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From the Dept. of Psychiatry, Univ. of California San Francisco, and the Dept. of Psychology, Sam Houston State University, Huntsville, Tx (rjc).
Correspondence: email@example.com (e-mail).
Received November 16, 2010; Revised May 23, 2011; Revised July 29, 2011; Accepted August 9, 2011.
Objective: Although health professionals increasingly are expected to be able to assess and manage patients' risk for suicide, few methods are available to evaluate this competency. This report describes development of a competency-assessment instrument for suicide risk-assessment (CAI–S), and evaluates its use in an objective structured clinical examination (OSCE).
Method: The authors developed the CAI–S on the basis of the literature on suicide risk-assessment and management, and consultation with faculty focus groups from three sites in a large academic psychiatry department. The CAI–S structures faculty ratings regarding interviewing and data collection, case formulation and presentation, treatment-planning, and documentation. To evaluate the CAI–S, 31 faculty members used it to rate the performance of 31 learners (26 psychiatric residents and 5 clinical psychology interns) who participated in an OSCE. After interviewing a standardized patient, learners presented their risk-assessment findings and treatment plans. Faculty used the CAI–S to structure feedback to the learners. In a subsidiary study of interrater reliability, six faculty members rated video-recorded suicide risk-assessments.
Results: The CAI–S showed good internal consistency, reliability, and interrater reliability. Concurrent validity was supported by the finding that CAI–S ratings were higher for senior learners than junior learners, and were higher for learners with more clinical experience with suicidal patients than learners with less clinical experience. Faculty and learners rated the method as helpful for structuring feedback and supervision.
Conclusion: The findings support the usefulness of the CAI–S for evaluating competency in suicide risk-assessment and management.
The national emphasis on attainment of competencies in the education of healthcare professionals has created a need for methods to assess competency in specific skills (1, 2). Competency in suicide risk-assessment and management is expected of mental health professionals, including psychiatrists, psychologists, social workers, psychiatric nurse-practitioners, and others (3, 4). According to the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology (ABPN) (4–6), assessment and management of risk for suicide is a core competency for psychiatrists. Moreover, calls have been made for increased training of primary-care providers in recognition and management of suicide risk, in light of research showing that approximately half of American suicide victims had contact with a primary-care provider during the month before their death (7). Although many programs have been developed to teach clinicians about working with suicidal patients (8–11), our literature review identified no published methodology for assessing the competence of individual clinicians in evaluation and management of risk for suicide.
This report describes development and evaluation of the reliability, validity, and acceptability of a method for assessing competency in suicide risk-assessment and management. We identified pertinent domains for a competency-assessment instrument for suicide risk-assessment (the CAI–S) on the basis of a literature review and focus groups with faculty from multiple sites in a large academic psychiatry department. We applied the CAI–S in the context of an objective structured clinical examination (OSCE) (12, 13), in which psychiatry residents and clinical psychology interns performed suicide risk-assessments of a standardized patient while observed by faculty members. The faculty rated learners' performance and provided feedback according to the structure of the CAI–S. We addressed the following questions about the CAI–S: What is its internal consistency, reliability, and interrater reliability? Do senior learners perform better than junior learners? Do learners who have more clinical experience with suicidal patients perform better than trainees with less experience? How satisfied are faculty and learners with this method of assessing competency in suicide risk-assessment and management?
We developed the CAI–S based on review of the literature on the standard of care in suicide risk-assessment and management (14–18), adaptation of criteria for evaluating the quality of suicide risk-assessment developed in a previous study of the effects of training on risk-assessment (11), and review of the literature on measurement of competencies in medical education (6, 12, 19–23). To further enhance the content validity of the CAI–S, we incorporated feedback on drafts of the measure from focus groups composed of clinical faculty at each of three sites of a large academic psychiatry department; these were 1) a county hospital, 2) a Veterans Administration hospital, and 3) a university hospital. The focus groups discussed factors that they felt were important for trainees to master in performing a competent suicide risk-assessment, including both content-related information (e.g., asking about suicidal ideation, knowledge about local civil commitment laws) and process-related issues (e.g., establishing rapport with the patient; reviewing the medical record; and obtaining information from collateral sources, such as family members or other clinicians). The CAI–S includes a checklist of 30 items concerning components of the risk-assessment process, each of which is rated on a 4-point scale, from 1: Task Not Done, to 4: Advanced. The 30 items include interviewing and data-collection (sources of information: 6 items; types of information: 6 items); case-formulation and presentation (6 items); treatment-planning (11 items); and documentation (1 item). Also, the CAI–S includes a rating of the overall quality of the risk-assessment for suicide, on a scale ranging from 1: Unacceptable, to 8: Advanced. The items in the CAI–S are summarized in Table 1. (The full CAI–S is available from the authors upon request.)
Participants, who are referred to here as "learners," were 31 trainees who attended a 5-hour workshop on risk-assessment in July 2008; 26 were psychiatry residents (12 in the first postgraduate year, 14 in the second postgraduate year), and 5 were clinical psychology interns. The workshop included a pretest, lectures on risk-assessment for suicide and violence, an OSCE, and a course evaluation. This report concerns the components pertaining to suicide risk-assessment. Learners heard a lecture based generally on APA Practice Guidelines for the Assessment and Treatment of Patients with Suicidal Behavior (14) and received relevant materials. Another lecture covered medical-legal aspects of risk-assessment and documentation. The lectures recommended gathering information about risk and protective factors, rationally weighing the significance of those factors to estimate the level of suicide risk, developing and implementing a plan of intervention to reduce the risk, and documenting the process. (Additional information about the content of the lectures in this model of workshop training in suicide risk-assessment is provided elsewhere (11)).
Thirty-one faculty (26 psychiatrists and 5 psychologists) were trained in use of the CAI–S in an OSCE setting. In this training, faculty observed mock OSCE sessions in which an individual interviewed a standardized patient, and presented the suicide risk-assessment findings to a mock examiner. Faculty observers rated the quality of the suicide risk-assessment with the CAI–S, discussed their ratings, and calibrated rating differences.
We trained 31 advanced trainees (27 psychiatry residents in their third or fourth postgraduate year, and 4 postdoctoral clinical psychology fellows) to be SPs in the OSCE. SPs were trained to follow a script based on a clinical vignette. The script described a young adult patient who presented to an emergency department with various risk factors for suicide and violence. The script included information about the SP's chief complaint, history of the present illness, psychiatric and medical history, family history, social history, and mental status presentation. (Additional details about the training of SPs and faculty raters are available from the authors upon request.)
Each OSCE team included a learner, an SP, and a faculty observer/rater. The OSCE included a 15-minute interview of the SP; 15 minutes for the learner to write a progress note concerning the patient; a 10-minute oral presentation by the learner, including a summary of the assessment and plan regarding the patient's risk of suicide; completion of the CAI–S by the faculty observer/rater; and a 25-minute discussion, during which the faculty observer gave the learner feedback based on the structure of the CAI–S. At the conclusion of the workshop, learners and faculty completed course evaluations.
To evaluate the interrater reliability of the CAI–S, in July 2009, we conducted a second study in which six faculty-observers (four psychiatrists and two psychologists) rated videos of three mock OSCEs. In each video, a different learner interviewed an SP and wrote a progress note containing the assessment and plan concerning the patient's risk of suicide.
The project was conducted in the Department of Psychiatry at the University of California, San Francisco, and was approved by UCSF Committee on Human Research. Participants were informed that participation in the OSCE was voluntary, and that the data would be coded in a way that removed identifiers and would not become part of individual learners' training files.
We calculated Cronbach's α to characterize the internal consistency reliability of the CAI–S. We used t-tests and correlation analyses for continuous variables, and chi-square analyses for categorical variables, to determine whether learners who were more senior and had more experience with suicidal patients performed better on the CAI–S than those who were more junior and had less experience. The subsidiary study of interrater reliability used the intraclass correlation coefficient (ICC1). We used SPSS Version 15.0 for data analysis.
The learners reported a mean (standard deviation [SD]: of 5.5 (9.0) hours of previous formal training in assessing and managing suicide risk, and 1.7 (2.0) years of previous experience providing mental health services. The number of suicidal patients encountered before the workshop included one learner with no patients, nine learners with 1–5 patients, four learners with 6–10 patients, three learners with 11–20 patients, two learners with 21–50 patients, and five learners with 51–100 patients (seven learners did not answer this item).
The internal-consistency reliability of the CAI–S was high (α=0.94), supporting the conclusion that the items on the instrument measure a common domain.
In the subsidiary study of interrater reliability, the intraclass correlation coefficient (ICC) for the 30-item CAI–S checklist was 0.94. The ICC for the rating of the overall quality of the suicide risk-assessment was 0.95.
For purposes of data analysis, we categorized the learners as Senior (second-year psychiatry residents, who had 6 months of supervised inpatient psychiatry experience that included frequent suicide risk-assessments) and junior (first-year psychiatry residents and predoctoral psychology interns). Senior learners performed better than Junior learners on the CAI–S. Mean (SD) ratings of the overall quality of the suicide risk-assessment were significantly higher for Senior learners (mean: 5.9 [0.9]), than Junior learners (mean: 4.8 [1.2]; t [29]= –2.67; p=0.01). Similarly, mean scores of the 30-item checklist of components of suicide risk-assessment were significantly higher for Senior learners (mean: 89.6 [11.1]), than Junior learners (mean: 77.3 [13.0], t [29] = –2.79; p<0.01).
More previous experience with suicidal patients was associated with better performance on the CAI–S, measured both by the rating of overall quality of the suicide risk-assessment (r=0.43; p=0.03) and the 30-item checklist (r=0.43; p=0.03). Similarly, more hours of previous training in suicide risk-assessment and management were associated with higher ratings of the overall quality of the suicide risk-assessment on the CAI–S (r=0.41; p=0.04), although this positive correlation did not reach statistical significance on the 30-item checklist (r=0.28; NS).
Summative judgments of whether learners had minimal competency in suicide risk-assessment and management were calculated by dichotomizing the ratings of overall quality of the risk-assessment as either Competent (rated as 5: Competent, to 8: Advanced) or Not Competent (rated as 1: Unacceptable, to 4: Working Toward Competency). Suicide risk-assessments by Senior learners were significantly more likely to be rated as Competent than risk-assessments by Junior learners (χ2 [1]=5.28; p<0.03); 100% of risk-assessments by Senior learners (14/14) were rated as Competent, versus 59% (10/17) of risk-assessments by Junior learners.
On course evaluations, both learners and faculty rated the CAI–S as helpful for assessing competency in suicide risk-assessment. When learners were asked whether the CAI–S would be helpful for getting feedback from supervisors in real patient encounters with potentially suicidal patients, the mean rating was 5.9 (1.0) on a 7-point scale, ranging from 1 (Not At All Helpful) to 7 (Extremely Helpful). Similarly, mean (SD) ratings by faculty on the same 7-point scale about whether the CAI–S was helpful for rating competency in working with potentially suicidal patients was 5.5 (1.1).
The results of this study support the promise of a new method for assessing the competency of individual clinicians in suicide risk-assessment and management. The CAI–S showed good internal-consistency reliability and interrater reliability. Content validity was addressed by developing the measure based on the literature on suicide risk-assessment, and by consultation from faculty focus-groups at various sites of a large academic psychiatry department. Support for concurrent validity includes the fact that senior learners in psychiatry and psychology performed better than junior learners on the CAI–S in the setting of an OSCE. Learners with more experience with suicidal patients performed better than learners with less experience. Evidence of acceptability of the method includes the finding that learners and faculty found it a helpful structure for learning and feedback about competency in suicide risk-assessment.
Limitations include the fact that the study was conducted in one psychiatry department and included only a modest number of participants. Also, given the cost of having faculty serve as raters in an OSCE, future research could evaluate the viability of having SPs rate the CAI–S. Another limitation is that although the OSCE provides a standardized context for application of the CAI–S, SPs may not show the range of problems that is comparable with actual patients encountered by learners on clinical rotations. Future research could address the applicability of the measure in clinical supervision.
Historically, evaluation of the competency of individual clinicians in skills such as suicide risk-assessment was left to summative evaluations such as examinations for board certification or licensure. Given current trends toward expectations that residency and other clinical training programs will document attainment of specific competencies (2, 6), we anticipate increased demand for objective methods to assess such skills. Methods such as the one described in this report have potential to provide a framework for formatively assessing trainees in building skills in risk-assessment, measuring acquisition of these skills, and providing feedback to them in development of competency in suicide risk-assessment and management. Furthermore, use of the CAI–S in an OSCE format may assist training programs in summative assessments related to this competency; for example, using it as part of the Clinical Skills Verification Examination (24).
Preliminary results were presented at the Annual Convention of the American Psychiatric Association, May 16–21, 2009, San Francisco, CA.
This research was supported in part by Grant T32 MH-18261 from the NIMH.
At the time of submission, the authors reported no competing interests.
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Kitchenology Blog | Newsletter | Find a Pro
Courtesy of Kalamazoo Outdoor Gourmet
Pellet grills, which are fueled by small wood pellets, can be used as grills or as smokers, and may be portable or freestanding. Wood pellets come in various flavors and can enhance the taste of your food. Bruce Bjorkman, who works for pellet grill manufacturer Traeger, says that pellet grills are free from flare ups and pellets burn more efficiently than charcoal or gas. He adds, "Because our (Traeger) grills burn at an efficiency rate of 98.8 percent, our carbon footprint is very small." Some high-end grills have hybrid fuel systems and can use gas, charcoal and even wood. Currently, you should expect to pay in the four-figure range for models that give you multiple fuel options. But this technology should eventually be available at a lower price range. "We suspect that dual-fuel technology will trickle down to moderately priced, just like infrared technology did," says Deidra Darsa of the Hearth, Patio and Barbecue Association (HPBA).
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Stanford senior is at the forefront in study of traumatic brain injury.
Interactive map showcases treasure trove of public art throughout the university.
From red roofs to outdoor art, the campus offers an eclectic mix of breathtaking views.
Stanford group explores competing interests of wildlife and people on the Galapagos Islands.
Are Some Degrees Worth More Than Others?3:30 p.m.
Bright Award Ceremony, Lecture and Reception4 p.m.
2013 Fall MFA Documentary Film Screening7:30 p.m.
Women's Basketball vs. New Mexico7 p.m.
Victory against Arizona State sends Cardinal football to second straight Rose Bowl.
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Diverse exhibitions include one of the largest collections of Rodin bronzes outside Paris.
Learn about Stanford's strong commitment to diversity.
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Stanford in Pictures


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SA Tri Champs/2011 this weekend will be an interesting event with the Likes of Tim Don(GBR) Hendrik De Villiers(RSA) Claude Eksteen(RSA) Erhard Wolfhaardt (RSA) Chris Felgate (ZIM) and about 7 other International athletes from all over!
Keen to get to P.E and settle down at the Raddison 5 star Hotel, Funded by BSG all the way! Wonderful sponsor, couldnt ask for a more organised/focused sponsor *Chris Felgate,**Gerg Reiss and the Team, THANKS


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A stolen car was found near Wauwatosa Avenue and Center Street on Jan. 30, abandoned not far from where it had been taken. The 5-year-old boy who had been in the backseat was still in the vehicle.
According to the Wauwatosa police report:
An officer saw a man fitting the suspect's description walking along 75th Street, breathing heavily. When the officer approached, the man looked around nervously and said he had just gotten off the bus. The officer, noting the proximity to the stolen car and the man's heavy breathing, handcuffed him and put him in the back of his squad.
"What happened?" the officer asked multiple times, adding that someone had taken a car and it was a good thing it had been found and no one was hurt. He added that the car thief must have gotten scared and run away because there was a child in the back. Hesitant at first, the man finally said that "something like that" happened.
"That's why I got out," the 19-year-old Milwaukee said after the officer asked if he knew the child was in the back before he took the car.
Since the incident happened in Milwaukee, the man was turned over to Milwaukee police for further questioning.
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The prince of persia is a typical monarch. He fancies fancy cars, shiny jewelry, expensive clothes, lavish parties.
From time to time, too much glitter makes my head spin and I find myself craving simplicity.
Take this tomato crisp for instance.
It's made out of simple ingredients : coconut, oats, olive oil, panko, parmesan cheese, pecans, pepper, salt, cherry tomatoes.
The cooking process is just as simple : drop the tomatoes in a baking dish, drop the rest of the ingredients on top of the tomatoes, drop it all in the oven for about 50 minutes.
The simplest way to eat this cheesy, nutty, scrumptious tomato crisp is with a spoon, right on the kitchen counter, far away from the twinkle and the sparkle of the prince's castle…
This recipe was chosen by Nicole for the Food Matters Project. Read her post on the giving table for the original recipe (I used extra evoo instead of butter, panko instead of bread crumbs and added about a 1/4 cup of finely grated coconut). Don't forget to check out what other FMP member's have done with this great Mark Bittman recipe.


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I ordered this dress online because I was looking for a white dress and this one looked great on the model. However, when I tried it on, it was see-through! I'm not sure if it is supposed to be a cover-up, but be aware that whatever you are wearing underneath WILL show through, at least in the white. I can't speak for the other colors. Overall it is a nice dress. I typically wear a 4/6 in dresses, but I always order down a size in Tommy. I got the XS and it fit fine. I did return this dress for a non-see-through dress.
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09:18 AM, Dec 10, 2013US will work with Narendra Modi if he becomes PM: Condoleezza Rice
The Bharatiya Janata Party, riding high on its victory in the recent assembly elections, has more reason to cheer. In a major boost to BJP Prime Ministerial Narendra Modi, former US secretary of state Condoleezza Rice claimed the Gujarat riots were no longer an issue and the US would work with Modi if he became the Prime Minister.
08:33 AM, Dec 10, 2013Rahul Gandhi not responsible for election debacle: Digvijaya Singh
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10:50 PM, Dec 01, 2013Both sides need to learn lessons, says Salman Bashir on India-Pak relations
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09:40 PM, Nov 03, 2013Sheila hits out at Oppn for attacking Rahul Gandhi
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08:02 AM, Oct 06, 2013


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My family and I stayed at Palacio Nazarenas for a total of 4 nights on our way to Machu Picchu and back. During our trip we stayed at other Orient Express properties as well as two non-OE hotels and there is nothing that can compare to Palacio Nazarenas. The rooms are stunningly beautiful and even the junior suites are huge... More
- Official Description (provided by the hotel):
- Set in a tranquil plaza behind Cuzco's main square, this former palace and convent is emerging from years of restoration to become one of the city's most exclusive hotels.Step past walls of Inca stones and into a cloistered courtyard with an ancient fountain at its heart. Then be surprised as contemporary Cuzco comes to the fore: a fabulous spa, the city's first outdoor pool and stylish restaurants serving cutting-edge local cuisine. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Orient Express, Expedia, Splendia, Booking.com, Hotels.com, Orbitz, Cheap Tickets, Travelocity, Otel, Tingo and Jetsetter so you can book your Palacio Nazarenas by Orient-Express reservations with confidence. We help millions of travellers each month to find the perfect hotel for both holiday and business trips, always with the best discounts and special offers.


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We read the reviews for this hotel and booked accordingly. Sadly, this hotel is very disappointing. As others have stated, it is very dated and actually bordering on run down. While the room is generally clean, the beds are a box spring and mattress on the floor, and the fabric on the bench is heavily stained. If you are hoping... More
- Also Known As:
- Sirin Hotel Hua Hin
- Reservation Options:
- TripAdvisor is proud to partner with Booking.com, Agoda, Travelocity, Expedia, Asiatravel.com Holdings, Priceline, Olotels, Hotels.com and Tingo so you can book your Sirin Hotel reservations with confidence. We help millions of travellers each month to find the perfect hotel for both holiday and business trips, always with the best discounts and special offers.


text:
Greenbuilders: Taking on Health and the Built Environment
20 years of USGBC: LEED then and now
City of Brotherly Love to Become a City of Hope
20 years of USGBC: The Woo-hoo gang
An Invitation to Dream
Importance of Green Buildings Stressed by Business and Industry at UN Climate Negotiations
USGBC and UL Environment Announce Exclusive Strategic Partnership on Building Materials...
The Center for Green Schools at USGBC Launches Global Coalition for Green Schools
Vote for Volunteer IMPACT! – Greening Nonprofits & Schoolyards
20 years of USGBC: LEED recollections
Green building without the 'green premium'
The U.S. Green Building Council (USGBC) is a 501(c)(3) nonprofit organization committed to a prosperous and sustainable future for our nation through cost-efficient and energy-saving green buildings.
USGBC works toward its mission of market transformation through its LEED green building program, robust educational offerings, a nationwide network of chapters and affiliates, the annual Greenbuild International Conference & Expo, and advocacy in support of public policy that encourages and enables green buildings and communities.


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Atlanta Metropolitan Area
Understanding Urinary Tract Infections -- the Basics
What Are Urinary Tract Infections?
Urinary tract infections (UTIs) are bacterial infections in the body's urinary system -- the bladder, kidneys, ureters, and urethra. In the kidneys, the infection is called pyelonephritis; in the bladder, it is called cystitis.
Urinary tract infections are common in women. Children with UTIs may show different symptoms than adults.
Am I at Risk for a Urinary Tract Infection?
People with a higher risk of developing urinary tract infections include:
- People with conditions that affect the bladder's nerve supply (including diabetes, multiple sclerosis, Parkinson's disease, and spinal cord injuries)
- Older adults
- Pregnant women
- People who have any kind of obstruction blocking the passage of urine, such as a tumor, kidney stone, or an enlarged prostate
- Those who use a contraceptive diaphragm or spermicide for birth control
- People who use a catheter, a tube placed into the bladder to drain urine from the bladder into a bag outside of the body
- Men who engage in anal intercourse, who have HIV infection, or who have never been circumcised.
Most of the risk factors listed also increase the chance that a simple bladder infection may quickly become to a more serious kidney infection, or to sepsis (an infection that has entered the bloodstream). Pregnant women with kidney infections have a greater chance of delivering their babies prematurely.
Local Search Results in Atlanta
- 6 Serious Medical SymptomsSome medical symptoms are warnings that you need immediate care. Learn to recognize these six.WebMD Feature
- Arthritis,ReactiveImportant It is possible that the main title of the report Reiter's Syndrome is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report. ...WebMD Medical Reference from the National Organization of Rare Disorders
- CryptococcosisImportant It is possible that the main title of the report Cryptococcosis is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report. ...WebMD Medical Reference from the National Organization of Rare Disorders
- Description of the EvidenceIncidence and Mortality Bladder cancer is the fourth most commonly diagnosed malignancy in men in the United States. It is estimated that 69,250 new cases of bladder cancer are expected to occur in the United States in 2011.[ 1 ] Bladder cancer is diagnosed almost twice as often in whites as in blacks of either sex. The incidence of bladder cancer among other ethnic and racial groups in the ...WebMD Public Information from the National Cancer Institute
- Treatment of Sexual Problems in People With CancerAlthough research is beginning to clarify the frequency and types of sexual problems people with cancer experience,few treatment programs for sexual dysfunction in cancer patients have been designed or tested. Programs that integrate medical and psychological modalities aimed at the treatment of sexual dysfunction in those who have had cancer are warranted. Additionally,these programs must be ...WebMD Public Information from the National Cancer Institute


text:
Cozen O'Connor's David J. Walton writes that BYOD policies should weigh the benefits in productivity and cost savings against data security concerns for mobile devices and their interaction with cloud-based services.
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'Bring Your Own Device' to Work Carries Data Security Risks
The Recorder
September 6, 2012
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Company: AMES Group
AMES is the first company offering EASA approved illuminated cabin signs. The AMES illuminated cabin signs are fully EASA certified and can be...
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I have completed 128 marathons and the Last Frontier was my 50th state. I can say with all sincerity that I've never encountered nicer people! I will be returning!
I really enjoyed the race. Great topography, perfect running temperature ( high 30's to low 40's) Beautiful scenery. Wonderful experience.
Great views, and the pass to Anton Larson Bay was strenuous, but I will run it next year again.
It was the first coast-to-coast marathon in Kodiak, Alaska. Very friendly people, and good BBQ. The run was great: ocean, rivers, tundra, mountains, pass, cold!
WMA makes no representations as to the accuracy of information on this site or its suitability for any use. | privacy policy | refund policy


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Funding Cuts Spur Healthcare Job Shifts
The pace of hospital job growth has slowed to a crawl this year. The root cause is "not just healthcare reform," says one analyst, citing about $100 billion of other cuts since 2010.
Slideshow: Percent Change in Employment |
Healthcare reform, federal funding cuts, a sluggish economy, and new technologies and treatments are accelerating a longstanding trend that has seen healthcare job creation shift away from hospitals and toward outpatient ambulatory care.
Nicole Smith and Artem Gulish, analysts from the Georgetown University Center on Education and the Workforce, said in an email exchange with HealthLeaders Media that ambulatory care employment first outgrew hospital employment in 1995 with the gap widening ever since. For the past 13 years hospital employment has been growing at a slower pace than the overall healthcare sector while ambulatory services has grown at a faster pace than the sector.
"The slow growth in hospital employment and fast growth in ambulatory care services has been the trend in healthcare since the 1990s," say Smith and Gulish, citing Bureau of Labor Statistics data. "This trend has been driven by the move away from high-cost, high-risk hospital care and towards more convenient, lower-cost ambulatory care… In recent years this trend has been driven by development of new technologies that have allowed patients who previously required hospital care to be treated in ambulatory setting, such as the use of stents for many people who previously required bypass surgery."
Comments are moderated. Please be patient.
- MU Compliance Announcement Sparks Concern, Confusion
- Scary Financial Challenges for 2014
- New G-Codes to Pay Doctors for Broad Array of Non-Face-to-Face Care
- Resisting the Healthcare Consolidation Frenzy
- MGMA Urges 'End-to-End' ICD-10 Testing
- 1 in 5 CT Screenings for Lung Cancer Results in Overdiagnosis
- Give Nurses in Wheelchairs a Chance
- HL20: George Halvorson—Expectations for Success
- 3 Better Ways to Market Bariatric Surgery
- LifePoint Bolsters Presence in Michigan's Upper Peninsula


text: Previously, my colleague Margaret Simpson wrote about clothing worn during Douglas Mawson's 1911-1914 expedition in the extreme environment of Antarctica. Space is also an extreme environment that requires its explorers to wear a specialised garment for survival: the spacesuit. A spacesuit is like a miniature spacecraft in itself, designed to protect the wearer from the harsh vacuum environment of space while conducting an extravehicular activity ('spacewalk'), or in the event that the life support system of their spacecraft fails.


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This morning |
Not surprisingly as I raised the pop holes on houses one, two and three, the hens squawked 'blow that for a game of soldiers' as they saw the whiteout conditions, and took to their perches for a day of clucky grumbling'. And who would blame them?
I wasn't expecting this - too far south, too far west etc but at 2.00am this morning snow was indeed falling. And it is falling still, some 18 hours later. Thank goodness that as it has fallen there has been something of a thaw because otherwise the white stuff would now be up to the eaves. (As I type this I notice that the sky is now clearing and the moon is out.) We lost the electricity at breakfast time and the snow filled the lane shortly afterwards. We've spent a lot of time today just looking out at the window.
...and this afternoon |
John brought a big bale of straw to shelter some lambs in a particularly exposed field but mainly they manage to find shelter of some sort. I remind myself that wool is brilliant insulation. Here in our field is a kind of sheep refugee camp - they are hunkered down in a fold in the land, sheltered by a thicket of blackthorn and out of the worst of the weather. A couple of old ewes seem to be babysitting.
I click the camera off - it's too cold to stand out here fiddling. The wind is coming from the north and driving hard little crystals of ice into my face - it's a bit like being sand blasted. Indoors seems like a very good idea.


text: iJolie gamesBookmark the permalink. Release date: Jan 11th, 2009 Price: 0.99 Version: 1 Seller: Khalid Shaikh Buy Now STP SCORE: Not yet reviewed Description Related Games Papa Sangre II Device 6 Lead the Brave Where's My Water? 2 Amateur Surgeon 3 Rymdkapsel Twin Moons Hero of Many Perfection. Sprinkle Islands


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Economics at Bucknell is an integral part of the liberal arts. The department's primary goal is to cultivate patterns of inquiry that produce economic literacy, independent thinking, and a commitment to lifelong learning and a socially responsible life.
Check out the latest news, statistics, and databases in economics. New links are on the resources page.
Contact Information
We are located on the first floor of
Academic West.
Department of Economics
Bucknell University
1 Dent Drive
Lewisburg, PA 17837
ph: 1.570.577.1476
fax: 1.570.577.3451


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Prayer Requests
We absolutely believe in the power of prayer.
Please know that your prayer requests are confidential within our Prayer Team, and we are ready to hear you. If this is an urgent need, please call 513.731.7400 (during work hours) or 513.731.7400 x1333 (after hours) so we can find someone for you to talk to right away. Thank you for trusting us with your prayer request.


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Quote:+1 ^I could have saved a lot of cash if I had followed the above advice.There is a bit of upgrading you can do to an EQ6 - buy an Aeroquest worm for it, or if you are feeling flush, buy a matched Aeroquest worm and ring gear for the RA. Still under $500 additional.
Quote:Out of curiosity, what is involved in hyper tuning a mount?


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Members of the Action 4 News team worked together to bring you this report.
A Hidalgo County father is facing upgraded criminal charges after his 6-year-old son died in the hospital.
Pharr police arrested 31-year-old Pedro Ibarra on an intoxication assault charge on Monday evening.
Investigators told Action 4 News that Ibarra was behind the wheel of a car that rear-ended an 18-wheeler.
The accident happened on the frontage road of U.S. Highway 281 near Nolana Avenue.
Police said Ibarra's 6-year-old son was trapped inside the car.
Firefighters got the boy out and paramedics rushed him to a local hospital but he died 9:20 p.m. Thursday.
Investigators told Action 4 News that they have filed second-degree felony intoxication manslaughter charges against Ibarra.
Related Links


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Today's random news roundup
Tuesday, July 15th, 2008A bit of departure from my normal blog posts… I spent a lot of today reading/listening to the news, or my version of 'the news' (not all of it new, not all of it newsy). I do this most days, but today, for some reason, a lot of what I read really struck me. Mostly in a bad way. Mostly because there's been so much coverage of the war on terror lately, and that never makes me a very happy camper.
The terror stuff
Three links for you. First, Omar Khadr. The Current (CBC Radio One) played tapes of his CSIS interrogations at Guantanamo today (Video on The Star's site. Not easy to watch/listen to). I won't lie… Canada's (and by that, I mean that government of Canada's) treatment of the Omar Khadr file absolutely disgusts me. The fact that it's often referred to as 'a file' disgusts me. He's a human being. A very young one, who was even younger when he was arrested on allegations of being an enemy combatant. Our governments' (both Liberal and Conservative, though the Liberals have now changed their stance) inability to do what's right an bring this child soldier home to Canada is completely infuriating and embarrassing. I'm not particularly proud to be Canadian at the moment.
While PM Harper argues that he's being treated humanely, Christopher Hitchens' article "Believe Me, It's Torture" (in the August issue of Vanity Fair, and recently interviewed on CBC Radio One's As It Happens) makes me doubt that my definition of humane is quite the same as that of the government of the United States. A 'favourite' quote, after Mr. Hitchens first-hand experience with water-boarding: "You are being drowned, but very slowly and under controlled conditions. It's not simulating the effects of drowning…"
And last but not least, the US's terrorism watch list has grown to include a million names (courtesy BoingBoing). Not a million people, but a million names. Because if your name is on there, regardless of whether or not you're the one to have done anything wrong, good luck with the whole hassle-free travel thing. Oh wait, no, it's not about ACTUAL wrongdoing. The list is all about the suspected potential for wrongdoing, proof (or even public knowledge of the criteria that gets you on the list) be damned.
Back to the internet…
In good news… the Top Friends app on Facebook looks like it's a goner! But not because people are mature enough to recognize that the kind of friendship gymnastics required by Top Friends are best left back in 2nd grade… it's because Facebook has launched a simplified version of the app's features (link: valleywag). That said, I understand the rationale–kind of. If I were spending as much time on Facebook as I used to (my use is largely limited to Scrabulous these days), I might spend a second or two caring about which friends show up on my profile when people view it, and that is something quite a bit different than labelling people my Top Friends… but that said, if I've added someone to my Facebook, why should I be worried about him/her showing up on my profile? Hmmm… could be grounds for a friends list cull.


text:
Irritable Bowel Syndrome Chart
New to This Edition
Laminated for durability, these generously sized, 20"x26" charts use beautifully rendered Netter illustrations to capture important clinical concepts in colorful, accurate detail. They're an ideal way to enhance the walls of any waiting room or examination room.
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- Grommets for easy hanging
Customer Reviews
- Charts & Posters
- Reference
- Trim Size: 12 1/16 X 9 1/5 in
- Imprint: Saunders
- Copyright: 2006


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Dear Sharon: I'm wearing this holiday red shiny Tahari dress with an open portrait neckline to my husband's company Christmas party.
I am wondering what shoes and jewelry to wear with it. Thanks! (H.E. via Fashion Advice)
I've spent some time pondering if I should sugarcoat this or not, and I need to be both truthful to you and to my professional style aesthetics.
I have to be honest here, I don't love the dress.…
Published on November 13, 2012


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Saboten Con 2013
Vendor Hall
Strawberry Crown Shop
TOPIC: Strawberry Crown Shop
Strawberry Crown Shop
4 months 2 weeks ago
Junior Boarder
Posts: 24
Thank you received: 2
Karma: 0
Hello Saboten Con! We are Strawberry Crown, a shop owned by two sisters from Tucson, Arizona. We have been to numerous conventions around the state of Arizona and have recently expanded to conventions in New Mexico and Nevada.
But enough about that! Let us introduce our little shop and all its goodies!
We sell a variety of items from prints and bookmarks to phone charms and key chains. We are also open to doing commissions from any series and specialize in adorable chibis! Our main artist is Deviantart member CaptainStrawberry and you can visit her deviant page at:
Take a look at her artwork or check out the commission samples below.
We have a new Facebook page where we will have updates on future conventions, new items and promotion codes for our shop. Give us a Like at:
You can also go to our new online shop on Storenvy to see all of the items that will be available at the convention:
If you won't be able to attend Saboten, you can use Promo Code
at the Storenvy checkout to get 15% of each item.
Some prices do vary from our online store and our booth. Here is a list of the booth prices for all of our items:
11 x 17 (Large) Prints = $12 ea.
8 x 11 (Small) Prints = $ 6 ea.
Stickers = Range from $.25 to $1.00
Regular Chibis = $1 ea.
Magnet Chibis = $2 ea.
Chibi Phone Charms = $4 ea.
Bell Charms = $3 ea.
Regular Phone Charms = $2 ea.
Key Chains = Range from $2 to $5
Bell Charms
Chibi Charms
Commission Prices:
If you want your original character drawn please bring a set of references for our artist.
(on 5.5 x 7.5 Sheet)
Sketch = $4
Line Art = $6
Colored in Copic (w/ line art) = $9
Full Body Character
(on 8.5 x 11 sheet)
Sketch = $10
Line Art = $15
Colored in Copic (w/ line art) = $20
Convention Specials!
Yes! We are notorious for having specials! We are bargain shoppers at heart and love to find and make great deals!
11 x 17 Prints are 2 for $20
8 x 11 Prints are 2 for $10
Regular Chibis are 5 for $4
Magnet Chibis are 3 for $5
New Items!
We just made a collection of adorable lace covered bows!
We've also turned your favorite chibis into stickers!
Lastly we have surprise bags and boxes.
The $5 bags have:
- 1 bookmark
- 2 Phone Charms
- 1 Magnet Chibi
- 1 Keychain
- 1 Hair bow clip
- A chance to win a 8 x 11 (small) Poster
Our $10 boxes include:
- 2 Phone Charms
- 1 Pair of Earrings
- 1 Bookmark
- 2 Keychains
- 2 Magnet Chibis
- 2 Hair bow clips
- 3 Stickers
- Chance to win 11 x 17 (Large) Poster
Last but no least, our $15 boxes include:
- 1 Bell Charm
- 2 Phone Charms
- 2 Pairs of Earrings
- 2 Bookmarks
- 2 Keychains
- 3 Magnet Chibis
- 3 Bow Clips
- 5 Stickers
- A Chance to Win a Large and Small Poster.
(Surprise bags/boxes are available while supplies last)
Last Edit: 4 months 4 days ago by
The administrator has disabled public write access.
Strawberry Crown Shop
4 months 1 week ago
Red Comet
Senior Boarder
elite mobile suit pilot
Posts: 54
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Glad to hear you'll be back. And I liked your Facebook page.
Is this too much kawaii for you?
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Thank you! We're super excited to be coming back. Also, thank you for liking our page!
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YAYY!! YOURE GONNA BE AT SABO!! I need a new kotetsu charm!! mine committed suicide.. :3 Maybe this year ill be able to commission you as well. Your art style is awesome!
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Yes, we are back! Thank you for the compliment. It's always appreciated. ^-^ And what happened to Kotetsu? ;~; Poor thing...
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Strawberry Crown Shop
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hi der! ^O^ IM HYPERR!
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I must buy stuff from you! XD
Don't keep calm, go freaking insane XD
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Fameccanica Group
The foundation of Fameccanica was immediately accompanied by a far-sighted vision: to become a leading company in its market and expand at international level.Nowadays, the Fameccanica Group is a reality and can rely on four companies: Fameccanica.Data in Italy, centre of excellence and key point of reference, Fameccanica Machinery Shanghai, Fameccanica do Brasil and Fameccanica North America.A strategy that allows Fameccanica to be close to its clients not just logistically but also culturally, with a system of relations that overcomes barriers, making the most of local resources while maintaining a central coordination of its projects.
Fameccanica operates in the production of disposable absorbent sanitary products.It devises, designs, manufactures and installs complete lines for the production, grouping together and packaging of diapers for babies, training and youth pants, lady napkins, pantiliners and products for incontinent adults including briefs, pull-ups, bed underpads and products for light incontinence pads and male guards.As well as this is their ability to develop special projects on request mainly aimed at disposable absorbent sanitary products and also sectors differing from the core business, for example, light logistics, the packaging of laundry&cleaning products, converting tissue and labelling.
Fameccanica's proposal includes numerous solutions to meet clients' varying needs both in terms of technology and automation and of performance and flexibility. Finished products with different construction structures and distinct features can be manufactured by making good use of the modularity characteristics of the design and fitting for the future integration of a product updating kit. Specific models are available to meet the needs of single markets including those in developing countries.The range is articulated across three technological platforms, Premium, Evolution and Basic and, for each one of these, from different machine models, each one is available in more than one arrangement.The ability to manage the platforms, models and arrangements is the key element with which Fameccanica manages to fully satisfy the specific needs of a wide range of clients, with perfectly adequate solutions that are simultaneously, highly competitive.Today, more than ever, Fameccanica can anticipate the needs of its clients and market trends and offer advanced technological solutions and high performance standards that ensure that their clients can operate with excellent results.
Fameccanica works daily to provide maximum satisfaction. This is why it set up a global organisation and a series of services that revolve around you and guarantee reliability, safety and tranquillity.
All Fameccanica Companies
Fameccanica Data Spa
Fameccanica.Data is the founder of the Fameccanica Group and the centre of excellence for the development and design of all the Fameccanica technological platforms and for the production of...
Read more »Fameccanica Do Brasil
After the inauguration and rapid expansion of Fameccanica Machinery Shanghai in March 2009, another subsidiary, Fameccanica do Brasil, entered the South American market.
Read more »Fameccanica North America
In 2002, Fameccanica opened a liaison office in the U.S.A., to meet the needs of the American market.
Read more »


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Dayside Restaurant Crew Job Listing at McDonald's in New Richmond, WI (Job ID mcdonalds4-489322529)
IndustriesFood, Beverage & Tobacco
DescriptionFull and part-time hours available, Monday - Friday, 5 am to 4 pm. No night or weekend requirements! We are seeking highly motivated individuals to join our team! Apply today to work in our fun, fast pace environment! Visit our website at www.McCourtesy.com.
Apply on Company Website |
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Make housetraining easier on yourself and your dog. Powerful oil-based attractant will not be washed away if it is used outdoors, and may be used on papers indoors as well. Simply sprinkle Train-UM where you want your dog to eliminate and show him where to "go." When following instructions, Train-UM works in as little as 72 hours. Can be used for puppies and older dogs.
Directions: Outdoors: To keep your lawns and flowerbeds clear, train your dog to defecate in a spot of your choice by placing several drops of train-UM there each day. Take your dog to this spot and after a few visits he will train himself. This also applies to walks, or strolls, where you can train him to use an area of your choosing and to keep pavements clean. Please click on "More Information" for ingredients and storage. | ||||||


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Note: This message is displayed if (1) your browser is not standards-compliant or (2) you have you disabled CSS. Read our Policies for more information.
If you would like to register to receive all DDRS updates, click here.
The Division of Disability and Rehabilitative Services (DDRS) Bureau of Developmental Disabilities Services (BDDS) provides services for individuals with developmental disabilities that enable them to live as independently as possible in their communities. BDDS assists individuals in receiving community supports and residential services using a person-centered plan to help determine which services are needed and who can best provide them. BDDS also monitors the quality of care and the facilities of those who are approved to provide these services in Indiana.
Online Application FAQ
Home & Community Based Medicaid Waivers (CIH and FSW) - Effective September 1, 2012
Webinar 05/30/2012
Provider Webinar 09/28/2012


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Survey of Energy Resources 2007
Hydropower Country Notes
There is a substantial potential for hydro development, with a total technically feasible potential of about 123 TWh/yr, most of which is located in Sarawak (87 TWh/yr) and Sabah (20 TWh/yr); a considerable proportion of Peninsular Malaysia's technically feasible potential of 16 TWh/yr has already been developed.
After being halted in 1997 as an austerity measure, construction of the 2 400 MW Bakun hydro project in Sarawak is once again under way. There is also a 300 MW hydro plant planned for construction at Ulu Terengganu, Peninsular Malaysia and a 210 MW scheme at Sungai and Pelus.


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Image courtesy of Apple iTunes and EarthNC
Shark Net
Compatibility: Apple iOS
Cost: Free
Scientific American says: "It's like Shark Week every week."
Description: EarthNC's Shark Net app lets you follow the movements of more than a dozen sharks being tracked by Stanford University and the Global Tagging of Pelagic Predators (GTOPP) project. In addition to providing a bio of each shark being tracked, the researchers have posted images and video of them in action.
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SA Staff Picks: 10 Apps for Your Smart Phone or Tablet |
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Preview Community Education's Spring Session at Open House on Dec. 8
'Your Place to Create' features more than 40 classes and workshops
The Community Education department of Watkins College of Art, Design & Film will host an Open House on Saturday, December 8, from 1:00 to 4:00 p.m., with free hands-on activities and demonstrations by faculty instructors in printmaking, book arts, stop-motion animation and more, providing a preview to Community Education's Spring 2013 session, "Your Place to Create."
More than 40 classes and workshops for youth, teens and adults will be offered January through April, in the categories of 3-D, painting and drawing, film, graphic design, interior design, print, paper & book, and special topics, including three classes available to the public in the College's Graphic Design and Interior Design degree programs.
At the open house, visitors can make their own wrapping paper at the printmaking booth, create paper star ornaments, and enjoy a winter wonderland backdrop for photographs. Bongo Java will provide light refreshments. Attendees can also enter a drawing to win a $50 certificate off the price of a class or workshop fee.
Among specific areas of study on the spring schedule are ceramics, acrylic and watercolor painting, figure drawing, clay sculpture, installations, welding, wood furniture, drawing and painting, comic illustration, screenwriting, stop-motion animation, graphic design and typography, programs and software (Final Cut Pro, Adobe Illustrator, Adobe Photoshop, WordPress, Google SketchUp), interior design fundamentals, darkroom and digital photography, linoleum block, monotype and intaglio printmaking, silk screen printing, self-publishing, bookbinding, clamshell boxes, knitting, and creative writing
In celebrating the spring session's theme of "place," new offerings include the digital film production class "Nashville: City on Film," where participants will create a cinematic portrait of Nashville through the "City Symphony" poetic style of documentary filmmaking. Also new is the "On Location" series, which will take class members off the Watkins campus for two photography workshops: Still-Life Photography at East Nashville vintage shop Old Made Good (Feb. 16), a lesson in staging beautiful still-life photographs and showcasing collections in artful ways taught by Vicky Pierce, and Food Photography at Germantown's SILO restaurant (Feb. 27), led by professional food photographer Kyle Dreier (dinner and non-alcoholic beverages included).
Three semester-long classes in the College's Graphic Design and Interior Design degree programs are open to non-degree seeking "special status" students: Web Development I (an introduction to multimedia design with emphasis on website creation), Textiles & Furnishing (basics of fiber, yarn, finishing and construction methods) and 20th Century Design (study of conceptual thinking in architecture and interior design).
Additionally on the Spring 2013 schedule is a teacher program for art educators on Friday, Jan. 25, from 9 a.m. to 4 p.m. "Site/Space/Location: Experiencing Place Through Art" is free, but registration is required: [email protected].
The Watkins Community Education Spring 2013 catalog is available online beginning Nov. 28 and in print form at the Open House. Registration deadline for adult classes is January 21; deadline for adult workshops and youth and teen programs is two weeks prior to start of class.
For more information on the December 8 Open House, course schedules and registration, or the teacher workshop visit Watkins.edu/ Community.
Watkins is located at 2298 Rosa L. Parks Boulevard in MetroCenter. Free parking is available in the campus lot.


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*I understand the new guideline about pet food recommendations, I am not recommending anything here, simply stating for reference*
Ok people, let's get real here.
Fat is not the issue here, as it is with humans. Let's not forget that in the wild, cat's are carnivores and would be eating muscly, fatty meat that could be predominately fat and protien. Recommending a low-fat cat food is not sound-- because chances are, it's the carbs and the protein that could be higher in compensation.
In cats, who are simply not meant to eat an 80/10/10 ratio, carbohydrates are the culprit. Fat in human's diet is to carbs in kitties diets-- they cause a host of health problems, including diabetes. Water content is also an issue. Given both of these concerns, many people are now advising people to feed canned food (3-5% carbs, perfect ratio, and has water), or to feed raw meat.
Here is a great article highlighting all the info on carbs and managing different diseases (including diabetes) in cats:
I understand that everyone is vegan on this forum, but please do not advise feed vegan food to cats. This is absolutely wrong! Legumes might have high protein levels but that's not what cats supposed to eat!
Eli, your cat has diabetes because there are grains in the food that you feed him. Cats are designed to eat raw meet. As of fats, there are also might be too much fat because the food for cats is made from sick overweight animals that were fed corn in order to gain weigh. My cat catches lizards everyday, he plays with them and then eats them. I'm sure there is not much fat in a lizard. Anyway, I hope your cat will get better, and when he will make sure that his food does not contain grains or starches.
'I understand that everyone is vegan on this forum, but please do not advise feed vegan food to cats.'
This part is not up for debate.
Vegan is the ONLY food that will be advised and debated here on 30bad.
Please read and respect our guidelines:
If you don't agree with the guidelines you have the option to stay out of the discussion or discuss it on another forum.
Thank you for your understanding and cooperating.
The 30bad Team.
Thanks for the link. I read the rules. Just for the reference, my cat has been adopted, if I would not have this cat AT ALL he would be dead a while ago.
You're welcome.
Just for the reference, if you would not have this cat AT ALL thousands of animals that you butchered and fed her wouldn't had to suffer and die.. so there's absolutely no point to save one animal than murder thousands of others to keep that single one alive.
My cat eats lizards and SOME of the canned food. I think feeding your poor animal vegan food is EXPLORATION and no other way around. My cat is not IMPRISONED he goes out in a wild every day and then back. I can say many things about my cat and your rules but I think there is no point to argue.
I just gave the suggestion to Eli and it is his choice what to do with that.
No need to explain yourself.. and indeed no point to argue, that's why we have the rules..
At least from now on you know not to make suggestions like this anymore..
Sorry about your cat.
Here is a thought.
If you are feeding him a processed cat food, it is possible that it may be too high in wheat products, and grains can be acid forming in the body and can cause arthritis. Some dyes and fillers can make cats sick too.
The food may not be balanced and may have caused his weight gain and diabetes too.
You can check out this website for vegan cat food options with less chemical fillers and see if these things work.
If possible, even if he does not want to walk outside with a collar, at least have someone sit outside with him for about 20 minutes a day at least in the sunlight. Natural sunlight can help his body cope with and alleviate many of his symptoms. (The same is true for human beings too:)
Last but not least, and I know this is painful to read, or even write, but if it is his time, it may be time to let go for his sake. When an animal refuses to eat, it is a signal that they are very sick and want to rest and heal, and or it is their time. We have to balance life saving measures with respecting that it may just be their/his time to go. If we keep them alive, it is only for our benefit, but not necessarily theirs if they are ill or in pain.
Remember the good times you had together, and as the famous sage Yoda said:
"Death is a natural part of life. Rejoice for those around you who transform into the Force. Mourn them do not. Miss them do not. Attachment leads to jealously. The shadow of greed, that is."
Peace, PK
May be this can talk you through it....
Very rarely but occasionally. He is much better now given oxygen back at the vet.
Now his blood sugar dropped to 227 from 440 given insulin.
He is finally drinking on his own but still not eating. Very lethargic.
His tongue isn't out when he is breathing so things have been much better.
He will be getting an ultrasound to see whether he has any heart condition related to cardiomyopathy. I have to put his bowl next to his mouth so he could drink since he is so tired to even pick himself up. He's been at the vet overnight now.
I will not decide to put him down as I know he has a fighting chance. He's the best friend I've ever had in my life.
Thank you for the update. I have been thinking about him all day. I hope that he continues to improve.
Thank you all for your help.
He was put into an ultrasound test and found to have pulmonary hypertension.
Although he was feeling better, he would have died during the night in pain through suffocation.
I made the decision to allow to put him to sleep after talking very long with the doctor whether they are positive in their diagnosis. I realized it's irreversible. She came in the room with him out of the oxygen tank and he was already gagging for air and looked in my eyes. He was in a blanket.
She put him to sleep.
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Image: Willi Schmitz/iStockPhoto
The Best Science Writing Online 2012
Showcasing more than fifty of the most provocative, original, and significant online essays from 2011, The Best Science Writing Online 2012 will change the way...
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For decades, a divisive debate has raged among biologists over the evolution of eusocial insects—those that thrive in cooperative societies of queens, workers and drones. On one side is the argument for "kin selection," a theory asserting that the nonreproducing members pass on their genes by helping relatives reproduce. The members of a colony should therefore be closely related. Yet those on the other side—most notably, renowned biologist Edward O. Wilson of Harvard University—contend that eusocial insects work together in colonies because it is to their individual advantage; their cooperative spirit is simply a consequence. If there is high relatedness in a colony, then it is a result of individuals choosing to stick around to reap the benefits of group life.
Researchers led by William Hughes of the University of Leeds in England say they have the first clear evidence that supports kin selection, rather than group selection, in eusociality. They examined 267 eusocial species of bees, wasps and ants and found that the insects evolved from monogamous conditions, which maximize a group's degree of relatedness. Moreover, they found that polyandry (having more than two mates) transpired only among lineages where workers had become permanently sterile—a prediction of kin selection theory for species that have become irrevocably eusocial. Behavioral biologist Andrew Bourke of the University of East Anglia in England says that the May 30 Science study indicates that kin selection is an essential precondition to eusociality.
Wilson, however, disagrees, asserting via e-mail that Hughes's work does not include data on many lineages that did not evolve eusociality and that the emergence of polyandry in eusocial societies has explanations not related to kin selection.
Note: This story was originally printed with the title, "Monogamy and the Queen Bee".
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Clean and well priced for Sao Paulo. Staff is friendly and breakfast buffet above average. The internet connecion on higher floors ( I was on 13) is spotty but you can always get a good connection in the lobby which is great for people watching. There is a Walmart within walking distance and two malls a short cab ride away.... More
- Also Known As:
- Ibis Sao Paulo
- Ibis Sao Paulo Expo Brazil
- Official Description (provided by the hotel):
- The Ibis Sao Paulo Expo hotel is 30 min from Guarulho airport and 10 km from Paulista Avenida, the largest business district in Brazil. Close to shops, tourist sites, the Convention Centre and the Exhibition Centre, the hotel offers for booking 286 air-conditioned rooms with Wifi connection, including 2 adapted for disabled persons. A restaurant, a bar, snacks 24/24 and covered pay parking are at your disposal. You can book 6 meeting rooms. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Travelocity, Hotels.com and ACCOR so you can book your Ibis Sao Paulo Expo reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.


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Miami Splash
Art Basel Miami Beach is a giant fair that's fueling the city's explosive arts scene
- By Phoebe Hoban
- Smithsonian magazine, December 2007, Subscribe
Miami has had its moments. In the 1980s it was "Miami Vice"—remember Don Johnson's five o'clock shadow and T-shirt-cum-blazer? In the 1990s it was South Beach, when seedy old Art Deco hotels blossomed into glamour destinations, luxury condos mushroomed all over town and supermodels rollerbladed along the beach. But since 2002, the year of the first Art Basel Miami Beach, it has been the city's art moment.
When the Miami Beach Convention Center opens its doors to the public on December 6 for the annual four-day Art Basel expo, a tsunami of artists, dealers, collectors, critics, curators and art-world followers will flood the 262,960-square-foot exhibition space to ogle, and possibly buy, everything from Impressionist landscapes and Cubist collages to neon sculptures and avant-garde video art—220 booths displaying the works of some 2,000 artists from 30 countries.
"Art Basel Miami Beach has one of the planet's highest concentrations of wealth and talent," boasts fair director Samuel Keller. "It's an explosive mixture of art, intellect, glamour and money." The art mart (a spinoff of the international fair held annually in Switzerland) has some of the glitz of Hollywood's Oscars, but it has also become one of the key events of the art-world calendar, a place where trends get set, deals get done and names get made—even if it has been criticized for its frenzied atmosphere and rampant commercialism. The New York Times has called it "an Art Costco for billionaires," and conceptual artist John Baldessari, whose work is marketed at the fair, observes: "You have to understand that it's not about mounting an art show, it's about selling art." But, he adds, "It's a chance to see a lot of good art in one place, even if it's not under optimum conditions."
"Art collectors love the sort of mall experience that art fairs provide," says Walter Robinson, editor of Artnet Magazine. "You walk down aisles and there's pressure to buy because the collectors know that there are other collectors there vying for the same choice artworks and they know they've only got a few days, if that, to make their move."
Why Miami Beach? "It seemed a good place to bring together the art scenes of the Americas and Europe in winter," says Keller, who is also one of the fair's founders as well as the director of Switzerland's fair. "The city was open and ready for a new international art show with a contemporary concept, and the South Florida art community was willing to actively support and embrace it."
While most of the action takes place at the convention center, there are a dozen or so subsidiary fairs—Pulse, Scope NADA, Aqua and Wave, among others—that have sprung up in Miami Basel's wake. An ancillary Design Miami fair, across Biscayne Bay in Miami's booming Design District, showcases furniture, lighting, antiques and objets d'art.
Sparked by Art Basel, Miami's art scene is enjoying a rapid escalation. Galleries in the Wynwood Art District, not so long ago a run-down area of old industrial buildings, warehouses and factories, are opening left and right. And two of the city's largest museums have announced ambitious expansion plans. The Miami Art Museum (MAM) is building a new $220 million space downtown, and North Miami's Museum of Contemporary Art (MOCA) will nearly double in size. The city's art mania is also due in no small part to a handful of energetic collectors.
Mera and Don Rubell, for example, moved to Miami from New York City in 1993. Three years later they converted a 40,000-square-foot former Drug Enforcement Agency building in Wynwood into a gallery for their contemporary art collection. For the first few years, viewing was by appointment only, but in 2000 the gallery opened to the public on a regular schedule. Four years later, the Rubells renovated the warehouse, doubling its exhibition space and adding a sculpture garden, café and library. Wynwood now boasts some 70 galleries and art spaces. "We used to be the only ones here," says Mera Rubell. "Now we hand out maps."
Subscribe now for more of Smithsonian's coverage on history, science and nature.
Related topics: Arts Celebrations Florida
Comments (2) |
I wonder if you could possibly give me the contact for the Don Rubell museum in Miami. I interviewed him with a camera and need pictures of some of his work. Kind regards, Serena Momberg
Posted by serena Momberg on March 14,2008 | 10:34 AM
so please, who did that amazing piece of art on page sixty? is that Frank Stella? it is simply breathtaking.
Posted by stephen lang on December 31,2007 | 02:17 PM
Art for A Cause Gallery is a juried fund raising event (running concurrent with Art Basel Miami Beach 2007) for the Dellutri Christmas Foundation, which provides annual Christmas party and gifts to over 10,000 inner city children. Other projects include new clothing distribution to inner city kids and personal finances education for children leaving foster care at age 18. Partnering with Old Navy and Regions Bank. We have over 10,000 sq. ft. of exhibition space in the Wynwood area of Miami available for this event. The show will take place at: Sal's Abatement 301 NW 36th St Miami, FL 33127
Posted by Judy on December 5,2007 | 10:02 PM
I love Miami! Such a beautiful city.
Posted by Kyle on November 29,2007 | 10:17 AM