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Effects of bispectral index monitoring as an adjunct to nurse-administered propofol combined sedation during colonoscopy: a randomized clinical trial
Article information
The efficacy of bispectral index (BIS) monitoring during colonoscopic sedation is debated. We aimed to determine whether BIS monitoring was useful for propofol dose titration, and to evaluate differences in sedative administration between expert and inexperienced medical personnel during colonoscopy procedures that required moderate sedation.
Between February 2012 and August 2013, 280 consecutive patients scheduled to undergo a screening colonoscopy participated in this study and were randomly allocated to the expert or inexperienced endoscopist group. Each group was further divided into either a BIS or a modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) subgroup. Trained nurses administered combined propofol sedation and monitored sedation using either the BIS or MOAA/S scale.
The mean BIS value throughout the procedure was 74.3 ± 6.7 for all 141 patients in the BIS group. The mean total propofol dose administered in the BIS group was higher than that in the MOAA/S group, independently of the endoscopists' experience level (36.9 ± 29.6 and 11.3 ± 20.7, respectively; p < 0.001). The total dose of propofol administered was not significantly different between the inexperienced endoscopist group and the expert endoscopist group, both with and without the use of BIS (p = 0.430 and p = 0.640, respectively).
Compared with monitoring using the MOAA/S score alone, BIS monitoring was not effective for titrating the dose of propofol during colonoscopy, irrespective of colonoscopist experience.
A colonoscopy is uncomfortable for the patient because of its long duration and the use of a larger-diameter endoscope that is routinely used for upper gastrointestinal endoscopy [1]. In addition, loop formation in the colon occurs frequently during the procedure. Therefore, sedation and analgesia are typically required to improve patient tolerance and compliance during the colonoscopy procedure [2]. However, achieving and maintaining an adequate level of sedation is difficult. Patients frequently become agitated when low levels of sedative drugs are used; however, adverse events such as respiratory distress and lack of patient cooperation can occur when an excessive dose of sedative is administered. Therefore, it is important to set an objective indicator for monitoring the patient sedation level during colonoscopy, especially when performed by inexperienced endoscopists.
Electroencephalography (EEG)-guided sedation has been used by anesthesiologists to achieve optimal titration of sedatives [3]. Bispectral index (BIS) monitoring is an EEG-based method that quantifies the depth of anesthesia by analyzing the EEG and uses a complex algorithm to generate an index score, which provides an objective measurement of the level of consciousness in sedated patients [3]. Previously, we validated the efficacy and safety of nurse-administered combined sedation using BIS monitoring during endoscopic retrograde cholangiopancreatography (ERCP) [4]. However, the value of BIS monitoring as an adjunct to colonoscopic sedation has been tested in only a limited number of colonoscopic studies [5-10].
The objectives of the current study were to determine whether BIS monitoring was useful for the titration of propofol in combined sedation, and to compare the efficacy of BIS monitoring performed by expert and inexperienced endoscopists during colonoscopy.
Study design and participants
This prospective, randomized, controlled, open-label trial was conducted in Kyungpook National University Hospital between February 2012 and August 2013. The Institutional Review Board of Kyungpook National University Hospital Ethics Committee approved this study. The trial was conducted in accordance with good clinical practice under the principles of the Declaration of Helsinki.
Consecutive patients who required a colonoscopy screening participated in the study. Informed consent was obtained from all of the participating patients. Exclusion criteria included age < 18 years, critical illness (defined by the American Society of Anesthesiologist [ASA] as class 4 or 5) [11], pregnancy, long-term use of benzodiazepines or opiates, history of allergy to eggs, past history of abdominal surgery, and other contraindications for endoscopy such as uncooperativeness, or signs of peritonitis.
Randomization and intervention
The randomization of patients was performed using the SPSS version 21.0 (IBM Co., Armonk, NY, USA). The patients were randomly allocated into either the expert or inexperienced endoscopist group. Endoscopists were considered expert if they had performed more than 300 colonoscopies, while inexperienced endoscopists had completed fewer than 100 colonoscopies [12]. A total of 10 endoscopists (five experienced and five inexperienced) participated in the study. Each endoscopist experience level group was further divided into either a BIS or a modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) subgroup. The endoscopist, trained nurse, and assistant nurse had access to the randomization scheme when the patient was admitted to the endoscopy suite. Three trained nurses administered the sedatives and performed the anesthetic protocol formulated by an experienced anesthesiologist (YHJ, who has performed > 1,000 general anesthesia procedures per year for the past 20 years). The patients received 0.03 to 0.06 mg/kg midazolam and 50 mg pethidine prior to the procedure. A trained nurse assessed the sedation grade using BIS monitoring or the MOAA/S scale every 3 minutes [6] and intermittently administered 10 to 20 mg propofol to maintain conscious sedation [13]. For the MOAA/S group, the sedation end point was an MOAA/S score of three. For the BIS group, the nurse was instructed to target a BIS value between 70 and 80 as the primary end point for propofol titration.
All patients were continuously monitored for heart rate, oxygen saturation (pulse oximetry), and blood pressure (automated blood pressure cuff with serial measurements every 3 minutes). Baseline vital signs were recorded immediately before the procedure. All patients were given supplemental intranasal oxygen (2 L/min). Respiratory depression was considered significant when oxygen saturation was < 80% for > 15 seconds with oxygen supplementation. A drop in systolic arterial blood pressure to below 80 mmHg, or a heart rate lower than 50 beats per minute, was considered to be a significant adverse event. All patients were monitored in the recovery area by electrocardiography, pulse oximetry, and blood-pressure recording. All patients in the BIS group were monitored for BIS scores using a BIS VIEW device (BIS monitoring system, Aspect Medical Systems, Norwood, MA, USA) and a specific BIS Quatro sensor (Aspect Medical Systems).
Outcome measures
Patients were moved to the recovery area immediately after the procedure if their vital signs were stable. An independent research fellow (JH), who was blinded to the randomization scheme, performed all preprocedural and postprocedural assessments. Total dose of propofol and midazolam, procedure time, patient pain level during the colonoscopy, satisfaction level of patients and endoscopists, and adverse events were compared between the BIS group and the MOAA/S group. After the colonoscopy was completed, a questionnaire, which evaluated the degree of pain and satisfaction using a visual analog scale (VAS), was administered to the patients and endoscopists. The results of the patient questionnaire were confirmed through telephone consultation or visiting the outpatient unit 7 to 10 days following the colonoscopy procedure. A VAS was used to score pain (0, none; 10, severe) and satisfaction (0, poor; 10, excellent). Comparisons between the expert and inexperienced medical personnel groups were performed by per-protocol analyses.
Sample size and statistical analysis
To determine if a 0.02 mg/min per kg propofol dose difference (from 0.08 in the BIS group to 0.10 in the MOAA/S group) was significant with a power of 0.80 and a two-sided α = 0.05, and standard deviation of 0.05 mg/min per kg, we calculated that a minimum sample size of 51 patients was required for each experimental group. Assuming a dropout rate of 20%, we determined that at least 248 patients were required to have four experimental groups, each with 62 patients. Continuous data were compared using a t test and categorical variables were tested using the chi-square test. The criterion for statistical significance was p < 0.05. The SPSS version 21.0 was used for the statistical analyses. Data are presented as mean ± standard deviation.
Baseline characteristics
Excluding the 20 patients who could not tolerate cecal intubation during colonoscopy, 280 patients were analyzed. Among them, 149 were enrolled in the expert endoscopist group and 131 in the inexperienced endoscopist group (Fig. 1). No significant differences were observed among the subgroups in baseline characteristics including age, sex, body surface area, or ASA physical status (Table 1).
Propofol titration dose and BIS value
The mean BIS value throughout the procedure (from insertion to removal of the endoscope) was 74.3 ± 6.7 for all 141 patients in the BIS group. The mean total propofol dose administered in the BIS group was significantly higher than that in the MOAA/S group (36.9 ± 29.6 and 11.3 ± 20.7, respectively; p < 0.001), in both the expert and inexperienced endoscopist groups (expert group: 38.8 ± 25.6 and 10.5 ± 15.8 mg, respectively, p < 0.001; inexperienced group: 34.8 ± 33.5 and 12.2 ± 25.3 mg, respectively, p < 0.001). The difference between the two groups remained significant after adjusting for patient body surface index and procedure duration (Table 2). However, the total dose of propofol administered in the inexperienced endoscopist group did not differ significantly from that in the expert endoscopist group, with or without the use of BIS (p = 0.430 and p = 0.640, respectively). The procedure time was longer in the inexperienced endoscopist group than in the expert group, with or without the use of BIS (27.8 ± 14.5 minutes vs. 20.1 ± 12.4 minutes, p = 0.001; 28.4 ± 14.3 minutes vs. 17.5 ± 7.6 minutes, p < 0.001).
Patient satisfaction and adverse events
The degree of pain assessed by VAS score during colonoscopy did not differ significantly between the BIS and MOAA/S groups in either the expert or inexperienced group (1.38 ± 1.03 vs. 1.56 ± 0.95, p = 0.264; 1.93 ± 2.10 vs. 2.14 ± 1.75, p = 0.526, respectively). Although overall patient satisfaction during colonoscopy was higher in the expert group than in the inexperienced group, with or without the use of BIS (p < 0.001 and p < 0.001), the differences between the BIS and MOAA/S groups in the expert and inexperienced groups were likewise not significant (Table 2). No adverse events, including frequency of oxygen saturation < 80%, hypotension (< 80 mmHg), or bradycardia (< 50 beats per minute), were observed. The endoscopists' satisfaction was excellent for all patients in each group. During the post-procedural follow-up assessment performed in the recovery area, no clinically significant hypoxic episodes were recorded in either group.
In the current study, we found that during colonoscopy examination the BIS group did not differ significantly from the MOAA/S group in terms of endoscopist or patient satisfaction. However, the propofol dose administered was higher in the BIS group than in the MOAA/S group. These results were not significantly different between the expert and inexperienced endoscopist groups.
Previous studies have reported the usefulness of BIS monitoring in endoscopic submucosal dissection or ERCP, as well as significant advantages in terms of the propofol dose administered, and in endoscopist and patient satisfaction levels [4,14,15]. However, in previous studies that targeted deep sedation during screening endoscopy, no significant differences in propofol dose or recovery time were found between the BIS and MOAA/S groups [5,6]. Similarly, in the present study, which involved moderate sedative colonoscopy, patient satisfaction and propofol titration dose did not differ markedly between the BIS and MOAA/S groups. Further, the results indicate that BIS may be more appropriate in the maintenance phase of sedation, rather than in the induction or recovery phase [5]. Likewise, an important point for application of BIS in the sedative endoscopic field may be the duration, not the depth, of sedation. Therefore, BIS could be more useful when a longer duration of sedation is required, such as during therapeutic endoscopic procedures.
BIS values range from 0 (coma) to 100 (fully awake), and reflect the sedation level regardless of patient clinical characteristics or the type of sedative drug administered [16]. In previous studies, BIS was validated for monitoring sedation, as evidenced by the good correlation with sedation level [10,17]. In this study, we set the threshold BIS score at 70 to 80 for moderate sedation based on prior recommendations for using BIS during colonoscopy [9]. However, in other studies, a BIS score of 80 was the approximate standard for moderate sedation [10,17]. Therefore, in our study, the higher propofol dose in the BIS group may have been related to the lower BIS score setting for moderate sedation. Nonetheless, the spectrum of changes from moderate to deep sedation may be very narrow. In a previous study, the BIS score for moderate sedation significantly overlapped with that for deep sedation [18]. Although further research is needed to determine the BIS score for moderate sedation, maintaining the BIS set point during sedative colonoscopy may be too difficult in clinical practice.
Because the need for endoscopic examinations is increasing, the use of sedatives, propofol in particular, has also increased [19]. However, in some countries, the use of a sedative agent is restricted and can only be administered by an anesthesiologist during colonoscopy. In this situation, the concern is the high cost. In a recent study from France, sedative colonoscopy, performed under sedation by an anesthesiologist, added 285% to the cost of nonsedative colonoscopy [20]. On the other hand, nonanesthesiologist administration of propofol showed greater safety and satisfaction levels compared with anesthesiologist-administered colonoscopy [21]. Interestingly, in our study, the propofol dose administered did not differ significantly between the expert and inexperienced endoscopist groups, irrespective of use of BIS (38.8 ± 25.6 vs. 34.8 ± 33.5, p = 0.430), or MOAA/S (10.5 ± 15.9 vs. 12.1 ± 25.3, p = 0.640). Moreover, there was no adverse event during colonoscopic examination in either group. The results suggest that the administration of combined sedation by a well-trained nurse could be considered a safe and satisfactory method for sedative colonoscopy.
The limitations of the current study included the fact that the nurses could not be blinded to the absence or presence of BIS monitoring during colonoscopy. However, it was impossible for this study to be performed in a totally blinded fashion. While additional, well-designed, double-blinded studies should be conducted to confirm our results, the implication is that sedation administered by well-trained nurses is efficacious in sedative colonoscopy. A second limitation of the study was that we did not investigate or set the BIS score for moderate sedation in accordance with the results of previous studies. Although further research is needed, we believed that setting a different BIS score for moderate sedation would not reduce the propofol dose titration. Finally, although we observed no adverse events during the procedures, we could not definitively conclude whether or not the experience level of the medical team conducting the sedation procedures had an effect on the complication rate.
In conclusion, compared with MOAA/S score monitoring alone, BIS monitoring was not effective for titrating the dose of propofol in colonoscopy, irrespective of endoscopist experience.
1. The bispectral index monitoring method doesn't seem like better than modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) when the trained nurse monitored in moderate sedation.
2. The moderate sedative colonoscopy could be well performed by the trained nurse using MOAA/S even though the operator is less experienced.
No potential conflict of interest relevant to this article was reported.
We thank all of the investigators and study personnel for their contributions. This work was supported by a grant from the Biomedical Research Institute, Kyungpook National University Hospital (2012).


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Summer/Fall 2009
You know what they say about a recession being a great time to go back to school? Well, it seems to make sense, if only because it beats drinking Fanta on the couch, paging through the classifieds and watching Golden Girls reruns.
Although that Bea Arthur was a hoot. (May she rest in peace.)
Anyway, in this, the Independent's first Education Guide of 2009, you'll find a pretty comprehensive rundown of educational options in the Pikes Peak region. We say "pretty comprehensive" because it focuses on academic classroom learning. If you want to find out about the myriad trade schools, art schools and other places geared toward developing specific skills or talents, please try the Yellow Pages or Google.
If in looking at the list below, you notice any schools or organizations that are missing, please let us know by sending an e-mail to firstname.lastname@example.com. Otherwise, happy browsing. And thank you for being a friend.
— The Indy staff
Post-secondary education
Beth-El College of Nursing & Health Sciences
University of Colorado at Colorado Springs
1420 Austin Bluffs Pkwy.
Colorado Springs 80933
Founded in 1904, Beth-El College merged with UCCS (see listing below) in 1997. Now a college within the university, it works closely with Memorial and Penrose-St. Francis hospitals, so its graduates benefit from real-world experience.
At the undergraduate level, Beth-El offers a four-year Bachelor of Science in nursing degree with different specialties available; an R.N.-to-B.S.N. bridge program; a four-year Bachelor of Science in health care services degree with options in nutrition and sports health and wellness; and forensic health science. Additionally, Beth-El offers several certificate options for undergraduate and graduate students. Many courses are offered online.
Admissions: Call 262-3383 for information.
Accelerated Bachelor of Science in nursing program: If candidate already has a bachelor's degree, a BS in nursing can be obtained in 16 months.
The Colorado College
14 E. Cache la Poudre St.
Colorado Springs 80903
389-6000; 800/542-7214
The Colorado College, founded in 1874, is a small, four-year liberal arts and sciences college with approximately 1,950 students. U.S. News & World Report consistently ranks CC among the nation's top liberal arts colleges. CC is distinctive for its "block" plan, in which the academic year is divided into eight 3½-week sessions, allowing students to focus on one class at a time.
Admissions: Applications are available online and from the college, and are to be returned to the admissions office with a $50 nonrefundable fee. Financial aid is available. For more, visit coloradocollege.edu.
University of the Rockies
555 E. Pikes Peak Ave.
Colorado Springs 80903
The University of the Rockies, operated by Bridgepoint Education, is a graduate school offering an Master of Arts in marriage and family therapy and/or professional counseling, a doctorate in clinical psychology and a doctorate in organizational leadership. Specializations include marriage and family therapy, professional counseling and organizational leadership. The university also offers continuing education for mental health professionals.
Admissions: Candidates must hold a bachelor's degree in any field from a regionally accredited higher education institution. They must have a cumulative GPA of 3.0 or above. Applicants with a GPA below 3.0 may be considered on a selective basis. An admissions packet may be requested from the admissions office or downloaded from the Web site. Scholarships available for military personnel; some other financial aid and loans are available.
Colorado State University at Pueblo
2200 Bonforte Blvd.
Pueblo 81001
Formerly the University of Southern Colorado, CSU-Pueblo is a member of the Colorado State University system. Its campus is the fastest-growing in the state, with an enrollment of more than 4,600 students and newly opened student recreation center, student recreation field, and football and track & field stadium. With 26 bachelor's degrees and seven master's degrees, CSU-Pueblo offers multiple paths to define your future through the College of Science and Mathematics, the Hasan School of Business, the College of Humanities and Social Sciences, and the College of Education, Engineering and Professional Studies. Also offering continuing education programs (see p. 26).
Admissions: Students must submit an application (available online) with a $25 payment, ACT or SAT scores and a high school transcript (or GED test scores).
College America at Colorado Springs
3645 Citadel Drive South
Colorado Springs 80909
College America's Colorado Springs branch offers programs in business, computer technology, medical specialties and graphic arts. Associate's degrees are available in computer programming, computer technology and networking, e-business management and accounting, medical specialties and graphic arts. The Bachelor of Science program includes accounting, business administration, computer science and health care administration. Flexible and online classes are available, with financial aid for those who qualify.
Admissions: Interested students can contact an enrollment adviser via the Web site, or apply online. Applicants must be high school graduates or have a GED.
Colorado Technical University
4435 N. Chestnut St.
Colorado Springs 80907
Colorado Technical University, founded in 1965, offers undergraduate, master's and doctorate degree programs for careers in business, management, criminal justice, public administration, visual communications and high-tech industries. Professional certificate programs also are available. Courses may be taken in a traditional classroom setting, online or through a combination of both.
Admissions: Applications can be made online or with the assistance of admissions representatives. A high school diploma or GED is required. Various financial aid programs are offered.
DeVry University
1175 Kelly Johnson Blvd.
Colorado Springs 80920
DeVry University's Colorado Springs campus mostly serves working adults with bachelor's programs in business administration, electronics and computer technology, network systems administration and technical management. Master's degree programs and graduate certificates are also available. Many programs are offered online.
Admissions: An application (at the campus or online) must be completed, as well as an interview with an admissions representative. A high school diploma or equivalent is required. Financial aid available.
Everest College
1815 Jet Wing Drive
Colorado Springs 80916
Everest College offers vocational programs designed to help graduates prepare for specialized and entry-level positions. They include accounting, business administration, computer information science (networking, programming, Web design), criminal justice, legal assisting/paralegal services, massage therapy, medical administrative assisting and medical assisting.
Admissions: Prerequisites for admission include the successful completion of a placement assessment and an interview with an admissions officer. Financial aid is available to those who qualify.
Fuller Theological Seminary
540 N. Cascade Ave., #202
Colorado Springs 80903
Fuller Theological Seminary is a nonprofit, private institution that is one of North America's largest seminaries. The Colorado Springs campus offers coursework leading toward certifications and graduate degrees in theology and Christian leadership.
Admissions: In general, applicants must have a bachelor's degree or its equivalent.
IntelliTec College
2315 E. Pikes Peak Ave.
Colorado Springs 80909
Founded in 1965, IntelliTec provides specialized career training and offers associate of occupational studies degrees in HVAC/refrigeration, architectural drafting and mechanical drafting, and programs for network systems administrators and automotive technicians. Free graduate placement assistance is available. The school is accredited ACCSCT.
Admissions: The school requires a high school diploma or GED; ability to read, write and speak English; and participation in a personal interview with an admissions representative.
IntelliTec Medical Institute
2345 N. Academy Blvd.
Colorado Springs 80909
IntelliTec Medical Institute was established in 1966. The school's programs include medical assisting, medical administrative assisting, dental assisting, massage therapy and programs to become medical lab technicians.
Admissions: The school requires a high school diploma or GED; evidence of good health; ability to read, write and speak English; and participation in a personal interview with an admissions representative.
National American University
5125 N. Academy Blvd.
Colorado Springs 80918
National American University (NAU), a private institution, offers master's, bachelor's and associate's degrees at its Colorado Springs campus. Courses include accounting, applied management, medical administrative assisting, medical assisting, business administration, health care and information technology. M.B.A. and master's programs in management are available, along with traditional and online courses. Regionally accredited through the Higher Learning Commission.
Admissions: You may call or write to NAU and request an application form, or apply online. Federal financial aid programs are available for those who qualify.
Nazarene Bible College
1111 Academy Park Loop
Colorado Springs 80910
Founded in 1967, Nazarene Bible College seeks to train adults for the ministry. It offers associate of arts degrees in church ministries, Christian ministries, early education and women's studies. Bachelor of arts degrees in ministry are available with majors in pastoral ministry, Christian education ministries, Christian school education, music ministries, leadership and ethics, counseling for Christian ministry, Christian counseling and Bible and theology.
Admissions: Applications can be made online or by contacting the college. The college requires a high school diploma or GED, a testimonial essay and letters of recommendation.
New Geneva Theological Seminary
3622 Galley Road
Colorado Springs 80909
The Colorado Springs campus of New Geneva Theological Seminary offers coursework toward certifications and graduate degrees in theology and biblical studies.
Admissions: Students must submit a degree application form (available on the Web site), along with a $25 application fee by mail.
Pikes Peak Community College
Enrollment Services: 502-3000
Switchboard: 502-2000, 800/456-6847
Pikes Peak Community College offers two-year liberal arts programs that enable students to qualify for admission as juniors at other colleges and universities. Also offered are programs in a variety of career and technical fields. Special military offerings complement significant support services and distance-learning options for all students.
Admissions: An online application is available. For information on financial aid and scholarships, call 502-3000.
Centennial Campus
5675 S. Academy Blvd.
Colorado Springs 80906
The Downtown Studio Campus
100 W. Pikes Peak Ave.
Colorado Springs 80903
Rampart Range Campus
11195 Hwy. 83
Colorado Springs 80921
Falcon Campus
11990 Swingline Road
Falcon 80831
Pima Medical Institute
Colorado Springs Campus
3770 Citadel Drive North
Colorado Springs 80909
The Colorado Springs branch of Pima Medical Institute offers dental assistant, medical assistant, medical administrative assistant, pharmacy technician, phlebotomy technician and veterinary assistant and technician programs. The school offers a full range of student services, including financial aid and lifetime job placement assistance.
Admissions: Candidates should have a high school diploma or GED equivalent. Those who do not have a high school diploma or GED and are over age 18 may take a federally approved application test. All applicants must take an entrance exam and pass with a minimum score.
PPNC School of Ministry
2130 Academy Circle, Suite F
Colorado Springs 80909
Originally a Bible and seminary school for women, PPNC now has opened a department of men's studies. Bachelor's, master's, doctoral and certification programs are available in pastoral holistic ministry (for nurses only) and pastoral holistic counseling. Theology/religious studies also has bachelor's, master's and doctoral programs.
Admissions: An online application is available. Tuition costs vary depending upon the program.
Regis University
7450 Campus Drive, #100
Colorado Springs 80920
Regis University was founded in 1877 by a group of exiled Italian Jesuits. It is a liberal arts college that comprises three schools: Regis College offers a range of programs in liberal arts, sciences, education and business; the College for Health Care Professions offers undergraduate, graduate and certificate programs for careers in health professions; and the College of Professional Studies offers undergraduate and graduate degree programs, academic certificates and non-credit corporate education for working professionals. Online courses and degrees are available.
Admissions: Each school has different admissions requirements. Contact the departments of admissions or visit the Web site for further information. A variety of financial aid packages are available; for assistance, call the financial aid office at 800/568-8932.
Remington College
6050 Erin Park Drive
Colorado Springs 80918
Remington College offers various programs and degrees, where students can earn an Associate or Bachelor of Science degree in criminal justice. Diploma programs for careers as a medical assistant and pharmacy technician are also offered.
Admissions: A high school diploma or equivalent is required for most programs. An interview with an admissions representative is required. Various forms of financial aid may be explored using links provided on the Web site.
Troy University
8610 Explorer Drive, #101
Colorado Springs 80920
A regionally accredited institution, Troy University offers on-site graduate programs in management and international relations and additional undergraduate online degrees. The programs are organized with working and military students in mind. Classes are held on the Fort Carson campus at 1675 Long St., and the classroom at 5825 Delmonico Drive, #120.
Admissions: Call the number above for information.
University of Phoenix
The University of Phoenix offers undergraduate, graduate and associate's degrees, as well as doctorates, in many fields, including business, education, criminal justice, social and behavioral science, health care services and technology. Classes are offered in the evening and on weekends, with the working professional in mind. Most courses can be taken online. There is a 20-month degree program for associate's degrees. Online programs are available.
Admissions: For the undergraduate program, applicants must have a high school diploma or equivalent, be at least 16 years of age and have access to an organizational environment where they can apply concepts learned in class. Graduate students are required to have a minimum cumulative GPA of 2.5 and at least three years of significant work experience. Specific degree programs may have additional admissions requirements. To enroll, students can complete and submit a request-for-information form from the Web site or call. Once the request has been received, students will meet with an enrollment adviser.
South Circle Drive Learning Center
2864 S. Circle Drive
Colorado Springs 80906
Southern Colorado Campus
5725 Mark Dabling Blvd., #150
Colorado Springs 80919
Pueblo Student Resource Center
121 W. First St., Suite A
Pueblo 81003
University of Colorado at Colorado Springs
1420 Austin Bluffs Pkwy.
Colorado Springs 80918
255-8227; 800/990-8227
One of four institutions in the University of Colorado system, UCCS offers a wide variety of bachelor's and master's degrees, as well as doctoral degrees. There are six colleges on campus: business and administration, education, engineering and applied science, public affairs, nursing and letters, and arts and sciences. UCCS also offers a number of graduate degrees through its graduate school and its Graduate School for Public Affairs.
Admissions: Applications are available from the college or online and are to be returned to the admissions office with a $50 application fee ($60 for graduate school). An official high school transcript, official ACT/SAT scores and transcripts of college coursework previously taken are required.
United States Air Force Academy
2304 Cadet Drive, #200
USAF Academy 80840
333-2520; 800/443-9266
Recognized as one of the nation's finest four-year institutions of higher learning, the U.S. Air Force Academy provides cadets with a solid foundation for a career in the Air Force and a life as an engaged citizen.
Admissions: Public law (Title 10) decrees that a cadet must be a U.S. citizen, unmarried, with no dependents, and be older than 17, but younger than 23, by July 1 of the year he or she enters the Academy. Full details can be found at the Academy's Web site.
Webster University
5475 Tech Center Drive, #100
Colorado Springs 80919
Webster University offers graduate business and technology degrees at its Tech Center Drive campus, as well as Schriever and Peterson Air Force bases, Fort Carson and the Air Force Academy. Students attend classes one evening a week from 5:30 to 9:30 and can complete a degree in two years or less. Master's degrees available in health administration, business administration, finance, information technology management, human resources development and management, management and leadership, information technology management, procurement and acquisitions management and space systems operations management. There's also a certificate program in government contracting. Many of these programs are available online.
Admissions: Students who have earned a bachelor's degree from a regionally accredited four year college or university and have a 2.5 GPA or higher will be admitted; no entrance exams (GMAT or GRE) are required. Visit the Web site to learn more about admissions.
K-through-12 education: area school districts
Colorado Springs School District 11
1115 N. El Paso St.
Colorado Springs 80903
Following a recent round of school closures, District 11 will open the 2009-10 school year with 35 elementary schools, nine middle schools, five high schools, six charter schools and six alternative schools. D-11 is the largest and most centrally located school district in Colorado Springs.
Academy School District 20
1110 Chapel Hills Drive
Colorado Springs 80920
District 20 consists of 20 elementary schools, seven middle schools, seven high schools and one charter school. Its test scores, graduation rates, college admissions/scholarships and student achievement awards put D-20 among the top-rated school districts in the state.
Harrison School District 2
1060 Harrison Road
Colorado Springs 80906
The second-oldest organized school district in El Paso County, District 2 was officially organized on Aug. 20, 1874. It currently consists of 14 elementary schools, one K-through-8 school, three middle schools, two high schools, including New Horizons Opportunity School, and three charter schools. Atlas Preparatory School (atlasprep.org) is a new, free charter school on Fountain and Murray boulevards, opening this August with 100 fifth-graders.
Cheyenne Mountain School District 12
1775 LaClede St.
Colorado Springs 80906
District 12 consists of six elementary schools, one junior high school, one high school and one charter school. Its students consistently score high on tests, and its families pride themselves on being involved with their children's education.
Falcon School District 49
10850 E. Woodmen Road
Falcon 80831
Falcon District 49 is one of the fastest-growing school districts in the area. It consists of nine elementary schools, three middle schools, three high schools and an academy, and three charter schools. The district strives to keep a small-town atmosphere as it grows.
Lewis-Palmer School District 38
146 Jefferson St.
Monument 80132
Lewis-Palmer School District consists of five elementary schools, two middle schools, two high schools and one charter school. It prides itself on its relatively small size, which increases opportunities for individual attention.
Widefield School District 3
1820 Main St.
Colorado Springs 80911
The students of District 3 are served by one preschool, nine K-through-6 elementary schools, three junior high schools and three high schools. The Community Center S.A. Wilson Preschool is located in District 3 but not partnered with the district, along with James Madison Charter Academy, which serves grades K-6.
Manitou Springs School District 14
405 El Monte Place
Manitou Springs 80829
The students of the Manitou Springs area are served by one high school, one middle school and two elementary schools. Manitou Springs is a small town, and District 14 is a small district, with an accomplished student body that represents the quirky nature of the community.
K-through-12 education: private schools
American Christian Academy
Currently offers tutoring services for grades 1 through 12, as well as an ESL (English as a second language) program. At publication time, the school was preparing to move to a new location; representatives suggested that interested readers call the number above to find out the new address.
The Colorado School for the Deaf and the Blind
33 N. Institute St.
Colorado Springs 80903
Voice: 578-2100
The Colorado School for the Deaf and the Blind is a state-funded school that provides educational services to those under age 21 who are deaf or hard of hearing and/or blind or low-vision. For students beyond a reasonable commuting distance, on-campus living is available from Sunday evening to Friday afternoons, as are after-school programs, athletics, peer advisers and work programs. Various living arrangements are available based on students' levels of independence.
Admissions: Students are required to have a documented hearing and/or vision loss, as defined by Colorado eligibility guidelines.
Colorado Springs Christian School
4855 Mallow Road
Colorado Springs 80907
Colorado Springs Christian School, a nondenominational K-through-12 Christian school, provides biblically based education. Also offered are home-schooling programs and the Handprints Early Education Center preschool.
The Colorado Springs School
21 Broadmoor Ave.
Colorado Springs 80906
The Colorado Springs School gives students in pre-kindergarten through 12th grade the opportunity to "learn by doing." The college-prep curriculum allows students to apply academic concepts to classroom activities and field studies on campus and in the community, the nation and the world. Small classes, a college counseling process that begins in middle school, and individualized guidance in high school coursework adjoined with testing tactics, essay writing and interviewing help every student present the best possible profile to colleges and universities.
Financial aid and scholarships are available to students who qualify. Transportation to the school is available throughout Colorado Springs.
Corpus Christi Catholic School
2410 N. Cascade Ave.
Colorado Springs 80907
Corpus Christi provides a "faith-filled" education for students in grades pre-K through 8.
Cornerstone Baptist Academy
3615 Vickers Drive
Colorado Springs 80918
Cornerstone is a K-through-12 Christian school for church members only.
Divine Redeemer Catholic School
901 N. Logan Ave.
Colorado Springs 80909
Divine Redeemer provides a Catholic education in an academically accelerated environment. Grades pre-K through 8.
Evangelical Christian Academy
Pre-K-through-6 campus:
2511 N. Logan Ave.
Colorado Springs 80907
Grades 7-through-12 campus:
4052 Nonchalant Circle South
Colorado Springs 80917
Evangelical Christian Academy is a ministry of Grace Presbyterian Church and Village Seven Presbyterian Church, focusing on holistic development.
Fountain Valley School
6155 Fountain Valley School Road
Colorado Springs 80911
Founded in 1929, Fountain Valley School is a private boarding and day school that stresses rigorous academics for grades 9 to 12.
Heartland Christian Academy
828 E. Pikes Peak Ave.
Colorado Springs 80903
Affiliated with Immanuel Lutheran Church, Heartland Christian Academy offers grades pre-K through 8.
HillSprings Learning Center
1257 Lake Plaza Drive, #120
Colorado Springs 80906
HillSprings Learning Center is a nonprofit, half-day learning center for K-through-8 students with learning disabilities or attention deficit disorder.
Hilltop Baptist School
6915 Palmer Park Blvd.
Colorado Springs 80915
Hilltop Baptist features small class sizes and the Bob Jones University Press curriculum for grades K through 12.
Pauline Memorial Catholic School
1601 Mesa Ave.
Colorado Springs 80906
Pauline, a Colorado Springs institution since 1955, welcomes students in grades pre-K through 8.
Pikes Peak Academy
5590 N. Nevada Ave.
Colorado Springs 80918
Pikes Peak Academy is an alternative Christian high school.
Pikes Peak Christian School
5905 Flintridge Drive
Colorado Springs 80918
Pikes Peak Christian offers a Bible-based education for grades pre-K through 12.
Springs Adventist Academy
5410 E. Palmer Park Blvd.
Colorado Springs 80915
Springs Adventist students, in grades K through 9, receive an education geared toward spiritual and academic excellence.
St. Mary's High School
2501 E. Yampa St.
Colorado Springs 80909
St. Mary's High School was one of the first schools in the Pikes Peak region. It is now an independent, coeducational Catholic high school with nearly 400 students.
Montessori schools
Montessori schools are based on principles developed in 1907 by Maria Montessori, Italy's first female physician. Learning through all five senses is emphasized, and children are allowed to learn at their own pace, choosing activities from numerous possibilities. Children are placed in multi-age groups, which encourages older children to share their knowledge with younger ones. The following Montessori schools are in Colorado Springs:
Born of the Golden Mountain Montessori School
306 W. Brookside St.
Colorado Springs 80906
Giving Tree Montessori School
1110 W. Moreno Ave.
Colorado Springs 80905
Hope Montessori Academy (West)
2041 Chuckwagon Road
Colorado Springs 80919
Hope Montessori Academy (East)
6353 Stetson Hills Road
Colorado Springs 80922
Hope Montessori Academy (North)
18075 Minglewood Trail
Monument 80132
Rocky Mountain Montessori Academy
7675 Lexington Drive
Colorado Springs 80920
Washington Elementary School
(taking over the former Buena Vista program for School District 11)
924 W. Pikes Peak Ave.
Colorado Springs 80905
Other public school resources
Pikes Peak Board of Cooperative Educational Services
4825 Lorna Place
Colorado Springs 80915
Founded in 1968, the Pikes Peak Board of Cooperative Educational Services serves nine school districts in the Pikes Peak region. The Pikes Peak BOCES helps member school districts find the best use of educational dollars by offering services in technology planning and implementation, program development for non-English-speaking students and more.
Home-school support
CMCA Home School Connection
2948 E. Fountain Blvd.
Colorado Springs 80910
A one-day-a-week enrichment program for home-schoolers in grades 1 through 11.
Online resources
This Web site provides comprehensive information on Colorado colleges, universities, career colleges, technical colleges, vocational colleges, technical schools, vocational schools and online degree programs.
The U.S. Department of Education Web site provides links to higher education options, grant information, common questions and state information before finding a college.
This link has a high school timeline to help students plan out the next phase, college. Research programs, apply to schools and learn more about financial aid in an organized way through Embark.
This site offers a free federal resource for preparing for and funding education beyond high school.
Continuing education
City of Colorado Springs Parks, Recreation and Cultural Services
1401 Recreation Way
Colorado Springs 80905
The city of Colorado Springs offers a multitude of learning opportunities for people of all ages through recreation centers, community centers and senior centers. Facilities include those owned by the city and those secured through cooperative agreements with schools and recreationally focused entities. Classes range from academic to recreational.
School District 11 Community Education
Mailing address: 1115 N. El Paso St.
Walk-in registration: 1033 N. Franklin St.
Colorado Springs 80903
District 11 offers dozens of community education classes for children and adults, with classes that range from various kinds of dancing and foreign languages to beginning computer skills and managing rental property. They take place in the district's schools year-round.
Colorado State University at Pueblo
2200 Bonforte Blvd.
Pueblo 81001
The division of Continuing Education offers classes in several majors to meet the needs of working adults and military personnel in Colorado Springs. These classes are held at three locations in Colorado Springs, including the Citadel Center, Fort Carson and Peterson Air Force Base. The entire curriculum of upper-division courses for degrees in social science, sociology, sociology/criminology, liberal studies (elementary education) and social work is presently available, as well as some lower-division general-education courses. In addition, non-credit, online courses may be used for professional development or personal growth and are not part of an academic degree program. Courses are available in a variety of topics, including computers, personal enrichment, entrepreneur/business, business administration/management, writing and Spanish.
Pikes Peak Library District
The Pikes Peak Library District offers book discussion groups, computer classes and numerous other learning activities for the community. Meetings and classes take place at PPLD libraries, branch libraries and online. Most activities are free or require a nominal fee. The PPLD has also opened an eBranch, which can be found online at ebranch.ppld.org.
Briargate Branch
9475 Briar Village Point
Colorado Springs 80920
Cheyenne Mountain Branch
1785 S. Eighth St., #100
Colorado Springs 80905
East Library
5550 N. Union Blvd.
Colorado Springs 80918
Fountain Branch
230 S. Main St.
Fountain 80817
Monument Branch
1706 Lake Woodmoor Drive
Monument 80132
Old Colorado City Branch
2418 W. Pikes Peak Ave.
Colorado Springs 80904
Palmer Lake Branch
66 Lower Glenway
Palmer Lake 80133
Penrose Library
20 N. Cascade Ave.
Colorado Springs 80903
Rockrimmon Branch
832 Village Center Drive
Colorado Springs 80919
Ruth Holley Branch
685 N. Murray Blvd.
Colorado Springs 80915
Sand Creek Branch
1821 S. Academy Blvd.
Colorado Springs 80916
Ute Pass Branch
8010 Severy Road
Cascade 80809
PILLAR Institute for Lifelong Learning
30 E. Rio Grande St.
Colorado Springs 80903
The PILLAR Institute for Lifelong Learning offers classes to all. More than 40 volunteers in the 501(c)3 nonprofit organization develop the curriculum, instruct classes and provide organizational structure. Class topics range from history and personal safety information to spiritual cinema. There are classrooms on-site with some at various locations around town, and fees vary.


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Last weekend we had friends over for dinner. Our plan was to play a board game all together, so that meant I needed to prepare an easy, fast and delicious (ofcourse) dish!
Vegetarian lasagna it is !
Personally I think oven dishes are just the best to make when you have guests over for dinner. You can prepare it in advance and after the oven does all the cooking, you have some time to clean up your kitchen!
So, let's get to the point!
What does my vegetarian lasagna contain?
It's filled with a green sauce (Bechamel sauce and pesto together), green beans, potatoes, mozzarella and that is all!
This is what you need (for 4-6 persons):
- 250 grams lasagna (I prefer fresh lasagna)
- 2x Mozzarella maxi
- 6 big potatoes
- 2 handful of green beans
- 2x 140 grams pesto
Bechamel sauce:
- 1 liter milk
- 100 grams flower
- 50 grams butter
- salt
- black pepper
- nutmeg
Fill in a pan with water and bring it to boil.
Peel the potatoes and cut them in half twice. (It will cook faster)
Cut both the ends of the green beans off.
When the water starts boiling, add salt to the water and put the potatoes and green beans in it together. Let it boil for around 12 min. Before taking them out, prick the potatoes with a fork to check if they are cooked. If the green beans are a bit crunchy, no worries, that is perfect!
Than you start making the bechamel sauce. Now as you can see in the pictures I made it with my Thermomix. You put all the ingredients in together, set the time and temperature and the thermomix will do the rest, it is an extra hand in the kitchen, very comfortable!
After the bechamel is ready, add the pesto and mix it until it has a nice beautiful green colour.
The bechamel sauce is ready and the potatoes and green beens are well cooked.
Before preparing your dish, don't forget to cut the mozzarella in slices.
Ok, now we can prepare our dish:
Start with a layer of Bechamel sauce
Then you cover it with a first layer of lasagna
Another layer of bechamel
Spread some green beans
Spread the boiled potatoes – smash it a bit with your fingers while you spread it over the green beans
A layer of mozzarella in pieces over the green beans and potatoes
Now you start all over and repeat the same procedure:
lasagna, green beans, boiled potatoes and mozzarella.
I usually do two layers.
When you finish the second layer, you finish it up with another layer of lasagna and you cover it all with bechamel sauce.
Usually I have some left overs, you can add them on top as you can see in the picture below.
Now your dish is ready to be put into the oven!
The time and temperature vary from which lasagna you are using,
so look on the box of the lasagna you are using. On the box you will find the instructions about the time and at what temperature you need to set the oven to.
I used fresh lasagna of Giovanni Rana (Love this brand!), you can find them in the fridge area at the supermarket. Cooking time was 20 min. and 170 °C (338 °F).
Your lasagna is ready!! Try it out and I'm curious to know how you liked it!
Buon appetito!


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ECR 2020 23.200 delegates
- Date
- 11.03.2020 8:00 - 15.03.2020 20:00
- Type
- Congress / Conference
- Calendar
- Add event to my calendar
The European Congress of Radiology (ECR) is the annual meeting of the European Society of Radiology (ESR). It is a trend-setting, dynamic and service-oriented congress, well-known as one of the most innovative meetings within the scientific community, embedded in a unique and inspiring ambience.
Every year more than 20,000 delegates from 101 countries attend the ECR conference at the Austria Center Vienna. The European Congress of Radiology represents the medical specialty of radiology throughout Europe and the Mediterranean.
Rooms: Whole Conference Center
Further information: www.myesr.org


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"Keep riding the good ride" said RJ who has two brothers with Aspergers. RJ was so generous with his compliments. "You are doing good things with your Bicycle" was just one of his comments.
"Keep riding the good ride" said RJ who has two brothers with Aspergers. RJ was so generous with his compliments. "You are doing good things with your Bicycle" was just one of his comments.
This entry was posted on Tuesday, December 5th, 2017 at 10:55 am and is filed under Kindness. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
Please help us spread our message of a Goal of Kindness to schoolchildren across the country. Your donations are crucial to making this a reality.
Mail donations to:
One Million Acts Of Kindness
PO Box 770054
Lakewood, OH 44107
You can also donate through PayPal:
Bogart is my travel companion on The Kindness Bus Tour for the next ten years. We will be on the road traveling to campuses across the country. Bogart is a eight year old Boston Terrier. He is a great people dog... he loves meeting new people. I am Bogart's fourth owner in his short 8 years of life... Not because of him but because his three previous owner's lifestyles changed after they took him in... Lucky for me!! Bogart is the luckiest, most spoiled dog on the face of the earth. He loves the bus and he loves to travel. Please come and visit him when we are on your campus.
The Blue Bird Corporation donated this amazing bus to One Million Acts of Kindness, allowing us the continue this initiative. It has been painted to closely resemble the original Kindness Bus. It will last well beyond the ten years of this mission. A very big thank you to Blue Bird from Bob Votruba and Bogart too!!
The original Kindness bus has been donated to a professor at Virginia Tech who will use it on campus and at schools in the Blacksburg area. The Kindness Bus will continue to inspire and comfort residents, students and visitors in that area for years to come.
One Million Acts Of Kindness is a goal. A goal for each person to individually perform One Million Acts Of Kindness in their life. Can you imagine a greater goal for one's life? It is a constant mind-set of kindness every day of your life for the next fifty-five years. Doing for others and kindness in your heart for everyone. It is my wish that you will dedicate your life to a charity... finding the passion in your heart for something or someone in need.
As a father of three college age kids I am concerned for the world in which all kids will live. A great way to create a safer, more caring world is for everyone to start their lifetime goal of One Million Acts Of Kindness. So I bought a bus, had about sixty family members, friends and neighbors help paint it and began a ten year journey with my Boston Terrier, Bogart, to college campuses across the country hoping to convince as many of you as possible about this much needed movement for this world. I love you guys too much to sit back and not do anything about this. Let's start a kindness movement in this country today to change the direction this world is headed!! You are the change that this world needs.
One Million Acts of Kindness | Copyright 2010


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Confession has to be one of the most neglected aspects of the Christian faith. In fact, most Christian organizations create a culture that dissuades confession. Churches have bogus "restoration processes" that are in print but not in practice. What often happens is more like a good old Amish shunning; "there are plenty of churches around, just find another one and we'll be praying for you." We don't hate the sin and love the sinner. Instead we hate the memory of the sin and ,well, every time I look at you I remember the sin, so…
I recently spoke to the young men at a Christian college chapel service. I asked them to raise their hand if any of them had premarital sex in the past month. Many of them laughed, which I expected. Because, like them, I knew that asking that question in that setting was preposterous. With the Dean of Students in attendance, anyone raising their hand would be booted out of school, *ahem*, go through a restoration process. So we create cultures with honor codes and conduct policies aimed at protecting those currently 'not sinning.'
The insanity is that, if we believe the Bible, we all sin and are in need of grace. So instead of policies and cultures that help sinners rebound, we create communities that don't exterminate sin but isolate sinners; isolated by expulsion if the sin is public. And even more demonic, isolation within themselves because they have to keep sin hidden, leading to a double life.
In fact, as parents, we can do the same thing. We create codes of conduct for our children that we don't live by or, worse yet, we do strive to live by but they never see or hear us confess our failure to live up to those standards. Parents rarely confess to their kids because they fear losing power over their kids' purity ("if dad had sex before marriage, than why can't I?")
All this does is create a dissonance in the child's life that, when in the teen years, translates into hypocrisy. The church is full of hypocrites. They preach control over teen lust but can't practice self-control at Chik-Fil-A. They preach grace but I'm raised in law. The prodigal's father gives his son his inheritance but my dad practices 'tough love,' and so on. It's no wonder 75% of churched teens are leaving the church when they move out.
When we hold on to our sin, it makes us expect perfection out of others in an unreasonably harsh way. Because we know we couldn't do it, so we innately need a perfect savior. If not us, then our spouse or our kids. That's the great lie of perfection. When we hold onto our sin, we decay. But we can find true healing and joy in confessing our sins to God and to our brothers (see James 5:16).
Jesus came to save sinners, not sinners that try and appear perfect.
"Christ can and will save a man who has been dishonest, but He cannot save him while he is dishonest." – A.W. Tozer
Confess today and be freed from your shackles. Wear your mistakes like a red badge of courage, the blood soaked in your bandages is not your own, but from the One who healed you.
So go ahead.
Confess and get kicked out.
Confess and get grounded.
Confess and lose respect.
Confess and lose your job.
Confess and sleep on the couch.
Confess and be saved from your sin.
Confess and never be apart from the One who truly loves and truly forgives.


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What Are the Causes of Black Toenails in Ski Boots?
What Blackens Toenails?
Black toenails are a common enough injury among skiers that doctors refer to them as "skiers' toe." Although not as dramatic as other common ski injuries like ruptured knee ligaments, skier's toe can be painful enough to keep you off the slopes, and sometimes even lead to losing toenails.
What turns a toenail black is bleeding under the nail, or what doctors call a subungual hematoma. Either a single intense impact or small repeated traumas can cause blood vessels in your toe to rupture and bleed under your toenail. The pressure of the trapped blood increases the pain.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Check Your Boot Fit
A common cause of skier's toe is bad boot fit 1. If your boots are too tight in the toe area, they may put pressure on your toenail, causing bruising or bleeding under the nail. Boots that are too loose, or that have packed-out liners, are just as bad. If your foot is flopping around inside your boot, your toenails can get bruised from the impact of your toes banging into the boots, especially if you are skiing bumps or terrain parks. A boot fitter can adjust your boots to prevent toenail damage.
Improper Ski Technique
Sitting back on your skis not only throws you off balance and causes you to lose control, it can injure your toenails by forcing them up against the tops of your boots. Especially on advanced terrain, the solution is to keep your weight centered, maintaining forward pressure of your shins against your boots and keeping your heels set in the boots' heel pockets. If you are struggling with proper powder or mogul technique, investing an hour in a ski lesson could save your toenails.
Long Toenails
Long toenails act as a lever, intensifying the pressure of your boots against the nail beds. Do yourself a favor and clip long toe talons. Closely clipped toenails will reduce your chances of black toenails.
Treating Black Toenails
The sooner you treat black toenails, the faster they heal. If your entire toenail is black, go to a doctor immediately. She will burn a small hole in the nail to release to trapped blood, relieving pain and helping the toe heal. For minor bruising, apply ice for twenty minutes every hour to reduce swelling and bleeding.
- rankomm/iStock/Getty Images


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Angular routing plays an important role in a real-world application which is responsible for loading different components which may have sensitive data as well. Angular provides a full proof mechanism to develop an application which can add a protecting shield for accessing components.
Continue reading Angular 7/6 | Use Auth Guards CanActivate and Resolve in Angular Routing Quick Example


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Tax, title, license and dealer fees (unless itemized above) are extra. Not available with special finance or lease offers. Tax, title, license (unless itemized above) are extra. Not available with special finance, lease and some other offers.
• The Chevrolet Camaro is a reasonably-priced sports car that is enjoyable to drive.
• It comes in a number of different colors, trims, and custom packages, including the choice between convertible and coupe bodies.
• The Camaro has been outfitting American sports car enthusiasts with unmatched performance and design for more than 50 years.
• The Camaro Z71 can get from 0 to 60 in 3.5 seconds, and you can choose from four available powertrains with up to 455 horsepower.
Shop our inventory of new Chevrolet Camaros in Shreveport to decide on the trim, colors, and options that you're looking for. For additional information on a Camaro test drive, give us a call at 318-703-4452.
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When I rock pastels I like to have a palette to work with, and having up to at least two colors but a maximum of 3 like I did in this post here. I chose three colors that blended subtly but boldly and uniquely played with details using my accessories.
When I wear prints i like to go bold or I might as well not wear prints anywhere. Depending on the patterns, I like to stick with similar shades or a very neutral color to make the print piece stand out for me. The other big trick that works is mixing similar bold patterns like I have done in the post below. Now enjoy scrolling through 😀


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For fifteen years (2000-2014), my year-end Top 10 Albums list was published exclusively by the Philadelphia City Paper (RIP, 1981-2015). URB is its new home (at present).
2015 was a memorable year for music, but this is the digital age—hundreds of incredible songs, but as is the trend, the quality of actual full-length albums remains in decline.
There is no true No. 1 album of 2015, in my mock-humble opinion. Kendrick Lamar's TPAB is the cross-genre critic consensus, but Pusha T's late Q4 offering is trump-tighter, as far as hip-hop goes.
Here's my two bitcoins, as it were.


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Now more than ever, there is reason to be hopeful as we treat our patients' cancer. Our ability to use, in novel ways "old medicines" and the ever-expanding frontier of new cancer treatments - equip Virginia Cancer Specialists with the tools we need to fight for and alongside our patients.
Medical Oncologist
Medical Oncology
Georgetown University Hospital, Medical Oncology and Hematology
University of Pennsylvania
Georgetown University School of Medicine
Haverford College
Dr. Irwin's commitment to caring for and treating oncology and hematology patients led her to join the Loudoun Office of Virginia Cancer Specialists in 2008. She is a member of the American Society of Clinical Oncology and is a national clinical trials researcher. Dr. Irwin regularly lectures in the community for Life With Cancer, has educated the public on clinical trials for the Leukemia and Lymphoma Society, and has given multiple physician Grand Rounds at INOVA Loudoun Hospital to educate her peers on current oncology and hematology cases and developments.
A recognized expert in the fight against breast cancer, Dr. Irwin is part of the national U.S. Oncology Breast Cancer Research Committee, has been interviewed as a breast cancer specialist on television and in magazines, and is repeatedly called on to speak at charity events for breast cancer awareness and prevention.
Awarded multiple commendations for outstanding patient care, Dr. Irwin has a long-standing commitment to providing the best outcomes for her patients. She completed her Internal Medicine residency at the Hospital of the University of Pennsylvania in 2005, where she was awarded the University of Pennsylvania's Holmes Award in Patient Oriented Evaluative Research. Dr. Irwin went on to complete her Hematology/Oncology fellowship after returning to Georgetown University Hospital's Lombardi Cancer Center. Her research and clinical focus during fellowship was in breast cancer and she completed a Bone Marrow Transplant rotation at the National Cancer Institute in Bethesda, Maryland.
Virginia Cancer Specialists Collaborating with Caris Life Sciences to Present New Molecular Findings at the 2018 ASCO Annual MeetingRead More
New clinical data for chemotherapy drug administered in metastatic breast cancer co-presented by Dr. Amy Irwin of Virginia Cancer SpecialistsRead More
Phase II Study of Eribulin Mesylate Administered Biweekly in Patients With Human Epidermal Growth Factor Receptor-2–negative Metastatic Breast CancerRead More


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- Page 1 Philips AJ300D iPod/GoGear Clock Radio Review
- Page 2 Philips AJ300D iPod/GoGear Clock Radio Review
- Page 3 Philips AJ300D iPod/GoGear Clock Radio Review
Towards the top is a largish blue backlit LCD screen. The backlight can be turned dimmed or turned off by pressing the Snooze button that sits at the top, or 'Repeat Alarm' as Philip calls it. Once set, the time and date is displayed large and cleanly, along with indicators for whether the two alarms are active.
Set flush in each corner are buttons for setting the two alarms – just hold down and wait for the beep. Adjustments to set the time and the alarms are made by the rather small buttons set round the dock. Also located here are buttons for switching between the tuner, the auxiliary input and the dock.
There are a number of buttons running down the sides as well. On the left is the power button, beneath this is the button for setting the time and underneath this there's a slider switch for choosing whether you want to wake up to music from the dock, the tuner or a buzzer. The latter two ensure this is still useful as an alarm without an iPod or GoGear present. The five buttons running down the right hand side are presets for the FM tuner.
Adding to the sense that this is a complete product is a small but smart remote control. The main Play/Pause button has a shiny silver surround and it also sports a Mute button, which isn't present on the body of the main unit. As you might expect you can skip tracks on your player with the remote and move between radio stations. The remote felt good in the hand and the buttons, while rubbery were better than some. Unfortunately, the main Play/Pause on our remote stopped responding, which was a shame – the others were all fine though.
While I was impressed by the look, feel and ease of use I wasn't expecting too much in terms of sound quality – it's just a clock radio after all. However, I was pleasantly surprised. It's rated at 12W RMS – 6W per speaker. I was surprised to find that there are actually two speakers behind the grille, so it is technically stereo, even though they're so close together it's virtually mono. However, by having two speakers it does make the sound output truer to the source.
Unlike other sites, we thoroughly test every product we review. We use industry standard tests in order to compare features properly. We'll always tell you what we find. We never, ever accept money to review a product. Tell us what you think - send your emails to the Editor.


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When Mr. Singh was questioned as to why, till date, none of the representatives of the Congress Party had visited the slum area, he assured that he would personally visit the demolition site tomorrow. Tougher questions await Mr. Singh tomorrow from all the people.
Expressing solidarity with the struggle, Ulka Mahajan from Anti-SEZ Movement, Raigad visited the dharna site today and lamented the fact that farmers and labourers from villages are being displaced and forced to migrate to urban areas, where they are being further bulldozed and evicted. It is in this context a moot question arises as to "Where should these lakhs of working class people, who contribute to the nation's progress go?"
It is notable that Member of Parliament, Shri. Sanjay Dina Patil, again visited the dharna site today and reiterated his support to the demand and struggle of slum dwellers. The Andolan has also received support from Major General (Retd.) Shri S.G. Vombatkere (NAPM-Karnataka) who wrote strong letters to the Prime Minister, Sonia Gandhi and the Chief Minister asserting that human rights and social justice must always be a non-negotiable part of the political processes of governance. Vombatkereji's statement that that 'the timing is especially cruel and devilish because it is the height of the summer and these people, especially children and the aged, are out in the open, while we watch cricket matches on TV in our comfortable homes", should make 'Urban India' think and re-think on how much it contributes to the plight of the toiling masses and how honestly it stands by the poor when in such times of distress.
Branding the ruthless demolition and burning of the hutments in Sathenagar as "assault on the Constitution and human life", veteran lawyer and human rights activist from Dhule Shri Nirmalkumar Suryavanshi assert that 'every citizen has right to stay on 'Indian Soil' and no government or political party can date violate this right. Senior labour and women's rights activist D. Gabriele from Tamil Nadu also conveyed the message of solidarity from the thousands of slum-dwellers in Chennai whose are facing the brunt of evictions as their Mumbai counter-parts in the name of 'urban renewal', but are also
posing a major challenge to the State through their organized strength. News has also come that a solidarity dharna, morcha and public meeting was organized in the cities of Pune and Aurangabad today, support of the slum dwellers.
Shramdaan began at Sathenagar today with all the people coming together in a spirit of camaraderie to re-build their ravaged houses. For the last 3 days, medical services are being provided by the medical staff of Apnalaya and Tath organisations. Further, the issue to loss of educational material of the school
going children is also being taken up by the Andolan.
Siraj Ahmed, Sumit Wajale, Sushila Patel, Medha Patkar
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Mumbai slum dwellers gherao MPCC President: Struggle continues
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