries into a single score. This step was take by Baker and colleagues in 1974 with the creation of the Injury Severity Score (ISS), [5] and this score has served as the standard summary measure of human trauma for more than 20 years. The ISS was defined as the sum of the squares of the single highest AIS score in each of the three most severely injured body regions. This definition was arrived at by a combination of intuition, experimentation, and opportunity. Of particular note, the use of only the single most severe AIS injury per body region was driven by the form for the study, which recorded only one injury for each body region. Despite its limitations, the ISS has proved very robust in use in trauma centers around the world. We believe that the ubiquitous nature of the ISS makes any improvement in its predictive power very worthwhile. The ISS has an idiosyncrasy that both diminishes its predictive power and complicates its calculation, however. As noted above, the ISS considers at most one injury per body region. In patients with multiple injuries confined to a single body region, the ISS thus considers only one of the injuries within that region. Moreover, in patients with injuries in several body regions, the ISS is often constrained to consider a second, perhaps less severe injury in a second body region rather than a second, more severe injury in the first body region. In effect, the ISS ignores all but the worst injury per body region, and often fails to consider more severe injuries in favor of less severe injuries that happen to occur in other body regions. The original intent of the ISS algorithm to consider the body as a whole is thus found to be in conflict with the more fundamental principle that more severe injuries should be considered over less severe injuries. We therefore tested a simple modification of the ISS, a score that we call the New Injury Severity Score (NISS). The NISS is the sum of the squares of the AIS scores of a patient's three most severe injuries, regardless of body region. Back to Top | Article Outline MATERIALS AND METHODS The American College of Surgeons' Level I trauma center in Albuquerque, New Mexico, has maintained a trauma registry since 1991. Included in this registry is a complete listing of each patient's injuries in the AIS lexicon (1990 revision). This injury data base is meticulously maintained by an Association for the Advancement of Automotive Medicinetrained designated trauma registrar, with the mandatory participation of admitting resident physicians and operating attending surgeons, frequent chart reviews, and weekly service conferences during which all injuries in every patient are reviewed and if necessary corrected. This registry contains data on 3,136 patients admitted during the 4 years from 1991 through 1994. Patients were predominantly young (92% younger than 56 years) and bluntly injured (75%). Ninety-one percent survived to hospital discharge. This data set provided a "natural laboratory" with which to test the performance of ISS and NISS. ISS was computed according to Baker et al. [5] NISS was computed as the simple sum of the squares of the three most severe AIS (1990 revision) injuries regardless of body region. A second data set consisting of 3,449 patients admitted to the Emanuel Hospital Trauma Service in Portland, Oregon, was also subjected to ISS and NISS scoring. This data set was also maintained by an Association for the Advancement of Automotive Medicine-trained designated trauma registrar. Patients in the Portland data set were also predominantly young (94% younger than 56 years) and bluntly injured (87%). The survival rate in the Portland data set was 93%. Comparisons between ISS and NISS included misclassification rates ((false positives + false negatives)/total cases), receiver operating characteristic (ROC) curve analysis, [6] and Hosmer Lemeshow goodness of fit statistics, [7] all calculated by SAS statistical software (version 6.10) Proc Logistic. [8] The ordinal measures ISS and NISS were converted into binary outcome predictions by simply selecting the value that minimized misclassifications (ISS cut points: Albuquerque = 44, Portland = 46.5; NISS cut points: Albuquerque = 54, Portland = 55.5). Misclassifications were then defined as the sum of survivors with scores above the cut point and nonsurvivors with scores below the cut point. The ROC statistic is a general measure of the power of a test to separate two mutually exclusive subpopulations. It is defined as the area under a graph of sensitivity x 1 minus specificity. A ROC value of 1 corresponds to a test that perfectly separates two subpopulations, whereas a ROC value of 0.5 corresponds to a perfectly useless test that performs no better than chance. The Hosmer Lemeshow statistic is a measure of how well calibrated a model is. It is calculated by dividing the data into deciles by NISS and then comparing the predicted number of nonsurvivors with the actual number of nonsurvivors in each decile. The result is evaluated by a chi squared test. A high (>0.05) p value implies that there is no reason to believe that a model is not well calibrated, i.e., that the model is a good one. p values and 95% confidence intervals for misclassification rates and ROC statistics were calculated using a paired resampling approach [9] implemented in Paradox Application Language (Borland International, Scotts Valley, Calif) on a desktop IBM-compatible personal computer. Back to Top | Article Outline RESULTS The majority of patients (59% of the Albuquerque data set and 60% of the Portland data set) had NISS values that were different from their ISS values. These NISS values were uniformly higher than the corresponding ISS values. This result is expected, because the ISS picks and chooses among a given patient's AIS injuries based on body region, whereas the NISS simply considers a patient's three most severe AIS injuries regardless of body region. The median ISS and NISS values for the Albuquerque data set were 11 and 17, respectively. The median ISS and NISS values for the Portland data set were 9 and 11, respectively, indicating that injuries in Portland were somewhat less severe on average. When we examine the data set graphically (Albuquerque, Figure 1; Portland, Figure 2) we see that NISS better separates survivors from nonsurvivors. This impression is confirmed by the doubling of the separation of the median values for survivors and fatalities by NISS over ISS in both data sets. (Albuquerque ISS median fatalities - ISS median survivors = 19; Albuquerque NISS median fatalities - NISS median survivors = 36; Portland ISS median fatalities - median survivors = 18; Portland NISS median fatalities - median survivors = 34) (Figure 1 and Figure 2). Figure 1 Figure 2 A formal statistical analysis confirms the superior predictive power of NISS over ISS. Virtually every measure examined was statistically significantly better for NISS than for ISS: misclassification rates, ROC curve areas, and Hosmer Lemeshow statistics (Table 1). Only the misclassification rate in the Portland data set is not statistically significantly improved under NISS. Table 1 Back to Top | Article Outline DISCUSSION Although the ISS has served as the standard summary measure of human trauma for more than two decades, its division of the human body into regions seems unnatural and now appears to be unnecessary. The use of only a single injury per body region in the calculation of the original ISS [5] was simply the result of the design of Baker's original study and has never been tested or validated. Although the ISS's ability to consider as many as three different injuries in its final outcome score represented a considerable advance over the earlier practice of summarizing a patient's injuries based on the single worst injury (maximum AIS), today's modern trauma data bases routinely record all of the injuries that a patient sustains. It seemed likely to us that a more modern summary measure of trauma that could take advantage of this richer description of patients' injuries would more accurately predict outcome than the original ISS. Two problems follow from the dependence of the ISS on body regions. First, the ISS often leaves some injuries out of the scoring process altogether, such as when a patient sustains multiple injuries to a single body region, in which case only the single worst injury contributes to the ISS. A second, related problem is that the ISS often ignores some more severe injuries in one body region in favor of less severe injuries to some other body region or regions, such as when multiple body regions are injured. NISS, by contrast, simply considers the three most severe injuries that a patient has sustained and thus avoids both of these shortcomings of the traditional ISS. An example may make the differences between ISS and NISS scoring more clear. Suppose a patient involved in a motor vehicle crash sustains a steering wheel compression injury to the abdomen. At laparotomy, a small bowel perforation (AIS score = 3) is first discovered. The ISS is now 9, as is the NISS. Next, a moderate liver laceration is discovered (AIS score = 3). The ISS remains 9, but the NISS increases to 18. Next, a moderate pancreatic laceration with duct involvement is encountered (AIS score = 3). The ISS still remains 9, whereas the NISS increases again to 27. A bladder perforation is next discovered (AIS score = 4). The ISS now increases to 16, whereas the NISS continues its climb to 34. Next, a bimalleolar fibular fracture (AIS score = 2) is discovered. The ISS increases to 20, but the NISS remains unchanged at 34. The NISS thus behaves in a way that is more consistent with a trauma surgeon's instincts than does the ISS: as injuries increase in number, death becomes more likely, even if these injuries are accumulating in a single body region. Furthermore, adding a trivial injury (fibular fracture) to a different body region should not significantly affect the likelihood of death. The price for the traditional ISS ignoring injuries or substituting less severe injuries in calculating its final outcome measure is, not surprisingly, a loss of predictive power. Additionally, this loss of predictive power is accompanied by substantially increased scoring complexity; not only must every injury be assigned to a body region before scoring, but these six scoring regions do not correspond to the nine anatomic body regions of the AIS lexicon. This complexity increases the likelihood of scoring errors and hinders "on the fly" mental estimation of ISS. The NISS prediction of mortality is based solely on the anatomic information specified by a patient's AIS injury descriptors. Its predictive accuracy can be increased by the addition of other types of information to the scoring process, such as patient reserve (usually specified by the surrogate of patient age) and physiologic derangement (usually specified as the Revised Trauma Score). [10] We have chosen to keep these three types of information separate, but they can be easily combined using a variety of statistical techniques, such as logistic regression or tree analysis, should a single predictor be called for. Other outcome prediction approaches (American College of Surgeons' Committee on Trauma (ASCOT)) [11] combine anatomic and physiologic data at the outset, but we believe that this is an error. Not only is the contribution of injury per se disguised, but the calculation of ASCOT is itself so complicated that a computer is required. We believe that part of the value of an injury summary score is that it can be calculated by clinicians. The popularity of ISS has stemmed in some measure from its ease of computation, relying as it does on the information contained in the AIS severity descriptors rather than on complex computation. NISS inherits and extends this advantage, relying as it does on the AIS severities for each injury, but simplifies the actual calculation by eliminating the need to consider body region. This is a retrospective, nonconcurrent cohort study that compares NISS with ISS values calculated at the time of discharge. A concurrent cohort study would presumably yield identical results, but would be of interest to further verify our results. Although the ISS has seen stalwart service as the de facto standard of trauma scoring, it was developed 20 years ago in an environment very different from the information-rich, computer-dominated world of today. NISS is better suited to take advantage of the richer, more complete injury descriptions now available in trauma systems. Because NISS is simpler to calculate and better predicts outcome, it should replace ISS. Back to Top | Article Outline CONCLUSION NISS better predicts survival and is easier to calculate than ISS. This difference is highly statistically significant and practically important, because NISS better separates survivors from nonsurvivors. We recommend that NISS replace ISS as the standard summary measure of human trauma. Back to Top | Article Outline Acknowledgments The authors thank the following reviewers who read the manuscript in draft form and improved it greatly with their comments and observations: Edward Bedrick, Guohua Li, Ellen MacKenzie, and Brian O'Neill. Back to Top | Article Outline DISCUSSION Dr. Carl A. Soderstrom (Baltimore, Maryland): Dr. Reath, Dr. Poole, members, and guests. In the beginning was AIS, which begat maximum AIS, which begat ISS. And their creators found it was good, but not perfect. Then there was TS (Trauma Score), RTS (Revised Trauma Score), TRISS (Trauma and Injury Severity Score), PATI (Penetrating Abdominal Trauma Index), ASCOT, and very recently a hierarchical network model using ICD-9 (International Classification of Diseases, Ninth Revision) codes. Now we add NISS to the alphabet soup. ISS is an old friend, a criterion standard that has been with us for more than 20 years. This methodology, which allowed us to begin to compare apples to apples, has three obvious inherent pitfalls. First, it was designed for blunt trauma. Despite attempts to improve the penetrating trauma scoring, many feel that it is still limited in this regard. Second, it does not take into account physiologic variables, hence TRISS. Third, as has been well articulated today, the ISS methodology takes into account only one injury per body region; hence, the patient's overall anatomic injury severity is often underestimated. The authors present a simple yet elegant modification of the ISS to overcome the third pitfall. By taking into account the patient's three most severe injuries, they were able to better discriminate patients who will die from those who will survive. This is demonstrated by almost a doubling of median scores among survivors and nonsurvivors in each group and 12-point increases in ROC-generated cut points that predict survival. The ISS is designed to evaluate live-or-die outcome from blunt trauma patients. The authors have a combined data base of 6,585 patients, including more than 1,200 patients who were 19% injured as a result of penetrating trauma. A much larger cohort, such as that of the Major Trauma Outcome Study, with almost 200,000 subjects, or even larger ones employed in other assessments, is needed to investigate the study question. Using two, T-W-O and T-O-O, small data bases, one with 3,000 blunt trauma victims and the other with fewer than 2,400, can make analysis dependent on individual cells with small numerators and denominators, resulting in obvious consequences. Questions: Did you analyze your data bases only for blunt trauma? If so, what were the results? If not, why not? Do you have any plans to tap into larger data sets to verify these preliminary findings? There were almost twice as many penetrating trauma victims in the Albuquerque group than in the Portland group. In the Albuquerque group, there was a significantly higher misclassification rate using the ISS compared with the NISS; however, there was no significant difference in ISS and NISS misclassification in the Portland group with its greater percentage of blunt trauma victims. Furthermore, the Hosmer Lemeshow statistics for each data set conflict with this misclassification trend and therefore are counterintuitive. Questions: How do you explain these findings? Do they suggest that the new methodology is not much of an improvement over the older one? Abbreviated injury severity scoring and NISS calculation, which is needed for calculation of TRISS, generally required trauma center registrars. Thus, if adopted, NISS would be limited to trauma center settings unless the MacKenzie ICD-9-to-AIS conversion is used, which is recommended only for very large sample sizes. Hence, studying all hospitalized trauma patients, the vast majority of whom are not treated in trauma centers, is not possible unless the MacKenzie conversion is used. As noted, ISS and NISS do not take into account physiologic variables. Furthermore, it is by no means certain that a quadratic equation is the best way to take into account the effects of multiple injuries. Questions: Considering these observations, why should we embrace the NISS? Shouldn't we focus our efforts elsewhere? In any case, six days haven't passed, it is not time to rest. My apologies to King James. I congratulate the authors on a much-needed research effort, and I thank the Association for the privilege of the floor. Dr. Turner Osler (closing): Thank you for your constructive suggestions and criticisms. We too noticed that we had more penetrating trauma in Albuquerque and that the NISS seemed to offer greater improvement in lowering misclassification. And that is not surprising, because with penetrating trauma, injuries tend to be clustered. And the whole idea behind this is that you allow multiple injuries in a single body region to contribute to the final score. So it is not surprising that it works better in the penetrating arena. NISS, however, also seems to work better in the blunt arena. We did separate out the blunt trauma, and the improvements are about half what they are for penetrating trauma, which seems, intuitively, just about right. I agree that there is a problem in requiring AIS scoring for every trauma patient in the country because not every hospital has the zeal or the financial resources to hire a trauma nurse coordinator to look after a trauma registry. They are extremely expensive, which is why we also suggested, in our previous paper, the business of simply using the ICD-9 data from the hospital information system. I do not think that there is ever going to be a best scoring system, or at least there will not be a final scoring system. But there is no question that the Injury Severity Score can easily be improved upon by simply calculating it based on the three worst injuries regardless of body region. I think that as long as we persist in using the Injury Severity Score, we should move right along to the New Injury Severity Score and obtain those benefits right away. Thank you. Back to Top | Article Outline REFERENCES1. Majno G. The Healing Hand: Man and Wound in the Ancient World. 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PDF (349) Journal of Trauma and Acute Care SurgeryThe New Injury Severity Score: A More Accurate Predictor of In-Hospital Mortality than the Injury Severity ScoreLavoie, A; Moore, L; LeSage, N; Liberman, M; Sampalis, JSJournal of Trauma and Acute Care Surgery, 56(6): 1312-1320. PDF (598) Journal of Trauma and Acute Care SurgeryDifferences in Mortality Predictions Between Injury Severity Score Triplets: A Significant FlawRussell, R; Halcomb, E; Caldwell, E; Sugrue, MJournal of Trauma and Acute Care Surgery, 56(6): 1321-1324. 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PDF (4158) Journal of Trauma and Acute Care SurgeryRisk Adjustment for Injured Patients Using Administrative DataClark, DE; Winchell, RJJournal of Trauma and Acute Care Surgery, 57(1): 130-140. PDF (409) Journal of Trauma and Acute Care SurgeryOutcome and Quality of Life 5 Years After Major TraumaSluys, K; Häggmark, T; Iselius, LJournal of Trauma and Acute Care Surgery, 59(1): 223-232. PDF (364) Journal of Trauma and Acute Care SurgeryAbbreviated Injury Scale Unification: The Case for a Unified Injury System for Global UseGarthe, E; States, J; Mango, NJournal of Trauma and Acute Care Surgery, 47(2): 309-323. Journal of Trauma and Acute Care SurgeryComparing Measures of Injury Severity for Use with Large DatabasesStephenson, SC; Langley, JD; Civil, IDJournal of Trauma and Acute Care Surgery, 53(2): 326-332. PDF (735) Journal of Trauma and Acute Care SurgeryRisk of Death among Cases Attending South Australian Major Trauma Services after Severe Trauma: The First 4 Years of Operation of a State Trauma SystemBrennan, PW; Everest, ER; Griggs, WM; Slater, A; Carter, L; Lee, C; Semmens, JK; Wood, DJ; Nguyen, AT; Owen, DL; Pilkington, P; Roder, DM; Somers, RLJournal of Trauma and Acute Care Surgery, 53(2): 333-339. PDF (678) Journal of Trauma and Acute Care SurgeryComparison of Alternative Methods for Assessing Injury Severity Based on Anatomic DescriptorsSacco, WJ; MacKenzie, EJ; Champion, HR; Davis, EG; Buckman, RFJournal of Trauma and Acute Care Surgery, 47(3): 441-446. Journal of Trauma and Acute Care SurgeryA New Approach to Outcome Prediction in Trauma: A Comparison With the TRISS ModelBouamra, O; Wrotchford, A; Hollis, S; Vail, A; Woodford, M; Lecky, FJournal of Trauma and Acute Care Surgery, 61(3): 701-710.10.1097/01.ta.0000197175.91116.10 PDF (855) | CrossRef Journal of Trauma and Acute Care SurgeryDifferent AIS Triplets: Different Mortality Predictions in Identical ISS and NISSAharonson-Daniel, L; Giveon, A; Stein, M; Peleg, KJournal of Trauma and Acute Care Surgery, 61(3): 711-717.10.1097/01.ta.0000235294.32326.e6 PDF (367) | CrossRef Journal of Trauma and Acute Care SurgeryCorrelation Between IL-6 Levels and the Systemic Inflammatory Response Score: Can an IL-6 Cutoff Predict a SIRS State?Giannoudis, PV; Harwood, PJ; Loughenbury, P; Van Griensven, M; Krettek, C; Pape, HJournal of Trauma and Acute Care Surgery, 65(3): 646-652.10.1097/TA.0b013e3181820d48 PDF (350) | CrossRef Journal of Trauma and Acute Care SurgeryLow-Impact Falls: Demands on a System of Trauma Management, Prediction of Outcome, and Influence of ComorbiditiesKennedy, RL; Grant, PT; Blackwell, DJournal of Trauma and Acute Care Surgery, 51(4): 717-724. PDF (115) Journal of Trauma and Acute Care SurgeryBase Deficit-Based Predictive Modeling of Outcome in Trauma Patients Admitted to Intensive Care Units in Dutch Trauma CentersKroezen, F; Bijlsma, TS; Liem, MS; Meeuwis, JD; Leenen, LPJournal of Trauma and Acute Care Surgery, 63(4): 908-913.10.1097/TA.0b013e318151ff22 PDF (388) | CrossRef Journal of Trauma and Acute Care SurgeryInjuries From Roadside Improvised Explosive DevicesRamasamy, A; Harrisson, SE; Clasper, JC; Stewart, MPJournal of Trauma and Acute Care Surgery, 65(4): 910-914.10.1097/TA.0b013e3181848cf6 PDF (342) | CrossRef Journal of Trauma and Acute Care SurgeryLate Outcomes of Trauma Patients With Infections During Index HospitalizationCzaja, AS; Rivara, FP; Wang, J; Koepsell, T; Nathens, AB; Jurkovich, GJ; Mackenzie, EJournal of Trauma and Acute Care Surgery, 67(4): 805-814.10.1097/TA.0b013e318185e1fb PDF (495) | CrossRef Journal of Trauma and Acute Care SurgeryA Fresh Set of Survival Risk Ratios Derived from Incidents in the National Trauma Data Bank from which the ICISS May Be CalculatedMeredith, JW; Kilgo, PD; Osler, TJournal of Trauma and Acute Care Surgery, 55(5): 924-932. PDF (342) Journal of Trauma and Acute Care SurgeryIndependently Derived Survival Risk Ratios Yield Better Estimates of Survival than Traditional Survival Risk Ratios When Using the ICISSMeredith, JW; Kilgo, PD; Osler, TMJournal of Trauma and Acute Care Surgery, 55(5): 933-938. PDF (225) Journal of Trauma and Acute Care SurgeryHead Injury and Outcome—What Influence do Concomitant Injuries Have?Lefering, R; Paffrath, T; Linker, R; Bouillon, B; Neugebauer, EA; Deutsche Gesellschaft für Unfallchirurgie/German Society for Trauma Surgery, Journal of Trauma and Acute Care Surgery, 65(5): 1036-1044.10.1097/TA.0b013e318184ee48 PDF (1319) | CrossRef Journal of Trauma and Acute Care SurgeryPrevalence and Predictors of Sexual Dysfunction 12 Months After Major Trauma: A National StudySorensen, MD; Wessells, H; Rivara, FP; Zonies, DH; Jurkovich, GJ; Wang, J; MacKenzie, EJJournal of Trauma and Acute Care Surgery, 65(5): 1045-1053.10.1097/TA.0b013e3181896192 PDF (454) | CrossRef Journal of Trauma and Acute Care SurgeryWhat's the Score?Baue, AEJournal of Trauma and Acute Care Surgery, 65(5): 1174-1179.10.1097/TA.0b013e318188e89b PDF (232) | CrossRef Journal of Trauma and Acute Care SurgeryFactors Predicting Serious Injury in Rock-Climbing and Non–Rock-Climbing FallsLocker, T; Chan, D; Cross, SJournal of Trauma and Acute Care Surgery, 57(6): 1321-1323.10.1097/01.TA.0000130609.23499.2F PDF (136) | CrossRef Journal of Trauma and Acute Care SurgeryThe Mind Does Matter: Psychological and Physical Recovery After Musculoskeletal TraumaSutherland, AG; Alexander, DA; Hutchison, JDJournal of Trauma and Acute Care Surgery, 61(6): 1408-1414.10.1097/01.ta.0000197562.34651.df PDF (341) | CrossRef Journal of Trauma and Acute Care SurgeryThe National Study on Costs and Outcomes of TraumaMacKenzie, EJ; Rivara, FP; Jurkovich, GJ; Nathens, AB; Frey, KP; Egleston, BL; Salkever, DS; Weir, S; Scharfstein, DOJournal of Trauma and Acute Care Surgery, 63(6): S54-S67.10.1097/TA.0b013e31815acb09 PDF (527) | CrossRef Pediatric Emergency CareRisk of Pediatric Back-over Injuries in Residential Driveways by Vehicle TypeDean, J; Pinkney, KA; Smith, A; Mann, N; Mower, GD; Davis, APediatric Emergency Care, 22(6): 402-407.10.1097/01.pec.0000221337.29551.00 PDF (120) | CrossRef Journal of Pediatric OrthopaedicsThe Health-Related Quality of Life of Children With an Extremity Fracture: A One-Year Follow-up StudyDing, R; McCarthy, ML; Houseknecht, E; Ziegfeld, S; Knight, VM; Korehbandi, P; Parnell, D; Klotz, P; CHAT Study Group, Journal of Pediatric Orthopaedics, 26(2): 157-163.10.1097/01.bpo.0000218521.98244.7e PDF (177) | CrossRef Back to Top | Article Outline Keywords: Mortality, Prediction of survival, Injury Severity Score, New Injury Severity Score, NISS, ROC analysis. © Williams & Wilkins 1997. All Rights Reserved.


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For a glimpse of where craft beer in American restaurants may be headed, scan the beer list of Alla Spina, the new Philadelphia dining spot that showcases distinctive, hard-to-find Italian craft beers and rustic Italian-style bar food.
The month-old gastropub is surprising patrons with Italian brews that show complex nuances of myrrh, juniper berries, citrus, ginger and absinthe. The fourth restaurant in Philadelphia for chef-owner Marc Vetri and his partners, Alla Spina means "f
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COWPENS, SC-- Kenneth Gold Bolin, Sr., 67, of Cowpens, died Tuesday, October 16, 2007, at his home. Born September 1, 1940, in Cherokee County, SC, he was the son of the late Ambers Lee and Elizabeth Gold Bolin of Blacksburg, SC. Mr. Bolin was an employee of Hoechst-Celanese Corporation's Spartanburg plant from its beginning as Manufacturing Manager and later Johns-Manville Corporation as Plant Manager. In his final years of work, he served as Vice-President at Teijin Monofilament U.S., Inc., in Spartanburg. He was active in community affairs and his contributions include Spartanburg School District 3 School Board member, P.T.A. President, Broome High School Band Booster Club President, United Way Chairman, Junior Achievement Chairman, Leadership Spartanburg, Little League coach, Cub Scouts Pack Leader, and served on numerous civic and church committees. He was a U.S. Navy Veteran, an avid golfer, and enjoyed fishing.
Survivors include his wife of 45 years, Peggy M. Bolin; two sons, Kenneth G. Bolin, Jr. and his wife Lesa, and Steven F. Bolin, all of Cowpens; a brother, John F. Bolin and his wife Patricia of Columbia; a sister, Beth M. Waddell of Spartanburg; and three beloved grandsons, Andrew Bolin, Jacob Bolin, and Jonathan Bolin, all of Cowpens.
A Celebration of Life visitation will be held from 5:30-8:00 PM Thursday, October 18, 2007, at Floyd's Greenlawn Chapel.
In lieu of flowers, memorials may be made to Cannon's Campground Ruritan Club, 1319 Old Converse Road, Spartanburg, SC 29307; to Epworth Children's Home, PO Box 50466, Columbia, SC 29250; or to Connie Maxwell Children's Home, PO Box 1178, Greenwood, SC 29648.
The family is at the home.
An online guest register is available at www.floydmortuary.com.
Floyd's Greenlawn Chapel


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ÂShell-shocked' D.C. United breaks down in loss to expansion Philadelphia, falls to 0-3
PHILADELPHIA -- D.C. United's perplexing season had finally begun to turn Saturday, a two-goal deficit erased in a five-minute span of the second half on a superb strike by Santino Quaranta and a fortuitous goal by Jaime Moreno.
"When we got the second [goal]," Coach Curt Onalfo said, "I thought we were going to win the game and, at a minimum, walk out of here with a point" for a tie.
Instead, United broke down again and was saddled with a 3-2 loss to the expansion Philadelphia Union, which made its home debut at Lincoln Financial Field in front of a crowd of 34,780 people, including Vice President Biden.
After United defender Dejan Jakovic received a red card, Sebastien Le Toux completed a hat trick with a 22-yard free kick in the 80th minute.
Two weeks ago United (0-3) was undone by early goals. Last week New England did the damage in the final 10 minutes. On this evening, problems at the beginning and end led to the downfall.
Le Toux scored in the fourth and 40th minutes for Philadelphia (1-1), which had a poor showing in its inaugural match and didn't appear to have the attacking personnel to endanger United.
"We talked all week about matching their intensity, but we were shell-shocked a little bit," Quaranta said. "We came out and didn't play any kind of soccer. I didn't think they were playing like Barcelona, you know?"
United lacked invention and ideas and was starved for possession. Its defensive effort was just as worrisome.
On the first goal, United goalkeeper Troy Perkins remained rooted on his goal line as Roger Torres served a cross to the six-yard box, allowing the unmarked Le Toux to snap in a header.
"That whole game is my fault," Perkins said. "The first goal I am too deep on my line, can't get to it."
The situation worsened in the 15th minute when Juan Manuel Pena departed with a strained hamstring. Le Toux doubled the lead by timing his run perfectly to collect Alejandro Moreno's exquisite long ball in stride and place a low, 18-yard shot into the far corner.
Incapable of creating anything in the run of play, United produced its best threat of the half off a set piece -- Danny Allsopp's header that missed the near side off Christian Castillo's corner kick.


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Packaging Design for a Cause
Get into "GET OUT"
The Lego Batman Movie - Hollywood may have finally gotten it right!
And Now...Graphic Design!
Over the next few weeks, I will be updating the website to reflect graybayne film/media's design capabilities. Ever the perfectionist, I was reluctant to include graphic design as an official service. But after several years of freelance and pro bono work honing my craft, not to mention a three year stint at the Art Center College of Design, where I availed myself of every design course I could pack into a course load, I am now comfortable adding graphic designer to my list of titles. If you have any design needs, problems, or branding issues that you'd like me to address, don't be afraid to reach out!
Over and out.


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Imphal, Oct.5 : Not many of us may know Manipur, the state popularly known for its regional languages, also has a Sanskrit college for the last six decades.
Dwijamani Dev Sharma Sanskrit Mahaviyalaya at Sangaipat has been in existence since 1947 in Imphal. Students can pursue graduate and post graduate degrees from this institute. Recently, it celebrated its diamond jubilee here.
Students irrespective of age can enroll at this college for studies in Sanskrit, a language described to be mother of all languages.
The association of Manipur with Sanskrit shows the similarity of cultural and historical past, which the state shares with rest of the country.
Rajshree Devi, one Sanskrit student, said: "Every person in this world knows that Sanskrit is mother of all the languages. We know that all the languages- whether it's Manipuri or Hindi or any other finds its origin from there only. This fact inspired me to learn this language."
Sishiliya Mangang, another student, said: "Though we are basically Manipuri but we are also an Indian, whose national language is Hindi. That's why we read Hindi. When I started learning Hindi, I realised that Sanskrit is very near to Hindi. I mean very similar to Hindi. A feeling, a desire originated in my heart to learn Sanskrit. I felt that if I studied Sanskrit, my study of Hindi would be completed in actual sense."
This educational institute showcases the desire among Manipuris towards learning ancient languages and relate themselves to the culture.
Till date, the institute has produced 130 graduates and 100 masters. Although, the numbers are not great but they are significant as most youngsters today prefer learning modern languages.
Besides, Manipur Sanskrit Parishad (council), one of the oldest organizations in Manipur, is also contributing to the propagation of Sanskrit, also celebrated its diamond jubilee.
Jhalajit Singh, President, Manipur Sanskrit Parishad, said: "Primary purpose is to propagate Sanskrit throughout the India, particularly in Manipur. Sanskrit is one of the most important languages of the world, in classical time. The Latin, Greek and Sanskrit all three are the classical language and Sanskrit is most important among them."
The body was established long back in year 1948, to propagate the language among the locals as well as in rest of the country. By L.C.K Singh


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Hello, I am a college student. I just obtained my Associates of Computer Science degree and am working on my Bachelors of Computer Science degree. I enjoy gaming (mostly Minecraft, Cubeland, Don't Starve, and occasionally Runescape for shits and giggles), exercising, really shitty programming, and watching anime. Basically one can think of me as that nerd that does not talk much and is essentially an awkward mess 80-90% of the time, but would help you with homework in a heartbeat. I hope to get a job as a programmer out of college.Interests RPG gaming, ty programming, anime, and foreign flicks
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For Ten Gun Design, Edmonds is the place
In November, during an event intended to attract businesses to Edmonds, a number of civic and business leaders made their cases for the city. But no one made more of an impression than a rapidly expanding company that has quietly – up until now – already been enticing workers to the city at a furious pace.
That company, Ten Gun Design, wasn't on the list of speakers for "Get to Know Edmonds." But heads swiveled and fixed on its CEO, Janelle Milodragovich, when she stood up as an audience member and explained why the company chose Edmonds.
Last week, Milodragovich gave her pitch once more – this time as a featured speaker at the annual State of the City address hosted by Mayor Dave Earling before a full house at the Edmonds Theater.
It's obvious why the city wanted to shine a spotlight on Milodragovich.
"Ten Gun's story is precisely the kind of case that we hope for here in Edmonds," Economic Development Director Patrick Doherty said. "That is, for firms located in Seattle or other congested and high-priced locations to discover the business case for relocating to Edmonds."
Milodragovich seems the perfect spokesperson for her company – and for Edmonds. The 39-year-old is energetic, easy to smile, easy to laugh, and has unrestrained praise for the city. She spoke recently from the company's future space at 120 Third Ave. South in an office filled with boxes, frequently raising her voice to be heard over a carpenter's saw.
"We've attracted many employees who lived in Edmonds already," Milodragovich said. "Really stellar people. They say, wait. You guys are down the street? I wouldn't have to commute, and I could do what I'm already doing? Done. There's another group of younger designers who make good money, but not Seattle house money. They're either single or with young families. They can't afford to buy in Seattle, but can afford to buy in Edmonds or south Snohomish County."
The influx of new employees made necessary the move to a larger location, which the company hopes to move into by the end of February or early March. Since 2009, Ten Gun has had its office tucked away in the 600 block of Fifth Avenue South. "Baicha (Tea Room) is our second Ten Gun," Milodragovich said.
Company began in Seattle
Ten Gun partners Jeff Dack, Shane DeBoer and Mark VonGunten (the company gets its name from an anagram, of sorts, of VonGunten's last name), are all originally from Ohio. While working for Sierra On-Line (now Sierra Gamers), graphic designer VonGunten did some work on packaging design for Microsoft's Xbox, which debuted in November 2001.
VonGunten soon made the move to Puget Sound, and was followed by his two partners, setting up a small shop on Seattle's Dexter Avenue. But they chose not to live in downtown Seattle. All three had families: Dack and VonGunten settled in south Snohomish County, and DeBoer in Magnolia (he has since moved to Shoreline).
In 2009, tiring of commutes and the general hustle and bustle, the partners moved to Edmonds, taking about 10 employees with them.
"In part, it was about being in a place where, as a partnership, they could put down roots, and they could have community support in doing that," Milodragovich said. "It would almost be a sanctuary for them. It wasn't this constant pressure of overhead and employee churn and commute crush, in addition to the difficult nature of building a business from the ground up.
"Beyond that, the fast-moving nature of clients means we try to be a drama-free workplace, and the drama comes from client deadlines. To make that happen, the partners felt they wanted to find a place that didn't have a crazy pace, and that was even before Amazon went in and we saw all of the revolutions we've seen at South Lake Union."
There was risk. The decision to move came during the economic downturn, when many businesses were averse to investing a significant amount of money into physical spaces and adding employees. But the three Ten Gun partners zeroed in on long-term growth and putting down roots.
Today, Ten Gun is split into two businesses, with about 50 employees in Edmonds and, as of three months ago, 35 in Redmond at Microsoft. At Microsoft, among Ten Gun's employee vendor services are designs for Xbox, Windows and Microsoft HoloLens, the latter transporting the user into a "mixed reality" of people, places and objects from real and virtual worlds.
The Edmonds office is promoted as offering "design, motion and marketing." That can encompass a variety of services, including brand management, environmental graphics, packaging, illustration, kiosk design, app design and development, cinemagraphs and 3-D marketing.
The closely held company does not release sales figures, but Milodragovich said revenue is "definitely in the millions." The biggest expense, as you might guess, is for staff, which hasn't stopped the company: There are always several job openings posted on its website. That doesn't mean Ten Gun ignores its bottom line – the HR director is also the finance director.
Extolling Edmonds
Milodragovich grew up in Missoula, Montana, graduated from Washington State University and law school at the University of Washington, and took work at the Foster Pepper and Littler Mendelson law firms in Seattle.
She joined Ten Gun in 2014. Although she lives in Kirkland with her husband and three young children, she says the drive to Edmonds every day – against traffic – satisfies her restless Montana spirit. But you figure the family might end up here one day.
"Being in Edmonds is different than many clients expect," she said. "I mean, Edmonds speaks for itself. My first couple of months here, it was great just being able to walk to the Cheesemonger. Some of our one-on-one client meetings are just loops around the city. I was working with a Microsoft client, and she said, I have to go where? I said it's where you catch the ferry, just north of Seattle. We went to lunch at Rusty Pelican and walked downtown, where I showed her the progress here."
Milodragovich admits that some clients may hold small-town biases about contracting with a design firm in Edmonds. "When you Google top design firms in Seattle, we don't rank. Not because our design isn't fantastic; it's because of our zip code. That's fine. We feel the quality of work, our people, and being in Edmonds, overcomes that."
And, once and for all, Edmonds seems also to be slowly shaking its "Deadmonds" reputation.
"The community is awake at night," Milodragovich said. "Everyone perceives it as an early bird community, but that's not my experience in last couple of years. Edmonds is dynamic, and the demographics are changing."
At Ten Gun, that demographic includes employees of all ages, races and lifestyles. It's not just millennials finding work there, although Milodragovich admits that, "I almost guarantee you that we employ 100 percent of Edmonds' man-bun population. Hipster beards included, at times."
Ten Gun sees a steady stream of applicants from Western Washington's design program.
Generally, those who Ten Gun hires at the start of their careers have formal design backgrounds earned in college or design schools. In addition, Milodragovich said, new hires have a general love of design and show a portfolio beyond what they have done in school.
"They have a universal skillset of a desire to learn more, to push past their natural stopping point on projects, with an insatiable curiosity and desire to tinker."
A new phase
As Ten Gun grows its presence, Milodragovich said it naturally will move to become more involved in the community. It has showed that, in a humorous way, by entering Edmonds' annual Scarecrow Festival. In November, it picked up first-place in the service category for its "It Takes a Village" entry.
But beyond that, Ten Gun has worked on several pro bono projects, including for Cascadia Art Museum, Adopt a Soldier and Kindering, the latter offering treatment for special-needs children from birth to age 3, including some in the Edmonds School District.
"We feel strongly about community involvement," Milodragovich said. "This is a community for everyone."
Said Development Director Doherty: "(Ten Gun) looked elsewhere, and immediately realized that Edmonds had the right combination of urbane walkability, small-town amenities, yet metropolitan sophistication – plus great proximity and accessibility for their staff. That's precisely what our business-attraction advertising campaign calls out."
The campaign's slogans?
- Smart businesses choose Edmonds!;
- Serious business in a relaxed and charming locale; and
- Thrive and smile!
It appears Ten Gun Design is ahead of the game.


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May 28, 2017
The Wedding Plan is one of the more unorthodox, yet wildly rewarding romantic comedies you may see this summer.
The Detroit Film Critics Society is pleased to announce the Best of 2016 winners in ten categories. The society was founded in Spring 2007 and consists of a group of seventeen film critics who write or broadcast in the Detroit area as well as other major cities within a 150-mile radius of the city including […]
There's a sense of obligation to a public who just loves them some superheroes, no matter what form they take. But when they're rendered with the kind of vapid and vicious stupidity on display in Batman v Superman: Dawn of Justice, there's precious little to love – and the circle of self-loathing eats its own […]
The film lineup and schedule for the 2016 Greater Farmington Film Festival earlier this month and it looks like a great selection of films this year.
How bad must a movie be if it can't even make me smile by killing Justin Bieber?
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- Please select a date to see the proper prices!
Description of the accommodation:
Rooms, services Lindenhof St. Kanzian am Klopeiner See is offering 28 tasfefully furnished, nice rooms for those looking for a place to stay at in Sankt Kanzian am Klopeiner See. If you feel like having a meal not included in your chosen type of catering, you can always taste local dishes in the restaurant of the hotel. Nearby table tennis opportunities will provide an excellent chance to spend your leisure time actively. The local bar will provide an ideal location for personal meetings and nice evening chats. In the safe you may secure your valuables. To learn more about the exact range of services of Lindenhof St. Kanzian am Klopeiner See (including services for an extra fee) and the exact equipment of the rooms, please check the information sheet below.
Payment Depending on the selected date, room and price, you may need to provide credit card guarantee or advance bank card payment to finalize your reservation.
Arrival, opening hours You will be able to speak with the personnel in English and German languages.
Lindenhof St. Kanzian am Klopeiner See rooms Rooms
- Please select a date to see the proper prices!
Accommodation services
- Pool (Outdoor - seasonally open)
Pet friendly, Garden, Bar, Safe deposit box
Own restaurant
Hairdryer, Desk in the room, Microwave oven, Tea/coffee-maker


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Michael T Haas is a talented investor who currently resides in North Carolina. He has lived in Virginia for fifteen years before moving to North Carolina, the state where he grew up and graduated from high school. Hass has started a number of businesses during his successful entrepreneurial career, including a fence building company, a pressure washing company, a private repo business, a limousine company, a general contracting business, a home theater company and many others.
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.
Michael T Haas - Risks of Investing in Precious Metals
Michael T Haas is an accomplished investor with a diversified portfolio.
When you invest in precious metals, you can either get a paper asset or a physical metal.
Paper investment vehicles associated with precious metals come in many forms and carry
their own risks with them.
The most obvious risk is the same risk that you have when investing in the stock market. It is
the risk of default. The second potential risk is fraud. When you buy physical gold and you
get it delivered, then you have the gold. Paper, on the other hand, is a promise to deliver the
asset, be it gold, silver, or ownership in a company.
Another way of investing in precious metals consists of investing in numismatic assets, which
come with their own risks.
When you invest in bullion bars of precious metals, you have 100% correlation between the
price of your bullion bar and the metal itself. If you have gold bullion and the price of gold
goes up fifteen percent, the price of your bullion goes up fifteen percent, too.
Numismatic value includes the metal content, but it is much more than that. The metal
content may be only a minor factor in the value of a coin. Gold double eagles are a great
example. Double eagles are American gold coins with a denomination of twenty dollars.
They were made from ninety percent gold and ten percent copper alloy. The first double
eagle coin was produced in 1849. Regular production started in 1850 and lasted until 1933.
You could easily find a double eagle coin valued at over five thousand dollars, even though
the value of gold in it may be less than one thousand dollars. The coin is worth so much
more because of scarcity, popularity, condition, and other factors.
Potential risks with numismatic coins include costs, grading, and dealer fees. Numismatic
coins usually have a wholesale price and a retail price. The difference between the two can
be as high as thirty percent. Bullion coins have much lower premiums, usually between two
and ten percent. The premiums for bullion bars are usually even lower than for bullion coins.
Silver and gold are the two most popular precious metals when it comes to physical
ownership. Physical ownership of other precious metals has a very small market which is
why experienced investors like Michael T Haas carefully consider all their options before
To Learn Nore,Visit : http://michaelthaas.jigsy.com/


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Wedding Jewelry-Tips to Prepare Jewelry for Your Wedding-Piece of jewelry that you use for your wedding that you sparkle and light. Make sure that to get the best advantage and the jewelry before the big day in perfect condition. These tips will help you to prepare your jewelry for your wedding.
On your wedding day, everyone will want to see your diamond ring. Every bride should your engagement ring professionally cleaned or two days before the ceremony, for it seems. You think you have enough bright ring, but wait, until you see the single steam – beautiful like that to look like your friend day a small velvet box is displayed. Cut not radiant diamonds, the worse than a hand lotion, so if you a manicure after cleaning remove their rings. And if you go up to set, to avoid hitting it makes opaque gems with your fingers.
If you a silver and Crystal Bridal jewelry are large, you want to ensure that the benefits looks better. Wipe your wedding jewelry Crystal with a soft, damp cloth to remove dust and fingerprints. Start the cloth to give a Polish part special cover silver shine. To do this, before getting a manicure for your wedding, because you can end up with a grunge nails! Without wedding gemstone silver jewelry can be immersed in a cleaner, there would be special color silver. Silver can dye a lot of gems, pearls, in particular damage and then use it only for all silver jewelry.
The Pearl is the symbol of the wedding elegance; You are also very fragile, so make sure that your children. They can be removed with a soft, dry cloth if necessary, but that's all. The best way to ensure that your beads in perfect shape for your wedding first should keep the dirt. Use always the Pearl wedding jewelry after her hair and makeup done. Hairspray is a sworn enemy of Pearl as the boring scent. Spritz on perfume you, before you can use of your marriage for the same reason pearls. Get always the silk thread of pearls, which is wet, because it can be sensitive to stretch and break.
The man who will lead the wedding jewelry, make sure that the lights are so good, what you look like. Silver bracelet with a cloth, restore them, can be polished to a new fragrance to Polish silver. If these large silver glitter and they need the bracelet can be bathed in silver cleaner. It is likely that your wedding band in good condition, but check whether you could benefit from a cool jewelry from Poland. When the groom high rings instead of the traditional, Poland asked interested in final Matt the jeweller of the brush wheel, has to make the mat. Only a minute to do and be the modern aspect of the band.
As they say, little things that mean a lot. If the honeymoon suite for the entire wedding day perfect months, which passed it only makes sense, the time to make sure that the accessories are as well. You be wedding in perfect condition with your jewelry from head to toe in your big day shine available.


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Betsy Graseck
Last quote by Betsy Graseck
We are raising our EPS and Price Targets, and re-aligning our portfolio to bake in a higher forward curve and accelerating capital return post Republican sweep ... Republican Sweep is positive for all financial stocks. More growth, higher rates, less regulation, lower taxes.feedback
Nov 14 2016 American politics
Betsy Graseck has been quoted 2 times in 2 different articles. On this page, you will find all of Betsy Graseck's quotes organized by date and topic. Alongside each quote is a link back to the article where the quote was reported, so you can go back to the source for more context if you need it. Topics that Betsy Graseck speaks about are Wells, Republican Sweep, and volatility, for example. Most recently, Betsy Graseck was quoted in the article Analysts cut Wells Fargo profit estimates ahead of results saying, "Yes, we could see more volatility ahead as headline risk persists, but Wells is rarely this inexpensive.".
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Fall into this edgy, action-packed, darkly comedic, dystopian love story, and be prepared to encounter a finicky time machine, a mysterious seashell, and a very clever dog (some sex, some swearing, some violence, but no vampires and absolutely no ditzes.)
In Another Life
Told in dual past and present-day narration and steeped in the rich history and romantic landscape of rural France, In Another Life is the story of Lia Carrer, a brokenhearted historian who becomes entangled in the echoes of an ancient murder. Her suspenseful journey reveals that the dead may not be as far from us as we think.
A Sunday Kind Of Love (A Football Romance)
A passionate triangle entangles an unmarried woman, a married man, the Green Bay Packers and a cast of colorful Midwestern characters. As the romance unfolds, they hit the heights of victory, feel the agony of defeat and find themselves forever changed.
a life of inches
A love triangle plays out around a baseball diamond as Ryan and Woodie square off to stand in the winner's circle and capture Molly's heart.
Convert This
Would you prefer a dead child or a gay child?
This is the question raised in this fictional tale of a famous actor who is traumatized by his experience in sexual reorientation camp as a teenager. H
Thieving Forest
Edgar-nominee Martha Conway has written a gripping new story in this "Little Women meets Last of the Mohicans" historical novel. THIEVING FOREST is "a powerful tale of sisterhood and survival" (San Jose Mercury News)
What Happened to Henry
Nine-year old Lauren Cooper is devoted to her brothe rhnery. Both she and her volatile younger brother Winston regard their big brother as mediator and guide–the go-to safe place.
Everything cha
The Way Up
My book is about a young man from a working class family, a boy who is admitted to law school and graduates, but can't find a job. To the dismay of his father, he joins a Jewish law firm. This after
The Unholy
The Unholy is a supernatural heroine's journey that lures the reader into a twilight realm of the dark side of religion as healer confronts evil incarnate….a fast-paced battle between good and evil
The Bouchard Legacy
Paul has earned his place in the world, but Randy owns it. The Bouchards, the Elsers. Families united in marriage but also torn by divorce, addiction, prejudice and greed struggling through a tumultuous time. Two young men desiring to do what's right. Carefree rich Randy and Paul, the disciplined vet. Can both win?


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The usual approach to the uncensored news from Jay (LJC ThreeThousand) but... it's Sunday and... it's the MORNING??? Ugh! Grab a coffee or three and hear him yawn through more of the news that the mainstream media seems to forget about.
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Writing is terrifying. You have no idea where your words will go or how they will come back to haunt you. It freaked Plato out twenty-five centuries ago and it freaks me out today.
Your only hope is that the reader will assume good faith. That she is willing to step inside the text and feel through your words, rather than put them on trial and find them, as they will always be, wanting.
The internet is wonderful in more ways than I need to tell you, but it does not abound in a willingness to assume good faith. Words unaccompanied by bodies are more easily misunderstood. It is easier to be careless or unpleasant through a keyboard than in the flesh. Mailing lists go to war over which way to open a boiled egg. Comment threads sprout into a hydra of misreadings, some wilful, some innocent. Not always, but often enough to make us wary.
Years ago, at an exhibition opening, I staged a battle reenactment of a (pretty tame) mailing list fight. Twelve of us sat around a table and read aloud twelve minutes of extracts from what had been twelve thousand words of mails. The guy whose attack on me had triggered the original episode agreed to read my words and I read his. It shook us both.
The internet is not often a safe place to be vulnerable. Good writing, unless it is well-armoured polemic, requires vulnerability. I suspect this is why so many of the writers I know have an angst-ridden relationship to the internet.
To write with no fear that your words will be held against you, that is what it takes for written words to come alive. And the model for this, I think, is the letter you write to a friend. There are certain books which started life as letters and they come alive in this way. I am thinking of John Berger's 'and our faces, my heart, brief as photos', parts of which must have been written as love letters, but I realise that I could be thinking of any of a dozen of Berger's books or essays. I am thinking also of Hugh Brody's 'The Other Side of Eden' which grew out of his letters to his friend Ted Chamberlin. Where technologies open gaps between us, whether the technology is the internet or the alphabet, friendship can make those gaps disappear into irrelevance. When you write to someone you know to be a friend, you don't worry about whether they will assume good faith.
I stumbled into blogging more than ten years ago. I was living in wild west China, one of maybe two dozen foreigners in a city of 400,000. This is not the place to try to explain how the experience changed me, but some days it was all too much. I started writing "round robin" emails to friends back home, then I got guilty about clogging the inboxes of those I never heard back from, so I started using a site called LiveJournal instead. After a couple of months of posting there, I realised with a jolt that two people I'd never met had started following my posts.
For a long time, though, blogging still felt intimate, a place where I could talk through whatever I was working on and assume that anyone who was interested enough to be reading would assume good faith. Then it didn't feel like that anymore. Lots of other things happened, I moved countries and changed the shape of my life, and I let my online life drift for a couple of years. Then this year, as I found my feet in Sweden, I started this site as a place to write about the work I'm doing.
I think it works. It's a public home, a place for publishing things. But lately I've been feeling the itch for a more personal way of writing over the internet. Around the same time, I started reading email newsletters from people like Warren Ellis and Deb Chachra – and I was struck by how different a newsletter can be to a blog.
A newsletter arrives in your inbox without demanding any response, which makes a pleasant change from most of the rest of the email you get. Still, it has to be interesting enough to actually make you want to read it. There's no comment thread. Often, there's not even a public archive, so it lives somewhere just a little more intimate. Sometimes it can feel like a personal email a stranger has sent you by mistake.
So, because clearly none of us has enough words in our inboxes already, I thought I'd try joining in the renaissance of the email newsletter. I give you Crossed Lines, an occasional letter about what I'm reading, writing, thinking and talking about. And about what ever else I feel like writing about. I hope you'll enjoy it.
The first letter will go out at sunrise, one morning in the near future.
Sign up for Crossed Lines here – make sure you click on the link in the Confirm email from TinyLetter.
(Image from here.)


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Moose Baxter
|Moose Baxter
|First baseman
July 27, 1876
Chippewa Falls, Wisconsin
|Died: August 7, 1926
(aged 50)
Portland, Oregon
|MLB debut
|April 19, 1907, for the St. Louis Cardinals
|Last MLB appearance
|April 24, 1907, for the St. Louis Cardinals
|MLB statistics
|Games played
|At bats
John Morris "Moose" Baxter (July 27, 1876 – August 7, 1926) was a Major League Baseball player. Baxter played for the St. Louis Cardinals in the 1907 season. He played in only six games in his single season career, with four hits in 21 at-bats.
Baxter was born in Chippewa Falls, Wisconsin and died in Portland, Oregon.
External links[edit]
- Career statistics and player information from Baseball-Reference, or Baseball-Reference (Minors)
|This biographical article relating to a baseball first baseman is a stub. You can help Wikipedia by expanding it.
- Major League Baseball first basemen
- St. Louis Cardinals players
- Butte Miners players
- Edmonton Eskimos (baseball) players
- Johnstown Johnnies players
- Milwaukee Brewers (minor league) players
- Montgomery Senators players
- New Orleans Pelicans (baseball) players
- Oakland Oaks (baseball) players
- Portland Browns players
- Rockford Red Sox players
- Scranton Miners players
- Sioux City Cornhuskers players
- Superior Longshoremen players
- Baseball players from Wisconsin
- People from Chippewa Falls, Wisconsin
- 1876 births
- 1926 deaths
- Baseball first baseman stubs


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8/92 Tanah Street West Mount Coolum 4573 QLD
- Two Level Modern Townhouse (Built in 2015)
- Two Bathrooms Upstairs + One Powder Room Downstairs
- Lock Up Garage + Undercover Carport
- Visitor Parking at Complex (10 Townhouses in total)
- Security Screens Throughout
- Front and Back Courtyards!
- Fully Fenced
- Dishwasher
- Stone Bench Tops
- Reverse Cycle Air Conditioning (Warm and Cool)
- Second Bedroom is Queen Size, with Built in Wardrobe
- LARGE Master Bedroom with Ensuite
- Bath Tub in 2nd Bathroom
- Walk to Mount Coolum Walking Trach, Beach, Bus Stop, Shops (Bakery, Coffee Shop, IGA)
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ORE prefers physical items to downloads but we will put occasional demos online. Alongside audio we will also provide other items for download, such as scores and ORE collateral.
ORE: Stubnitz
First track by ORE as Sam's solo project.
STOCKHAUSEN: Sagittarius from Tierkreis
ORE : Sagittarius from Tierkreis (Stockhausen) by ORE
A short Stockhausen movement recast in the ORE doom aesthetic, plummeting to the depths from its high-pitched origins.
DEMO : Charioteer
ORE : Charioteer (studio demo) by ORE
LIVE : Ouroboros is Broken
ORE : Ouroboros is Broken (live, with guests) by ORE
DEMO : In Hungary They Used To Burn Bagpipers
ORE : In Hungary They Used To Burn Bagpipers (demo) by ORE
Download the score to our piece K.A.L.D. – composed by Stuart Estell.
Should you use this, we'd love to hear what you do with it.


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Detalii loc de munca - România
Descrierea jobului - România
Responsibilities: • Realize the tool set up and improvements • Participate in corrective and preventive intervention level I, II and III of the tools available in the department according to the procedure • Keep track of all documents in its field. • Participate to changes in tools - and proposes solutions to achieve this in time. • Participate in the reception of the repaired tools and also in the reception of the molds for the new projects. • Apply the provisions of the system and operational procedures for quality assurance in its field • Responsible for the correctness and the deadlines of tasks. • Responsible for raising, by his own effort, the level of training; • Propose measures to be analyzed by his hierarchical superior for the improvement of the workshop • Respect Safety and Environment rules; • Respect entirely work instructions and provisions of technical documentation on the work they perform to not endanger the environment.
Requirements: - vocational school or high school; - Knowledge of technic drawing; - potential to accumulate new technical knowledge; - knowledge of working with manufacturing machinery (lathe, milling machine, grinding machine with massive electrode electrical discharge) - is an advantage.
Nivel minim de educatie necesara Liceu / scoala profesionala


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Discussion in 'OT Technology' started by dissonance, Dec 10, 2008.
Good business decision.
I guess that way they can give drives that fail QA/QC to OEMs to use. Very nice.
One more reason to use a RAID.
5 years for a hard drive is just too much time as far as i'm concerned. the profit margins on those things has to be so low with current pricing. having a longer warranty doesn't decrease your chances for losing data, it just means that 1Tb drive that you paid $30 for will be replaced if it fails at 4.5 years. i was always impressed with such a long warranty and even 3 years is above and beyond what most computer parts manufacturers give.
You're a company rep in disguise, aren't you?
lol. i'm generally not a fan of big corporations and find that they do little for consumers. i do find though that storage costs are insanely cheap for the home user and the warranties didn't seem to match the low cost. i'm all for cheapness, but i also want good businesses to be profitable. you have to admit that most people here seem to like either seagate or western digital drives, so they must be doing something right.


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Over 1.8 million nonprofits and charities for donors, volunteers and funders
Causes: Arts & Culture, Children's Museums, Education, Elementary & Secondary Schools, International, International Development, Literacy
Mission: To provide for the health. Education, and development of abandoned and orphaned children and to provide a medical ministry to developing countries.
Programs: Provided support for 19 orhpaned children in romania, including missions trips to romania to help train people, provide construction assistance and visit the orphanges.


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Chicago Yacht Club Race to Mackinac partners with Chris Bedford
by Winn Soldani on 14 May 2010
BMW Oracle Racing Weather man Chris Bedford interviewed by Paul Cayard on 2007 Louis Vuitton Cup Day 3 BMW Oracle Racing © Photo Gilles Martin-Raget
The Chicago Yacht Club Race to Mackinac will be here soon! In support of the race and the racers, the Chicago Yacht Club has once again partnered with Chris Bedford of Sailing Weather Service, to be the official weather services provider for the Race.
Chris has extensive experience in forecasting for sailing and sailboat racing, at the highest levels, including eight America's Cups, three Volvo Ocean Race/Whitbread races, and four US Sailing Olympic campaigns. Most recently, he was team meteorologist for BMW Oracle Racing in their victory in the America's Cup. Chris has also provided forecast services for many top finishers in Chicago-Mac races in 25 years of forecasting the race.
On July 23, at the skippers' meetings for the Mac, Chris will prepare and present a forecast for the race that will be insightful, informative, and relevant to racers. Importantly, he will brief at both the morning skippers' meeting and the evening skippers' meeting. All sailors are invited to attend the briefings at both meetings if interested.
In addition, Sailing Weather Service will be providing online resources for sailors. A website portal will be built and updated that will include:
High resolution model forecasts of wind speed and direction over Lake Michigan
Text and graphical forecasts for the race area
Satellite and radar imagery
GRIB files for routing software
We're excited to have Sailing Weather Services and Chris Bedford as part of our event. Weather is one of the most important variables in the race and a key safety concern, and we are glad to have one of the best sailing weather forecasters in the world on our team for the Mac race.
Should you have any question or comments, please contact the Chicago Yacht Club Race Coordinator, Amanda Matta at: firstname.lastname@example.com
The Sailing Weather Service can be accessed at: www.sailwx.com
If you want to link to this article then please use this URL: www.sail-world.com/69533
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News that changes are being mooted to put the America's Cup on a longer-term footing is being floated in the Daily Telegraph (UK) by the British Challenger, Land Rover BAR. According to the Telegraph, some of the teams in the 2017 America's Cup are keen to lock-in parameters which would bind successive holders of the a style and frequency for the next America's Cup Match.
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On the final day, two of the three Classes were so close that the winners were decided on the last race. Spectacular sailing conditions prevailed with a brisk 20 knots of wind from the south east. Oyster yachts are built to sail the oceans and revelled in the conditions.
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America's Cup- Mitchell fires new salvo at ISAF Jury Officials
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America's Cup- Oracle crew mate lodges ISAF complaint against Tienpont
Last Friday, former OTUSA's Matthew Mitchell issued a media release stating that he has lodged a complaint with the ISAF
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Posted on 28 Jan 2015
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Client Chronicle Books
Title Expectations: Thirty Women Talk About Becoming a Mother
Author Laurie Wagner
Fine art photographic printer Seth Dickerman
Review Hamersky's beautiful portraits of thirty new mothers are accompanied by Wagner's text, based on in-depth interviews. The mothers range from a successful artist to a young drug addict to adoptive parents to the mother of triplets. The stories of the women encompass a complex range of emotions--not only "full-bodied, heart-wrenching, breath-stopping love," but confusion, disaster, ambivalence, sorrow, fatigue, and bemusement, too. The breadth of experience reflected in the text, combined with the portraits of real people, sends a powerful message to new mothers: Mom, you are not alone. --Ericka Lutz, Amazon.com


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Interest prohibition and financial product innovation
We give a rough sketch of the Judaic, Greek, Islamic and Christian positions in the matter of interest prohibition during the last few millennia and discuss the way in which interest prohibition is dealt with in Islamic finance, the problems with authority-based arguments for interest prohibition, and the prospects of interest prohibition with the advent of electronic money.
If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
|Date of creation:
|Apr 2011
|Publication status:
|Published in Finance Islamique: Regard(s) sur une Finance Alternative, pages 274--284, Mazars Hadj Ali, 2011
|Contact details of provider:
| Web page: http://arxiv.org/
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The Last Supper Trailer (2005)
12 February 2005 Drama, Horror, Mystery 92 mins
A plastic surgeon who excels at his job hides a dark secret in THE LAST SUPPER. After finally succumbing to his desire to taste human flesh, the surgeon soon finds himself addicted to the taste of his patients' skin, which leads him to discover further culinary delights at a seedy restaurant with some highly dubious special dishes. Murder and mayhem ensue as the demented doctor continues to find new and gruesome ways to satisfy his appetite.
Watch the official The Last Supper 2005 trailer in HD below or find more The Last Supper videos on Vidimovie.


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Puradown 50% Duck Down Chamber Pillow
Puradown 50% Duck Down Chamber Pillow
Puradown Australian pillows are put together keeping in mind comfort and warmth for their customers.
The soft duck down provides a comfortable nights sleep and the box wall construction ensures this pillow never loses its shape.
With Box Wall construction and Center support, the Chamber Pillow is perfect for a refreshing nights sleep. The box wall construction helps with the longevity of the pillow, in terms of fluffiness, shape and comfort.
Made in Australia. All feathers are cleaned in Australia.