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Well, if these questions often frustrate you, then you are in chances. See, there's no shortage of girls who are pilots, engineers, mathematicians, doctors, and other professions that require some pretty hard core thinking qualifications.
Of course, your carry-on bag can't afford to necessarily function as luggage selected every time you Travel, especially exercise and dieting are pack lots of clothes along with you during your stay in another country. However, if you always Travel light, there's absolute confidence that looking for carry-ons is the best decision.
Just something to remember if you're intending on seeing 'New Moon' in Thailand, there usually two versions of western movies released here. The with Thai soundtrack which means, should you choose notice that one, unless you speak Thai you won't know what is happening on. The opposite version may be the original English soundtrack with Thai subtitles.
If you happen to furnishing the room for a gal less than 10 yr old then in order to advised that you choose through various cute ideas. Use the softer shades of pink. For the rooms in the teenage girls you must take into consideration, the preferences of your ex. You can also make involving a theme design noticable the room look brilliant. There are various theme designs options to select from. You can make use of the flowers, butterflies and other abstract designs to decorate a girls cabin. Should decorate wall space with princess themes and stickers. You can even opt for the ballerina theme or the beach style theme.
Ralph Thomas is the founder-director with the National Association Of Investigative Specialists. An author of beyond what 32 books on aspects to conducting investigations, Thomas is also the CEO of: Thomas Investigative Publications, Inc.; The Spy Exchange and Security Center; SpyTek Wholesale Imports.
While @SI_BTBaseline noted later that 23-year-old Ivanovic shouldn't "definitively confirm" a renewed relationship with Steve Williams' new employer ("It was nice observe him again," Ivanovic told BTBaseline's Courtney Nguyen), the observer's website went into a bit more detail.
Double decker bus: The often shown to be in big cities, but essentially the most famous greater london. If one happens to have a double-decker bus service to promote your city, these stress balls helpful for very nicely. This is quiet size 94mm x 45mm x 29mm and oozes character. Stress ball buses and coaches are among the most popular forms of road transport market. Possess a good look, because as a no doubt a form available permits work well for your following promotion.


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Monthly Archives: November 2010
Old design new twist
Had some customers write in to say they love the idea and design on the F&L diaper and the absorbency is great! Maybe a little too great. Some expressed the desire for yet another doubler.
But wait…I thought you just said the absorbency was too great. Well, perhaps an additional doubler would be super so that the OS diaper as an actual day time work horse too without the additional absorbency of the added 11 layered prefold!
So…you asked, I answered. I am now offering the prefold to be made traditionally as I do my other prefolds with a 2x5x2 layering (instead of the 3x5x3), and including an additional insert! Now you can make your prefold night time worthy with the stand alone insert and when your baby steps up to the OS diaper, it can be used with the stand alone insert for day time duty (making it quite trim!) or use it with the prefold and insert for 17-21 layers!
Double over the stand alone insert where your baby needs it most for a diaper with TWENTY ONE layers of absorbency! Believe it or not, it's really not bulky!
They go on sale Monday, November 15!

subset: commoncrawl


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Fermeture du portail BDSP le 1er juillet 2019. En savoir plus...
Immunochemical vs guaiac faecal occult blood tests in a population-based screening programme for colorectal cancer.
BRITISH JOURNAL OF CANCER, vol. 74, n° 1, 1996, pages 141-144, 15 réf., ISSN 0007-0920, GBR
Centro per lo Studio e la Prevenzione Oncologica. Viale A Volta 171. ITA
Two faecal occult blood tests (FOBTs), Hemoccult II (guaiac based) and Hemeselect (immunochemical) were compared in a population screening for colorectal cancer on 24 282 subjects aged 40-70.
Hemeselect was interpreted according to a lower (+and ±) and a higher (+) positivity threshold.
A total of 8008 compliers were enrolled in the study.
Positivity rates :
Hemeselect (+and ±)=8.2%,
Hemeselect (+)=3.1%. Among FOBT-positive subjects complying with the diagnostic work-up, 22 had colorectal cancer (17 Hemeselect-positive (+), four Hemeselect-borderline (±), 15 Hemoccult-positive) and 166 subjects had adenomas (62 Hemeselect (+), 56 Hemeselect-borderline (±), 79 Hemoccult-positive) were detected.
The positive predictive values (PPVs) for cancer were as follows :
Hemeselect (+and ±)=3.8%,
Hemeselect (+)=8.4%. The PPVs for adenoma (s) were : Hemoccult=19.7%,
Hemeselect (+and ±)=21.4%,
Hemeselect (+)=30.5%. The specificity for cancer was : Hemoccult=94.1%,
Hemeselect (+and ±)=92%,
Hemeselect (+)=97.1%. Ratios between detection rates of each test and expected incidence of colorectal cancer suggest that Hemoccult anticipates cancer diagnosis by approximately 2 years on average whereas the mean diagnostic anticipation of Hemeselect ranges between 2.5 and 3.2 years.
Hemeselect is superior to Hemoccult as it is at least as effective but more efficient and acceptable than guaiac testing. (...)
Mots-clés BDSP : Dépistage, Homme, Sang, Etude comparée, Spécificité, Diagnostic, Cancer, Programme santé, Appareil digestif [pathologie], Intestin [pathologie]
Mots-clés Pascal : Tumeur maligne, Côlon, Rectum, Dépistage, Programme sanitaire, Homme, Sang, Fèces, Exploration, Immunochimie, Etude comparative, Spécificité, Valeur prédictive, Diagnostic, Appareil digestif pathologie, Intestin pathologie, Côlon pathologie, Rectum pathologie
Mots-clés Pascal anglais : Malignant tumor, Colon, Rectum, Medical screening, Sanitary program, Human, Blood, Feces, Exploration, Immunochemistry, Comparative study, Specificity, Predictive value, Diagnosis, Digestive diseases, Intestinal disease, Colonic disease, Rectal disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0324505
Code Inist : 002B24O06. Création : 10/04/1997.


text: MH 0 Report post Posted January 4, 2018 A few months ago my boyfriend of a year and a half admitted to cheating on me. We got together when we were 16 and had a really loving relationship (well thats what I thought), we were serious and everyone was completely shocked that he cheated as it was something so out of character for him. I broke up with him but he still wants to be together, I don't know what to do. As weeks went by, more and more things were being revealed, he cheated on me multiple times, not just physically but by sending nude photos, flirting with girls, having files of over 1000 photos of girls we knew without their consent that he would use to masturbate to. I knew he watched porn but but I did not realise how immoral and indecent the type of things he would watch and how frequent it was. We had previously had a period of time where he seemed completely disinterested in me and he now admits that he was having romantic feelings for another person which he tried to pursue while we were together. He came to the conclusion that he was a porn, sex and love addict. He had this type of behaviour for years before we even knew eachother. He says he used the porn and photos of girls as a way to cope with his depression. He wants to change and has been partaking in the online community NoFap and will start seeing a psychosexual counsellor soon.Right now I'm waiting for a specialist for their opinion on whether or not he is an addict because at least that way I would have some closure. Hes dealt with severe mental health issues for years, throughout his adolescene. I have remained friends with him as I deeply care for him and love him. But it is also largely due to the fact after the breakup his mental health plummeted and he is still struggling with feelings of suicide after several attempts. This time has been really intense but he is being put into counselling for his depression and I've been receiving counselling myself too. Hes fully aware about how I feel. I love him but I am not in a place to have a relationship at all let alone him. I know I could find someone else, even being single now I have had casual encounters with people. But despite everything I love him so much. Maybe I'm being young and stupid but I thought I was going to marry this guy. We will both be moving away to go to university (not sure where yet) in Autumn this year and I have tried to explain to him how we are so young and have so many opportunities ahead of us to meet someone else. But hes convinced that he wants to spend the rest of his life with me. I tell him how unrealistic that is but he just tells me its what he want. So really, when I'm ready and he's recovering, do I try again? Is it worth it? Another complication is that after all this I'm refusing to be long distance. I wish someone would just give me their honest opinion and advice. Please help Share this post Link to post Share on other sites


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Saturday, 23 April 2011 07:06 AM
BEIRUT (AP) — Thousands of people gathered for funerals in Syria on Saturday, draping bodies in white cloth to prepare them for burial after security forces killed more than 75 people in the deadliest day of the uprising against authoritarian President Bashar Assad.
About 5,000 people were gathering near the Osman Ibin Afan mosque in Izraa, a southern village that was the scene of some of the worst violence Friday, witnesses said. Fifteen corpses were to be buried after the noon prayers.
Syrian security forces fired bullets and tear gas Friday at tens of thousands of protesters across the country, in a clear sign that regime was prepared to escalate an already bloody response to more than five weeks of unrest. Some 300 people have been killed since the uprising began in mid-March.
In Washington, President Barack Obama said the violence was "outrageous" and called on Assad to obey the will of his people by giving them freedom of expression, association, peaceful assembly and the ability to choose their leaders.
Among those killed Friday were a 70-year-old man and two boys ages 7 and 10, according to Amnesty International.
The scenes of carnage were posted on the protest movement's main Facebook page.
In Izraa, a man ran through the streets carrying the body of a young boy, whose hair was matted with blood from a gaping wound on his head, as another child wept and shouted, "My brother!"
Six Syrian human rights groups said security forces had killed 76 protesters in different parts of the country Friday. The groups, including the National Organization for Human Rights in Syria, called on the government to set up a judicial investigation committee to try those who shot at protesters and to release all political detainees.
The highest tolls were in the central city of Homs, where 19 people were killed, and in Izraa, where 18 were shot dead, the human rights groups said.
In the Damascus suburb of Douma, hundreds of people gathered near Hamdan hospital where the body of at least one person was to be taken to the area's Grand Mosque for prayers, a witness said.
He added that most shops were closed with little security presence in the area.
It was not clear if the little security presence was an attempt to avoid a new confrontation with protesters Saturday.
Saturday's witness accounts could not be independently confirmed because Syria has expelled journalists and restricted access to trouble spots. Witnesses spoke on condition of anonymity for fear of reprisals.
The bloodshed so far has only served to invigorate protesters whose demands have snowballed from modest reforms to the downfall of the 40-year Assad family dynasty. Each Friday, growing numbers of people in multiple cities have taken to the streets despite the near certainty that they would come under swift attack from security forces and shadowy pro-government gunmen known as "shabiha."
Besides the government crackdown, Assad has been trying to defuse the protests by offering a series of concessions, granting citizenship to thousands among Syria's long-ostracized Kurdish minority, firing local officials, releasing detainees and forming a new government. The recent lifting of emergency laws — which gave authorities almost boundless powers of surveillance and arrest — had been a top demand.
But many protesters said the concessions have come too late — and that Assad does not even deserve the credit, because the protest movement is forcing his hand.
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Seattle in 2020
A bid by SWOC to hole the 2020 Westercon in Seattle, WA July 4-8, 2020.
|This is a bid page. Please extend it by adding information about who was bidding, officers, committee list, what they were bidding for, who their opponents were, and anything notable about the bid, etc.
page revision: 1, last edited: 23 Jan 2018 01:01


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Saturday, January 11, 2014 | 8:00pm - 10:00pm
California Landscape into Abstraction Members Reception & Private Viewing
Join Chief Curator Dan Cameron, exhibition artists, and museum supporters for the members reception for California Landscape into Abstraction: Works from the Orange County Museum of Art.
One of the recurring themes in California art over the past century is the relationship between abstraction and landscape. Particularly in Southern California, a deep schism opened up in the 1930s between naturalist landscape painters and those of a more modernist inclination, and the breach has never entirely healed. This exhibition, drawn entirely from OCMA's collection, explores ways in which artists from the West Coast have played a role in transforming landscape into abstraction and then back again.


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Faith Hill plans first Christmas album
'Joy to the World' due in the fallNEW YORK -- Faith Hill's first Christmas album, "Joy to the World," will arrive Sept. 16 via Warner Bros. The first single is an original track, "A Baby Changes Everything," written by Tim Nichols, Craig Wiseman and K.K. Wiseman.
Among the contributors on the album are the Nashville Orchestra, London's Metro Voices and Oratory School Boys Choir and arranger David Campbell. Members of Hill's fan club enjoyed an exclusive preview of the material during a June 6 Nashville playback.
Hill's most recent release, last year's "The Hits" collection, has sold 257,000 copies in the U.S., according to Nielsen SoundScan. Her last studio album was 2005's "Fireflies," which is at 2.2 million to date.
Here is the track list for "Joy to the World":
"Joy to the World"
"What Child Is This"
"Santa Claus Is Coming to Town"
"Little Drummer Boy"
"O Come All Ye Faithful"
"Holly Jolly Christmas"
"Away in a Manger"
"O Holy Night"
"Winter Wonderland"
"Silent Night"
"A Baby Changes Everything"


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Just a quick reminder that Thursday evening at 5:30 we'll be hosting the annual RPMGA Recognition potluck at Craig Center at the Rock County Fairgrounds.
Bring family and friends and a dish to pass. Everything else will be provided.
Hope to see all of you there!! If you need to plug in a crock pot or put something in the oven or put the finishing touches on your creation come a little early. The kitchen will be open!
Looking forward to seeing everyone!!


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Friday, November 6, 2009
Tokyo Parasite Museum
Situated not all that far from Meguro Station, in Tokyo, is an unforgettable rejoinder to the foodstuffs unveiled elsewhere in this hack blog.
The Tokyo Parasite Museum is a trendy dating locale for young couples (no joke), and right near its entrance you get the gist of the theme: There's a Godzilla-sized specimen of a tapeworm, 10 metres (30 feet) in length, that was extracted from some poor fool in Yokohama.
Established by a group of Japanese University parasite-specialist professors, the museum showcases some repellingly mammoth and subversively fascinating microscopic exhibits - revealing a collection of grotesque real-life freeloaders, most of 'em uglier than those imaginary alien terrors from old sci-fi movies. Move over, Predator and James Arness.
This is the only museum in the world where you can see 300 varieties of parasites lumped together in specimen jars, and the notes make you aware that many of them are naturally ingested with… food.
It's enough to put you off the delights of sushi. Well, almost, anyway.
Mmm... sushi.
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Coggeshall Farm, Rhode Island
Jeanne Maxon 6/25/2012 7:35:01 AMthe composition, with the roof lines drawing your eye into the scene than returning to the sheep in the foreground, is excellent - also deep rich saturated colors and textures in the grass and barn stand out - for me, a very eye-catching, satisfying, rural/peaceful kind of scene!
Vincent J. DeSanto 6/25/2012 7:36:57 AMJeanne, thank you very much for such great comments. I truely appreciate them. #10199194
Tomás Widow 6/28/2012 6:53:11 AMGreat work Vince!
Vincent J. DeSanto 6/28/2012 12:00:44 PMTomas, as always thank you for the nice compliments and your support. #10204534
Exif: F Number: 5.6, Exposure Bias Value: -1.33, ExposureTime: 1/1250 seconds, Flash: did not fire, compulsory flash mode, ISO: 400, White balance: Auto white balance, FocalLength: 50.00 mm, Model: Canon EOS 60D
Uploaded on 6/24/2012 7:34:06 PM
Camera: Canon EOS 60D Digital SLR Camera
Copyright for this gallery photo belongs solely to Vincent J. DeSanto. Images may not be copied, downloaded, or used in any way without the expressed, written permission of the photographer.
Log in to follow or message this photographer or report this photo.


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The HearMyText program by EquipMyFinance.com is new for 2017. After seeing the positive impact that our free translation program has had, we've decided to take it a step further.
The idea came from something that is popular among truckers. Listening to audio books while on the road. It's a great way to pass the time as they roll down the highway. Truckers rely on them to stay awake, educate themselves, and sometimes just to plain keep their sanity.
But more importantly, our visually impaired community relies on audio recordings to educate themselves and take in important information.
There are various technologies available that help this community, but they still aren't the best. We can all agree that hearing something spoken by a real human is much better than a robotic voice. Mispronunciations are also very common among those technologies.
We are proud to offer free audio recordings of various text, books, articles, blogs, websites, and other types of content to serve the visually impaired.
We accept requests to make a free audio recording from those that create content, or from those that are visually impaired themselves. Unfortunately, because time is of the essence, we are forced to be selective in our screening process as we get many submissions.
Please complete the form below, and you'll hear back from us within a week!


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Know more about computerprotect05.info
Computerprotect05.info is identified as a malicious site, which is used by cyber crooks to deliver fake BSOD alert stating that you've been infected and you need to call a number for help. In order to draw more attention, this web page keeps popping up within all your web browsers, such as IE, Chrome and Firefox.
Mind you, the computerprotect05.info pop-up is just a tech scam support. It is caused by an adware or a potentially unwanted program that currently gets installed on your PC without your notice. Seeing the computerprotect05.info pop-up is your very first hint that your PC is at risk.
In a word, the BSOD alert from computerprotect05.info is intrusive. Do not call the given number! Otherwise, you will be cheat to purchase their paid support services and products, which has nothing to do with the real condition of your PC. Therefore, you need to remove computerprotect05.info immediately.
Rid your PC of computerprotect05.info - You can make it!
The following passage is going to provide TWO different solutions on removing computerprotect05.info or any other unwanted adware. Please read carefully and try to understand the removal guide below.
Solution A: Manually Remove computerprotect05.info
Solution B: Automatically Remove computerprotect05.info with SpyHunter
Solution A: Manually Remove computerprotect05.info
1. Stop computerprotect05.info associated running process in Windows Task Manager
Note: If you cannot close the computerprotect05.info web page, try this step; otherwise, go to step 2 directly.
Press "Ctrl+Shift+Esc" together to open Windows Task Manager, click Processes tab, find your internet browser's running process and click on it, then click the "End Process" button.
2. Uninstall computerprotect05.info related program in Control Panel
Windows 10:
1) Tap the Windows key + I to launch Settings.
2) Click on Control Panel.
3) Open Uninstall a program.
4) Delete any suspicious program.
1) Click "Charms bar", choose "Settings" and click "Control Panel".
3) Look for suspicious or unfamiliar program, select its entry and click "Uninstall".
Windows 7 or Windows Vista:
1) Launch the Start menu and select Control Panel.
2) Access Uninstall a program.
3) Remove any suspicious program.
Windows XP:
1) Access the Start menu.
2) Open Control Panel.
3) Launch Add or Remove Programs and eliminate any suspicious program.
Internet Explorer:
1) Open Internet Explorer, click on the gear icon, choose "Internet options", go to General tab, enter your favorite website address, click "Apply".
3) Click "OK" to close the Internet Options window.
4) Click "Start", find "Internet Explorer" and then right click on it, choose "properties".
5) On the pop-up window, go to Shortcut tab, delete the extension after ".exe" in Target, click "OK".
Google Chrome:
1) Open Google Chrome, click on the icon menu (top right), select "Settings".
2) Go to On startup option, click "Set pages", delete the unwanted website address and then "OK".
3) Go to Appearance option, check "Show Home button", and then click "Change".
4) On the pop-up window, delete the unwanted website address in Open this page option, click "OK", and then uncheck "Show Home button".
5) Go to History tab, click "Clear browsing date…" button. On the confirm window, click "Clear browsing date", and then close Chrome.
6) Click "Start", find "Google Chrome", right click on it, select "properties".
7) On the pop-up window, go to Shortcut tab, delete the extension after ".exe" in Target, click "OK".
1) Open Mozilla Firefox, click on the icon menu (top right) and select "Options".
3) Here select "History", click the "Clear Recent History…" button. On the pop-up window, click "Clear Now".
4) Click "Start", find "Mozilla Firefox", right click on it, select "properties". On the pop-up window, go to Shortcut tab, delete the extension after ".exe" in Target, click "OK".
4. Speed up your PC by using RegCure Pro
RegCure Pro is an advanced optimizer which is able to solve your computer system problems, remove your privacy items produced by online searches, delete junk files, uninstall malware and fix performance problems. You can download and use RegCure Pro with confidence for it doesn't contain any additional items or conflict with your current used antivirus program. Here shows how it works:
1) Free download RegCure Pro by clicking the below button.
2) Click the "Run" button to enter in installation process and then follow the instruction to install the program step by step.
3) When the program is successfully installed, double click on its desktop shortcut to open it. On the Overview tab, check all the scan settings and then click on the "Click to Start Scan" button to run a system scan on your computer.
5) When the system scan is done, click on "Fix All" button to completely remove all the performance problems in your computer.
-Want a quicker way to get you out of current issue?
Solution B: Automatically Remove computerprotect05.info with SpyHunter
SpyHunter is a powerful, real-time anti-spyware application designed to assist the average computer user to detect, remove, and protect their PCs from the latest malware attacks. Here shows how it works:
2. Click the "Run" button to enter the setup program and follow the installation steps until setup is complete.
3. If SpyHunter does not automatically start, click the icon on your desktop or Start menu to open it.
4. Allow the program to scan by clicking the "Scan Computer Now!" button. You are advised to have a full scan on your PC, please uncheck the "Quick Scan" box.
5. The first scan will take some time, please be patient while waiting for the scanning result.
6. After the scan is done, you can see that all threats are successfully detected. Check the "Select All" box and then click the "Fix Threats" button to fix all threats in your PC.
To Summarize:
computerprotect05.info is really a trouble maker that should be kicked out of your computer immediately without any hesitation.
Download SpyHunter to Protect Your PC from Malicious Threats.
Download RegCure Pro to Fix Slow PC Performance.
Good Luck and be safe online.
Note: The free version of SpyHunter/RegCure Pro is only for malware detection. If SpyHunter/RegCure Pro detects malware on your PC, you will need to purchase its malware removal tool to remove the malware threats.


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Today President Obama announced that he is rejecting the EPA's recommendation to adopt more protective rules to curb smog pollution.
Ironically, he made the announcement just before the Labor Day weekend, the time of year that ozone levels typically spike due to warm temperatures and increased vehicle traffic.
It's typical of bureaucratic cowardice to release unpopular news on a Friday afternoon in the hopes that it will escape media attention. The most unpopular news is usually saved for Friday afternoons before long holiday weekends.
Today's action certainly stands out as one of the most disappointing examples of environmental back-peddling by the Obama Administration. In a sharply-worded press release, the American Lung Association stated that the "decision not to enact a more protective ozone health standard is jeopardizing the health of millions of Americans, which is inexcusable" and pledged to take the Administration to court for failing to follow the Clean Air Act.


text: – Hey there! I'm@idependonme7and so much has gone on and changed in under a year. A year ago- I was visiting@mcbacardi in NYC and fell in LOVE with that place! While I was there- I got a call from my mom that my Pawpaw had passed away and it felt like I had been shot. […]Read more "SEVENDIETPLAN UPDATE'S"


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Briefing. Independent sector treatment centres. October Introduction. Why were they introduced?
- Gloria Malone
- 3 years ago
- Views:
1 October 2009 Independent sector treatment centres Introduction (ISTCs) provide services to NHS patients but are owned and run by organisations outside the NHS. They were introduced in England in 2003, primarily to help the NHS reduce waiting times for planned operations and diagnostic tests. Although the NHS has used services provided by the independent sector throughout its history, ISTCs are distinctive in two ways: ISTCs were created as a deliberate policy of central government athough privately owned, ISTCs provide services only to NHS patients. ISTCs therefore represent a new form of independent sector involvement in public health care, and have been the subject of considerable controversy since their introduction. This briefing paper explains why ISTCs were introduced, and how they are funded, staffed and regulated. It assesses their impact so far, including the quality of their services and whether they provide good value for money. Finally, it examines what their future may be now that the contracts ISTC providers hold with the Department of Health are beginning to expire. Authors: Chris Naylor Sarah Gregory The King s Fund Cavendish Square London W1G OAN Tel Registered charity: Why were they introduced? The rationale for introducing ISTCs can be explained by addressing two questions: first, why were treatment centres set up separate from hospitals; and second, why was the independent sector involved in providing these services? The NHS Plan (Department of Health 2000) announced the intention to establish Diagnostic and Treatment Centres. These would begin to address a long-standing concern The King s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas. 1 The King s Fund 2009
2 that hospitals were not providing planned tests and operations efficiently because the competing demands of providing emergency care frequently led to appointments being delayed or cancelled. It was hoped that by separating planned operations from emergency care, treatment centres would help to reduce waiting times. They would also increase capacity in specialties with long waits, such as ophthalmology and orthopaedics, again helping to reduce waiting times in these areas. The rationale for involving the independent sector in the delivery of treatment centres was originally based on creating additional capacity to reduce waiting times. In 2002, the Department of Health engaged strategic health authorities (SHAs) in a national capacity planning exercise, and concluded that in order to achieve rapid reductions in waiting times, an expansion of independent sector capacity would be required. This expansion was achieved through the ISTC programme, which procured treatment centres from the independent sector (Department of Health 2002a). The Department later stressed that the ISTC programme could also play a role in achieving other government ambitions (Department of Health 2006a; House of Commons Health Committee 2006a): introducing competition with the intention of stimulating NHS providers to improve their own services, particularly in terms of increasing productivity and reducing waiting times providing patients with a greater choice of providers creating a space for innovation, in which new forms of service delivery could be developed providing a more cost-effective way for the NHS to utilise capacity in the private sector. By purchasing services in bulk rather than through ad hoc spot purchasing arrangements, it was hoped that the ISTC programme would provide better value for money. How many ISTCs have been set up? There have been two waves of ISTCs procured centrally by the Department of Health, each constituting a five-year investment programme. The first ISTC opened in The second wave of procurement was announced in 2005, with the first centre opening in Under Wave 1, 25 fixed-site centres and two chains of mobile units were opened (Hansard 2009a). The Department of Health states that these were targeted on areas with a lack of capacity or long waiting times, as identified by SHAs in conjunction with local primary care trusts (PCTs) (House of Commons Health Committee 2006a). Wave 2 initially involved 24 schemes (House of Commons Health Committee 2006a), but was scaled back to 10, of which nine were operational by June The Department of Health explained this reduction by stating that the changing situation in health economies meant that extra capacity was no longer needed in some areas (House of Commons Health Committee 2006a). It should be noted that Wave 2 contracts were considerably wider in scope, covering services provided over multiple sites rather than a single centre. A number of NHS-owned treatment centres have also been developed since By 2006, 48 NHS treatment centres were open or under development (Department of Health 2006b, 2006c). What services do ISTCs provide? ISTCs vary widely in terms of the scope of their services and the way they are organised. Some offer only a narrow range of services while others cover multiple specialties and offer 2 The King s Fund 2009
3 outpatient care, diagnostics and day surgery. Specialties commonly provided include orthopaedics, ophthalmology, and various forms of surgery. ISTCs do not provide highlevel intensive care. A small but growing proportion of NHS elective care is now provided by ISTCs. Table 1, below, shows the proportion accounted for by ISTCs each year since the programme began. The figures are based on inpatient procedures, and do not include diagnostics. Table 1 ISTC activity as a proportion of total NHS activity Year ISTC activity (FCEs)* Total NHS elective ISTC activity as (from HES** data) activity proportion of (from HES** data) elective activity (%) 2003/4 3,633 5,544, /5 36,599 5,530, /6 53,388 5,821, /7 67,210 5,590, /8 105,604 5,900,000*** 1.79 * Finished Consultant Episodes - represents a patient s completed period of care under a consultant. ** Hospital Episode Statistics *** Audit Commission estimate Source: Audit Commission (2008) Within particular specialties, the proportion of work conducted in ISTCs is higher. By the end of 2006/7, ISTCs were performing 4 per cent of cataract procedures, 7 per cent of hip procedures, and 9 per cent of arthroscopies nationally (Audit Commission 2008). But these national-level statistics fail to shed light on the proportion of activity accounted for by ISTCs at local level. The Healthcare Commission reported that in some areas, all elective care within particular specialties is conducted in an ISTC (Healthcare Commission 2007). The proportion of NHS elective activity performed by ISTCs will continue to rise as Wave 2 schemes become fully operational. But for the foreseeable future, it is unlikely to reach the 15 per cent envisaged at one stage by the Department of Heath (Department of Health 2006a). How are they funded and how much do they cost? The funding arrangements for ISTCs were specified in five-year contracts negotiated by the Department of Health. These contracts have not been published in full on the grounds of commercial sensitivity, but certain details are known. The price for work conducted in ISTCs is based on the national NHS tariff the standard payment system for providers of NHS services supplemented with an additional provider-specific premium to encourage entry into the market and cover the costs associated with setting up a new treatment centre. The size of these premiums have not been published, but the Department informed the House of Commons that Wave 1 ISTC providers received, on average, payments that were 11.2 per cent greater than the NHS equivalent cost. The NHS equivalent cost is derived from tariff values but also includes fixed costs borne by the NHS outside of the tariff for example, pension payments (House of Commons Health Committee 2006a). 3 The King s Fund 2009
4 In addition to the premium paid per procedure, ISTC contracts also include minimum volume guarantees to act as a further incentive for providers to enter the market. Wave 1 ISTCs were given a take or pay guarantee, stipulating that PCTs would pay for 100 per cent of the contract value, regardless of whether activity reached the contracted level. Wave 2 ISTCs are not guaranteed to receive 100 per cent of the contract value, but do receive a guaranteed fixed value (GFV). GFV payments are calculated with reference to providers fixed costs, and reduce incrementally over the course of the contract. The Department of Health rather than PCTs is liable for GFV payments. The total cost of payments to ISTCs from the programme s inception up to 31 March 2009 was 1.2 billion (Hansard 2009b). The estimated cost for the next five years, from April 2009, is 1.4 billion (Hansard 2009c). Averaging this out over five years, and taking the total budget for the NHS in England of 98.4 billion in 2009/10 (HM Treasury 2008), this represents less than 1 per cent of overall annual expenditure. How are ISTCs staffed? To avoid staff being poached from the NHS, Wave 1 ISTC providers were not allowed to recruit staff who had worked within the NHS in the previous six months. As a result, many staff were recruited from other countries. The House of Commons Health Committee strongly criticised this additionality policy as having led to a lack of integration with local NHS providers and problems associated with staff not being familiar with surgical techniques and administrative processes used in the United Kingdom, as well as language problems (House of Commons Health Committee 2006a). Mindful of these concerns, the Department of Health relaxed the recruitment restrictions for Wave 2. Providers are now permitted to recruit NHS staff, but staff within defined shortage professions are allowed to work for ISTCs only outside their contracted NHS hours (NHS Employers 2007). The profile of the workforce in ISTCs is evolving over time, and also varies between centres. For example, in 2007, 25 per cent of clinical staff (on average) in Wave 1 ISTCs were on secondment from the NHS, but this was as high as 83 per cent in one centre (Player and Leys 2007). Wave 2 ISTCs are contractually obliged to make at least one-third of all activity available for the training of junior clinical staff, should the deans of local educational bodies require it. This was a response to the concern that if a large proportion of simpler, routine work was to be conducted within ISTCs, local NHS hospitals would be left with a disproportionate number of more complex cases that may not be suitable for training purposes (House of Commons Health Committee 2006a). Evidence suggests this concern is legitimate for example, in one NHS hospital, the percentage of patients referred for cataract surgery whose condition required them to be operated on by a consultant increased from 5.5 per cent to 19.6 per cent after an ISTC opened in the area (Barsam et al 2008). As is the case in all NHS and private hospitals in the United Kingdom, doctors and surgeons working in ISTCs (including those from outside the United Kingdom) must be registered with the General Medical Council for the specialism they wish to practise, and other professionals must be registered with the relevant regulatory body. This is designed to provide some guarantee of competence. However, ISTCs do not have an equivalent of the Advisory Appointments Committees used in the NHS, which include representation from the royal colleges and serve as an additional quality control mechanism. Without this, the onus lies on ISTC providers to ensure that recruitment processes are robust. An investigation by the Healthcare Commission found that ISTCs generally met national minimum requirements in this respect, but found some shortfalls in areas such as continuing professional development and appraisal (Healthcare Commission 2007). 4 The King s Fund 2009
5 How is the quality of their services regulated? The quality of work performed by ISTCs was regulated by the Healthcare Commission until 2009, and is now regulated by the Care Quality Commission (CQC). The standards for independent sector providers differ from those used for public sector providers, as different legislation applies. Under the Healthcare Commission, independent sector providers were required to meet the national minimum standards (Department of Health 2002b), whereas NHS providers were regulated against the NHS core standards, along with more demanding developmental standards (Department of Health 2006d) and additional requirements described in other policy documents such as the National Service Frameworks (NSFs). These arrangements have been continued on an interim basis by the CQC. From April 2010, the current regulatory framework will be replaced with a single registration system. All organisations providing services to patients, whether publicly or privately funded, must be registered with the CQC by law. The registration requirements will replace the national minimum standards and NHS core standards, representing a degree of harmonisation in the regulation of publicly and privately owned providers (Health and Social Care Act 2008). However, the new improvement standards, which will replace the current developmental standards, will apply only to public providers. ISTCs must also report to the Department of Health on 26 key performance indicators (KPIs), covering areas such as clinical measures, complaints, and patient satisfaction. These indicators are reported at least once a month, with some being reported on a daily basis (House of Commons Health Committee 2006b). The data submitted to the Department of Health are not made public, as it is argued that this information is commercially sensitive. If an ISTC persistently breaches defined thresholds for any of the indicators, sponsoring PCTs are able to impose financial penalties or, ultimately, terminate the contract (Department of Health 2006a). What impact have ISTCs had? The information available is not adequate to support a conclusive assessment of the impact of the ISTC programme. However, there is some limited evidence relating to waiting times, quality of care, value for money, and innovation. Waiting times The ISTC programme was intended to reduce waiting times for diagnostics and planned operations in two ways first, by adding extra capacity to the system, and second, by introducing competition that would stimulate productivity improvements in NHS facilities. The ISTC programme has made only a small contribution in terms of adding extra capacity. As noted earlier, in some areas, and within certain specialties, ISTCs may account for a substantial proportion of activity (Audit Commission 2008). However, at the national level, only around 2 per cent of all NHS elective activity occurs in ISTCs, which suggests that their contribution has not been a significant factor in the dramatic reductions in waiting times for elective procedures. It is more difficult to assess the contribution ISTCs may have made to reducing waiting times by stimulating productivity improvements in NHS facilities. Anecdotal evidence suggests that some NHS providers have made changes to the way they deliver services in response to an ISTC opening in their area. A joint report from the Audit Commission and Healthcare Commission found that for some NHS providers, the competitive threat posed by ISTCs provided a useful tool to engage clinicians and work with them to deliver change (Audit Commission 2008). 5 The King s Fund 2009
6 Based on evidence submitted by NHS providers, the House of Commons Health Committee enquiry into ISTCs concluded that the galvanising effect of competition on the NHS may have been the greatest benefit delivered by the ISTC programme, but criticised the government for not systematically evaluating this effect. The committee recommended that the National Audit Office should conduct such an evaluation, but to date this recommendation has not been acted on (House of Commons Health Committee 2006a). There is no quantitative evidence to substantiate suggestions that competition with ISTCs has been a factor in reducing waiting times in NHS facilities. A recent analysis by The King s Fund, comparing areas with ISTCs to those without, found no difference in the rate at which waiting times were reduced. Quality of care Comparing the quality of care provided in ISTCs with that in NHS facilities is not simple, as they differ in terms of the profile of patients treated (case-mix), the regulatory framework they operate within, and the data they collect on their activities. However, the evidence that does exist suggests that most care provided is of a comparable standard to that found in the NHS. One research study found that improvements in functional status and quality of life were slightly higher in ISTCs for patients undergoing cataract and hip replacement operations, but slightly lower for patients undergoing hernia repair (after adjusting for case-mix). The authors cautioned against placing too much weight on these findings, though, as the number of ISTCs participating in the study was low and it is possible that case-mix adjustment was inadequate (Browne et al 2008). A review carried out by the Healthcare Commission in response to concerns submitted to the House of Commons Health Committee reported that it could provide some positive assurance about the quality of care provided by ISTCs. Their inspections found that processes of care in most ISTCs appear to function well. They did, however, find isolated examples of poor care and of centres where staff did not properly understand the need to set up systems for clinical governance. In particular, there were some difficulties around the transfer of care from ISTCs to NHS facilities for example, when patients experience complications beyond the scope of services ISTCs are able to provide (Healthcare Commission 2007). The same report criticised the Department of Health and other statutory bodies for not ensuring that ISTCs provided high-quality data on patient care. Despite improvement over the last two years, the quality of data is still not comparable to that collected by NHS providers (NHS Information Centre 2008). For example, in the second quarter of 2007/8, information on patient diagnosis was missing for 42.6 per cent of records submitted by ISTCs to the Hospital Episode Statistics (HES) database, as opposed to 0.1 per cent from NHS-owned treatment centres, and 1.5 per cent from NHS hospital trusts (Healthcare Commission 2008). This limits our ability to compare the quality of services provided by ISTCs and NHS providers. Value for money Several issues need to be considered in assessing whether ISTCs have delivered value for money: the higher price paid to ISTCs per procedure; the effect on spot purchasing arrangements with the independent sector; concerns related to case-mix; and the volume guarantees included in ISTC contracts. The Department of Health argues that the higher prices paid to ISTCs are justified on the grounds that independent sector providers face costs over and above those borne by the 6 The King s Fund 2009
7 NHS, such as corporate taxation (House of Commons Health Committee 2006a). It has also stated that although prices exceed NHS equivalent costs, they are significantly below typical spot purchasing prices used when the NHS purchases care from the independent sector on an ad hoc basis (House of Commons Health Committee 2006a). However, full details on the data and methodologies used to reach these conclusions have not been made available on the grounds of commercial sensitivity. There is some evidence to suggest that the ISTC programme may have succeeded in its aim of reducing spot purchasing throughout the independent sector (House of Commons Health Committee 2006a; Audit Commission 2008). It could therefore be argued that the ISTC programme has created an environment in which independent sector capacity can be utilised at lower cost. ISTCs are constrained in terms of the complexity of the cases they can accept, and there has been some concern that the pricing system used in the NHS may not be sufficiently differentiated to be able to recognise this and reduce payment accordingly (Audit Commission 2008). In theory, this could lead to ISTCs (along with NHS treatment centres accepting a limited range of cases) being overpaid relative to NHS hospitals. Data limitations mean that it is difficult to assess whether or not this is happening (Mason et al 2009). Perhaps the most significant issue relating to value for money is the volume guarantees included in ISTC contracts. Information published by the Department of Health shows that many ISTCs have been under-utilised. By the end of September 2008, Wave 1 ISTCs had performed 85 per cent of the activities they had been paid for up to that time (Department of Health 2008a). For Wave 2 ISTCs, contract utilisation for elective schemes by September 2008 also stood at 85 per cent, and for diagnostic schemes was only 25 per cent (Department of Health 2008b). This under-utilisation may reflect resistance within the NHS to using ISTCs and poor relations with local GPs and other providers (Audit Commission 2008), and has been tackled in some PCTs by giving GPs financial incentives to refer patients to ISTCs (Carvel 2006). It may also indicate that some of the extra capacity created by ISTCs is now surplus to requirements. Innovation ISTCs were intended to provide a space in which innovative approaches could be developed, which could then spread throughout the NHS. The Health Committee enquiry concluded that ISTCs have indeed embodied good practice and introduced innovative techniques, such as the use of mobile units, streamlining the supply of prostheses, and the construction of facilities based around patient flow. However, some witnesses claimed that these practices were also happening within the NHS (House of Commons Health Committee 2006a). No evidence is available on whether good practice and innovation developed by ISTCs has subsequently been adopted by NHS providers. What is the future of ISTCs? Thirteen of the Wave 1 contracts are due to expire by the end of 2009/10 (Hansard 2009d), with most of the remainder expiring in the following two years. Wave 2 contracts will expire between 2011 and 2017 (Hansard 2009c). The Department of Health has stated that there will be no further central procurement of ISTCs (Department of Health 2007). Once centrally negotiated contracts expire, ISTCs will operate under the same rules as other independent sector providers. They will be able to treat private patients and will no longer be subject to restrictions on employing NHS staff. New contracts will be agreed with PCTs, and competition rules state that these contracts should not contain guaranteed payments or volumes except in exceptional circumstances (Department of Health 2008c). PCT commissioners are expected to base arrangements with ISTCs 7 The King s Fund 2009
8 on the standard NHS contract, which specifies a range of responsibilities providers must accept for example, compliance with the 18-week referral to treatment target (Department of Health 2008d). In at least 14 cases, the NHS will be obliged to pay providers for the residual value of ISTC buildings and facilities when contracts expire (Hansard 2008). The NHS will then own these assets and may choose to rent them out to ISTC providers, should the contract be renewed or put out to tender. The estimated total value of these payments is 176 million for Wave 1 and 40 million for Wave 2 (Hansard 2009e). It is unclear whether PCTs, SHAs or the Department of Health will be liable for these payments. As of April 2008, patients being referred for routine care have the right to be seen by any provider (NHS or independent sector) that is registered to provide the service they need, willing to accept NHS prices, and either holds a contract with their local PCT or is listed on a national choice network. Initially, ISTCs will be registered to provide only those services covered by their original national contracts. However, they will be able to expand their scope by applying to become registered for other services, presenting providers with wide-ranging new business opportunities. In theory, therefore, the future of ISTCs rests with patients and the choices they make about who provides their care. However, the extent to which patients are currently given a choice of provider at the point of referral is questionable in 2007, only 45 per cent of patients recalled having been given a choice (Department of Health 2008e). This suggests that, in practice, some power regarding the future commercial success of ISTCs rests in the hands of GPs and others involved in the referral process. Conclusion There is a limited amount of information relating to ISTCs due to a combination of problems with routine data collection, commercial sensitivity, different regulatory frameworks applying to NHS and independent sector providers, and a lack of systematic evaluation of the effects of ISTCs on the NHS. These limitations make it difficult to compare different types of provider. Shifting responsibility for ISTCs to the local level may further complicate comparisons, given that the Department of Health is under no obligation to collect details of arrangements agreed between PCTs and independent sector providers. As the NHS moves towards greater diversity of provision, with increasing involvement of the independent sector, it is important to ensure that data on quality and cost are publicly reported so that regulators, commissioners and patients can judge the relative performance of providers on a level playing field. 8 The King s Fund 2009
9 References Audit Commission (2008). Is the Treatment Working? Progress with the NHS system reform programme. London: Audit Commission. Barsam A, Heatley CJ, Sundaram V, Toma NM (2008). A retrospective analysis to determine the effect of independent treatment centres on the case mix for microsurgical training. Eye, vol 22, no 5, pp Browne J, Jamieson L, Lewsey J, van der Meulen J, Copley L, Black N (2008). Case-mix & patients reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers. BMC Health Services Research, vol 8, no 78. Available at: www. biomedcentral.com/ /8/78 (accessed on 3 June 2008). Carvel J (2006). GPs offered payments to send patients private. The Guardian. 11 May. Department of Health (2008a). ISTC Phase 1 Contractual Information (as at 30 Sept 2008). Available at: htm?idcservice=get_file&did=178489&rendition=web (accessed on 2 September 2009). Department of Health (2008b). ISTC Phase 2 Contractual Information (as at September 2008). Available at: htm?idcservice=get_file&did=178488&rendition=web (accessed on 2 September 2009). Department of Health (2008c). PCT Procurement Guide for Health Services. London: Department of Health. Available at: Guide.pdf (accessed on 2 September 2009). Department of Health (2008d). The Standard NHS Contracts for Acute Hospital, Mental Health, Community and Ambulance Services and Supporting Guidance. London: Department of Health. Department of Health (2008e). Report of the National Patient Choice Survey, England September 2007 [online]. Available at: Publications/PublicationsStatistics/DH_ (accessed on 2 September 2009). Department of Health (2007). Johnson outlines new measures to deliver more choice and faster treatment to patients. Press release, 15 November. Department of Health (2006a). ISTC Manual. London: Department of Health. Department of Health (2006b). NHS Orthopaedic Schemes April-May Available at: FILE&dID=22139&Rendition=Web (accessed on 2 September 2009). Department of Health (2006c). NHS Ophthalmology TC Schemes April-May Available at: htm?idcservice=get_file&did=26610&rendition=web (accessed on 2 September 2009). Department of Health (2006d). Standards for Better Health. London: Department of Health. Department of Health (2002a). Growing Capacity Independent Sector Diagnosis and Treatment Centres. London: Department of Health. Department of Health (2002b). Independent Health Care National Minimum Standards. London: The Stationery Office. Department of Health (2000). The NHS Plan: A plan for investment, a plan for reform. London: The Stationery Office. Hansard (House of Commons Debates) (2009a) 9 February 2009 col 1768W. Hansard (House of Commons Debates) (2009b) 6 May 2009 col 207W. 9 The King s Fund 2009
10 Hansard (House of Commons Debates) (2009c) 13 March 2009 col 784W. Hansard (House of Commons Debates) (2009d) 10 March 2009 col 382W. Hansard (House of Commons Debates) (2009e) 16 March 2009 col 897W. Hansard (House of Commons Debates) (2008) 27 February 2008 col 1768W. Healthcare Commission (2008). Independent Sector Treatment Centres: The evidence so far. London: Commission for Healthcare Audit and Inspection. Healthcare Commission (2007). Independent Sector Treatment Centres: A review of the quality of care. London: Commission for Healthcare Audit and Inspection. Health and Social Care Act 2008 (c 14). London: The Stationery Office. Available at: www. opsi.gov.uk/acts/acts2008/ukpga_ _en_1 (accessed on 2 September 2009). HM Treasury (2008). Pre-Budget Report 2008: Facing global challenges: supporting people through difficult times. Available at: htm (accessed on 2 September 2009). House of Commons Health Committee (2006a). Independent Sector Treatment Centres. Fourth Report of Session Volume I. HC 934 I. London: The Stationery Office. House of Commons Health Committee (2006b). Independent Sector Treatment Centres. Fourth Report of Session Volume III. HC 934 III. London: The Stationery Office. Mason A, Street A, Miraldo M, Siciliani L (2009). Should prospective payments be differentiated for public and private healthcare providers? Health Economics, Policy & Law. 5 February. [Epub ahead of print] Available at: ez?db=pubmed&cmd=search&term=%22siciliani%20l%22%5bauthor%5d&ito ol=entrezsystem2.pentrez.pubmed.pubmed_resultspanel.pubmed_discoverypanel. Pubmed_RVAbstractPlus (accessed on 1 September 2009). NHS Employers (2007). Human Resources Framework. To support independent sector elective and diagnostic schemes. August 2007 (updated). Available at: org/aboutus/publications/documents/hr_framework_istc_phase2_2007.pdf (accessed on 2 September 2009). NHS Information Centre for health and social care (2008). Data Quality Report for Independent Sector NHS funded treatment Q1 2008/09. Available at: uk/webfiles/key%208/is%20information/0810_the%20nhs%20ic_data%20 Quality%20Report%20for%20Independent%20Sector%20NHS%20Funded%20 Care%20Q1% pdf (accessed on 2 September 2009). Player S, Leys C (2007). Confuse and Conceal: The NHS and independent sector treatment centres. Monmouth: The Merlin Press. 10 The King s Fund 2009
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text:
In another move to grow the NPPA's position as the voice of visual journalism, the nppa.org website has undergone a redesign that launches in April. The new look improves navigation, upgrades the ability to display video and multimedia and puts visuals at the center of everything.
NPPA Secretary Seth Gitner was the project manager, guiding priorities to migrate from an underwhelming design into something that could display cutting-edge multimedia and also be agile enough for new features as the site evolves.
"I have been involved with the NPPA's technology since I was elected to the board in 2014. We knew we needed a redesign even then, but it was really important for us to get a handle on all of our technology issues and there were plenty," said Gitner who also serves as the NPPA technology chair.
The online presence for Monthly News Clip Contest, the TV Quarterly, Best of Photojournalism and other NPPA competitions became the first priority and was redesigned in 2016. Gitner said that successful project will remain on a subdomain at competitions.nppa.org.
The nppa.org redesign started soon after. Visuals are the centerpiece on the new homepage and breaking news from NPPA will be more easily displayed. The Job Bank, member profiles and Find a Photographer are among the features that remain.
The design will also include a digital version of News Photographer. Previously, a PDF of the magazine was uploaded to the site but now the stories will be formatted for better display of visuals and the inclusion of video.
The project was challenging, in part to size of the membership database and the news archives.
"There were a lot of legacy issues that we've had to deal with all along the way; from costly servers to a monstrous member database, to a design that did not display photographs very well at all," Gitner said. "It wasn't until we really got in there and took a look around that we were able assess all that needed to be done."
The technical work of the redesign was handled by Winter Creative, a full-service digital agency based in Truckee, California that specializes in design and data-driven development.
"This was a massive overhaul and should help position the NPPA for the future," said Winter Creative President Justin Winter. "I'm proud to have helped build something that can help feature the amazing talent of the NPPA."
The NPPA team worked directly with Winter and his developers along the way.
"Working with Winter Creative has been great. We did not have to go through an account sales representative. We worked directly with a web developer who knows when you ask the question whether something is doable or not," Gitner said. "Plus, Justin has a background in photography. He knows imagery and how to play it well on-line."
Showcasing outstanding photojournalism was the central purpose of the new design.
"This gives us so many options to share outstanding visual journalism," said Tom Burton, editor of the NPPA. "We need to be as creative as our membership in publishing the NPPA's stories and this site is the perfect tool."
Burton said that the new design will allow for more videos on the homepage from NPPA members.
"Photojournalists working in broadcast newsrooms and the growing number of multimedia journalists are doing amazing work and we need to be able to display that," Burton said.
Many of the site's features will remain exclusive to NPPA members through their logins. During the launch, most of the features will be open to anyone as a virtual open house, but will be behind the user login access soon after.
"I think the NPPA membership will notice a big difference right off the bat and be able to see that the NPPA is keeping up to date and will remain a relevant advocate for visual journalists," Gitner said.


text:
Truce Over: Hill Shill Rangel Calls Obama Remarks "Absolutely Stupid"
With Rep. Charles Rangel, the Clintons get in the last word on race.
NY1 has video of Rangel calling Obama's race remarks "absolutely stupid" in an interview yesterday.
Hours after Barack Obama and the Clintons agreed to a a supposed "racial" truce , Hillary supporter Charles Rangel called Obama "stupid" over his race remarks.
CNN reported:
As both Hillary Clinton and Barack Obama tried to lower the tension after days of charged rhetoric over race, a congressional supporter of Clinton's presidential bid called the Illinois senator's remarks attacking her over recent comments about President Lyndon Johnson and the Rev. Martin Luther King Jr. "absolutely stupid."
"How race got into this thing is because Obama said 'race,'" New York Rep. Charlie Rangel, one of the highest-ranking African-Americans in Congress, said in an interview on NY1.
"But there is nothing that Hillary Clinton has said that baffles me. I would challenge anybody to belittle the contribution that Dr. King has made to the world, to our country, to civil rights, and the Voting Rights Act," said Rangel. "But for him to suggest that Dr. King could have signed that act is absolutely stupid. It's absolutely dumb to infer that Doctor King, alone, passed the legislation and signed it into law."
Related… Grand Old Partisan takes a look back at the democrat's attack on blacks back in 1901.
Hat Tip BG
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text:
>why client makes new connections to proxy when another persistent connection between same client and same proxy exists. Thanks > One of the reasons is usually that you can start displaying the page if you have the top (of a long page) and the images at the top. If I remember correctly mozilla will not pipeline on the main connection for a page (they will reuse the main connection as an ordinary persistent connection when the main page is fetched). They do this since the page is normally large, and the images in it are many and small. If they do not pipeline on the main connection, they want several threads to start getting the images that are needed. If they can start display the page correctly quick and load the rest with only the scrollbars updating the user will think that the browser is faster giving a more happy user. Of course the total time to download a page with images takes a bit longer for each extra connection, but experienced user time is not equal to total time... I may be wrong about how mozilla is doing things now though, but I still belive that they do it like this (or has tweakable options for this). /roboReceived on Tuesday, 2 March 2004 19:04:12 UTC
This archive was generated by hypermail 2.3.1 : Tuesday, 1 March 2016 11:10:37 UTC


text:
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- Item Type: casual shoes
- Fit: Fits true to size, take your normal size
- Lining Material: Cotton Fabric
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1).we located in Guangdong the largest shoes &Bag market of China, We have the unique geographical advantages and the prosperity of foreign trade .We offer a huge number of electronic businesses from all over the world.
2).You pays the FACTORY PRICE!
We sell brand new items directly from factory in Asia. That is why our prices are competitive.
To maintain quality control we do personally inspect for each item prior to shipment .All items are 100% new and inspected.
International Buyers Please Note:
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However, the tax is determined by buyer custom not by us, different countries for different tax rate, so if any tax then the buyer should bear it.
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3).Please check with your country's customs office to determine what these additional costs will be prior to bidding/buying.
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- Unit Type: Pair
- Package Weight: 0.8kg (1.76lb.)
- Package Size: 30cm x 20cm x 10cm (11.81in x 7.87in x 3.94in)
- Unit Type: Pair
- Package Weight: 0.8kg (1.76lb.)
- Package Size: 30cm x 20cm x 10cm (11.81in x 7.87in x 3.94in)