text:
Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial
- Narcís Gusi1Email author and
- Pablo Tomas-Carus2
DOI: 10.1186/ar2377
© Gusi and Tomas-Carus; licensee BioMed Central Ltd. 2008
Received: 30 September 2007
Accepted: 22 February 2008
Published: 22 February 2008
Physical therapy in warm water has been effective and highly recommended for persons with fibromyalgia, but its efficiency remains largely unknown. Should patients or health care managers invest in this therapy? The aim of the current study was to assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia.
Costs to the health care system and to society were considered in this study that included 33 participants, randomly assigned to the experimental group (n = 17) or a control group (n = 16). The intervention in the experimental group consisted of a 1-h, supervised, water-based exercise sessions, three times per week for 8 months. The main outcome measures were the health care costs and the number of quality-adjusted life-years (QALYs) using the time trade-off elicitation technique from the EuroQol EQ-5D instrument. Sensitivity analyses were performed for variations in staff salary, number of women attending sessions and time spent going to the pool. The cost effectiveness acceptability curves were created using a non-parametric bootstrap technique.
The mean incremental treatment costs exceeded those for usual care per patient by € 517 for health care costs and € 1,032 for societal costs. The mean incremental QALY associated with the intervention was 0.131 (95% CI: 0.011 to 0.290). Each QALY gained in association with the exercise programme cost an additional € 3,947/QALY (95% CI: 1,782 to 47,000) for a health care perspective and € 7,878/QALY (3,559 to 93,818) from a societal perspective. The curves showed a 95% probability that the addition of the water-based programme is a cost-effective strategy if the ceiling of inversion is € 14,200/QALY from a health care perspective and € 28,300/QALY from a societal perspective.
The addition of an aquatic exercise programme to the usual care regime for fibromyalgia in women is cost effective in terms of both health care costs and societal costs. However, the characteristics of facilities (distance from the patients' homes and number of patients that can be accommodated per session) are major determinants to consider before investing in such a programme.
Trial registration
Current controlled trials ISRCTN53367487.
Fibromyalgia (FM) is a chronic disorder of widespread pain in combination with tenderness of at least 11 of 18 specific tender points [1]. FM affects approximately 2–3% of the general population, and more than 90% of patients are female [2–4]. The average yearly cost (updated to 2005 using a 5% annual inflation) for service utilization among patients with FM is approximately € 4,500, and the societal cost is € 8,960 [5]. These costs are largely due to the frequent use of medical services such as consultations (approximately 10 per year) and medication, and the health system and societal expenses of disability from work [2, 3]. Patients with FM consume health care resources to a similar extent as patients with other chronic diseases such as diabetes mellitus and hypertension [6]. Patients with FM also incur about twice the health care costs as the general population [7], and are absent from work approximately twice as much as other employees [8].
Studies reported in scientific literature have demonstrated evidence of the benefits of physical therapy on health-related quality of life and fitness [9, 10]. In particular, physical exercise in warm water has been effective in short-term programmes (less than 6 months) and is highly recommended to reduce pain and minimize mechanical impact during exercise [11–15]. However, in our earlier study of patients with FM we found that most of the gains in health-related quality of life and physical fitness achieved in 12 weeks of water-based exercise were lost after a subsequent similar period of physical inactivity [11, 16]. These findings suggest the need for longer programmes or maintenance programmes, but the effectiveness of such programmes remains unknown.
These programmes must be considered in light of limited health system resources. Health system managers or decision-makers frequently select the treatment strategies based on the lowest cost per quality-adjusted life-year (QALY). Cost utility is the ratio of the incremental effectiveness of one strategy compared to another (e.g. standard medical practice), and is measured in QALYs divided by the incremental cost. To our knowledge, there is no cost-utility or cost-effectiveness study of these exercise programmes for patients with FM.
Cost-effectiveness may be studied from a health service perspective by including the costs to the health care system or from a societal perspective by adding to the health care costs those borne by the patients and society. These additional societal costs include time spent, travel costs, lost work hours, etc. The approach from a health service perspective can help inform decisions about adding services to the current health care system.
The purpose of this study was to assess the cost utility of adding an 8-month, supervised, warm water exercise programme to the usual care of Public Health Service for women with FM.
Materials and methods
Study design
Socio-demographic characteristics of females with fibromyalgia at baseline
Exercise group
Control group
p Value
Age (years)a
50.7 (10.6)
50.9 (6.7)
Body mass index (kg/m2)a
28.8 (4.5)
26.6 (3.5)
Duration of symptoms (years)a
20.1 (8.0)
19.4 (6.9)
Number of tender points (1 to 18 points)a
16.9 (1.8)
17.2 (1.3)
Number of specific drugs (anti depressives, muscular relaxants, analgesics)a
1.3 (0.8)
1.5 (0.8)
Employment status, n (%):b
Blue collar
8 (53.3)
6 (40.0)
White collar
2 (13.3)
3 (20.0)
5 (33.3)
6 (40.0)
Education level, n:b
Unfinished studies
1 (6.7)
1 (6.7)
Primary school
9 (60.0)
6 (40.0)
Secondary school
1 (6.7)
6 (40.0)
University degree
4 (26.7)
2 (13.3)
Usual care and the addition of a water-based exercise programme were compared in the CG and EG, respectively. The usual care included standard medical attention in the public system (hospital and outpatient clinic including primary care) and the social support of the local FM association. This care could be considered the average standard of care or better for patients with FM.
The intervention added an exercise programme in a in a waist-high pool of warm water (33°C). A qualified exercise leader instructed and trained the intervention group three times a week for 1 h per session over a period of 8 months. Each session included 10 min of warming up with slow walking and easy movements of progressive intensity, 10 min of aerobic exercises at 60–65% of maximal heart rate, 20 min of overall mobility and lower limb strength exercises using water resistance, another set of 10 min of aerobics at 60–65% of maximal heart rate, and 10 min of cooling down with low intensity exercises. Heart rate was monitored using a pulse meter (Polar Accurex Plus, Kempele, Finland). During this 8-month period participants in the control group continued their daily activities, which did not include any form of physical exercise similar to that in the programme. This programme was designed without reference to any explicit behavioral model or theory, and was intended as a pragmatic intervention that could be easily organized for a large population.
Data collection
Participants completed questionnaires, including the EuroQol EQ-5D health status instrument [17] at the beginning of the programme and after 3 and 8 months. During the same period, private and public health care was recorded, including hospital stays, drug usage, secondary and primary care appointments.
Unit costs
The expense and time needed for travel from the patient's residence to the rehabilitation pool varied, because this facility is a scarce health resource serving a large area. To allow for a range in such additional costs, we performed two economic analyses, one from a health service perspective and another from a societal perspective. The first perspective is recommended by the National Institute for Clinical Excellence (NICE) in the UK to inform decisions on health care policy for an expensive condition. This perspective could help to decide whether to finance the addition of the programme to the health system. The second perspective is recommended to consider the combination of the burden to the patient and the health care system. The unit costs are expressed in Euros (€) based on prices in 2005.
Costs were not adjusted or discounted for changes in currency value over time, as we focused solely on effects over less than 1 year. The programme's cost was calculated based on the following: salaries at the level for a university graduate, cost of staff to run the programme, salaries at minimum wage for the patient's time (based on the 2005 official bulletin of the regional government), cost of renting a pool at a university at public prices without a grant, public bus prices, and private external management costs of the programme (insurance, monthly retrievals from patients and withdrawals to employees). Health care prices (consultations, etc.) were based on the 2005 official bulletin of the regional government. Drug prices were obtained from the Spanish version of Vademecum International [18].
Health outcomes
The EQ-5D [17] was used to assess five dimensions of health related quality of life: (1) mobility, (2) self-care, (3) daily activities, (4) pain and discomfort, and (5) anxiety or depression. The scale for each dimension is from 1 to 3 (with 1 no problems, 2 some problems, and 3 extreme problems). Using a combination of these dimensions, a total of 243 possible health states exist. Each health state has been previously defined using the time trade-off method of utility analysis based on the response of a sample of the Spanish population [19]. This total score of utility was scaled from 1 = fully functional quality of life to 0 = death. The quality-adjusted life years (QALYs) that participants experienced over the 8-month period were estimated by calculating areas under health utility curves [20]. To avoid bias, data were adjusted by regression analysis for differences in baseline EQ-5D scores [21].
Cost utility analysis
First, we estimated the incremental mean costs of the water-based programme and the mean QALYs added by the programme from a health care and societal perspective. Secondly, the incremental cost effectiveness ratio for the water-based programme was calculated by dividing the incremental costs by incremental QALYs.
To report the uncertainty due to sampling variation, we calculated the 95% confidence interval using the non-parametric bootstrapping technique (1,000 replicates re-sampled with replacement from treatment and control populations) and plotted a cost effectiveness acceptability curve [22, 23]. This curve shows the probability that the intervention is cost effective compared with the alternative, across the range of values that decision makers are willing to pay to achieve an additional QALY. The "investment ceiling" is the level of spending that should not be exceeded, even assuming unlimited funding availability. For the health care system in Spain, the 2005 adjusted investment ceiling was set at € 34,729/QALY [24]. Decision makers should compare this upper limit of acceptable payment with estimated incremental cost effectiveness ratios to determine whether a given treatment is cost effective relative to the alternatives.
For the health system and societal perspectives, seven sensitivity analyses were performed to explore the robustness of the estimates and how dependent the results were on estimates of participants' unit costs and efficacy. From the health system perspective, the first analysis examined the influence of participation rate in the programme as this could influence the productivity by affecting the number of participants per unit of time provided by the technician. A second analysis explored the variations due to the salary changes of the technician, since this is a major source of variability in economic studies [25]. From a societal perspective, in addition to two previous analyses the third analysis estimated the cost of increasing the mean distance (in terms of time spent and the number of bus tickets purchased) from the patient's residence to the rehabilitation pool. Finally, from both perspectives, the robustness of cost effectiveness was examined by exploring scenarios combining the influence of the variations in staff salary, rate of participation, distance to the facility and effectiveness, from the lowest to the highest limit of the 95% confidence interval.
Incremental cost of the exercise programme compared to usual care
Over 8 months (€)
Total (€)
Health system costs:
Sport technician
€ 9/h
€ 6.5/h
Insurances and prevention
€ 350
Facilities (renting pool and safeguards)
€ 55/h
€ 24/month
Medication (total health system perspective)c
Drug price
Additional societal costs:
Time spent in therapy
€ 2.15/h
Time spent in displacements and clothing
€ 2.15/h
Travel costs (bus tickets)
€ 0.5/ticket
Sub-total, societal additional costs
Total societal (additional costs and health system costs)
Cost-utility analyses
Usual care
Usual care plus exercise
EQ-5D utility at baselinea
0.331 (0.150 to 0.511)
0.316 (0.162 to 0.470)
EQ-5D utility at 3 monthsa
0.334 (0.175 to 0.494)
0.582 (0.434 to 0.729)
EQ-5D utility at 8 monthsa
0.334 (0.175 to 0.493)
0.528 (0.380 to 0.675)
QALY over 8 monthsb
0.002 (-0.087 to 0.091)
0.133 (0.034 to 0.231)
QALY difference vs. usual carec
0.131 (0.011 to 0.290)
Health system perspective:
Incremental cost/person (€)
Cost-utility (€/QALY)c
3,947 (1,782 to 47,000)
Societal perspective:
Incremental cost/person (€)
Cost-utility (€/QALY) ‡
7,878 (3,559 to 93,818)
Health outcome
Table 3 shows that the water-based programme was associated with a greater increase in the EQ-5D utilities than the usual care during the first 3 months and this difference was preserved during the subsequent 5 months.
Cost utility analysis
From a societal perspective, the mean cost per QALY was € 7,878/QALY and there is a 95% probability that the addition of the aquatic training is cost effective if the ceiling of inversion is € 28,300/QALY. A 97.5% probability requires an inversion higher than € 42,000/QALY.
Sensitivity analysis
Sensitivity analyses by treatment group
Manipulation of variables
Incremental cost versus usual care per person (€)
Cost utility ratioa (€/QALY)
Health system analysis:
Number of participants per pool session:
30% lower (10 patients/group)
30% higher (20 patients/group)
Salary of personnel:
30% lower (monitor and nurse)
30% higher (monitor and nurse)
No additional salary of nurse
Best case scenario of salary, participation and effectivenessb
Worst case scenario of salary, participation and effectiveness v
Societal analysis:
Number of participants per pool session:
30% lower (10 patients/group)
30% higher (20 patients/group)
Salary of personnel:
30% lower (monitor and nurse)
30% higher (monitor and nurse)
No additional salary of nurse
Distance to facilities per session:
Near (without bus ticket and 1.5 h spent)
Far (4 bus ticket and 2.5 h spent)
Best case scenario of salary, participation, effectiveness and nearb
Worst case scenario of salary, participation, effectiveness and farc
Principal findings
Previous studies reported the efficacy of aquatic training on patients with fibromyalgia [11–15, 26, 27] and the cost-utility of a 2.5 week spa treatment [28], but to our knowledge the present study is the first to report cost-utility. The major finding of this study was that the water-based programme was a cost-effective addition to usual care from both health system and societal perspectives. More precisely, an investment in this aquatic training for a similar population (sedentary women with FM) has a greater than 95% probability of being efficient according to the investment ceiling in Spain.
Strengths and weakness
The acceptable efficiency threshold, investment ceiling or maximum willingness to pay for each gained QALY varies among countries or societies because of differences in salaries, priorities, etc. The current study applied the commonly lower threshold of € 34,729 (€ 23,153 for 8 months) used in the Spanish literature [24], but similar conclusions about the efficiency of the addition of aquatic training to usual care could be achieved using the threshold updated to year 2005 (annual inflation of 5%) often reported in American literature ($ 50,000 to $ 60,000) or Dutch literature (€ 28,940) [29].
The retention rate of patients in the our programme (88%) was similar to rates previously reported in community group-based exercise programmes in fibromyalgia (70–90%); however, aquatic training programmes usually report lower retention rates (55–75%) [9]. The social support provided by physicians, research teams, and peers with FM from the local association may have contributed to this high retention rate and the improvement in the psychosocial dimensions of health related quality of life and QALY in the exercise group. Particularly, the patient's affiliation with the local FM association brought them additional care (social support, information, etc.) in comparison to what is offered by the Public Health Care System. In this sense, the care received by the control group could be considered better than usual. By contrast, care that combines the study programme with other therapies may be even better than the programme alone. This issue could not be addressed in the current study because patients were excluded if they used other therapies (standardized behavioral or physical therapies such as massages, etc.).
The small sample size led us to use non-parametric bootstrapping techniques to treat the confidence intervals and probability curve. Health economists recommend bootstrapping techniques, rather than standard deviation-based methods, for treating the uncertainty of cost-effectiveness ratios [22, 23, 30–33]. The small sample, the fact that subjects were self-selected according to bioethics requirements and the catchment throughout local patient associations may limit the generalization of our findings to treatment of less motivated patients.
Use of health care
The current study did not find any evidence for decreased use of health care services during the study period. However, the lack of change in the ratio of frequency (consultations/month) can be explained partially by the limits of supply and the management of free appointments in the general practices of the National Health System in Spain. A study in a non-limited supply setting could address the question of whether an aquatic programme could reduce the use of other health care services.
The increase in the medication cost in both groups may be partly explained because the perception of pain is slightly increased in the summer in persons with fibromyalgia [34]; with a change in the average temperature in Extremadura from 14°C at baseline to 22°C at the end of programme.
By contrast, the aquatic training in facilities with warm water was a cost-effective addition to usual care but it was not compared to other physical therapies that could reduce geographic inequalities (e.g., land-based therapies such as low-impact aerobics, walk-based exercise, tai chi, etc.) because their facilities are cheaper and easier available in more municipalities.
An 8-month aquatic training programme is a cost-effective addition to the usual care provided by the Public Health System. This programme enhances the health-related quality of life in women with FM. However, the characteristics of facilities (distance from patients' homes and the number of patients that can participate per session) are major determinants that have to be considered before a health manager decides to invest in such a programme.
List of abbreviations
= control group
= exercise group
= fibromyalgia
= quality-life adjusted-years.
Thanks to Yolanda Garcia for her technical support as research assistant. The study was supported by the European Social Funds and the Government of Extremadura, Spain (2PR02B017 and Health Department).
Authors' Affiliations
- Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA, Hamaty D, Lessard J, Lichtbroun AS, Masi AT, Mccain GA, Reynolds WJ, Romano TJ, Russell IJ, Sheon RP: The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990, 33: 160-172. 10.1002/art.1780330203.View ArticlePubMedGoogle Scholar
- Wolfe F, Anderson J, Harkness D, Bennett RM, Caro XJ, Goldenberg DL, Russell IJ, Yunus MB: A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia. Arthritis Rheum. 1997, 40: 1560-1570. 10.1002/art.1780400904.View ArticlePubMedGoogle Scholar
- Carmona L, Ballina J, Gabriel R, Laffon A: The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis. 2001, 60: 1040-1045. 10.1136/ard.60.11.1040.PubMed CentralView ArticlePubMedGoogle Scholar
- White KP, Speechley M, Harth M, Ostbye T: The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. J Rheumatol. 1999, 26: 1570-1576.PubMedGoogle Scholar
- Boonen A, van den Heuvel R, van Tubergen A, Goossens M, Severens JL, van der Heijde D, van der Linden S: Large differences in cost of illness and wellbeing between patients with fibromyalgia, chronic low back pain, or ankylosing spondylitis. Ann Rheum Dis. 2005, 64: 396-402. 10.1136/ard.2003.019711.PubMed CentralView ArticlePubMedGoogle Scholar
- Doron Y, Peleg R, Peleg A, Neumann L, Buskila D: The clinical and economic burden of fibromyalgia compared with diabetes mellitus and hypertension among Bedouin women in the Negev. Fam Pract. 2004, 21: 415-419. 10.1093/fampra/cmh411.View ArticlePubMedGoogle Scholar
- White KP, Speechley M, Harth M, Ostbye T: The London Fibromyalgia Epidemiology Study: direct health care costs of fibromyalgia syndrome in London, Canada. J Rheumatol. 1999, 26: 885-889.PubMedGoogle Scholar
- Kivimaki M, Leino-Arjas P, Kaila-Kangas L, Virtanen M, Elovainio M, Puttonen S, Keltikangas-Jarvinen L, Pentti J, Vahtera J: Increased sickness absence among employees with fibromyalgia. Ann Rheum Dis. 2007, 66: 65-69. 10.1136/ard.2006.053819.PubMed CentralView ArticlePubMedGoogle Scholar
- Koulil SV, Effting M, Kraaimaat FW, Lankveld WV, Helmond TV, Cats H, van Riel P, de Jong A, Haverman J, Evers A: A review of cognitive behaviour therapies and exercise programmes for fibromyalgia patients: state of the art and future directions. Ann Rheum Dis. 2006, doi:10.1136/ard.2006.054692Google Scholar
- Mannerkorpi K: Exercise in fibromyalgia. Curr Opin Rheumatol. 2005, 17: 190-194. 10.1097/01.bor.0000154202.56962.85.View ArticlePubMedGoogle Scholar
- Gusi N, Tomas-Carus P, Hakkinen A, Hakkinen K, Ortega-Alonso A: Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with fibromyalgia. Arthritis Rheum. 2006, 55: 66-73. 10.1002/art.21718.View ArticlePubMedGoogle Scholar
- Jentoft ES, Kvalvik AG, Mengshoel AM: Effects of pool-based and land-based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain. Arthritis Rheum. 2001, 45: 42-47. 10.1002/1529-0131(200102)45:1<42::AID-ANR82>3.0.CO;2-A.View ArticlePubMedGoogle Scholar
- Altan L, Bingol U, Aykac M, Koc Z, Yurtkuran M: Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int. 2004, 24: 272-277. 10.1007/s00296-003-0371-7.View ArticlePubMedGoogle Scholar
- Assis MR, Silva LE, Alves AM, Pessanha AP, Valim V, Feldman D, Neto TL, Natour J: A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia. Arthritis Rheum. 2006, 55: 57-65. 10.1002/art.21693.View ArticlePubMedGoogle Scholar
- Redondo JR, Justo CM, Moraleda FV, Velayos YG, Puche JJ, Zubero JR, Hernandez TG, Ortells LC, Pareja MA: Long-term efficacy of therapy in patients with fibromyalgia: a physical exercise-based program and a cognitive-behavioral approach. Arthritis Rheum. 2004, 51: 184-192. 10.1002/art.20252.View ArticlePubMedGoogle Scholar
- Tomas-Carus P, Hakkinen A, Gusi N, Leal A, Hakkinen K, Ortega-Alonso A: Aquatic training and detraining on fitness and quality of life in fibromyalgia. Med Sci Sports Exerc. 2007, 39: 1044-1050. 10.1249/01.mss.0b0138059aec4.View ArticlePubMedGoogle Scholar
- Herdman M, Badia X, Berra S: EuroQol-5D: a simple alternative for measuring health-related quality of life in primary care. Aten Primaria. 2001, 28: 425-430.View ArticlePubMedGoogle Scholar
- Vademecum. [http://www.vademecum.es]
- Badia X, Roset M, Montserrat S, Herdman M, Segura A: The Spanish version of EuroQol: a description and its applications. European Quality of Life scale. Med Clin (Barc). 1999, 112 (Suppl 1): 79-85.Google Scholar
- Matthews JN, Altman DG, Campbell MJ, Royston P: Analysis of serial measurements in medical research. BMJ. 1990, 300: 230-235.PubMed CentralView ArticlePubMedGoogle Scholar
- Manca A, Hawkins N, Sculpher MJ: Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ. 2005, 14: 487-496. 10.1002/hec.944.View ArticlePubMedGoogle Scholar
- Fenwick E, Byford S: A guide to cost-effectiveness acceptability curves. Br J Psychiatry. 2005, 187: 106-108. 10.1192/bjp.187.2.106.View ArticlePubMedGoogle Scholar
- Willan AR: On the probability of cost-effectiveness using data from randomized clinical trials. BMC Med Res Methodol. 2001, 1: 8-10.1186/1471-2288-1-8.PubMed CentralView ArticlePubMedGoogle Scholar
- Sacristan JA, Oliva J, Del Llano J, Prieto L, Pinto JL: What is an efficient health technology in Spain?. Gac Sanit. 2002, 16: 334-343.View ArticlePubMedGoogle Scholar
- Sevick MA, Dunn AL, Morrow MS, Marcus BH, Chen GJ, Blair SN: Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults: results of project ACTIVE. Am J Prev Med. 2000, 19: 1-8. 10.1016/S0749-3797(00)00154-9.View ArticlePubMedGoogle Scholar
- Mannerkorpi K, Ahlmen M, Ekdahl C: Six- and 24-month follow-up of pool exercise therapy and education for patients with fibromyalgia. Scand J Rheumatol. 2002, 31: 306-310. 10.1080/030097402760375223.View ArticlePubMedGoogle Scholar
- Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C: Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. J Rheumatol. 2000, 27: 2473-2481.PubMedGoogle Scholar
- Zijlstra TR, Braakman-Jansen LM, Taal E, Rasker JJ, van de Laar MA: Cost-effectiveness of Spa treatment for fibromyalgia: general health improvement is not for free. Rheumatology (Oxford). 2007, 46: 1454-1459. 10.1093/rheumatology/kem157.View ArticleGoogle Scholar
- van den Hout WB, Tijhuis GJ, Hazes JM, Breedveld FC, Vliet Vlieland TP: Cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis: a randomised comparison of clinical nurse specialist care, inpatient team care, and day patient team care. Ann Rheum Dis. 2003, 62: 308-315. 10.1136/ard.62.4.308.PubMed CentralView ArticlePubMedGoogle Scholar
- Coupe VM, Veenhof C, van Tulder MW, Dekker J, Bijlsma JW, van den Ende CH: The cost-effectiveness of behavioural graded activity in patients with osteoarthritis of hip and/or knee. Ann Rheum Dis. 2006, doi:10.1136/ard.2006.054478Google Scholar
- Briggs A, Fenn P: Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane. Health Econ. 1998, 7: 723-740. 10.1002/(SICI)1099-1050(199812)7:8<723::AID-HEC392>3.0.CO;2-O.View ArticlePubMedGoogle Scholar
- Lothgren M, Zethraeus N: Definition, interpretation and calculation of cost-effectiveness acceptability curves. Health Econ. 2000, 9: 623-630. 10.1002/1099-1050(200010)9:7<623::AID-HEC539>3.0.CO;2-V.View ArticlePubMedGoogle Scholar
- Epps H, Ginnelly L, Utley M, Southwood T, Gallivan S, Sculpher M, Woo P: Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis. Health Technol Assess. 2005, 9: iii-iv. ix-x, 1–59.View ArticlePubMedGoogle Scholar
- Hawley DJ, Wolfe F, Lue FA, Moldofsky H: Seasonal symptom severity in patients with rheumatic diseases: a study of 1,424 patients. J Rheumatol. 2001, 28: 1900-1909.PubMedGoogle Scholar
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Web Stories
Glover to deliver Tanner Lectures on Human Values, Feb. 12-13
Posted February 6, 2003; 05:23 p.m.
Humanism in Psychiatry" will be the theme of the two Tanner Lectures on Human Values to be delivered at 4:30 p.m. Wednesday and Thursday, Feb. 12-13, in McCosh 10. Jonathan Glover, professor of ethics and director of the Centre for Medical Law and Ethics at King's College London, will present the talks.
Glover's most recent book is titled "Humanity: A Moral History of the 20th Century." He has also edited "Women, Culture and Development: A Study of Human Capabilities" (with Martha Nussbaum) and "Utilitarianism and Its Critics."
More information on the lectures and the four scholars who will deliver commentaries is available online .
The lectures are sponsored by the University Center for Human Values . Each lecture will be followed by a reception at Prospect House. For more information, call (609) 258-4798 or e-mail the center .
Contact: Tom Bartus(609) 258-3601

subset: commoncrawl


text:
Web Stories
South East Asia Society presents 'Binds,' April 11-13
Posted April 8, 2002; 01:45 p.m.
The South East Asia Society presents "Binds" at 8 p.m. Thursday through Saturday, April 11-13 in Wilson Blackbox. A matinee performance will be held at 2 p.m. Saturday, April 13. The play is presented in conjunction with Asian Pacific American Heritage Month.
"Binds" is written and directed by Frankie Ng. It is a story about three women ghosts trapped in a toilet on the third floor of St. Nicholas Girls' Secondary School in Singapore. Caught between God and Satan, Buddha and Mara, destiny and nothing, they struggle to remember their pasts and to come to terms with how they are bound by forces of society, religion and fate.
Tickets are $5 and can be purchased by calling the Frist Ticket Office at 258-1742 or e-mail Xiuhui Lim .
This event is sponsored by the Third World Center , SHARE , Department of East Asian Studies , International Center , Department of Anthropology and the Department of English .
Contact: Marilyn Marks (609) 258-3601


text:
I realized that the JP account was needed ONLY to allow access to their MarketPlace where you can initially download the demo. That is all you need on your HDD.
Afterwards, just creating another (non-JP) account on that same console, still has that JP demo show up in your Recent Games menu.
Launch! >>>> another code!
Haven't tried it in a week or so but I know certain LIVE areas were down the other morning/late night -- the day of the big Minecraft Update.
Update: Still works for me!
Yeah, i tried it again for myself and it was not working. Looked at how many "New" accounts I had on the Xbox, erased the "New" ones and tried again......worked perfectly.
Looks like you can only have a certain amount of accounts on a Xbox at a time doing this method. If anyone knows otherwise, please fill us in.


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The Cumberland near Selfridges
In 1909 Gordon Selfridge opened a store in London which was to put Oxford Street on the world retail map. A lot may have changed over the last 100 years, but Selfridges has remained at the heart of the West End shopping experience. The Cumberland Hotel is two minutes away from the neaby Selfridges London and is an ideal central location for any shopping trip.
Among hotels near Selfridges, the luxury Cumberland Hotel offers the finest in hotel room services at affordable luxury prices. Located at Oxford Street and Marble Arch, The Cumberland is perfectly located for shopping trips to Selfridges, with the hotel only a few minute walk from the store.
Discover the Selfridges shopping experience and the top hotel deals from The Cumberland Hotel - our best available rates online are guaranteed!
The Cumberland Hotel
Distance: 0.1 miles
Located at the Marble Arch end of Oxford Street, The Cumberland Hotel is ideally located for exploring the Selfridges shopping experience. Take a break from shopping and enjoy lunch or dinner at The Cumberland's Rhodes W1 brasserie, Rhodes W1 Michelin star restaurant or have a drink at the Carbon bar.


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Release Date. 15/10/12
Catalogue Number. BDDNL216
Amon Tobin marches to no one's beat but his own. In a career spanning over ten years he has been connected to but never belonged to a host of scenes and styles. He has consistently made the music he feels he needs to make, not what other people think he ought to make, always exhibiting a level of attention to sonic detail which makes his music more intensely textured, beautiful and brutal than almost anyone's out there.
Make no mistake – Stunt Rhythms is about beats and bass, and nowhere is that made clearer than in the form of this double A-side single. "Sweden"s thunderous bass rolls in like evil-looking weather fronts, its glacial synths breaking through like welcome shafts of light. Full of purpose and addictive funk, it's the perfect intro to the Stunt Rhythms album.
"Razorback" comes on like a whole new soundtrack for an as-yet-uninvented future pop-locking. Its infectious glitches, stabs and sub bass develop in intensity, making the listener want more, and feel intensely satisfied when more is given.
If you imagine Mantronix as a Kenworth K100 truck, Two Fingers is what happens when the truck turns into Optimus Prime.


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Toggle: English / Spanish
Cyanotic heart disease is a heart defect, present at birth (congenital), that results in low blood oxygen levels. There may be more than one defect.
Right-to-left cardiac shunt; Right-to-left circulatory shunt
Normally, blood returns from the body and flows through the heart and lungs.
Heart defects that children are born with can change the way blood flows through the heart and lungs. This abnormal blood flow is called shunting.
Many of these heart defects involve the heart valves. Heart valves are found between the heart and the large blood vessels that bring blood to and from the heart. These valves open up enough for blood to flow through. Then they close, keeping blood from flowing backward.
Heart valve defects that can cause cyanosis include:
Other heart defects that may cause cyanosis include:
Cyanotic heart diseases may be caused by:
Some heart defects cause major problems right after birth. Others cause few, if any, problems until adulthood.
One symptom is cyanosis, which usually seen as a bluish color of the lips, fingers, and toes. It may occur while the child is resting, or only when the child is active.
Some children have breathing problems (dyspnea). They may get into a squatting position after physical activity to relieve breathlessness.
Others have spells, in which their bodies are suddenly starved of oxygen. During these spells, symptoms may include:
Infants may get tired or sweat while feeding and may not gain as much weight as they should.
Fainting (syncope) and chest pain may occur.
Other symptoms depend on the type of cyanotic heart disease, and may include:
The doctor will listen to the heart and lungs with a stethoscope. Abnormal heart sounds, a heart murmur, and lung crackles may be heard.
Tests will vary depending on the cause, but may include:
Some infants may need to stay in the hospital after birth so they can receive oxygen or be put on a breathing machine. They may receive medicines to:
The treatment of choice for most congenital heart diseases is surgery to repair the defect. There are many types of surgery, depending on the kind of birth defect. Surgery may be needed soon after birth, or it may be delayed for months or even years.
Your child may need to take water pills (diuretics) and other heart medicines before or after surgery. Be sure to follow the correct dosage. Regular follow-up with your doctor is important.
Many children who have had heart surgery must take antibiotics before, and sometimes after having any dental work or other medical procedures. Make sure you have clear instructions from your child's heart doctor. It is very important to have your child's teeth cleaned regularly.
Ask your child's doctor before getting any immunizations. However, most children can follow the recommended guidelines for childhood vaccinations.
The outlook depends on the specific disorder.
Complications of cyanotic heart disease include:
Call your health care provider if your baby has:
Women who are pregnant should get good prenatal care.
Some inherited factors may play a role in congenital heart disease. Many family members may be affected. If you are planning to get pregnant, talk to your health care provider about screening for genetic diseases.
Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Zipes DP, Libby P, Bonow RO, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 11th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 65.
Bernstein D. Cyanotic congenital heart disease: Evaluation of the critically ill neonate with cyanosis and respiratory distress. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 423.
Perloff JK, Child JS, AboulHosn JA. Congenital Heart Disease in Adults. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch)
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Now that we can count our posts again, many are being called (and very possibly are) "post padders."
Shame we've survived so long without being counted and as soon as we count again we immediately try to build up our posts to the highest point.
Oh well...tis the way of life I suppose, but lets not let it get out of hand. We have enough rivalrys lets not let the post number get in the way.
"Are you now or have you ever been a post padder?"


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Clay County is a large underwritten municipality with the county seat located in West Point, Mississippi. They have 93 employees with benefits through Blue Cross & Blue Shield of Mississippi. They have been a Healthy Workplace group since October 2011. In their first year as a Healthy Workplace, the group displayed a great deal of enthusiasm. They have a wellness champion that is on board to ensure all employees have the ability to participate in worksite wellness activities and also have a dedicated team of department heads. They had 75 percent participation in the Personal Wellness Profile in 2011 and 55 percent in 2012.
Business Challenge
The greatest challenge Clay County employees face is dedicating the time to focus on their health. The majority of the employees are shift workers with various workday hours. There are several employees that work night shifts and it becomes a challenge to actively participate in some of the wellness programs offered to the employees who work day shifts.
The Solution
In 2011, a Personal Wellness Profile and Health Screenings were introduced to the Group. The employees expressed interest and excitement in beginning a wellness program that offered the education needed to improve their health. The wellness committee worked to schedule the screenings where each employee would have the opportunity to attend. The group also worked with their Board of Supervisors to allow employees time away from work for their Healthy You! visit. The employees are eager to participate in any wellness challenge presented and are better educated to understand healthy habits.The Results
In 2011, 75 percent of Clay County employees participated in the Personal Wellness Profile and Health Screenings with 55 percent in 2012. The decrease in participation was a result of unscheduled events that could not be avoided during the screenings. The biometric comparison from year one to year two reflected positive results with a decrease in the amount of employees with a Body Mass Index reading of obese, a decrease in total cholesterol and a significant decrease from 32 percent to 24 percent of employees with an at risk blood pressure reading. The employees also reflect positive results with improved lifestyle behaviors including an increase from 19 percent to 26 percent of employees exercising regularly. Additionally, 88 percent of employees practice good stress management skills. Other positive results include 54 percent of employees reporting they eat breakfast daily or almost every day. This is a good health practice related to longevity and improved mental and physical performance.
In 2013, Clay County will focus on nutrition related to "Eating on the Go." With numerous Clay County employees who work offsite or irregular shifts, this group faces significant challenges when it comes to healthy eating. There will also be a focus on establishing healthy habits around exercise by providing employees educational material with the basic information on cardiovascular exercise, strength training and flexibility exercises.


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BM: I had seen you speak about Wilbur Wants to Kill Himself at the Boston Film Festival back in, probably, 2003, it must have been?LS: Yeah, probably. Or 2004. I can't remember. I wonder what I said! [Laughs.] I still like that film a lot. There's something about it that I really like. The music is really beautiful!
BM: I was actually going to single that out! If there was anything I was disappointed with with this new film [An Education], it was that you didn't use the same composer…LS: I couldn't.
BM: Why couldn't you?LS: I'm the only Danish element in the film.
BM: You must've wanted to use the same composer.LS: Well, I liked Paul Englishby [An Education's composer] very much. He's done the music to this one, and he's one I wanted to work with. But, oddly, when it came down to it, if you could only bring one person, which one will it be? And like, if I'm going to shoot a film in England again…and I think the composer is the most personal relationship, actually, that you have…even more than your assistant, or your DoP [Director of Photography], 'cause it's much harder to describe music. But Paul and I, we got along really well, and I think he's very sensitive, and it was fantastic to actually record at Abbey Road Studios! To have a reason to cross that street crossing [laughs], I felt really proud! And the train station, St. John's Wood, the subway station, has a little Beatles café and I loved it. So, I'm not complaining about Paul Englishby, but I do like that Norwegian/Danish composer very much, who did Wilbur [Joachim Holbek].
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Log In now to add this Gigapan to a group gallery.
Log In now to add this Gigapan to a gallery.
About This GigapanToggle
- Taken by
- David Engle
- Explore score
- 28
- Size
- 0.08 Gigapixels
- Views
- 4173
- Date added
- Jul 09, 2009
- Date taken
- Jul 09, 2008
- Categories
- Galleries
- Competitions
- Tags
- brown, brochstein, 17x1, keck, fondren, rmc, chapel, rice, sx110, riceu, valhalla
- Description
Last week, I took a GigaPan of which this following snapshot was extracted, www.gigapan.org/viewGigapan.php?id=27578&snapshot_id=84354, and because of the comment of Kilgore's, I again became interested in the life of William Herschel and of his sister, Caroline, especially the astronomical achievements that the two Herschel's made (newhumanist.org.uk/1508 ) while living in Bath, England (from a GigaPan; Zoom Baby, Zoom, their house can be seen here: www.gigapan.org/viewGigapan.php?id=9802&snapshot_id=85077).
Today in the New York Times, there is a review of a book concerning exactly what I am searching for and is entitled, The Age of Wonder (tinyurl.com/mr6zk4 ), which I would very much like to look at, but Fondren does not have it; however they have another book (The Georgian Star) concerning Mr. Herschel and his sister that I took a fancy to and drove over to the library to get, BUT before going in, I wanted to take a GigaPan of the north side of Brochstein Pavilion and this GigaPan is the result :)
With the price of gasoline as it is, it is expensive to be driving back and forth to Fondren all the time and I should maybe consider just to buy a book at the bookstore; however, there is no bookstore in all of the world that has the panoramic vistas that Rice University has and each time I travel there, I see at least one view that I had not noticed before.
NOTE: If you never have clicked, View in Google Earth, now is the time to do it.
Gigapan Comments (2)Toggle Minimize gigapan_comment
Thanks, This panorama is just another example of how good the GigaPan Stitching software is and how good the Google Earth interface is when showing 360-degree panos... it really adds a bit of realism to the vista.
As Texas_Photo says, this is really worth looking at in Google Earth - it is as if you were there amongst the dappled light of the trees.
Where in the World is this GigaPan?Toggle
Stitcher NotesToggleMinimize
GigaPan Stitcher version 0.4.4087 (Macintosh)
Panorama size: 78 megapixels (22372 x 3527 pixels)
Input images: 17 (17 columns by 1 rows)
Field of view: 360.0 degrees wide by 56.8 degrees high (top=27.2, bottom=-29.5)
All default settings
Original image properties:
Camera make: Canon
Camera model: Canon PowerShot SX110 IS
Image size: 2592x3456 (9.0 megapixels)
Capture time: 2008-07-09 12:50:40 - 2008-07-09 12:52:37
Aperture: f/8
Exposure time: 0.008
Focal length (35mm equiv.): unknown
White balance: unknown
Exposure mode: unknown
Horizontal overlap: 27.4 to 68.7 percent
Computer stats: 2048 MB RAM, 2 CPUs
Total time 6:28 (0:22 per picture)
Alignment: 0:44, Projection: 0:52, Blending: 4:51


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Temporarily Out Of Stock
Don't get too bummed. This item is on the way and will be available for purchase as soon as it rolls into the warehouse.
Can't wait? Consider one of the other Men's Summer Road Gloves we have in stock.View Similar Products
6 Reviews
Control the road.
Castelli designed its new S. Tre. 1 Gloves for the rider who prefers a minimal design, but still demands the cushioning, support, and solid grip necessary for day-long endeavors in the saddle.
Castelli constructed the S. Tre. 1's palms from a synthetic leather with a thin foam insert padding. This combination breathes extremely well and provides just the right amount of cushioning for choppy roads. The result is a palm material that allows you to adequately feel the road through the bars, while keeping your hands cool and dry. Silicone printed logos across the palm inserts provide texture for added grip, and microsuede panels along the backs of the thumbs allow you to comfortably remove sweat from your face.
The back panels utilize lightweight printed Lycra, which stretches to conform to your hands and aids in the transferring of moisture from your skin. Hook-and-loop closures at the wrists keep the gloves securely fastened, and easy-off central pull tabs let you remove them with ease.
The Castelli S. Tre. 1 Gloves are available in six sizes from X-Small to XX-Large and in the colors Black/white, Black/yellow fluo, Red/white, White, and White/ocean.
- Item #CST2606
Tech Specs
Gearhead Help
Tech Specs
- Reviews
What do you think about this product?
Have questions about this product?
- Familiarity: I've put it through the wringer
Great fit, lightweight with minimal padding. I was worried that the padding would not be enough but after several rides I actually prefer it to gloves with denser padding. Buying second pair as they are a great deal right now.
Love 'em
- Familiarity: I've put it through the wringer
Lightweight, fits like a second skin, nice velcro closure and just enough padding in all the right places. Much better than the S. Rosso Corsa Gloves I was wearing and by far my favorite gloves yet.
Castelli S Tre 1 gloves
Excellent feeling glove very lite not a lot of padding which make the glove feel lie second skin great fit
Best Glove I have
- Familiarity: I've put it through the wringer
- Fit: True to size
I like how thin these are, very light weight too. Gives up some padding for that, but oh well, it's not noticed. The top material is very form fitting and flexible, I really like that about this glove.
the get the job done Glove
- Familiarity: I've put it through the wringer
I can now say that i have put these through the ringer! they are very good gloves. i still like to see how long they last most gloves last me a season depending on the mileage. like the ease of pulling them off. like the fit - did not size up, like the material for warm weather and had good grip. very happy.
Pleasantly surprised
- Familiarity: I've put it through the wringer
I was initially shocked at how tight these gloves seemed to fit, and wondered if I was sent the wrong size (I ordered Large). They feel small when putting them on and taking them off -BUT - once they are on the fit is, at least for me, absolutely perfect. The padding is not excessive, but is a great balance between grip/feel and protection. These gloves 'disappear' on long rides. These are my go-to gloves, a great all-rounder that I'd highly recommend.
I totally agree with you on sizing.
I'm wondering about sizing here... I typically wear XL or XXL in winter gloves, but according to this sizing (my middle finger to base of palm is 9") I"m barely a LRG. Is this correct? (This IS my first pair of biking gloves, so maybe I'm just a noob.) Thanks!
Well, the LRG fits me despite my wide hands. Trust the sizing guide. One note on these though, the padding in the palms is light, and I think I need something beefier.


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product launch
Gulf Traffic to see key product launches
Several key product launches by local and international organisations from the road and transport sector are set to take place at Gulf Traffic, a major exhibition that is opening in Abu Dhabi tomorrow. The three day event runningMore…
Top speakers, new sectors for Gitex 2011
The upcoming Gitex Technology Week 2011 in Dubai will feature the strongest ever lineup with brand new sectors and leading technology gurus while connecting more than 130,000 professionals with 3,500 suppliers, said the organisers of the event.More…
The Office Exhibition success
A variety of Middle East product launches took place at the ninth Office Exhibition, a leading showcase for the high-end products, technology and services, which closed today (February 11) after a successful three-day run. The HP-sponsoredMore…


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Im having trouble with this ethernet module. What pinout did you use with the jeelabs library.thanks Michael
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AD7000W setup very confusing??
Hi, I have just bought one of these and the quick start guide seems pretty useless?
We have computers and iphones in the home all connected to a BT Router fine.
I use the quick start guide to set this up and get all the way through the points, until I get to the point about opening Safari, and entering 192.168.1.1 from the iPhone.
This works, and gets me to the set up page where I can choose my router and WPA password. I then click ok, and I just get :
"Safari cannot open the page because the server cannot be found" ??
This happens every time? Therefore I never get a beep from the Unit and its not set up? - Im tearing my hair out!
I have had this working in the "incorrect sense" though..
I chose the Philips in WIFI settings, and in my iPhone itunes, the "airplay' emblem and I can play to the AD7000W..
But this is easily forgotten and i have no internet/WiFi whilst in this mode??
Can anyone help, and does this retain the settings after its switched off so we can just connect again???
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Updated on 25 January 2013
Indian Thyroid Society releases 'Clinical Practice Guidelines for the Management of Dyslipidemia and Thyroid dysfunction'
Bangalore: The Indian Thyroid Society (ITS), which has been executing various initiatives throughout the year to create awareness about thyroid disorders, released 'Clinical Practice Guidelines for the Management of Dyslipidemia and Thyroid dysfunction' based on analysis of data collected from randomized trials, clinical experience and opinion of experts.
The guidelines suggest universal screening for thyroid disorders in patients with dyslipidemia and recommends thyroxine therapy for those diagnosed positive for hypothyroidism, irrespective of the age. The guide also suggests that screening should begin at the age of 35 years and repeated after an interval of every five years, in otherwise healthy persons without dyslipidemia.
Thyroid disorder is a medical condition that impairs the normal functioning of the thyroid gland causing abnormal production of thyroid hormone. Excess hormone production results in hyperthyroidism, while insufficient production leads to hypothyroidism. Thyroid disorders could be due to genetic, environmental or dietary factors. They can occur at all ages but are most commonly diagnosed between the ages of 20 and 40.
Symptoms of hypothyroidism, include fatigue or lack of energy, weight gain, feeling cold, dry skin and hair, heavy menstrual periods, constipation, slowed thinking, brittle nails, swelling in arms and legs and hair loss.
According to Dr R V Jayakumar, president, Indian Thyroid Society and professor of endocrinology, Amrita Institute of Medical Sciences and Research Center (AIMS), Cochin, sadi that, "Majority of Indians are unaware that they suffer from thyroid disorders despite experiencing the symptoms, therefore it is necessary to go for the TSH test, a simple and most useful blood test for thyroid screening. While there is no permanent cure for thyroid disorders, with timely screening, appropriate treatment and regular check-ups it can be controlled and patients can continue to live a normal life."
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Well, it took a while to figure this computer stuff out… and really don't think I have it down yet, BUT.. I did get an update in on the SMMPodcast tab (page).
You can now listen to the last 10 or so show right here on the blog. You can also access all the SMMPodcast shows at the PTCMedia archive.
Hope this helps you easily find shows that you are looking for.
Thanks for visiting the Blog and listening in on my little show.
Have a Great Scouting Day!


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Wednesday, September 29, 2010
[Photos via WhoWhatWear, The Cherry Blossom Girl, People and Refinery29.]
9 comments:
- Dressing On The Side said...
this reminds us more of what our hair looks like after the highlights/sunlight has grown out and we're left with dark roots...
- September 29, 2010 at 12:57 PM
- ...love Maegan said...
lol ...or you could just let your roots grow out after summer. lol.
- September 29, 2010 at 1:03 PM
- ita darling. said...
I went WAY WAY too blond early on this summer, and then started working in an office with the most atrocious flouro lighting in the loo. I was really sick of being high maintenance salon girl and equally tired of the telltale straight root line when my blond grows out, so I decided to go ombre (the bumble salon i frequent calls it "shadowing") and they gave me the business. I kinda love it! I feel very natural and low maintenance. I have read that it is being called "recession proof hair".. haha. either way-Go for it!
- September 29, 2010 at 5:40 PM
- mrs boo radley said...
I had a dream about this hair the other night! Upper right is my fave. CTRL + D into saved hair favorites right now!
- September 29, 2010 at 6:43 PM
- Maggie May said...
this is how my hair is now, has been the last two years or so, darker brown and then brown blonde on the ends, and i love it.
- September 29, 2010 at 10:33 PM
hi!This was a really admirable theme!
I come from uk, I was fortunate to find your topic in bing
Also I learn much in your subject really thanks very much i will come daily
- September 30, 2010 at 7:09 PM
- ita darling. said...
just saw this write up of the sofia coppola for LV lookbook and thought that this should be your hair-spiration!
- October 11, 2010 at 10:05 PM
- Dreaming of Palm Trees said...
What a cool look! So chic!
- October 15, 2010 at 2:30 PM
- the lil bee said...
God, I just love this look! LOVE!!
- November 17, 2010 at 7:46 PM


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By Carlie Kollath Wells/NEMS Daily Journal
From the Biz Buzz blog …
We went by Salad Creations this morning and found a "closed" sign taped to the door. It looks like some of the furniture inside also has been removed.
Sadly, it looks like Salad Creations is gone for good.
The restaurant in June opened at 3952D North Gloster St., near Bed Bath & Beyond. The space previously was occupied by Southern Ice Cafe.
Click here for more at the Biz Buzz blog.


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Are Backbones All They're Cracked Up To Be??
A comb jelly from the phylum Ctenophora
Student Exploration
That's Not A Jellyfish!
People love their cute furry mammals, and we certainly appreciate other types of animals with backbones like birds and fish. But did you know of all the 34 animal phyla, animals with backbones occur in only one phyla (Chordata). Of the 34 animal phyla, most of the organisms we think of as animals occur in only one. Invertebrates are breathtaking in their diversity. The variety of their body plans tell us much about the many different ways animals can make a living. They tell us much about ecosystems and how animals interface with their environment. Looking at the fossil record, they present intriguing information about how animals change and develop through time. Yet many of them are unknown to most people. Take ctenophores for example or "jellyfish" as they are often called; the problem is ctenophores aren't jellyfish. They are ctenophores, or if you prefer "comb jellies". They may bear some superficial resemblance to jellyfish, but when you look closely, they are very different animals. Thanks to ctenophores appearing in aquariums around the world, people are starting to learn more about these intriguing animals. But not all ctenophores have made it into aquariums yet. Watch the below videos to see some truly unique ctenophores which people do not mistake for jellyfish. Nope, people don't mistake the benthic ctenophores for jellyfish, but some people do mistake them for flatworms (Phylum Platyhelminthes), which aren't really worms! Some phyla just can't catch a break!
Here you can see ctenophores living symbiotically on the sea star Echinaster callosus. Trace the tentacles back to their source to identify the ctenophores. It is not certain if this relationship is harmful to the sea star (that would be a parasitic relationship).
Take special note of the branching tentacles seen in this video.
Extension Investigation
Use the resources below to answer the following questions:
- How big can ctenophores grow? Where do these types of ctenophores occur? What problems exist in studying these ctenophores?
- How do ctenophores feed? Do they all feed in the same manner? Explain your answer as fully as you can.
- How did the invasion of a ctenophore lead to the collapse of Black Sea fisheries? How was this species of ctenophore introduced to the Black Sea?
- Why does being hermaphroditic help ctenophores invade new ecosystems? What other characteristics do they have that can be useful for invasion?
- At one time, ctenophores were grouped together with cnidarians but they are now considered separate phyla. Compare and contrast the characteristics of the phylum Ctenophora and the phylum Cnidaria.
- Do ctenophores have a thru-gut (meaning both a mouth and an anus)? Explain your answer as fully as you can.
Resources Cited
- http://faculty.washington.edu/cemills/Ctenophores.html
- http://www.youtube.com/watch?v=9u77t8TllFc
- http://faculty.washington.edu/cemills/Shiganova1998.pdf
- http://www.youtube.com/watch?v=wDQubDhvLkQ
- http://www.youtube.com/watch?v=61fHJDgFARE
- http://www.imagequest3d.com/pages/general/news/blackseajellies/blackseajellies.htm
- http://www.hbwbiology.net/taxonomy-ctenophora.htm
- http://www.ncsu.edu/project/bio402_315/cnidaria/Ctenophores.html
- http://zoology.muohio.edu/crist/Zoo312/Cnidaria.html
- http://www.earthlife.net/inverts/an-phyla.html


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May 21, 2012
The 26th annual "Where the Hell's Maybell?" bike ride took place Saturday morning along U.S. Highway 40. The event began in Craig and took participants on a 30-mile route to Maybell.
Stories this photo appears in:
Maybell cycling event draws small but enthusiastic crowd
Pedaling west on U.S. Highway 40, the Santistevan family of Craig powered through the chilly climate that surrounded them Saturday morning. Although the cool weather wasn't quite what Tony, Sara and their son, Dustin, had expected for their big bicycling weekend, being able to ride together was well worth the unfavorable temperature. Cold weather led to a low turnout for the 26th annual "Where the Hell's Maybell?" bike ride. Craig Parks and Recreation organizers said the turnout was less than half of the usual crowd of 150 they had expected to join in the 30-mile day trip across Moffat County from Craig to Maybell.
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Tag Archives: Helen Clark
Tobacco Costs the World More than GDP of All Low Income Countries
"Tobacco use alone costs the world 1-2% of its GDP each year," Helen Clark, administrator of the United Nations Development Program told the United Nations on July 11th. The world's GDP in 2013 was nearly $75 trillion. One percent of the world's GDP makes the global cost of tobacco higher than the total GDP of… Read the full article >
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Obviously enough, Tomlin's favorite word is 'obviously'
In his news conferences, he used the adverb seven times in 2010 -- and 322 times in 2013January 11, 2014 11:18 PM
It's Dec. 30, the last Steelers press conference of the season. And as the elite of the city's sportswriters, photographers and talk radio jocks file into the briefing room on the South Side, they take their best shot at guessing something almost as anticipated as the season's final record:
Exactly how many times will head coach Mike Tomlin say "obviously" today?
"We fell short this year of getting ourselves in the tournament to chase the ultimate prize, which obviously every year is our intention," the coach said to the cameras. Someone makes a tick in his notebook. "... Obviously, I don't want to make emotional decisions, and obviously we've been on an emotional journey."
Obviously enough, Tomlin's favorite word is 'obviously'
Mike Tomlin seems to enjoy using the word "obviously," given its prominence in his many press conferences. A speech pathologist explains why people favor certain words. (Video by Andrew Rush; 1/12/2014)
Mr. Tomlin is widely regarded as one of the most well-spoken coaches in the National Football League. In contrast to his predecessor Bill Cowher, he remains remarkably even-keeled after both wins and losses.
He is, however, obviously in something of a rhetorical rut. Over the past four seasons, his use of that four-syllable modal adverb has skyrocketed, from seven times in 2010 to more than 300 in 2013. He now says "obviously" an average of 20 times per press conference, more than he says "football."
It has become a cultural marker for the coach, who declined comment for this story, and no impression is complete without it. Talk radio gleefully announces the count each week, replete with replays. A new car dealership TV ad spoofing Mr. Tomlin's press conferences includes no fewer than two "obviouslys" from a faux coach.
So does it mean anything?
The Post-Gazette pulled transcripts from every regular-season and post-season Tuesday press conference Mr. Tomlin has given since 2010 -- the Steelers kindly type them up for reporters -- and ran a word-frequency analysis on his statements. "Obviously" is the coach's 25th-most frequent word, topped only by "the," "that" and other monosyllables we all need to put sentences together. (He's shown a vocabulary of about 7,000 words.)
The stats also reveal that Mr. Tomlin's reliance on the word increases after the Steelers lose a game. Over four years, the coach said it 11 times in Tuesday press conferences following a loss, compared with an average of just five times after a victory.
Armchair psychologists might conclude each instance of "obviously" shows Mr. Tomlin is on the ropes, dodging tough questions about the team's performance or puffing his chest out in defense.
The real truth might not be so -- pardon the expression -- obvious, speech researcher Michael Dickey says.
"We have certain habits, certain turns of phrase which we use all the time," said Mr. Dickey, an associate professor at the University of Pittsburgh. "Some of it is laziness. We do things we've done frequently in the past -- use words, follow a particular pattern in our house. It's just something we naturally do."
"But," he adds, "that kind of increase in three years is this particular context is pretty striking. That would make my eyes pop."
Mr. Dickey suspects the Steelers coach has no idea he's picked up a new speech pattern -- unless he listens to AM sports radio. As people talk, they build pathways in their brains that become stronger over time, making it more likely they'll repeat certain phrases or idioms. These patterns are unique, forming a vocal fingerprint that instantly identifies the speaker (and thusly gives the professional impersonators on "Saturday Night Live" a living).
Indeed, "obviously" may be Mr. Tomlin's flavor of "uh" or "um," those filler words that buy us time to form our next word, Mr. Dickey said. But if that's the case, the coach has made an intriguing choice.
" 'Obviously' has the interesting property of drawing you in as a listener," the professor said. " 'Of course you agree with me,' 'of course you saw this,' or 'we all know this.' " The implication: Everyone agrees, and if you don't, you're missing something -- well, obvious.
Broadcaster Stan Savran, who hosts "The Mike Tomlin Show" on the ROOT Sports television network, can't pin down the date he heard Mr. Tomlin first say "obviously."
"Now, you're kind of waiting for it," he said. "When the first word is 'obviously,' that's a bad sign. You're greasing the tracks, then."
The veteran broadcaster has heard it all before. Longtime Steelers coach Chuck Noll favored the phrase "Get on with your life's work" when he had to let a player go. If he wanted to shut a reporter down, he'd simply say, "If you say so."
For Mr. Cowher, the line was, "There's a fine line in this business," which he applied to all manner of situations, Mr. Savran said. Mr. Cowher also had a reputation for repeatedly mispronouncing certain words, prompting winces every time he misspoke "deter" as "de-tier."
But he had another coach in his corner: his wife, the late Kaye Cowher, who watched most of his press conferences and pressed him to perform better.
"I don't know if Mike's wife, Kiya, watches," Mr. Savran said. He laughs. "I know his kids watch the coaches' show and make fun of him."
Mr. Savran believes Mr. Tomlin's overuse of "obviously" is just a verbal crutch, despite grumbling that it comes off as a condescending dig. In the end, the broadcaster doubts the coach has given his verbal twitch much thought.
"I don't know if he even notices it," he said. As obvious as it may be.
Andrew McGill: email@example.com or 412-263-1497.


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Appearance / Description of Object(s)
Three bright white stars moving together in a triangular shape.
Size of Object(s)
Like the first very bright star at sunset.
Distance to Object(s) & Altitude
5 kms or more.
Description of Area / Surroundings
In the north of Montreal at St Michel surrounding. No military base nearby but airport at some kilometers away.
Full Description & Details
My friend came to collect an old pair of loudspeakers by 22hrs30. We had a brief conversation and then I went upstairs to smoke a cigarette on the front balcony before going to bed. After a couple of puffs I noticed three bright stars moving slowly in a triangular isoceles shape at a very high altitude. I did not notice any shade or dark spot in between them may be because of the high altitude but suddenly the first bright star at the head started fading away until it disappeared and afterwards the second on the left side. Just then I called my wife before the the third vanished. Shortly then the third bright star vanished and I moved at the back of the house for may be it would light up again but alas there was no more sightings.
Can sighting be explained as any conventional man-made or natural object?
None of these
Witness Background
Electronic technician and musician.
Views on UFOs, before and after sighting
Thouands of people saw UFO's and I saw mine lately. We can't be suffering from delirium. Watch T.V programs on UFO sometimes but now fully believe in these objects.
Other Comments
We are not alone in the universe.
Reported Sighting?Yes
Reported To:Friends and relatives
Your Location:Montreal


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Bakadeshi wrote:I've been losely following the manga behind ones like Mx0, claymore, and kakaishi wich hold higher prioirty for me, but I have noticed the same problem I sometimes have with the manga even more prevelent in this show... the seperateness of each chapter or in this case each episode... where the end of one epsiode has almost nothing to do with the openeing of the next. what I mean is as an example, you could probably watch episode 4 and not miss a single thing important from episode 1-3. I wish both the manga and the anime explored more of a single story more often than just going on single episode tangents most of the time. It is still early tho, so we'll see what they do with the anime later on.
Series like this one (see UFO Princess Valkyrie) tend to start of like this and then start going in a straight line about 10-15 episodes in.


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By NEMS Daily Journal
"If a brother or sister is naked and lacks daily food, and one of you says to them, "Go in peace; keep warm and eat your fill," and yet you do not supply their bodily needs, what is the good of that? So faith by itself, if it has no works, is dead." (James 2:15-17 NRSV)
Over and over again the Bible calls us to care for the poor. God calls us to "share your bread with the hungry, and bring the homeless poor into your house" (Isa. 58:7 NRSV). Jesus even says the impoverished are an embodiment of him, saying "whatever you did for one of the least of these brothers of mine, you did for me." (Matt. 25:40 NRSV)
"For I was hungry and you gave me food, I was thirsty and you gave me something to drink, I was a stranger and you welcomed me, I was naked and you gave me clothing, I was sick and you took care of me, I was in prison and you visited me." (Matthew 25:35-36 NRSV).
from a hunger policy statement, Church of the Brethren
The challenge of the Easter celebration is living like Jesus, effectively becoming his extensions in whatever place the Gospel can be practiced.
Mississippi, with multiple cultural ills, offers the most basic kind of opportunity: Feeding hungry people.
Not everyone in Mississippi faces what's called "food insecurity," but an organization called Feed America offers compelling statistics about why food banks and Christian feeding ministries must continue as daily practices in our state:
• Food insecurity exists in every county in America, ranging from a low of 5 percent in Steele County, ND to a high of 37 percent in Holmes County, Miss.
• Seven states exhibited statistically significant higher household food insecurity rates than the U.S. national average 2009-2011, which was 14.7 percent. Mississippi stands at 19.2 percent, with Arkansas.
The other leading hunger states are:
• Texas – 18.5 percent
• Alabama – 17.4 percent
• Georgia -17.4 percent
• Florida -16.2 percent
• North Carolina -17.1 percent
In a broader sweep, in 2011, "50.1 million Americans lived in food insecure households, 33.5 million adults and 16.7 million children. In 2011, 14.9 percent of households (17.9 million households) were food insecure. In 2011, 5.7 percent of households (6.8 million households) experienced very low food security. In 2011, households with children reported food insecurity at a significantly higher rate than those without children, 20.6 percent compared to 12.2 percent.
"In 2011, households that had higher rates of food insecurity than the national average included households with children (20.6 percent), especially households with children headed by single women (36.8 percent) or single men (24.9 percent), Black non-Hispanic households (25.1 percent) and Hispanic households (26.2 percent). In 2011, 8.8 percent of seniors living alone (1 million households) were food insecure."
The directive is short and clear in scripture:
"The third time Jesus said to him, 'Simon son of John, do you love me?' Peter was hurt because Jesus asked him the third time, "Do you love me?" He said, "Lord, you know all things; you know that I love you."
"Jesus said, 'Feed my sheep.'" John 21:17


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Gaynold Eileen (Carr) Brown
OREGON-Gaynold Eileen (Carr) Brown, age 89, passed away on Thursday, Oct. 24, 2013, at Oregon Manor.
She was born on Dec. 4, 1923, in Sauk County the daughter of Floyd and Helen (Faga) Carr. Gaynold was a 1942 graduate of Ithaca High School in Richland County. She graduated in 1967 from the Madison School for Occupational Therapy and worked in several area nursing homes. Gaynold retired in 1991 from the Dane County Public Health Department. She also worked for many years with the Foster Grandparent program at the Central Wisconsin Center.
Gaynold is survived by her children, Judy (Mitch) Parr of Rockford, Ill., Janet (Larry) Wanless of Cambridge, Janeen (Steven) Running of Verona, and Scott Brown of Jersey City, N.J.; 10 grandchildren; several great-grandchildren; brother, Gaylord (Drucilla) Carr; and her nieces. She is preceded in death by her parents; son and daughter-in-law, John and Patricia Rentz; and son-in-law, Clifford Ripley, Jr.
A Memorial service will be held at GUNDERSON OREGON FUNERAL HOME, 1150 Park St., Oregon, at 11 a.m. on Thursday, Nov. 7, 2013. Visitation will be held at the funeral home from 10 a.m. until the time of service.
Online condolences may be made at www.gundersonfh.com.
Gunderson Oregon
Funeral & Cremation Care
1150 Park Street


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The Society established an oral history program in 2005 to document the reminiscences of retired Judges of the New York State Court of Appeals (New York's highest court), retired judges and justices from other courts in the State, and prominent New York lawyers. Starting in 2009, all interviews were videotaped. Interviews prior to that time were almost all either audio or video taped. Interviews were conducted by a person or persons selected by the subject who was familiar with both the person interviewed and New York jurisprudence. In many instances, the interviewers were former clerks of the judges.
This archive covers almost a century of New York State's legal history. Subjects were invited to not only reflect on their contributions to the law and legal process, but also on their childhoods, backgrounds, and the historic events which shaped them as people and legal luminaries. The result of this broad outlook is a project that has captured a unique look at the history of the workings of the Rule of Law in both New York and the nation.
The Society prepares a transcript of the recording of each interview for its archives. The transcripts of the record are reviewed by subjects and interviewers for clarity and accuracy, and corrected. The transcripts are then further reviewed by the Court of Appeals and the NYS Law Reporting Bureau (LRB). Edits of the Court and the LRB are noted in the transcripts. The final version of the transcripts are then deposited in the Society's archives.
An oral history transcript is not intended to present the complete, verified description of events. It is rather a spoken personal account by a Subject given in response to questions. It is intended to transmit the Subject's thoughts, perceptions, and reflections. It is unique and irreplaceable.
All uses of these transcripts are covered by signed agreements between subjects, interviewers, and the Society. The information is thereby made available for purposes deemed suitable by the Society, including research and education. All copyrights and literary rights in the transcripts, including the right to publish, are reserved to the Society. No part of any transcript may be quoted for publication without the written permission of the Society.
The Society plans to make most transcripts available to the public on this website. The Society has no immediate plans to make the video recordings from which the transcripts are developed available to the public.
On April 4 and September 5, 2003 an oral history interview with NYS Court of Appeals Judge Richard D. Simons was conducted for the Society by David E. McCraw, Counsel, The New York Times Company. Mr. McCraw served as a clerk to Judge Simons from 1992 to 1994, The interview was published in our journal, New York Legal History, Vol. 1, 2005:
To date the Society has collected the oral histories of the following individuals:
Associate Judge of the New York Court of Appeals (1987-2000)
[Interviewed: 08/05/2009]
Chief Judge of the State of New York (1979-1984)
[Interviewed: 08/30/1990]
Associate Judge, New York Court of Appeals (1986-1993)
[Interviewed: 06/18/2011]
Associate Judge, New York Court of Appeals (1968-1985)
[Interviewed: 04/15/2005]
Chief Judge of the State of New York (1993-2008)
[Interviewed: 09/26/2011, 09/28/2011, 10/19/2011, & 10/20/2011]
Associate Judge, New York Court of Appeals (1993-2002)
[Interviewed: 05/10/2012]
Associate Judge, New York Court of Appeals (1979-1984)
[Interviewed: Between 2000-2002]
Associate Judge, New York Court of Appeals (1999-2006)
[Interviewed: 12/21/2009]
Associate Judge, New York Court of Appeals (1983-1997) & Acting Chief Judge (1992-1993)
[Interviewed: 04/04/2003 & 09/05/2003]
Associate Judge, New York Court of Appeals (1992-2006)
[Interviewed: 08/19/2009]
Chief Judge of the State of New York (1985-1992)
[Interviewed: 12/21/2011]
Associate Judge, New York Court of Appeals (1997-2003) / Judge, United States Court of Appeals for the Second Circuit (2003-Present)
[Interviewed: 05/17/2012]
Chief Administrative Judge of New York (1974-1979)
[Interviewed: 2/25/2005, 5/13/2005, 9/02/2005, & 2/08/2007]
Presiding Justice, New York State Supreme Court, Appellate Division, 2nd Department (1978-1990)
[Interviewed: 07/21/2009]
Associate Justice, New York State Supreme Court, Appellate Division, 2nd Department (1980-2001)
[Interviewed: 05/15/2009]
[Interviewed: 12/01/2015]
[Interviewed: 05/26/2009]
New York County Clerk (1969-2014)
[Interviewed: 09/30/2009]
Director of Court Operational Services, New York Office of Court Administration
[Interviewed: 05/18/2010]
[Interviewed: 03/10/2016]
District Attorney, Wyoming County, New York (1950-1953)
[Interviewed: 07/13/2011]
The Historical Society of the New York Courts 140 Grand Street, Suite 701 White Plains, NY 10601 914.824.5863


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24 September 2004
Down the PKK flow from Puka Nui
27 September 2004
Harvest Moon through vog
Map of flows from Pu`u `O`o: 24 August 2004
Map shows lava flows erupted during 1983-present activity of Pu`u `O`o and Kupaianaha (see large map).
Shades of red and bright yellow denote Mother's Day flow field, which began erupting on May 12, 2002 and continues to the present. Darkest red indicates lava flows erupted in November 2003-24 August 2004, including the labeled Banana flow, which developed gradually starting in the middle of April. Orange shade denotes MLK flow, erupted in January and, in brief spurts, subsequently. Yellow shade indicates Kuhio (PKK) flow, active most of the time from March 20 to August 24. As of August 24, most activity was located in the Banana flow, fed by the Banana branch of the Mother's Day tube. The PKK flow remains active, too.
Through September and into early October 2003, lava was moving along the east and west sides of the Mother's Day flow. The east-side lava (known as the August 9 breakout) came from the August 9 rootless shield, itself fed by the main Mother's Day tube from Pu`u `O`o. The west side lava, known as the Kohola arm of the Mother's Day flow, branched off the tube system below the rootless shield.
In early October 2003, the August 9 breakout stopped moving, the Kohola died back to a trickle, and the one labeled rootless shield gained prominence. By October 16, however, the shield had partly collapsed, leaving several drained perched ponds behind. Upstream from the shield, many hornitos and small flows formed over the Mother's Day tube. Soon thereafter, other rootless shields began to form over the Mother's Day, August 9, and Kohola tubes.
New vents opened at the southern base of Pu`u `O`o on January 19 and fed Martin Luther King (MLK) flows, which remained active until March 5. Several small vents formed during this time. On March 20, Kuhio (PKK) flow originated from two vents, main one about 250 m south of base of Pu`u `O`o. This flow has remained active most of the time to the August 24 date of this map.
The Banana flow developed from breakouts from the Mother's Day lava tube, centered near the former Banana Tree kipuka. The breakouts become prominent in the middle of April, and lava started down Pulama pali shortly thereafter. This is the time that we assigned the name Banana to the flow.
Vents in West Gap Pit became active in early October, were quiet for 3 weeks, and then resumed intermittent activity that continued well into December. Other vents were also sporadically active in Puka Nui (near West Gap Pit) and in the crater of Pu`u `O`o.
Map of Pu`u `O`o and vicinity: 24 August 2004
Map shows vents, lava flows, and other features near Pu`u `O`o frequently referred to in updates (see large map). These features change often, but this map should help those viewers lost in the terminology. The cones in West Gap are just outside the boundary of the crater--the oval-shaped depression containing the seven numbered vents (now down to 6, as Humble Vent has been buried by a mound of lava flows erupted from Dave's Pit/Vent in March. Red color denotes flows--the Mother's Day flows--erupted since May 12, 2002. Light orange color indicates episode-55 flows erupted between March 1997 and August 2002 (exclusive of Mother's Day flows). Darker orange represents MLK flows; yellow, PKK flow; purple, Puka Nui flow. Vents for these sets of flows shown by indicated symbols. Gray shows flows of earlier episodes.
Contact: email@example.com
Updated: 11 November 2004 (DAS)


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ACHICA > Hübsch
Sale closed
Hübsch aims to design furniture with Nordic warmth and a rustic flair. Its furniture is created to welcome cosiness into your home, as only the Scandinavians know how. These pieces epitomise the themes of bohemian modernity and beautiful simplicity. Every piece shares Hübsch's very unique Danish style and is sure to look at home in your dream house.


text:
Main Content
This item ships within one business day.
$4.99 flat rate shipping and handling. See other shipping options.
Wow everyone with your killer look in the Brights full zip hoodie from Hurley! It has a soft fleece lining and embroidered Hurley lettering.
- Woven Hurley clip tag
- Soft fleece lining
- Quality embroidery
- Full zip
- Imported
- 60% Cotton/40% Polyester
- Hood with drawstring
- Two front pockets
- Full Zip
- Imported
- Brand: Hurley
Special event items are produced by manufacturers only after the outcome of a game or event. These are advanced sale items and will ship immediately after they are received in our warehouse.
Manufacturer direct items are shipped directly from the manufacturer. These items are not available for international or expedited shipping.
Customized items can be personalized with options such as your name, your favorite number, and/or designs. Some options may be limited by league rules.


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Israeli chief spokesman to speak at Binghamton University
Arnon Perlman, chief spokesman and head of communications for Israeli Prime Minister Ariel Sharon, will speak at Binghamton University at 8 p.m. Tuesday, February 17, in Lecture Hall 2 on the campus. Perlman will discuss Israel's role as the only democracy in the Middle East and offer perspective, as a former journalist and current media adviser, on Israel's coverage in the media. His remarks will be followed by a question and answer session.
The event is free and open to the public.
In addition to his role as chief spokesman, Perlman also serves as a member of Prime Minister Sharon's think tanks in the political, economic and foreign policy fields. Prior to his current role, Perlman owned and operated a consulting company, which specialized in crisis management, strategic counseling and public relations for large public bodies such as the Jewish Agency and the Rabin Medical Center. From 1996 to 1997, Perlman served a spokesman for the Tel-Aviv-Yaffo municipality.
A former economic journalist for the Telegraph, Perlman wrote news article and columns on public economy, health, education and the Labor Federation. He also served as chief of reporters for Ha'aretz, a leading Israeli newspaper, where he managed and coordinated news and feature writers.
Perlman's presentation is co-sponsored by Hillel, Harpur College, the Judaic Studies Department, the Middle East North African Studies program, and Caravan for Democracy, an initiative of the Jewish National Fund, Media Watch International and Hamagshimim.
For more information, contact Hillel at 607-777-4980.


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Small family hotel located in Central Copenhagen. Close to the promenade at Islands Brygge with Copenhagen's only outdoor bath...
Want good times, friendly staff and cool features? Welcome to Sleep-in Heaven - it's more fun!
This is a brand new, affordable, 5-star hostel, centrally located within walking distance of all the city's main attractions.
City Public Hostel consists of dormitories from 6 � 32 people for male and female with garden view and separate showers for males and females.
Centrally located in the heart of Copenhagen, adjacent to the main railway station, and within walking distance of many tourist attractions and sights, Hotel Nebo makes a great base from which to explore the city...
The Saga Hotel is a comfortable friendly hotel centrally located in downtown Copenhagen; just a few minutes walk from the central station and Tivoli Gardens...
We are a cheap, clean and cosy hostel in the absolute centre of Aarhus. We are five minutes from anything you could possibly desire and just two kilometers from the beach
Hotel Jorgensen is for backpackers as well as friends and families with better things to spend money on than a posh place to sleep.
Danhostel Odense City is situated directly in the heart of Odense within walking distance to the shoppingarea and museums.
Basementflat in privat house in Glyngore. Peacefull surroundings.45 kvm. 4 persons. 300 m to nice beach.
Find a Denmark hostel and save money on discount lodging. Hosteling in Denmark offers a different travel experience than staying at traditional accommodations. Youth hostels allow you to meet new people and learn from other international and worldly travelers. Most hostels are conveniently located in the center of the action close to public transportation, including buses and rails. Staying at a Denmark hostel is a great option whether you are backpacking or traveling on a budget . Browse our hostels and plan your Denmark vacation today!


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- For the first time, Gemma Ward has publicly confirmed that she had a relationship with Heath Ledger. "I have taken a break from the media spotlight for the past few years and it was something spurred by Heath's death."
"(Heath and I) first met in New York and we were both struggling with things that I won't get into, and we bonded over that. I kind of met him at first and said, 'Listen, my mum's living with me right now and I'm kind of going through a hard time and I'm not interested in having a serious relationship with somebody right now,' and he was like, 'You know, um, let's just be there for each other through these hard times we're both going through.' And we developed a relationship and we started seeing each other." They met in November of 2007, and spent that Christmas together, with their families. "The time we spent in Perth was incredible because we were both from Perth and it was also a time when it was beautiful in Perth and both our families were there and we met each other's families. We were able to not be in any kind of a spotlight and not have to be meeting with people or be hounded by press or anything. We lived in a magical kind of world where we weren't intruded upon." Ledger died in January of 2008. Ward is returning to Perth this month to take the lead role in the Perth Theatre Company's debut play, and her next film, Pirates of the Caribbean: On Stranger Tides comes out in May. The print version of this article ran with a new Peter Ash Lee photo of Ward at home in New York, one of the first authorized pictures of Ward made available since she mostly ceased modeling; it's not online, but you can see a scanned copy here. For the record, Ward — who has always maintained that she intends to continue modeling, eventually — doesn't rule out a return to the industry. [Herald Sun]
- Costume designer Amy Westcott is upset about being written out of the press history of Black Swan. Rodarte designers Kate and Laura Mulleavy — who were responsible for some of the ballet costumes, tutus, and one of Natalie Portman's dresses, for about seven outfits in total — have been the focus of most of the film's costume-related coverage. There were even highly Rodarte-friendly stories that argued the sisters should share a costume design credit with Westcott. "'Controversy' is too complimentary a word for two people using their considerable self-publicising resources to loudly complain about their credit once they realised how good the film is," says Westcott. "I was too trusting." [Clothes on Film]
- Michelle Obama went on Good Morning America to say, "Look, women, wear what you love. That's all I can say. That's my motto." Oscar de la Renta and the Council of Fashion Designers of America recently criticized Obama for wearing a British designer's dress to a state dinner. [NYDN]
- Speaking of fashion in politics, and political fashions, Carla Bruni-Sarkozy gave an interview where she wrote off her left-wing political identity as an affectation of her "artistic" younger days. "I don't really feel left-wing anymore," says Bruni, who said in another interview just two years ago that she "would never vote on the right." The next French presidential election is in 2012; though he is expected to run, Nicolas Sarkozy has yet to confirm his candidacy. [Telegraph]
- Bruni explained her decision as a reaction to how the French left treated two sex offenders whom she personally happens to like: Roman Polanski, and Frédéric Mitterand. If she was trying to better her husband's political chances, naming two figures who are deeply unpopular in France as close friends might not have been the best move. Also, rapists suck. [Daily Mail]
- Actress Greta Gerwig, on dressing for the red carpet: "Nothing short, no huge heels. I'm not a streetwalker. I don't see the need to wear streetwalker shoes. I went to Barnard. I have a degree. That equals low heels." [WWD]
- Madonna allegedly made Kelly Osbourne sign an "extensive" confidentiality agreement before signing Osbourne as the face of her Material Girl clothing line. Former spokesmodel Taylor Momsen compared the line to the wardrobe of a "high-class hooker," which gaffe Madonna and her team are likely looking to avoid. [Daily Mail]
- Tommy Hilfiger is launching a new capsule collection called "Prep World," and he's enlisted Preppy Handbook author Lisa Birnbach to promote it. [WWD]
- Diane Kruger is on the cover of the March issue of Glamour. When she became a contracted face of Calvin Klein, she celebrated by splurging — but not on Calvin, on Hermès. "The biggest fashion purchase I ever made I thought about for six years. I'm not kidding. All my life I wanted to own an Hermès Constance bag, and when I signed with Calvin Klein, I decided this was the time that I could afford it. I truly broke a sweat when I paid for it." [Glamour]
- Rosie Huntington-Whiteley appears on the March cover of British Vogue, struggling a little to close her red blazer over her breasts. [Vogue UK]
- Hermès, always vigilant about the protection of its intellectual property, is suing a designer who printed a picture of a Birkin bag on a cotton tote, which act Hermes believes is "confusing, deceiving and misleading the public." [SheFinds]
- If your answer to the question, "Should we be excited by an OPI nail polish collection themed around Texas?" is "Only if it includes colors named 'Austin Tatious' and 'Do You Think I'm Texy,'" — then you, my friend, are in luck. [Refinery29]
- Latvian model Olga Cerpita, on agencies in Europe vs. agencies in the U.S.: "In Europe, they tell you to be skinny and they don't care how you become skinny. Here, they're telling us to be skinny but healthy." [WWD]
- Rebecca Minkoff's new shoe collection is extremely cute. [Refinery29]
- Here is a photo of model Francisco Lachowski and Rico "Zombie Boy" Genest that might just blow your mind. Happy Tuesday! [WOW]


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Travel slowly, staying in vacation rentals (villas, farms, cottages, apartments)
The Slow Travel Contest 2006 - Winners
A history of the contest
Winners were announced Friday, January 13, 2006 - noon MST. Drawing was on Saturday, January 14, 2006 - noon MST. Congratulations to all the winners!! And a big THANK YOU to everyone who entered.
This is the list of 100 winners of the Slow Travel Contest 2006. The winners were drawn from a "hat" to decide the order they choose their prizes. We had over 400 entries and it was very difficult to choose the winners because all the entries were very good. We included our comments for each winning entry, so you can see what made us select it. Each person who entered got a Slow Travel "door prize" (choice of mousepad or luggage tags).
Sort by category, member name or entry title by clicking on the heading links.
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For a homemade H Bridge of that calibre, you could do it with 2x SPDT relays. If you need PWM control, you need 1 MOSFET between the relays and power source.
because the coil in the relay is going to suck a lot of current isn't it?
You do appear to need 2 different PWM signals to the board, and what are the parameters of the current and voltage signal out? Unfortunately, they rarely seem to have much documentation.
Quotebecause the coil in the relay is going to suck a lot of current isn't it?Depends on the relay but 20 to 100 mA is not a lot.
If you are considering using relays, you might instead get two switches like below (one for each motor).http://www.radioshack.com/product/index.jsp?productId=2062530
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