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Ms. Beird is the PACS System Administrator of Ann Arbor VA Healthcare System, Ann Arbor, MI.
E veryone in the industry is talking about picture archiving and communication systems (PACS)--how to design a system, the challenges of implementation, and the impact digital imaging can have on patient care. At Ann Arbor VA Healthcare System, when we talk about PACS we speak from experience. Our PACS integrates all modalities into a 100% digital environment that streamlines workflow, reduces operating expenses, and improves patient care.
Current and prior imaging studies are available consistently for interpretation or review. We have eliminated lost or missing films. More importantly, Dr. Charles Marn, Chief of Radiology Services, reports that timely access to a patient's previous studies (from any modality) improves the quality of diagnostic results we provide.
Our 147-bed facility provides ambulatory and tertiary services for veterans in the Southeast Michigan area and is a teaching hospital affiliated with the University of Michigan.
The hospital began with mini-PACS, which included a 0.5 terabyte archive and two primary diagnostic work-stations, and a teleradiology system that connected the main facility with an outpatient clinic in Toledo, Ohio. In 1997, we began to upgrade to a full-scale PACS.
All imaging modalities were connected to the PACS by 1998, and the hospital significantly reduced expenses for film and chemicals from $125,145 in fiscal year 1996 to $20,419 in fiscal year 1999 (Table 1). Labor costs have been trimmed by $26,300 a year. Because we are a teaching hospital, our percentage of missing films is high--between 15% to 20%. Therefore, digital imaging has also eliminated the cost of labor and consumables for retakes. At the same time, workflow is improved. Imaging studies are now available in just minutes to referring physicians on any floor of the hospital. With the film-based system, it might take 2 to 6 hours for a referring physician to see a film study.
Digital imaging has also improved technologist productivity and patient throughput. It may also improve the quality of care we are able to provide. Currently, we are conducting a study that compares how many previous studies a radiologist examines with a film system as compared with a digital imaging system. We are also tracking how long it takes for radiology reports to be made available, for technologists to process studies, and for patients to complete their exam.
Needs assessment
Prior to interviewing any vendors, we created a multi-disciplinary committee to develop a list of requirements. This step was critical to our success, because it established goals and objectives that drove the selection and implementation of the final, full-scale PACS solution.
Our PACS team consisted of the chief of radiology, a hospital administrator, the chief technologist, and a referring clinician. The chief of radiology and the chief information officer had the foresight to recognize the importance of a dedicated, full-time system administrator. Thus, I was transferred from the IT staff to facilitate the PACS team.
We developed our PACS team in 1996 and spent 4 to 5 months outlining our goals. During that time, each department representative collected input from, and reported to, a group of his or her peers. All team members agreed on the overall objectives for PACS and participated in creating a detailed system plan and installation guide.
Based on the initial needs assessment, I created a detailed request for proposal. After interviewing several vendors, Cemax-Icon, a Kodak Company, best met our list of requirements, which included: functionality of the diagnostic workstation; enterprise-wide networking expertise; archive storage and database technology; teleradiology experience; and validation and integration of imaging modalities.
With the vendor selected, we began to implement PACS. This gradual implementation was desirable because of management and training issues, as well as financial concerns. In our case, this timeline was controlled tightly because of a new construction project. The PACS was cost-justified as part of a $70 million clinical addition, which features a new radiology department, ambulatory care center, diagnostic imaging service, operating rooms, and intensive care units.
In January 1997, our first phase began when we brought the portable CR system and two ICU referral-quality workstations online. In the next stage, which began in May 1997, we integrated ultrasound and RF systems. In June 1998, we integrated CT and MR systems as part of phase three. Phase four, in October 1998, involved connecting angiography suites, a digital chest unit, and general radiographic rooms to the PACS and coincided with our move to a new facility. This stage completed our conversion to digital imaging and now all images are read with on-screen digital display.
Our current stage, phase five, involves establishing worklist management on all modalitites except angiography (completed); and providing remote access to images and the electronic medical record over the Internet (currently being tested). Figure 1 illustrates the PACS workflow for radiology.
Validation process
Each imaging modality was validated before it was brought online. In 1997, Cemax-Icon had a DICOM validation group that was responsible for validating the clinical and technical functionality of its system with leading imaging modalities. This group established protocols and used phantoms to create a series of images that were analyzed for integrity during capture, viewing, and storage. They compared softcopy images with film output to ensure that the images were identical and to verify that positional markers and other critical elements were correct.
Most of our imaging systems had already been validated, with the exception of our new MR and RF units. The DICOM validation group provided a phantom and a series of imaging protocols and we acquired the test images, which were then evaluated.
This validation effort was critical to ensuring the clinical accuracy of all images, as well as the smooth integration of each imaging modality. It also allowed any non-conformance issues to be addressed prior to linking the modality to the PACS network--which ensured the integrity of every patient study in the archive.
Storage and networking issues
In 1997, we moved our existing image files from our initial archive to our new 17.5 terabyte digital linear tape (DLT) archive. At this time, we began to take full advantage of the workflow benefits of our new large-scale digital archiving system.
Film studies that are necessary for comparative purposes are being digitized as needed, however we are not converting our entire film library. Previous research has shown that film studies are rarely accessed after 18 to 24 months. At our current volume of 60,000 studies per year, we estimate our archive requirements to be 1 to 2 tera-bytes a year in storage. Newer tech-nologies, such as spiral CT, and the increased demand to provide primary diagnostic services to remote facilities will expand our storage needs, so we have built scalability into our system.
Our storage system supports hierarchical storage management and an object-oriented database to speed retrieval times. In our system, the patient is the object. We can enter a patient ID or Social Security number and rapidly locate every study and report for that patient.
We have recently added Modality Worklist, which eliminates the need for technicians to key a patient's name and other demographic information. With this feature, patient demographics are linked to imaging studies through a HIS/RIS (hospital/radiology information system) gateway. For example, a CR system operator can access a list of all scheduled studies for a given day and click on a patient's name, then all of the patient's demographic information is attached to the image and transmitted to the PACS. This workflow enhancement improves full-time equivalent productivity and significantly reduces manual archiving reconciliations.
A bi-directional interface between the PACS and HIS/RIS system enables radiology reports to be accessed from any PACS workstation throughout the hospital. This interface also transmits study schedules to the archive, where previous studies are pre-fetched and posted to the primary diagnostic workstation for comparison with the new study.
Human factors
In any major system conversion, human factors must be considered. For example, we tailored our training efforts to the needs of each audience and described how each staff member would benefit from the PACS. We explained to physicians and nurses in ER and ICU, for example, that the new PACS would provide faster access to images and eliminate lost or missing films. We emphasized to all audiences that the primary purpose of our PACS is to achieve improved access for medical staff and optimized care for patients.
We also stated that we were not going to run parallel systems. Once training was completed and the modality was brought online, everyone would be required to use the new system as it was intended. There is little motivation to learn a new system if you know the old system is still going to be accessible. So it is important to notify everyone up front that they will be required to convert to the new system.
It is helpful to identify a "champion" within each group that has a good understanding of the system and can help encourage and train others on an informal basis. If users are enthusiastic, they will quickly overcome the initial discomfort that accompanies the adoption of a new technology, which will speed learning and create proficiency.
Advantages for radiologists
By far the most important achievement of our PACS is that any image from any modality can be retrieved from any diagnostic workstation in seconds. Dr. Marn and other radiologists report that access to comparative information can influence a diagnosis. Because the PACS is connected to HIS/RIS, patients' previous studies of the same or multiple modalities will be pre-fetched automatically and packaged with current studies. Images are also available on an ad hoc basis. If a radiologist sees a suspicious nodule at the bottom of the lung, he or she can immediately request the patient's most recent chest radiograph.
Dr. Marn outlines additional advantages our PACS offers radiologists: 1) customizable options allow radiologists to create parameters they find most productive for viewing different types of studies. A radiologist can create automatic instructions for the system to retrieve a chest CT with every thoracic spine MR exam, and create hanging protocols that direct the order and location for the placement of each study and image; 2) digital enhancement tools enable radiologists to adjust contrast, enlarge selected areas, and use other viewing techniques to check subtleties in an image. In addition, on-screen measuring tools are so precise that Dr. Marn notes he now includes more measurements in reports; and 3) the use of "bookmarks" allows radiologists to save their place when interrupted for STAT reads, which saves time and reduces frustration. This is also a valuable teaching tool that allows radiologists to share research and teaching cases in an extremely intuitive format.
Future plans
In addition to implementing digital imaging, we have also replaced paper patient records with electronic medical records. Our goal is to make reports and images available to remote clinics and physicians' offices and homes by using the Internet and an interface to electronic medical records.
Enterprise-wide distribution will bring us closer to our referring physicians, while equipping them with diagnostic information they need. That is what PACS is really about--better patient care. AR


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subset: commoncrawl


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What is the correct French noun for a school report? A school report is the report on a child's progress written by a teacher.
Take the tour
French Language Stack Exchange is a question and answer site for students, teachers, and linguists wanting to discuss the finer points of the French language. It's 100% free, no registration required.
Depending on the context:
| |||
In France, we say bulletin scolaire or carnet de notes (mostly for children under 11 or 12). | |||
The expression relevé de notes is also used, mainly for students. | |||
Tiens, justement je viens de signer ce matin le livret d'évaluation de ma fille en maternelle. Apparemment, c'est un document qui suit l'élève sur tout un cycle, c'est-à-dire plusieurs années. | |||
I would go for "bulletin scolaire" See http://fr.wikipedia.org/wiki/Bulletin_scolaire | |||


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Hi all -
I'm going to be giving a talk on Red One at the IFA (Independent Film Academy, http://www.independentfilmacademy.com) conference running in parallel with the Sitges Film Festival.
We've wrangled a Red One (finally!) to be present, and I'll be demonstrating (with Jendra Jarnagin) workflow etc. to the Spanish market that hasn't seen it yet, including a live workflow demo.
The presentation will be at 4pm at the Miramar Building in lovely Sitges, Spain (right on the beach), and run until approximately 7pm.
So come on down if you're nearby...


text: With the holidays just around the corner, it's always helpful to know what goodies people are most interested in, and what better way to find out than a new rendition of alaTest Trends? Here are some of last month's most popular items, sure to be hot topics this holiday season. Read the rest of this entry »


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You're watching...
The Fine Line of Enforcing Immigration Laws
Political analyst Carl Jeffers on the enforcement of Arizona's immigration law.
Jun 26, 2012
You're watching...
Political analyst Carl Jeffers on the enforcement of Arizona's immigration law.
Jun 26, 2012
Also in this playlist...
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Auto-advanceThis transcript is automatically generated
Can the -- tenacity as -- best offense not to help Arizona of these illegal.
Detainees even after this unanimous.
Supreme -- vote on my question.
It is what did the president -- -- not to help Arizona do well.
Essentially what what the what the president is saying is that to the extent that Arizona was in the end they judgment of the Justice Department.
National prerogatives in terms of an immigration law enforcement.
That the federal government will not be part of implementing that or assisting.
Arizona and doing that because for instance the example is Don.
If if I'm Jay walking in Arizona.
You can arrest me for Jay walking and -- -- as a result have the right to inquire about my immigration status.
But it can take no -- time.
That it takes normally for me to be involved in the Jay -- process so if you add an extra day.
To inquire about my immigration status beyond what it normally takes to acquire about.
-- Jay walking.
That could be unconstitutional.
And the court is saying they're gonna monitor that.
The federal government is not going to assist Arizona in making those kinds of activities -- -- -- -- point died judge -- A look -- -- -- they've most recent appointee to the Supreme Court.
Recused herself she did not vote on that is.
Because she was previously solicitor general now it is quite likely that now she recuse herself -- this decision.
If it comes back again for review based on monitoring.
And also based on racial profiling and civil rights -- violations that -- likely be the next level of charges that could make their way to -- Supreme Court.
Alain Kagan may very well feel that because she be accused -- -- -- this decision.
She could participate.
In the next round of by judicial.
Of -- view at the level of the Supreme Court.
And no I don't typically the other way to make it an even more in -- it.
Reversal of that that decision there.
Do you -- draw all the -- but is that -- wrong and asking me suspects.
To show their papers.
To show their papers and I think that -- and and America.
I believe in enforcement of the law and if you are a guilty or -- or perceived to be.
Violating an existing law.
And that's what they law enforcement is focuses on.
Now we do know that if they pull you over they can search your car search your trunk and if you -- pulled over speeding and they find drugs marijuana or something.
That you can be prosecuted for that.
There's just something that I'm very uncomfortable about.
With this particular activity because of the fact -- That it suggests a specific targeted group of Americans.
Are more likely to be candidates for these types of searches and that becomes a really close slippery slope.
To racial profiling and I have a great concern about it but you see the way UN I talking about it Don.
Would be helpful for more Americans -- have well conversation in this way and not on -- I'd love certain.
-- looks like -- the jobs.
Almost suspect over for a legitimate reason okay -- generation right they've they've run -- -- lighter than you know what I.
-- run -- red -- short so then do you favor.
All orders support.
Then asking them if -- liberal and -- asking them to support on affirmative answer with their papers while.
First while I don't favorite at all personally of -- -- -- that part of the question nor do I support it however I do accept the notion.
From a legal perspective.
That if a person because we have this established an American jurisprudence.
I -- in law enforcement throughout the country that affects all of its white black brown -- whatever if you are pulled over or stopped because of a legitimate.
That they -- law enforcement does have the right.
To look for other things like marijuana like -- hidden weapon that kind of thing I think you could make the argument.
That this would entitle you to do that the problem in Arizona was that Hispanics had.
The perception.
That the police would pull them over because they looked Hispanic.
And as a result -- -- -- there was a higher probability.
Of being able to find a violation of immigration.
That's the problem and that's where the constitutional issue has to still be addressed.
But the -- -- eleven -- that is some of those other areas.
Burroughs on -- close of the border into the Lorton face.
-- horrific situation.
Been robbed and most kinds of things -- -- various kinds of crime.
Solved by illegal immigrants primarily.
Well we'll have a club dog -- -- about all of us so.
That's true Don but but but without question.
If we're talking about.
People who rob Steele.
Wonder farmland and and and the individual property of Americans it doesn't matter what -- immigration status is they need to be apprehended and prosecuted under the laws on the books against those specific statute violations and there's plenty of law that would take there are of the penalties and the remedies for that that they don't need to even deal with the other aspect of -- data with the data criminals.
But stable but -- people on the borders -- all the star one.
Bob immigration.
Not been enforced -- and -- got a porous border.
You know -- -- -- -- British checking up -- so that's sort of position knock on Centre opposition of somebody's.
Committed a crime regardless early on elevated right chorus of -- -- all sort of thing so.
Right and I must say Don that the Supreme Court yesterday.
Did in fact uphold the principle that whether you are comfortable or unhappy with the act.
Activity on the border with regard to enforcement it is not to State's prerogative -- their responsibility that's the federal governments are you merited -- -- -- They're willing to draw what -- holder.
-- -- -- -- anybody who's not Aysu who as of a -- of personality enjoys good music likes of Ron James likes Tiger Woods -- Duke Ellington and Frank Sinatra I think we could certainly have a nice evening auction -- necklace and of handcuffs.
Isn't such concern and I did doesn't concern me -- my she'd drysdale abrasive around me on the hour.
OK and political resolve by the gay bull in a -- -- a very fine college effort to -- I'm -- I'm -- --
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text: What's Hot 2013 Gift Ideas Remembering Mandela World Cup Draw GALLERIES Benicio Del Toro Pics 0 17 Back to Top ▲ Benicio Del Toro Pics Benicio Del Toro Pics AskMen Editors Some men just ooze cool. James Dean was dripping in it, and Steve McQueen had it in spades. Robert De Niro owned the '80s and Sean Penn was the king of cool in the '90s. However, with modern day Hollywood suddenly overrun by those dreaded metrosexuals, the notion of cool is sadly being determined by the Zac Efrons of the world. Luckily, we have Benicio Del Toro, the Oscar-winning star of films... Continue reading Benicio Del Toro's profile. Next Page Exclusive Access Get the best deals for men on Black Friday, Cyber Monday & more ✓ You're in!We'll be in touch soon. ✗ Something went wrong.Try again later. Subscribing to a newsletter indicates your consent to our Terms of Use and Privacy Policy.


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The HelpDesk is the technology support center for St. Cloud State University students, faculty and staff.
On-campus student employment positions available:
Apply Now for Fall Semester positions!
HelpDesk consultants are:
Some of the areas HelpDesk can assist you:
You can find a more complete list on the HelpDesk Services page.
ResNet information
If you live in a residence hall, you will find information about ResNet on the ResNet
If you are currently working with a HelpDesk Consultant and require Remote Assistance, click here. The HelpDesk Consultant will give you a session key, which you will need to type to complete the connection.
Tracking your help request (incident)
The HelpDesk uses special software to track technology-related problems
and issues. When you call the HelpDesk, staff members will ask for your HuskyNetID
so they can track the incident and respond to you using your campus contact information.
You will receive an e-mail confirmation when the HelpDesk creates a ticket for an unresolved technology issue and also when your incident is officially closed.


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Milk snake
Milk Snake Shake?
June 29, 2011 - 6:24pm | by kateThe other morning while out for a walk with the dog, a friend of mine pulled over in her car on the way to work. After waving hello, she called out "Did you see that snake back there on the road?" I walked over to her, mentally wondering if it was dead or alive, a firm grip on the dog just in case. Together we went to look at the snake, which was beautiful and very much alive slithering across the road.
Respectfully keeping our distance but at the same time trying to urge the snake towards the safety of the field, we tried to work out what type of snake it was. I took a photo on my phone and, after discussing various options and watching it slide effortlessly into the long grass, we parted ways, each going in our separate directions to work.


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November 19, 2011
David Cloninger GamecockCentral.com
It was the same expression and answer, really, as they have been for the past three years. As amazing as it is, it's also routine at South Carolina. ...More... To continue reading this article you must be a member. Sign Up Now for a FREE Trial
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A Virgin Experience Day is your day to remember, a day to step out of the routine and concentrate on really enjoying yourself. What will really make your day? The best bit is that it's up to you!
This collection offers a whole range of experiences to choose from – visit www.virginexperiencedays.co.uk/choicebox for full details and the latest choice - taking your pick is all part of the fun. Once you've chosen, we'll send you a gift pack including a personalised voucher and message card and everything you need to book your experience.
Get ready to seize the day!
It's your choice - will it be a chimpanzee, a meerkat or even one of the big cats?
• Afternoon tea for two • A choice of 26 venues • Available all year round


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bozo big cake
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Select a tag to browse associated projects and drill deeper into the tag cloud.
Open Computer and Software Inventory Next Generation is an application designed to help a network or system administrator keep track of computer configuration and software installed on the network. It also allows deploying softwares, commands or files on Windows and Linux client computers.
Copyright © 2013 Black Duck Software, Inc. and its contributors, Some Rights Reserved. Unless otherwise marked, this work is licensed under a Creative Commons Attribution 3.0 Unported License . Ohloh ® and the Ohloh logo are trademarks of Black Duck Software, Inc. in the United States and/or other jurisdictions. All other trademarks are the property of their respective holders.


text:
WYLD Usage Statistics: Gale Databases |
all statistics library catalogs members |
Gale PowerSearch inflates numbers of searches and sessions.
All Databases - Monthly Usage Reports
See Also: Chilton Library | Gale Legal FormsCumulative Data
Fiscal Year Summaries:FY13 (Jul 12 - Jun 13)
FY12 (Jul 11 - Jun 12)
FY11 (Jul 10 - Jun 11)
- Usage is reported based on the location id used in the access URL
- Grzimek's Animal Life Online was discontinued by Gale on June 30, 2012
- Over 50 Gale databases were added to statewide access in early 2010 - see details at http://wyld.state.wy.us/wyld/gale/
- Eighteenth Century Collections Online & Nineteenth Century U.S. Newspapers contract began May 2009
- Opposing Viewpoints statewide contract began July 2007
- Literature Resource Center contract began July 1, 2004
Sessions: Cycle of user activities that starts when a user connects to a database and ends by connecting to another database or leaving the service through a logout or timeout due to user inactivity.
Searches: A specific intellectual query submitted through a search form to the database.
Retrievals: Sum of all full text abstract and extended citation records examined downloaded or otherwise supplied to user to the extent these are recordable and controlled by the Gale server rather than the browser.
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As you get ready for Sunday's game, get all you need to know when it comes to the wild card on our RAVE-TV special.
WBAL-TV 11 Sports Director and "Voice of the Ravens" Gerry Sandusky will give you a behind the scenes look at the preps for this weekend's game.
Ravens Report: Wild Card Edition airs at the following times this weekend:
-- on WBAL-TV 11
Friday at 7:30 p.m.
Sunday at 11:30 a.m.
-- on WBAL Plus (Digital Channel 11-2; Comcast 208; Verizon FiOS 460)
Saturday 11:30 a.m.


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So I played my first game in probably about a year and just completely lost whatever little skills I had since beta. I would like to improve my skills so I played a game and I came up with some things I need to work on:
1. Last hitting
2. Learn to farm and get my gpm higher because it was an embarrassment
3. Positioning
Can someone help me with how I can get started on improving those three points and my match id was 89505973. Feel free to criticize and come up with other points on what I need to improve because I believe just about any comments besides "just quit" and other troll comments will help me at this point. I'll try to play more games in the next few days and post some more match IDs and I guess I'll go from there.
avoid mmr games! you do not want to mess up ppls games and mmr, right?
=> go practice mode, go through some heroes you want to play and get a feeling for them. try melees with and without axe and stuff like that. practice last hitting, even add an enemy hero to make it a bit harder for you to last hit/deny by letting him auto attack. that should be ok for the start.
=> go nostats games and IGNORE EVERYBODY talking to you since it will most likely be flames and trolling. doesnt matter, work on your stuff to improve your play. why nostats?
=> watch honcast / VODs and Streams to learn from the pros (picking teams/combos, jukes, when to go for a fight and when not, when to farm and when to join teamfights and so on)
=> ask for a mentor in the training grounds or join the 'epoch project' (use search function here), there are lots of ppl willing to help new ppl or like in your case ppl who get back after a long break from the game.
Dont waste too much time on the forums or thinking about ****. go practice like a fu..ck..ing shaolin monk until you achieved what you WANT(ed) to achieve.
When you get stuck - stop playing for 1-2 weeks. this really helps (!!!)
I think you should apply to the project epoch clan. They have people that would be willing to help you regain your lost skills.
Go in the bathroom; turn off the lights; close your eyes; put your head down and say "get good" rinse and repeat for 1 week.
This right here, is the quote of the month.
Seriously though, you need to perfect your lasthitting capabilities, learning when to gank and when not (like if you're laning mid you should always push your lane at the 1:30 , 3:30, 5:30 etc so you can go grab the rune and gank) etc.
Also, watching both your replays and other peoples can make you inprove significantly.
I know the best thing for learning how to last hit...it is really boring but it helps A LOT...
so, basically you go into practice mode and pick a hero with bad attack animation and/or low damage....u buy no items, u get urself no levels and u just go to the lane...
i forgot the ratio but it's solid/good if u have arround 80 killed and 30-40 denied...(not sure on the ratio...long time since i did that)
after u think you mastered last hitting (like it's ever possible but u know what i mean) u can do ultimate challenge...
get that creepscore with maliken-> go into practice mode, pick maliken, give yourself level 7 and take lvl 4 green sword...u will have less damage than ranged creep and that is really really really hard...especially when 2 catapults come .D


text:
Number one: The Bridge
Ten Swedish things you should be talking about
December 12, 2013
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People with incomes of less than $57,000 per year can file their annual income tax forms for free, U.S. Rep. Richard Hudson will remind taxpayers in Lumberton today.
Hudson will appear with representatives of the Internal Revenue Service and N.C. Department of Revenue to promote the Free File program. This provides eligible taxpayers free use of name-brand tax software products through a partnership between the IRS and tax software companies.
Taxpayers with an adjusted gross income of $57,000 or less in 2012 - 70 percent of all taxpayers - can use Free File, a release says. It helps them save on the cost of tax preparation, and allows them to claim credits and deductions for which they are eligible.
Following the briefing, the Computer Communications Industry Association will hold a Free File Training workshop open to the public.
The event starts at 11:30 a.m. at Robeson Community College, 5160 Fayetteville Road, Building 14, Room 1453A, in Lumberton.
For more information about NC Free File, go to taxprephelp.org or dornc.com, click on the efile logo, then Free or Low Cost Electronic Filing Options.
- Paul Woolverton
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Hudson Health Plan to Recruit Medical Practices for a New Initiative to Improve Patient Health
Centers for Medicare & Medicaid Selects Hudson to Join a Groundbreaking Multi-Payer Initiative; Primary Care Practices Will Earn Higher Fees for Coordinating Care for Patients
TARRYTOWN, N.Y., June 19, 2012 /PRNewswire-iReach/ -- Think about what irks patients about doctor visits: hurried exams and no time to talk. Then think about what irks physicians: no reimbursement for practicing preventive medicine or for taking the time to coordinate patients' care with specialists. Finally, think about what irks everybody: spiraling costs and inconsistent, fragmented care. Now, Hudson Health Plan is participating in a new Comprehensive Primary Care (CPC) initiative that will address those problems in New York's Capital District-Hudson Valley Region. Hudson expects the initiative will create a win-win-win situation for patients, providers, and payers, alike.
"The current system of primary care isn't working, particularly for people with chronic illness. Someone has to coordinate their care, and their primary care physicians are the ideal people to do that," explains Georganne Chapin, President & CEO of Hudson, a community-based not-for-profit managed health care organization. "But there is something dreadfully wrong in expecting primary care physician groups to assume this responsibility without reimbursement. Paying primary care physicians a care management fee will give them the means to keep patients in better health at a lower overall cost."
The CPC initiative is a multi-payer project organized by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. On June 6th, CMS announced that it had finalized a memorandum of understanding with Hudson Health Plan and five other insurers in New York's Capital District-Hudson Valley Region in which the insurers and CMS agreed to provide incentives to primary care practices that coordinate care for patients. For example, CMS, which pays for Medicare services, will pay physicians an average of $20 monthly for each Medicare patient.
In addition to financial incentives, Hudson and the other private insurers willcollaborate closely with providers to leverage shared data. Insurers have agreed to work together to develop standardized reports, with the ultimate goal of aggregating all payer patient data into one report.
CMS, which also plans to share any cost savings with providers as a further incentive, anticipates that enhanced payments will allow doctors to spend more time with their patients and – most importantly – coordinate their care. With nearly half of all Americans living with at least one chronic health condition, according to the Commonwealth Fund, there is an urgent need to coordinate their care over multiple settings. A Commonwealth Fund survey found that 23% of respondents with chronic conditions saw four or more doctors during the last 12 months. Doctors struggle to collaborate in caring for a mutual patient, and primary care physicians, often the least compensated in the system of care, are not reimbursed for this task. "If more primary care physicians were able to effectively coordinate the care of chronically ill patients, there would be less chance of the patients falling through the cracks," Ms. Chapin notes.
Strength in Numbers
Hudson has been a leader in working with providers to improve health care quality since 1999, when it became the first health plan in the region to offer pay-for-performances bonuses to practices that met or exceeded quality standards. But Hudson's incentives compensated providers for only its members, not the entire practice. While there was some spillover effect that improved the quality of care for other patients, the incentives weren't sufficient to transform practices. "An incentive program really needs to cover a large percentage of a provider's practice to support real changes in the way care is delivered. This initiative will cover about 60% of all patients in each practice to encourage providers to change," points out Janet Sullivan, MD, Chief Medical Officer at Hudson.
Now the CPC initiative care coordination fees and the quality reports, collected from multiple payers, will cover the majority of patients. Primary care providers will be able to invest in health care technology and connect to networks of specialists and hospitals so they can collaborate on patient care. "Practices will have the means to share and analyze data which is the backbone of effective care coordination," says Catherine Clancy, Senior Vice President and Chief Strategy Officer at Hudson.
Provider Deadline Is July 20th
Hudson has begun to talk about the initiative to primary care providers in its service area of Dutchess, Orange, Rockland, Sullivan, Ulster and Westchester counties. To qualify, primary care practices must agree to provide enhanced services for their patients, including offering longer and more flexible hours, using electronic health records; delivering preventive care; coordinating care with patients' other health care providers; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases. Primary care providers are invited to check their eligibility using an online pre-screening tool. Applications will be accepted until July 20, 2012.
Ms. Chapin believes the initiative will allow primary care physicians to spend more time doing what they do best: talking to patients face to face and engaging them in caring for their own health. "Physicians want to help people live healthier lives and take better care of their health," she says. "We are finally giving them a chance to do it."
About Hudson Health Plan
Hudson Health Plan is a community-based not-for-profit health care organization that provides state-sponsored Medicaid Managed Care, Child Health Plus, and Family Health Plus insurance coverage to over 115,000 members in New York's Hudson Valley. Hudson uses every government dollar it receives to fulfill its mission, which is "to promote and provide access to excellent health services for all people." Hudson improves the health of its members and the communities in which they live through its innovations in care coordination, and by supporting over 5,000 local health providers. In both 2009 and 2010, Hudson achieved the highest quality incentive scores of any Medicaid plan in New York State, and in 2010, it received the highest overall performance rating of any Medicaid plan in the Hudson Valley. It also has earned the highest ratings in overall satisfaction among Medicaid Managed Care members in the Hudson Valley region every year since 2003.
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I use these on my single speed 29er on the trails around Phoenix and they rock! The dual (or triple?) compound is perfect for this area. They're durable, light, they corner well, provide great traction... I mounted them on my Sun Charger Pro tubeless rims and they went on and sealed as easy as any tubeless tire I've encountered.
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This is the front tire that came on my new Yeti SB-66. The rear is a Schwalbe Racing Ralph. After about two months of use I am very satisfied with them. They're lightweight, have excellent grip and are tubeless ready. The only negative with Schwalbe tires is their price. Having said that, when it's time to replace my tires, I most likely will go with Schwalbe again.
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So far I've been really happy with these. Going around a really tricky high speed corner, I hit my back wheel on a sharp rock, hard enough to get a flat. Good news was the tire was totally fine and so was the rest of my bike. I have yet to test these in thick mud but on everything else (e.g. rock, loose leaves, pine straw, dirt) they've been great. No complaints!
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Makes a great front tire with a nice combination of predictable handling and good rolling resistance.
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We love cars. So we understand why you own your collector car, and we give you insurance options that make sense for how you use it. Our range of products can accommodate any owner's needs — from dedicated collectors to someone in love with just one classic — with prices and knowledgeable service that leave conventional insurers in the dust. With Hagerty, you get:
Our rates are significantly lower than the companies who insure your regular-use vehicles. Hagerty offers the best coverage — a full coverage policy that includes comprehensive, collision and liability — and the best service out there, all at an affordable price.
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From the person who services your policy to the person who handles your claim, every Hagerty employee that you encounter is knowledgeable about collector cars and insurance. We all go through collector car training, we support the hobby with youth initiatives and legislative advocacy, we keep experts on staff to answer your toughest questions — all because we genuinely care about your needs and want to provide you with the best possible car-owning experience.
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Your Hagerty policy is designed specifically for you, your car and your participation in the hobby. We have coverage to meet your needs whether you own one car or one hundred, are restoring a vehicle, travel with your car, collect automobilia, or own valuable spare parts or tools.
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All coverage not available in all states. This is only a general description of coverage. All coverage is subject to policy provisions, exclusions and endorsements.


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Police: 3 shot in apparent murder-suicide in Md.
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Foundation commits $1M for business grants
Reproduction of 'The Thinker' stolen from campus
A 2-foot-tall, 100-pound reproduction of Rodin's "The Thinker" has gone missing from a college campus.
Salisbury teaming up with Estonia on cyber
Salisbury University is teaming up with the Tallinn University of Technology in Estonia for a new academic program on cybersecurity.
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Maryland Senate candidates debate on economy
Four candidates for U.S. Senate in Maryland debated on Wednesday about how to improve the economy and health care during their first such meeting.
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3 percent tuition hike approved for University of Md.
The university system's Board of Regents approved a 3 percent tuition hike for in-state students. Students who go to Salisbury University will see a 6 percent increase.
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Engineer pushes to create bike lanes in Salisbury
If Matt Drew gets his wish, Salisbury might soon have bike lanes connecting the downtown area and the Salisbury University campus.
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Salisbury U. gets $2M for English as 2nd language
Salisbury University has secured a $2 million grant to continue funding courses that help local teachers reach students who are learning English as a second language.


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A group of South Florida medical responders are returning home Sunday and Monday after spending two weeks assisting with Hurricane Sandy recovery in New York.
The team of doctors, nurses, pharmacists, paramedics and mental health experts are expected to arrive at local airports.
While in New York, the medical responders staffed a field hospital in Long Beach providing first aid, triage and medical care.
The team is part of the National Disaster Medical System, a federal network that provides assistance in case of a natural disasters or other catastrophes, where area medical facilities are stretched to their limits.
The team that assisted in Sandy recovery is comprised of medical professionals from Broward and Palm Beach counties.
They represent personnel from Broward Sheriff Fire Rescue, Coral Springs Fire Rescue, Pembroke Pines Fire Rescue, Hallandale Beach Fire Rescue, Davie Fire Rescue, Boca Raton Fire Rescue and Palm Beach County fire rescue departments.
The medical personnel on the team are from Broward Health, Memorial Healthcare System, Boca Raton Regional Medical Center, West Boca Medical Center and Palms West Hospital.


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The campaign to this point has been an exquisitely miserable one. Maybe it's inevitable, given all the hype, that when you put any two people on a stage so vast, they are going to come across as smaller than life. But not last night.These two people could not possibly be any more different, they despise each other, and both of them, especially Republican Scott Brown, had no problem letting it be known.
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What I've got so far for Chapter 1, mostly unedited. Uh, enjoy? :P Feedback much appreciated.
Birds twittered softly in the distance as the sun sleepily raised its head over the hills. Soft golden light illuminated the country side, and poured in through a murky window. Inside, a girl stirred underneath the heavy blankets.
Fawn slowly felt herself waking up as the warmth washed over her, and immediately wished it would stop. She rolled over to try and shield her eyes from the light, but only succeeded in disturbing the blankets and sending dust motes swirling through the air. One of them flew up her nose, and she sneezed violently.
Well, at least she was awake.
Yawning, she threw her legs over the side of the bed and rubbed her eyes. She stumbled as she made her way across the vast, mostly empty room that looked like it had a good clean in years - probably because it hadn't. The old floor creaked with every step Fawn took, and she groaned, hoping she didn't wake anyone up.
Why did old houses have to be so noisy, anyway?
Hopping as she pulled on a pair of old pants that were definitely becoming too tight for her, Fawn smelt something wafting up from downstairs. Rich and bittersweet, Fawn would know that scent anywhere- coffee. They had coffee.
She was still tugging a shirt on over her singlet as she bolted down the stairs, and nearly ran into a wall as she pulled it over her face. On any other morning, Fawn would curse her clumsiness, but the only thing running through her mind was the word coffee. Coffee, coffee, coffee.
They had coffee.
Fawn tumbled into the kitchen, not bothering to slow down before slamming herself down in a chair. "Morning, Lachie," she chirped in between pants.
Lachie turned around from the counter and carefully carried two steaming cups over to the table. "Why can't you be this pleasant every morning?" he sighed as he set her cup in front of her.
Ignoring his jibe, Fawn tousled his thick brown hair. He scowled. She knew he hated it when she did that.
The coffee was watery and weak- no milk or sugar- but it was still the best thing Fawn had tasted in months. Rarely did they have coffee, and when they did it was usually all gone before she got any.
"Have I ever told you you're my best friend?" Fawn crooned as she sipped at the drink.
"Every time I feed you." Lachie laughed, and his dark hazel eyes crinkled at the corners.
Fawn sat back in her chair and felt the caffeine pump through her veins, savouring the sensation. She closed her eyes and listened as Lachie drummed his fingers on the table. His nails made an annoying tap, tap, tap as they hit the table, and Fawn couldn't help but feel jealous. A nervous nail-biting habit left her with unsightly, stumpy nails.
"So, how long have you been awake?" she asked, her eyes still closed.
"Oh, about an hour or so." Tap, tap, tap, tap. Fawn wished he would stop that.
"Do you ever sleep?"
"I can sleep when I'm dead."
Fawn shot up and grabbed his wrist, stopping the tapping. "Don't say that!" she snapped.
Lachie blinked, looking dumbfounded. "What?" he grumbled, seizing his hand back.
"Nothing," Fawn murmured, looking down. Her cheeks grew hot. Fawn would never admit to Lachie that the thing she feared most was him dying. He would only laugh at her.
But to be truthful with herself, Fawn really was scared for him. Every single time they went out to gather supplies, something dark and cruel in her mind stirred and she found herself picturing him with an arrow through his head or a blade slicing his throat. If he died, she would have no one.
Sure, Fawn liked the rest of the group. They took care of each other, and got along just fine. But Lachie was her only true friend.
"Morning, you two."
Fawn turned in her chair to see Oliver, their group leader standing in the doorway. He had to duck his head as he walked through.
"Listen," said Oliver, clapping his hands together. He always skipped pleasantries. "I need you guys to go out tonight and get some supplies. We're gonna be out in a few days."
Fawn spat her coffee back into her cup mid-sip. Unfortunately, she breathed before it was all in the cup and started coughing violently. "Are you kidding?" she asked incredulously as her coughing fit subsided. "The summer markets have barely finished!"
"Well, yes. But you should be fine if you go at night." He pulled up a chair next to Lachie and clapped him on the back. "Besides, I'm sending my two best thieves, aren't I?"
Lachie puffed his chest out proudly at Oliver's less-than-subtle attempt to win them over, but Fawn just felt even less inclined to go. She hated the word "thief". It made feel like a lowlife. Like a criminal. Like a… thief.
"Come on," urged Lachie. "We'll be fine, Fawn."
Reluctantly, Fawn said she would go. Her heart curled lower, out of her ribcage, making itself comfortable in her stomach.
Fawn barely registered as Oliver's wife Sarah shuffled into the kitchen, followed by Lauren, a girl roughly Fawn's age, and her post-adolescent brother Thomas.
The hands of the dusty kitchen clock, still working by some miracle, crawled past slowly. Eventually, the sun set, and the cool of the night sent draughts through the old house.
Fawn and Lachie had been sitting on the floor of the lounge room, playing cards with Thomas. Lauren had been playing, but had immediately thrown her cards down in a fit and left with barely a flick of her ash blonde hair when she lost. Fawn had always found Lauren a bit ridiculous; for someone with so little, she always expected quite a lot.
Looking out the window, Lachie sat up. "Well, I guess we'd better start heading off." He sounded too eager, and his eyes flashed with something that looked suspiciously like excitement.
Fawn and Lachie left the house twenty minutes later with kitchen knives stashed in their belts. As they began to set into the night, Fawn stole one last fond look at the manor.
The safe house sat in a clearing, almost blending in with the forest, as overgrown with vines as it was. Barely visible between the vines was the beautiful violet and white-flecked stone the manor was made of, turned grey-green with moss and age. It had been raining, and the wet mud soaked through Fawn's sneakers, squelching uncomfortably between her toes.
"Brilliant," she muttered under her breath.
Aside from Lachie's heavy breathing beside her, the night was silent. The closer they got to the town, the heavier Fawn's heart grew with worry. When the town lights became visible on the horizon, she almost turned back towards the forest and bolted for the house.
Haven, a large town hugging the coast of the Southern East Island, always attracted tourists from all over the Kingdom when summer hit. Bright stalls and tents were slowly set up, dousing the streets in colour and celebration. People would flock from all over until summer peaked, and the heat would send people packing – but no matter how many frowns could be seen passing in horse-drawn carriages, the people always had the comfort of knowing that the markets would be back again next year, without fail.
The town shone like a beacon in the darkness, despite it being past ten, at least. Most people would be in bed, and those who weren't would be working to pack up the market stalls that lined the streets after a busy week of tourism, haggling and festivities.
It was a dangerous time to be in town, for obvious reasons, but that wasn't the only reason Fawn was avoiding this trip. She had grown used to her lifestyle, where she lived for each day and left no regrets, but seeing so many happy, carefree people stirred a spark of jealousy inside her. They could peruse shops and stalls to their leisure, buying what they pleased, when Fawn would be left picking scraps from bins and sneaking food when no one was looking.
The entire town was surrounded by an eight-foot tall wall made of enchanted white stone, put in place for the exact purpose of keeping normal humans like Fawn and Lachie out. No matter; they had found their way around this obstacle over the years of travelling to and from Haven for supplies.
"Come on," whispered Lachie into Fawn's ear, making her jump slightly as she broke out of her reverie. "This way."
Fawn knew where she was going, but didn't object to being led. The wall was completely circular, with only two entrances in and out, each guarded by enchantments – not to mention the always-alert security guards that were posted there 24/7. Neither of these entrances were part of the break-in plan.
Fawn mentally shuddered at the term "break-in". An image of Lachie and her skulking around in black robber's clothes, half bent over and suspicious-looking, crept into her mind. Well, they were both wearing black – but they walked with straight backs, keeping their eyes wide open and ears pricked, ready for anything.
Lachie stopped suddenly, and Fawn nearly ran into the back of him. A large rose bush grew against the wall, in stark contrast to the white. If she weren't so used to it, Fawn might have stopped to marvel at the beauty of it.
Without saying anything, they both began to cautiously part the branches, minding the thorns. After a few pricked fingers and scratches, they reached the ground underneath the plant. The thick leaves concealed the tunnel here – hand dug by Oliver himself one late winter's night a few years back. It was definitely worth a few scratches to not have to hoist each other over the wall and be left vulnerable, in clear view.
"Ladies first." Lachie winked and motioned with his free hand, the other pushing against the bush, keeping the plant from snapping inwards.
Fawn climbed into the hole slowly, minding where she put her hands and knees. There was no hurry; as long as they both kept kneeling, Fawn and Lachie were completely concealed by the rose bush. The plant left a few parting scratches as Fawn's legs disappeared down into the tunnel.
When they had first started using the tunnel entrance, Fawn had been worried about the dirt crumbling and the tunnel collapsing, burying her alive. After a few trips, she realised that the dirt was really more like hardened clay – Oliver had truly been a saint in digging this for them with his bare hands.
Despite occasionally despising Oliver for sending her on suicide missions like this one, Fawn had to admit that he always did what was best for the group. He had faith in her and Lachie; it was worth having them take this risk so that the rest of the group didn't starve.
The tunnel continued for some time, Fawn and Lachie passing under the feet of unsuspecting citizens. Every now and then Fawn would even her footsteps echoing dully from above. The tunnel stank of earth and rot, and Fawn could barely move her knees and shoulders enough to edge herself along.
Just as Fawn started fearing that the roof would suddenly collapse or that they would be trapped and slowly suffocate to death, she hit her head on something in the pitch black. They'd reached the end of the tunnel. Fawn hastily began feeling the roof above her, her fingers searching for a fault line.
There it was; small and barely tangible, but definitely there. Fawn dug her fingers in around the crack and pushed with her other arm. Her legs shook, struggling to hold her upper body up in such a confined space. The exit finally loosened, and Fawn carefully lifted it up stuck her head out into the night air.
The tunnel ended in the middle of the orchard – convenient and safe. The chances of Fawn and Lachie being sighted by a random passer-by were practically non-existent here, and they could grab food and go without having to walk around in the open.
"Clear," Fawn grunted to Lachie as she hoisted herself out of the hole in the ground. They silently paced up and down the lines of trees, stopped at each one to pick a few pieces of fruit. They had to be careful to make it inconspicuous; no random patches on the tree completely stripped of fruit. That might raise a few questions.
The night was cool and quiet, the far-off chirping of insects the only sound that filtered down through the trees. Fawn's nerves were beginning to abate, but she still watched her footing as she walked, being careful so as to not snap a stray twig underneath her foot. There was no one around to hear it, but you could never be too careful when trespassing on a freak's property- and everywhere was freak's property. With a sinking in her stomach, Fawn frowned. There was truly nowhere they were welcome.


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Take the college student survey to share your opinions about your school and be entered into a $1,000 scholarship!
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F A+F Campus Resources: it is a SCAM turn around save your money@@!!!
D- A+F Campus Resources: Very for all the money we paid at least give our room ligt sockets.
D- A+F Campus Resources: Their selection is so crappy. Overall sorry ass school!!
F A+F Career Services: you cant even transfer your credits from this school because of their accredited its not by wasp.
F A+F Academic Experience: They have this teacher name Flores that teaches 6 classes. She is very unprofessional. She wishy washy.. Tell you one thing and test you on something that she said wasn't going to be on the test.
F A+F Academic Experience: This school is awful!!! Consumers beware!!! Fraud Alert!!!!!!This school is so shady everything they tell you is all twisted somehow!!!They tell you when you meet with one of the counselors that you are getting quality education for the money your are spending with them. Dina the counselor said that the school will help you if you are struggling! BS! They will help you reach deep into your pockets and snatch the green right out of your hands! The dean Dr. Bralock promises you that they will bring in tutors to help you. She promised me that they have a thing called remediation that once your grade starts to hit lower then 83 percent they will put you in remediation. During my meeting with Dr. Bralock on my second interview to make it into the school she said, "Remediation is something that we have at this school that will help our students if they are struggling." Yes people they do have Remediation to help students!!! What it is they make you sign a piece of paper saying you are at 83 percent in the class. You are in jeopardy of failing. And that it! There is your help Dr. Bralock promises you. She forget to mention that they have this horrible teacher name Professor Tracy Beltran Flores. If you still think that this review is Bull Ish ask the girl in the front desk name is Christine. Or even ask Dina or Dr. Bralock when she interviews you. If they have a teacher with this name, and see what they tell you. She so bad many students complain about her and her teaching style. But the school and the administration don't even care of your complaints. The school doesn't care because Professor Flores teaches around 6 to 8 classes. Yes that is correct! She teaches Patho, Gerontology, Intermediate Med Surg, Advance Med Surg, Life Span, and a couple of Labs. Wow that is a lot of information that this teacher is taking on and TRUST ME PEOPLE she mixes up all the info from each class. She will tell you that this part of the lecture you don't need to know for the test example strictly definitions only just go over the bold face in the book I'm not going into depth on this test. And what do you know on test day the class average is in the 50's!!!! She'll tell you on her lecture, diabetes you will have to know front and back there no way around it pretty much you must know it like the back of you hand, and on test day oop she ask 3 question on diabetes! Wow! really! This should be clear as mud she always says!! One of her favorite lines! I think she was describing her teaching style! Anyway back to this corrupted school... Dina the counselor was going around telling students that the school will give any student 5 community hours to each student that goes on the internet and leaves a positive review about AMERICAN UNIVERSITY OF HEALTH SCIENCE,.. AUHS... not so Christian like they advertise. Let me also mention that this school is not accredited by the right governing body.. Which means if you want to transfer your credits say into Cal state fullerton or any other university they will deny you because they don't care about CCNE like the school keeps bragging about. Shoot they even had mandatory meetings with all the students bought us food to coach us on what to say when the officials from CCNE came to check the school out. What a crock of s***!!! By the way if you are planning to advance into your masters program it won't happen at another school! because AUHS isn't accredited with WASP! Yeah you could get your masters at American University of Health Science so plan on living in Long Beach for the next 6 to 8 years because other school will tell you sorry cant do nothing about it. And if you fail out good luck with the 100k debt the AMERICAN UNIVERSITY OF HEALTH SCIENCES leaves you with because the credits you take here will not be transferable! IF YOU DONT' BELIEVE ME CHECK WITH OTHER SCHOOLS!!!! PRETEND THAT YOU ATTEND AUHS AND ASK THEM EMAIL A NURSING COUNSELOR FROM ANOTHER SCHOOL THEY WILL REPLY TO YOU TRY IT!!! It won't hurt anything you are investing 100k to this sorry A** school.I COULD KEEP GOING ON ABOUT THIS CROOKED SCHOOL BUT I WONT DO YOUR HOMEWORK AND BACK GROUND CHECK ON THIS SCHOOL BEFORE YOU THROW YOUR MONEY AWAY!!!! I didn't and I regret it!!!!!
A+ A+F Campus Resources: we have a fully stocked library , computers , and staff always around when you need them
A A+F Campus Resources: very nice school , friendly staff , loving and caring teachers.
Online Courses: Unfortunately, my college hasn't offer any online courses yet; therefore, I'm unable to answer this question.
B A+F Student Body: The Student Bodies at my college are very hard-working students. Most of which I know dedicate a lot of hours to stay on campus to plan and prep events for school eventhough they have jobs and family. As nursing students they want earn a reputation and given a title in honor of their hard work and efforts. This will help each of them get a job in the medical field once other people are aware of who they are and what they did in addition of being a diligent, hard-working students.
A A+F Online Courses: They use Hybrid classes, on-campus and online, for many of the subjects. The system is easy to use and submit work to.
B A+F Academic Flexibility: You get what you pay for. The school warns you that they are not very flexible when it comes to scheduling since they only offer 1 class for the subject you need per quarter. So do not expect this to be like a community college or large college that offers 10 different English 101 classes; they offer only one. If you need it you have to schedule your life around school.
B- A+F Academic Experience: Cost is high however the classes you need are guaranteed to be offered. The school specializes in nursing and pharm D degrees so the health sciences and math courses are very thorough. Due to the small size of the school you simply have to take the classes that they offer, if your schedule does not match up there is no way for you to schedule the same class later or on a different day. This is why they suggest you do not work while in the BSN program.
B+ A+F Campus Resources: Since campus is smaller, all students have more ways to interact with other and participate in a more intimate holiday parties. Volunteer services for all students to assist the whole community.
A- A+F Campus Resources: There is a library that is open from 8-7 for students to use computers and printer service. Also, there is wifi- but many times there are slow connection when many people are on at one time.It gets frustrating but it is still workable.
B+ A+F Tuition & Financial Aid: Other than the cost for education, there are usually delays in the financial aid department, such as when it is time to receive our cost of living checks. So our daily living cost is also delayed.
A A+F Student Body: Students Interaction – Students at AUHS are very approachable. If you have any problems with your classes, you could easily ask them about it. AUHS is a great school. At AUHS, time will not be wasted. Think about going to City Colleges, how many years are you going to wait? Instead of waiting you should have just enrolled at AUHS and get done with everything. Then you will work and will be able to pay off for your loans. I am so happy and contented at AUHS. I don't have any regrets going here. Everyone is very approachable and helpful. They really want you to be successful. As a whole, it is still up to you want you to be in the future. If you do well then you will get what you want. So if you decide to go to AUHS, expect that you will be spending your 3.5 years studying.
A+ A+F Campus Resources: small classroom settings for personal help for one on one communication between student and teachers and library accessible
A A+F Overall Experience: I applied to AUHS in October 2011 for their spring semester of 2012. I recently got accepted into their BSN program and i start at the end of march 2012. My application was tough because of all the due dates but AUHS was well organized with due dates. Overall my experience so far with AUHS has been great but i am afraid of all the payments that are to come. i believe this program is around over $80,000 and hopefully by applying for financial aid, and scholarships i will get sufficient help in order to make all payments.
A+ A+F Online Courses: No online courses are offered, only on campus classes. Which I think is best because I feel that a student needs to be physically in class to learn about nursing topics.
A+ A+F Campus Resources: What sets my school apart is that they focus in helping minority students earn a Bachelor's degree in nursing without wait-listing. American University of Health Sciences focuses on the one-to-one relationship with their students. Many schools report to have that attention, but AUHS really does focus on ways to have their students succeed in the program and once they graduate.
A+ A+F Career Services: Post-Grad Services – At NSCC there are always career workshops going on, and professors always advise students to talk to Advisors if they have worries about a class or career placement.
A+ A+F Student Body: Students Body – The students body is very organize. ALthrough there are no sports actives on the campus, the students body tries hard to come up with new actives every day. I know this because I always participate.
B A+F Online Courses: Don't Procrastinate! I have a bad habit of procrastinating a lot, especially with online courses thinking I still have the whole day tomorrow to finish up 1 week worth of homework. Personally, I don't like taking hard classes online because without the supervision of a professor, I don't read the material.
B+ A+F Academic Experience: A Little to Strict – The staff are a little too strict but it's a good thing. If a student is averaging a 70% in the class, they are mandated to take one-on-one tutoring classes with the professors.
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And we'll all go out to meet Her when She comes.
And we'll all go out to meet Her when She comes.
The Way is always uncontrived. Yet there's nothing it doesn't do. -- Tao te Ching
i never got scared of that threat... ever... as a child...
i remember one time in school one of my teachers cam ein and i bursted out like: hello wassup man
and the teacher got all pissed and took my books and otok em to the deans office
and said he was gonna put me in detention for the rest of the year if i didnt say sorry for sayin hello
i spent the rest of my JHS school days in detention (which was a month cuz it was the last month of the year)
but i never gave in or said sorry... lol.. ihate authority without integrity or balance.
What if She can only come when enough people have awoken to the fact that she's been inside of us the whole time?
What if you slept? And what if, in your sleep, you went to heaven and there plucked a strange and beautiful flower? And what if,when you awoke,you had the flower in your hand? Ah, what then?
― Samuel Taylor Coleridge
Optimystic (07-23-2010)
I never scolded my son for telling me when he did wrong. He knew that he could come to me and confess and I would help him work it out. I did, however, get tough on him for any lying or deceptiveness. As an Indigo I despise lying more than anything. I can't even watch actor being deceptive on TV shows anymore it bothers me so much.
I revere integrity and character. Telling the truth is such an undervalued virtue. I have more respect and admiration for a murderer who tells the truth than a clean cut leader who lies through her teeth.
Sorry for derailing.
" All the problems of the world can be solved with a garden." Geoff Lawton
lmao i think he knew i was different from the group but wanted to break me.. mentally... the dean tried it.. a lot of teachers tried.
my fam told me my pops tried to break me too cuz he would try to give me a spanking and i would just stare at him, no crying, nothing
and it made my pops more mad lol
only time i would cry is when my moms came in the room and said stop (obviously i dont remember this but this is what they tell me.. my mother & sister that is)
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lmao i dunno but i know i was in detention that whole month and i never apologized.. and even tho i knew i was in trouble, i was proud cuz i didnt give in and apologize for saying hello to a teacher...lmao
Hence my mission of the week.
The Way is always uncontrived. Yet there's nothing it doesn't do. -- Tao te Ching
Well there was that time that the X-men attacked the HARP facility, and I almost didn't make it out alive. Morph was captured, and Wolverine was going ballistic, and I just didn't even want to TRY to calm that motherfucker down (especially when he's got the pointies out).
The Way is always uncontrived. Yet there's nothing it doesn't do. -- Tao te Ching
You can't derail a runaway train.


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You're watching...
Dietze: Obama's Agenda Favors Tech
David Dietze, Point View Wealth Management, on President Obama's second-term agenda and how it impacts the market.
Jan 22, 2013
You're watching...
David Dietze, Point View Wealth Management, on President Obama's second-term agenda and how it impacts the market.
Jan 22, 2013
Also in this playlist...
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-- -- President Obama tries to push -- his agenda for the next four years what can you do to make some money.
Right now for these next four years David -- -- you know management president chief investment strategist.
Joins me now first let's talk about where we had dinner last four years you look at the Dow the last four years.
We -- 65%.
S&P gained 75.
Per -- are you bullish about the next four years for the markets.
Yeah I am fundamentally I think we're a little overbought here but basically.
The Federal Reserve has done a masterful job at depreciating the value of our concern currency.
Lowering interest rates to the point where is now pushing asset prices not because.
Money it earns nothing -- a bank account there's nothing -- -- Money is going into stocks is going into longer dated bonds is starting to go into houses last year -- -- first here's to 2000 stick to the housing prices up so I think of that is wanted to keep the -- to -- down the money's gonna continue to follow the stock.
But but one of the things that has been a volatile sector in the last four years has been energy sector whether tighten about -- what you're talking about alternative -- after -- here's the thing coal stocks you say needs due to walk away from this group -- gonna be more pressure in this group -- this process yeah.
Absolutely and we heard from mr.
Obama's inaugural speech yesterday basically he renewed his push for clean energy and of course you start thinking about what's -- thirtieth energy out there and that's call in of course the other thing that's happened is because of the new technologies the so called fracking technologies have pushed down the price of natural gas that's also made coal.
Less economical so again.
Given mr.
Obama's initiatives and given where we are -- -- -- we would steer clear of.
Cole okay and another group that you do alike and that has been performing amazingly in the last -- your -- the technology sector if you look at the group over the last four years under this president -- up a 100%.
Whether he can take credit for that or not I'm not gonna say.
But you still say the technology is a positive were getting apple numbers tomorrow Google's coming out this week you're saying go for the tac.
Yes absolutely I mean detectives actually a little out of favour now because some of the larger legacy -- -- Microsoft's your Intel even your IBM's Hewlett-Packard.
Had an off here there's a lot of focus on apple but now of course we're seeing -- not everyone does want an iPhone 5 I don't some thought about galaxies out -- -- we think.
Given the superior dividends in the tech space in the fact that Intel Microsoft they've been growing those dividends double digits of the -- I did I think.
Given you know the continued need for more technology that you're gonna see more investors push into that area and we think that's an attractive.
All right see you look at Ford apple -- looking forward to Google but Intel disappointment -- your -- out of and yeah absolutely but you.
It seems to me it was over done by investors they told us what we already knew which is they don't have the foothold quite yet in the chips for the mobile sector but you know they're spending about seventeen billion.
Com into the research and development they'll get there.
On top of that people were cautious about -- capex plans right nevertheless you're enjoying a four point 4% dividend.
Given that the ten year treasury at one point eight that's track.
Last sector the but I -- wanna go through that is health care and that is indicative the president's health care legislation which was passed through in the last term going forward though.
What about the big pharmaceutical names what -- -- Johnson & Johnson why not your -- are these names to bet on.
In the next four year.
Well I you know basically -- and he basically I think.
We've heard in mr.
Obama's speech that there's still going to be Medicare for all every one need to health care safety net.
Nevertheless of course he did allude to the cost of it so you do need to be careful that -- -- -- price controls put on.
Your proprietary drugs some some of those concerns are already the stock kept above average -- -- of course pick up the global reach a lot of other countries want to cut health right we -- so basically fundamentally the -- and fighters and -- -- in this world we do like.
Dumb -- about Ambien David that's telling us man I want David -- thank you very much for coming into the CNN has always been.
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- With Mayo Clinic neurologist
Jerry W. Swanson, M.D.
read biographyclose windowBiography of
Jerry W. Swanson, M.D.
Jerry W. Swanson, M.D.
Dr. Jerry Swanson is a board-certified neurologist at Mayo Clinic in Rochester, Minn. He is also board certified in headache medicine and is a professor of neurology at College of Medicine, Mayo Clinic. He has a special interest in medical education.
Dr. Swanson, a Lacon, Ill., native, was appointed to the Mayo Clinic staff in 1982 and works in the Department of Neurology with more than 90 other physicians. He formerly chaired the department's Division of Headache and continues to work with headache subspecialists around the world. He has published and lectured widely on headache disorders. He also serves as assistant dean for assessment at Mayo Medical School.
"In a manner similar to the printing press, Internet technology enables the unprecedented ability to communicate with the global community about health information," Dr. Swanson says. "There is no doubt that the knowledgeable individual contributes greatly to his or her own health care, and now we can share information much more widely.
"There is much information already available about health care on the Internet. Unfortunately, much of it is not founded on sound principles. It is exciting to be a part of the web team and contribute to the creation of a reliable and timely health resource."
Dr. Swanson is the neurology editor for "Mayo Clinic Family Health Book" and has reviewed articles for "Mayo Clinic Health Letter" and "Mayo Clinic Women's HealthSource." He is also editor-in-chief of the "Mayo Clinic on Headache" book, published in 2004. In 2008 the magazine Women's Health named him one of America's Top Doctors for Women. In 2011 he received the Mayo Medical School Dean's Recognition Award for his contributions to undergraduate medical education.
Definition (1)
- Demyelinating disease: What causes it?
Symptoms (1)
- Multiple sclerosis: Can it cause seizures?
Treatments and drugs (1)
- Acetyl-L-carnitine: Can it relieve MS fatigue?
Lifestyle and home remedies (3)
- Is pregnancy safe if you have MS?
- Is there a multiple sclerosis diet?
- Vitamin D and MS: Is there any connection?
Vitamin D and MS: Is there any connection?
Is there any proof that vitamin D supplements can prevent MS or keep symptoms of MS from worsening?
from Jerry W. Swanson, M.D.
A study conducted by researchers at the University of Oxford and another conducted at the New Jersey Medical School have suggested that maintaining adequate levels of vitamin D may have a protective effect and lower the risk of developing multiple sclerosis (MS). Another study conducted at Maastricht University in the Netherlands and others suggest that for people who already have MS, vitamin D may lessen the frequency and severity of their symptoms. More research is needed to assess these findings.
When a person has MS, his or her immune system attacks the coating that protects the nerve cells. Research suggests that a connection between vitamin D and MS could be tied to the positive effects vitamin D has on the immune system.
The link between vitamin D and MS is strengthened by the association between sunlight and the risk of MS. The farther away from the equator a person lives, the higher the risk of MS. Sunlight is the body's most efficient source for vitamin D — suggesting that exposure to sunlight may offer protection from MS.
Screening for vitamin D deficiency is important for African-Americans and other ethnic groups with dark skin, due to decreased natural production of vitamin D from sun exposure.
The Institute of Medicine recommends 600 international units (IUs) of vitamin D a day for adults ages 19 to 70. The recommendation increases to 800 IUs a day for adults age 71 and older.
Some doctors question whether these levels are adequate and think that getting more vitamin D would benefit many people. However, the Institute of Medicine recommends that adults avoid taking more than 4,000 IUs a day.
If you are diagnosed with vitamin D deficiency, it may be appropriate to use up to 50,000 IUs weekly for up to three months until your vitamin D levels become normal, and then switch to a maintenance dose.
Very large doses of vitamin D over an extended period can result in toxicity. Signs and symptoms include nausea, vomiting, constipation, poor appetite, weakness and weight loss. In addition, vitamin D toxicity can lead to elevated levels of calcium in your blood, which can result in kidney stones.
If you're concerned that you're getting too little — or too much — vitamin D, talk with your doctor about what's right for you.
Next questionDemyelinating disease: What causes it?
- Raghuwanshi A, et al. Vitamin D and multiple sclerosis. Journal of Cell Biochemistry. 2008;105:338.
- Ramagopalan SV, et al. Expression of the multiple sclerosis-associated MHC class II allele HLA-DRB1*1501 is regulated by vitamin D. PLoS Genetics. 2009;5:e1000369. http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.1000369. Accessed July 26, 2010.
- Pierrot-Deseilligny C. Clinical implications of a possible role of vitamin D in multiple sclerosis. Journal of Neurology. 2009;256:1468.
- Smolders J, et al. Vitamin D status is positively correlated with regulatory T cell function in patients with multiple sclerosis. PLoS One. 2009;4:e6635. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0006635. Accessed Mar. 1, 2013.
- Dietary supplement fact sheet: Vitamin D. Office of Dietary Supplements. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/?print=1. Accessed Mar. 1, 2013.
- Dietary Reference Intakes for calcium and vitamin D. Institute of Medicine. http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. Accessed Mar. 1, 2013.
- Vitamin D. The Merck manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/nutritional_disorders/vitamin_deficiency_dependency_and_toxicity/vitamin_d.html?qt=&sc=&alt=. Accessed Mar. 1, 2013.
- Weinstock-Guttman B, et al. Vitamin D and multiple sclerosis. The Neurologist. 2012;18:179.


text: I know that Avril's dance is hot.. I like it.. but... those dancers are just too much for me. I don't think that they fit Avril's music, especially at her concerts (the music video is ok). Avril said that she likes the punches and kicks, but she can do them alone! lol I'm not sure how much important is our opinion.. but I didn't like this dancers idea at all. What do u think?


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Siegel/Simmons: Time for Franson to step up
Ferraro on Scrivens sitting, Leafs/Kings
Dilfer on RG3/Shanahan, McCown vs. Cutler
Stark: Availability of Rasmus, Tanaka suitors
McKenzie: Outdoor games in Winnipeg/Phx?
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Stock Quotes
Atlanta 5/08/2012 04:05 PM GMT (TransWorldNews)
DVD And Blu Ray Movie Releases This Week: December 2 – December 6
The Punk Singer In Theaters November 29
Strong Black Woman In Theaters November 28
Maurice Sendak, a popular children's book illustrator and author perhaps best known for the hit classic Where the Wild Things Are, died this week from complications of a stroke he suffered last Friday. A rep for Sendak says the 83-year-old passed away at his home in Connecticut around 3 a.m. Tuesday.
Sendak began his career illustrating books in the late 40s. He soon began writing and illustrating his own books and published his first, Kenny's Window, in 1956. Sendak wrote three other books before publishing Where the Wild Things Are in 1963. The book was awarded the Caldecott Medal in 1964 and was adapted into a movie by Spike Jonze in 2009. Sendak's other work includes In the Night Kitchen, Seven Little Monsters and Outside Over There. His last book, Bumble-Ardy, was published in 2011.
When he was not writing and drawing, Sendak designed sets for TV shows, plays, operas and ballets. He lived with his companion, psychoanalyst Eugene Glynn, for 50 years before Glynn died in 2007.
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Primary Location for Dr. Naples
2249 Elm Rd NE
Cortland, OH 44410
Ratings and Reviews for Dr. Robert Naples
GoodDr. Robert Naples has an average rating of 3.5 stars (out of 5) with a rating of Good based on 3 reviews.
If you know and have received services from Dr. Robert Naples, you can rate and review Dr. Robert Naples by clicking the following button.
Board Certification, Specialty and Expertise
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Hospital Affiliations
A hospital affiliation covers any doctor who has an affiliation, association or admitting privilege with a hospital. A doctor's particular affiliation to a specific hospital can translate to the overall quality of that provider.
Dr. Naples is affiliated with 1 hospital:
1350 E Market St
Warren, OH 44483
Dr. Naples attended medical school at Des Moines University College of Osteopathic Medicine and Health Sciences and graduated in 1983 having 30 years experience.Get more education details on your free report
While there is no proven correlation between the quality of one's educational institution and the quality of one's professional competence, it is often an indicator. Medical schools have various levels of selectivity (some are harder to get into than others), and both the quality of their clinical training and level of research are measured. Additional medical training in both residency and fellowships and the facilities they are conducted at also provide a history of the doctors' level of training and experience.
Patients may also know Dr. Robert Naples DO as:
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Naruto-Arena forces you to select 3 characters when you start a new game. This page gives you an overview of all characters available in the Naruto-Arena game. Not only can you view each character's skills, you can also discuss the characters by posting comments.
Tsunade is the Godaime Hokage and a Legendary Sannin. Her skill with medical ninjutsu allows her to do significant damage and heal herself and teammates.
Requirement to unlock: Mission: Disciples of the Slug
Major Summoning Katsuyu
By summoning Katsuyu, Tsunade will heal all allies including herself for 20 health and they will gain 50% damage reduction for 2 turns.
Cooldown: 6
Chakra required:
Classes: Chakra, Instant, Unique
Painful Sky Leg
With her insane strength, Tsunade performs a drop kick on one enemy dealing 30 damage and that enemy has their chakra or ranged skills stunned for 1 turn.
Cooldown: None
Chakra required:
Classes: Physical, Instant, Melee
Creation Rebirth
Tsunade unleashes all of her stored chakra to heal herself returning her health to 100.
Cooldown: 4
Chakra required:
Classes: Chakra, Instant, Unique
Tsunade Replacement Technique
This skill makes Tsunade invulnerable for 1 turn.
Cooldown: 4
Chakra required:
Classes: Chakra, Instant
Posted on December 1, 2013 at 10:22
aldo2001 Posts: 0 |
if you want to my clan pm me..... and you happy in my clan |
Posted on December 1, 2013 at 12:52
lucassero Posts: 0 |
sempre odiei ele por essas regenerações |
Posted on December 2, 2013 at 14:08
lucassero Posts: 0 |
pq nn vem kabuto |
Posted on December 2, 2013 at 15:56
kidou5 Posts: 0 |
ha ha:suspicious |
Posted on December 2, 2013 at 16:06
kidou5 Posts: 0 |
ha ha:suspicious |
Posted on December 2, 2013 at 19:51
davidsonn Posts: 287 |
Fala galera Estou recrutando para o clã Kuro No Kishidan - Br Nível atual: 51 Nosso xat: xat.com/knketernal_ Interessados mandar pm para mim ou nara_shikamaru10 ou também pode entrar no xat e procurar por Kohiashi ou faca. Obs: Seja ativo no xat! Obg! |
Posted on December 4, 2013 at 18:26
lucassero Posts: 0 |
por favor,quem usar kabuto eu uso ele por uma semana |
Posted on December 9, 2013 at 17:38
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Open Heart
Kief Davidson and Cori Shepherd Stern
Eight Rwandan children with serious heart disease travel to the Salam Centre in Sudan for treatment.
These are the first Academy Award nominations for Kief Davidson and Cori Shepherd Stern.
Sean Fine and Andrea Nix Fine
Sari Gilman and Jedd Wider
Cynthia Wade and Robin Honan
Jon Alpert and Matthew O'Neill