text:
AOL 'Smash Bros.' Review - 'Six Minigames Just Aren't Enough toJustify A $40 Price Tag'
Another author just opened a can of worms with this review.
I'd like to clarify something... That info posted up there is wrong. It's in fact quite falsely written, since it's talking about ninja reflex, not SSBB.
"Even if you can round up any friends, "Brawl" has plenty to offer, including a decent solo adventure and the ability to enter matches online. In short, it's everything "Smash Bros." addicts have been waiting for, and it's absolutely essential for anyone who loves all things Nintendo. Three-and-a-half stars out of four.", straight from the web page. 3½ stars out of 4 stars.
Thus how did this ever get approved, since contributor didn't bother to read it thoroughly? It had 3 different reviews in one package, not one review.
WTF!? How did this get approved? First, it's a series of reviews not just one. Second, the score is 3.5 out of 4!!!!
Seriously, WTF!?
I prefer MK and SF to Brawl but WTF?


text:
August 2012 Volume 05 Issue 08
President's Note Dear SLMA Members, colleagues, friends, As we move on to the second half of the year we reach a time of the year that is packed with academic activities. This was not the case 15 years ago. At that time the second half of the year was a quiet time in terms of medical academic activities in Sri Lanka. To fill this void in 1997, the then President of the SLMA, Deshamanya Dr S. Ramachandran proposed the establishment of Foundation Sessions of the SLMA. The Foundation sessions that we hold in November this year would be the 15th in an unbroken series of conferences that we have been holding. We plan to have a unique programme this year the details, of which would be announced shortly. We request you to keep the dates – 9th to 11th November 2012 – free and join us for the Foundation Sessions. Thank you. On behalf of the Council of the SLMA,
Prof. Vajira H.W. Dissanayake President, Sri Lanka Medical Assosiation, No.06, Wijerama Mawatha, Colombo 07, Sri Lanka
Page No. Notice Board 4
Chronic Kidney Disease of unknown aetiology (CKDU)
National Blood Transfusion Service wins the ISBT award for developing countries
Looking to the future - Beyond the Millennium Development Goals
SLMA cricket team wins OPA six a side cricket tournament
SLMA Ethics Committee
Past Presidents of SLMA 16 - 17 Prof. Anoja Fernando Dr Kumar Weerasekera Prof. Nimal Senanayake Dr D. N. Athukorala Deshamanya Dr Surendra Ramachandran
Preserving the independence of the SLMC
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August, 2012
Notice Board UPCOMING EVENTS Joint Clinical Meeting with the Wathupitiwela Clinical Society 6 October 2012 at Wathupitiwela
Annual Scientific Sessions of the Anuradhapura Clinical Society in Collaboration with the SLMA 17 and 18 October 2012 at Anuradhapura
SLMA Foundation Sessions 9 to 11 November 2012 at the SLMA
Medical Dance 2012 8 December 2012 at Cinnamon Grand
FERCAP 2012 12th Asia Western Pacific IRB/IEC conference "Ethnicity, Culture, Religion and Ethical Research for Health" 18 – 22 November 2012 Colombo, Sri Lanka Organised by the Forum for Ethics Review Committees in Asia and the Western Pacific and the Sri Lanka Medical Association http://www.slma2012.com/FERCAP
Calling All Medical Inventors Are you an inventor? Have you invented a device that is useful in the medical field? Would you like to showcase your invention at the SLMA? If so, the SLMA would like to hear from you. Please email us on email@example.com giving details of your invention and your contact details 4
August, 2012
Chronic Kidney Disease of unknown aetiology (CKDu)
n February this year the Sri Lanka Medical Association organised a symposium to enable researchers to present their research findings. At that meeting a request was made to wait for the findings coming out of the work carried out by the WHO in collaboration with the Ministry of Health prior to coming to final conclusions. The research, which was presented, can be accessed at http://issuu.com/slmanews/ docs/ckdu_abstract_book A summary of some of the WHO work released by the Ministry of Health is now in the public domain and has been the topic of discussion in medical circles. It is reproduced below for the benefit of the readers of SLMAnews. If you have any comments about the report please send it to firstname.lastname@example.com. We will compile your comments and publish it in the next issue of SLMAnews.
World Health Organization (WHO) report on Chronic Kidney Disease of unknown Aetiology (CKDu) in Sri Lanka - A summary 01. Mission report, 6-8th June 2011, WHO, Geneva, Switzerland Chronic disease prevention and management, Senior advisor and coordinator, Dr Shanthi Mendis
Results of the phase 01 of this research programme reveal that in the north central and Uva provinces a minimum of 15 per cent of people in the age group 15-70 years are affected by CKDu. Men over the age of 40 years who are engaged in farming for more than 10 years are at higher risk of developing this disease. In addition exposure to agrochemicals also increases the risk of developing CKDu. The majority of men and women suffering from
this disease excrete raised levels of arsenic and/or cadmium in the urine. Exposure to a combination of factors that are toxic to the kidney seems to cause this kidney disease. Toxic factors identified up to now include arsenic, cadmium and nephrotoxic agrochemicals. Recommend to develop a regulatory frame work to improve the quality control of imported fertilizer particularly with regard to nephrotoxic agents such as arsenic and cadmium. It is imperative that the steps are taken as soon as possible. Delaying action will cause further accumulation of toxic agents in the environment and result in cumulative damage to the health of the people living in these areas. 02. Mission report, 5-7 October 2011
Cumulative nature of heavy metal exposure and progressive natural history of CKDu, for which there is no known cure, demand urgent action to improve safe use and quality control of agrochemicals and quality control of fertilizer. As advised by the Honorable minister of Health, a multisectoral strategic plan need to be developed jointly with relevant ministries with short, medium and long term measures by the end of 2011 and implemented as early as possible in 2012 to minimize the growing public health risks to the population. It is essential that steps are taken as soon as possible. Delaying action will cause further accumulation of toxic agents in the environment and result in cumulative damage to the health of the people living in these areas and with time also affects younger age groups. In the long term there will also be severe social and economic consequences that will negatively impact the on-going development and poverty alleviation efforts of the region. 03. Progress report 13 Feb 2012
In the urine analysis of 496 cases of CKDu 56 per cent had a urine cadmium excretion over 1 ug/g creratinine. Data from recent studies show that changes of early kidney damage occurs at cadmium excretion levels of even 0.6-1 ug/g creratinine. About 63 per cent of CKDu patients had urine arsenic levels above
21 ug/g Ceratinine. Urine arsenic levels above 21 ug/g creatinine have been shown to cause changes in kidney tissue that lead to chronic kidney disease. Approximately 88 per cent of CKDu patients had urine arsenic >21 ug/g and/or urine cadmium >0.6 ug/g Arsenic was also analyzed in hair and nails of people living in NCP including CKDu patients. In about 90 per cent arsenic levels in hair were higher than those observed in developed countries (0.02 ug/g).In about 94 per cent arsenic levels in nails were higher than those observed in developed countries (>0.03 ug/g) Our analysis did not find high levels of cadmium exposure as reported in previous studies. The mean exposure for adults is at borderline of Recommended Total Weekly intake (TWI) of 2.5ug/kg body weight. Water from 98 water sources used by patients with CKDu was analyzed for hardness. 99 per cent are hard to very hard. Hardness of water is known to affect heavy metal toxicity through antagonistic mechanisms and this may play a role in renal toxicity caused by heavy metals in the north central province.
Recommendations 1. Implement the recommendations in previous reports. 2. Strengthening the institutional arrangements for the implementation inter sectoral coordination, monitoring and evaluation of control of pesticides and fertilizer. 3. Increasing the public awareness of the adverse health effects of agrochemicals. The general public should be made aware of the actions taken to control agrochemicals and the importance of applying safety and control measures. Health education programmes should focus on high risk populations including farmers, vendors and also expanded to involve school children and the public at large. 4. Strengthen water purification schemes in north central region. Recommendations have been made for the maximum and minimum levels of calcium and magnesium in drinking water and total hardness. 5. As there are 66 ayurvedic prescriptions that contain aristolochia, increase awareness of ayurvedic practitioners and public of renal toxicity of aristolochia species.
August, 2012
National Blood Transfusion Service Wins the ISBT Award for Developing Countries
ational Blood Transfusion Service (NBTS) Sri Lanka has a distinguished history of more than fifty years for the timely supply of quality assured blood and blood components for the entire government sector hospitals and for the majority of the private sector hospitals. It's a special campaign coming under the ministry of health having a network of more than ninety blood banks scattered around the country and National Blood Centre in Narahenpita being the operational headquarters. Organized according to the WHO recommended concepts and National requirements, the service has been able to provide quality assured blood and blood components required for the modern day medical treatments over the years.
NBTS has won the ISBT award for the transfusion services of developing countries The International Society of Blood Transfusion (ISBT) is the premier international professional society for the field encompassing transfusion and transplantation science and
National Blood Transfusion Service current director Dr. Vijith Gunasekara and National Blood Transfusion Service former director Dr. Ananda Gunasekara handing over the award plaque to the Minister of Health Maithripala Sirisena.
medicine. With a long and respected history of achievement, its current strategic vision is: 'Facilitating knowledge about transfusion medicine to serve the interests of donors and patients'. Founded in 1935, The Society brings together more than 2000 professionals in the field, from over 97 countries. At the ISBT congress 2011 held at Taipei, Taiwan an open invitation
The National Blood Transfusion Service at Narahenpita
was annoucing the selection of best transfusion service among developing countries. Applications were called on the official ISBT website and NBTS Sri Lanka also applied for the competition. Each competitor had to answer a structured essay type common questionnaire providing supportive evidence for all the answers given. In this competition performance during the years 2009, 2010 and 2011 were evaluated covering all aspects that account for the improvement of the relevant transfusion service. NBTS Sri Lanka was able to successfully prove its ability and win the ISBT award for developing countries for 2012. The news of this award is published on the Official website of ISBT http://www.isbtweb. org/news/article/winner-isbt-awardfor-developing-countries/ and the certificate was awarded at the 23rd International ISBT Congress held on 8 July 2012 at Cancun, Mexico to the Sri Lankan team headed by the former Director NBTS Dr Anada
August, 2012
Gunasekara who is currently the Deputy Director General of Medical Services and Dr Vijith Gunesekara the Director NBTS. In addition to the international recognition this award brings to the entire Health Care System of the country, NBTS was invited to deliver a speech at the Central Body Meeting of the ISBT Congress. At the 3 day parallel educational sessions of the congress the NBTS team conducted an educational review on the Improvement of Education and Training programs of the NBTS Sri Lanka. The ISBT gave a grant of 10,000 Euros to the NTBS to conduct an international educational symposium in Sri Lanka for professionals engaged in the Transfusion Service in other countries. Winning the ISBT Award for Developing Countries is a consequence of a target oriented process of activities initiated at NBTS. It is another feather in the cap for the NBTS which would enable it to achieve its mission which is "To be a unique model for the world�.
August, 2012
Looking to the Future - Beyond the Millennium Development Goals Birth Defects Surveillance, Prevention and Control
ri Lanka Medical Association in collaboration with the Ministry of Health, Family Health Bureau and The Human Genetics Unit of Faculty of Medicine, University of Colombo organised a symposium to brainstorm and streamline the national initiative to prevent and control birth defects at the Sri Lanka Medical Association 125th Anniversary International Medical Congress. Additional Secretary to the Ministry of Health Dr Palitha Maheepala presented the Sri Lanka situation Beyond the MDGs - Significance of Birth Defects Prevention and Control. Consultant Community Physician and National Programme Manager for Maternal and Child Morbidity and Mortality Surveil-
lance Dr Kapila Jayaratne described Sri Lanka's plans to introduce birth defects surveillance. The Roles of the Obstetricians and Paediatricians in Birth Defects Surveillance, Prevention and Control were presented by Consultant Obstetrician and Gynaecologist Dr Gayan de Silva, and Consultant Neonatologist Dr Medha Weerasekara respectively. Two world renowned experts - Prof. I. C. Verma
and Prof. Dhavendra Kumar spoke at the Workshop. The other foreign speakers were Dr S. Suresh from India and Dr Farha Zahir from Canada. The workshop concluded with a panel discussion with major stakeholders involved in birth defects prevention and control in attendance - Ministry of Health, National Focal Point for Birth Defects Prevention and Control Deputy Director General (Public
Health Services), Dr M. L. R. Siyambalagoda; Family Health Bureau, Director, Dr Deepthi Perera; Sri Lanka Medical Association, President, Prof. Vajira H. W. Dissanayake; World Health Organisation, National Professional Officer, Dr. Anoma Jayathilake; College of Community Physicians, President, Dr Vinya Ariyarathne ; Sri Lanka College of Paediatricians, representative, Dr Medha Weerasekara; College of Forensic Pathologists of Sri Lanka, President Elect, Dr S. M. H. M. K. Senanayake; College of Pathologists of Sri Lanka, Secretary, Dr H. A. A. Priyani,; and Perinatal Society of Sri Lanka, Sri Lanka College of Obstetricians and Gynaecologists and President, President Elect, Prof. Hemantha Senanayake.
SLMA SNAKEBITE HOTLINE Faced with a snakebite management dilemma? Now you can seek expert advice, day or night. Call one of the following: For adult snakebite victims Prof. S. A. M. Kularatne: 0812-388369 or 0773-420771 Dr M. K. Ragunathan: 0777-904500 or 0718-166599 Prof. Ariaranee Gnanathasan: 0112-508200, 0112-364088 or 0773-279659 Dr Suresh Mendis: 0773420491 For snakebites in the Jaffna District, especially saw-scaled viper bites Dr S. Sivansuthan: 0777916231 For paediatric snakebite victims Dr Udaya de Silva: 0718-607697 SLMA Expert Committee on Snakebite August, 2012 8
August, 2012 2012 August,
SLMA cricket team wins OPA six a side cricket tournament The SLMA cricket team won the six a side cricket tournament organised by the Organisation of Professional Associations (OPA), Sri Lanka held on 11 August 2012 at the Bloomfield Grounds, Colombo beating all other Professional Association, which participated in the tournament.
The winning team with the Team Manager, Dr Indika Karunathilake and the OPA President
The captain of the SLMA team, receiving the Champion's trophy from the OPA President
10 10
August, 2012
SLMA Ethics Committee This article is continued from the SLMANews July issue.
he next session was chaired by Dr Malik Fernando. Dr Ajith Amarasinghe presented five cases that had been investigated by the Ethics Committee of a Private Hospital. Summaries of these cases are in the case boxes. The three discussants as well as the participants contributed to the lively discussion after each presentation. There was much interest in the cases and many issues were raised and discussed.
Case No 1 - Disclosure of personal information without consent: A Patient with HIV A male British patient admitted to the hospital was diagnosed to have HIV infection. He was reported as being "not completely sane". His partner had been informed of his infection. His parents were arriving from the UK to take him back, to look after him. ("Not completely sane" is taken as "not competent to give consent") Questions: Was it ethical to have informed his partner and his parents about his infection without obtaining his consent? Could the hospital be found fault with? The SLMC guidelines were not very clear about confidentiality issues. The GMC guidelines gave the following
advice: "Disclosure of personal information without consent may be justified where failure to do so may expose the patient or others to risk of death or serious harm. Where third parties are exposed to a risk so serious that it outweighs the patient's privacy interests, you should seek consent to disclosure where practicable. If it is not practicable you should disclose information promptly to an appropriate person or authority. You should generally inform the patient before disclosing the information." The committee ruled that in this instance there was no breach of confidentiality. Contd. on page 18
August, 2012
Past Presidents of SLMA 2001
Prof. Anoja Fernando MBBS (Cey), BA, FRCP(Lond)
Emeritus Professor of Pharmacology, University of Ruhuna Founder Professor of Pharmacology, Faculty of Medicine, University of Ruhuna, 1981-2010 Dean, Faculty of Medicine, University of Ruhuna, 1991-1996 President, Physiological Society of Sri Lanka, 1994 and 1995 Chairperson, National Bioethics Committee, 2004-2008, and Chairperson, National Committee on Ethics in Science and Technology, National Science Foundation, from 2011 President, Asian Bioethics Association, from 2010
rofessor Fernando's main areas of interest were medical education and medical ethics. She initiated the establishment of a new committee on Medical Education in 1995 and chaired it from 1995 to 2004. During this period, the committee, with contributions from many consultants, and WHO support, published "Recommendations on Internship Training", with a log book. A shortened version of the log book was used by the Sri Lanka
Medical Council in the internship program. In 2002, the Medical Education Committee successfully conducted the first distance learning programme on Continuing Medical Education for general practitioners and grade medical officers in state hospitals in the Southern Province. Bimonthly CME Bulletins, containing an update on a common topic as well as MCQs, were posted to 450 doctors, and CME certificates awarded to those who completed the required
evaluation. Prof Fernando has chaired the Ethics Review Committee since 1999, and in 2003, initiated the formation of the Forum for Ethics Review Committees in Sri Lanka (FERCSL). Professor Fernando's Presidential Address was titled "From Medical Ethics to Bioethics: Challenges for the 21st Century". During her year, the first edition of the book "Guidelines for the use of Non-EPI Vaccines", prepared by the Committee on Com-
Dr D. N. Athukorala MBBS,FRCP(Lond), FCCP(SL),FAAD,Dip Derm(Lond) Consultant Dermatologist President Sri Lanka Association of Dermatologists 1998, 1999 President Ceylon College of Physicians 1988 Secretary of the SLMA 1986-88; Including the SLMA centenary in 1987
he Presidential address titled "The profession and the Association" focused on encouraging research and audit and the need for continuing medical education. The first ever SLMA Ethical review committee on Biomedical Research, and a new committee on
Mental Health was formed in this year. The "E.M. Wijerama endowment lecture" was inaugurated to recognize a person for continuing outstanding research in the field of medicine, and was delivered by Dr C.H. Uragoda. The foundation sessions, inaugurated by Dr S.
municable Diseases, was published, and the second floor of the extension to Wijerama House was completed. In addition to the regular CME programmes conducted by the SLMA and its committees, a series of lectures on non-medical topics were given by eminent people. Professor Fernando also initiated the formation of the new Committee on Women's Health in 2001. Dr Anura Weerasinghe served as the honorary secretary in 2001.
he late Weera took o SLMA at the century with to take the A into the new as a strong a taking the ce in advocacy. took over as he was the y person to tak President of an honour he the appointm Honorary Se the year 200 H. W. Dissan President of in 2012.
Ramachandran were carried forward creating a new tradition to the SLMA. The SLMA was recognized by the World Bank as a key player in health sector reform and health policy planning in Sri Lanka, Seven Regional meetings were held jointly with the regional clinical societies. The SLMA moved to its new office on the first floor of the new building, and sections of the building needing renovation was attended to. The new membership services committee added new incentives for SLMA members and an identity card for members was issued. Dr Prasad Kumarasinghe served as the Honorary Secretary in 1998.
Rama renow Physi in the sion d
August, 2012
Dr Kumar Weerasekera MBBS, MD Consultant Oncologist, National Institute of Health, Maharagama
e Dr Kumar asekara over the e turn of the the vision Association w millennium association entre stage . When he s President, youngest ke over as the SLMAe held until ment of his ecretary in 00, Dr Vajira nayake, as the SLMA,
His Presidential address was titled "Rupees and sense of Ageing". The address set the tone for the Health Sector Development activities which he initiated and carried out during the year. The President proposed the use of a Health Card as referral system for the Health System in Sri Lanka. The Ministry of Health accepted this proposal on principle and he was working towards achieving this goal after he relinquished office as President, SLMA until his untimely death. The theme of the
he late Deshamanya Dr Surendra achandran was a wned Consultant ician and an icon e medical profesduring the past
year's Annual Session was "New horizons in healthcare in the new Millennium". This provided an opportunity for taking stock of Sri Lankan achievements in the field of health identifying where performance might have been better and what might have been the impediments and more importantly mapping out a strategy for the future. He was able to bring together the entire medical profession under one roof during the year, with all collages and associations participating in the sessions.
Deshamanya Dr Surendra Ramachandran MD, FRCP, Hon. DSc Consultant Physician, National Hospital of Sri Lanka, Colombo President, Ceylon College of Physicians – 1990 half a Century; He was a man of rare distinction. During his lifetime he made a colossal contribution in several fields such as medical education, medical research, patient care and medical associations. He was the President of the SLMA in
1997. The theme of his Presidential address was 'Meeting the challenges ahead'. During his tenure of office he rendered a very important service to the medical profession with the extension to the Wijerama House, the refurbishment of
Prof. Nimal Senanayake MBBS, MD, PhD, DSc, FRCP, FRCPE, FAAN, CBiol, FIBiol Senior Professor of Medicine, Faculty of Medicine, University of Peradeniya
or the first time in its long and cherished history of the SLMA the Annual Sessions were held outside Colombo in the hill capital the deliberation of the sessions were designed in general to converge on the theme "From the decade of the brain to a millennium of the mind". His vision of the theme was as one approaches the end of the decade the profession and the rest of the society was to focus on the mind because "Mind is the forerunner of all states" (The Dhammapada) His presidential address was titled "Literary work and Medicine" held at the BMICH was very exhilarative and appreciated very much by the audience. Dr Shyam Fernando served as honorary secretary in 1999. the building and the Lionel Auditorium. The first 'Foundation Sessions' of the Sri Lanka Medical Association was his brain child and the first sessions were held in November 1997.The crowning glory of an unmatched career in research was the fact that Dr Suren Ramachandran was awarded no less than 14 Scientific Orations in Sri Lanka invited to deliver as many as 12 Guest Lectures abroad.
Dr Ramachandran was undoubtedly an artist. Single handed, he produced the decor for the prestigious Medical Dance of the Sri Lanka Medical Association on at least two occasions. His budget allocation was very small. Nevertheless he converted the Lanka Oberoi Grand Ballroom into a spectacular showpiece on these occasions. Dr Devaka Fernando served as the honorary secretary in 1997.
August, 2012
Contd.from page 14
SLMA Ethics... Case No 2 - Relationships with colleagues and other health workers: Conflict between a surgeon and an anaesthetist. A relative of a patient awaiting surgery abused an anaesthetist 'A' over the phone stating that she had been told by the surgeon 'S' that her father's surgery had been postponed due to the clinical incompetence of 'A'. On the same day 'S' had also abused 'A' on the same issue over the phone. When 'A' complained to the ethics committee about these incidents, 'S' made a counter complaint claiming that 'A' was clinically incompetent. Question: Are there clinical ethics issues here or is it one of professional ethics? The committee perused the patient's clinical records, interviewed both consultants, and also interviewed another senior anaesthetist to seek information about the circumstances when an anaesthetist may refuse to anesthetize. The clinical records revealed that the patient had IHD and COPD and had had two epi-
sodes of spontaneous pneumothorax. He had also been refused surgery previously by several surgeons because of the anaesthetic risk. The patient had been admitted for surgery without prior consultation or agreement with an anaesthetist. A cardiologist had advised against surgery and the anaesthetist had refused to anesthetize the patient on that basis. The surgeon admitted at the inquiry that he had told the patient and the bystander that the operation was not done because the anaesthetist was obstructing the surgery. He also admitted that he abused the anaesthetist. The SLMC guidelines give the following advice regarding relationships with colleagues and other health workers (Adapted from the Commonwealth Medical Association – 1993, Guiding Principles in Medical Ethics and Human Rights):
1. Principle 12:- Medical practitioners have a responsibility to co-operate fully with their medical colleagues in the interests of providing the best possible health care for the community; 2. Principle 13:- Medical practitioners should recognize and respect the expertise of other health workers and collaborate with them in the interests of providing the best possible health care; and in section 5 of the Instructions on Serious Professional Misconduct 3. Deprecation by a doctor of the skill, knowledge, qualifications or services of another colleague constitutes serious professional misconduct. The committee ruled that the behaviour of surgeon "S" constituted serious professional misconduct and recommended that he be advised to refrain from such behaviour in the future. At the same time, counselling to improve his relationship with colleagues was recommended. (Note: Surgeon "S" continued to serve the hospital for another 3 years without any complaints against him.) Contd. on page 20
August, August, 2012 2012 Contd.from page 18
SLMA Ethics... Case No 3 - Informed Consent and Medical Qualifications: Unethical practice by a consultant A complaint was made by 8 consultants to the effect that: a consultant gynaecologist had been admitting patients for laparoscopic gynaecological procedures that were in fact performed by a gastroenterological surgeon, the patient being unaware of the involvement of another consultant in carrying out the procedure; This gynaecologist was not qualified to be a consultant. This issue resulted in a major furore in the institution. An anonymous article appeared in a national newspaper followed by some letters to the editor. The SLMC requested a report from the hospital about the incident. Questions: Was there a factual basis for the complaint? Was the gynaecologist at fault in not informing/obtaining consent from the patient to obtain the help of another consultant in carrying out the intended procedure? Was the gynaecologist "unqualified" to hold the post of consultant? The ethics committee reviewed the degree certificates of the gynaecologist "G", perused the clinical records of all patients who had undergone
laparoscopic procedures by "G" and interviewed all the consultants concerned including "G" and the gastroenterological surgeon. A comprehensive 7-page investigation report was compiled and submitted to the SLMC. Excerpts of this report appeared in a national weekend newspaper. The committee found that: Of 78 laparoscopic procedures done by "G" the gastroenterological surgeon was involved in 19 and other consultants in 12 (total 31); and Consent forms in relation to procedures by "G" mentioned only her name even where other consultants were involved, despite the consent forms having provision for the insertion of more than one name. In addition: "G" stated that the surgical gastroenterologist was called in only to insert the laparoscope, as she was not competent to do so, and hence the patients were not informed about his involvement; and She could not give an acceptable explanation how in that event she was able to do some of the procedures on her own. The committee found that "G" had adequate qualifications to function as a Consultant Obstetrician and Gynae-
cologist. The SLMC guidelines were not adequate to decide the issue of informed consent in this case. The GMC guidelines (Seeking patients' consent) state thus: "You must not exceed the scope of authority given by a patient except in an emergency. Therefore if you are the doctor providing treatment or undertaking an investigation you must give the patient a clear explanation of the scope of consent being sought. This will apply particularly where different doctors provide particular elements of an investigation or treatment." The committee ruled that the gynaecologist was adequately qualified to hold the post of consultant in the field of obstetrics and gynaecology. She had however, failed to obtain consent from the patients before obtaining the services of other consultants to perform procedures that she had offered. The SLMC decided to cancel the registration of "G". Comment: There was much discussion relating to the issue of obtaining consent for procedures that centred on the circumstances when a surgeon can call for assistance from a colleague, whose involvement has not been intimated to the patient at the time of obtaining consent. In an unforeseen situation this would be ethical. It may depend on hospital rules and procedures e.g. in private hospitals patients may rightfully expect to be treated by persons of their choice; this may not always be true in Government hospitals. But generally speaking, consent should be sought, and given, for the procedure to be done by a named person. Hospital policy on this matter can go a long way towards clarifying the issue. Contd. on page 22
August, 2012
Contd.from page 20
SLMA Ethics... Case No 4 - An issue of professional etiquette: Conflict between a Physician and an Administrator A consultant working in the hospital was admitted with a severe head ache and suspected dengue fever under a consultant physician "CP". He was referred to a neurologist for an opinion by "CP". A doctor involved in hospital administration visited the patient unknown to "CP", informed the neurologist who had been called in consultation and prescribed medication. Neither "CP" nor the ward doctor had been informed by him of the treatment prescribed. "CP" complained about the incident alleging interference and breach of confidentiality.
Questions: Interference with patient care and Breach of confidentiality. The ethics committee sought a written explanation from the administrator; interviewed the patient; and perused the clinical records. The committee found that there had been an ongoing rift between "CP" and the medical administrator and hence the administrator had not attempted to inform the physician about the change of treatment. The administrator was not involved in any way with the clinical care of the patient. The GMC guidelines are
clear on the point that an administrator has the right to examine notes of a patient. If any notes of an administrative nature are made, this has to be entered on a sheet separate from the clinical notes. The committee ruled that there was no breach of confidentiality by the administrator perusing the patient's clinical record. However, seeking to treat the patient without a request to do so by the patient's physician was against medical etiquette. The administrator was informed about the findings of the ethics committee and requested to refrain from such behaviour in the future.
This article will be continued on the SLMANews September issue
22 22
August, 2012
Preserving the independence of the SLMC The SLMA believes that freedom of speech is a fundamental right in a democratic society and that all members of the society should agree to disagree and tolerate one another's views. We condemn the attempt to cause harm to Dr Ranasinghe and his family and call on the authorities to take measures to promptly identify the culprits and bring them before the courts of law.
he Sri Lanka Medical Association condemns the recent grenade attack on the house of Dr Lalantha Ranasinghe, Consultant Surgeon and Member of the Sri Lanka Medical Council (SLMC). Dr Lalantha Ranasinghe is an honest and hardworking surgeon who has rendered yeoman's service to the people of Sri Lanka. He is a person who is not afraid to express his views in any forum and we believe that his outspoken representation of the views of the medical profession that he represents at the SLMC would have led to this attack. The SLMA believes that freedom of speech is a fundamental right in a democratic society and that all members of the society should agree to disagree and tolerate one another's views.
We condemn the attempt to cause harm to Dr Ranasinghe and his family and call on the authorities to take measures to promptly identify the culprits and bring them before the courts of law. The SLMA also notes with sadness that none of the culprits behind such attacks on members and officials of the SLMC over the past few years have been apprehended so far. The SLMC is a government organization empowered with the task of protecting the patients by regulating medical education and postgraduate medical training thereby ensuring that only those appropriately qualified to practice medicine and surgery in Sri Lanka are allowed to do so. Therefore it is in the interest of the entire population of the country that the members and officials of
the SLMC are allowed to discharge their duties without fear, and ensure that patient safety is not compromised by commercial interests of a few. Any attack on the members and officials of the SLMC is an attack on the government and therefore the law enforcement authorities should spare no time in apprehending the culprits. Chronology of Acts of Violence against SLMC members and officials • Bomb Attack on the House of former President of the SLMC – Dr H.H.R. Samarasinghe – 2002 • An attempted shooting at the House of the former Registrar of the SLMC – the Late Prof. P.S. S. Panditharatne – 2002 • Assault on the current Registrar of the SLMC – Dr N.J. Nonis – 2011 • Grenade Attack on the House of Member of the SLMC Council – Dr Lalantha Ranasinghe – 2012 Vidyajyothis Prof. Lalitha Mendis, Immediate Past President of the SLMC says "Enough is enough". Here is her full statement I have no doubt that the
whole medical fraternity of Sri Lanka will join me in condemning the grenade attack on Dr Lalantha Ranasinghe's residence on the 16th of August 2012. He is a member of the Sri Lanka Medical Council (SLMC). This cowardly act is one of many that SLMC members have been subjected to. Dr Ranasinghe served on the medical council during the whole of my tenure of office as President SLMC. He is forthright, does not mince his words and speaks on matters of principle. He has done so on many issues facing the medical council at present. The foremost duty of the medical council is to promote and maintain the health and safety of the public by ensuring proper standards in the training of doctors and other health care workers (HCW); ensuring proper standards in the practice of medicine; Registering doctors, dentists and other HCW and regulating the practice of those registered. Contd. on page 28
August, 2012
Contd.from page 24
Preserving the independence... In the course of performing its duties, decisions have to be made and opinions expressed which may be unpalatable to some individuals and institutions. Here lies the problem, that in performing their duties by the public, some members of the medical council have had to face acts of intimidation. In 2002, the residence of a former President of the medical council was bombed, shots fired at the residence of the then Registrar, and an attempt made to set fire to the medical council office. In 2011, the Registrar of the medical council was assaulted
at the gate of his residence. I myself as President of the medical council was verbally abused on various occasions including over the radio. Therefore, the grenade attack on Dr Ranasinghe's residence is just another in a series of intimidatory acts by vested interests who resent having to conform to standards and who have reckless disregard for the safety of the public. Does the public of this country want its health and safety protected by the medical council? If so I hope they will with one voice rise and say "Enough is enough�
Vidyajyothis Prof. Lalitha Mendis
Vidyajayothi Prof. Lalitha Mendis is the only person in history to have been the Dean, Faculty of Medicine, University of Colombo; Director, Postgraduate Institute of Medicine, University of Colombo; President, Sri Lanka Medical Association; and President, Sri Lanka Medical Council.
T ig u
P assat
The official news paper of the Sri Lanka Medical Association
Published on Aug 22, 2012
The official news paper of the Sri Lanka Medical Association

subset: commoncrawl


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Boutique Hotel Perched on Bluff Above Columbia River Gorge
Stretching for more than 80 miles through the Cascade Range, the Columbia River Gorge is one of the Pacific Northwest's most beautiful sights. Towering waterfalls spill over black-basalt cliffs amid forests filled with lush greenery. A 2013 TripAdvisor Certificate of Excellence winner, Columbia Cliff Villas gives visitors prime views of the breathtaking scenery from a cliff-top perch more than 200 feet above the river. This getaway also includes vouchers for wine tasting at two to six nearby wineries in the Columbia River Gorge wine country.
Columbia Cliff Villas is a boutique hotel offering 37 villa suites and hotel rooms. Euro queen and euro king rooms are simply decorated and equipped with flat-screen TVs and WiFi. Euro king suites have fireplaces and kitchenettes. Guests of Columbia Cliff Villas have access to the amenities at the historic Columbia Gorge Hotel next door. There, guests can enjoy the award-winning locally-sourced restaurant and spa. Be sure to seek out the hotel's well-manicured gardens and the 208-foot Wah Gwin Gwin Falls.
Hood River, Oregon: Riverside Town with World-Class Watersports and Wineries
Hood River is located one hour east of Portland, at the intersection of the Columbia River Gorge and the Cascade Range. Its diverse terrain unravels like a slideshow of quintessential Pacific Northwest landscapes—snowcapped mountains, woodland trails, and river rapids abound—making it a top destination for outdoor sports. There are spots for small- and largemouth bass fishing, waterfall hikes, and year-round skiing and snowboarding at Mount Hood.
The Columbia Gorge wine region's various microclimates produce an assortment of unique wines ranging from albariño to zinfandel. Fruit orchards and farm stands dot the countryside, providing the ingredients for a sophisticated dining scene downtown.


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Three times a year, KEXP, Starbucks and STG partner together to present Little Big Show, a concert series created to benefit our city's arts organizations, with 100% of ticket sales donated to local non-profits. The upcoming Little Big Show – at Neptune Theatre this Friday, May 16 – will feature Cloud Cult and Benjamin Verdoes. All proceeds for this show will benefit Hugo House Youth Programs.
Located in Capitol Hill, Hugo House is a community non-profit occupying a Victorian house originally built in 1902. Founded by three writers – Linda Jaech, Frances McCue, and Andrea Lewis – with the intention to support writers of all ages and backgrounds, Hugo House is, essentially, the beating heart of Seattle's diverse literary scene. Hugo House is named after Seattle-based creative writing teacher and poignant poet Richard Hugo, a Northwest favorite. With programs like Cheap Wine & Poetry, Cheap Beer & Prose, and Works In-Progress, Hugo House has been working hard since 1997 to keep the people of Seattle amused, educated, and stimulated by the active community of Northwest writers and readers alike. Additionally, Hugo House is home to ZAPP, one of the world's largest collections of independent zines, comics, chapbooks and other small press periodicals.
With the revenue from Little Big Show's ticket sales, Hugo House will be bolstering their youth programs in order to engage young authors in the already established writing community that the beautiful Northwest offers. So, grab your tickets here, and we'll see you at the Neptune on May 16th!


text: The good news: Daytime Volume, a promising band of four South Bend natives, has a big gig in New York City this Friday as part of the annual CMJ Music Marathon. The bad news: They have to get there somehow. The good news: Their label got them a van. The bad news: Vans run on gas. The good news: To earn money for said gas, Daytime Volume is playing this Wednesday at the Anchor Inn, along with 2Big 2Be Buried, Ways to Be Worse and the recently formed Kidboots. This mass of musicians contains a number of people who are connected through former bands. Explaining exactly how would take a whole separate article, but suffice to say, the show will be a big happy homecoming of sorts -- and the first local appearance by Daytime Volume in its official four-person incarnation. The band is Jared Myers of South Bend on guitar and vocals; Michael Beaton of San Francisco on guitar; Patrick Bayliss (brother of Umphrey's McGee's Brendan Bayliss) of Portland, Ore., on bass; and Matthew Morgan of Portland on drums. Morgan also produced their album, "The Day We Transposed." The album has yet to be released, but songs posted on the Web offer a taste of the band's sound: whispery, sad-pretty, kind of playfully spooky, reminiscent of Elliott Smith or the Decemberists. As Bayliss explains, Daytime Volume started with a few good songs. Some time ago, Myers recruited some friends and fellow musicians to help flesh out some tunes he'd written. "It was more of a collective just trying to finish this record way before it was a band. ... We were working on it because we just wanted the songs to be the best they could be for Jared," Bayliss says. The "collective" eventually evolved into a four-man band, which later became separated by some 2,000 miles when some of its members relocated. According to Myers, the album really was a collective effort. It was a slow process, he says, getting it finished and forming the band, but he's impressed with the results. "Oh, I'm very happy with ('The Day We Transposed'). It just went so much further than I ever thought it would," he says. Myers describes the band's sound as "a little more spacey, but still melodic," with some definite folk elements. The album, he says, sounds very cohesive thanks to Morgan's handiwork. Daytime Volume has done some gigs together out west, and, as of now, there aren't any plans for them to converge in one city. The album is set for release early next year, but some advanced copies should be available at the show. Also making its mark at the show is Kidboots. The band features singer and guitarist Josh Hensley (also known as solo artist the Rutabega), bassist Andrew Martin and drummer Jeremiah Wade. On some songs, they're joined by Josh's wife, Emily Hensley, who provides harmonies, and Leslie Smucker on the violin. The very new band has been around since August and has racked up about 15 songs. Hensley offers the scoop on their emerging sound. "The tone is feeling kind of like White Album ('The Beatles')-era Beatles with a little Neal Young thrown in with The Shins," he says. "Somewhere in that world. Clearly poppy, but not overly cartoony." After years of solo work, Hensley was missing "the energy of playing with other musicians," and he's excited to be bringing the new project to the stage. Two bands doing their South Bend premieres on the same night, plus two more local acts to boot? There's nothing but good news there. Staff writer Karen Rivers: email@example.com (574) 235-6442


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There are many reasons for visiting Croatia-the six sites declared World Heritage by UNESCO:
The old town of Dubrovnik (undoubtedly one of the most beautiful cities in Europe),
Diocletian's Palace in Split, the historical core of Trogir, the Cathedral of St James in Sibenik,
National Park Plitvice Lakes, and Episcopal Basilica in the Historic Center Eufrasio Porec (Istria).
Nature is another reason to spend time in Croatia. The National Parks have varied fauna and flora in a full splendor, with a coastline that winds from the Istrian Peninsula to the southern Dalmatia, leaving beautiful coves, beaches and cliffs. The islands like Hvar or Korcula in Dalmatia or Rab and Losinj in the Kvarner Bay, host millions of tourists seeking its crystalline waters for peace and splendor.


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West Rim Trail is a 25.6 mile moderately trafficked point-to-point trail located near Morris, Pennsylvania that features a river and is rated as moderate. The trail offers a number of activity options and is best used from March until October. Dogs are also able to use this trail.
dog friendly
nature trips
trail running
wild flowers
A beautiful hike with some great views of the PA Grand Canyon that most people take three days to complete.
Beautiful trail with moderate hiking difficulty and abundant water sources and established campsites. Did the trail south to north parking my car in the northern terminus parking lot and using the Pine Creek Outfitters shuttle to be brought south to the start. Upon the shuttle drivers suggestion, I began on the Bohen Trail, a 1.4 mile trail a couple miles north of the southern terminus, which gives a really nice view of the Bohen run creek and saves a few miles of hiking through stinging nettles (according to the shuttle driver). Very glad I made the decision to start here. Bohen trail is technically "closed" due to a washout a few hundred meters into the trail, but it is very easily climbed over.
Did this trail as my first solo hike in about two and a half days. Almost all hiking through forest for the first half of the trail, then views of the canyon start peeking out along the second half after Bradley Wales campground. The trail does cross dirt roads a couple times and there are a few miles that you have to hike on dirt roads, but for the most part the trail is very secluded. Did the hike Saturday to Monday, and saw no one along the trail until I got close to the end.Best views are around Barbour Rock in the last couple miles of the trail. Highly recommended for anyone looking for a good 30 mile easy-moderate trail with plenty of access to water!
Awesome hike, have done the entire trail point to point and have done half by starting at Bradley Wales. Awesome vistas and a lot of cool hikes through the woods. The trail can get a little close to the edge at times but all in all is safe, just watch your step. Will probably be doing it again in a few years.
This trail is amazing!! We've done this trail twice now. The 1st time we didn't leave ourselves enough time to hike the whole thing so we drove in and day hiked a couple of the spots with great vistas, it was the 2nd weekend in oct last fall, the colours of the leaves where still amazing. The 2nd time was this spring and we started our hike at the 16 mile mark and completed it in 2 days. Next time, the whole 30 miles!!
Also the staff at Pinecreek Outfitters are absolutely incredible, so helpful and friendly.
This being my first really backpacking trip, the views really only came at the end most of the trail was wet and uneven. A lot of yo and downs, the north end of the trail is where you want to be. Some amazing views at the north of the trail, but tons of water sources throughout a lot of little spots to rest, watch of for the 7 min. Itch also a lot of snails and toads i
Beautiful trail with lots of great vistas at the top. Completed the 30.5 in 44 hours, 2 nights, going north bound. The terrain changes up a lot, from flat, incline, decline, rocky, stream crossings and just about everything in between so it is a great trail to get a bit of everything. There are lots of camping sites on the first half from the southern terminous but on the second half we spotted a lot less and didn't see any in the last 6 miles but we were moving quickly because it was raining so we could have missed something. Also the second half is the most senic if you are going north bound. There was plenty a water along the way. We saw 8 people NoBo on the second day and a group of 3 guys and a dog head SoBo along the trail.
All in all this would be a great trail to take your time. I would have love to do this trail in 3 days instead of rushing through but we had a time limit.
Hiked the 8.2 miles from Siemans Trail to north terminus trailhead. Mostly downhill for this sectiin which allowed for a quick pace. Only one group of 4 hikers headed south. Nice walk through the woods.
Hiked during Easter weekend, nice trail with some steep hills, plenty of water, good camp site with plenty of wood for bonfire, beautiful view of the canyon, spectacular night sky and trout fishing. If you hike with dogs be careful there are porcupines! Staff at Pine Creek Drove our car to our final destination (for a fee) so we didn't have to hike back to point of origin. Cant wait to do it again.
Beautiful trail best done over three days, great vistas well established campsites and plentiful water. Didn't see a soul for two days, had the trail to ourselves. The Pennsylvania Grand Canyon is breathtaking. Hit the Wellsboro diner for a meal before you head out. It's a great town!
Did whole trail in 2.5 days with two pups. Keep those dogs on leash if you bring them along. Lots of places they can get into trouble. Couple of tricky climbs in the rain, but all in all, well marked trail with beautiful views. Lots of great places to camp. Did north to south, seems like was the less popular direction, but worked out well for us. Lots of quiet time!
Took 2.5 days to do the whole 30 mi. I was surprised to find that there are no mile markers so we had to guess where we were based on roads we passed and elevation. All in all it was an awesome experience!
Did 16 or 18 miles last year with a couple friends and my 8 year old daughter. Great backpacking trail, breathtaking views.
I started at 10 Sundat morning and completed the 31 miles by 6 Sunday evening. I'd suggest anybody on the fence, plan to take 2 nights. this hike is great, from the views to the changes in scenery to the wildlife and I could go on but hope you find out for yourself.
Great trail to start backpacking on. Takes 2-3 days depending on how fast you're moving. We started from the south and went north. I suggest this because you get to see the best views on the last day.
I went here with my brother and it was a great trail to go backpacking for a weekend. I have to warn you there are bear cubs on some vista points so the mom bear was on the trail and we had to stick to the road for a little bit and get back on the trail.
What we did is pay Pine Creek Outfitters $50 to take the car at the end of Rattlesnake Rock. We started at the Northern Terminus. The trail was somewhat obvious and well marked. I can't say the same for the maps and there is no service unless you are on some vistas. To add the trail has very muddy roads which would lead to the river runs so don't bring brand new shoes!
Nice outlooks, well maintained trails, great for young kids.
30.2 miles. Point to point. Pine Creek Outfitters has a shuttle service. Solo hike in later Oct 2016. Well marked. Terrific views from the vistas.
It was definitely *NOT* "moderately trafficked" when we were there. We hiked South to North and saw a couple of day hikers few miles in at the first viewpoint along with two unprepared backpackers whom we never saw again. We only ran into one group hiking SOBO - A father with 2 daughters. We did see a few people while walking through 2 parks in the Northern section, but they were there with their cars / not on the trail. Much of the Southern section of the trail was overgrown (summer 2015), but there are some amazing views with great campsites and some older growth forest. We did the entire trail in 2 1/2 days. We could have pushed it to 2, but were in no hurry/ When we came out, we turned around and did a SOBO 2 day bikepack of the Pine Creek Rail Trail. The combined trip was a fantastic experience - I'd do it again in a minute!
A great overnight on the West Rim Trail along the Grand Canyon of PA.
Check the full trip report here :
Only did half but it was really beautiful. Want to come back and backpack the rest soon.
Backpacked this trail over a stormy weekend 10-2 thru 10-4, 2015. We set up camp 2.7 miles in on Friday night at the Northern Terminus. The first 16 - 17 miles had many vistas and well-maintained. But after the park, the brushes were overgrown - lots of tripping hazards! After Bohen Run the trail was more of a goat pass, you would be hiking on the precipice of a ridge with your foot flexed most of the time. At the top of this you will find your last vista. We bailed out due to an injury i sustained 1/2 mile before West Rim Rd. At this point we have already done 30 miles ( we missed a blaze that added 2 miles to our trip, where there is a fenced area of land to protect new forest growth from deer). If the trail was anything like the last 13 miles, we decided it was not worth it.
The West Rim Trail is actually a 30.5 mile point-to-point trail from the southern trailhead on PA route 414 at Rattlesnake Rock access just south of Blackwell to the northern terminus on Colton Point Road, Ansonia, PA. My new friend Dan and I hustled up this moderate path on May 4, 2014, a perfect day for hiking. We parked my vehicle at Ansonia and, in Dan's car, took the scenic ride on West Rim Road to our starting point on Route 414. This ride on the gravel no-winter-maintenance road through the hardwood forests of Tioga State Forest is well worth the extra time, compared to the hard road route that goes through Wellsboro, Morris, and thence to Blackwell. Dan and I got a relatively late start, beginning our hike at 9:00 a.m. with light packs consisting mostly of water and energy bars. It was a warm day for early May, requiring lots of water to keep hydrated. However, you'll find there is no shortage of water (you'll want to filter it) on this well maintained and blazed trail. Dan is a much faster hiker than I am. He hustled ahead several times and waited for me to catch up. Consequently he burned off more water than I did, going through seven liters of H²O. At the beginning of the West Rim Trail we experienced he steepest and longest ascent up Lloyd Run Hollow. However, it's a modest climb of about 1000 feet over a course of 1.77 miles topping out at 1875 feet elevation near the intersection of Long Run Trail. The pathway stayed relatively level for the rest of our journey, treating us to several vistas overlooking the Grand Canyon of Pennsylvania along the way. A free map from Department of Conservation and Natural Resources (DCNR) pinpoints sixteen vistas that begged us to stop for photo taking. I did not take any pictures for two reasons. Firstly, we had to cover over thirty miles before dark and secondly, I forgot my camera. Be inspired by the many photos on the link below. Phone coverage is very spotty in this remote area so I'd advise that you stick with your hiking companions. Most hikers respectfully treat the West Rim Trail as a backpacking adventure, completing the 30+ miles in about two-and-a-half days. There are many desirable primitive camping spots along the way that do not require a special permit if you camp for only one night. Dan and I completed our ambitious hike within our goal of less than twelve hours. I arrived at the northern terminus at 8:50 p.m., catching up with Dan who had been there for almost an hour. I was not disappointed that my 79 year old legs carried me the distance.
Hiked this trail with my son over a 3 day period in late may. The vistas of Pine Creek Gorge are splended. The trail is well marked. Water and camping sites are abundant, especially on the northern half. We started on a tuesday afternoon and finished on friday afternoon. We encountered noone else until late Friday morning. This is a great trail as you get a sence of isolation and great views from one end to the other. I would recomend it to anyone.
My family and I backpacked this over 3 days. We hiked it southbound and view is best in the northern part of the trail. Southern portion was less pretty and the brush really encroached on the trail at places near the southern end. Camping sites were not as easy to find as we went past the halfway point.
I just finished the hike from South to North this past weekend by myself. Being from Pittsburgh, for the past year, I drove to State College the night before to minimize the drive out the next morning. I arrived Friday morning at Pine Creek Outfitters to take their shuttle service to the South Terminus. Both I and another gentleman had them follow us to the North Terminus to leave our vehicles there so we didn't have to walk back to the shop. After some good conversation with the shuttle driver, we had arrived at Rattlesnake Rock where the Southern Terminus is located. I quickly shed my jacket and tossed the pack on then proceeded to start the first climb. I should say that I have spent the past nine years in Oklahoma so I wasn't used to such terrain as what abounds out here. However, I have been training myself on my bike for a trek like this. As soon as you enter the wooded area, you immediately get the feeling that this journey will be quite enjoyable. From the small stream that travels down on your left to the birds watching your ascent, the sounds are enticing. The one thing that struck me most on this first day were the amount of tiny brown frogs everywhere. No bigger than a nickel, they were scattered across the trail for miles. I had previously read Chuck Dillons guide for this trail so I had a good idea on what to expect but I was quite surprised at the diversity of the forest. Starting off the first day's climb through thick pines, one quickly passes through rhododendron that this time of the year is quite thick. Trail width can go from 4 feet across to wading through the brush. After a couple hours of admiring my surroundings, I came upon the first vista. I had seen others' pictures of the area but to experience it myself was a completely different emotion. It is hard to truly gauge the scale of beauty unless you can see it for yourself. Being the second weekend in September, the leaves were not in full color, but the subtle changes in their hues had begun to emerge. For the next several miles the trail was like a gentle roller coaster up and down, skating to the edge of the gorge then back into a hollow. I pressed on ahead to where I planned on camping that evening. Arriving about 4:30 pm at the vista approx 10 miles from the South Terminus. After dropping my pack to rest my legs and admire my view, the hammock was hung. I established a small fire and ate my dinner while perched on a log overlooking the expanse below. With darkness approaching soon, I had hung my food sack then extinguished flames and got a good night's sleep while listening to distant owls.
Some light rain came in early morning but soon subsided. I struck camp then was back on the move to cover some good ground this second day. I stopped about a 1/4 mile down the trail to top off my water supply for the morning. Hiking out of this hollow was a good way to get the heart pumping early in the morning. Some of the ascents have a decent incline to them, if only for a short distance. The trail breaks west here to bypass a bog area then puts you on a gravel road for a bit. It was interesting to feel the welcome of the forest as I entered it again. Hiking along the road just was not as comfortable. Heading back towards the rim is a small climb to the Bradley Wales picnic area. After a lengthy look at some more beautiful vistas, it was back to a gentle up and down scenario for another few miles. Filling up my water reserves again at Little Slate Run, I tried to keep my pace up as my planned distance was half done. Back and forth, next to the rim and down into hollows was the lay of the land for the next couple hours. At this point in the day, the sun had arrived from behind the cloud cover for the first time. Watch the light filter through the canopy to the forest floor was enlightening. This is where I came across Allan, descending the hill going down to Painter Leetonia Road. I had wished him a good afternoon and we stopped to discuss how magnificent the area was. He was from the area and maintains much of the Northern sections by volunteer work. After listening to some of his stories I kept on moving to where I planned my second night on the trail. The trail once again follows a road for some time before crossing back uphill. After another mile, and passing Painter Leetonia Rd again, I saw the campsites I had planned on. The first one I came across didn't appeal due to its proximity to the road. I had decided to press on another mile or two on until I saw the perfect little hideaway just in front of me. It only take a slight walk down the side of the road to put you on a private wooded paradise. Four Mile Run bubbles right next to the campsite and it was tucked away just off the road to provide a sense of seclusion from even a fellow hiker. After hanging the hammock and eating dinner, I sat at the fire letting my thoughts dwell on the sights and sounds of the day.
I awoke next morning to a chilly start. A cup of coffee and a q
This is a favorite weekender for some friends and I. I have done the trip several times, including my first backpacking trip when I was 7 years old. In my opinion, October is the best time to make the trip especially if you time the leaves changing color. The overlooks are very nice for Pennsylvania, and it's an all around fun experience. I recommend doing the trail in 2.5 days.
Nice trail, very pretty. There were not as many vistas as I expected, plus it rained the whole time so the views were quite misty. Still had a great time. Finished the whole stretch in 2 days. I was also visited by a very nonchalant porcupine at my first camp.
Great trail, great views. One of the best in PA.
Great trail.. very doable in 2.5 to 3.5 days. The southern half has quite a bit of descending and ascending.. the views are amazing
Beautiful trail that follows the west rim of the "Pennsylvania Grand Canyon". Fairly easy trail, although it could have been the hardest trail in the state and you would be too preoccupied with the incredible views of pine creek to even notice. This trail should be done in the fall when possible as the fall foliage adds an extra bit of beauty to the trail
Hiked out and back making it a 4 nite 61 mile hike. superb vistas. encountered the rear end of a bear in the trail. took off immediately, he not me. was about 30 ft away. Great pix of the gorge. awesome mountain pix. AAA rated by me. tioga st forest.


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text: WHITE PIGEON - James A. Voorde, 61, died at 2:02 p.m. Saturday at Thomas Road and Silver Street, Mottville Township, from injuries received in an automobile accident. Survivors include three sons, James A. Jr. of Leondas, Mich., Thomas of Burr Oak and Michael of Mendon, Mich.; his mother, Maxine Calvert of South Bend; and a sister, Beverly Lind of Three Rivers. A memorial service will be held at 6 p.m. Tuesday in his home, 10714 Barker Rd., White Pigeon. There will be no visitation. Farrand Funeral Home is handling arrangements.


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Bureau recommendation of 40% hike unlikely; but medical inflation is a reality
[caption id="attachment_33065" align="alignright" width="324" caption="Mike Lopez, Brian Murphy and Bill Merget"][/caption]
NORTH BAY – The body that oversees and makes recommendations on workers' compensation rates recently submitted a filing of cost drivers, a move that could be the first step before it recommends brokers raise premium rates by as much as 40 percent.
But while the Workers' Compensation Insurance Rating Bureau mulls over making the recommendation on premiums, insurance executives in the North Bay said that although rates may still increase, they likely would not be near the rate that the bureau has recommended.
"This workers comp market is still very volatile in nature," said Michael Lopez, vice president of Vantreo Insurance Brokerage in Santa Rosa, noting that earlier this year, the bureau recommended a pure premium rate increase of 27 percent.
[caption id="attachment_33066" align="alignleft" width="420" caption="Click on chart to enlarge"][/caption]
Earlier this month, that recommendation rose to 39.8 percent, as the bureau cited the rising costs of medical care as one of the primary reasons for an increase in rates.
The 27 percent increase never materialized, and the 40 percent increase may still yet be averted. But insurers nevertheless cautioned that rates could soon be on the rise, and that the only certainty with workers' comp rates is uncertainty.
The bureau only made an "informational filing," meaning that for now they didn't change rates but instead addressed why the rate increase is warranted and likely coming in the future, according to Brian Murphy, vice president of Heffernan Insurance Brokers North Bay Branch in Petaluma.
"The uncertainty is then what the insurance companies are all going to do with that information," Mr. Murphy said. "Are they going to raise rates or not? Ultimately it's going to be driven by what the market will bear."
That likely won't be 40 percent, said Bill Merget, principal at Edgewood Partners Insurance Center in Petaluma, a notion that was echoed by others.
"While work comp rates will go up in time, I believe it will be a relatively slow process," he said. "There may be a several-percentage point increase over the next several quarters, but certainly not the hair-on-fire 40 percent," Mr. Merget said.
Mr. Merget said any increase would likely be passed onto employers, although larger employers might be able to offset any increase through alternative systems, such as high deductible programs, retrospectively-rated policies or forms of self insurance.
Doug Dilley, a partner at George Petersen Insurance in Santa Rosa, agreed that an increase in rates could occur, but that the 40 percent would be too politically risky.
"There's just no way 40 percent is going to pass," he said. "But would I tell my clients to brace themselves for at least a 10 percent increase? Yeah, I absolutely would."
Mr. Lopez said he has seen rate increases, but numbers far below what the bureau proposed.
"What I have been seeing thus far with a few carriers this year is a rate increase in the range between 4 percent and 7 percent," he said. "I do think [rates] will be going up."


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Salyst that several smartphones with different operating systems, Android is the most popular home systems largely have taken place. In such circumstances, the operating system should be evolved in a variety of applications, resulting in unnatural not too many people to edit your images instead of the professional programs, such as Photoshop Windows, use the application and a very simple style Android operating system they use. Photo Editor Pro is one of these with a simple interface and easy photo editing apps for Android OS is released by Google Zentertain and so far has experienced nearly 500 million downloads. This application Aplkyshn keep users satisfied very good and acceptable scored 4.3 out of 5 that were involved in the registration of nearly 2 million people.
Photo Editor Pro Professional software for editing and filtering on Android phones and tablets. With this comprehensive program you can make any changes you want on your photos and make themmuch morebeautiful than the last. In this program, a lot of stickers and photo editing and effects features have been put to use users can easily perform editing operations on the images themselves. With this program you can capture stunning images with visual special effects or existing photos in your gallery as professionals with creativity and intelligence make editing your photography. With this application you can see photos taken with a smartphone simply edit and fix its defects and become a professional photographer. In addition, you can select multiple photos in a photo and merge them together and created the so-called collages of images and share them on social networks with friends and family to share.
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- Name: Photo Editor Pro
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Helios (the Sun) was out on his daily trip, when the Gods decided to divide the world among them. Greedy and hasty as they were, they forgot all about him. Not even a stone was left for him.
On returning from his trip, he saw Rhodes, the daughter of Aphrodite emerging from the sea, where she had been submerged up until that point. When he learned of the injustice that had been done, he demanded that Rhodes be given to him. Zeus, who had been planning to keep her for himself, had no choice but to accept.
That is how the beauty, the clear blue sky and the seashells found on the mountains of Rhodes are explained in mythology.
Her charm and location have always been the cause of her wealth as well as of all her troubles through the centuries. Located in the middle of three continents, where seas and civilizations are connected, it has always been desired by persistent, yet not always kind, lovers.
Since 4,000 BC, Rhodes has been loved by Greeks, Romans, Byzantines, Arabs, Genoans, Pirates, Knights, Turks and Italians. They all had a different way to show their affection.


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Dear Friends,
First of all-- THANK YOU!
When I recently asked your help for my project Radio Ghosts, your response was HUGE. My collaborators and I received enough gifts to cover almost all of our costs-- a serious accomplishment considering the project ended up needing $ 2,000 to complete.
With your help we were able to pay for travel expenses, acquire necessary materials, rent rehearsal and performance venues in Philadelphia AND New York City and present a highly successful presentation in TWO cities!
Additionally, it was really nice to re-connect with many of you and re-establish a correspondance (how are you doing?). Plus, all of the wonderful notes and cards and messages were outstanding. I still have all of them and plan to do something highly creative with them.
In short-- You Rule.
So....I come for your help again, this time for a journey that will last the next THREE years.
Three years?
Holy Moly!
The press release below explains in more detail, but the short version is that Dallas-based company, Audacity Theatre Lab, has agreed to produce THREE of my plays over the next THREE years.
You heard that right.
Three plays. Three years.
We're calling this project 3P/3Y and it launches in May 2008 with a production of The Most Beautiful Lullaby You've Ever Heard.
This is a HUGE undertaking and we need your help to make it happen.
So how can you help, you might ask?
Audacity Theatre Lab has flown me in once to help with the production process for Lullaby. To help out, I have volunteered to raise enough money to fly me back to Dallas for opening weekend (May 7-10!).
Thus, my immediate goal is to raise $ 300.
However-- because I am feeling ambitious, Audacity Theatre Lab and I have agreed that any additional funds raised during this ask will go directly to additional 3P/3Y needs.
With that in mind, I am setting the goal to raise $ 2,000.
And because I'm asking something from you, I want to EARN your gifts.
So, to symbolize the incredible journey ahead (and because I love road trips), here's what I want to do.....
Philadelphia and Dallas are roughly 1,500 miles apart. I need you to donate enough miles to get me from Philadelphia to Dallas.
Using the immediate goal of $ 300, you can donate miles for 20 cents a piece! For a dollar, you will send me five miles! For a hundred dollars, you will send me 500 miles!
And here's the fun part:
I will map your donated miles, beginning from my house in Philadelphia towards my destination in Dallas. And whichever city I land in (whichever city you send me to!), I will write you a play inspired by that city and send it to you in the mail.
How about that?!
I will write a play for YOU and mail it to you.
How long of a play? (you might ask).
It depends on how many states you send me through. I will write you a page for every state that your gift makes me pass through.
For example!:
When you donate 50 dollars-- at 20 cents a mile-- you've just sent me 250 miles! Which means...you've sent me to Mount Jackson, Virginia!
Imagine a play written just for you about Mount Jackson! This would be a 4-page epic being that your gift sends me through Pennsylvania, Delaware, Maryland, and Virginia.
And if that's not good enough, for just over 100 bucks, I will write you a 5-page play about Blountville, Tennessee!
Or-- if you prefer, you can pick your own destination. Say-- you want me to write you a play about Washington DC. DC is 150 miles away! For $ 30, I would write you an awesome play about Washington DC! And the play would be 3 pages because I'd have to pass through Pennsylvania, Delaware and Maryland!
How fun is that?!
And all the while (let us not forget), you will be contributing to the production of THREE PLAYS over the next THREE YEARS!!
Everyone Wins!! Could there be anything better?!!
So what do I do to hop aboard this train? (you might ask)
Here's how we make it happen:
1. Send donations (and fun notes) directly to me (by May 1st):
Greg Romero
214 Beck St
Philadelphia PA 19147
2. When I receive your gift, I will email you, confirm receipt, and let you know which city I'll write your play about (and how long the play will be).
3. I will mail you your completed play by the end of June, 2008.
It's that simple!
A play just for you! And THREE PLAYS over the next THREE YEARS for me!
Thank you in advance for making this happen!


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60-Day Money Back Guarantee
Your order is covered by our 60-Day Money Back Guarantee (excludes processing and handling), which starts upon the receipt of your order. To return your product, first call customer service at 973-287-5199 to receive a return merchandise authorization number. With this number, you can return your items to the address provided below for a refund of your purchase price, excluding processing and handling. You the consumer are responsible for the cost of returning the product.
If you would prefer to receive your return authorization number via email, please email your request firstname.lastname@example.com. Include your First & Last name, zip code, phone number and or order number with the request for the RMA and any other information to locate your order.
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8. So you don't want me anymore is it? I hate you. Go.. : kruthika
9. It will be done when it has to be done. Patience i.. : thuso
10. Dream above the all that that are possible : alphadom


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The Witcher - Review @ 2404.org
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November 25th, 2007, 20:48
Very nice review.
Kind of summons up much of how I feel about the game too.
Though to be honest, I think more of Planescape Torment or even Fallout when I want to compare it to other games. Torment for the story driven aspect, plus the thing about open up for new areas through story related quests instead of having it all open from scratch.
Also the main chr both suffered from amnesia, making you able to have some influence on his personality.
And Fallout for some of the mature aspect of the game, sex, prostitutes, drugs etc.
Visually it looks more like Gothic 3 than Oblivion I think.
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Platform: PC
Developer: Toxic Games
Q.U.B.E. ostensibly stands for Quick Understanding of Block Extrusion, and as names go, it's absolutely spot-on. After waking up in a mysterious facility clad in a pair of powerful gloves, the entire first person experience revolves around extruding (i.e. moving) coloured blocks out of the floor and walls by simply clicking on them. Different colours of block denote different abilities, such as red blocks that form linear platforms, yellow customisable staircases, blue bounce pads and freely moveable green cubes.
New features such as pulleys, revolving walls and lenses are introduced in later stages, but engaging with the environment is as accessible as jabbing the left mouse button to extrude a block or clicking its fellow to retract them. It's a masterpiece of streamlining.
These simple cuboid elements are assembled in increasingly imaginative ways. Extruding a few platforms may be child's play, but using them to deflect a rolling ball into coloured filters and direct it into the correct receptacle becomes an exercise in precision timing and lateral thinking. Getting a green block to where you need it most would be a piece of cake if only you could pick it up, but manoeuvring the walls and floor becomes the order of the day. Levels sometimes resemble elegant mechanisms that need to be assembled in advance, or insane obstacle courses begging to be configured and enjoyed. Tight physics and the simple controls allow you to get on with the task in hand rather than fighting the mechanics, and I was genuinely taken aback by the sheer variety that Toxic Games delivered with their blocky premise.
One notable section takes place in pitch blackness, which requires you to individually illuminate blocks. It's breathtakingly stylish, though once the shock wears off, you'll realise that it's essentially just a memory test. The darkness doesn't actually add anything to the solution beyond making the extrusion take a lot longer than normal, and a lot more aggravating to boot.
Otherwise, the puzzles are intelligent, varied, well-crafted and thoughtfully paced... but there's a catch. The fact that interactive elements are clearly highlighted means that you'll rarely feel that 'Eureka' moment when exploration and luck come together; when you feel that you solved the puzzle by yourself without being railroaded by the developers. While the likes of Trine 2 and Portal deliver these endorphine-soaked moments in spades, Q.U.B.E.'s rooms can all be solved by just working backwards from the objective and seeing what blocks you have to play with. There's still plenty of satisfaction to be found here, just tempered with the knowledge that you've essentially just assembled a jigsaw after being given all four corners.
Mentioning Portal wasn't just a throwaway comment. I can't put it off any longer. Q.U,B.E. is quite different from Valve's puzzle juggernaut in terms of game mechanics, but visually, it's a dead ringer. Which is to say, of course, that it looks great. The stark primary colours and crisp, clean lines make the experience exceptionally attractive if a little on the minimalistic side, and I'm unwilling to mark it down for looking a bit like that other first person puzzle game.
Unlike that other first person puzzle game, however, Q.U.B.E. completely eschews any hint of a plot and uses gameplay as its only hook.
This poses an interesting and controversial question: do puzzle games actually need a storyline? I frequently argue that they don't, after all, Tetris and Bejeweled wouldn't be improved by shoehorning a nonsensical premise into the mix. But by placing the player's hands on-screen, Toxic Games have unwittingly created a protagonist, and many players will doubtlessly feel short-changed by never really understanding why you're extruding all those blocks in the first place. Q.U.B.E. suffers from a vexing lack of personality, and the lack of time trials or high scores are a glaring omission that could have filled this void.
Sadly, being short-changed is the other major problem with Q.U.B.E. Linear puzzle games are bereft of replay value by design, and a short campaign length (probably a couple of hours depending on whether you get stuck on the later levels) compounds the weak raw value that Q.U.B.E. brings to the table. It's still worth your small time investment, but to fully enjoy the experience, you'll want to limit yourself to a couple of levels per day. Considering that there are only nine, it still won't take you long... and £10 feels just a little too steep for a wholehearted recommendation.
- Generally impressive puzzles
- Effortlessly stylish
- Accessible and satisfying...
- ... but lacks true inventiveness
- Lacks personality, invites reductive Portal comparisons
- Weak raw value, demands high scores/ speed runs/ metagame
The Short Version: Q.U.B.E. is a surprisingly effective puzzler that makes the most of simple ingredients. Low replay value and lack of a strong storyline may disappoint some, but the gameplay and art direction are more than solid enough to warrant a purchase.


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