text:
Cost-effectiveness of improving pediatric hospital care in Nicaragua
Costo-eficacia de la mejora de la atención hospitalaria pediátrica en Nicaragua
Edward I. BroughtonI,*; Ivonne GomezI; Oscar NuñezI; Yudy WongI
IUniversity Research Co., LLC/United States Agency for International Development, Health Care Improvement Project, Bethesda, Maryland, United States of America
IIUse of a shared learning approach among a large number of quality improvement teams who work together toward the same aim to rapidly achieve significant improvements in the processes, quality, and efficiency of services (5)
OBJECTIVE: To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures.
METHODS: Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness.
RESULTS: Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204).
CONCLUSIONS: After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.
Key words: Hospital costs; hospitals, pediatric; cost-benefit analysis; diarrhea; pneumonia; delivery of health care; Nicaragua.
OBJETIVO: Determinar el costo y la eficacia en función del costo de una intervención para mejorar la calidad de la atención de niños con diarrea o neumonía en 14 hospitales de Nicaragua, sobre la base de la información sobre gastos y la medición de las repercusiones.
MÉTODOS: Se compilaron datos sobre la duración de la hospitalización y la mortalidad de una muestra aleatoria de 1 294 historias clínicas compiladas en 7 de los 14 hospitales participantes antes de la intervención (2003) y 1 505 historias clínicas compiladas después de dos años de ejecución de la intervención ("postintervención", 2006). Los años de vida ajustados en función de la discapacidad (AVAD) se obtuvieron de los resultados asistenciales. Se calcularon los costos de hospitalización según los registros de los hospitales y del Ministerio de Salud, y datos del sector privado. Los costos de la intervención se obtuvieron de los registros contables del proyecto. Para calcular la relación costo-eficacia incremental se usó un análisis de árbol de decisiones.
RESULTADOS: La duración promedio de la hospitalización disminuyó de 3,87 y 4,23 días antes de la intervención a 3,55 y 3,94 días después de la intervención para la diarrea (P = 0,078) y la neumonía (P = 0,055), respectivamente. La letalidad disminuyó de 45/10 000 y 34/10 000 antes de la intervención a 30/10 000 y 27/10 000 después de la intervención para la diarrea (P = 0,062) y la neumonía (P = 0,37), respectivamente. Los costos totales promedio de la hospitalización y de los antibióticos para ambos diagnósticos fueron de US$ 451 (intervalo de confianza [IC] de 95%: US$ 419 a US$ 482) antes de la intervención y US$ 437 (IC 95%: US$ 402-US$ 464) después. La intervención representó un ahorro de costos en cuanto a los AVAD (IC 95%: -US$ 522 a US$ 32 por cada AVAD evitado) y costó US$ 21 por cada día de hospitalización evitado (IC 95%: -US$ 45 a US$2 04).
CONCLUSIONES: Después de dos años de ejecución de la intervención, la duración de la hospitalización y la mortalidad por diarrea disminuyeron, junto con la duración de la hospitalización para la neumonía, sin un aumento de los costos de hospitalización. En caso de que estos cambios fueran totalmente atribuibles a la intervención, esta representaría un ahorro de costos.
Palabras clave: Costos de hospital; hospitales pediátricos; análisis costo-beneficio; diarrea; neumonía; prestación de atención de salud; Nicaragua.
Pneumonia and diarrhea are responsible for the highest burden of morbidity and mortality among children in Nicaragua (1, 2). Significant gaps have been found between the clinical management of children in referral hospitals with these two diagnoses and that recommended in the World Health Organization (WHO)/UNICEF Integrated Management of Childhood Illness (IMCI) strategy for low-income countries in general (3) and Nicaragua in particular (4). To reduce these gaps, Nicaragua's Ministry of Health (MINSA) worked with the U.S. Agency for International Development (USAID), through its Quality Assurance Project (QAP), and UNICEF, to design and implement a hospital-based intervention based on the quality improvement (QI) collaborative approach.2
Known as the Pediatric Hospital Improvement (PHI) Collaborative, the intervention was launched in 2004 at 14 regional hospitals and focused on children admitted to the pediatric ward with severe cases of diarrhea or pneumonia. Intervention objectives, identified during a 6-month evaluation conducted at six hospitals in 2003, were designed to address various quality-of-care problems, including:
Lack of a standardized diagnosis and classification system based on explicit clinical criteria, standard definitions for identifying patients with severe dehydration, and uniform guidelines for treating those patients;
Inappropriate prescription of antibiotics and other medications;
No specified room for close, constant monitoring of critically ill children;
Poor recognition of danger signs by clinical staff;
Inadequate triage system for patients seen in the emergency room;
Inadequate written guidelines such as clinical algorithms and treatment protocols to direct medical and nursing staff to evidence-based care;
Poor transportation system for transferring critically ill children to referral facilities; and
Poor ability to identify the nutritional status of patients.
The QI strategy included eight components: 1) introducing the WHO/UNICEF referral care manual (6) to standardize the clinical approach to treatment of children with severe diarrhea or pneumonia at the hospital level; 2) defining quality indicators to measure compliance with standards and identify performance gaps; 3) forming QI teams to promote clinical practice changes that would lead to improved quality of care; 4) establishing mechanisms for prioritizing the care of children who come to emergency rooms; 5) changing hospital organization so critically ill children are concentrated in a single hospital environment to allow closer and continuous monitoring; 6) developing skills in medical and nursing staff to identify, manage, and monitor for danger signs; 7) improving adherence to standardized prescribing practices for antibiotics; and 8) involving local authorities in supporting quality activities.
While routine monitoring of quality indicators by PHI Collaborative hospital teams showed that the intervention was associated with a decline in case fatality rates for diarrhea and pneumonia as well as an increase in compliance with clinical protocols (including the appropriate use of antibiotics) and reduced hospital stays, its costs and cost-effectiveness were not known. To fill this gap, the authors of the current study used data on the intervention's expenditures and various measures of its impact to determine its overall cost and economic efficiency. This information could help Nicaraguan decision-makers determine if nationwide implementation of this type of intervention would be affordable and cost-effective compared to other strategies to improve care.
The study was based on two years of intervention implementation (2004- 2005). Pre-/post-intervention evaluations were conducted to determine intervention impact. The research team examined diarrhea and pneumonia inpatient medical records and admissions registers completed at participating hospitals 1) before the intervention (in 2003) ("preintervention"), and 2) after two years of its implementation (in 2006) ("postintervention"). Expenditure data were obtained from hospital and MINSA records and private sector calculations (for hospitalization costs) and UNICEF and USAID/QAP accounting records (for intervention costs). Miscellaneous training costs (e.g., transportation, food, and housing) were based on author estimates. Impact measures and expenditures were defined according to the criteria of MINSA and USAID/QAP.
The 14 hospitals participating in the PHI Collaborative did not begin the intervention simultaneously. Therefore, to ensure the consistency of the data, the study sample was limited to hospitals where QI teams had implemented improvement cycles and monitored the indicators of interest for at least two years (i.e., since the intervention's launch in 2004). The seven qualifying hospitals were Chinandega, Madriz, Estelí, Boaco, Granada, Masaya, and La Trinidad. The authors randomly selected hospital records from all patient charts available for review for both the pre- and post-intervention evaluations. For the pre-intervention evaluations, 647 clinical records were selected for both diarrhea and pneumonia. For the post-intervention evaluations, 750 records were selected for diarrhea and 755 records for pneumonia. A total of 2 799 records were examined out of the 14 833 case records (9 938 diarrhea and 4 895 pneumonia) available at the seven hospitals included in the study. Sampling was stratified by hospital. A sample of 90-110 records was taken from each hospital. The sampling number was determined according to USAID/QAP monitoring requirements. Cases of severe diarrhea and pneumonia were identified based on IMCI definitions (7). Patients with a simultaneous diagnosis of diarrhea and pneumonia were excluded from the sample.
Cost data
Total costs were calculated retrospectively based on data from 1) hospital records, MINSA, and private sector calculations (for hospitalization costs) and 2) UNICEF and USAID/QAP accounting records (for intervention costs). Hospitalization costs included the salaries of the doctors, nurses, and ancillary staff required to staff the pediatric wards, calculated according to MINSA salary rates; hospital bed costs, including food, water, medical supplies, electricity, and other utilities, calculated according to rates established in private hospitals; the amount paid for antibiotics prescribed and consumed during hospitalization, calculated according to the MINSA price list of basic medicines; and the amount paid for laboratory blood tests for all patients (pneumonia and diarrhea), a chest radiograph for each pneumonia patient, and a fecal laboratory test for each diarrhea patient, according to MINSA records. For items that are not accounted for in Nicaraguan public hospitals (e.g., clinical line items), estimated costs were based on those established for the private sector (which are considered a reasonable approximation to costs in the public sector). All costs were recorded in Nicaraguan córdobas, converted to U.S. dollars using the January 2006 exchange rate (C$17 per US$1) (8) and adjusted to 2010 by applying an annual inflation rate of 3%.
Effectiveness measures
The three measures of the QI intervention's impact on cases of diarrhea or pneumonia were 1) hospital length of stay (LOS), 2) disability-adjusted life years or DALYs (years of potential life lost due to premature mortality and years of productive life lost due to disability), and 3) deaths. Data on LOS and mortality were collected from the patient records sampled in the participating hospitals. DALYs for acute illness were estimated using disability weights assigned to severe cases of pneumonia and diarrhea, obtained from Murray and Lopez (9), and assuming average age of onset was 2 years. Age weighting, a discount rate of 3% per annum, and a life expectancy of 73 (10) were applied to DALYs for mortality calculations according to a standard methodology that used similar economic analyses without regard to gender (11, 12) (Table 1). The total number of patients admitted for each of the two diagnoses was obtained from hospital admission registries.
Decision-tree analysis was used to compare the QI intervention strategy (improved compliance with clinical guidelines) to "business-as-usual" (preintervention clinical management of diarrhea and pneumonia case) in a single iterative model (Figure 1). The incremental cost-effectiveness ratio (ICER), defined as the incremental change in cost divided by the incremental change in effectiveness, was calculated by comparing indicators at the seven participating hospitals pre- and post-intervention. In terms of DALYs, the ICER represented the cost per additional DALY averted ($/DALY) associated with the QI strategy. The lower the ICER value, the better the relative cost-effectiveness of the care delivered post-intervention compared to that provided pre-intervention. A positive ICER value indicates that an additional expenditure is required to achieve better health outcomes, whereas a negative ICER value means the intervention is associated with better health outcomes and a decrease in overall cost and is thus designated as "cost-saving." The equation used to calculate the ICER (incremental cost/average number of incremental DALYs) is shown below.
Because the outcome data used in the current study were collected from a random sample of cases from seven different hospitals, the sampling distribution associated with the ICER point estimate (PE) (the average of multiple ICER point estimates, representing estimated hospitalization and antibiotic costs, across multiple data sets) needed to be taken into account to determine a credibility interval (CI). The authors used Monte Carlo simulations in which repeated sampling from the distributions of all input variables was used to calculate a probability distribution for the ICERs. This allowed for calculation of a 95% CI.
One-way probabilistic sensitivity analysis was used to rank the variables by their relative importance to the costeffectiveness result (in terms of DALYs) by using each of the variables in turn and performing Monte Carlo simulations to determine CIs based on the degree of uncertainty for each specific variable. Appropriate probability distributions had to be assigned to the input variables as some were not statistically significant at the alpha = 0.05 level. These distributions were determined based on the study data (Table 1).
Average LOS decreased from 3.87 days pre-intervention to 3.55 days postintervention for diarrhea cases (P = 0.078) and from 4.23 days pre-intervention to 3.94 days post-intervention for pneumonia (P = 0.055). The case fatality ratio decreased from 45 per 10 000 preintervention to 30 per 10 000 postintervention for diarrhea (P = 0.062) and from 34 per 10 000 pre-intervention to 27 per 10 000 post-intervention for pneumonia (P = 0.37) (Table 1).
Intervention costs are listed in Table 2. Technical assistance, which accounts for almost 25% of the total cost of the QI intervention, included all work done by USAID/QAP personnel to implement the eight strategy components. It did not include the time cost of MINSA administrators or hospital officials because their roles in these activities were considered part of their normal work duties and therefore did not incur additional cost to MINSA. The time cost of hospital personnel attending the training sessions was included, even though this did not incur any additional direct cost to MINSA, because attendance in the sessions took these health workers away from their regular duties, and whether or not relief staff were brought in to compensate for this absence it was important to account for this potential loss in productivity. Training sessions consumed the greatest proportion of total expenditures (43.2%).
Costs per day for hospitalization (excluding antibiotics) remained unchanged (pre- versus post-intervention) at $93.30 and $99.12 per day for diarrhea and pneumonia cases respectively. The cost of antibiotics per day increased from $8.80 to $11.80 for diarrhea and from $13.70 to $14.00 for pneumonia. The average total cost of hospitalization and antibiotic medication for both diagnoses was $451 pre-intervention and $437 post-intervention.
In terms of DALYs, the QI intervention was cost-saving compared to "business-as-usual" (95% CI: -$522-$32 per DALY averted; Table 3). When the variability of the result is plotted on a cost-effectiveness acceptability curve, the intervention is 100% certain to be cost-effective when the health care funder is willing to pay $200 or more per DALY averted (Figure 2). In terms of hospital days, the intervention cost $21 (per hospital day averted) (95% CI: -$45-$204).
One-way probabilistic sensitivity analysis is shown in Table 4. The larger the credibility interval, the greater the uncertainty associated with the variable and therefore the greater its importance to the cost-effectiveness result. LOS variables had the greatest effect on the result, followed by case fatality ratios and cost of antibiotics. Uncertainty in the cost of hospitalization had a small impact on the result, while uncertainty in the cost of the QI intervention and the ratio of diarrhea to pneumonia cases had almost no effect on the result.
This study found close to statistically significant decreases in LOS (for diarrhea and pneumonia) and in deaths (for diarrhea) that were associated with the QI intervention. Calculation of cost-effectiveness in terms of DALYs showed that the intervention was cost-saving, indicating a high likelihood that the QI intervention improves health outcomes and decreases costs to the hospital system. This result explains the decrease in case fatality rates for both diarrhea and pneumonia that was observed following the QI intervention.
In terms of LOS, the ICER was $21, indicating that decreasing the average LOS would most likely result in a small additional cost. The fact that the ICER was positive in terms of LOS but negative (i.e., cost-saving) in terms of DALYs can be attributed to the scope of the DALYs metric (which considers deaths, and acute illness) versus that of the LOS metric (which treats all discharged patients as one and the same regardless of the outcome). The LOS ICER is presented to show the intervention's relative cost-effectiveness in financial terms regardless of whether or not it meets the criteria for DALY calculations.
Even when considering the point on the cost-effectiveness acceptability curve at which there is 100% certainty of costeffectiveness (a willingness to pay of $200 per DALY averted), the ICER is highly favorable. WHO defines a health intervention as very cost-effective if its ICER is less than the GDP per capita of the population it serves (13). As Nicaragua's per capita GDP is $2 900, the PHI Collaborative intervention would be considered very cost-effective (14). Comparing the efficiency of the QI strategy used in this intervention to strategies used in other health interventions in Nicaragua or other Central American countries is difficult given the paucity of economic evaluations of health programs from the region (15). To the best of the authors' knowledge, no other cost-effectiveness studies have been conducted to evaluate interventions for pediatric diarrhea or pneumonia cases. The PHI Collaborative intervention appears to be significantly more cost-effective than cervical cancer screening in Nicaragua, reported to cost $3 700 per DALY averted (16), and compares favorably with rotavirus vaccination for diarrheal disease prevention in both Honduras, reported to cost $269 per DALY averted (17), and Northeastern Brazil, based on another economic analysis that showed its effects on costs for diarrhea were not cost-saving (18).
Diarrhea and pneumonia are the two most common causes of infant death worldwide, accounting for 40% of all mortality in children under 5 years old (19, 20), and remain significant public health problems in Nicaragua, where the infant mortality rate is 27/1 000 (21). Any strategies that help address the high burden of disease resulting from these two conditions are likely to have a significant impact on the overall effectiveness of the health system.
Money saved due to the slight decrease in average LOS that occurred over the course of the intervention was partially offset by the increase in expenditure for antibiotics that resulted from improved compliance with clinical guidelines. Before the intervention, prescription practices for antibiotics in Nicaragua were reported to be generally poor, leading to suboptimal outcomes and an increase in the risk of resistance (22). Suboptimal practices included the prescription of cheaper antibiotics that in many cases were not recommended. The intervention addressed this issue by standardizing prescribing practices and facilitating the use of more appropriate (and often more expensive) antibiotics for diarrhea and pneumonia. Therefore, while this part of the intervention achieved the desired result of improved compliance with prescribing standards, it also led to an increase in the average cost per patient for antibiotics.
Sensitivity analysis showed that the uncertainty in LOS input variables had the greatest impact on the cost-effectiveness result. Given that the differences between pre- and post-intervention LOS were not statistically significant, achieving a more accurate estimate of these inputs by using a larger sample size would have yielded a more precise result.
By definition, collaborative improvement is a temporary intervention designed to 1) address specific problems in the quality of services and 2) institutionalize the changes made in care processes to ensure sustainability of the results. Once this occurs, QI teams either move onto another set of problems or disband. If that definition holds true, favorable results would continue to be achieved upon completion of the PHI Collaborative intervention at the targeted facilities, without further intervention and expense. If this were the case, the QI intervention strategy would prove more cost-effective when considered over a longer time period.
While no other interventions were implemented to address the quality of diarrhea and pneumonia care in Nicaraguan hospitals either before or during the PHI Collaborative intervention, the lack of a control group in this study design leaves open the possibility that the changes detected in the pre-/post-intervention comparisons could have been due to factors other than the intervention. Further studies using a control group or an analogous design would help determine how much improvement was attributable specifically to the PHI Collaborative initiative.
Other than the start-date of their respective intervention activities, there were no substantive differences between the seven hospitals selected for the study sample and the remaining seven that were not. Nevertheless, the possibility of selection bias would have been reduced and the case for generalizability improved if all 14 hospitals (or a random sample from all 14 hospitals) had been studied.
This study did not consider the possible downstream benefits to either the health system or other departments in the participating hospitals of having better trained and more highly engaged and motivated clinical staff as a result of the QI intervention. According to the literature, QI collaboratives have produced downstream benefits such as improved provider engagement with their work, and increased trust among providers (23); better staff relationships; and the extension of QI approaches to other areas within the facilities (24). The higher-quality clinical care for diarrhea and pneumonia resulting from the PHI Collaborative intervention may also have led to a decrease in morbidity and mortality from other causes, but these outcomes were not measured. If these benefits did occur and had been quantified and included in the analysis, the cost-effectiveness of the intervention would be higher. The intervention's effect on the care of those diagnosed with malnutrition (without pneumonia or diarrhea) was not considered either, even though part of the intervention addressed quality of care in this area. In addition, the authors did not consider factors related to cost-effectiveness from the societal perspective, such as potential cost savings for families caring for children with diarrhea and pneumonia after their discharge from the hospital. Once again, given the decreased burden of disease associated with the intervention, the cost to families and caregivers would have most likely decreased, improving overall cost-effectiveness.
Recommendation and conclusion
Due to the improved patient outcomes resulting from the intervention, overall hospital expenditures for the care of children with diarrhea and pneumonia would not increase if MINSA expanded the intervention to other pediatric hospitals in Nicaragua that were not part of the initial implementation. The $45 124 cost of the intervention, when divided by the number of children admitted to hospital pediatric wards with either diarrhea or pneumonia, is equivalent to about $3 per child served. This is less than 0.7% of the average cost of hospitalization for either of the two conditions. The decrease in the overall burden of disease associated with the intervention indicates that it may lead to a substantial net benefit to the health system. Assuming that the cost of implementing the QI intervention in other pediatric facilities is approximately the same as it was in the initial seven facilities, the $3-per-child investment may produce substantial cost-savings per DALY averted. Given the potential for large cost-savings, implementation of the QI intervention by MINSA throughout the country seems prudent. However, further research is needed to establish whether or not the improvements seen were completely attributable to the intervention before the authors can unreservedly recommend its adoption to all hospitals in this setting.
Acknowledgments. The authors thank the staff and administrators of the hospitals for their participation in this study, and the Nicaraguan Ministry of Health (MINSA) for their support and assistance. This work was supported by the American people through the United States Agency for International Development (USAID) and its Quality Assurance Project (QAP) (contract no. GHN-I-01-00003-00) and Health Care Improvement (HCI) Project (contract no. GHN-I-01-07-00003-00), implemented by University Research Co., LLC (URC).
1. World Health Organization. Disease and injury country estimates: burden of disease. Deaths estimates for 2008 by cause for WHO Member States [Internet]. Geneva: WHO; 2009. Available from: http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html. Accessed 8 March 2011.
2. Becker-Dreps S, Paniagua M, Dominik R, Cao H, Shah NK, Morgan DR, et al. Changes in childhood diarrhea incidence in Nicaragua following 3 years of universal infant rotavirus immunization. Pediatr Infect Dis J. 2011;30(3):243-7.
3. Duke T. Child survival and IMCI: in need of sustained global support. Lancet. 2009; 374(9687):361-2.
4. USAID Health Care Improvement Project. Improving pediatric care in Nicaragua. Bethesda, MD: University Research Co., LLC; 2008.
5. Nembhard IM. Learning and improving in quality improvement collaboratives: which collaborative features do participants value most? Health Serv Res. 2009;44(2 Pt 1): 359-78.
6. World Health Organization; UNICEF. Integrated Management of Childhood Illness chart booklet. Geneva: WHO; 2008.
7. World Health Organization; UNICEF. Model IMCI handbook: integrated management of childhood illness. Geneva: WHO; 2005.
8. Exchangerateusd.com. 2006 historical exchange rates [Internet]. Available from: http://www.exchangerateusd.com/historical currency/2006. Accessed 15 September 2010.
9. Murray C, Lopez A. The global burden of disease. Cambridge, MA: Harvard University Press; 1996.
10. World Health Organization. Global health observatory data repository: country statistics. Nicaragua [database on the Internet]. Geneva: WHO; 2009. Available from: http://apps.who.int/ghodata/?vid=14800&theme=country. Accessed 8 March 2011.
11. Kim SY, Goldie SJ, Salomon JA. Cost- effectiveness of Rotavirus vaccination in Vietnam. BMC Public Health. 2009;9(1):29.
12. De la Hoz F, Alvis N, Narváez J, Cediel N, Gamboa O, Velandia M. Potential epidemiological and economical impact of two rotavirus vaccines in Colombia. Vaccine. 2010; 28(22):3856-64.
13. World Health Organization. CHOosing Interventions that are Cost Effective (WHOCHOICE). Threshold values for intervention cost-effectiveness by region [table on the Internet]. Geneva: WHO; 2010. Available from: http://www.who.int/choice/costs/CER_levels/en/index.html. Accessed 23 August 2010.
14. World Bank. World Development Indicators database. Gross national income per capita, 2009: Atlas method and PPP [Internet]. Washington: World Bank; 2010. Available from: http://siteresources.worldbank.org/DATASTATISTICS/Resources/GNIPC.pdf. Accessed 10 August 2010.
15. Iglesias CP, Drummond MF, Rovira J; NEVALT Project Group. Health-care decisionmaking processes in Latin America: problems and prospects for the use of economic evaluation. Int J Technol Assess Health Care. 2005;21(1):1-14.
16. Goldie SJ, Diaz M, Constenla D, Alvis N, Andrus JK, Kim SY. Mathematical models of cervical cancer prevention in Latin America and the Caribbean. Vaccine. 2008;26 Suppl 11: L59-72.
17. Rheingans RD, Constenla D, Antil L, Innis BL, Breuer T. Potential cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries. Rev Panam Salud Publica. 2007;21(4):205-16.
18. Centenari C, Gurgel RQ, Bohland AK, Oliveira DM, Faragher B, Cuevas LE. Rotavirus vaccination in northeast Brazil: a laudable intervention, but can it lead to cost-savings? Vaccine. 2010;28(25):4162-8.
19. Vilchez S, Reyes D, Paniagua M, Bucardo F, Möllby R, Weintraub A. Prevalence of diarrhoeagenic Escherichia coli in children from León, Nicaragua. J Med Microbiol. 2009;58(Pt 5):630-7.
20. Ministerio de Salud (NI). Sala de situación. Boletín epidemiológico. May 3. Managua: MINSA; 2011. Available from: http://www.minsa.gob.ni/index.php?option=com_content&view=article&id=31:sala-desituacion&catid=6:direccion-general-vigilancia-de-la-salud-publica&Itemid=40. Accessed 15 September 2011.
21. UNICEF. At a glance: Nicaragua [Internet]. New York: UNICEF; c2010. Available from: http://www.unicef.org/infobycountry/nicaragua.html. Accessed 26 August 2010.
22. den Engelsen C, van der Werf C, Matute AJ, Delgado E, Schurink CA, Hoepelman AI. Infectious diseases and the use of antibiotics in outpatients at the emergency department of the University Hospital of León, Nicaragua. Int J Infect Dis. 2009;13(3):349-54.
23. Ayers LR, Beyea SC, Godfrey MM, Harper DC, Nelson EC, Batalden PB. Quality improvement learning collaboratives. Qual Manag Health Care. 2005;14(4):234-47.
24. Bradley JE, Mayfield MV, Mehta MP, Rukonge A. Participatory evaluation of reproductive health care quality in developing countries. Soc Sci Med. 2002;55(2):269-82.
Manuscript received on 10 October 2010.
Revised version accepted for publication on 13 May 2011.
* Send correspondence to: Edward I. Broughton, firstname.lastname@example.com; firstname.lastname@example.com


text:
NEW DELHI, India (CNN) -- An Indian court has issued arrest warrants for 22 Pakistanis wanted in connection with last year's terror attacks in Mumbai.
The suspects are accused of being the masterminds behind the attacks, which killed more than 160 people. One of the warrants is for Hafiz Mohammed Saeed, the founder of the Pakistani-based militant group Lashkar-e-Taiba.
The warrants were handed down because of a motion by the prosecutor in the trial of Ajmal Kasab, accused of being the lone surviving gunman among the 10 men who launched the attack.
"We have substantial evidence" against the suspects, all of whom are Pakistani, Special Public Prosecutor Ujjwal Nikam told CNN.
Nikam said authorities want to arrest five additional suspects but warrants have not been issued because their "full names are not known yet," only their addresses.
In all, there are 35 suspects wanted in the case, including additional members of Lashkar-e-Taiba, authorities said.
Nikam said some of the evidence is based on Kasab's confession, in which he revealed names.
The three-day rampage started November 26, 2008. The attackers targeted 10 sites in Mumbai and took over several five-star hotels and a Jewish center.

subset: commoncrawl


text:
Five categories of independents emerged from the analysis of the survey results:Can I be 4 of those? thinks the pesky independent -- who will always deny being a closet partisan. But then, that would be part of the closet partisan game.
"Deliberators," who are classic swing voters.
"Disillusioned," who are acutely upset with politics today.
"Dislocated," who are both social liberals and fiscal conservatives.
"Disguised," who are partisans on the left and right who behave almost identically to Democrats or Republicans.
"Disengaged," who generally sit on the political sidelines.
Unlike most other independents, the Deliberators are generally satisfied with the political system and have positive views of the two parties....Actually, I'm easily categorizable as "dislocated." I wonder what's going on with that "least religious" angle. It's easy to articulate a theory that would annoy people.
The Disillusioned are highly dissatisfied with the political system. Nine in 10 said the two-party system does not work for them. Many volunteered that "neither party" better represents their views on important issues, including more than seven in 10 who said so about their position on Iraq....
The ideologically Dislocated are far more likely to say that the Democrats better represent their views on social issues, while a majority asserted that the government in Washington is doing too many things that should be left to individuals and businesses. They are also the least religious of any of the five groups.
Disguised partisans generally walk and talk like Democrats or Republicans -- sometimes with even more passion. They reject party labels but usually back one side or the other....
The Disengaged make up about a quarter of all independents and typically have little or no interest in politics. They are the least likely to be registered to vote, the most likely to have at most a high school education, and the youngest of any group. Four in 10 are younger than 30.


text:
WARNING! - RANT VENTING! Hey, you know that lung thing I've been down with. Turns out to be Pneumonia... the woosy kind you don't go to hospital for and that normally the young or OVER 65 get... For fuck sake!!!. Well, ain't this fucking great. If I had the capacity I'd kick a puppy, I'm that pissed. No beer just more antibiotics. Bahh! I was sweating buckets just doing this report but I'm fed up with myself so... RANT VENTING OVER...
An eerie glow begins to pulse from a red gem on Blitzens wrist...
All I can say is that hell has a special place for me and Massam. She is 16 now, right?!. Err, sorry Blitzen.
A weird transformation takes place... um.
Just not right. The things you do for fun. *sigh*
The Blitzen/Witchblade meld to each other greatly enhancing her powers and providing a weapon that can change at need to items of deadly power.
A special Hell, with special kinds of nasty red hot purgatory for people like us, Massam. We are so dead.
Blitzen engages her Witchblade shield and deflects a response shot from an UDSM as she closes on them.
The Witchblade rapidly grows into an obsidian blade which she uses to de-limbs one of the OTC Glaive armed UDSM's.
Then she shivs him right through the back destroying his holstered Blaster Rifle in the process.
Before spinning him around...
and slamming him into the wall as a shield. The UDSM is still alive as he still has his head but he's in trouble having been pinned on Blitzens Witchblade.
The Assassin Droid hoping to catch out the bunched together UDSM eposes himself on the remains of the tower.
Before he can fire another UDSM fires in response.
It's a hit!..
The Assassin Droid is down but gets to make an "I'll be back" regeneration roll in the end phase.
The Crying Deadly Spaceman is in trouble too and makes an impassioned plea to an estranged colleague.
Crying Deadly Spaceman wrote: We few, we happy few, we band of brothers;
For he to-day that sheds his blood with me
Shall be my brother!
A once member of the Azure Guard considers his life to date...
and finds it lacking. Swayed by the words and what he used to be he turns on his Brothers.
And displaces to a defendable corner of the base.
The Crying Deadly Spaceman scarpers for cover firing as he goes. The shots impact on the UDSM but his OTC got in the way of the head shot, again another UDSM down but not dead.
The Crying Spaceman turtles in a corner of the towers ruins.
The Trikes find the mass of rubble hard going but make as much distance as they can.
Mini-Warhead finally wakes up after being thrown by an explosion (6+ roll on a D6 and it took about three turns, well, he is still just a kid). He recalls some Peach bastards were responsible.


text:
There's something in common between the show's host Lee Eunmi and Han Young-ae who joined NAGASU season 2 on the second night of the second round (6/10/2012) after the band Baekdusan was eliminated and Park Wangyu graduated with honor. Both of them are ex-singers of the legendary blues rock band Shinchon Blues (1986~present); Han was one of its original members (Eom Inho (leader/guitarist/singer), Lee Jungseon (guitarist/harmonicist/singer), Kim Hyunsik (singer), and Han) and Lee joined the band as guest singer in 1990 after Han's departure.
While watching Han's surprising special performance on the Voice of Korea (5/11/2012), I personally wished the NAGASU producers would cast her and was very happy to hear the news that she was joining the show. Han made her recording debut at the age of 22 in 1977 as a founding member of the Sunflowers (해바라기, Haebaragi) that consisted of Lee Jungseon, Lee Juho, Kim Youngmi, and Han. Last April, she marked her 35th anniversary as a recording artist at 57 (in Western age, and 58 in Korean age). The last time I saw her perform live on stage was close to 20 years ago and I haven't seen her sing live since I came to the U.S. And when I saw her singing on the Voice of Korea (VOK) last May, I thought she looked exactly the same. When I saw her again on NAGASU though, she looked a lot older (yet still much younger for her age) but one thing that has not changed is that she still sings with the same charisma, the same bewitching voice, and the same engaging stage manner.
Han sang Ibyeore Jongchangnyeok (이별의 종착역, "The Last Stop of Farewell") and I think there were reasons for her choice. The song was originally written in 1960 for the movie of the same name and sung by Sohn Sihyang and it was covered twice by the legendary singer Kim Hyunsik, first on Shinchon Blues's third album (1990) and then on his sixth solo album (1991). I may be wrong but I think she wanted to sing the song in tribute to the late Kim Hyunsik and in homage to Shinchon Blues. Her understated performance of great depth was memorable to me but couldn't quite captivate an eager audience. As she failed to make it into the top three, she would compete with other 5 singers, the bottom three from each group, in the elimination round.
[AUDIO ONLY] Han Young-ae: "The Last Stop of Farewell"
on MBC's NAGASU (aired on 6/10/2012)
Lyrics: "The Last Stop of Farewell"
I walk and walk but my lonely journey never ends.
It's a deep foggy dawn and I'm leaving for the last stop of farewell.
People come and go but why can't she come?
Under the blue moonlight, I'm shedding tears on the last stop of farewell.
Ah, when will the fog covering my heart completely lift?
Ah, when will the sun rise and shine bright on my heart?
I walk and walk but my weary journey never ends.
It's windy, raining, and snow-storming on the last stop of farewell.
Ah, when will the fog covering my heart completely lift?
Ah, when will the sun rise and shine bright on my heart?
I walk and walk but my weary journey never ends.
It's windy, raining, and snow-storming on the last stop of farewell.
Kim Hyunsik: "The Last Stop of Farewell" (1991)
I also really loved watching Jeong Yeop and JK Kim Dongwook who made the top three. Jeong sang Bo-ine (보이네, "I See….") originally sung by Na Mi, an 80's dance music diva, with a 21st-century interpretation; and JK sang Haengboge Nararo (행복의 나라로,"To the Land of Happiness") written and originally sung by Han Daesu, a 70's iconic grassroots activist singer/song writer, with technical bravura. Just like Lee Janghee's songs, this song was banned for a ridiculous reason during Park Chunghee-Chun Doohwan's military dictatorship (1963~1987); the Korean Governmental Body of Music Censorship interpreted "the land of happiness" as indicating North Korea and falsely accused him of praising the country's enemy. Which was a total blah!
on MBC's NAGASU (aired on 6/10/2012)
Lyrics: "I See…."
I see it, I see that alley.
I see it, I see that streetlight.
Will he come back after tonight?
He held my hand the first day we met.
My longing for him is soaking my heart again.
(Refrain) While thinking of my dear, I'm getting skinnier.
I left my dream here
And long, long years have passed since.
Ooh, why can't we meet again?
Why can't we meet again?
I can see my dear (my dear, my dear)
My eyes can see.
I see them, I see those lights.
I see them, I see those pupils.
Will he be forgotten, buried in time?
His teacup's already cold and he's leaving me.
My longing for him is soaking my heart again.
Original Version: Na Mi
Bo-ine "I See...." (1985)
[AUDIO ONLY] JK Kim Dongwook: "To the Land of Happiness"
on MBC's NAGASU (aired on 6/10/2012)
Lyrics: "To the Land of Happiness"
Take down the tent.
With your small eyes, let's open this world.
Open the window.
Let's feel the dancing breeze once more.
Let me walk on the light grass.
I want to listen to the sound of spring and the birds.
I want to cry and I want to laugh.
Please caress my heart.
I will go to the land of happiness.
It's early evening and I lie down to fall into a reverie.
And I get carried away with thoughts.
Through the small window in the wall
Flows in the fresh sound of children playing.
Ah, I will live as long as the sun shines
In the arms of the night, sky, and wind.
I will survive the sound of rain and thunder and dance.
I will go to the land of happiness.
You're hanging your head low
But open your eyes and listen carefully
So when you wake up in the morning,
You can't even find yourself
Or can't tell night from day.
Let's keep our heads up and come hand in hand,
Turning the last page of youth and temptation.
The wilderness is vast and the sky is blue.
Let us all go to the land of happiness.
Let us all go to the land of happiness.
Haengboge Nararo "To the Land of Happiness" (1974)
Lee Eunmi performed barefoot, living up to her nickname "the barefoot diva" (JK Kim Dongwook often performs barefoot (as he did this time) and on NAGASU, Lee made a couple jokes about who's the original barefoot.) and was announced the winner of the night. Trust me. Lee is my all-time favorite and her Ae-in Isseoyo (애인 있어요, "I Have a Lover") is one of my all-time favorite songs (to sing at noraebang). And I know she performed an entertaining medley of Saranggwa Pyeonghwa (사랑과 평화, "Love and Peace") songs but to be honest, I was a little underwhelmed by her performance. Maybe it's because I just loved the original versions by Love and Peace, a 70's iconic rock band, which were clean, forthright yet very unique.
[AUDIO ONLY] Lee Eunmi: Love and Peace Medley
"Haven't Heard from Her for a While" &
"Cannot Put My Finger On It"
on MBC's NAGASU (aired on 6/10/2012)
Lyrics: "Haven't Heard From Her for a While"
I haven't heard from her for a while.
I was wondering what was going on with her.
Afraid she was sick,
I was so antsy and so edgy.
I haven't seen her for a while.
I felt awkward and distant when I saw her again.
Afraid she changed her mind,
I was so antsy and so edgy.
Every night I opened the window and told the moon.
I declared my ardent love for her to the moon.
Helplessly I vented my spleen on the moon.
Helplessly I vented my spleen on the moon.
Original Version: Love and Peace
Handong-an Ddeumhaesseotji
"Haven't Heard from Her for a While" (1978)
"Haven't Heard from Her for a While" (1978)
And now, last but not least, I'd like to talk about Kim Gunmo. As his nickname Gukmin Gasu (국민가수, "Nation's Singer") speaks for itself, needless to say, he is one of the best singers in Korea. Ironically enough, however, I think he's one of the most underrated singers, too. Let me put it this way. Have you ever watched the 2010 Olympic figure skating champion Kim Yuna do her triples? Her jumps look just so effortless, so seamless, and so easy that people easily forget how difficult they are and rarely realize what a great jumper she is. Just like that, people don't realize how difficult to sing Kim Gunmo songs and what a great vocalist he is until they sing themselves his songs. And I think comedy is in his blood and he's hilarious to the core, which sometimes is reflected in his singing and hurts his image as a singer. This was familiarly instanced in the early controversy over his elimination in NAGASU season one. (Click for details.)
The original concept of NAGASU was focused on entertainment and Kim carried out his performance rather comically, faithful to the show's concept. It was, however, ill-received by the studio audience and led him to placing at the bottom of the pack. And check how he ended his performance this time. I'd say his funny ending was Hwa-Sa-Cheom-Jok (화사첨족) rather than Hwa-Ryong-Jeom-Jeong (화룡점정). Hwa-Sa-Cheom-Jok or simply Sa-Jok translates to "Draw a snake and ruin it by adding feet to it" or an English idiom "a fifth wheel." On the other hand, Hwa-Ryong-Jeom-Jeong translates to "Draw a dragon and complete it by adding eyes to it," that is, "Make a perfect final stroke." But what can I say? I just love Kim Gunmo.
Kim chose to sing Nae Maeumeun Dangsin Gyeoteuro (내 마음은 당신 곁으로, "My Heart Is Running to Your Side") which was originally sung by Kim Jeongsu in 1980 and since, it has been covered by various singers such as Cho Yongpil (1985), one of Korea's legendary singers and Gukmin Gasu, Min Haegyung (1987), Cho Kwanwoo (1999), the late Taiwanese singer Teresa Teng (aka, Dèng Lìjūn) in Japanese in 1988, and many other Japanese singers.
[AUDIO ONLY] Kim Gunmo: "My Heart Is Running to Your Side"
on MBC's NAGASU (aired on 6/10/2012)
Lyrics: "My Heart Is Running to Your Side"
A streak of tears running from your shining eye
Brought cold winds to my heart that turned into a fallen leaf.
I tried to forget and forget but your warm smile
Turned my heart into candlelight of love that will glow forever with you.
(Refrain) Though the blowing wind takes my body away,
My heart feels lonely by your side.
Though all things pass away,
My heart is running to your side.
Because I loved you so much, I'm harboring too many regrets.
Now it has turned into bygone memories I can never catch.
Original Version: Cho Yongpil
Nae Maeumeun Dangsin Gyeoteuro
"My Heart Is Running to Your Side" (1985)
"My Heart Is Running to Your Side" (1985)
KOREAN MUSIC: MBC's "I Am a Singer" Season 2 (4)
KOREAN MUSIC: MBC's "I Am a Singer" Season 2 (5)
KOREAN MUSIC: MBC's "I Am a Singer" Season 2 (7)


text:
Ubisoft today announced the PC specifications and requirements for Far Cry 3. They revealed three separate sets of specs for a vast array of machines, so hopefully yours meets one of them. If not, there is still time to upgrade as Far Cry 3 isn't due out on PC until December 4, 2012 in North America.
In addition to the PC specs, Ubisoft also revealed the protection details for the game, which I'm sure many of you are concerned about. Far Cry 3 will require a one-time activation via Uplay PC. Obviously internet connection will be required to perform this process. Once activated, the game can be played online to enjoy the social features in both single player and multiplayer, such as Friends, Party and Chat, or switched to offline mode in the Uplay PC settings menu for a single player experience without broadband connection.
Below are the three sets of specs to offer an optimal Far Cry 3 experience depending on your rig.
Example minimum 1 (NVidia/Intel)
- NVidia GTX8800
- Intel Core2 Duo E6700
Example minimum 2 (AMD)
- AMD Radeon HD2900
- AMD Athlon64 X2 6000+
Recommended Specs
DirectX11 graphics card with 1024MB Video RAM Quad core CPU 4GB Memory
Example recommended 1 (NVidia/Intel)
- NVidia GTX480
- Intel Core i3-530
Example recommended 2 (AMD)
- AMD Radeon HD5770
- AMD Phenom II X2 565
Hi-Performance Specs
- Latest DirectX11 graphics card
- Latest quad core CPU
- 8GB Memory
Example hi-performance (NVidia/Intel)
- NVidia GTX680
- Intel Core i7-2600K
Example hi-performance (AMD)
- AMD Radeon HD7970
- AMD Bulldozer FX4150


text:
Enjoy reading with Total Boox
Download our app for your Android device, and tap "Get Books" to browse our catalog and download books.
Enjoy reading FREE
By clicking "Sign up" or "Sign up with Facebook", you confirm that you accept the
Terms of use and
Privacy Policy.
Can't find your library? Forgot your library ID or pin? Click here for assistance.
Download our app to read on your
iPhone, iPad,
Kindle Fire
This book is listed in:
By Virginia Woolf


text:
Living in a tourist town like La Fortuna, Costa Rica, we often get the opportunity to talk with folks who have seen our videos or cruised around our blogs and website. Usually, it's because they recognize us on the street and are kind enough to come up and say, "Thanx guys, we appreciate all the INFO, keep up the good work." It happened to me yesterday while riding my bike. These guys were so NICE- said they had seen most of our videos and were doing many of the things on their travels that we had recommended. As a matter of fact, they had just had pizza at 'Just Good Food' who we had just done a video for (you can see it HERE if you want) and they loved it.... *At first I was a little nervous to ask if they enjoyed the food, because although I love 'Just Good Food' every now and then they under cook the pizza.... WHEW!
Which leads me to my point.
We take what we DO very seriously and are very cautious on who we 'get in bed with'. We don't want to be like 'most' websites pertaining to Costa Rica travel, which seem intent on 'pushing paradise' at any cost in order to make a few bucks off unsuspecting tourists.
If the people or businesses we get in bed with aren't all they say they are, then we're NOT interested and if we were to get hookwinked for a minute or two, we'd tell you and then KICK the BUSINESS to the CURB. So, just like yesterday, we're fairly certain 9 out of 10 people will LOVE Vamos 4X4 if they rent a car from them and the same goes for Gecko Trail Adventures, who is the travel agency we recommend (video below). When we were researching if we wanted to recommend Vamos 4X4 or not, we were talking with the owner, George S. and he told me he wasn't in it for the money, rather he loved what he was doing and if he couldn't do it with integrity and honesty than he wouldn't do it.. and unlike many Costa Rican businesses here, he does believe the 'Customer is King', and take my word, although that's mostly true in the United States, it isn't here- so it's appreciated. And after further investigation, he wasn't kidding. And the exact same principles are held by the folks at Gecko Trail Adventures. I can't tell you how nice and refreshing it is to run into like minded people or businesses here in Costa Rica.
And the same goes for the Adventure Tours D'Angelo and I will be selling in La Fortuna, when we say we will SAVE you a TON of money, we hope you know it's TRUE (actually, do your homework and compare, we're sure you'll be BACK!)
Anyway, THANX to all the people who take the time to give us a SHOUT OUT! And also want to say, "THANX" to the folks at Vamos 4X4 and Gecko Trail Adventures for believing in us as much as we believe in THEM. pura vida.
In case you haven't seen them, our videos for Vamos 4X4 Car Rental Agency and the Travel Agency we work with and recommend, Gecko Trail Adventures. ENjoY!
TONS of Costa Rica Travel Info and VIDEOS on our website: Travel Costa Rica NOW and if you want to visit our YouTube Channel: iCostaRica24 ENjoY!


text:
Middlesex District Attorney's Officer
John Burbine, 49, of Wakefield, Mass., is accused of sexually abusing more than a dozen young children.
A Massachusetts man raped and sexually abused more than a dozen young children in their homes and videotaped the assaults, a prosecutor said Thursday.
The purported victims were as young as 8 days old, Middlesex District Attorney Gerry Leone said.
"This is among the most troubling and disturbing cases of child abuse ever prosecuted in Middlesex County," Leone said in a statement.
John Burbine, 49, of Wakefield, was indicted Thursday by a Middlesex grand jury on more than 100 counts of child sex offenses. He gained access to many of the children through a child care service operated by his wife, Leone said at a news conference Thursday.
According to authorities, Burbine and his wife advertised child care and tutoring services on various websites including parenting websites and coupon service websites. They also transported children to another family's home for day care and ran a summer activities program in which they took children to various places, prosecutors said.
Burbine raped and sexually assaulted at least 13 infants and young boys and girls who were in his care from August 2010 through August 2012, according to the indictment. Many of the children were abused multiple times over several months or years, the charges allege.
The victims ranged in age from 8 days to 3½ years old and are from Stoneham, Medford, Newton, Reading, Melrose, Woburn and Waltham, prosecutors said.
Investigators said they found images and videos on Burbine's home computer of the victims "posed in various states of nudity and engaged in sexual acts" "It is alleged the defendant videotape recorded the assaults on the victims," the prosecutor's office said.
"He committed these unspeakable crimes in the victims' homes and communities. Further, the defendant filmed the repeated, unthinkable abuse," Leone said. "The defendant gained access and opportunity to abuse young children through advertising child care services with his wife, who operated a tutoring and child care business, which was not licensed. Children are our most vulnerable victims and we will continue to prosecute to the fullest extent those who harm or exploit them."
Watch US News crime videos on NBCNews.com
Burbine's wife, Marian Burbine, 46, of Wakefield, has been indicted on charges of reckless endangerment of a child and operating an unlicensed day care business. Prosecutors said she was not present during the alleged rapes and did not know about them. She is free on bail, with conditions that she wear a monitoring bracelet, stay in her home from 6 p.m. to 8 a.m., and have no contact with alleged victims, clients, former emloyees, and any children under 16.
John Burbine was originally arrested Sept. 28 in Reading by Massachusetts State Police assigned to the Middlesex District Attorney's Office after an investigation into allegations of unlicensed child care at Waterfall Education Center, the business run by his wife, purportedly uncovered evidence of a sexual assault on a child.
Leone said his office obtained a court order shutting the business down while the criminal investigation continued. Following John Burbine's arrest, the Middlesex District Attorney's Office said it discovered more victims as well as video evidence allegedly showing the assaults on the victims, leading to the indictment Thursday.
Burbine will be arraigned Dec. 12 in Middlesex Superior Court.
More content from NBCNews.com:
- 2012 warmest year in US? Odds rise to 99.7 percent
- Buzzkill: Feds fire warning shot over pot legalization
- Abortion mandate costs Planned Parenthood a few affiliates
- Contest to kill Burmese pythons in Everglades includes $1,500 grand prizes
- Video: $45 million worth of cocaine hauled in from sea
Follow US news from NBCNews.com on Twitter and Facebook


text:
Unit buy back bill sees frightening unintended consequences
In a move that could spell the death of many strata-title retirement villages in Queensland, a bill was submitted to the Queensland Parliament last month that would require operators of strata-title villages to "buy back" unsold units after 18 months. While it's called a "buy-back", many operators of strata-title villages never owned the units in the first place, so it would be more of a "compulsory acquisition".
Of course, the bill is proposed with the best of intentions — to match the guarantees offered to residents of strata-title villages with those of leasehold villages. However, the unintended consequences are frightening. And once again it's the little people who will be the worst affected.
Think about a retirement village of 100 units, built by a property developer 25 years ago. On completion of the project the developer sold all the units, and left the village to be administered by a body corporate run by the residents. Today, the average age of the residents in the village is around 80, with a number in their 90s. The body corporate runs the infrastructure, but each owner is solely responsible for their own unit — after all, they own it. And if the development is like most of its kind the quality of the homes will be a continuum: most will be fine, a few will be pristine, and a small minority will leave much to be desired.
Under the existing regulations, it is the responsibility of each owner to arrange their own sale for the best price they can get. But if this bill passes into legislation things will change from next May. No longer will it be just the owner's problem if a unit is hard to sell — it will now be every owner's problem. That's right: the other 99 residents could be responsible for buying back the unsold unit.
Rachel Lane of Aged Care Gurus, spoke to the manager of a strata-title village in Brisbane's northern suburbs. The scheme operator is a company with 104 shareholders: the residents of the village. Units in the village sell for between $290,000 and $360,000. The village manager said: "Obviously we don't have the funds on hand to come up with that kind of money: we would need to levy the residents. Worst case scenario, say we have two or three that can't sell, we would need to levy the residents $8000 to $9000 … many of our residents are pensioners, who simply wouldn't be able to afford it."
A Department of Housing and Public Works spokesperson said that operators who find themselves in financial hardship as a result of the buybacks "can seek relief". That's easier said than done.
What potential buyer in their right mind is going to be interested in buying a unit in a development where there is a strong chance that they will be forced to contribute to a fund to compensate an owner whose unit is unable to be sold? This lack of demand will drive prices down even further. It's the ultimate catch-22.
The bill would cause problems for commercial operators too. The developers sold the units to the residents, receiving the upfront purchase price, and entered into a management agreement with the operator to manage the village for the right to an exit fee when the units sold in the future. Under the proposed new rules, to get the exit fee the operator would potentially need to "buy back" a unit they never sold, spend the amount necessary renovating and marketing and then sell it. Only then could they get their exit fee. One thing is for sure, if the operator can afford to buy the unit, it won't be sold next time as strata-title.
As President Reagan said, "The nine most terrifying words in the English language are: I'm from the government and I'm here to help".
- Noel Whittaker is the author of Making Money Made Simple and numerous other books on personal finance. Email email@example.com


text:
Your search did not match any results.
We suggest you try the following to help find what you're looking for:
Oracle WebCenter Content provides a unified repository to house unstructured content, enabling organizations to deliver it to business users in the proper format and within the context of familiar applications that fit the way they work.
Access your files from anywhere via mobile apps.
The easy-to-use interface makes it simple to browse folders and view files.
Find important information fast using the new search interface with type-ahead search results and saved searches.
Quickly view files without opening an application using integrated document viewing and rendition access.
Integrated with enterprise applications.
Publish content updates from an enterprise repository.
Oracle's partner community of more than 20,000 partners (including 1,000+ specialized partners) provides you with solutions and services that meet your unique business needs.
Engage a Sales Expert>


text:
A fan on Tigerboard.com drew my attention to the posting a week ago of Southeast Missouri State's schedule, which includes a Tuesday, April 30th visit to Columbia to play the Tigers.
♦ The Columbia Tribune today reported MU baseball to play series at Southern Miss. Tex and Hunter mentioned on the air toward the end of the 2012 season that MU's opening series in 2013 will be in the middle of SEC country at Southern Mississippi, a pretty good Conference USA team (32-24 in 2012)
♦ SEC Schedule: The SEC released their 2013 Baseball Schedule a couple of months ago (unlike the Big 12, which has always kept such information tightly held)
♦ Mention has been made this past season that both the San Francisco series and the Memphis series are home-and-away agreements that will bring USF to CoMo for a weekend in 2013 and send Missouri to Memphis for an away weekend series in 2013. Memphis has released their official 2013 schedule, which verifies the February 22-24date of Mizzou's series with Memphis as we previously posted on the schedule below, and San Francisco also has posted their schedule, confirming the March 8-10 series we had previously posted.
♦ Because of the length of the SEC schedule, there will only be 4 weekend non-conference series at the beginning of the season. Since MU usually plays on the road until March, we can expect only 2 home series prior to the beginning of SEC play.
♦ A follower of SimmonsField.com reminded me that Tex said the home opener will be March 1st against Northwestern. That fills in the last question mark for the weekend series schedule.
♦ 2013 Weekend series dates
2/15-2/17 - @ Southern Mississippi
2/22-2/24 - @ Memphis
3/1/-3/3 - Northwestern
3/8-3/10 - San Francisco
3/15-3/17 South Carolina at Missouri
3/22-3/24 Missouri at Tennessee
3/29-3/31 LSU at Missouri
4/5-4/7 Missouri at Georgia
4/12-4/14 Missouri at Vanderbilt
4/19-4/21 Florida at Missouri
4/26-4/28 Auburn at Missouri
4/30 Southeast Missouri at Missouri
5/3-5/5 Missouri at Texas A&M
5/10-5/12 Missouri at Alabama
5/16-5/18 Kentucky at Missouri
5/21-5/26 SEC Tournament


text:
800-313-9128 FAQ | Contact | Dealer Login | Drop Ship Dealers Wanted
|(116 Items) Sort:
|Show: / page
Chrome Knot Key Chain 5"
Chrome Bell Key Chain 4"
Antique Copper Ship Wheel Key Chain 5"
Out of Stock
Similar to Key Chains
Key Chains
Carry your favorite nautical symbol with you wherever you go with one of Handcrafted Nautical Decors fabulous solid brass key chains. Whether you prefer the classic Admiralty Pattern Anchor, a charming solid brass Dolphin, or a stylish Brass Telescope, Handcrafted Nautical Décor has the perfect key chain for you. Great for stocking stuffers and corporate gifts as well, these delightful key chains are the perfect nautical accessory for everyone.
Handcrafted Nautical Décor offers a stunning array of brass key chains, each depicting a symbol of the sea, and as ancient mariners carried their individual good luck charms your key chain will be a personal talisman. Keep your keys close together and your love of the sea close to your heart, and find the perfect nautical gifts for everyone.


text:
The Pacific Rim Rogue bed frame is made of solid maple and can be ordered either unfinished or finished with PRW Standard Oil Finish (tung oil, linseed oil and varathane), or All Natural Tried and True Finish (primarily polymerized linseed oil).
The Platform style supports a futon, foam or innerspring mattress.
Platform style bedframes come with a Standard Slat Roll that has 2 1/2 inch spacing between the slats. You may choose the Upgraded Slat Roll with 1 1/2 inch spacing between the slats. This creates a firmer and stronger foundation and is recommended for heavier mattresses.
All Pacific Rim furniture is guaranteed by the manufacturer to be free of defects in both materials and workmanship.
Furniture is made to order, and takes approximately 2-4 weeks to be delivered. It is shipped via common carrier or UPS Ground. Please note that with this service, the delivery people generally do not bring furniture inside your home, and they do not take packaging away. These services may, however, be available for an additional fee.
Shipping, (Standard Curbside), is free for most addresses in the continental United States although we may need to charge a nominal fee for some addresses. In this case you will be contacted with the final shipping quote. We will not process your order until we receive your approval of the final quote. First Threshold and White Glove are available for a fee. Please contact us for a quote.
Height Dimensions: Headboard Post- (19 5/8"), Footboard Post-(19 5/8"), Under Rail-(10 1/2"), Mattress Platform- (15 1/4")
Width x Length Dimensions of Mattress Platform: Single-39"x76", Double-54"x76", Queen-60"x80", King-78"x80", Cal King- 72"x84"
Legs are 1 ¾" square and have a 1/8" round-over on the top of the post and all 4 sides.


text:
Lindsay Lohan may be stuck wearing a SCRAM bracelet, but the star is trying to be alcohol-free in style.
"Can CHANEL please help me out by getting me some stickers to put on my scram bracelet so that I can at least wear a chic dress?! maybe!?" she Tweeted on Thursday night, asking the famed fashion house for help.
VIEW THE PHOTOS: The Trials & Tribulations Of Lindsay Lohan
U.S. & World
Earlier in the day, she revealed her new drinking regimen on Twitter.
"Red Bull and Waters and Work - my new bff's hehe - everyone should try it!" she Tweeted. "It's more fun - you'll see :)"
VIEW THE PHOTOS: Jet Set Chic: Stars Who Travel In Style
The star was assigned the alcohol-monitoring bracelet in court on Monday, however, should she be at all worried about setting off the device by accident while she's out and about? Not likely, said SCRAM national sales manager AJ Gigler.
"We've had a number of cases where people tried to bring up excuses – from ingesting certain types of food, mouthwash for example," Gigler recently told Access Hollywood's Maria Menounos. "Somebody would have to drink close to three full bottles of mouthwash to get the impact from just having two glasses of beer."
He joked that Lindsay could indeed "bling" her SCRAM.
VIEW THE PHOTOS: Stars Who Twitter
"We've been approached by a number of people who wanted to bling up the device… Here in LA, I think that would be appropriate," he joked, adding on a serious note, "We want the equipment to be returned."
In other recent Lindsay style news, she debuted her Linda Lovelace look in a pair of posters for her in-development biopic on the porn star, "Inferno," released on Thursday.
VIEW THE PHOTOS: Stars With Amazing Style
Copyright 2010 by NBC Universal, Inc. All rights reserved.
This material may not be published, broadcast, rewritten or redistributed.
Related Content from AccessHollywood.com:
PLAY IT NOW: Can Lindsay Lohan Scam Her SCRAM?
PLAY IT NOW: Judge Marsha Revel Firmly Lays Down The Law To Lindsay Lohan
More from Access: [ Lindsay Lohan Style Courts ]


text:
As the victim of a gang rape in New Delhi fights for her life in Singapore's Mount Elizabeth Hospital, Indian communities across the world are offering donations and messages of support to her and her family.
In Singapore, where the girl remains in "an extremely critical condition" at the hospital's intensive care unit, the Indian High Commission says it has received many offers to help the victim, including financial support.
"We have received numerous queries regarding the condition of the patient and also many offers to help," said a statement from the Indian High Commission in Singapore. "We are deeply grateful for all these offers."
A separate statement released Thursday said that many in the city-state are sending messages of sympathy and support.
The Indian High Commission stressed that the privacy of the victim, whose name has not been released, and her family needs to be respected.
Indian communities in Australia and Thailand – like thousands in India and around the world – are urging the Indian government to take strong action against the alleged rapists, who are currently being held in Delhi.
According to local press reports, ethnic and expatriate Indians in Thailand have signed a petition to Indian Prime Minister Manmohan Singh demanding tough action, while others in Melbourne held a peaceful rally in front of the city's Indian consulate.
The victim, brutally raped on a bus on Dec. 16, was moved from Delhi's Safdarjung Hospital to Singapore's Mount Elizabeth Hospital this week. She has undergone three surgeries since the attack and suffered a cardiac arrest. Doctors in Singapore Friday released further details on her condition, including that she is suffering from brain injury.
"Our medical team's investigations upon her arrival at the hospital yesterday showed that in addition to her prior cardiac arrest, she also had infection of her lungs and abdomen, as well as significant brain injury," said Dr. Kelvin Loh, chief executive office and Mt. Elizabeth Hospital.
"The patient is currently struggling against the odds," Dr. Loh added. Mount Elizabeth's medical team is currently working to stabilize her condition.
Follow India Real Time on Twitter @indiarealtime.


text:
For anyone looking for a first job, exploring a career change, or just setting up for future success, social media sites are proven platforms for facilitating connections, demonstrating passions and interests, and ultimately landing the job. Job Searching with Social Media For Dummies enables you to harness the power of the Internet to research and identify job opportunities, and then create a strategy for securing a position.
Job Searching with Social Media For Dummies features in-depth coverage of topics such as: creating effective online profiles and resumes to sell your strengths; maintaining your online reputation and understanding electronic etiquette; using the power of personal branding and building your brand online; avoiding common pitfalls, such as jumping into filling out a social media profile without a strategy; getting to know Twitter, the only real-time job board with literally thousands of jobs posted daily; using social media sites to uncover opportunities in the "hidden job market" ahead of the competition; and much more.
If you're a recent graduate, changing careers, or have been away from the job-search scene for a while, turn to the trusted guidance and expert insight of Job Searching with Social Media For Dummies.


text:
And, as the post-warranty turbines that now dominate the US fleet break down, the witch hunting is likely to begin.
Gearboxes have traditionally been seen as the weak link in turbines. In some cases, turbine makers and operators whose machines fail blame the gearbox manufacturers. Some turbine makers have even sought to cut the gearbox out of the picture altogether by devising direct-drive units. Others have suggested that gearboxes are simply being abused and have become scapegoats. Indeed, as we exclusively report this month, experts say that Winergy is seeking to prove the gearbox's innocence in turbine failures by demonstrating that turbine manufacturers have been placing them under undue stress.
The suspicion is that gearboxes in the field experience greater torque and bending forces than the turbine designers planned for - and that the gearbox makers certified their components for when they were installed. Many investors will find it extraordinary that the sort of real-time load studies being launched by Winergy are rarely undertaken. Given that a turbine typically outlasts its gearbox by around a decade and that gearboxes have consequently become the bete noire of wind technology, it is remarkable that gearbox makers sometimes choose not to go back to operators to check whether their kit is being subjected to inordinate loads.
Therefore, it is perfectly reasonable for Winergy to launch its programme. Companies cannot be expected simply to take the blame for failures they believe are not their fault. The worry is, where will the Winergy tests lead?
There is a danger that, should Winergy uncover evidence of serial over-exertion of turbine gearboxes, the industry could plunge into yet another unseemly legal battle. The clash between Mitsubishi and GE over intellectual property rights (see page 77) has been unedifying enough. A flurry of claims and counter-claims by gearbox makers, turbine makers and manufacturers, each trying to shift the blame for technological failures on to the others, has the potential to be even worse. A spate of court appearances will ultimately serve only to swell the coffers of lawyers, loading in new costs to a price-sensitive sector whose attention should be focused on fighting competition from other energy types, rather than on wrangling with companies within the same industry.
Face challenges together
Instead of causing wind to turn in on itself again, it is crucial that the Winergy tests, and any similar ones carried out in the future, are used to help advance the sector. The wind industry is an adolescent - still growing up, still learning. New data helps. If the Winergy programme does reveal that gearboxes have been over-stretched - and that is far from certain - the industry should come together to improve components or regulate operations, or both, to ensure gearbox lives are extended and turbine downtimes minimised.
Wind is best advised to face up to its challenges as one. The Nobel Prize-winning economist John Nash observed that the market benefits when an individual does what is good for him - and also for the group. Certainly, in this case, an internecine carve-up will be of help to no-one in the wind sector but the lawyers.


text:
BGS have produced updated geological and mineral resource maps for Malawi at a scale of 1:1 million and a series of brochures on the mineral potential for use by mineral exploration companies in a project lasting only three months.
A geological map was used a backdrop to accompanying mineral resource and magnetic anomaly maps, together with a series of four geology-based prospectivity brochures. These materials were prepared by the BGS with financial support from the Department for International Development (DFID). The work is intended to be part of a longer term capacity building relationship with Malawi's Geological Survey Department (GSD).
David Ovadia and Bill McCourt of the BGS visited Malawi in October 2008 to obtain agreement from the local DFID area manager for the go-ahead of Phase 1 of the project. The GSD national mineral resource and occurrences map (published in 1990) and aeromagnetic data were brought back to the UK to compile some derivative digital products. A follow-up visit was made in November by Peter Pitfield to liaise with the commercial mining sector and to obtain up-to-date information and illustrative material for the brochures.
We digitised and edited the existing 1:1 million-scale national geological map, produced a revised legend consistent with modern regional lithostratigraphic schemes and added cross-section. The mineral occurrences were taken from the 1990 mineral resources map and augmented with more recently developed mineral prospects.
The geological and mineral occurrence maps were completed in November 2008 and the Principal Researcher, Peter Pitfield presented draft copies to Dr Leonard Kalindekafe, Director of the GSD. Peter explained ' 'the new maps and exploration activity show that Malawi, far from being poor in mineral wealth, has lots of potential'.
Landsat, gravity and airborne radiometric, aeromagnetic and electromagnetic data are also available. The aerogeophysical data indicate that the maps need updating in the west-central part of the country where the African surface is best developed. These data have not been used but there is potential for their application in a second phase.
The brochures and maps were launched at Indaba in February 2009 by Ted Kalebe, Malawi's Minister of Energy and Mines. Dr Kalindekafe commented 'We are very supportive of this work by BGS. It will help investment in Malawi '.
The maps and brochures, which describe different mineral deposits associated with different geological settings, are available from the Geological Survey Department, Malawi.
Download the prospectivity brochures from the BGS website at BGS Downloads


text:
"Our close and trusting relationship with Fujitsu is based on many years of joint projects, and is characterized by our mutual focus on solutions and success."
Dr. Jakob Bärz, Development Manager, Autodesk GmbH
The American software company Autodesk develops computer aided design (CAD) and computer animation software for digital 2D and 3D design in the fields of architecture, building services engineering, above and below ground construction, the automotive and transport sector, mechanics and machine building, media and entertainment and logistics and telecommunications. Customers in the above sectors use Autodesk's technology to create digital models and processes to visualize, simulate and analyze their projects. It allows them to test and optimize their ideas and concepts under realistic conditions, before investing time and money into the implementation. At its development site in Darmstadt, Germany, the company mainly uses its VRED software to develop for the automotive design sector.
Expansion of software development capabilities and construction of an on site demo center.
Conversion from CAD workstations to a PRIMEFLEX for HPC cluster solution from Fujitsu.
Read the full Autodesk case study (322 KB/A4, 2 pages)
Jaga seda lehte


text:
Cher Lloyd Brings 'I Wish' to the Macy's Thanksgiving Day Parade [VIDEO]
Cher Lloyd brought sass to the Macy's Thanksgiving Day Parade!
Lloyd rocked black and white for her performance atop the colorful Hess Truck float. The pint-sized brunette, sporting a black pom-pom hat, black jacket, black and white striped pants and black and white polka dot gloves delivered an adorable performance of 'I Wish.' The only thing missing was T.I. -- okay, and like, half the song because NBC cut off her performance to get to more balloons!


text:
Our goal is to create and share value for and with our customers through our products and services. We are constantly striving to develop new products and processes that meet our rigorous quality and safety standards, while having a lower environmental footprint.
We take pride in the fact that many of our relationships stretch back for years – and even decades. We believe this is because we are continually working together to find the most sustainable, cost-effective solution to complex challenges.
Our long-term ambition is that all our packaging material will be made from 100 percent renewable materials, without compromising safety, quality or functionality. With more than 70 percent of our packages made from paperboard, we continue to focus our efforts on sustainable timber, while also innovating around polymers and aluminium.
Every day, we work with our customers to find more efficient processing and packaging solutions. Our joint aim is to minimise waste and spoilage, while reducing energy and water consumption – keeping efficiencies up and costs down.
We offer our customers a range of services that help them understand their current costs and impact and identify opportunities for savings and optimisation. With this holistic view, our customers can become more sustainable while adding value to their business.
Do you want to learn more about how we engage with customers?
About Tetra Pak
Together with our customers we make food safe and available, everywhere. Since the start in 1951 we have taken pride in providing the best possible processing and packaging solutions for food.
Tetra Pak is one of three companies in the Tetra Laval Group – a private group that started in Sweden. The other two companies are DeLaval and Sidel. Tetra Laval is headquartered in Switzerland.


text:
I was wondering if it was possible to retrieve the CPU Temp through windows xp using VB, C++ or C#. I have an P4 Abit motherboard w/ factory temp reader. thx
Nothing sounds more like freedom than the thunderous roll of a Tomahawk.
It is definitely passible, as there are a number of applications available to do it. You need to know the address of the temperature pin in order to get it, though, and I don't know how to do that.
However, you might want to take a look at Motherboard Monitor. It will monitor things like core voltage, fan speed, and case temp as well. Very handy utility.
Government is like fire - a handy servant, but a dangerous master - George Washington
Government is not reason, it is not eloquence - it is force. - George Washington.
Join the UnError community!
Striek is quite right....it is theoretically possible but very difficult to put into practice
The main problem is that the MoBo and processor combinations are so varied, and the manufacturers are apparently reluctant or slow in releasing those details.
I tested two monitoring systems for guys a couple of years ago, I deleted both apps as I knew they were reporting rubbish (the box would have exploded!!!)_They are most reliable with home built machines and least reliable with branded ones like Dell. I suspect that this might be due to customised BIOSes???.
I tested with seven machines. Only 5 were recognised, and only 2 gave believable results.
Forum Rules
Advertiser Disclosure:
Some of the products that appear on this site are from companies from which TechnologyAdvice receives compensation. This compensation may impact how and where products appear on this site including, for example, the order in which they appear. TechnologyAdvice does not include all companies or all types of products available in the marketplace.


text:
our advantages
1. Various Choice: The fine mist sprayer we produce has various colors and sizes. You can choose any fine mist sprayer as you like.
2. Application:Used for low viscosity liquid such as perfume, air freshener, body spray or deodorant.
3. Good Quality:Our fine mist sprayer are guided and monitored under ISO9001. High transparent environmental protection raw material, durable, delicate and cabinet.
4. Good services: We have an excellent team group to provide the best service for you. As long as you have any problems, please contact with us. We will deal with it in time.
5. Supply: We have our own factory, so we can supply the products by ourselves. And we accept OEM and ODM.
Our Company
Our factory is a professional manufacturer in personal care, cleaning products, perfume, cosmetic, pharmaceutical and food packaging, cosmetic packaging etc. We have more than 10 years experience and 30,000 square meters land areas about factory.
And we have integrated with all of the process of production line, including injection machine, blowing machine vacuum plaiting and UV lacquering, ultra-sonic welding, hot stamping and silk screening machine etc. In addition, we have a professional team in mold manufacture, who continually develop more new products. And also make any new molds which according to the different requirements of the customers. We always guarantee optimal quality and the more beautiful design to adapt to the market competition. Our products have won a wide market and high reputation in domestic and foreign market!
Our service
1.We offer best service and price for customer home and aboard.
2.Customized color and design are available
3.Customized samples are available
4.Inspection during & after production is accepted
5.Factory visit is welcomed
6.We sincerely hope customer and us developing together and sharing mutual benefits
1) Can we get your free samples?Yes, you can. Our Samples are only free for the customers who confirm order. But the freight for express is on buyer's account.2) Can we combine many items size in one container in my first order?Yes, you can. But the quantity of each ordered item should reach our MOQ.3) What is the normal lead time ?A. For plastic products, we will send goods to you within 35-40 work days after we receive your 30% deposit.B. For aluminum product, the delivery time is 35-40 days after we received your 30% depositC.For OEM products, the delivery time is 35-40 work days after we receive your 30% deposit.4) What is your payment term?T/T. 30% deposit, balance against the B/L copy within 25-30 days after departure from port.5) What is your shipping way?We will help you to choose the best shipping way according to your detail requirements.By sea, by air, or by express, etc.6) How do you control the quality?We will make samples before mass production, and after sample approved, we will begin mass production. Doing 100% inspection during production; then do random inspection before packing; taking pictures after packing.7) If any quality problem, how can you settle it for us?If any breakage or defect products were found, you must take the pictures from the original carton. All the claims must be presented within 7 working days after discharging the container. This date is subject to the arrival time of container.We will advise you to certify the claim by third party, or we can accept the claim from the samples or pictures you present, finally we will completely compensate all your loss.


text:
UBS Wealth Management Americas hosted a client event on Monday in Dallas with former Presidents Bill Clinton and George W. Bush as part of its Revitalizing America Initiative, which aims to find non-partisan ways to improve the U.S. economy. Late last week, UBS and William J. Clinton Foundation announced the launch of a New York-based pilot project that is also part of this initiative and involves both financial advisors and their clients.
"Investors across the country have shared their concerns, and it is clear that their greatest worries revolve around the future of America as a continued economic force," said Robert McCann, head of UBS in the Americas at the Dallas event, which had about 400 attendees. "Questions regarding the budget deficit, global competitiveness, the American workforce and the strength of the dollar inspired us to initiate an ongoing conversation with our clients about what it will take to revitalize America."
As part of its Revitalizing America Initiative, UBS recently conducted a poll of more than 1,000 clients and prospects. It found that 67% of Texas respondents are "extremely worried about the size of the national debt," and a near majority is also quite concerned about U.S. competiveness, according to UBS.
At the event, McCann described the debt dialogue in Washington as having thrown a "wet blanket" on CEOs trying to determine whether or not to expand, according to a story in Monday's Fort Worth Star-Telegram.
"There's actually a lot going in this economy to feel good about," he said. "Corporate profits are quite strong. Corporate balance sheets are in better shape than they've been in years. There's the beginnings of some job creation."
UBS and Clinton first announced the formation of the CEO-UBS Small Business Advisory Program during the Clinton Global Initiative-America conference in June. It involves both UBS financial advisors and their clients.
"As small businesses across America strive to expand and grow jobs, I am proud of the fact that UBS advisors and our clients have volunteered to work with the entrepreneurs enrolled in this pilot program," said McCann in a press release.
"By providing the knowledge and skills necessary to support these promising individuals as they pursue their goals, we hope to help revitalize the most critical engine of job creation in America – our small businesses," McCann added.
In the program, 10 entrepreneurs that currently run "high-growth businesses with significant potential for job creation" in the greater-New York area — including Harlem, Long Island City, Newark and Brooklyn — will receive pro bono strategic financial and business advice, according to UBS.
Each participating entrepreneur has been matched with a UBS financial advisor and a client who will provide tailored advice to enhance the knowledge and skills necessary to support the businesses' expansion and long-term success, the wealth-management group says.
"Promoting the success of small businesses within underserved communities is a key component to ensuring a balanced economic recovery" said President Clinton in a statement. "I am pleased that my foundation is partnering with UBS Wealth Management Americas to provide small businesses in New York City with the essential resources, assistance and access they need to grow and contribute to job creation within their communities."
As of June 30, the number of FAs in the wealth-management unit in the Americas is 6,862 – up from 6,760 last year and 6,811 in the first quarter of 2011. Assets under management are 694 billion Swiss francs vs. 742 billion Swiss francs last year and 750 billion Swiss francs in the earlier period.
Invested assets under management for the group are 650 billion Swiss francs, or roughly $113 million per advisor. Gross production or fees and commissions per rep stood at $884,000 in the second quarter of 2011.
"Improvements in wealth-management Americas are quite visible and in line with our plans," said UBS-Americas CFO Thomas C. Naratil, during a recent earnings presentation. "And … contrary to market rumors, this division is part of our global wealth-management business and is not for sale."


text:
4704.0.55.002 - The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples: Summary Booklet, 2005
Latest ISSUE Released at 11:30 AM (CANBERRA TIME) 28/04/2006 First Issue
|Page tools: Print Page Print All RSS Search this Product
Provides a summarised statistical overview, largely at the national level, of Aboriginal and Torres Strait Islander health and welfare. Among the topics included are: maternal and child health; risk factors; ill health; disability and ageing; mortality; and access to, and use of, services.
Document Selection
These documents will be presented in a new window.


text:
Episode 60
Its been a long break but we're back for good.
Hey guys its been a long time since we have had an episode but we are back with new people and new things. This week we have Jake from 9to5mac joining us.
If your interested in Sponsoring the Show please email email@example.com