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To identify and validate a surrogate measure of long-term adherence to positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA).
Retrospective cohort study.
Academic center.
220 consecutive patients with OSA.
In patients with OSA who were receiving PAP therapy (for > 1 year), PAP adherence measured by device-download and defined by Medicare criteria was compared to refill rates for mask and other PAP therapy accessories. First, receiver operating characteristic (ROC) curves were constructed to identify a threshold value of refills per year that discriminated best between PAP adherent and non-adherent patients (derivation set; n = 100). Then the predictive accuracy of the threshold value of refills per year was tested in an additional 120 consecutive patients (validation set).
From the derivation set, ROC curve with good discriminant characteristics (ROC 0.83; 95% confidence intervals [CI], 0.75, 0.91, p < 0.0001) was used to identify a threshold value of refills (0.7 refills/year) for distinguishing PAP adherent and non-adherent patients. Subsequently, when the threshold was applied to the validation set, the likelihood ratio for a positive test (weighted for prevalence) predicting adherence to PAP therapy was 7.3 (95%CI, 3.8, 14), and likelihood ratio for a negative test was 0.6 (95%CI; 0.4, 0.8).
Refill rate of PAP accessories exhibited good test characteristics for predicting long-term PAP adherence. Such a surrogate measure based upon insurance claims data can be a powerful epidemiological tool in bioinformatics-aided comparative-effectiveness research and to monitor clinical performance of health systems.
Patel N; Sam A; Valentin A; Quan SF; Parthasarathy S. Refill rates of accessories for positive airway pressure therapy as a surrogate measure of long-term adherence. J Clin Sleep Med 2012;8(2):169-175.
Obstructive sleep apnea (OSA) is a prevalent condition that is most frequently treated with positive airway pressure (PAP) therapy.1,2 Non-adherence to PAP therapy, however, afflicts a high proportion of adults with sleep apnea (46% to 83%),3 and such poor adherence is associated with increased risk for fatal and non-fatal cardiovascular events.4 Consequently, assessment of adherence to PAP therapy has been advocated as a physician performance assessment tool in the management of patients with OSA.5 However, obstacles to the universal and consistent measurement of PAP adherence remain.5 Therefore, a reliable surrogate for measuring long-term PAP adherence—both within and across healthcare systems—is direly needed for more consistent assessment of the performance of healthcare systems and providers.
Adherence to medications can be measured both directly (by measuring metabolites of drug in urine) or indirectly by measuring claims data pertaining to medication refills.6 While the former methodology may be more accurate, the latter offers a more pragmatic yet reliable tool for assessing medication adherence and is universally accepted as an adequate surrogate.6 Superior medication refill rates have been associated with more favorable patient outcomes, such as reduced exacerbations in chronic lung disease, reduced hospitalizations in patients with cardiovascular disease and schizophrenia, and reduced relapse rates in patients with rheumatoid arthritis and multiple sclerosis.7–12 Similarly, although PAP device download affords the best measure of adherence to PAP therapy,13–18 information pertaining to refill of PAP accessories (masks, hoses, filters, humidifiers, and even PAP machines) due to wear and tear may potentially serve as a surrogate measure of adherence. To our knowledge, a systematic assessment of the relationship between refills of such PAP accessories and objectively measured device-downloaded adherence data has not been performed. Such an association between refills of PAP accessories and objective device-downloaded adherence, if validated, could better facilitate adherence monitoring in health systems and support quality improvement initiatives that target management of OSA.
Current Knowledge/Study Rationale: Adherence to medications assessed by medication refill rate is a pragmatic real-world bioinformatics aided tool that has been associated with patient outcomes in many disease conditions. To our knowledge, a systematic assessment of whether refills of PAP accessories can parallel objectively measured device-downloaded adherence data has not been performed.
Study Impact: Refill rates of PAP device accessories exhibited good test characteristics for predicting long-term adherence to PAP therapy. Such a surrogate measure of long-term PAP adherence - based upon insurance claims data - can be a powerful epidemiological tool to assess quality of healthcare delivery in the management of patients with sleep-disordered breathing.
In line with such rationale, we set out to identify and validate a surrogate measure of long-term adherence to positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA). We hypothesized that refill rates for PAP device accessories can predict long-term PAP adherence in patients with OSA.
This is an analysis of an historical cohort contained in an electronic disease-registry that was set-up for a quality initiative in 2003 at the Tucson VA Sleep Program. Two hundred twenty consecutive patients who had received PAP therapy > 1 year were included in the analysis as follows: (a) An initial derivation set of 100 consecutive patients with OSA receiving PAP therapy (> 1 year) in whom PAP adherence was measured by device-download. (b) A validation data set of the next 120 consecutive patients with OSA receiving PAP therapy (> 1 year) in whom PAP adherence was measured by device download.
OSA was diagnosed by polysomnography that revealed an apnea-hypopnea index > 5/h, with hypopneas defined as > 50% reduction in flow or effort and ≥ 3% oxygen desaturation.
Fourteen percent of the consecutive patients were excluded due to unavailability of the download that resulted in the 220 patients reported in this study. The study was approved by the University of Arizona Institutional Review Board and the VA Research and Development Committee.
Adherence to PAP therapy was measured by device download using manufacturer software and mailed in memory cards (ENCORE Pro, Philips-Respironics, Murrysville, PA). The usage was expressed in minutes of use per day, and adherence was defined by Medicare criteria requiring ≥ 4 h of PAP use on 70% of nights (5 of 7, which translated into 21 of 30 days) during 30 consecutive days within the prior 90-day period. Unlike Medicare criteria that require such data from the first 90 days of therapy, the adherence reported here was collected from the prior 90 days of therapy because our objective was to measure a correlate of long-term PAP adherence. Additionally, adherence was also defined by a more strict criterion of device usage > 4 h/day on all days.19,20 For the latter, the total number of hours of usage during the prior 90-day period available in the device memory was divided by the total number of days (90 days), which yielded average use of PAP therapy. Patients with an average device use ≥ 4 h were considered to be adherent.
Refills of masks, hoses, filters, humidifiers, chin straps, and even PAP devices were derived from the dispensation logs that were maintained for each patient in the prosthetics department of the integrated healthcare system at Tucson VA. The number of total refills during the entire follow-up period (ranging from 1 to 7 years) was divided by follow-up period expressed in years to yield the refills per year. Moreover, similar refill rates were calculated for each of the above-mentioned accessories. All of the patients were receiving care exclusively from the VA in Tucson. Patients at the VA in Tucson are "means tested" and seldom have third party insurance. Patients who died or disenrolled from the Tucson VA were included if they had been on PAP therapy for at ≥ 1 year of PAP therapy, as this was our a priori definition for long-term PAP adherence and served as an inclusion criterion. For those patients who expired, or disenrolled, after being on 1 year of PAP therapy, the duration of time that they were alive since the time they received PAP therapy was censored at the day of death (or disenrollment) and expressed in years.
Adherence to PAP therapy was treated as a binary dependent variable (defined by Medicare criteria). In the derivation set of 100 patients, the sensitivity and specificity with which the total number of refills per year could discriminate PAP adherent and non-adherent status was assessed with receiver operating characteristic (ROC) curves.21 The area under the ROC curve, which summarizes the performance of the refills per year in predicting PAP adherence, was calculated. Cross-plots between sensitivity and specificity values were performed to objectively identify the threshold value with the best sensitivity and specificity to discriminate PAP adherent and non-adherent patients.
The threshold value of refills per year derived from the initial derivation data-set was then used a test to predict long-term PAP adherence or non-adherence in a validation dataset of 120 patients. True positive, true negative, false positive, false negative, sensitivity, specificity, positive predictive value, and negative predictive value were derived as per standard convention.22
Likelihood ratio (LR) for refills per year as a diagnostic test to predict long-term PAP adherence was performed using conventional and prevalence weighted techniques for positive test (LR+) and negative test (LR−) results.23 The LR+ is calculated as LR+ = (sensitivity)/(1-specificity) and LR− = (1-sensitivity)/(specificity). In our case, LR+ greater than 1 indicates the test result (i.e., refills per year) was associated with the condition of interest (i.e., long-term PAP adherence), whereas LR− less than 1 indicates that refills per year was associated with non-adherence. LR+ greater than 1 would argue in favor of long-term PAP adherence; the bigger the number, the more convincingly the finding suggests that long-term PAP adherence exists. Findings whose LR+ lie between 0 and 1 argue against PAP adherence; the closer the LR is to 0, the less likely the patient is PAP adherent. Findings whose LRs equal 1, or whose 95% confidence interval (95% CI) overlaps the value "1" lack predictive value. Because LR+ can change based upon the prevalence of the condition (in this case the prevalence of long-term PAP adherence), LR+ was weighted for prevalence as follows LR+[P] = (prevalence)(sensitivity)/(1-prevalence)(1-specificity).24 Similarly, LR− was weighted for prevalence as follows LR−[P] = (prevalence)(1-sensitivity)/(1-prevalence)(specificity).
Sensitivity analysis with adherence defined by a stricter definition of 4 h/night was also performed. Also, test characteristics for mask refills alone was performed. Sensitivity analysis with arbitrarily defined threshold levels of refills (total and mask alone) were also performed. We performed univariate linear regression with long-term PAP adherence (expressed as average min used per day) and determinants such as age, gender, BMI, days on PAP, Epworth score, AHI, total refills per year, mask refills per year, AHI at therapeutic pressure (residual AHI), and PAP pressure. Significant determinants (p < 0.05) were entered into a multivariate regression model (forced entry), and care was taken to prevent collinearity between determinants by performing collinearity diagnostics. Group comparisons of continuous variables were made by unpaired t-tests or nonparametric equivalents. p values < 0.05 were considered significant. All data are shown as mean and standard deviation (SD), or median and interquartile range (IQR). SPSS v12.01 (SPSS Inc., Chicago IL) was used for statistical analysis.
There were 220 patients (age 57 ± 11 years; 94% men) with a body mass index 37.4 ± 5.8 kg/m2 (Table 1). Average therapeutic CPAP pressure was 10.7 ± 3.1 cm H2O. Seven percent of patients received bilevel PAP therapy, while 93% received CPAP therapy. The mode of therapy did not influence adherence. In the derivation set, the duration of follow-up was 4.8 ± 1.2 years (range 1 to 7 years). In the validation set, the duration of follow-up was 4.7 ± 1.2 years (range 1 to 6.25 years). For both definitions of adherence, the duration of follow-up was not different between the adherent and non-adherent groups (p > 0.8). In the validation set, the proportion of patients who were adherent by Medicare criteria was 67%, and by the strict 4-h criterion was 54%. Of all the various types of refills, besides total refills per year, we selected mask refills alone rather than refill rates of hose, filter, humidifier, or even device by themselves, because the mask refills constituted the bulk of refills. Specifically, masks constituted 54.7% of total refills, whereas filters (30.4%), hose (5.8%), device (5.3%), and humidifier (3.7%) constituted a minority of the total refills requested.
Characteristics of patients
* Self-reported race not reported or unknown is not shown;
§ Initial mask interface that was issued; AHI, apnea-hypopnea index; BMI, body mass index; NS, not significant; IQR, interquartile range; SD, standard deviation.
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In the derivation set, the refill rate of all PAP-related accessories was a median of 0.75/year (interquartile range [IQR], 0.17, 1.8) and for masks alone was a median of 0.4/year (IQR; 0, 0.8). Filters, hoses, humidifier, and PAP device constituted the remainder of the refills, with a median of 0.2/year (IQR; 0, 1.0).
In the derivation set, when adherence was defined by Medicare criteria, total refill rate of all PAP-related accessories was greater in adherent (median 1.5/year; IQR 0.5, 2.9) than in non-adherent patients (median 0.2/year; IQR 0, 0.74; p < 0.0001). Similarly, mask refill rate was greater in adherent (median 0.67/year; IQR 0.3, 1.1) than non-adherent patients (median 0.17/year; IQR 0, 0.41; p < 0.0001). When adherence was defined by 4 h of usage on all days, total refill rate of all PAP-related accessories was greater in adherent (median 1.8/year, IQR 0.9, 3.1) than in non-adherent patients (median 0.3/year; IQR 0, 0.8; p < 0.0001). Similarly, mask refill rate was greater in adherent (median 0.8; IQR 0.4, 1.2) than non-adherent patients (median 0.2/year; IQR 0, 0.5; p < 0.0001). Adherence to PAP therapy (measured as min of usage/day) was correlated with refill rate for PAP device and accessories (R = 0.42; p < 0.0001; Figure 1). Similarly, adherence to PAP therapy (measured as min of usage per day) was correlated with refill rate for masks (R = 0.5; p < 0.0001).
Long-term adherence to positive airway pressure (PAP) therapy downloaded from PAP device is plotted against refill rate of PAP device accessories (masks, hoses, filters, humidifier, chin strap, and even PAP devices)
All adherence information is represented as minutes of use per day on all days of the week. Refill rate of PAP device accessories was closely related to adherence to PAP therapy (R = 0.42; p < 0.0001).
Long-term adherence to positive airway pressure (PAP) therapy downloaded from PAP device is plotted against refill rate of PAP device accessories (masks, hoses, filters, humidifier, chin strap, and even PAP devices)All adherence information is represented as minutes of use per day on all days of the week. Refill rate of...
For patients in the derivation dataset (n = 100), ROC curves were constructed for various threshold levels of total refills and mask-only refills and are shown in Figure 2. Different ROC curves were plotted for the various definitions of long-term PAP adherence (Figure 2). The corresponding area under the curves and the threshold value of refill rate associated with the best sensitivity and specificity are shown in Table 2.
Receiver operating characteristics (ROC) for refill rate of all PAP device accessories (blue line) or refill rate of mask alone (green line) in discriminating long-term PAP adherent and non-adherent patients are shown for Medicare definition (left panel) and a stricter definition of 4 h/night on all nights (right panel)
The ROC area under the curve for accurately discriminating long-term PAP adherence and non-adherence was good.
Receiver operating characteristics (ROC) for refill rate of all PAP device accessories (blue line) or refill rate of mask alone (green line) in discriminating long-term PAP adherent and non-adherent patients are shown for Medicare definition (left panel) and a stricter definition of 4 h/night on all nights (right panel)The ROC...
Receiver operating characteristics of refill rates of accessories for positive airway pressure therapy versus adherence status in derivation dataset
{ label (or @symbol) needed for fn } Area, Area under the curve plotted by receiver operating characteristics curve that depicted the pattern of sensitivities and specificities observed when the performance of the test is evaluated at several different diagnostic thresholds; SE, standard error; 95%CI, 95% confidence intervals (upper and lower); Threshold, Threshold value with the best sensitivity and specificity identified by performing a cross-plot of sensitivity and specificity at varying thresholds.
* Based upon device-download of usage with adherence defined as usage > 4 h/day on 5 days a week.
** Based upon device-download of usage with adherence defined as usage > 4 h/day on all days.
Test characteristics of threshold values of refill rates used to predict long-term PAP adherence in the validation dataset (n = 120) are shown in Table 3. The refill rate of all PAP related accessories had the best LR+[P] for predicting long-term PAP adherence by Medicare criteria. In general, the test performance characteristics of refill rate of all PAP related accessories were good for both definitions of long-term PAP adherence (Table 3). We also performed sensitivity analysis with regard to the threshold level of mask refills by arbitrarily selecting a threshold of 3, 2, and 1 mask per year as well, as for 3, 2, and 1 total refills (any PAP accessory including mask) per year. Such thresholds were associated with excellent LR+ (0.7 to 1.0) and PPV (2.5 to ∞), but the LR− (0.3 to 0.84) and NPV (0.37 to 0.7) suffered.
Test characteristics of the threshold values of refill rates used to predict long-term PAP adherence
§ Mean values are in bold font, and 95% confidence intervals are within parentheses; PPV, positive predictive value; NPV, negative predictive value; LR+, likelihood ration of a positive test; LR−, likelihood ration of a negative test; LR+[P], likelihood ratio of a positive test weighted for prevalence; LR−[P], likelihood ratio of a negative test weighted for prevalence;
* Threshold value of 0.7 per year;
@ Threshold value of 0.5 per year;
$ Threshold value of 0.9 per year;
** Threshold value of 0.4 per year.
We performed linear regression with long-term PAP adherence (expressed as average min used per day) and age, gender, BMI, days on PAP, Epworth score, AHI, total refills per year, mask refills per year, AHI at therapeutic pressure (residual AHI), and PAP pressure. In univariate regressions, greater BMI, higher AHI, greater total refills, or greater mask refills per year were found to be significantly associated with adherence to PAP therapy (p < 0.0001). Multivariate regressions yielded greater AHI and greater total refills per year as being independently associated with greater adherence to PAP therapy (model R2 = 0.20; p < 0.0001). We did not load mask refills per year together with total refills per year, as they were collinear. When masks per year was loaded into the model (model R2 = 0.27; p < 0.0001), greater masks per year was independently associated with greater odds of long-term PAP adherence.
Refill rate of PAP device accessories exhibited good test characteristics for predicting long-term adherence to PAP therapy (defined as > 1 year of therapy). Specifically, refill rate of all PAP accessories (mask, hoses, filters, humidifier, and even PAP devices combined) had the best predictive value for discriminating long-term PAP adherence and was superior to that of mask refill rate alone. Notably, refill rates were much greater in PAP adherent patients than in non-adherent patients, regardless of how adherence was defined—Medicare criteria or 4 hours per day on all days. To our knowledge this is the first study to systematically develop and validate a surrogate measure of long-term PAP adherence based upon refills of PAP accessories in a manner similar to that of accepted techniques of measuring medication adherence based upon refill rates.6
Non-adherence to PAP therapy afflicts a high proportion of adults with sleep apnea,3 and such poor adherence is associated with increased risk for fatal and non-fatal cardiovascular events.4 There are numerous interventions and factors that either promote or are associated with better adherence to PAP therapy.3,14,20,25–28 However, in order for such reversible factors to be targeted, or interventions to be implemented, physicians and healthcare systems need to universally monitor PAP adherence. But there are many impediments to implementing such practices, including greater cost, lack of care coordination with durable medical equipment companies, differing software platforms across various manufacturers, and lack of patient cooperation (such as failure to bring or mail memory cards or even transmit data via phone or internet).
While objective measurement of short-term PAP adherence (90 days) is required in Medicare beneficiaries, there is no requirement for measuring long-term PAP adherence.29 Although data suggests that long-term adherence patterns are established early,30 this may not be true for all patients.15 Long-term adherence over one year may differ from adherence measured in the first month of treatment initiation.15 In a time series analysis by Aloia and colleagues, slow decliners, slow improvers, and variable users constituted as much as 44% of a cohort of PAP users followed for one year.15 Our validated surrogate measure of PAP adherenc—based upon PAP accessory refills—was measured beyond 1 year and up to 7 years of PAP therapy and is therefore indicative of long-term PAP adherence.
Long-term PAP adherence has been shown to confer cardiovascular disease modification and survival benefits in observational cohort studies over a 10-year follow-up period.4 Such benefits cannot possibly be achieved within the recommended 90 days of commencing PAP therapy.29 Therefore, it follows that we should be cognizant of measuring long-term (> 1 year) adherence while keeping costs of such adherence monitoring low. Measurement of refill rate for PAP accessories can be a powerful tool in integrated healthcare systems or in Medicare beneficiaries to monitor long-term adherence to PAP therapy in a cost-effective manner. Such surrogate monitoring of PAP adherence can assist health services researchers to account for the effects of PAP therapy when measuring patient outcomes, healthcare utilization, and performance of healthcare systems.5 Also, it is unclear as to whether the health systems that struggle to accomplish PAP adherence measurements over the first 90-day period can indeed effectively "monitor" adherence over the years that it takes to accomplish benefits. We believe that this implementation gap can be effectively filled by the surrogate measure of adherence that we have proposed and validated.
The test characteristics of all refills of PAP accessories reveal that this surrogate measure has good PPV and LR+[P] values for predicting long-term PAP adherence (Table 2). However, the NPV and LR−[P], although acceptable, are not as good. This discrepancy may be explained by the fact that some patients may have continued to use their old masks and PAP accessories over the long term. Therefore, unlike medications, resilient PAP accessories may have lower refill rates that may conceivably underestimate long-term PAP adherence (Figure 1).
There are limitations to our study. First, the proposed surrogate measure for long-term PAP adherence is dependent on refill benefits of a given healthcare system. While the PAP accessory refill allowances of our integrated healthcare system is mirrored after the Medicare benefits, other systems may have more lenient or stricter refill benefits. Therefore, the threshold rate that we propose in this paper may not be generalizable to other integrated healthcare systems or healthcare systems that are not integrated. However, this problem can be surmounted by calibrating or validating the surrogate measure of long-term PAP adherence within other healthcare systems prior to implementation. Also, outcomes studies or physician performance assessments within a healthcare system should not be influenced by such sources of error. Moreover, our study was made feasible because we are an integrated healthcare system with PAP refill information made easily available from the electronic medical records-derived disease registry, which may not be as easily accomplished in systems that do not have such an integrated model. All of the patients were receiving care exclusively from the VA in Tucson, but we realize that they may sought PAP refills through other sources. However such refills from outside the system are unlikely for the following reasons: (a) Patients at the VA in Tucson are "means tested" and seldom have third party insurance. (b) Even when such private insurance exists, the veterans are unlikely to seek refills from such sources because they would need to pay full price (online) or co-pays (private insurance-based) for such refills, whereas the refills from the Tucson VA's prosthetics department are available at no cost.
Second, considering the time period of 1 to 7 years in our validation dataset, this surrogate measure is not recommended for the assessment of PAP adherence in the short term (61-90 days) or support continued coverage from Medicare. Third, our data were primarily derived from middle-aged to older men; this limits generalizability to women. Systems with greater representation of women may need to reproduce our results Fourth, while the threshold levels of the surrogate measure predicted long-term PAP adherence in a validation dataset, care should be taken in not using refills of PAP accessories as a prospective predictor of adherence on the basis of this study. Lastly, masks or total refill was associated with long-term PAP adherence, and therefore a causal effect cannot be implied.
Refill rate of PAP accessories exhibited good test characteristics for predicting long-term adherence to PAP therapy. Such a surrogate measure based upon insurance claims data can be a powerful epidemiological tool in comparative-effectiveness research utilizing bioinformatics of claims data from integrated healthcare systems or Medicare beneficiaries, and for monitoring performance of health systems and supporting quality improvement initiatives that promote PAP adherence.
This was not an industry supported study. Dr. Parthasarathy has received a Philips-Respironics, Inc. research grant to Biomedical Research Education Foundation of Southern Arizona. The other authors have indicated no financial conflicts of interest.
Work conducted at Southern Arizona VA Health Care System, Tucson, AZ. Support from the National Institutes of Health (Grant No. HL095748 awarded to Dr. Parthasarathy) and Department of Veterans Affairs Health Service Research & Development (Grant No. PPO 10-066 awarded to Dr. Parthasarathy).
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text:
Locum GP Cover Required in Orpington
- Recruiter
- The GP and Nurse Practitioner Agency
- Location
- Orpington
- Salary
- £650 per day
- Posted
- 24 Jan 2019
- Closes
- 24 Feb 2019
- Function
- Locum
- Sector
- NHS, Out of Hours, Private
- Hours
- Full Time
- Contract Type
- Contract
The GP Agency has secured contracts to supply GPs to a surgery in Orpington.
Our client is looking to use our locums to cover vacancies, leave and sickness. They have regular sessions and ad-hoc requirements.
Depending on the site we usually require a mixture of the following for part (3-4 hrs) or full day (7-10 hrs) bookings:
-AM session 16 face to face patients between 2.5-4 hours
-Potential tele triage, home visits, admin, prescriptions, letters, referrals (all optional)
-PM session 16 face to face patients between 2.5-4 hours
(also, on-call sessions are sometimes requested)
The above is dependent on a number of factors, but you will always have a full breakdown of shifts when you receive requests.
Usually we can offer work between 4-8 weeks in advance, along with late notice requests.
Please email your CV to firstname.lastname@example.com or call us on 0203 906 6956 if you are interested. Visit: http://www.thegpandnursepractitioneragency.co.uk/ for more information.
We have other locum opportunities available nationwide, so if you don't see a job that's in your area, get in touch and we can discuss further.

subset: commoncrawl


text:
Job Information
The PIC Group Inc. Quality Inspectors - Automotive Inspection in Toledo, Ohio
TRIGO Global Quality Solutions has several immediate openings for Quality Inspectors for Toledo, OH and surrounding areas.Job Description For Quality Inspectors:Examine manufactured products, primarily automotive parts to ensure the parts meet all standards of presentation and quality.Act as an impartial third party between the production source and the customer facility to ensure the product meets set criteria.Study product specifications and work instructions.Perform visual inspections, mechanical and functional verification of parts to ensure compliance to set specification and quality standards.Make independent judgments for subjective calls.Collect and record accurate data regarding defects.Tag and isolate defective material.Provide description or justification for defective material.Communicate sort/inspection results to managers, supervisors and production source.Complies with relevant local Health and Safety legislation.Supports Company Health and Safety Policies.Other duties as assigned..and.nbsp;Qualifications For Quality Inspectors:High School diploma or equivalent desiredMust have.and.nbsp;reliable transportationExcellent written and verbal communication skillsAbility to coordinate, prioritize and multitaskDemonstrated flexibility within a fast-paced challenging environmentAbility to take initiative and recognize needsAbility to handle highly sensitive and confidential material.and.nbsp;About TRIGO Global Quality SolutionsFor over 30 years, PIC has remained the leading provider of full-service quality solutions, servicing the automotive, aerospace and manufacturing industries throughout the United States, Canada and most recently, Mexico. As the only full-service quality solutions provider of its kind, PIC provides containment, inspection, quality engineering consultants, training, and supplier development services..and.nbsp; Not only do our quality solutions help customers meet their immediate needs, but they help to rectify quality issues long term..and.nbsp; With our extensive geographic footprint, we are the largest global provider of quality solutions with the ability to respond quickly and effortlessly, when and where our customers need us. Following a merger with TRIGO Group in November 2015, PIC has expanded its geographic footprint globally and created the largest and most comprehensive breadth of quality solutions available worldwide.TRIGO Global Quality Solutions.and.nbsp;is committed to the core values of equal employment opportunity. We are committed to treating people fairly, and with respect and dignity. We offer employment opportunities based upon an individual's qualifications and performance, free from discrimination or harassment because of race, ancestry, place of origin, ethnic origin, color, citizenship, creed, sex, sexual orientation, age, marital status, family status, and disability.For more information, or to apply now, you must go to the website below. Please DO NOT email your resume to us as we only accept applications through our website.https://www.applicantpro.com/j/1226900-21531


text:
|Nellie (taken in 1916)
|Nellie and Deb (taken in 1976)
Check out the television behind us!
My Written Journey Back To My Roots and Heritage : From England to Australia
|Nellie (taken in 1916)
|Nellie and Deb (taken in 1976)
Check out the television behind us!
How lucky you were to be able to spend time with NellieReplyDelete
I was very lucky, if only I knew it back then I would have asked her so much more about her life. xxDelete
She sounds as if she was a beautiful lady, such treasured memories of her.ReplyDelete
Thank you Ann, I do have many treasured memories of her. She was the only g/grandmother I ever knew. My other three g/grandmothers had passed away before I was born. xxDelete
A lovely profile of a very obviously much admired great gran. You are so lucky to have memories of her.ReplyDelete
Love those little sausage curls she has and the expression on her face in both that and the one with you.ReplyDelete
you've got treasured memories of Nellie.ReplyDelete
What a delightful commemoration of your great-grandmother. How fortunate you are to have such special memories -she sounds like she was a special lady.ReplyDelete
Special thanks to ScotSue, Kristin, Gould Genealogy & Pauleen for your lovely comments. I truly appreciate your regular readership and your support. xxReplyDelete


text:
Carrie Ellen Adamian's passion and love of the performing arts began with dancing and singing at the age of 4 years. Her lifelong dedication to the art form carried her to the Broadway stage where she performed in productions that included Tommy Tune's Grand Hotel and Grease!
After graduating from Fordham University, Ms. Adamian's career took an administrative turn at PACE Entertainment. There, she climbed the ranks by successfully building the theatrical subscription base in the top Canadian markets, while launching marketing campaigns for numerous Broadway shows and touring productions across the U.S. Ms. Adamian was promoted to corporate level upon SFX Entertainment's acquisition of PACE Entertainment, where she was instrumental in developing company-wide brand and sponsorship platforms across a multifaceted organization. She also created the first-ever one-stop shopping opportunities for live entertainment advertising directed at blue chip companies. Clear Channel Communications was attracted to SFX for its unique marketing platform and, once the company changed hands, she was charged with developing the new Clear Channel Communications brand as the "out of home" advertising platform. She was eventually lured away from the corporate world to utilize her corporate entertainment marketing expertise within the performing arts sector.
Carrie Ellen Adamian became the marketing director at The Public Theater, one of New York City's most renowned theatrical institutions, and later served in the same capacity at "Jazz at Lincoln Center," where she reversed subscription base erosion by 40% within three years, grew the single ticket base by 20% and generated $9M in ticketing and venue rental revenues. She is thrilled to be back home in Texas, where she is raising her two daughters and making exciting new inroads with established patrons, newcomers, and the Greater North Texas community.


text:
Training Services BRC – Global Food Standard – Interpretation Training
The SGS BRC Global Food Standard Interpretation Training helps you understand the British Retail Consortium (BRC) Global Food Standard and supports the related implementation process.
If you are a food manufacturer, supplier or retailer wanting to implement management systems based on the standard – and to comply with its requirements – you should attend this training.
After completing this course, you will be able to support the implementation of a management system based upon BRC Global Food Standard requirements. These concern food quality and safety, your manufacturing and/or retailing operations, and all of your legal obligations.
To attend, you need some previous knowledge of food safety or Hazard Analysis and Critical Control Point (HACCP) programs.
Course outline:
- History of food safety systems
- BRC relevance
- PAC / HACCP main concepts and evaluation principles
- PAC / HACCP evaluation methods and application of food safety standards
To find out more about our BRC Global Food Standard Interpretation Training, contact SGS today.


text:
On September 23, the SEC lifted the general solicitation ban on advertising private offerings, a key portion of the Jumpstart Our Business Startups (JOBS) Act enacted earlier this year. This means that private equity firms can begin advertising their funds to the general public, a practice forbidden since the 1930's.
Although your clients might think that they are in investing in the next Google or Facebook through a JOBS Act investment, advisors should educate their clients on more established methods to obtain exposure to private equity in a more liquid and fee-friendly fashion, such as listed private equity.
The following are the four main publicly available listed private equity structures. Advisors should familiarize themselves with these structures and understand how each can provide diverse, unique benefits for client portfolios.
1. Asset Managers
Investors may be most familiar with this listed private equity structure, which includes managers such as Kohlberg Kravis & Roberts (KKR), The Blackstone Group (BX), and Apollo Global Management (APO). These alternative asset managers provide exposure to private equity returns in two ways: directly, through co-investment in their own private equity funds, and indirectly, through carried interest earned on private company sales. Private equity manager stocks provide liquidity and brand name recognition, but they are one of the least direct ways to gain exposure to private equity in the listed private equity space. Their returns are based primarily on the overall ability to grow assets under management and generate fees, rather than the underlying private company returns.
2. Direct Investment Firms
Direct investment firms may be less familiar to investors in the United States, but they are a common structure for private equity firms in Europe and elsewhere. Direct investment firms raise a permanent pool of capital from investors, and invest this capital in a basket of privately held businesses. Then then grow these companies and exit them over time. The net asset value growth of these private holdings is the key driver of stock price movements, providing a much higher correlation to traditional private equity fund returns. Examples of direct private equity investment vehicles include Electra Private Equity (ELTA LN) and HGCapital Trust PLC (HGT LN).
3. Fund-of-Funds
Private equity fund-of-funds strategies are quite common, but most investors are unfamiliar with publicly traded versions of this structure. Quoted fund-of-funds structures including Harbourvest Global Private Equity (HVPE LN) and Pantheon International Participations (PIN LN) invest balance sheet capital as a limited partner in a diverse set of private equity funds. These structures can provide investors exposure to funds managed by well-known names such as TPG, Bain Capital and Hellman Friedman, which are otherwise unavailable to retail investors. The downside of this structure is the potential for fee layering, where fund-of-funds managers charge their own fees in addition to fees charged by underlying fund managers.
4. Business Development Companies
Although business development companies (BDC) are referred to as private equity vehicles, they rarely provide true private equity exposure for investors, as they are typically debt investors. They often do not have a controlling stake in their holdings, and therefore, have little influence on the strategic direction of their private investments. BDCs must pay out 90% of their gross income as dividends, and, being primarily a debt investment, their returns can be highly sensitive to interest rate.


text:
Spy applications that operates on cellphones are analyzed like way forward for the cellphone software programs that enables you to keep track of steps of your youngster, worker and so on. You could possibly relate spy application about the mobile devices for saving motives too. Utilizing cellular phone's internet capabilities, it's prone to record actions and upload Gps system spots inside your phone's spy accounts. To make sure that all uploads you have to log in to your bank account on cellular phone spy internet site. It will be easy to verify the data which are separately shown according to the types. mobile spy software
Cellular spy equipment will allow you to spy on any individual you want to monitor. Managers normally surrender mobile phones towards the staff members just for business dialogue, but a few of them exploit it for individual purposes. This computer software will make it possible for executives to inspect staff's cellular phone utilization kind. This application will also help you to get info on what your young ones performing. call sms tracker
You want to monitor Managers
- Mobile phone spy equipment will permit you to spy.
In difference to other cellular phone spy software, the data inside of cellular phone spy software is adequately shielded. At any reason for time and with just one single certificate, you can spy on 3 distinct mobile phones. phone spy app
Phone texting spy app my
By utilizing mobile phone spy deals, you can management numerous steps at some point. All saved specifics are strongly kept which you may well recuperate by way of using the username and password. It documents each message, SMS time and time, senders brand and also recipient's variety. Since you now are aware of all the functionalities of this software program, use it to follow each and every small point you do right behind your rear. spy cell phone
- In difference to other cellphone spy software program, the skills inside of cellular phone spy application is adequately.
- mobile sms spy.
- Spy software programs that operates on mobile phone devices are assessed like way.
- call sms tracker.
- By making use of cellular spy packages, you may handle many actions.


text:
UPTIME(1) NetBSD General Commands Manual UPTIME(1) NAME uptime -- show how long system has been running SYNOPSIS uptime DESCRIPTION The uptime utility displays the current time, the length of time the sys- tem has been up, the number of users, and the load average of the system over the last 1, 5, and 15 minutes. FILES /netbsd system name list SEE ALSO w(1) HISTORY The uptime command appeared in 3.0BSD. NetBSD 8.1 April 18, 1994 NetBSD 8.1
You can also request any man page by name and (optionally) by section:


text:
"Overnight Millionaire System" Reviews – Legit or Scam?
In this review, You will find these answers:
- Is Overnight Millionaire System a scam or a legit one?
- What kind of guarantee is given?
- Is there a discount?
- Can I find Overnight Millionaire System in rapid, torrent or download sites for free?
- What is the product owner's credibility?
"Overnight Millionaire System" Features
|Product Name:
|Overnight Millionaire System
|Publisher Web Site:
|Availability Status
|Yes. It's legit.
|Money Back Guarantee:
|Publisher Conduct
|Extremely Good
|Total Downloads
|Over 196.
|Bonus Offered:
|Editors' Rating:
|– Very Good.
|User Rating:
|– Excellent.
|Refund Policy:
|60 Days Unconditional
|Vendor's E-mail
|Visit Official site.
|Refund Rate:
|None so far.
|Product Status:
|Active. Tested and found exquisite. Not Scam.
|Last Updated:
"Overnight Millionaire System" Warnings
Advertising must tell the truth and not mislead consumers. In addition, claims must be substantiated. Can You Tell the Difference Between a Scam & the Real Thing? You hear the reviews everywhere on the net like that: Before you buy something, especially an e-product, go online and check the user reviews. It makes sense to learn what people who bought a product think about it. But can these reviews be trusted? In most cases they can, but not always. Some are written by salespeople, retailers or manufacturers trying to enhance their business. Some or them are posted by people who are paid to write fake reviews.. Read How to Spot a Fake Online Product Review.
"Overnight Millionaire System" Advantages & Disadvantages
|Overnight Millionaire System is totally portable, meaning it can go with you on a thumbdrive, smartphone, or other portable device and run on any Windows PC.
|Easy to download. Overnight Millionaire System is safe.
|24/7 Customer Support.
|Technical excellence.
|Most of the common features and stability. No notable bugs, very stable.
|Adequate training documents. One solution for all your envisaged needs.
|The cost is affordable.
|Eggs in your beer.
|The risks will continue to be monitored closely with primary objective to release a stable and qualified review.
|We have limited feedbacks. So far they are positive. But, to be sure, future Customer Satisfaction surveys may bee needed.
Are they safe?
You are doubtlessly safe ordering from Overnight Millionaire System.
How is their support?
Our experience with their support was fast and reliable. We received feedback from other customers who experienced the same.
Most of the scams & frauds are designed to look very legitimate to the average consumer. Some even go to great lengths to create a scam that looks & feels exactly like the real thing. Be careful.
Product Features
|Personalized URL
|Post Comments
|eMail Support
|Privacy Settings
|User Forums
|Report Spam
|Report Abuse
|Safety Tips
|Personal Videos
|Instant Messaging
Where to buy and download:
After lots of searching on the net we saw that Free version of Overnight Millionaire System can not be found anywhere on the internet. To download safely your risk free copy of Overnight Millionaire System with the special discount visit Overnight Millionaire System. Do not trust a torrent, free download, rapidshare, filesonic, mediafire, megaupload, serial crack file or keygen and etc. Free serial keys and keygens may include trojan and virus, they can harmly damage your computer and always waste of time. We hope you enjoy your Overnight Millionaire System after downloading it safely.
Our site is unable to sell Overnight Millionaire System directly. Actually, it is not available in any bookstore or supermarket. You can only order via their official website Overnight Millionaire System.
If you want to try Overnight Millionaire System risk free, please click the following link
Domain "Whois"
Overnight Millionaire System is not a scam. Our Review Team had similar thoughts about all products but after checking out Overnight Millionaire System, we are very confident about its reliability. Our past experiences have thought us not to believe in products very easily. They do not give what they promise. But when we heard about the money back guarantee offer from Overnight Millionaire System, we were tempted to give it a try. The first time we used it, we were really satisfied with what we got.
Overnight Millionaire System is a easy to use guide including step-by-step pictures, diagrams and schematics show you how everything is done. We have now used it for 2 weeks and believe us you will never see a better product than Overnight Millionaire System.
There are so many program like Overnight Millionaire System in today's market. Most of them promise the best performance. When you want to buy them, you are not sure which one to buy because most of the reviews you go through are scam. But when it comes to Overnight Millionaire System , it is different from others. After using Overnight Millionaire System, We are so impressed that we did not hesitate to give our reviews on it.
With the work they do on this, I think its a real bargain.
Final Decision:
User Reviews
I was skeptical, not anymore! At first i thought it was a scam not legit. But now I do not regret my purchase one bit. I am as happy as I can possibly get with this right now. It deserves the rating that it has above.
They truly did an amazing job with this. I thank you.
Users found this comment helpful. Was it helpful to you?
I can't tell you how much I appreciate you offering this product. My situation was similiar to your's.
Thanks to your review evaluation, things have changed and I've finally discovered the real way. 100% recommended.
Users found this comment helpful. Was it helpful to you?
I've been reading the content and reviews about the product on the other sites for some time and the content has been fantastic. Even the free content is worthwhile,
This site has saved me money and time. I highly recommend. Satisfaction guaranteed
Users found this comment helpful. Was it helpful to you?
It is a relief to know there are people like yourself out there helping people with the internet. There are numerous things I noticed having looked into this site. The site is rather easy to look through and the price is not as extortionate as many of it's competitors.
Thumbs up. Says what it does and follows up on it.
Users found this comment helpful. Was it helpful to you?
I started using Overnight Millionaire System from the day I joined it. I was wondering how to use that effectively. That is when I saw the manual which was provided by Overnight Millionaire System . It gave me a good overview on how to use it. To be frank, it has been the best guide which I have used when compared to the previous products used. Overnight Millionaire System also never disappointed me when it came to investment. It was the best product which I had bought.
Users found this comment helpful. Was it helpful to you?
Overnight Millionaire System is sold through the money processor Clickbank.com. Clickbank.com provides 60 days full money back guarantee for their customers. If at any time during 60 days you decide Overnight Millionaire System isn't the program you want, just send an email and get 100% of your money back, no questions asked. So trying out eCash Opinions would be risk free.
Users found this comment helpful. Was it helpful to you?
Do you have experience with Overnight Millionaire System? Is it Scam or The Real Deal?, please post a review below.
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text:
Why I'm Giving ABC's Rom-Com Manhattan Love Story a Second Chance (Despite a Bad First Date)
Sep 29, 2014 3:23 PM EDT
I'll be the first to admit I didn't love the pilot of ABC's Manhattan Love Story. In fact, you could even say I was disappointed. A show about dating, set in New York City is totally up my alley. But months after watching the less-than-stellar p… Read more


text: The role 'creepshots' have in the denigration of women, and broader questions concerning privacy, the body, and public spaces, need to be considered. Shutterstock July 13, 2017 Explainer: what are 'creepshots' and what can we do about them? Andrea Waling, La Trobe University 'Creepshots' are provoking questions concerning rights to privacy in public, and ethical concerns regarding technology and bodily autonomy.


text:
Shower tap washer replacement
Could you please send send me a quote to replace the washer.View »
September 7, 2016 at 9:00 am | Leaking Tap Repairs
At My Home Plumber, we offer leaking tap repairs, dripping taps fix, installing new taps, replacing taps services . Our tap fix specialists works 24/7 basis and available . Our tap repair specialists are available for the same day wall taps repair, mixer tap fix or installing new taps. In emergency our plumbers can reach your residential or commercial property within 1 hour of booking to fix leaking kitchen & bathroom wall or mixer taps. Burst pipe can happen at any time either during the night or daytime, not only do they happen during the normal business hours, this is the reason as to why our highly trained team of plumbers in burst pipes are fully available throughout the 24 hours of the day and the 7 days.
Please visit our Customer Enquiries page
Fixing up leaking taps something should never be ignored. Sometime,replacing old mixer or wall taps become mandatory to save up your money on bills etc.
[RICH_REVIEWS_SHOW category="Leaking Tap Repairs"]


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Overrides the Transaction Timeout setting of the Transaction Service for an individual bean. The default value, 0, specifies that the default Transaction Service timeout is used. If positive, this value is used for all methods in the bean that start a new container-managed transaction. This value is not used if the bean joins a client transaction.
ejb (sun-ejb-jar.xml)
none - contains data


text:
Summary Report for:
19-2042.00 - Geoscientists, Except Hydrologists and Geographers
Study the composition, structure, and other physical aspects of the Earth. May use geological, physics, and mathematics knowledge in exploration for oil, gas, minerals, or underground water; or in waste disposal, land reclamation, or other environmental problems. May study the Earth's internal composition, atmospheres, oceans, and its magnetic, electrical, and gravitational forces. Includes mineralogists, crystallographers, paleontologists, stratigraphers, geodesists, and seismologists.
Sample of reported job titles: Engineering Geologist, Environmental Protection Geologist, Exploration Geologist, Geological Specialist, Geologist, Geophysicist, Geoscientist, Mine Geologist, Petroleum Geologist, Project Geologist
Tasks | Technology Skills | Tools Used | Knowledge | Skills | Abilities | Work Activities | Detailed Work Activities | Work Context | Job Zone | Education | Credentials | Interests | Work Styles | Work Values | Related Occupations | Wages & Employment | Job Openings | Additional Information
- Analyze and interpret geological, geochemical, or geophysical information from sources such as survey data, well logs, bore holes, or aerial photos.
- Plan or conduct geological, geochemical, or geophysical field studies or surveys, sample collection, or drilling and testing programs used to collect data for research or application.
- Prepare geological maps, cross-sectional diagrams, charts, or reports concerning mineral extraction, land use, or resource management, using results of fieldwork or laboratory research.
- Analyze and interpret geological data, using computer software.
- Investigate the composition, structure, or history of the Earth's crust through the collection, examination, measurement, or classification of soils, minerals, rocks, or fossil remains.
- Assess ground or surface water movement to provide advice on issues such as waste management, route and site selection, or the restoration of contaminated sites.
- Locate and estimate probable natural gas, oil, or mineral ore deposits or underground water resources, using aerial photographs, charts, or research or survey results.
- Locate and review research articles or environmental, historical, or technical reports.
- Communicate geological findings by writing research papers, participating in conferences, or teaching geological science at universities.
- Measure characteristics of the Earth, such as gravity or magnetic fields, using equipment such as seismographs, gravimeters, torsion balances, or magnetometers.
- Conduct geological or geophysical studies to provide information for use in regional development, site selection, or development of public works projects.
- Identify risks for natural disasters, such as mudslides, earthquakes, or volcanic eruptions.
- Design geological mine maps, monitor mine structural integrity, or advise and monitor mining crews.
- Advise construction firms or government agencies on dam or road construction, foundation design, land use, or resource management.
- Inspect construction projects to analyze engineering problems, using test equipment or drilling machinery.
- Develop applied software for the analysis and interpretation of geological data.
- Identify deposits of construction materials suitable for use as concrete aggregates, road fill, or other applications.
- Collaborate with medical or health researchers to address health problems related to geological materials or processes.
- Determine methods to incorporate geomethane or methane hydrates into global energy production or evaluate the potential environmental impacts of such incorporation.
- Determine ways to mitigate the negative consequences of mineral dust dispersion.
- Develop strategies for more environmentally friendly resource extraction and reclamation.
- Develop ways to capture or use gases burned off as waste during oil production processes.
- Identify new sources of platinum group elements for industrial applications, such as automotive fuel cells or pollution abatement systems.
- Identify possible sites for carbon sequestration projects.
- Locate potential sources of geothermal energy.
- Provide advice on the safe siting of new nuclear reactor projects or methods of nuclear waste management.
- Research geomechanical or geochemical processes to be used in carbon sequestration projects.
- Research ways to reduce the ecological footprint of increasingly prevalent megacities.
- Review work plans to determine the effectiveness of activities for mitigating soil or groundwater contamination.
- Study historical climate change indicators found in locations such as ice sheets or rock formations to develop climate change models.
Technology Skills
- Analytical or scientific software — EarthWorks Downhole Explorer; RockWare Geochemist's Workbench GWB; Seismic Micro-Technology KINGDOM; The MathWorks MATLAB (see all 85 examples)
- Computer aided design CAD software — Atoll GeoCAD; Autodesk AutoCAD ; Evolution Computing EasyCAD; Trimble Terramodel (see all 12 examples)
- Data base user interface and query software — GeoPLUS Petra; Geosoft DAP server; Microsoft Access ; MJ Systems Logsleuth (see all 8 examples)
- Data conversion software — BOSS Didger
- Document management software — Adobe Systems Adobe Acrobat ; MHC Document Express
- Electronic mail software — Email software; Microsoft Outlook
- File versioning software — Git
- Graphics or photo imaging software — ACD Systems Canvas; Adobe Systems Adobe Photoshop ; Golden Software Surfer (graphics or photo imaging feature)
- Internet browser software
- Map creation software — ESRI ArcGIS software ; Geographic information system GIS software ; Geosoft Oasis montaj; Leica Geosystems ERDAS IMAGINE (see all 19 examples)
- Object or component oriented development software — Python
- Office suite software — Microsoft Office ; OpenOffice.org
- Presentation software — Microsoft PowerPoint
- Project management software — Microsoft Project
- Spreadsheet software — Microsoft Excel
- Web platform development software — Microsoft Active Server Pages ASP
- Word processing software — Microsoft Word
Hot Technology — a technology requirement frequently included in employer job postings.
Tools Used
- All terrain vehicles tracked or wheeled — All terrain vehicles ATV
- Atomic absorption AA spectrometers — Atomic absorption AA spectrophotometers
- Axes
- Bench scales — Electronic bench scales
- Benchtop centrifuges — Centrifuges
- Binocular light compound microscopes — Illuminated microscopes; Optical compound microscopes
- Chemical absorption gas analyzers — Portable organic vapor analyzers
- Chromatographic scanners
- Clinometers
- Cold chisels — Rock chisels
- Colorimeters
- Commercial fishing nets — Plankton nets
- Compasses — Mapping dividers
- Compressed air gun — Pneumatic airscribes
- Conductivity cells — Electrical conductivity cells
- Conductivity meters — Electrical conductivity meters
- Cyclone or vortex grinders — Rotary grinders
- Desktop computers
- Digital cameras
- Dissolved oxygen meters
- Drafting kits or sets — Mapping scale sets; Vertical sketchmasters
- Dredgers — Biological dredges
- Drying cabinets or ovens — Drying ovens
- Electromagnetic geophysical instruments — Alternating field demagnitizers; Degaussing wands; Impulse magnetizers; Thermal specimen demagnitizers
- Electron microscopes — Electron microprobes
- Electronic toploading balances
- Forestry increment borers — Tree corers
- Fume hoods or cupboards — Fume hoods
- Geological compasses — Geological stratum compasses; Pocket transits; Sun compasses
- Global positioning system GPS receiver — Global positioning system GPS receivers
- Graphics tablets — Digitizing tablets
- Gravimeters — Gravity meters; Microgravimeters
- Hammers — Chisel hammers; Crack hammers; Soft face hammers
- Heating or drying equipment or accessories — Dessicators
- Height gauges — Abney levels; Altimeters
- Hydraulic rock drills — Hydraulic earth drills
- Inductively coupled plasma ICP spectrometers — Argon plasma atomic emission spectroscopes
- Ion chromatographs
- Jaw crushers
- Laboratory box furnaces — One-atmosphere furnaces
- Laboratory crushers or pulverizers — Laboratory rock pulverizers
- Laboratory mechanical convection ovens — High temperature laboratory ovens
- Laboratory mixers — Agitators; Roto torque mixers
- Laboratory separators — Isodynamic separators
- Laboratory sifting equipment — Sieve shakers
- Laser printers
- Levels — Hand levels
- Magnetometer geophysical instruments — Rock magnetometers; Vibrating sample magnetometers
- Magnifiers — Hand magnifying lenses
- Mainframe computers
- Map measurers — Analog map measurers; Digital map measurers; Planimeters
- Mass spectrometers
- Medical computed tomography CT or CAT scanners or tubes — Computed tomography CT scanners
- Microscope slides
- Nitrogen gas analyzers — Brunauer-Emmett-Teller BET surface area analyzers
- Notebook computers
- Open stream current meters — Water current meters
- Open stream water level recorders — Water level recorders
- Optical diffraction apparatus — Submicron particle size analyzers
- Organic carbon analyzers — Carbon analyzers
- Paramagnetic susceptibility analyzers — Magnetic susceptibility measurement systems; Magnetic susceptibility/anisotropy systems; Magnetic susceptibility/temperature systems; Pocket magnetic susceptibility meters
- Penetrometers — Underwater sediment bearing strength probes
- Personal computers
- Pestle or mortars — Motorized mortars/pestles
- pH meters
- Picks — Geo/paleo picks; Rock picks
- Plotter printers — Large-format plotters
- Pneumatic rock drills — Powered rock-coring drills
- Polarizing microscopes — Petrographic microscopes
- Portable data input terminals — Mobile wireless handheld communication devices
- Portable seismic apparatus — Seismic stations
- Protractors
- Pry bars
- Radarbased surveillance systems — Ground penetrating radar GPR; Long range radar equipment; Short-range radar equipment
- Radiation detectors
- Rangefinders — Laser rangefinders
- Resistivity geophysical instruments — Earth resistivity meters
- Reverse osmosis equipment — Reverse osmosis systems
- Rock cutters — Rock saws
- Sand testing apparatus — Sand grain size gauges
- Scanners — Digitizers
- Scintillation crystal assemblies — Gamma ray scintillometers
- Seismic geophones — Geophones
- Seismic recorders or seismographs — Digital seismographs; Seismic activity recorders; Seismographs
- Soil core sampling apparatus — Sediment piston corers; Soil augers; Soil samplers; Tube samplers (see all 9 examples)
- Soil testing kits — X ray fluorescence XRF lead detectors
- Solid phase extraction preparations — Fusion fluxes
- Sonars — Echosounders; Multibeam echosounders; Side scan sonars; Towed sonars
- Spectrofluorimeters or fluorimeters — X ray fluorescence spectrometers
- Spectrometers — Gamma ray spectrometers
- Stereo or dissecting light microscopes — Stereo microscopes
- Test sieves
- Theodolites — Laser theodolites; Total stations
- Thermistor — Thermistor chains
- Thermographs — Temperature profile recorders
- Titration equipment — Digital alkalinity titrators
- Transmission electron microscopes — Cathodoluminescence scopes; Fluid inclusion microscopes
- Triple beam balances
- Ultrasonic cleaning equipment — Ultrasonic sieve cleaners
- Ultraviolet UV lamps
- Underwater cameras
- Vacuum or rotary evaporators — Rotoevaporators
- Video attachments for microscopes — Stereoscopes; Video microscopes
- Water analyzers — Mercury analyzers
- Water samplers — Sediment samplers; Tubular water samplers; Water sampler bottles
- Well logging downhole test equipment — Borehole cameras
- Winches
- X ray diffraction equipment — X ray diffractometers
- Mathematics — Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
- English Language — Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
- Physics — Knowledge and prediction of physical principles, laws, their interrelationships, and applications to understanding fluid, material, and atmospheric dynamics, and mechanical, electrical, atomic and sub- atomic structures and processes.
- Geography — Knowledge of principles and methods for describing the features of land, sea, and air masses, including their physical characteristics, locations, interrelationships, and distribution of plant, animal, and human life.
- Chemistry — Knowledge of the chemical composition, structure, and properties of substances and of the chemical processes and transformations that they undergo. This includes uses of chemicals and their interactions, danger signs, production techniques, and disposal methods.
- Engineering and Technology — Knowledge of the practical application of engineering science and technology. This includes applying principles, techniques, procedures, and equipment to the design and production of various goods and services.
- Computers and Electronics — Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
- Biology — Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.
- Critical Thinking — Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Reading Comprehension — Understanding written sentences and paragraphs in work related documents.
- Science — Using scientific rules and methods to solve problems.
- Speaking — Talking to others to convey information effectively.
- Active Listening — Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Complex Problem Solving — Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Judgment and Decision Making — Considering the relative costs and benefits of potential actions to choose the most appropriate one.
- Writing — Communicating effectively in writing as appropriate for the needs of the audience.
- Active Learning — Understanding the implications of new information for both current and future problem-solving and decision-making.
- Mathematics — Using mathematics to solve problems.
- Monitoring — Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
- Systems Analysis — Determining how a system should work and how changes in conditions, operations, and the environment will affect outcomes.
- Time Management — Managing one's own time and the time of others.
- Coordination — Adjusting actions in relation to others' actions.
- Instructing — Teaching others how to do something.
- Systems Evaluation — Identifying measures or indicators of system performance and the actions needed to improve or correct performance, relative to the goals of the system.
- Inductive Reasoning — The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
- Category Flexibility — The ability to generate or use different sets of rules for combining or grouping things in different ways.
- Deductive Reasoning — The ability to apply general rules to specific problems to produce answers that make sense.
- Oral Comprehension — The ability to listen to and understand information and ideas presented through spoken words and sentences.
- Oral Expression — The ability to communicate information and ideas in speaking so others will understand.
- Problem Sensitivity — The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
- Written Comprehension — The ability to read and understand information and ideas presented in writing.
- Written Expression — The ability to communicate information and ideas in writing so others will understand.
- Speech Clarity — The ability to speak clearly so others can understand you.
- Information Ordering — The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).
- Mathematical Reasoning — The ability to choose the right mathematical methods or formulas to solve a problem.
- Speech Recognition — The ability to identify and understand the speech of another person.
- Near Vision — The ability to see details at close range (within a few feet of the observer).
- Fluency of Ideas — The ability to come up with a number of ideas about a topic (the number of ideas is important, not their quality, correctness, or creativity).
- Number Facility — The ability to add, subtract, multiply, or divide quickly and correctly.
- Far Vision — The ability to see details at a distance.
- Flexibility of Closure — The ability to identify or detect a known pattern (a figure, object, word, or sound) that is hidden in other distracting material.
- Originality — The ability to come up with unusual or clever ideas about a given topic or situation, or to develop creative ways to solve a problem.
- Perceptual Speed — The ability to quickly and accurately compare similarities and differences among sets of letters, numbers, objects, pictures, or patterns. The things to be compared may be presented at the same time or one after the other. This ability also includes comparing a presented object with a remembered object.
- Selective Attention — The ability to concentrate on a task over a period of time without being distracted.
- Visualization — The ability to imagine how something will look after it is moved around or when its parts are moved or rearranged.
Work Activities
- Analyzing Data or Information — Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.
- Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.
- Interacting With Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
- Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
- Processing Information — Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
- Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job.
- Interpreting the Meaning of Information for Others — Translating or explaining what information means and how it can be used.
- Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.
- Identifying Objects, Actions, and Events — Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
- Thinking Creatively — Developing, designing, or creating new applications, ideas, relationships, systems, or products, including artistic contributions.
- Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
- Estimating the Quantifiable Characteristics of Products, Events, or Information — Estimating sizes, distances, and quantities; or determining time, costs, resources, or materials needed to perform a work activity.
- Monitor Processes, Materials, or Surroundings — Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.
- Provide Consultation and Advice to Others — Providing guidance and expert advice to management or other groups on technical, systems-, or process-related topics.
- Organizing, Planning, and Prioritizing Work — Developing specific goals and plans to prioritize, organize, and accomplish your work.
- Communicating with Persons Outside Organization — Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.
- Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time.
- Developing Objectives and Strategies — Establishing long-range objectives and specifying the strategies and actions to achieve them.
- Scheduling Work and Activities — Scheduling events, programs, and activities, as well as the work of others.
- Developing and Building Teams — Encouraging and building mutual trust, respect, and cooperation among team members.
- Performing General Physical Activities — Performing physical activities that require considerable use of your arms and legs and moving your whole body, such as climbing, lifting, balancing, walking, stooping, and handling of materials.
- Coordinating the Work and Activities of Others — Getting members of a group to work together to accomplish tasks.
- Coaching and Developing Others — Identifying the developmental needs of others and coaching, mentoring, or otherwise helping others to improve their knowledge or skills.
- Evaluating Information to Determine Compliance with Standards — Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
- Judging the Qualities of Things, Services, or People — Assessing the value, importance, or quality of things or people.
- Training and Teaching Others — Identifying the educational needs of others, developing formal educational or training programs or classes, and teaching or instructing others.
Detailed Work Activities
- Analyze geological or geographical data.
- Interpret research or operational data.
- Prepare maps.
- Research geological features or processes.
- Measure environmental characteristics.
- Locate natural resources using geospatial or other environmental data.
- Review professional literature to maintain professional knowledge.
- Communicate results of environmental research.
- Instruct college students in physical or life sciences.
- Prepare scientific or technical reports or presentations.
- Advise others about environmental management or conservation.
- Develop software or applications for scientific or technical use.
- Analyze geological samples.
- Determine methods to minimize environmental impact of activities.
- Advise others on management of emergencies or hazardous situations or materials.
- Coordinate cross-disciplinary research programs.
- Develop plans to manage natural or renewable resources.
- Develop sustainable industrial or development methods.
- Research hydrologic features or processes.
- Research impacts of environmental conservation initiatives.
- Review plans or proposals for environmental conservation.
Find occupations related to multiple detailed work activities
Work Context
- Electronic Mail — 88% responded "Every day."
- Face-to-Face Discussions — 63% responded "Every day."
- Duration of Typical Work Week — 75% responded "More than 40 hours."
- Telephone — 50% responded "Every day."
- Freedom to Make Decisions — 46% responded "A lot of freedom."
- Structured versus Unstructured Work — 46% responded "A lot of freedom."
- Work With Work Group or Team — 50% responded "Very important."
- Importance of Being Exact or Accurate — 38% responded "Extremely important."
- Indoors, Environmentally Controlled — 42% responded "Once a week or more but not every day."
- Contact With Others — 50% responded "Contact with others most of the time."
- Letters and Memos — 38% responded "Once a week or more but not every day."
- Impact of Decisions on Co-workers or Company Results — 50% responded "Important results."
- Spend Time Sitting — 54% responded "More than half the time."
- Responsible for Others' Health and Safety — 33% responded "High responsibility."
- Level of Competition — 46% responded "Moderately competitive."
- Frequency of Decision Making — 38% responded "Once a week or more but not every day."
- Indoors, Not Environmentally Controlled — 46% responded "Once a week or more but not every day."
- Outdoors, Exposed to Weather — 42% responded "Once a week or more but not every day."
- Time Pressure — 42% responded "Once a month or more but not every week."
- Responsibility for Outcomes and Results — 42% responded "Moderate responsibility."
- Consequence of Error — 33% responded "Very serious."
- In an Enclosed Vehicle or Equipment — 38% responded "Once a week or more but not every day."
Job Zone
|Job Zone Four: Considerable Preparation Needed
|Most of these occupations require a four-year bachelor's degree, but some do not.
|Related Experience
|A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. For example, an accountant must complete four years of college and work for several years in accounting to be considered qualified.
|Job Training
|Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.
|Job Zone Examples
|Many of these occupations involve coordinating, supervising, managing, or training others. Examples include real estate brokers, sales managers, database administrators, graphic designers, chemists, art directors, and cost estimators.
|SVP Range
|(7.0 to < 8.0)
Percentage of Respondents
|Education Level Required
|Bachelor's degree
|Master's degree
|Doctoral degree
Interest code: IR Want to discover your interests? Take the O*NET Interest Profiler at My Next Move.
- Investigative — Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally.
- Realistic — Realistic occupations frequently involve work activities that include practical, hands-on problems and solutions. They often deal with plants, animals, and real-world materials like wood, tools, and machinery. Many of the occupations require working outside, and do not involve a lot of paperwork or working closely with others.
Work Styles
- Analytical Thinking — Job requires analyzing information and using logic to address work-related issues and problems.
- Integrity — Job requires being honest and ethical.
- Attention to Detail — Job requires being careful about detail and thorough in completing work tasks.
- Initiative — Job requires a willingness to take on responsibilities and challenges.
- Persistence — Job requires persistence in the face of obstacles.
- Dependability — Job requires being reliable, responsible, and dependable, and fulfilling obligations.
- Independence — Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.
- Innovation — Job requires creativity and alternative thinking to develop new ideas for and answers to work-related problems.
- Achievement/Effort — Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.
- Adaptability/Flexibility — Job requires being open to change (positive or negative) and to considerable variety in the workplace.
- Self Control — Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.
- Stress Tolerance — Job requires accepting criticism and dealing calmly and effectively with high stress situations.
- Cooperation — Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
- Leadership — Job requires a willingness to lead, take charge, and offer opinions and direction.
Work Values
- Independence — Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
- Achievement — Occupations that satisfy this work value are results oriented and allow employees to use their strongest abilities, giving them a feeling of accomplishment. Corresponding needs are Ability Utilization and Achievement.
- Recognition — Occupations that satisfy this work value offer advancement, potential for leadership, and are often considered prestigious. Corresponding needs are Advancement, Authority, Recognition and Social Status.
Related Occupations
Wages & Employment Trends
|Median wages (2018)
|$43.81 hourly, $91,130 annual
|State wages
|Employment (2018)
|31,000 employees
|Projected growth (2018-2028)
|Average (4% to 6%)
|Projected job openings (2018-2028)
|State trends
|Top industries (2018)
Source: Bureau of Labor Statistics 2018 wage data and 2018-2028 employment projections . "Projected growth" represents the estimated change in total employment over the projections period (2018-2028). "Projected job openings" represent openings due to growth and replacement.
Job Openings on the Web
Sources of Additional Information
Disclaimer: Sources are listed to provide additional information on related jobs, specialties, and/or industries. Links to non-DOL Internet sites are provided for your convenience and do not constitute an endorsement.
- American Association of Petroleum Geologists
- American Geophysical Union
- American Geosciences Institute
- American Institute of Professional Geologists
- American Society of Civil Engineers
- Association of Environmental and Engineering Geologists
- Environmental and Engineering Geophysical Society
- Marine Technology Society
- Mineralogical Society of America
- National Ground Water Association
- Occupational Outlook Handbook: Geoscientists
- Society for Mining, Metallurgy and Exploration
- Society of Economic Geologists
- Society of Exploration Geophysicists
- The Geological Society of America


text:
Israel lobby silent on Syria
As President Barack Obama moves closer to calling for military action against Syria, a powerful ally that could help him win over skeptics is staying quiet.
The Israel lobby, including the high-profile American Israel Public Affairs Committee and other Jewish groups, isn't pushing for intervention even as evidence emerged this week that the Assad regime used chemical weapons against its citizens.
Story Continued Below
The silence could be a problem for Obama, since the Jewish groups are connected across the political spectrum, wielding influence from the far right to liberal Democrats on issues critical to the Middle East — especially when it comes to the use of military force.
And while Obama has been willing to strike a foreign country without Congress's approval — as he did in Libya — this time he not only faces a reluctant Congress, but a vocal chorus of Republican and Democratic lawmakers publicly advocating against entanglement.
( See POLITICO's full Syria coverage)
"Everyone is in a wait-and-see mode about where this is all leading," former Israeli Deputy Ambassador to the United States Dan Arbel told POLITICO. "The fact is, right now, the picture is not so clear."
That has led groups to move slowly.
"I think that's why you see organizations like AIPAC and others being more low-profile and cautious," Arbel said.
Behind the scenes, several veteran pro-Israel lobbyists also said they don't want a repeat of the Iraq War, when the vast majority of groups and Jewish leaders supported taking out Saddam Hussein. Afterward, many felt they were left with the blame when the war became deeply unpopular with the American public.
"They don't want this to be seen as a Jewish or an Israel war," said one veteran pro-Israel activist. "This is not a clear-cut North versus South civil war where you know you want the North to win. There are some real issues with the rebels here and they aren't sure what would be better. Syria under [President Bashar] Assad, the border has been fairly quiet."
Israel itself has not taken a stance, either.
( Also on POLITICO: Peter King: Obama has 'right' to act on Syria)
"Israel is also cautious about this," Arbel said. "Realizing that Israel itself cannot intervene. I think the Jewish organizations are looking at also the Israeli position."
Prime Minister Benjamin Netanyahu has said, "This situation cannot continue," but he has not prescribed what action should be taken, according to news reports.
Israel's position is further complicated by this being the first major crisis since Ron Dermer took the reins as ambassador to the United States.
The outside groups' quiet posture comes despite many Jewish leaders moving gradually to support the rebels in Syria over the past year. Part of the delay was due largely to the general stability in the region under Assad and worry over the outcome of Egypt's uprising, according to foreign policy experts.
While AIPAC declined to comment, the group has laid out a set of three "talking points" on its website calling, on the country to stop committing human rights abuses, noting that Syria supports terrorism and that it must open up its nuclear program.
( Also on POLITICO: Syria concerns hit stock markets but boost oil)
There are multiple reasons AIPAC might not feel the need to take a more public posture — it appears the Obama administration is going to move in the direction they would like and they are also looking to Israel for leadership.
The decision not to get out front on Syria doesn't come as a surprise to all. AIPAC opted against weighing in earlier this year after critics of Defense Secretary Chuck Hagel accused him of being anti-Israel and tried to scuttle his nomination.
Still, AIPAC regularly engages its lobbying presence in Middle East politics. This spring, the group had its more than 13,000 members fan out across Capitol Hill. Atop its agenda: Press lawmakers to support a bill that would broaden sanctions beyond Iran's energy and financial transactions. The members also urged lawmakers to find a way for the sequester to not impact the $3.1 billion in U.S. aid to Israel.
AIPAC also has gotten involved in lobbying for the U.S. to continue providing Egypt aid. The group sent a letter to top members of the Senate Foreign Relations Committee in July, opposing an amendment from Sen. Rand Paul (R-Ky.) that would have cut off aide to the country until it held free and fair elections.
Meanwhile, other Jewish groups like J Street, the Jewish Institute for National Security Affairs and the American Jewish Committee have also not begun a Capitol Hill offensive.
The AJC's director of government and international affairs, Jason Isaacson, said he hasn't seen any evidence of a significant Jewish organization making a play on Capitol Hill.
"We have not adopted an advocacy posture on this on Capitol Hill. We certainly talk to folks about the situation in the Middle East when asked, but haven't approached the Hill on the matter," Isaacson said, noting that AJC will continue to monitor the situation closely.
( PHOTOS: International response to Syria)
AJC did put out a policy position that the Obama administration needs to take action following Secretary of State John Kerry's statement on chemical weapons being used in Syria.
"There is now clear evidence that the Syrian regime has used such weapons to kill and maim, and not for the first time," the policy states. "To ignore violation of a 'red line' it has established would undermine U.S. credibility not only in Damascus, but also in Tehran, Syria's essential ally."
J Street declined to comment.
Jewish Institute for National Security Affairs Executive Director Michael Makovsky said he believes the U.S. should act — though the group's primary focus is preventing a nuclear Iran.
"President Obama said that Assad needs to go and we need to do what we can to contribute to his downfall," Makovsky said, noting that JINSA looks at the issue as about the impact on Iran. "That is, I think, the larger issue here in the Middle East."
CORRECTION: In an earlier version of this article, the AJC quote above contained an incorrect word.


text:
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