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A conversation with Carl Levin, Democratic United States Senator from Michigan and the Chairman of the Senate Committee on Armed Services.
Next, a conversation with Nick D'Aloisio, British-Australian entrepreneur, computer programmer and designer who has become known for the creation of Summly and its technology. [Broadcast Date: March 28, 2013]
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Here at Review Centre we work hard to make sure we are the best place on the internet for honest, unbiased consumer reviews - we are grateful for your help in keeping us that way!
Written on: 24/03/2013
You asked for a review and you will get one. It is a very good product and I'm happy with my package but more assistance and advice on updates would be very welcome, not just an annual renewal call.

subset: commoncrawl


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Pull on your hiking boots and join in the march at the North Devon and Exmoor Walking Festival.
The North Devon and Exmoor Walking Festival is a wonderful way to put your best foot forward and explore the stunning North Devon coast and countryside. There are plenty of walks of varying distances and difficulties to choose from, depending on your rambling experience and stamina, and the guides on each walk are happy to answer questions about the local area along the way.
The festival kicks off with an evening in a pub where festival-goers can meet each other and the guides, and moves from town to town along the North Devon coast with plenty of opportunities to discover all that this outstandingly beautiful part of the country has to offer, in the company of like-minded people.
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Top Story Instapoll 8/31/11:Obama Issues "Rules Of Behavior" For 9/11 Memorial
The White House has issued "talking points" or "rules of behavior" for American diplomats and "individuals" for 9/11/11. Basically they are; minimize Al Queda and "it's not just about us." Are you glad to see the president stepping up and telling us how to act? Vote Here
Get 5000 Loyal Listener Club points just for participating in the instapoll! Trade those points in for a chance to win other prizes.


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NetWellness is a global, community service providing quality, unbiased health information from our partner university faculty. NetWellness is commercial-free and does not accept advertising.
Thursday, September 21, 2017
Face and Jaw Surgery
Jaw replacement
i had my right jaw removed 7 years ago for a begnine tumor and the piece that the physicians replaced the jaw in was supposed to only last for 5 years, and like a paper clip after being bent several times, the metal in my jaw would break if not replaced. I need to know if there are any new types of surgeries available which do not involve removing bone marrow from my hip to replace the jaw with bone and thereby allowing this piece to be `accepted`... I totally do not want to have this surgery done because they said the hip would hurt more than the jaw.. . yikes.
Metal bars do break after a period of time. Most cancer centers (ENT surgeons) now use fibula, not hip grafts. The fibula is one of the bones in your lower leg. It is the smaller one located in the back of the leg. This bone is an excellent source for a graft with minimal post-surgical consequences (It does not affect the patient's ability to walk, etcetera).
Dental implants are usually placed in the bone during the same surgery by an oral surgeon which allows the prosthodontist (restoring dentist) to make a fixed bridge to restore function. Interestingly enough, I am currently restoring a patient with a similar situation as yours. The patient has had a fibula graft and implants placed.
Take care.
Meade C van Putten, DDS, MS
Associate Professor of Primary Care Dentistry
College of Dentistry
The Ohio State University


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After listening to Colorado State commitment Crockett Gillmore, it is tough to believe the young man is anything but a solid commitment to the Colorado State football team. Gillmore, a 6-foot-6, 22...
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Novice traditional shaving enthusiasts often want to explore their new "surroundings," but do so inexpensively. And many also want to experience that life-altering, zen-inducing, height-of-sophistication shave. The two ideas may seem like polar opposites but in fact it can be done! The key lies in samples. For example, high-end shaving companies like eShave, Truefitt and Hill and Trumpers offer sample kits to give you a taste of what they offer for a very reasonable price (and remember, in the case of Truefitt and Hill, a Sharpologist advertiser, you can take 15% off a web order just by using the coupon code manticsblog at checkout)! In the case of shaving cream samples there are usually several different varieties with each sample having enough for two or three shaves. Cologne samples may be enough for quite a while, depending on how often you use cologne (I should note that, although Penhaligons doesn't offer shaving cream samples, they do have a very nice cologne scent sampler).
Some artisan shaving soap or cream makers will offer a samples as well. Here are a few I know about:
Nanny's Silly Soap (UK)
Some artisan soap and cream makers will send you a sample if you ask nicely (especially if you have an allergy or are concerned about a particular ingredient or scent).
Finally, Garry, an enterprising soul, has opened a web "sample shop" where it is possible to purchase small amounts of select products: http://sampleshop.blogspot.com/ .


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Dog Veterinary
Ask a Dog Vet and Get Answers to Your Dog Health Questions
Welcome to JustAnswer! I am a licensed veterinarian and would be glad to help!
Unfortunately - the answer is yes.
From experience - cats can be quite fickle with their food intake and there is a very good chance they may develop of a food aversion with a change such as this.
This is normal for them in the environment - it is called copraphagia: LINK
What then happens - they eat the stool laced with something that tastes bad, they then associate the stool with a bad taste, then in the future understand and associate the taste and stool - then stop eating and going after the stools
See above
There is also a product on the market called Forbid (LINK HERE) - more for dogs that eat their own stool rather than dogs that eat other's stools.
Forbid would be an option for you.
Otherwise I would not use chemicals.
Moreover, anything you add to the diet, tasty enough for them to eat...is only going to entice the dogs more, not deter them
I Would certainly consider training them, listed above - as with many causes in dogs - they respond to training well!
My personal dog responded best to training with bitter apple for issues such as this.
You are very welcome!
If you have any follow-up questions - please do not hesitate to ask! Otherwise - please remember to click ACCEPTFind me any time if needed: http://www.justanswer.com/veterinary/expert-criticalcarevet You can always request me through my profile, bookmark my page for future help, or beginning your question with "For CriticalCareVet"
____________________________________________________________________________________________________________________________ Please click the "GREEN ACCEPT" button if the information I have provided has been of help so I receive credit for helping you. Bonuses are always welcome and appreciated. This is necessary so that I can get credit for assisting you and compensated for my time. Once you click accept, your question will not close, and you will still have the opportunity to follow-up if needed. Also remember, sometimes the medical information and recommendation may not be what you want to hear, but it is being made in the best interest of your pet - please be courteous in your response, even if this is not exactly what you wanted to hear - we are only making the best and safest possible recommendations for you and your loved ones. Please keep in mind that if you do not list all the important information above (medical history, current medications, previous illness, etc) it is harder for me to give you the most complete information. With this communication - we are here to guide you in making the best decision for your pet. This is for informational purposes only. We are not allowed to diagnose and prescribe medications - rather provide a course of action to speak to your veterinarian about - and any medical therapy and treatment should only be performed after an in-person examination with your veterinarian as a professional-client relationship has not been established on the site. While information may be discussed, this is not intended as an encouragement for you to self treat your pet, rather information online, and any treatment provided should only be performed after consulting your veterinarian.


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Free Sample ~ Miracle Grow
Here is a free sample of Miracle Grow Expand & Grow. I watched a short video about this product. It is really cool. Once you add water to the Miracle Grow mixture it expands. So, you get up to 3 times the flowers and vegetables. Plus, it gives your plants food for six months. It makes me want to start a garden.
Enjoy your free sample. It is a simple form….easy!!!


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Thanks to TFW2005 user starfish, we now have an in-hand gallery of the recently released reissue of Generation One Sixshot. The reissue is an Asian Territory Exclusive, features a metallic paint job, and also comes with a commemorative coin like previous Hong Kong Transformers releases.
An additional gallery has also been posted by a user on ACToys.


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The big news of the week in the sports world was Texas head football coach Mack Brown was stepping down and the resulting speculation that Alabama's Nick Saban will move over to replace him.
The big news of the week in the sports world was Texas head football coach Mack Brown was stepping down and the resulting speculation that Alabama's Nick Saban will move over to replace him.
A writer named Chip Brown (no relation), of OrangeBloods.com, a website devoted to covering Texas football that is owned by Rivals.com first broke the story early Tuesday and the national publications came in with confirmations later in the day.
Chip Brown has done as much as he can to take credit for the scoop, appearing on several diferent sports talk outlets that afternoon insisisting his report was accurate.
Mack Brown, who coached Texas for 16 years and won a national championship for the Longhorns, was meanwhile off in Florida on a recruiting trip. He has refuted the story, causing some confusion for a few hours on whether the reports had simply jumped the gun.
Even as of Thursday afternoon, Mack Brown or the University of Texas had not officcially confirmed the story. It even appears as there might be a power struggle going on behind the scenes. Could it be that Mack might not get the knife?
Another reporter in Texas, presumably hoping to break the next big scoop tweeted out "Saban to Texas,", but then later backtracked a bit saying he didn't believe his source.
It's what we have come to in our present day of websites and 24/7 social media reporting. Being first has become so important, that being correct hasn't been as as stressed as it used to be by jouranlisim ethics.
Here in Arkansas, when Houston Nutt was on the hot seat a few years ago, there were several false reports by media outlets that Nutt had been fired before the official announcement came.
With expecations always sky high in Texas, Mack Brown was already under a lot of speculation and a couple of early season losses made it look like it was just a matter of time and semantics on whether Brown would return in 2014.
Still, Brown did manage a 8-4 record that included a win against archrival Oklahoma this year and the team is currently preparing to face Oregon in the Alamo Bowl.
Big-time coaches know the big-time expectations and big-time pressures come with the territory and they are making big-time money, too.
Conventional wisdom says its all just a matter of semantics whether Brown has "decided to step down" or "was forced out" and probably a matter of a working out a financial settlement, too.
You would think a class act like Mack Brown deserves a little more respect than to be stabbed in the back while he was out on a recruiting trip.
Grant Tolley is a Times Record sports writer. Email: firstname.lastname@example.com. Twitter: @Grant_Times Rec


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Chris Galen, senior vice president of communications, National Milk Producers Federation (NMPF), was interviewed as part of the recent "Nightline" segment. While only a few seconds of his interview aired in the segment, preparation played a critical role in responding to tough questions.
Q: How did you prepare for the interview?
A: I reviewed existing industry messages on animal care, milk quality, food safety, and other topics that I suspected would come up. I practiced answers for at least 12 different topics. I also developed some new points that would make good sound bites because I needed short and catchy phrases for my responses. I also rehearsed with a media trainer playing a hostile interviewer and did the same with my wife (who is also skilled in media training and messaging, but not usually as hostile).
Q: How did this process differ from other media interviews you've conducted? Did the "investigative" interview differ from a straight news interview?
A: This was certainly the most confrontational interview I have ever experienced. I also had not anticipated as many questions on somatic cell count levels. The reporter assumed that bad things are happening on dairy farms. The presumption was guilt, not innocence. Being on the proverbial witness stand, I was on the defensive and had to demonstrate the industry's innocence while looking at videos indicating otherwise.
Q: Knowing the reporting team had an agenda for the interview, how did you make sure your points came across?
A: I knew it would be critical, so I planned for the worst. I assumed that the video generating the coverage would be the same that PETA put on its Web site last fall. The main thing to ensure my point got across was to state the same message several times, using similar phrases. The "World News Tonight" and "Nightline" stories used different sound bites, but both were positive affirmations about animal care that I had prepared.
Q: Did this interview offer you any new perspectives on how the industry addresses the public about on-farm practices?
A: During the interview, and now in the aftermath, the role of NMPF — and for other dairy producers, perhaps — is this: We have to defend practices that are justifiable, criticize practices that are not, and exercise the discretion and wisdom to know the difference. This involves not assuming the worst about a farm operation based on a hidden video, but also making clear that obviously unacceptable practices, such as hitting a cow with a wrench, are not OK. Of all the lessons here, that is the most important.
Q: What would you recommend to dairy producers/industry representatives who receive questions from investigative reporters?
A: Do your homework on messages and practice with another person. Don't feel you have to answer every question or justify what somebody else is seen doing. You can only talk about your own farm.
Source: Dairy Management, Inc.


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Metal Gear Solid 3: Snake Eater
Where can I find (SVD)?
Is there anywhere else that I can get the SVD besides right before you see The End for the first time? Is there a way to get it early in the game?
HammrLord - 8 years ago
Accepted Answer
there are three locations that I know of, the first is during the VM, when you first see the guards, head to your right until you come up on a path leading up hill, take it and the svd is right there. the second is just after you exit the caves, travel up the swamp (where you first encounter the flying platforms) until you see stone walls instead of trees, there should be a path leading to your left, take it, the svd is in a room filled with ammo. the third is located where you start your fight with the end. in the north western part you should find a building (if you are fighting the end, either be quick getting past the door, or be as stealthy as possible, you are safe until you leave the building). I am sure that there are other places (possibly in eva's side car) because the svd is needed near the end of the game.
Superinsomniac - 8 years ago
This question has been successfully answered and closed.
More Questions from This Game
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The natural gas powered Honda Civic GX and the Civic Hybrid have been chosen as the official vehicles for the traditional "Peace, Youth and the Environment" message trek between past and future Winter Olympic cities. A team of cyclists, hikers, rowers and sail-boaters will travel from Salt Lake City to New York State and on to Torino, Italy to share a message of peace with youth and civic groups in towns and cities along the route. The nearly zero emission Honda sedans will serve as support vehicles to the volunteers carrying the message for the American portion of the route, which begins on April 4.
The team's message will be a special delivery from the mayor of Salt Lake City to the mayor of Torino, Italy, demonstrating the commitment and importance of the environment, young people and peace throughout the world while on the world's stage.
"The ideals of peace, youth and the environment closely match Honda's corporate philosophy," said Gunnar Lindstrom, Senior Manager of Alternative Fuels for American Honda, "We are proud to have this opportunity to demonstrate that Honda offers clean technology compatible with the goals of this trek."
Manufacturing vehicles that are safe, environmentally friendly and socially responsible, Honda pursues a philosophy of being a company that society wants to exist. The development of cleaner and more efficient vehicles and alternatives like the Civic GX are part of Honda's commitment to reducing the impact of the automobile on our environment.
For example, the gasoline-powered Honda Insight and Civic Hybrid captured four of the top five spots in the EPA's 2004 fuel economy rankings. And with the introduction of the Accord Hybrid in 2004, Honda become the only automaker to offer U.S. customers three distinct hybrid models and the first company to offer a V6-powered hybrid. Additionally, the Civic GX was dubbed the "cleanest internal combustion engine ever tested" by the USEPA. For 2005, Honda is the only manufacturer to offer a natural gas powered vehicle on a light duty platform. The promise of tomorrow, alive today, is the hydrogen-powered Honda FCX, the only fuel cell vehicle certified by the California Air Resources Board (CARB) and U.S. EPA for everyday commercial use. Honda undertook fuel cell research in 1989 and has been road-testing vehicles in the US since 1999; Honda also began rolling out vehicles in a demonstration fleet in December 2002 and currently has 14 vehicles in regular daily operation with 6 customers in 3 states.
# # #
For more information or downloadable high-resolution images of Honda vehicles, please visit www.hondanews.com. Consumer information is available at www.hondacars.com.


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/seg'ee/ British shorthand for a Unix segmentation fault.
[Jargon File]
Tagged: s
Read Also:
- Segment
noun 1. one of the parts into which something naturally separates or is divided; a division, portion, or section: a segment of an orange. 2. Geometry. a part cut off from a figure, especially a circular or spherical one, by a line or plane, as a part of a circular area contained by an arc […]
- Segmental
adjective 1. of, relating to, or characterized by segments or segmentation. 2. Linguistics. noting or pertaining to the discrete elements of sequential speech, as consonants and vowels. adjective 1. of, like, or having the form of a segment 2. divided into segments 3. (linguistics) of, relating to, or constituting an isolable speech sound
- Segmental anesthesia
segmental anesthesia seg·men·tal anesthesia (sěg-měn'tl) n. Loss of sensation limited to an area supplied by one or more spinal nerve roots.
- Segmentalize
[seg-men-tl-ahyz] /sɛgˈmɛn tlˌaɪz/ verb (used with object), segmentalized, segmentalizing. 1. to make segmentalized.


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The owner of a Butte County medical pot club has been arrested on suspicion of illegally selling marijuana.
The Chico Police Department says 62-year-old Joel Kelly Castle was arrested Friday night for allegedly trading two ounces of marijuana for an item posted for sale on the Web site Craigslist.
Police say they received a complaint from a Chico Craigslist user who said Castle had offered to trade marijuana for the item.
Police officers posed as the seller and arranged to meet with Castle, who is the founder of the Chico Cannabis Club.
He was arrested at a motel where police reportedly found more than five pounds of marijuana and a loaded semiautomatic firearm.
Information from: Chico Enterprise-Record, http://www.chicoer.com


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Limitations of Mammograms
Mammograms are the best breast cancer screening tests we have at this time. But mammography has limitations. A false-negative mammogram looks normal even though breast cancer is present. A false-positive mammogram looks abnormal but there's no cancer in the breast.
The value of a screening mammogram depends on a woman's overall health status. Finding breast cancer early may not help her live longer if she has other kinds of serious or life-threatening health problems, such as congestive heart failure (CHF), end-stage renal disease, or chronic obstructive pulmonary (lung) disease (COPD). The American Cancer Society screening guidelines emphasize that women with serious health problems or short life expectancies should discuss with their doctors whether they should continue having mammograms. Our guidelines also stress that age alone should not be the reason to stop having regular mammograms.
It's important to know that even though mammograms can show breast cancers that are too small to be felt, treating a small tumor does not always mean it can be cured. A fast-growing or aggressive cancer might have already spread.
False-negative results
A false-negative mammogram looks normal even though breast cancer is present. Overall, screening mammograms do not find about 1 in 5 breast cancers.
- Women with dense breasts have more false-negative results.
- Breasts often become less dense as women age, so false negatives are more common in younger women.
False-positive results
A false-positive mammogram looks abnormal but no cancer is actually present. Abnormal mammograms require extra testing (diagnostic mammograms, ultrasound, and sometimes MRI or even biopsy) to find out if the change is cancer.
- False-positive results are more common in women who are younger, have dense breasts, have had breast biopsies, have breast cancer in the family, or are taking estrogen.
- About half of the women getting annual mammograms over a 10-year period will have a false-positive finding. The odds of a false-positive finding are highest for the first mammogram.
- Women who have past mammograms available for comparison reduce their odds of a false-positive finding by about 50%.
- False-positive mammograms can cause anxiety. The extra tests needed to be sure cancer isn't there cost time and money and maybe even physical discomfort.
Over-diagnosis and over-treatment
Screening mammograms can find invasive breast cancer and ductal carcinoma in situ (DCIS, cancer cells in the lining of breast ducts) that need to be treated. But it's possible that some of the invasive cancers and DCIS found would not grow or spread. (Finding and treating cancers that would never cause problems is called over-diagnosis.) This means that some cancers are not life-threatening, and never would have been found or treated if the woman had not gotten a mammogram. The problem is that doctors can't tell these cancers from those that will grow and spread.
Over-diagnosis leads to some women getting treatment that's not really needed. We don't know which women fall into this group when the cancer is found because we can't tell which cancers will be life-threatening and which won't ever cause problems. Treating women with cancers that would never cause problems would be considered over-treatment.
Because doctors often can't be sure which cancers and cases of DCIS will become life-threatening, all cases are treated. It exposes these women to the adverse effects of cancer treatment that's really not needed.
Still, over-diagnosis is not that common. There's a wide range of estimates of the percentage of breast cancers that might be over-diagnosed by mammography, but the most credible estimates range from 0% to 10%.
- Mammogram Basics
- Mammograms: What to Know Before You Go
- What Does the Doctor Look for on a Mammogram?
- Getting Called Back After a Mammogram
- Understanding Your Mammogram Report
- Breast Density and Your Mammogram Report
- Limitations of Mammograms
- Having a Mammogram After You've Had Breast Cancer Surgery
- Mammograms for Women with Breast Implants
Hubbard RA, Kerlikowske K, Flowers CI, et al. Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study. Ann Intern Med 2011;155:481-492.
Puliti D, Duffey SW, Miccinesi G, et al. Overdiagnosis in mammographic screening for breast cancer in Europe: a literature review. J Med Screen, 2012;19:Suppl 1:42-56.
Rosenberg RD, Hunt WC, Williamson MR, et al. Effects of age, breast density, ethnicity, and estrogen replacement therapy on screening mammographic sensitivity and cancer stage at diagnosis: Review of 183,134 screening mammograms in Albuquerque, New Mexico. Radiology 1998; 209:511–518.
Last Medical Review: June 1, 2016 Last Revised: August 18, 2016
American Cancer Society medical information is copyrighted material. For reprint requests, please contact email@example.com.


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Isabelle: I watch as we pass a lot of people I had never met before...like the mail man, and ice crem truck driver. I smile and watch them pass skipping while holding Bella's leash. " it's so nice out!"
Max: I laugh and say " I know it is". I stopped and looked around as I heard a big bagging sound but then continued walking beside my sister.


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To say that this is not your ordinary sunscreen is an understatement. It was named 2008 Cosmetic Innovator of the Year by ICMAD. Not just because it's a great sunscreen (there are lots of those!) and not just because it multitasks (although that's nice too!) but because it's something you'll want to wear every day of your life (have you ever said that about a sunscreen?). Features natural melanin and broad spectrum UVA/UVB protection. If you're going to do just one nice thing for your skin, this is it.
Benefits: Broad spectrum protection against UVA (aging rays) and UVB (burning rays) damage. Ideal for priming skin for makeup. Reduces photo aging. Softens, soothes and hydrates skin.
Recommended daily use: Apply every morning to the face and neck.
- 1 oz.
- By ZO Skin Health™.
- Item #242191


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Shire to decide stance on Gisborne tavern pokies bid
The Macedon Ranges Shire is expected to decide its position tonight on a proposal for more gaming machines in Gisborne.
A consultants' report to be presented at tonight's shire meeting recommends councillors oppose the application for eight new poker machines at the Victorian Tavern.
The hotel already has 42 machines and has applied to the Victorian Commission for Gambling Regulation for the increase.
However, the consultants have found the machines would have a detrimental effect on vulnerable groups, including young people and those under housing stress.
They say the hotel is in an area of social and economic disadvantage and improvements to the venue would not bring substantial benefits to the community.
The council is advised to further restrict the tavern's operating hours and ask it to increase its support for problem gambling groups, if the commission approve the application.
Topics: gambling, local-government, gisborne-3437, bendigo-3550


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Related topics
Missing American's family believe he will be found
The family of an American man who has been missing in Hong Kong for a fortnight are still convinced he can be found. Gregory Brooks Winston, (pictured) disappeared after visiting a Buddhist temple in Sung Shan New Village, Yuen Long, with his wife. About 1.7 metres tall, weighing 76 kilograms and bald, Winston, 49, was wearing a yellow-and-green T-shirt, white shorts, white socks and white slippers. His sister Leslie said Winston started showing signs of extreme paranoia about three weeks ago and appeared to have suffered some form of nervous breakdown. A HK$40,000 reward has been offered for information that leads to Winston being found safe. People with information can contact investigating officers on 2860 1045 or 9886 0034 or call any police station, while the family can be contacted at helpfindgregb @gmail.com.
Typhoon warnings lowered as storm passes
The Hong Kong Observatory lowered all typhoon signals about 8am after tropical storm Doksuri weakened and moved away from the city. A No 8 storm signal was in effect for more than four hours from late on Friday as Doksuri brought winds gusting to 100km/h on high ground and offshore while passing 70 kilometres southwest of the city. The storm caused no reported injuries but several roads were blocked by fallen trees. Part of Prince Edward Road East, in Wong Tai Sin, was sealed off about 1am when a 30-metre section of scaffolding was in danger of collapsing.
Dragonair pilots in no-confidence vote
Dragonair Pilots Association members, who were due to vote on an immediate work-to-rule at a meeting last Wednesday that might have disrupted summer holiday flights, instead passed a vote of no confidence in the airline's management. The action came after Dragonair introduced a new contract which the union said denied pilots equality in pay and remuneration. The union is now seeking an immediate start to talks.
Stranded German held at immigration centre
A penniless German citizen who forced to squat in a Lamma Island building after being stranded in Hong Kong for more than a year due to passport problems has been detained at Castle Peak Bay Immigration Centre since May 14. In March, Ewald Widiner, 62, told the South China Morning Post that the German consulate in Hong Kong had cited an unpaid tax bill when it refused to give him the new passport he needed to return to the mainland, where he has taught English and German since 2004. Widiner's girlfriend, Maya, last week contacted the Sunday Morning Post and told of his detention. A German Consulate General spokesman said it was aware of the case but could not disclose any information regarding individual passport applications.
Florence Hui to stay where she is - for now
Florence Hui Hiu-fai, widely tipped to be the city's first culture minister, would remain as undersecretary for home affairs until a decision is made on the new government's structure, the Chief Executive-Elect's office said. Julia Leung Fung-yee would also remain as undersecretary for financial services and the treasury.
Two more patients show respiratory symptoms
Another two patients, aged 54 and 55, in a male long-stay ward of Castle Peak Hospital are showing symptoms of respiratory illness. On Thursday, five patients in the ward tested positive for respiratory syncytial virus. The patients are in isolation.
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With his penchant for meaningless self-indulgence and fickle obsession with all that's elemental about pop music, Jack White maintains a certain distance from even his most ardent fans. I have less of a problem with Meg White's limited drumming than I do with The White Stripes' lack of bass guitar, but Jack wouldn't be Jack without his peccadilloes, and in any case he's got his other band, The Raconteurs, to scratch any conventional rock-band itch.
After the instrumental experimentation of "Get Behind Me Satan," the refocus on loud blues guitar sounds great. If "Icky Thump" is compositionally inferior to its predecessor, it compensates with better riffs and a wackier, more inviting world view. When Jack does get experimental, it's tempting to wonder if his recent marriage to an English model didn't somehow turn him into Damon Albarn, but then he whirls around and shoots out "Little Cream Soda," a white-hot hard-rock tune that is more characteristic of the album's overall tone. Given that the record was put together in Nashville, it's surprising there are no country songs, but being a self-indulgent, fickle obsessive means never having to live up to expectations.


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Skip to content
Haunted Places
Haunted Scottish Castles
A – Abegeldie to Auchen
B – Balcomie to Borthwick
B – Braemar to Buckholm Tower
C – Carbisdale to Castle of Park
C – Castle Stuart to Culzean
D – Dean to Duntulm
E – Earlshall to Ethie
F – Fernie to Fyvie
G – Gight to Glamis
H/J – Haining to Jedburgh
K – Kellie to Knock
L – Lauriston to Lordscairnie
M – Macduff's to Muchalls
N – Neidpath to Newton
R – Rait to Roxburgh
S – Sanquhar to Sundrum
T/W – Tayside to Wemyss
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Ticket #143 (new defect)
implicit_resolver does not work with literal block scalars, here is the test
|Reported by:
|Owned by:
import yaml import re
s = """ good: foo bad: |
class Test(yaml.YAMLObject):
yaml_tag = '!test' pattern = re.compile(r'foo') yaml.add_implicit_resolver('!test', pattern)
def init(self, s):
self.s = s
def repr(self):
return 'Test(%s)' % self.s
@classmethod def from_yaml(cls, loader, node):
value = loader.construct_scalar(node) return cls(value)
print yaml.load(s) # emits>> {'bad': 'foo', 'good': Test(foo)}
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JOSEPH RAY KELLY, 81, of Hudson, OH died Oct. 29, 2010 surrounded by his loving family.
Beloved husband and family man, he is survived by his wife Ruth (neé Barrack) of 59 years; sons Douglas (Nancy) of Moreland Hills, OH, Kenneth (Pamela) of Monroe, CT, David (Sheryl) of Hudson, OH; grandchildren Daniel and Matthew; Ryan (Kristina), Sarah, and Thomas; William, Joseph, and Michael; one great-granddaughter, Annabelle; and sisters Anne Hoffman and Jean Bair.
A graduate of Langley High School in Pittsburgh, PA and Antioch College in Yellow Springs, OH, he began his career in the Rubber Industry working for Vernay Laboratories for four years before joining Goodyear Tire and Rubber where he retired in 1991 as the General Sales Manager of the Chemical Division. A resident of Hudson since 1964, Mr. Kelly was an active member of the First Congregational Church of Hudson, where he served as a deacon for many years.
An Eagle Scout himself, Mr. Kelly was Scoutmaster of the church-sponsored Boy Scout Troop 320 from 1966 to 1972. During his tenure the troop produced 31 Eagle Scouts, including his three sons.
Athletic throughout his life, in 1984, Joe ran the Columbus Marathon and was honored that year to carry the Olympic Torch through Akron on its journey to the Los Angeles Olympics. A man of many accomplishments, he considered his family to be his finest. He will be sadly missed by all of them.
A memorial service will be held at 11:00 a.m. on November 13, 2010 at the First Congregational Church of Hudson, OH. Memorial donations may be made to the, Great Trail Council, Boy Scouts of America; Attn: Joseph R. Kelly Camp Manatoc Fund (1601 Main St., Akron, OH 44309-0068) or the First Congregational Church of Hudson (47 Aurora Street, Hudson, OH 44236).
Arrangements by: JOHNSON-ROMITO FUNERAL HOME HUDSON, OH (330-650-4181)


text:
Why not? We put together this mock draft last May, a week after the 2011 draft. It involved a lot of NFL guesswork (which NFL teams would suck?) and college guesswork (who would come out, blow up, and stink?).
Of the 32 players projected last May, some stayed in school (Jones, Barkley, Te'o to name a few), and a couple let success go to their heads and had awful seasons (Harris, Burfict). A few of them are likely to get selected tonight (Worthy, Jeffery, Upshaw, to name a handful).
Hits (drafted in the 1st round):
Andrew Luck – 1st
Quinton Coples – 4th
Dre Kirkpatrick – 8th
Justin Blackmon – 13th (the only direct hit, to the Jags)
Trent Richardson – 14th
Luke Kuechly – 16th
Matt Kalil – 17th
Mark Barron – 22nd
Dont'a Hightower – 24th
Brandon Weeden – 27th
Those wild swings turned into Thursday's mock draft, which correctly identified 24 of the 32 first round picks, and had eight direct hits (the first four, Tannehill, Floyd, Kirkpatrick, Reiff).
But enough with the back-patting. It's time to move on to some bad NBA playoff picks. But who is excited for next week's 2013 mock draft? Oh yeah, it's coming!


text: disclaimer :i would like to excuse all of those who might find this not classic enough. There was a time when Jazzy Jeff and the Fresh Prince were the thing to hear, LA GEAR was the sneaker to rock and Neon was the tone to wear independent to the color to pick... those days are back in fashion judging by the colors of sneakers and track jackets being sold in stores, so it seems appropriate to present my fellow retro'ers Kitty Kat and the electric dreams Specs (help) : Head size: 90 Lenght: 27 Beam: constant 25 mm Flex: ?? Weight: ??? (will add later) balance: ??? (hL for sure)


text: (again, I insist for this thread to appear on -i18n. Nearly all i18n/l10n involved people read it while they may read -devel less carefully...or not at all) > > Does your package generate a file for Arabic? I'm not sure that the > > ar localisation of Firefox is included upstream, though. > > For the moment, it doesn't include Arabic, because this language is not > available in mozilla.org. > I can include it, anyway, if somebody points me to the right XPI. I forwarded this to the Arabeyes people, one of them is working on Firefox Arabic translations, IIRC. I'm in close touch with them and hope to give you news soon. > > > > > Can you indeed give us here the list of mozilla-firefox-locale-xx > > packages your package currently generates? > > For the moment: > ast-ES > cs-CZ > da-DK > en-GB > fi-FI > fr-FR > he-IL > hu-HU > ro-RO > ru-RU > sl-SI > sv-SE > zh-CN > zh-TW > > César Kostas, what about Greek ? Can you check this with whoever maintains mozilla-firefox-locales-el if such package exists? --


text:
Need Appliance Repair Help? Ask a Technician for Answers ASAP
Obviously make sure your water supply is turned on. Did he pull the unit out to uninstall it, or did he do it in place through the hole like I just did on someone's today? If he went in from the front, there's not much way he did anything other than knock something off the board. What you should do is select hot wash, and cold wash and see if you get anything off either. Make sure the shutoff's are on at the wall, and if they are call him back out there and make him fix it. There's no way anything broke from changing a gasket, however it's easy to knock a wire off. And if you paid to have a gasket changed it's not right for me to walk you through tearing the machine down to fix something he broke. Thanks!
Not imparticular, but if he was in there banging around, the control board is upfront with all wiring on it. You need to either have him come out, or remove the 2 screws in the top panel and take it off , and check each connector 1 by 1 on the board. Most likely it's just a loose connection. Easy fix, but I'm a principle guy, I would wait a week to have him fix it rather than just fix it myself if he broke it. Thanks!


text:
Dinner ideas for 25 people
Recipes / Dinner ideas for 25 people (1000+)
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for you. Ten More Meatless Ideas for
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or an intimate little dinner for three and one lion, enough for 4 people Orange Cinnamon
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could eat this for dinner by itself. tight-fitting lid and cook for 25 to 30 minutes
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used for baking, many people Scroll down for 25 Ideas: Cake Blondies Dinner rolls
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people forgeta great idea, since turkeyto be saved for a special readers a $25 Visa gift
Taking On Jamie - Dish 1 - Mushroom Fafalle
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for 4 people, I froze the leftovers for a dinner250 gms Mushrooms 25 gms Dried mushrooms
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shipped through the mail. I'm looking for ideas for treats that can be shipped to our
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Share your tips, recipes and menu ideas for the holiday that is centered on gratitude
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the dead of winter?????) Please share ideas for gardening, cooking, best farmers' markets
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as a main course for you and your family. And if you have more ideas for light and healthy
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Dinner Planner, There are so many options for great things to cook for
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text: Mobile Storage Georgia Mobile Storage Sterling Mobile Storage Sterling Mobile Storage Search Results We've found 1 Sterling mobile storage companies that deliver to Sterling - Click on any one of them for more information. Refine Search Size 5x5 5x10 5x15 10x10 10x15 10x20 10x30 Features Climate Controlled Drive-up Access Auto/Boat/RV Neighborhood None Found PODS Moving & Storage Moving & Storage PODS container delivered directly to you! Sterling, GA 877-614-5101 Specials Enter Promo Code: FREEMONTH More Info


text:
Trial Attorney - Westchester County, New York
Description :
Where good people build rewarding careers.
Think that working in the insurance field can't be exciting, rewarding and challenging? Think again. You'll help us reinvent protection and retirement to improve customers' lives. We'll help you make an impact with our training and mentoring offerings. Here, you'll have the opportunity to expand and apply your skills in ways you never thought possible. And you'll have fun doing it. Join a company of individuals with hopes, plans and passions, all using and developing our talents for good, at work and in life.
Job Description
The Litigation Services Attorney job family is responsible for managing Insurance Defense and Tort Litigation / Disputes work and related issues/matters.
Represents insureds and the Company in the defense of bodily injury and property damage lawsuits, subrogation, and Allstate Financial cases. Prepares for and conducts hearings, trials, arbitrations, mediations, and depositions. Prepares and argues pre and post-trial motions. Assists colleagues in the resolution of calendar conflicts. , Provides counsel to business clients on day to day issues. Monitors and reviews new laws, regulations, and case law; identifies and summarizes relevant issues; collaborates with other areas of L&R department; proactively provides advice and counsel to business unit on the impact of new laws on business; monitors counsel
Allstate's Staff & Retained Counsel team represents policyholders in claims-related litigation / disputes through staff counsel offices at approximately 77 locations in 35 states and, when appropriate, through the retention of outside law firms around the country. It also represents the Company in a variety of litigation as well. This unit is responsible for leading, coordinating and advancing Allstate's large nationwide staff counsel organization and the strategic management of the Claims panel of retained outside counsel. This team works closely with our Claim Department as well as the Company's regions to regularly assess both short and long-term strategic needs, direction and trends.
- Are you an expert litigator with a passion for insurance defense?
- Do you have an interest in being a subject matter expert for a leading insurance carrier's claims litigation team?
- As Trial Attorney, you will bring your subject matter expertise in claims defense litigation to represent clients who are customers of Allstate Insurance Company, Encompass Insurance Company, and Esurance ("the Company") in: bodily injury (BI), property damage, no-fault/PIP, special investigations (SIU), arbitration and subrogation cases. You will acquire broad knowledge of the Company and our business lines as well as assert processes, procedures and best practices. You will manage a caseload from end to end by acquiring, compiling and integrating case-related information and legal research, developing and implementing litigation strategies in cooperation with your clients and claims personnel. You will determine litigation tactics and negotiate cases for timely claims resolution.
Represents insured's of Allstate and the Company in the defense of low to moderate to exposure bodily injury and property damage law suits. Assess liability and damages and develop defenses to allegations for a successful resolution of cases.
Allstate's Litigation Services team provides legal assistance in connection with large and complex claims cases, and manages controversies arising from the implementation and execution of claims policies and procedures, both before and after litigation has commenced (including appeals). This practice group also assists with insurance coverage disputes by providing legal opinions and managing related litigation. This group also provides training and advice to the claims organization.
- Effectively negotiate settlements including all aspects of liability and damages
- Attend hearings and conduct trials
- Argue motions; take effective depositions of lay and expert witnesses
- Consult with clients and opposing counsel and the judiciary
- Coordinate the case handling with claims personnel
- Complete necessary system documentation
- Assist other attorneys in resolving calendar conflicts
Job Qualifications
Successful candidates will possess the following experience, skills and attributes:
- Juris Doctorate (J.D.) and member in good standing of the New York state bar
- Approx 2-5 years of litigation experience; insurance defense strongly preferred
- Jury trial experience a plus
- Proven time management skills including ability to handle multiple cases, prioritize and organize, and establish and meet time lines
- Excellent interpersonal, verbal and written communication skills; strong presentation and collaboration skills including the ability to partner with a variety of internal and external contacts as well as for preparing reports, pleadings, and correspondence, etc.
- Independent worker as well as team player to collaborate and work cohesively with a group of attorneys, paralegals, administrative assistants, supervised by Lead Counsel
- Demonstrated problem solving and decision making skills
- Effective negotiation skills
- Computer proficiency with Microsoft, LexisNexis (preferred), and the Internet
The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.
Good Work. Good Life. Good Hands®.
As a Fortune 100 company and industry leader, we provide a competitive salary – but that's just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, you'll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy.
Learn more about life at Allstate. Connect with us on Twitter, Facebook, Instagram and LinkedIn or watch a video.
Meet Some of Allstate's Employees
Director Of Technology Strategy
Josh is constantly looking for opportunities for Allstate to use technology and computer software in innovative ways that continue to build on the company's core strengths.
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text:
start a contest
sign in
$100 Award for a Business Name
Company that provides subscription based online training and consulting to small and mid-size retailers about loss prevention and security. Customers will have access to interactive modules, policy templates, and other information related to retail loss prevention. The focus is on providing simple, effective, logical, actionable strategies. Explanation of LP:
Business Names
submit a name
LPology or LPologist ~ The Loss Prevention Specialists~


text:
Tapping into its archives for inspiration, adidas Originals has just introduced this trainer-style sneaker to its collection for Summer 2011. The silhouette may look familiar to some as it was originally introduced back in 1984 to commemorate the Olympic Games that were being held that year in the city of Los Angeles. With a grey suede detailing on the toe and heel counter, contrasting white laces and green signature stripes, the sporty sneaker is currently available for purchase through select adidas Originals stockists worldwide.
Source: suelas de goma


text:
Dane County has seen a recent surge in daytime burglaries over the past week, according to an alert released Friday by the sheriff's department.
Within the past week, four residential burglaries have occurred in the townships of Dane and Roxbury; each burglary occurred between the hours of 10 a.m. and 4 p.m. According to the alert, perpetrators have been entering homes with force, if necessary.
"It's a crime of opportunity," said Elise Schaffer, spokesperson for the Dane County Sheriff's Office. "And realize, most people are at school or at work during the day and it's a time for [burglars] to get into homes when, for the most part, they feel no one is going to be home."
The office is witnessing an elevated number of burglaries in homes located in "more secluded" areas so there is a lesser chance of getting caught.
Although Shaffer said daytime residential burglary is nothing new, she added her office has seen an increase in this trend over the past year.
"[The economic downturn is] certainly a factor that we look at when we're investigating these crimes," Schaffer said. "People are looking for any opportunity to get money and many times taking things that they can easily pawn off for cash."
Schaffer said Friday evening the sheriff's office released reverse 911 calls to homes across the townships of Roxbury and Dane.
The calls are sent to a targeted area and contain a recorded message about the burglaries and what to do to prevent them from happening. The calls reached 2,176 homes.
Topf Wells, chief of staff for Dane County Executive Kathleen Falk, said the sheriff and county executive are ultimately urging people to be careful.
"You don't want to insult people's intelligence but remind them to do obvious things: Be careful about locking doors (and) leaving garages open," Wells said.
Schaffer said detectives are currently working on the daytime burglary cases and are looking for the public to call in if they see any activity.
If you have information related to past activity, officials ask you to call the Dane County tip line at (608) 284-6900.


text:
Housing slump not quite over
Posted August 26, 2009
Updated March 31, 2016
Existing home sales had their biggest jump in over a year, rising 7.2 percent in July and 5 percent in June according to the National Association of Realtors.
This data has given economists and other market participants a level of confidence not seen in quite some time. So, the question at hand is: Is the housing slump OVER and are we on a road to recovery?


text:
|Home | About | Journals | Submit | Contact Us | Français
Objectives: To measure the strength of agreement between the concepts and records retrieved from a computerized patient database, in response to physician-derived questions, using a semantic terminological model for clinical findings with those concepts and records excerpted clinically by manual identification. The performance of the semantic terminological model is also compared with the more established retrieval methods of free-text search, ICD-10, and hierarchic retrieval.
Design: A clinical database (Diabeta) of 106,000 patient problem record entries containing 2,625 unique concepts in an clinical academic department was used to compare semantic, free-text, ICD-10, and hierarchic data retrieval against a gold standard in response to a battery of 47 clinical questions.
Measurements: The performance of concept and record retrieval expressed as mean detection rate, positive predictive value, Yates corrected and Mantel-Haenszel chi-squared values, and Cohen kappa value, with significance estimated using the Mann-Whitney test.
Results: The semantic terminological model used to retrieve clinically useful concepts from a patient database performed well and better than other methods, with a mean detection rate of 0.86, a positive predictive value of 0.96, a Yates corrected chi-squared value of 1,537, a Mantel-Haenszel chi-squared value of 19,302, and a Cohen kappa of 0.88. Results for record retrieval were even better, with a mean record detection rate of 0.94, a positive predictive value of 0.99, a Yates corrected chi-squared value of 94,774, a Mantel-Haenszel chi-squared value of 1,550,356, and a Cohen kappa value of 0.94. The mean detection rate, Yates corrected chi-squared value, and Cohen kappa value for semantic retrieval were significantly better than for the other methods.
Conclusion: The use of a semantic terminological model in this test scenario provides an effective framework for representing clinical finding concepts and their relationships. Although currently incomplete, the model supports improved information retrieval from a patient database in response to clinically relevant questions, when compared with alternative methods of analysis.
Clinical data in computer systems have to be accurate if they are to support patient care, research, and health service management, but despite this there is little published literature devoted to measuring this in electronic health care records.1 Inaccurate data can lead to an underestimate of disease prevalence, with potentially serious consequences for monitoring the success of health care interventions and detrimental effects on decision support protocols and alert systems.2
The retrieval of meaningful information is dependent on data being entered in an organized way, and to maximize the benefit of electronic health care records, an underlying structure is required.3 If data are collected in free text, the text has to be converted to computer-understandable codes and structures to extract meaningful data.4 It is postulated that the content of the electronic health care record should be provided by a clinical terminology in which concepts and their relationships are formally expressed.5 Clinical Terms Version 3 (The Read Codes) (CTV3)6 is a clinical terminology in which concepts are represented according to their meaning (semantically) with reference to standard structured hierarchies of component values, e.g., anatomy and micro-organisms (semantic terminological model). The use of this formal semantic model for describing the intrinsic characteristics (atoms) of concepts in CTV3 has parallels in other schemes such as LOINC7 and the cross-references available in SNOMED International.8 The model employed by GALEN uses GRAIL to express sanctioned associations between primitive concepts.9 Similarly, SNOMED RT uses the KRSS description logic to formally express relationships.10 Thus, there is an emerging convergence of approaches toward the use of a concept-based clinical terminology with an underlying formal semantic terminological model (STM).
There has been little reported work on the effect of different search methods on the efficacy of data retrieval from clinical records. However, significant efforts have been invested in initiatives in the U.K. with the development of CTV3,11 in Europe with the GALEN-in-Use project,12 and in the United States with the development of SNOMED RT.10 These initiatives have confirmed that considerable resources are required to create and maintain such products, and they are all based on the assumption that a clinical terminology will bring improved data quality. There is, therefore, an urgent need to investigate whether the use of semantic-based terminologies will deliver any practical advantages over simpler existing systems.
This study explores the hypothesis that the use of an STM improves the quality of information retrieval in response to a battery of physician-derived questions from a clinical database. The Diabeta patient database,13 populated with the CTV3 terminology, has been used to compare retrieval using an STM (semantic differential retrieval) with more established approaches. The experiment measures the strength of agreement between the concepts and records retrieved from the database using the STM with those concepts and records expected clinically by manual identification. The performance of semantic differential retrieval is also compared with more traditional methods, including free-text searching, class retrieval using the CTV3 hierarchy table,14 and the framework of the International Classification of Diseases and Related Health Problems, 10th revision (ICD-10).15
Clinical Terms Version 3 was developed during the Clinical Terms Project to provide a common terminology for electronic health care records.6,11,16,17 The structure of CTV3 provides a formal framework for representing the meaning and relationship of clinical findings and procedures, allocating each unique clinical concept a Read code.6,14 Each concept code is labeled with a unique unambiguous preferred term and, where appropriate, synonyms. Concepts are formally arranged in a hierarchy in which those of more narrow meaning appear as "types of" concepts of more general meaning (subtype hierarchy), e.g., bacterial meningitis is a subtype of meningitis (). Concepts are also mapped, where appropriate, to ICD-10 and the U.K. surgical procedure classification OPCS-4.18 These cross-mappings have been subject to independent quality assurance and practical evaluation in use since 1994 and are, therefore, considered to be of high quality.
The design of CTV3 employs object-attribute-value triples stored in a template file as a mechanism for defining each core clinical concept in relation to more primitive value concepts, e.g., anatomy, pathological processes, and micro-organisms.6,19 This feature allows the semantic definition of concepts according to their meaning (). The model describing the formal relationship between the core terminology and their constituent values (atoms) is referred to in this paper as the STM (semantic terminology model) to distinguish it from alternative models describing the structure of the record and models of health care. A detailed but provisional STM has been developed within CTV3, describing disorders.20 This has been extended in this study to provide at least partial representation of other findings, including symptoms and signs ().
The provisional STM defined 44.7 percent of the Diabeta concepts completely, with the 55.3 percent remaining concepts containing at least one additional nonrepresented characteristic.21 Incomplete definitions included concepts such as Osteogenesis imperfecta, Scleroderma variant, Osteopetrosis, and True hermaphrodite, whose semantic definitions are not amenable to full representation using the present STM. Characterization of these might be achievable from consideration of more detailed aspects of their embryologic, cellular, and molecular origins, but this would require considerable specialist clinical input, which might not be consistently applicable to other areas.20 The definition of other classes of concepts, such as Cicatricial junctional epidermolysis bullosa is highly dependent on the extensiveness of purely descriptive elements that do not currently exist in the supportive hierarchies.
Despite this level of incompleteness, 818 of these partially defined concepts had unique definitions that did not coincide with others. Thus, within the clinical database examined (Diabeta), the STM provides either a complete (1,175) or unique (818) semantic definition for 76 percent (1,993) of findings, with a residual 24 percent (634) of concepts having incomplete definitions that are shared with other concepts.22
Diabeta is a computerized clinical record system that has been developed and used with ongoing modification since 1973 at St. Thomas' Hospital, London (part of The Guys', King's College, and St. Thomas' Hospitals Medical and Dental School).13 It is used for supporting the management of patients attending the medical outpatient department, many of whom have diabetes mellitus.23 The original system (Diabeta 1) allowed, at every encounter between the patient and clinician, the recording of clinical findings as "problems" using a locally created list of reusable free-text term strings. The system thus allowed the collection of a large corpus of clinically relevant terms without any potential restraint of a fixed terminology. This database has been converted to a new database of patient problem records (Diabeta 3), in which every unambiguous clinical finding term string has been matched to an applicable term in CTV3. During the translation process between the existing Diabeta database and CTV3, any clinically important concept or term that was found to be absent was incorporated into the next release of CTV3 and was thus available for the analysis experiment. Consequently, the created Diabeta test database represents a valuable corpus of clinically derived concepts.
The experimental Diabeta database contained 12,696 different term strings (accounting for 106,000 "problem" record entries) mapped to 3,049 unique terms associated with 2,625 unique Read-coded concepts. Mappings to ICD-10 were available for 2,301 concepts (87.7 percent). Those concepts without an ICD-10 map fell into two groups: observations that are not specifically included in ICD-10, e.g., alcohol consumption and persistent microalbuminuria, and classes of concepts based on anatomic regions not accommodated by the axes in the classification, e.g., limb complication and limb infection.
A key function of a terminology is the support it provides for the retrieval of information from a clinical system.* In practice, the interrogation of a clinical database, to answer a specified question, usually involves two main steps:
The kernel of the problem is to measure how well the concepts (and records) retrieved in response to a clinical question match the expectation of the clinician who posed it. The objective of the study was to measure the strength of agreement between the concepts and records retrieved using an STM from a computerized patient database with those concepts and records expected clinically by manual identification in response to physician-derived questions. It tests the hypothesis that the use of an STM for clinical findings improves the performance of data retrieval in comparison with the more established retrieval methods of free-text search, ICD-10, and hierarchic retrieval.
A survey was performed to gather a battery of clinical questions relating to clinical findings that a clinician might want to ask the Diabeta clinical information system. Fifteen copies of a questionnaire were distributed to all grades of medical staff in two clinical academic departments. Eight completed forms were returned, which collectively suggested 47 unique questions relating to clinical findings (). These questions were then formulated into database queries using the four alternative methods of retrieval.
A table of the Diabeta clinical term strings mapped to CTV3 was created in an Microsoft Access database together with their frequency in records in the system and the concept (Read code) to which they had each been mapped (e.g. diabetes mellitus| 7463| C10..). A separate table was created, containing the default ICD-10 maps for each concept (Read code) using the mapping table from the October 1997 Read Codes release. Another table expressed the semantic definition of each concept with reference to the attributes expressed in the STM ().
The semantic definition table contained an entry for each concept with a separate column for every attribute. The applicable values (atoms) for each concept were entered in the appropriate column field (). The database design dealt with the uncommon circumstance in which a concept had an attribute containing more than one value by replicating the line for each value (e.g., Vulvovaginitis has a separate row for the attribute [Site]: Vulval structure and Vaginal structure).
These resource tables were then used to retrieve concepts and records in response to each of the 47 clinical questions. The principle adopted was that a user would want to retrieve the chosen clinical concept and any subtypes of that clinical concept, e.g., Gallstone chronic pancreatitis was retrieved when searching for cases of Chronic pancreatitis. The concepts and records of the experimental Diabeta database were identified and flagged for each question and stored in 47 separate tables using each of the following four approaches:
Free-text searching was performed using standard Access query methods to find phrases containing the required string, which has previously been found to be effective.24 For example, record entries of Frozen shoulder were retrieved by searching for all strings containing <*froz*> (where * is a wildcard representing any characters). Multiple searches were allowed to identify alternative expressions of the same concept; for example, both <*IHD*> and <*ischaemic heart*> were used to identify records of Ischaemic heart disease.
The ICD-10 categories required for retrieval for each question were identified with reference to the ICD-10 (volume 3) index. A single ICD-10 code or list of codes was constructed and its appropriateness to the clinical question validated by an independent clinician. The ICD-10 code (or codes) were then used to retrieve a unique list of Read-coded concepts that were relevant to the question, to identify the concepts with applicable maps, e.g., L92.1 for cases of Necrobiosis lipoidica.
The October Read Version 3 browser25 was used to identify the Read-code node of the hierarchy required for each question. For example, Myocardial infarction (Read code X200E) was identified as the superordinate node marking the hierarchy of concepts required, in response to the question "Find all types of Myocardial infarction." A unique descent from this identified node was then performed using the "descent" functionality of the Version 3 browser. Occasionally, more than one Read code descent was needed to retrieve the concepts required to answer the clinical question, e.g., Ischaemic heart disease and Peripheral vascular disease.
Semantic retrieval was performed by exploiting the "atoms" of concepts in the STM and the formal structuring of the underlying primitive values that have a strict subtype arrangement.22 For example, to find all "disorders affecting the limbs," a list of concepts was created that had a semantic definition containing [Site]: Limb structure, or a subtype of Limb structure (). In the example shown, this would result in the retrieval of two concepts, Toe infection ([Site]: Toe structure) and Ulcer of foot ([Site]: Foot structure). The described STM of clinical findings contains a large number of attributes, and a more complex query might involve the differential retrieval of concepts that have more than one characteristic in common (semantic differential retrieval). For example, to retrieve all "limb infections," a list of concepts was created that had a semantic definition containing [Site]: Limb structure or a subtype and [Process]: Infection (). In the example shown, this would result in the retrieval of a single concept, Toe infection, but not Ulcer of foot (as its semantic definition does not contain the [Process]: Infection).
To evaluate the retrieval performance of a terminology, comparison against a gold standard is needed. The creation of such gold standards in medical informatics is recognized as problematic.26 Ideally, such a standard should represent the (perfect) "truth" about the population against which the performance of the information resource can be compared. In the evaluation of the performance of a terminology, the gold standard is the complete subset of concepts from the terminology that all clinicians (with perfect knowledge) would expect to retrieve in response to a particular clinical question. Thus, a separate gold standard is required for each discrete clinical question (and relating to the version of the terminology at the time of the query).
An initial flagged list of concepts was created that one would expect to be retrieved from the total 2,625 concepts in the database, in response to each question posed. The quality of these was then independently assured by a second clinician, who had a good knowledge of the contents of the original Diabeta database. A 10 percent sample was then further validated by a third clinician, to create the final gold standard list of concepts expected to be retrieved from the database for each of the 47 questions.
A table was constructed for each question and search method for all concept database tables (141 fields) and record database tables (168 fields). These tables contained those concepts and records that were expected for each question and those that were actually observed for each method ().
The choice of the statistical method for the evaluation of the retrieval performance of a clinical terminology requires careful consideration.27 The retrieved concepts and records are nominal data, dictating the use of 2 × 2 continency tables as the most appropriate method to compare the observed retrieval with that of the gold standard.17 Individual derived measures and means of performance across all 47 questions were calculated and expressed by the mean detection rate (TP/(TP + FN)) and mean positive predictive value (TP/(TP + FP)). The likelihood of the association was estimated using the Yates continuity-corrected chi-squared test. This test was chosen because it provides a more robust estimate of the exact probability (compared with the chi-squared test) where the expected and observed numbers are relatively small, e.g., when the clinical questions are specific and generate only small frequencies of retrieved concepts (e.g., Frozen shoulder).
The Cohen kappa (κ) has been used as an index of the strength of agreement (between the observed retrieval and the gold standard) against that which might be expected by chance.26,28 A value of +1 indicates perfect agreement, and some authorities consider a kappa value above 0.4 as evidence of useful agreement, but this threshold obviously depends on the clinical application and may need to be set at a level higher than 0.8 for the evaluation of retrieval performance.27
To express the collective results for all retrievals and produce a summary index of the overall performance of a terminology, means of the derived indexes from the 2 × 2 contingency were used. In addition, the Mantel-Haenszel chi-squared test was quoted, which also pools the results of the individual subsets using the following formula:
where a is the observed value, Ea is the expected value of a, and Va is the variance of a.
The Mann-Whitney test was used as a measure of the significance of association because it provides a more conservative estimate, as the assumption that the data always come from a normal distribution may not always be true. For example, the very fact that a question may (by design) retrieve concepts sharing one or more particular characteristics suggests that it is safer to assume that the data are nonparametric.
A 2 × 2 contingency table was constructed for each of the 47 questions for all four methods relating to both concept and record retrieval (although free-text retrieval related only to records). These individual contingency tables related the actual numbers of concepts and records observed by each method compared with those expected (by the gold standard). The number of concepts expected to be retrieved ranged from 1 to 219 (from a total of 2,625 concepts); the number of records expected ranged from 0† to 4,231 (from a total of 106,000 records).
The mean detection rate of semantic differential retrieval was significantly better for both concept (0.86) and record (0.94) retrieval (). The use of the ICD-10 framework was slightly better than hierarchic retrieval, with free-text retrieval having the lowest detection rate (0.61). The detection rate is a useful indicator in assessing the ability of the retrieval method to identify all relevant concepts (avoiding false negatives), in contrast to the positive predictive value, which is a valuable indicator of the retrieval of false positives. This latter index again shows that semantic differential retrieval performs better than ICD-10, hierarchic, or free-text searching, although this does not reach significance in comparison with hierarchic retrieval.
The large mean Yates corrected chi-squared and Mantel-Haenszel chi-squared values confirm the expectation of a strong association between the focused set of concepts and records retrieved compared with the gold standard, in the context of a large total population. The strength of association indicated by the mean Yates chi-squared is significantly greater with semantic differential retrieval for both concepts and records, with ICD-10 and hierarchic retrieval being of intermediary status and free-text retrieval again fairing least well.
The calculated means of the Cohen kappa for all methods of retrieval were greater than 0.4 (empirically stated as evidence of useful agreement).26,28 Cohen's kappa value for concept (0.88) and record (0.94) semantic retrieval were significantly better than for the other approaches and were above the benchmark of 0.81 (considered by some as almost perfect29), indicating that high levels of retrieval accuracy from clinical records are achievable.
The evaluation of data retrieval can be tested against technical markers such as speed, but from the clinical perspective, although these usability issues are important, it is more vital to evaluate whether an information system can accurately answer the spectrum of questions that might be posed. The lack of reported work on the effect of different search methods on the efficacy of data retrieval from clinical records1 is surprising, considering the large investment in terminology development in the United Kingdom and abroad10,11,12 and the assumptions that data storage in computers will deliver sufficiently accurate information to underpin health service planning and decision support.30 The effort required by terminology developers to semantically define concepts is considerable and has been quoted as varying between 4.6 and 20.5 minutes per concept.22 The recent commencement of the cooperative development of SNOMED Clinical Terms (SNOMED CT)31 heralds yet another massive effort embracing the principle of an underlying STM to provide reference functionality. This study provides the first practical evidence of the utility of such an approach in providing enhanced and accurate data retrieval from clinical records.
The clinical questions required retrieval of information from multiple perspectives. The multi-axial directed acyclic graph structure of CTV36 offered a moderately good mechanism for retrieval. This finding mirrors experiments using the cross-references of SNOMED International, which enabled the attainment of good detection rates and positive predictive values.32 The performance of hierarchic retrieval in the study, however, was dependent on the expressed relationships between concepts in CTV3. Theoretically, if all possible relationships were expressed within the hierarchy, retrieval using this approach would be as good as any other method. The lack of some hierarchies representing a particular clinical perspective (e.g., "limb disorders") led to a number of false negatives, resulting in reduced performance (indicated by poor detection rates) in response to some clinical questions, e.g., retrieval of "limb complications." Creating an exhaustive list of all potential clinical perspectives could rectify hierarchy omissions, but these may be difficult to predict and would eventually cause an unwieldy "explosion" of large numbers of relationships. The performance measures indicate that, although the semantic method had significantly better detection rates compared with hierarchic retrieval rates, the positive predictive values were more comparable. This result reflects the formality of the pure subtype hierarchy and its success in providing a robust mechanism to avoid false positives.
While the disorder hierarchy present in CTV3 was unable to support retrieval of "limb disorders," the semantic method was able to exploit the more complete value hierarchy. The anatomy chapter of CTV3 utilizes the notion of "structure," which encompasses both the whole and "part of" descriptions of that site to ensure that the subtype structure is maintained.33 This anatomy hierarchy contains the concept "limb structure" with applicable class members, allowing the creation of a semantic differential retrieval of all concepts having a definition [Site]: Limb structure or a type of limb structure (). Thus, although the complete classification of "core" disorder concepts may not be possible (or desirable), the complete multiple classification of the underlying primitive values is essential. It is only with the exhaustive polyhierarchic arrangement (complete multiple classification) of primitive values that retrieval from the multiple perspectives that are clinically required is assured.
Evidence from examination of the raw free-text entries in Diabeta 1 suggests that clinicians may not always record the concepts they require with sufficient semantic pedantry. For example, the term "Paget's disease" may have a clear meaning in the context of a patient's record juxtaposed to an entry of Mastectomy, but following retrieval of the concept, outside this environment, it acquires ambiguity as to whether it is Paget's disease of the breast or Paget's disease of the bone. The study also revealed some discrepancy in the interpretation of the semantics of the question posed between the standard setter and the retrieval performer. This discrepancy was the main reason for the suboptimal performance of semantic differential retrieval in 13 of the 47 questions posed. For example, the meaning of the question "retrieve all cases of diabetic cataract" might be interpreted to include all cases of "cataract" (and its class) associated with diabetes; or only cases where the disorder of "diabetic cataract" was explicitly recorded. The rules of data entry can thus affect the result of the retrieval; e.g., if all cataracts in patients with diabetes mellitus are recorded as Cataract but retrieved as Diabetic cataract, no cases would be found. This experience identifies the important association between of the semantics of data entry and data retrieval and suggests that caution may be necessary before wholesale adoption of the principle of separation between the interface and reference features of terminologies that has been suggested.
The use of ICD-10 as a retrieval tool was comparatively effective as a method for retrieving data, a finding recently supported by an investigation of the coding and retrieval of stroke patients.34 Retrieval with ICD-10 performed less well when questions fell outside its scope, e.g., levels of alcohol consumption, or required detail not present in the restricted number of categories available, e.g., absent foot pulses. Overall, the performance of ICD-10 as a retrieval tool was good when it was used within its scope. The method of free-text retrieval fared less well, despite this approach having previously been shown to be effective.24 The performance may have been improved with the use of more sophisticated natural language processing tools,35,36,37 and there have been reports of better detection rates in limited studies.38
The collected battery contained clinical questions from a diversity of perspectives, and the STM supported semantic differential retrieval from these various viewpoints significantly better than the other methods. The indications of the experiments on the Diabeta database are that good detection rates and Cohen's kappa values are achievable (despite the STM being incomplete), and the success supports further investment in exploring this approach. The success of the STM for retrieval was achieved by the flexibility of approach this afforded; however, this was at the expense of its being more complex to use. The method required the analyst to have a good understanding of relational databases and the resource tables (such as the hierarchy table) in CTV3. These operational issues could be improved by the fashioning of clinically intuitive human-computer interface designs.
The investigation has demonstrated a number of key points (see sidebar). It has shown that the use of an STM significantly improves information retrieval from a clinical database in response to physician-derived questions, in comparison with free-text, hierarchic, and ICD-10 approaches. This indicates that an STM provides a useful framework for the representation of clinical findings and that there is merit in the current approach of defining health care concepts semantically. The study has also indicated that alternative methods of analysis will give different results, depending on the purpose for which they have been designed. Greater understanding of the design and scope of ICD may help with the appreciation of its merits as well as its restrictions as a statistical tool for data analysis.
The experiment used a clinical database that was oriented toward the collection of data from patients with diabetes. These patients, with their diversity of complications and associated comorbidities, make the Diabeta database a valuable test bed for retrieval experiments. It is likely that the principles identified in this study are applicable to data represented by a terminology in other health care environments, but this will need confirmation.
The corpus of concepts in the disorder chapter of CTV3 is large, and the extent to which these have been completely semantically represented has been shown to be dependent on the specialist area.20 For example, concepts describing mental health, neurologic, and dermatologic conditions are less amenable to complete characterization. Further effort is required to model these areas and to test whether such specialist extensions can be developed and be mutually compatible with a global STM for clinical findings. Finally, although the use of an STM as the basis for retrieval appears to be valuable technically, further investigation is required into the development of intuitive user-friendly interfaces and the practicability of its use by clinicians.
The authors thank Steve Carey at St. Thomas' Hospital for technical support in extracting data from the Diabeta database, the clinicians who contributed to the formulation of the battery of clinical questions, and Henri Brown for additional quality assurance. They are also indebted to Philip Young, Department of Mathematics, University of York, for statistical advice.
Some of the results of this work were presented at the AMIA Annual Symposium, Washington, DC, November 6-10, 1999.
*A system in this context refers to the hardware, software and terminology populating the database.
†Zero records were retrieved for the question concerning the concept Diabetes treated with diet alone as the status of the patient whose record contained this entry changed during the interval between the original extraction of the Diabeta database and the subsequent retrieval experiments.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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The COG
Welcome to the COG, the center of community interaction for Gonzaga University. Gonzaga residents, faculty, staff and guests are all welcome to dine, socialize and explore our expanded dining options. Named after the original COG, the new COG is carrying on the best traditions into the John J. Hemmingson Center.
Today's COG is a two level facility designed to provide a fresh and exciting dining environment with plenty of natural lighting, soaring ceilings, and beautiful architectural finishes. The kitchen facilities have been custom designed and equipped to meet the needs of today's student palates and the highest levels of food handling safety. Led by Campus Executive Chef Thomas Morisette, CEC, and Resident Dining Chef Tompall Nichols, our culinary staff will prepare meals fresh before your eyes at six uniquely themed platforms.
Each restaurant-style station within the COG is designed to provide a complete meal, or you can mix and match items from each station. Menus at each station change for breakfast, lunch and dinner, as well as on a daily basis throughout the semester.
Fresh deli style sandwiches featuring house-baked breads, homemade soups, salads and baked goods from our own bakery.
Classic American comfort food like chicken pot pie, meatloaf, burgers and fries, plus our famous made to order omelets.
Mongolian-style grill stationed at the center of the COG serving fresh stir fry custom made for each guest.
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Located on the 2nd level, serving dishes inspired by the cultures surrounding the Mediterranean Sea, including pizzas and flatbreads from the wood fired oven.
Located on the 2nd level, serving cuisine from around the globe. This station also features our Simple Servings platform – menus designed free of the 8 most common food allergens – allowing students with food allergies to dine with confidence and convenience.
Faculty or Staff? Live off campus? Even if you're not a resident boarder, the best way to take advantage of all dining available on campus is with a meal plan. Community Meal Plans are now available for faculty, staff, and any student not required to have a meal plan. Community Meal Plans can be purchased online any time at https://ZagDining.sodexomyway.com/shop.
Still don't have a meal plan? You don't need swipes or blocks to join us at the COG! Bulldog Bucks give you a discounted door price, and we accept cash, too
*We gladly accept cash, credit/debit and Bulldog Bucks.
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On the Menu
Hours of Operation
Week of: 09/18/2017 - 09/24/2017
Monday - Friday: 7:00 a.m. - 10:30 a.m.
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Monday - Friday: 10:30 a.m. - 1:30 p.m.
Mid- Meal :
Monday - Friday: 1:30 p.m. - 4:30 p.m.
Monday - Thursday, Sunday: 4:30 p.m. - 8:30 p.m.
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COG Door Prices 2017-2018
Breakfast $7.78 $6.70
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