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A wide variety of organizations allow students the opportunity to explore all areas of the art from technical theatre to production, performance, and even improv. Examples of our student organizations include:
- United States Institue for Theatre Technology (USITT)
- The Performance Collaborative
- Duse Society
- Musical Theatre Club
- Red Eye Theatre Project
- Ruckus
United States Institute for Theatre Technology
USITT is a student chapter of a national organization, the United States Institute for Theatre Technology. It serves to offer opportunities for education and practice of all technical theatre roles (lights, sound, stage management, set construction, etc.). Members are often placed in the crew of Pitt Rep shows, or in the two shows produced as partnerships with Pitt's Musical Theatre Club. Other voluntary and employment opportunities are also offered. Students may also attend regional and national conferences that offer workshops, seminars, and the chance to meet professionals in the field.
Meetings are on Fridays at 3:00 PM in B-20 in the Cathedral basement.
For more information, visit the Pitt USITT website.
The Performance Collaborative
The Performance Collaborative organizes opportunities for performance students to work their craft such as: workshops, staged readings, and student-organized productions. The organization acts as a vehicle for utilizing, promoting and learning from the myriad resources available in the Theatre Arts Department of the University of Pittsburgh, and it increases undergraduate involvement in the decisions made by the Theatre Department.
Meetings are Fridays at 4:30 PM in room 1601 in the Cathedral of Learning.
Learn more about The Performance Collaborative here.
Duse Society
The Duse Society is the organization of graduate students in the Department of Theatre Arts. It is named for Eleanora Duse (pronounced DOO-zuh), who, as legend has it, succumbed to influenza at what is now Pitt's William Pitt Student Union. Every graduate student in the department is a member of the society, which typically meets once a month.
The society does all manner of things, from organizing mini-conferences and professional development workshops to planning social events and putting together a guidebook for incoming graduate students.
Contact the Duse Society, or visit the Duse Society Calls for Papers Blog.
Musical Theatre Club
Since 2009, the Musical Theatre Club has provided opportunities to Pitt's undergraduate students who have a passion for musical theatre. The organization's mission is to foster and further the knowledge, appreciation and awareness of musical theatre. Club members can gain experience in all areas of musical theatre, from singing/dancing/acting, to playing in an orchestra, to technical production. Throughout the year, the club organizes a wide variety of activities (in and out of the weekly meeting setting) including: seeing local musical theatre productions, formal dances, game nights, viewings of film musicals, and workshops. Each year the club produces, in collaboration with Pitt's USITT students, two productions: a fall variety show, "Broadway in the 'Burgh", and a full-length spring musical.
Meetings are held on Wednesdays at 9:00 pm in the Cathedral of Learning Room 358.
For more information check out the Club's Facebook page: http://www.facebook.com/PittMusicals/, or email the club directly at email@example.com.
Redeye Theatre Project
Redeye Theatre Project (RTP) is a 24-hour theatre festival. For every performance, RTP has spent the past 24 hours writing and rehearsing a festival of brand-new plays.
The clock starts when the playwrights' pens hit paper (or their fingers hit the keyboard). Project participants take a bit of time before the actual 24 hours begins, to allow playwrights and directors assigned to a particular performance to get acquainted, and to cast the shows, but that's all the extra time permitted. From 8 p.m. Friday to 8 p.m. Saturday, the show really must go on.
The work produced is all original, all written on the spot. Many of the project's playwrights don't write outside the confines of this festival; many of their plays will never be seen on stage again (and if they are, they'll almost certainly be heavily revised). That means attending an RTP performance is a one-of-a-kind experience.
The next Redeye festival will be November 15, 2014.
Contact the Redeye Theatre Project for more information, or to join the mailing list.
Ruckus is a Pittsburgh based improvisational comedy (improv) troupe of gifted and fearless young Pitt students. Ruckus performs in weekly shows around campus as well as in professional comedy clubs around the city. Critically acclaimed "spirited young folk," Ruckus is devoted to improving its members' comedic and performance skills and saving the world one joke at a time.
Friday Night Ruckus: Jam w/ us @ 11pm every Friday in the Henry Heymann or Studio Theater
Saturday Night Shows: 9pm every Saturday in Cathedral room G24
Contact Ruckus: firstname.lastname@example.com
- News Blog
- Student Organizations
- Performance Spaces
- Seating Charts
- Newsletter
- The Richard McMillan Fund


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Department of Equity
12111 NE 1st Street
Bellevue, WA 98005
Phone Number
(425) 456-4027
Shomari Jones
Director of Equity
An equitable and excellent school district is one in which all students achieve high levels of academic success, regardless of any student's race, ethnicity, culture, country of origin, religion, gender, special needs, sexual orientation, neighborhood, income of parents, or mother tongue. In an equitable and excellent school district, there are no persistent patterns of differences in the academic achievement or treatment of students grouped by race, ethnicity, culture, special needs, country of origin, religion, gender, sexual orientation, neighborhood, income of parents, or mother tongue. Equity and excellence occur when each and every student is served effectively to achieve at high levels.
Equity for Each & Every Student
Align policies and practices with our mission of achievement for each and every student.
Identify and examine critical disparities in our educational system to ensure that opportunities and supports exist for high achievement by each and every student regardless of special needs, race, ethnicity, or financial status.
Provide a rigorous (challenging academic environment) education for each and every student.
Expect and support relevant, culturally competent learning environments.
Teaching & Learning
Ensure each and every student is performing at or above grade level within a continuum of learning from early childhood through high school graduation, to prepare them for college, career, and life success.
Ensure that each and every student has access to engaging & relevant common curriculum designed to ensure Equity in order to eliminate the achievement and opportunity gaps.
Employ effective research-based instructional practices.
Provide educational options that address the individual needs of each and every learner.
Student & Family Supports
Create an additive, not subtractive or deficit oriented, welcoming, inclusive, and safe school environment.
Develop partnerships with families to support their engagement in student success and academic achievement by fully removing any disparities or barriers.
Communicate effectively and frequently with students, families and partners in a culturally competent and equitable manner.
Provide integrated support services including transportation, nutrition, mental health, and other community resources in an equitable manner.
Leadership & Equity in the Workplace
Create and implement an equitable recruitment and hiring model that ensures the hiring of personnel that reflects our community demographics.
Create and provide a welcoming work environment to all District staff by developing and implementing an onboarding, induction & mentorship plan to support existing and newly hired employees of diverse backgrounds.
Design and implement a retention & promotion plan that includes best practices to retain highly skilled employees, particularly those employees of diverse backgrounds.
Provide effective professional development, which will be analyzed for its implications relative to equity and cultural competence.
Do we have the will to educate all the children?Asa Hilliard III

subset: commoncrawl


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Cunningham Piano Company is proud to be the agent of some of the most advanced technologies available in pipe organs as well as the finest 21st century digital technologies.
Please browse our offerings and feel free to get in touch with us for more information.
Fratelli Ruffatti
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Celebration Recital for a New Organ
Don McFarland will be performing at Emmaus United Methodist Church in Smithville, NJ to celebrate their new Johannus Opus 270 organ Sunday, March 26 4 pm.read more
First Presbyterian Church of Ambler
When we heard of the care and consideration that Michael Joy and Carol Anders, the musicians at First Pres. of Ambler, put into choosing a new organ for their sanctuary, we were very impressed. They got a tremendous amount of input, hired a consultant who knew the...read more


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2nd Trumpet in Bb from 3 & 1/4 Classic Favourites for Five Brass!
An arrangement of three popular classics, with a clip from William Tell at the end! The three classics are:Mozart 40, Spring from the Four Seasons and Trumpet Voluntary by Clarke.
A fun piece for brass quintets to entertain there audiences with.
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I love my 12 week old baby....
But I am wearing thin. Between her regular painful gas and this major running/stuffy nose all she wants to do is cry(scream) or sleep (while being held only).
On top of all that I had athletes foot and before I knew what it was I was popping the blisters. Now my foot is majorly infected. I have already had one trip to the doctors and another trip to er. I cannot walk because of the blisters on my feet.
I just need a break or some relief.
Oh my! I'm so sorry to hear this. When it rains, it pours, right? I hope everything starts getting better for you, mama!
I am seeing my doctor again tomorrow. I'm hoping she releases the blisters or something. The er ordered me to sit with my foot up and I have been on the couch since Sunday evening.
Oh my, you have a lot going on. I hope things start looking up for you soon. Also I hope you have help with the little one. Hang in there!
Monday the hubby was off... Today my brother came by for a few hours and tomorrow my mom is coming over.
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JMM offers educational programming that showcases the American Jewish experience. A tour of JMM answer questions about the Jewish experience in the US, but also provides a vehicle for your visitors to discover their own questions. Through docent-led tour, films, interactive displays and exhibit spaces, the Museum provides a forum for discussion about contemporary issues, including immigration, tolerance and civic involvement.
The Museum's content is directed towards students in grade four and higher and adult groups of all types. JMM has hosted senior centers, churches and synagogues, corporate diversity training programs, book clubs, Red Hat groups, and family reunions. Our tours can be directed toward specific themes like the Holocaust or Immigration or can be focused on presenting a broad sense of the Jewish experience.
JMM exhibits and themes correspond with the Wisconsin Model Academic Standards. The staff of the Jewish Museum Milwaukee will customize programs that fit your students' needs. Docents are also available to come to your classroom prior to your trip to the Jewish Museum Milwaukee. For more information or to book your visit, please contact Ellie Gettinger.
Learn more about Group Rates>>
Other Education Highlights:
Community Partners
SPARK! Cultural Programming for People with Memory Loss


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instructables.com via jovino
Keep a handful of zip ties in the bathroom to address a variety of issues, most notably clogged drains. The next time you need to clear a drain, use a wire cutter to snip diagonal slots into the sides of a long, wide zip tie or several shorter ones linked together. Cut about halfway through the strip, angling toward the bottom, and then bend the slits out to create a series of barbs. Remove the drain stopper, and carefully feed the zip ties down into the drain as far as they will go. Pull up slowly—the hair and other gunk will get stuck on the barbs, and then all you have to do is throw it away!
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Convention Center Summary
|Total Meeting Rooms:
|Distance from Airport:
|26 miles
|Total Meeting Space (sf):
|Tax Rate (%):
|Largest Ballroom Space (sf):
|Relative Location:
|Metro Population:
|MSA Rank:
Convention Center Description
The new Colorado Convention Center is one of the most practical and "user friendly" meeting facilities ever built. More than 100 professional meeting planners worked with the architects to design every aspect of the building. The results? A scruple, sensible, state-of-the-art facility with easy traffic flow and everything you need… all in a stunningly beautiful building in the heart of exciting downtown Denver.
The exhibit level offers 584,000 sq. ft. of contiguous exhibition space that can be divided into six individual halls varying in size from 90,000 to 106,000 square feet. On the West entrance of the building, adjacent to the exhibit hall level is a 7,500 square feet outdoor terrace which offers extraordinary views of the Rocky Mountains. This is a perfect space for opening receptions, VIP parties and more.
There are 63 meeting rooms, totaling 100,000 square feet, all on one level. A total of 85,000 square feet of hotel quality ballroom space is also available. A 35,000 square feet ballroom that is divisible in half or thirds, and a 50,000 square feet ballroom that is divisible into eighteen individual meeting rooms or literally hundreds of possible configurations.
Unique Differentiators
A highlight of the new convention center is the Wells Fargo Theatre, a 5,000 seat theatre. It is designed to be muti-functional for use as a lecture hall or general session area for conventions and tradeshows, a concert hall for national headline entertainers and can easily host comedy or family shows. The room can be divided into three separate rooms to allow for concurrent sessions.
Another highlight of the facility is the new Light Rail Train Station located under the attached 1,000 space pal-king garage. Each amenity provides greater access and options for our commuting public. The Parking Garage provides greeters on each floor who assist parking patrons with credit card transactions and directions to their event destination; it also boasts a bridged walkway to the Denver Performing Arts Complex.
Services & Amenities
|Audio/Visual Equipment Available
|Business Center: Banking
|ATM Machines
|Business Center: Copy/print
|Copier/Printer Available
|Business Center: Workstations
|Workstations Available
|Catering Available
|Dressing Rooms
|Dressing Rooms Available
|Electrician (on-site)
|On-Site Electrician Available
|Meeting Planning
|Meeting Planning Available
|Packaging & Shipping (on-site)
|On-Site Packaging & Shipping Available
|Parking (self)
|Self Parking Available
|Plumber (on-site)
|On-Site Plumber Available
|Security Personnel
|Security Personnel Available
|Chairs Available
|Dance Floor
|Dance Floor Available
|Electric: 0-2000 Watts
|Electric: 0-2000 Watts Available
|House Sound System
|House Sound System Available
|Rope and Stanchion Section
|Rope and Stanchion Section Available
|Satellite Services
|Satellite Services Available
|Sound Equipment
|Sound Equipment Available
|Tables, Skirting and Vinyl Covering
|Tables, Skirting and Vinyl Covering Available
|Telecom: Credit Card Lines
|Telecom: Credit Card Lines Available
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|Telecom: Shared Ethernet Available
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|Telecom: Single Line Voice Available
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|Telecom: Speaker Phone Available
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|Telecom: T1 Service Available
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|Wi-Fi Available
Close-by Hotels
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|(303) 458-5318
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CVB & Convention Center ContactsPaid membership required to see this information
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Publication date: January 2018 Source:Optics and Lasers in Engineering, Volume 100 Author(s): Xue Zhang, Xiangfeng Meng, Yongkai Yin, Xiulun Yang, Yurong Wang, Xianye Li, Xiang Peng, Wenqi He, Guoyan Dong, Hongyi Chen A two-level image authentication method is proposed; the method is based on two-step phase-shifting interferometry, double random phase encoding, and compressive sensing (CS) theory, by which the certification image can be encoded into two interferograms. Through discrete wavelet transform (DWT), sparseness processing, Arnold transform, and data compression, two compressed signals can be generated and delivered to two different participants of the authentication system. Only the participant who possesses the first compressed signal attempts to pass the low-level authentication. The application of Orthogonal Match Pursuit CS algorithm reconstruction, inverse Arnold transform, inverse DWT, two-step phase-shifting wavefront reconstruction, and inverse Fresnel transform can result in the output of a remarkable peak in the central location of the nonlinear correlation coefficient distributions of the recovered image and the standard certification image. Then, the other participant, who possesses the second compressed signal, is authorized to carry out the high-level authentication. Therefore, both compressed signals are collected to reconstruct the original meaningful certification image with a high correlation coefficient. Theoretical analysis and numerical simulations verify the feasibility of the proposed method.
Publication date: 1 February 2018 Source:Mechanical Systems and Signal Processing, Volume 100 Author(s): Haidong Shao, Hongkai Jiang, Haizhou Zhang, Wenjing Duan, Tianchen Liang, Shuaipeng Wu The vibration signals collected from rolling bearing are usually complex and non-stationary with heavy background noise. Therefore, it is a great challenge to efficiently learn the representative fault features of the collected vibration signals. In this paper, a novel method called improved convolutional deep belief network (CDBN) with compressed sensing (CS) is developed for feature learning and fault diagnosis of rolling bearing. Firstly, CS is adopted for reducing the vibration data amount to improve analysis efficiency. Secondly, a new CDBN model is constructed with Gaussian visible units to enhance the feature learning ability for the compressed data. Finally, exponential moving average (EMA) technique is employed to improve the generalization performance of the constructed deep model. The developed method is applied to analyze the experimental rolling bearing vibration signals. The results confirm that the developed method is more effective than the traditional methods.
Publication date: January 2018 Source:Biomedical Signal Processing and Control, Volume 39 Author(s): Shunqi Zhang, Xiaoqing Zhou, Shikun Liu, Tao Yin, Zhipeng Liu Functional imaging method of biological electrical characteristics based on magneto-acoustic effect gives valuable information of tissue in early tumor diagnosis. Common exciting and measuring method is to use single pulse. The imaging quality and the imaging speed are limited by the signal to noise ratio (SNR). In this study, we propose a processing method based on coded excitation and pulse compression to improve SNR of magneto-acoustic imaging. Barker code is widely used in ultrasonic signal processing, which can effectively improve the signal to noise ratio. It is introduced to increase SNR of the magneto-acoustic signal. Simulations on magneto-acoustic signal and pulse compressed signal under Barker coded excitation with a group of bit lengths are computed. Experiments on sample made of pork and graphite slices are done to validate the proposed coded excitation method. The pork sample is imaged to validate this method. SNR is investigated using Barker codes with different bits. The results showed, the SNR of magneto-acoustic signal is improved by the coded excitation. When 13 bit Barker code mode is adopted as the exciting signal, SNR improved by 21.5dB. For a similar SNR improvement, the processing time of coded excitation method can be shortened by 95.8% compare with single pulse excitation method. In a conclusion, the coded excitation method is effective to improve the magneto-acoustic signal SNR and imaging quality. It also improves the magneto-acoustic imaging speed.
Publication date: January 2018 Source:Optics and Lasers in Engineering, Volume 100 Author(s): Sheng Yuan, Yangrui Yang, Xuemei Liu, Xin Zhou, Zhenzhuo Wei An optical image transformation and encryption scheme is proposed based on double random-phase encoding (DRPE) and compressive ghost imaging (CGI) techniques. In this scheme, a secret image is first transformed into a binary image with the phase-retrieval-based DRPE technique, and then encoded by a series of random amplitude patterns according to the ghost imaging (GI) principle. Compressive sensing, corrosion and expansion operations are implemented to retrieve the secret image in the decryption process. This encryption scheme takes the advantage of complementary capabilities offered by the phase-retrieval-based DRPE and GI-based encryption techniques. That is the phase-retrieval-based DRPE is used to overcome the blurring defect of the decrypted image in the GI-based encryption, and the CGI not only reduces the data amount of the ciphertext, but also enhances the security of DRPE. Computer simulation results are presented to verify the performance of the proposed encryption scheme.
Publication date: 15 January 2018 Source:Spectrochimica Acta Part A: Molecular and Biomolecular Spectroscopy, Volume 189 Author(s): Suyu Li, Yanhua Li, Zhe Shi, Laizhi Sui, He Li, Qingyi Li, Anmin Chen, Yuanfei Jiang, Mingxing Jin We measure the backward fluorescence spectra generated by the femtosecond filament transmitting through the butane/air flame, and study the fluorescence emission from combustion intermediates (CN, CH and C2 radicals), air (mainly N2 and N2 +). It is found that the fluorescence emission from combustion intermediates, N2 and N2 + shows difference when the femtosecond filament transmits through different parts of the butane/air flame, and we attempt to analyze it in this paper. This study demonstrates that the filament-induced fluorescence technique can be utilized to sense the combustion intermediates.
Publication date: May 2018 Source:Information Fusion, Volume 41 Author(s): Stevica Cvetković, Miloš B. Stojanović, Saša V. Nikolić Extreme Learning Machines (ELM) have been successfully applied to variety of classification problems by utilizing a single descriptor type. However, a single descriptor may be insufficient for the visual classification task, due to the high level of intra-class variability coupled with low inter-class distance. Although several studies have investigated methods for combining multiple descriptors by ELM, they predominantly apply a simple concatenation of descriptors before classifying them. This type of descriptor fusion may impose problems of descriptor compatibility, high dimensionality and restricted accuracy. In this paper, we propose a hierarchical descriptors fusion strategy at the decision level ("late-fusion"), which relies on ELM ensembles (ELM-E). The proposed method, denoted as H-ELM-E, effectively combines multiple complementary descriptors by a two-level ELM-E based architecture, which ensures that a more informative descriptors will gain more impact on the final decision. In the first level, a separate ELM-E classifier is trained for every image descriptor. In the second level, the output scores from the previous level are aggregated into the mid-level representation which is conducted to an additional ELM-E classifier. The exhaustive experimental evaluation confirmed that the proposed hierarchical ELM-E based strategy is superior to the single-descriptor methods as well as "early fusion" of multiple descriptors, for the visual classification task. Additionally, it was shown that significant accuracy improvement is achieved by integrating ensembles of ELM as a basic classifier, instead of using a single ELM.
Publication date: January 2018 Source:Optics and Lasers in Engineering, Volume 100 Author(s): Alejandro Velez Zea, John Fredy Barrera, Roberto Torroba In this paper we present a data multiplexing method for simultaneous storage in a single package composed by several optical fields of tridimensional (3D) objects, and their individual cross-talk free retrieval. Optical field data are extracted from off axis Fourier holograms, and then sampled by multiplying them with random binary masks. The resulting sampled optical fields can be used to reconstruct the original objects. Sampling causes a loss of quality that can be controlled by the number of white pixels in the binary masks and by applying a padding procedure on the optical field data. This process can be performed using a different binary mask for each optical field, and then added to form a multiplexed package. With the adequate choice of sampling and padding, we can achieve a volume reduction in the multiplexed package over the addition of all individual optical fields. Moreover, the package can be multiplied by a binary mask to select a specific optical field, and after the reconstruction procedure, the corresponding 3D object is recovered without any cross-talk. We demonstrate the effectiveness of our proposal for data compression with a comparison with discrete cosine transform filtering. Experimental results confirm the validity of our proposal.
Publication date: 5 November 2018 Source:Journal of Hazardous Materials, Volume 341 Author(s): Ya Xiong, Wangwang Xu, Degong Ding, Wenbo Lu, Lei Zhu, Zongye Zhu, Ying Wang, Qingzhong Xue Layered metal dichalcogenides (LMDs) semiconducting materials have recently attracted tremendous attention as high performance gas sensors due to unique chemical and physical properties of thin layers. Here, three-dimensional SnS2 nanoflower structures assembled with thin nanosheets were synthesized via a facile solvothermal process. When applied to detect 100ppm NH3 at 200°C, the SnS2 based sensor exhibited high response value of 7.4, short response/recovery time of 40.6s/624s. Moreover, the sensor demonstrated a low detection limit of 0.5ppm NH3 and superb selectivity to NH3 against CO2, CH4, H2, ethanol and acetone. The excellent performance is attributed to the unique thin layers assembled flower-like nanoarchitecture, which facilitates both the carrier charge transfer process and the adsorption/desorption reaction. More importantly, it was found that the sensor response enhanced with increasing oxygen content in background and was improved by 3.57 times with oxygen content increasing from 0 to 40%. The increased response is owing to the enhanced binding energies between SnS2 and NH3 moleculers. Theoretically, density functional theory was employed to reveal the NH3 adsorption mechanism in different background oxygen contents, which opens a new horizon for LMD based structures applied in various gas sensing fields.
Publication date: March 2018 Source:Communications in Nonlinear Science and Numerical Simulation, Volume 56 Author(s): Gavin M. Abernethy, Mark McCartney, David H. Glass A computational study of a system of ten prey phenotypes and either one or ten predator phenotypes with a range of foraging behaviours, arranged on two separate one-dimensional lattices, is presented. Mutation between nearest neighbours along the prey lattice occurs at a constant rate, and mutation may or may not be enabled for the predators. The significance of competition amongst the prey is investigated by testing a variety of distributions of the relative intraspecific and interspecific competition. We also study the influence this has on the survival and population size of predator phenotypes with a variety of foraging strategies. Our results indicate that the distribution of competition amongst prey is of little significance, provided that intraspecific is stronger than the interspecific, and that it is typically preferable for a predator to adopt a foraging strategy that scales linearly with prey population sizes if it is alone. In an environment of multiple predator phenotypes, the least or most-focused predators are most likely to persist, dependent on the feeding parameter.
Publication date: 2018 Source:Introduction to Aircraft Structural Analysis Author(s): T.H.G. Megson Expressions for the direct stress distributions and the displacements due to the bending of symmetrical and unsymmetrical section beams are derived. Anticlastic bending is discussed and the sign conventions and notation established. A method for the resolution of bending moments is presented and load intensity, shear force and bending moment relationships obtained; illustrative examples on their use are given. The use of singularity functions is described and these are then applied to the solution of beam deflection problems. Beam section properties are calculated and the approximations used to calculate the properties of thin-walled sections included. The application of bending theory is discussed and the effect of temperature variation on thin-walled beam sections is investigated.


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von Willebrand Factor (VWF) is secreted as hyperactive, ultralarge multimers that are cleaved by the metalloprotease ADAMTS13 to smaller multimers. Cleaved VWF is activated by hydrodynamic forces found in arteriolar bleeding to promote hemostasis, whereas uncleaved VWF is activated at lower, physiologic shear stresses and causes thrombosis. ADAMTS13 cleaves a specific peptide bond in the VWF A2 domain. Here we use single molecule experiments to test the hypothesis that tensile force, applied to the N and C-termini of the A2 domain, acts as a cofactor for its enzymatic cleavage. Unfolding of the A2 domain occurs in a physiologically relevant range, with an intermediate unfolded state. The unfolded, but not folded A2 domain is cleaved by ADAMTS13. The lifetime of the unfolded state of 1.9 s in absence of force provides a limited time window for cleavage. The single molecule KM is lower than for peptide substrates, suggesting that A2 unfolded by force is the physiologic substrate. In shear flow, force on a VWF multimer goes up with the square of multimer length and is highest at the middle, providing an efficient mechanism for homeostatic regulation in vivo of the size distribution of VWF multimers by force-induced A2 unfolding and cleavage by ADAMTS13.
VWF is the key shear-sensing protein in hemostasis, and is especially important in arterial bleeding where shear is high (1). VWF is biosynthesized and stored in the Weibel-Palade bodies of endothelial cells in an ultralarge form (ULVWF). The VWF 240,000 Mr monomer (Fig. 1a) is concatenated through specific disulfide bonds at both its N and C- termini into multimers of up to ~50 × 106 Mr in ULVWF (1, 2). ULVWF is secreted in response to thrombogenic stimuli. A portion of secreted ULVWF is bound locally to endothelial cells from which it is released, and also through its A3 domain to collagen at sites of tissue injury. Vessel wall-bound VWF multimers, as well as multimers free in the bloodstream, are extended to a length of up to 15 μm by the hydrodynamic forces in shear flow (2). These forces induce a conformational change in VWF that exposes a binding site in the A1 domain for the gpIb molecule of platelets, enabling formation of a hemostatic platelet plug (1, 3).
Within two hours after release from endothelium into the circulation, ULVWF is converted by ADAMTS13 to smaller multimers with a wide range of size distributions that are characteristic of the circulating pool of VWF (4). Since the length of VWF multimers strongly correlates with hemostatic potential, cleavage by ADAMTS13 is an important regulatory mechanism. Absence of ADAMTS13 results in increased thrombogenic potential of VWF, and thrombotic thrombocytopenic purpura, a life threatening disease caused by uncontrolled microvascular thrombosis (5). On the other hand, mutations in the A2 domain that presumably destabilize it cause excessive cleavage by ADAMTS13, and a shift in the distribution of VWF multimers to lower Mr. The smaller VWF multimers have less hemostatic potential, and result in the bleeding disorder known as type 2A von Willebrand disease (3, 6).
VWF is cleaved by ADAMTS13 within the A2 domain at its Tyr1605-Met1606 bond (1, 3, 5, 7, 8). Cleavage is activated by shear when A2 is present in large VWF concatamers, but not when present as the much smaller, isolated domain (5-7). Presumably, this is because the forces acting on proteins in shear flow scale with protein size and length (9). Shear flow elongates VWF (2), and tensile force exerted on the concatamer is thought to cause conformational changes in A2 domains that enable cleavage (3, 5, 8). The nature of this conformational change is unknown. The A2 domain of VWF is cleaved specifically. It is thought that the scissile bond would be buried in the native state (10, 11). Therefore, partial or complete unfolding may be the mechanism for substrate activation (6). Here, by directly applying force with laser tweezers (12, 13) to a single A2 domain, we test the hypothesis that unfolding and folding of the A2 domain may occur at forces capable of being experienced by VWF in its transit through the circulation or at sites of hemostasis and thrombosis, and that force acts as a cofactor to unfold A2 for cleavage by ADAMTS13.
Single, N-glycosylated A2 domains coupled to DNA handles through N and C-terminal Cys tags (Fig. S1) were suspended between beads held in a laser trap and micropipette (Fig. 1b). A2 domains were subjected to cycles of force increase, force decrease, and clamping at a low force to enable refolding prior to the next cycle (Fig. 1c). A2 domain unfolding was marked by abrupt tether extension events (Fig. 1c inset and 1d, cycle ii). The increase in length at different forces was fit to the worm-like chain (WLC) model (14) (Fig. 2a), yielding an A2 contour length of 57 nm ± 5 nm and a persistence length of 1.1 nm ± 0.4 nm. A2 N-terminal and C-terminal residues Met1495 and Ser1671 are 1 nm apart in the folded state (15). The total length of 58 ± 5 nm divided by an extension length of 0.36 nm/residue yields unfolding of 161±14 residues. This corresponds well to complete unfolding of the predicted 177-residue A2 domain.
Over a range of force loading rates, unfolding force was determined and plotted against the logarithm of the loading rate (Fig. 2b). The fit to a single-barrier kinetic model (16) yields an unfolding rate in the absence of force, , of 0.0007 s−1 (confidence band of 0.0002 s−1 to 0.003 s−1), and a force scale, fβ, which exponentially increases the unfolding rate , of 1.1 ± 0.2 pN.
A subset of about 20% of unfolding events included a discernable pause (defined by 4 or more data points at a short-lived (Fig. S3), partially unfolded intermediate state, which was directly observed in force-extension curves (Fig. 2c). Fit to the worm-like chain model of the A2 extension distances (Fig. 2c, inset) shows that the intermediate state usually lies 40% of the distance between the fully folded and unfolded states.
During the pause at a clamped force between each cycle of force decrease and increase, the A2 domain had the opportunity to refold (Fig. 1c). Subsequent unfolding revealed folding during the pause (Fig. 1c,d, cycle ii), while a lack of unfolding suggested an absence of refolding (Fig. 1c,d, cycle iii). The binary state of the domain was further confirmed with force extension curves, which have distinct branches for the unfolded and folded states (Fig. 1d). The force dependence of refolding (Fig. 3) was fit using maximum likelihood to an f2 model, which takes into account the soft compliance of the unfolded state (16-19): (see also Fig. S3). We found a refolding rate in absence of force , and compliance κ = 0.18 +/− 0.04 pN/nm.
Using the folding and unfolding rates in the absence of force, we can estimate the free energy difference between the two states: . This is close to the ΔG of 5.9±0.8 kBT ( 3.5±0.5 kcal/mol) estimated from urea-induced unfolding of an E. coli A2 fragment (20).
To test the hypothesis that A2 unfolding is required for cleavage by ADAMTS13, A2 was mechanically unfolded in the absence or presence of ADAMTS13, and relaxed to a clamped force of 5 pN (Fig. 4a). At this force, the lifetime of the unfolded state is >140 s, making refolding unlikely during the incubation with ADAMTS13. Cleavage by ADAMTS13 was detected as a drop in force on the tether to 0 pN (Fig. 4a, panel 1). Spontaneous rupture at 5 pN, i.e. the background with no enzyme (Fig. 4a, panel 2), was rare (Fig. 4b inset). In experiments with a lower force ramp, unfolding sometimes did not occur, as shown by lack of the characteristic force-extension signature. No cleavage of folded A2 at 5 pN with 100 nM or 1 μM enzyme was observed.
With unfolded A2 in presence of enzyme, the fraction of surviving tethers decreased exponentially with time, demonstrating first-order reaction kinetics, and yielding the time constant τ for cleavage at three different enzyme concentrations (Fig. 4b inset). The observed enzymatic rate, i.e. reciprocal of τ, was fit with the single-molecule Michaelis-Menten equation (21), 1/τ = kcat[ADAMTS13]/([ADAMTS13]+ KM) (Fig. 4b).
As the largest known soluble protein, VWF has more force exerted on it than any other free protein in the vasculature. Hydrodynamics and the overall shape and orientation of VWF multimers in flow are relevant to understanding the tensile force exerted on A2 domains within ULVWF, and trimming by ADAMTS13 (5). In shear flow, the rate of fluid flow increases from the wall toward the center (Fig. 5a,b). The product of shear rate and viscosity, shear stress, in units of force per area, imparts force to particles in shear flow that is related to their surface area. Compared to VWF free in flow, the hydrodynamic force at a given shear is much higher on VWF immobilized on a vessel wall or bridging two platelets free in flow, and at intermediate levels for VWF bound to a single platelet free in flow (9, 22). Because of weak attractive interactions between domains within each multimer, VWF multimers have an overall compact, yarn ball-like shape in stasis (2, 23-25). Above a critical shear stress of 50 dyn/cm2 (see supplement), the attractive forces are overcome by hydrodynamic drag, and VWF free in flow periodically elongates and contracts (2, 25) (Fig. 5c). Shear flow can be conceptualized as the superposition of rotational flow and elongational flow (Fig. 5b). The rotational flow causes particles to tumble (Fig. 5c). Tumbling is very evident for polymers such as DNA (26); however, the attractive forces between VWF monomers appear to keep it largely zipped up during tumbling, but with alternating cycles of elongation and compaction (Fig. 5c) (2, 25).
Several concepts from the field of polymer dynamics have not previously been introduced in the VWF literature. Importantly, for an extended VWF multimer with N monomers, the force on a monomer increases with distance from the nearest end of the multimer (Fig. 5d), and force at the middle of the multimer is proportional to N2 (Fig. 5d) (27)(Supplement). Force increases with the square of length because both multimer size, and the difference in velocity between shear lamina in which the two ends of the multimer find themselves, increase with length ((9, 27) and Supplement). This previously unremarked second power dependence has important implications not only for unfolding of the A2 domain and cleavage by ADAMTS13 (Fig. 5d), but also for shear-induced aggregation of platelets through the A1 domain of VWF, since it explains the much greater potency of longer than shorter VWF multimers both in hemostasis and thrombosis (1, 5).
Could the tensile force on VWF free in the circulation reach levels in vivo sufficient to explain unfolding of the A2 domain and cleavage by ADAMTS13? The tensile force is estimated (Supplement) to reach 10 pN on the middle of a VWF 200-mer at the maximal shear stress of 100 dyn/cm2 (shear rate of 5,000 s−1) found in healthy vessels in vivo (5, 28) (Fig. 5d). Using a loading rate of 25 pN/s estimated from the VWF tumbling rate in shear (Supplement), the A2 domain typically unfolds at about 11 pN (peak of the unfolding force distribution, Fig. 2b). The upper size limit of VWF in the circulation is variously estimated to correspond to a 100-mer (1) or a 200-mer (2, 23, 24) (Supplement). Thus, our single molecule data on the A2 domain successfully predicts the observed upper size limit of VWF multimers in vivo as ~200 monomers (Fig. 5d). Caveats include uncertainty in the angle of maximally extended VWF with respect to flow direction, which could influence the magnitude of the peak force estimate by several fold (Supplement), simplifying assumptions made in the calculations, and a possible contribution of platelets to VWF trimming (22, 29). The dynamics of VWF in shear flow is an important area of future investigation for understanding susceptibility to ADAMTS13 as well as activation in hemostasis.
The existence of a clear threshold for the lengths of VWF multimers has been shown in vivo; a bolus of ULVWF released from endothelium into the circulation is trimmed to the pre-existing equilibrium length distribution of circulating VWF multimers within 2 h by ADAMTS13 (4). Our analysis illustrates the principles that dictate the maximum length of circulating VWF multimers in vivo, and the previously unappreciated concept that the force on VWF free in the circulation is sufficient to induce unfolding of the A2 domain and cleavage by ADAMTS13.
Another important concept known in polymer dynamics (26) not previously introduced in the VWF literature is elongational flow (Fig. 5a,b). In contrast to shear flow, which has both rotational and elongational components (Fig. 5a left), close to a site of hemorrhage flow will transition to elongational (Fig. 5a right). Although the actual flow pattern would be complex, the overall picture is that tumbling and alternating cycles of compression will tend to cease, and VWF will only experience elongation. Alignment of extended VWF with the flow direction could increase peak tensile force approximately 10-fold over that experienced in shear flow (Supplement).
We have definitively established that unfolding is required for cleavage of the A2 domain by ADAMTS13. Intriguingly, in a proportion of unfolding events, a transient intermediate state was observed. In VWF A2, the N-terminal β1-strand is central in the fold, whereas the C-terminal α6-helix is peripheral. Therefore, unfolding induced by elongational force will begin at the C-terminus, as confirmed by simulations (15). Unfolding of 40% of the contour length in the intermediate state would thus correspond to the unfolding of about 70 C-terminal residues, up to and including the β4-strand, which contains the scissile Tyr1605-Met1606 peptide bond. Studies with peptide fragments show that C-terminal, but not N-terminal segments distal from the cleavage site are recognized by ADAMTS13 (30). Thus it is possible that ADAMTS13 could recognize and cleave the intermediate unfolded state.
Our single-molecule kcat for the ADAMTS13 enzyme of 0.14 s−1 is in the range of 0.14 to 1.3 s−1 determined in bulk phase with unfolded peptide substrates corresponding to the C-terminal 70 residues of A2 (11, 31). However, our KM of 0.16 μM is lower than previous estimates of 1.7 and 1.6 μM (11, 31). The lower KM value determined here may reflect a more physiologic state of the substrate. Notably, different domains within ADAMTS13 recognize different portions of the unfolded peptide substrate that are far apart in sequence (30, 31). Whereas peptide substrates have essentially random configurations, tension applied to the unfolded A2 domain partially orders it in one dimension, and this more linear configuration may be more optimal for recognition by different domains within ADAMTS13.
VWF will only be exposed to peak shear intermittently during each tumbling cycle, and only to high shear during transit through arterioles and capillaries. The lifetime of about 2 s of the unfolded state in the absence of force is longer than the time period of peak force exposure (9) (Supplement), and provides a window of opportunity after unfolding for cleavage of circulating VWF by ADAMTS13. Refolding to the correct low energy state after tension is released is another property of the A2 domain that is important to its function in vivo. Aberrant refolding could permit cleavage by ADAMTS13, as is observed with some A2 domain preparations from E. coli (32).
Our single molecule enzyme assays suggest that the rate of VWF cleavage is limited by ADAMTS13 concentration in vivo, which at 6 nM (33), is substantially below the KM of 160 nM, and yields a timescale for cleavage in vivo of ~200 s. Although the numbers may be altered for cleavage of unfolded A2 within intact VWF, these rough estimates are relevant to understanding events in vivo. Thus, over the short time periods of < 1 s important in hemostasis, binding of VWF through the A1 domain to gpIb on platelets and through the A3 domain to collagen on the subendothelium should win out over cleavage of the A2 domain by ADAMTS13. These kinetic differences enable the same biophysical principles, i.e. the relation of force to the second power of multimer length, and the transition from shear to elongational flow at sites of hemorrhage, to activate both hemostasis by VWF, and cleavage by ADAMTS13.
A further wrinkle is added by a cis-Pro recently discovered in the A2 structure (15) consistent with a small number of A2 tethers that suddenly stopped refolding, and after a long delay, resumed refolding (Supplement). VWF, bound to platelets at sites of hemorrhage, would be exposed to forces sufficient to accelerate cis-to-trans peptide isomerization (34) in unfolded A2. A trans-Pro would be a long-lasting (100 to 1000 s) impediment to refolding that would enhance cleavage by ADAMTS13 during wound repair.
Its unique lack of protection by disulfide bonds within VWF (Fig. 1a), and low resistance to unfolding, suggest that the A2 domain has evolved to be the shear bolt domain of VWF. A shear bolt breaks above a designed force threshold, to protect other parts of a machine from accidental damage. Similarly, the A2 domain unfolds when present in VWF multimers that experience high tensile force and is cleaved by ADAMTS13, resulting in down regulation of the hemostatic activity.
Supported by NIH HL-48675 (TAS), the Rowland Junior Fellows (WPW), and AHA 525918T (XZ). The authors are indebted to Drs. Carlos Bustamante, Susan Marqusee, and Ciro Cecconi for protocols for DNA-protein coupling. We thank Drs. J. Evan Sadler, Diane Schaak, Jongseong Kim, Joonil Seog, Chafen Lu, and Alfredo Alexander-Katz for reagents and insightful discussions, and Graham Dempsey for work on the early stages of this project.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Doctor insights on:
Which Doctor To See When Have Double Vision
Should I see a doctor if I have double vision?
Yes: Double vision that does not go away always needs to be evaluated. Occasionally, people with normal vision who get very tired can experience double vision. It usually goes away once you wake up. See an eye doctor or neurologist immediately if it does not resolve after rest. ...Read moreSee 1 more doctor answer
Vision (Definition)
Vision is a feature of a person's brain that allows him to see. He must have normal eyes, optic nerves (that stretch from the eyes to the back of his brain), and visual cortex (the vision center in the brain), in order to see properly. An ophthalmologist is a ...Read more
How long can I wait with double vision to see if it goes away without seeing a doctor?
Not long: Most doubllng of vision is acute following trauma, head injuries or due to intracerebral vascular events or tumors. The injury may also be direct trauma to the structures around the eye, as well as tumors and conditions like thyroid malfunction. If persistent more than 2 days or so, you should see your ophthalmologist or better yet a neuro-ophthalmologist who can sort this out for you. ...Read moreSee 2 more doctor answers
What kind of doctor sees somebody for double vision?
Ophthalmologist: Double vision should be evaluated by an ophthalmologist. If it occurs with only one eye open, it is related to the eye itself. If it only occurs when both eyes are open, it is an alignment issue. This is usually related to a nerve or muscle problem. Your ophthalmologist can refer you for tests and further work-up by other specialists if necessary (neurologist, for example). ...Read moreSee 1 more doctor answer
I have double vision from last one month can it be curable as my my medical reports are ok there is nothing serious. Doc. Says it is due biological?
Paralysis of EOM: Temporary vascular occlusion of BV to the extra ocular nerve can cause these symptoms. ...Read more
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See ophthalmologist: There are many causes of double vision and you need to see an ophthalmologist to sort it out. Don't wait to do this as there a serious causes for double vision such as diabetes, aneurysm and tumor. ...Read more
One of my eyes sometimes involuntarily turn inwards, causing double vision. Should I go to the doctor?
Yes: Double vision should be evaluated to check for the cause. Intermittent esotropia may not be a problem, but best to determine that with an eye care provider first -- may be a peds or neuro-ophthalmologist. ...Read moreSee 1 more doctor answer
My doctor can't get me in today and I have a migraine. I've been vomiting non stop and have blurry double vision. What should I do?
Go to ER: If you are feeling sufficiently ill and need to be seen immediately, go to an er. Problem is you may be waiting for lengthy time periods. Hope this clears up soon. ...Read moreSee 1 more doctor answer
Hi doc I just had cateract surgery on both eyes , my near vision is very good but I have double vision wen looking far , it is almost a mth since my s?
Oh dear!: If your surgeon has not yet identified the cause, treatment and prognosis of the problem, you should seek a second opinion. Issues may be 1) surgical damage to an ocular muscle or nerve, 2) decentered or misplaced lens implant, 3) corneal damage, 4) induced optical error (astigmatism), 5) diabetes induced muscle weakness or nerve defect, or 6) something entirely unrelated to the surgery. ...Read moreSee 1 more doctor answer
I having double vision in with my cable box and signs on the street while driving...Went to the eye doctors need glasses really bad?
See Eye MD: Double vision can be sign of very serious, even deadly, disorders. See an ophthalmologist soon. ...Read more
Dehydration diagnosis, double vision, walking drunk with slurred speech. Er doc said dehydrated. Came on sudden, effects hours after. Could be more?
Yes: Sometimes patients may have more than one problem. If those symptoms did not resolve completely with rehydration, then medical care should be sought immediately. Even if they did resolve, follow up with a primary care physician is important. ...Read more
Double Vision (Definition)
When two separate images which are displaced in space are perceived at the same time due to a ...Read more
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Ranchero Rice Casserole
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READY IN: 55mins
Recipe by GirlyJu
This recipe is super-easy and great reheated. The casserole works well as either a main entree or a side dish. It's always been a big hit at family gatherings and work potlucks. I included the chicken in the ingredient list, but I've always left it out. (cook time includes time to prepare the spanish rice)
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Ingredients Nutrition
- 2 (7 5/8 ounce) packages Spanish rice
- 3 cups shredded cooked chicken (optional)
- 1⁄2 cup sour cream
- 1 (7 ounce) canchopped green chilies
- 2 (4 1/2 ounce) cans black beans, drained and rinsed, seperated
- 2 cups frozen corn, thawed and seperated
- 1 cup italian plum tomato, chopped
- 4 ounces shredded mexican cheese
- 1⁄4 cup fresh cilantro, coarsely chopped
Directions See How It's Made
- Heat oven to 375 degrees. Spray 3 quart baking dish with nonstick cooking spray. Prepare Spanish rice as directed on package.
- In large bowl, combine cooked rice, chicken, sour cream, chilis, and half of beans and half of corn; mix well.
- Spread mixture evenly in sprayed dish and top with remaining beans, remaining corn, tomatoes an cheese.
- Bake at 375 for 20-25 minutes or until thoroughly heated. Sprinkle with cilantro before serving.


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Hey there, time traveller!
This article was published 7/3/2013 (1630 days ago), so information in it may no longer be current.
The Selinger government will present its 2013 provincial budget on April 16.
That is the day in which the second session of the 40th legislature will resume after it was adjourned on Dec. 6.
The government introduced 19 bills in the session, which began on Nov. 19. Only one of them was passed before the legislature took a recess.
Finance Minister Stan Struthers' budget will attempt to grapple with a deficit that has proved to be more difficult to tame than the government previously thought.
Following upon a record $999-million deficit in 2011-2012, which was blamed in large part on the 2011 flood, the government initially projected a $460 million deficit for the current fiscal year. But in December it adjusted that forecast to $567 million for the year ending this March 31.
Struthers also admitted late last year that the province would have to delay balancing its books until 2016-2017, breaking a promise to begin running surpluses by 2014-2015.
"Provinces across Canada and countries around the world are coping with the challenges of uncertainty in the global economy, and the Bank of Canada forecasts that Canada's economy will grow at a slower rate this year," Struthers said today in a news release. "We'll tackle the challenges ahead of us with a balanced approach that is focused on the priorities of families and will grow our economy."
The minister said the best way to keep the provincial economy growing is to create opportunities to train more people for skilled jobs. He said the government is also committed to maintaining Manitoba's affordable cost of living.


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What Is Medical Coding?

Medical coding is the process of translating into standardized numeric or alphanumeric codes the words in a medical record used to describe diagnoses, procedures, services, and equipment. Medical coding takes the information contained within medical records and creates data sets that are easily handled by computer systems across different businesses, governments, countries, and languages.

Why Use Medical Billing Codes Rather Than Words?

Medical coding is done by a health care professional called a coder. Coders read hospital records, patient visit notes from doctors' offices, procedure notes, and other types of medical records and translate each mention of a patient's diagnosis, a procedure performed, or a service rendered into the appropriate medical code. In this way, the essence of each medical record is distilled into a manageable data set of medical codes.

In the United States, the most commonly used medical codes are codes used to describe medical diagnoses and codes used to describe services and procedures.

ICD-9 and ICD-10 codes describe a patient's diagnosis. ICD-10 codes are used in countries across the planet. There are ICD-10 codes to describe diagnoses literally as simple as a freckle, and ICD-10 codes used to describe complex diagnoses like acute on chronic combined systolic and diastolic congestive heart failure.

 CPT® codes are used to describe procedures and services rendered by physicians, nurse practitioners, and physician's assistants. There are CPT® codes to describe things as simple as a well-baby visit in a pediatrician's office to much more complex things like surgical procedures. CPT® codes are used primarily in the United States.

 HCPCS level II codes are used in the United States to describe primarily non-physician based services and equipment. Examples include ambulance rides and home oxygen systems.

 DRGs are used in the United States to describe inpatient hospitalizations.

How Medical Coding Works

The process of medical coding starts with the physician or other health care provider documenting his or her findings and interventions in the medical record. The more detailed this documentation is, the more accurately the medical coding will reflect what was actually wrong with the patient and what services were rendered.

Once the medical record has been completed by the physician, nurse practitioner, or physician's assistant, the medical coder reads it. If the documentation in the medical record isn't clear, the coder may have to ask the physician to clarify something before the medical coding process can be completed. The coder then applies an exhaustive set of rules and guidelines to assign the medical codes that best represent the diagnoses documented in the medical record and the services rendered or procedures performed.

Frequently, the medical coder has software to help code a medical record. However, software alone isn't enough. It also takes a good understanding of the guidelines, rules, and regulations surrounding the use and application of each set of codes to be able to accurately code a medical record.

The rules governing the use of each set of medical codes are very detailed and extensive. For example, one set of guidelines, rules, and regulations applies just to CPT® coding. The American Medical Association's guidebook to CPT® coding, CPT® 2014 Professional Edition, is 976 pages. Those 976 pages are not an instruction manual; it assumes users are already fluent in the language of CPT® coding. Those 976 pages are just descriptions of CPT® codes and the guidelines for applying them.

Another equally complex set of rules and guidelines applies just to ICD-10 coding. Yet another set applies to HCPCS coding, and another to assigning a DRG for an inpatient hospitalization.

For this reason, there are specialties and even sub-specialties within medical coding. For example, one coder might specialize in hospital inpatient coding while another specializes in coding outpatient procedures. Yet another may sub-specialize by being an expert in coding only outpatient interventional radiology procedures.

Once the medical coder has coded the medical record, the codes are used to submit a claim to the health insurance company, Medicare, or Medicaid. Because accurate medical coding requires such attention to detail and the mastery of a complex set of rules, health insurers, Medicare, and Medicaid might review the medical coding submitted with a claim for accuracy. For example, Medicare's Recovery Audit Program reviews the medical records associated with paid Medicare Part A and Medicare Part B claims in part to make sure the record was coded correctly. If the RAC contractor finds a record it feels was upcoded, Medicare can take back part or all of the money it paid for that claim.

In addition to being used to submit, process, and pay your health insurance claim, the codes can be used as a part of your medical record, in part to define your medical history succinctly. Other uses for the information contained in data sets of coded medical records include tracking health care utilization trends, tracking epidemics, determining disease prevalence across populations or geographic territories, predicting future health care costs, helping to apply scarce financial resources where they can do the most good, research, and developing health care policy.


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Now that The Father has called a black man to be America's president, His purpose for that office has become clear: no chicks allowed (thin or otherwise).
With that part of His plan in place, The Lord decided that whosoever is accepts His gift of presidency should first be able to pass a simple test of worthiness before bearing the burdens of the office.
These burdens are unique to the office of America's presidency and have consequences for the entirety of America's Planet, so it is vital that the man who holds the office be able to pass God's test for him, know what the burdens are and pray to The Baby Jesus for the strength to uphold the honor and dignity of the Presidency.
The TestEdit
- are you a man?
- are you American?
- are you rich?
The BurdensEdit
- be confident
- keeping America safe
- protecting the sanctity of America's women
- bringing democracy to the rest of America's Planet
- solemn responsibilities
- lead the cause of freedom
- advance the cause of peace
- be moral leaders


text: I use Adobe Premiere Pro CC and have been using it on a higher end laptop but even a high end laptop chokes big time on 4K footage so I researched building a desktop workstation and just placed the order for it today. At first I was looking for an entry level editing system in the $1K-$1.5K range but there isn't much at that price point that is well suited to 4K video so I upped the budget and looked again. When all is said and done the new box I came up with is a tad under $3K so quite a bit more than my initial plans but much less than the next step up at about $5K. You can, of course, spend $20K or more on a high end rig but me no gots that kind of money... So, what I came up with is: 1. Thermaltake V71 case 2. Thermaltake TPD-0750M power supply 3. Asus x99 Pro/USB 3.1 motherboard 4. Intel i7-5820K unlocked CPU 5. Corsair H100i GTX CPU water cooler 6. G.Skill Ripjaws DDR4 RAM at 3200 with low CAS 7. EVGA GeForce GTX 980 Ti water cooled GPU 8. Samsung Pro 950 512GB PCIe SSD 9. WD Black 6TB HD 10. LG 14x SATA Blu-ray writer 11. Atech Flash Technology PRO-77U USB and flash reader 12. Microsoft Sculpt Comfort Desktop keyboard and mouse 13. Microsoft Windows 10 Home USB So, just placed the order today with most items ordered from Amazon with Prime shipping -- should have most of it Monday, but the CPU and RAM coming from Newegg will likely be a day later and the flash reader not until the end of the week. One last item ordered from Amazon is a 18"x24" anti-static mat with wrist straps and ground plug for parts assembly. I live in an apartment with nothing but carpeting and that stuff is a static generator particularly in the low humidity south west and even more so in the winter. I haven't built a PC since 2003 but most of this is common sense and taking your time. Doing research on Youtube is very helpful as you can glean things from others and seeing with your own eyes is a great help. I figure it will take me a half day to build and then a day to install Windows and programs and get everything setup properly. This is not the end, of course, as I anticipate adding a few things over time to further improve performance and mostly to add more storage. At present the system will have just two drives -- the 512GB SSD and a 6TB HD, but I'd really want another 950 Pro for working storage and several more HD's for bulk storage. I was tempted to order two of the 950's, but I'm hoping they release a 1TB version soon as that would actually be the better choice for working storage. The 950 set's some new performance points with reads speeds of about 2.5GB/sec and write speed of about 1.5GB/sec -- that kind of performance will be very helpful during editing and rendering. Brian


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Lucto Kamani is a playable character in Ivar-Jedi's epic "Rise of The Jedi Knight" He was portrayed by Darth Namialus.
Lucto is a young pilot in the Rebel Alliance. After the death of his father during the battle of Liffle, Lucto took command of the Rebel Troopers his father was leading and drove the outnumbered Imperial Troopers away.
After his father's funeral Lucto stayed on Liffle to try and de-code several Imperial computer before the Empire would strike back. But they were suprised when no other then Darth Sidious arrived and 'took care' of them all. Lucto and 3 of his troopers escaped on a speeder and barely survived the 3 days in the ice cold nothingness of the planet before being found by The Fire Skeleton and a pack of Snowspeeders.
Rise of The Jedi KnightEdit
Lucto Kamani was the first person in the entire game to be voted off. He was arrested and brought to a holding cell to await further qeustion about his loyalty. Before they could question him though, he panicked and accidently broke a gas pipe in his cell and died to exposure. He was later proven Loyal. The cause of his death was confirmed two days later.


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Mr Big of Bankstown
By Andrew Moore
In 1955, Raymond Fitzpatrick - a rough-hewn, ill-educated, Sydney businessman known in the media as 'Mr. Big of Bankstown' - and Frank Browne - a journalist with a bent for verbal attacks on politicians - joined forces to teach a troublesome Member of Parliament, Charles Morgan, a lesson that Morgan wouldn't forget. Fitzpatrick and Browne published an article that insinuated Morgan was implicated in an immigration racket. However, it was Fitzpatrick and Browne who ended up learning a lesson when Morgan responded by raising this issue in Parliament under the Privileges Act. Colorful personalities, personal animosities, and the self-interest of several individuals intersect and collide in this true story about two individuals who were imprisoned on a vote of the Commonwealth House of Representatives. Set in the iconic Australian era of the 1950s, while the Cold War simmered, this history features knockabout types in a public scandal. The Australian Law Journal described the case as "one of the most significant constitutional law cases of the 20th century in Australia." With corruption, violence, and bribery - mixed with a healthy dose of comical charm - Mr. Big of Bankstown has it all.
262 pages
Publication Date: 10/15/2011
Format: Paper


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Ingemarie H. Hays, 83, a former resident of Roseland and Essex Fells, died Sunday, July 15, 2001 at her home in Sante Fe, N. M. A memorial reception will be held in her home on Thursday, July 26. Mrs. Hays was born in Hermansruhe, Germany, on Jan. 9, 1918. After World War II, she moved to Switzerland with her family where she met her future husband, John H. Hays. They married and moved to Essex Fells and later Roseland. Mrs. Hays moved to Santa Fe in 1991. She worked as an administrative secretary in the New Jersey public school system, retiring in 1984.
In New Mexico, she was an active volunteer with the Museum of New Mexico and belonged to the Historic Santa Fe Foundation and the Newcomers Club.
A lover of travel, Mrs. Hays traveled extensively in her life to, amongst other places, Europe, North Africa, the Pacific Islands and Russia.
Predeceased by her husband in 1963, she is survived by a son, John P. Hays; a daughter-in-law, Laurie Longiaru; and two grandchildren, Melissa Longiaru and Eryn Hays.
Interment will take place later this year at Mount Hebron Cemetery, Upper Montclair.
The family asks that donations be made in her name to the Southwest CARE Center, 649 Harkle Road, Santa Fe, N. M., 87505.


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If you can walk, you can ski.
Tiny skiers with big dreams can step into the Marker Kids' M4.5 EPS Junior Ski Binding for solid, safe beginner performance that encourages the learning process and enables quick progression. Even the smallest skiers can move up the ranks, because this lightweight binding provides the easy-turning and easy-releasing necessary to prevent injury and promote growth as a budding skier.
- DIN range of 0.75 to 4.5 accommodates the youngest and smallest skiers learning and then moving onto intermediate terrain
- Binding works best for skiers between 29-125lb
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- Compact step-in heel is lightweight and provides precise release during falls to reduce injury
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- Item #MRK0053
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Have questions about this product?
Good binding for a junior ripper
- Familiarity: I gave it as a gift but have feedback to share
I like Marker bindings and when the skis bought for my daughter had bindings that were just haggard, I replaced them with these...good retention and she loved the color.


text: A place of elegance beauty and old world charm the Biltmore Hotel is a luxury golf and spa resort located in the elegant Coral Gables area of Miami Florida. This historic resort features grand hotel rooms and suites highly acclaimed restaurants a worldclass spa and fitness center and spacious stateoftheart conference facilities. Surrounding the Miami Biltmore Hotel are 150 acres of lush and tropical landscapes which include an 18hole Donald Rossdesigned golf course 10 tennis courts and the worldfamous Biltmore pool with private cabana suites. An oasis of privacy and tranquillity in the vibrant city of Miami our upscale Florida hotel is just minutes from the electricity of South Beach and downtown Miami as well as the flourishing business districts of Coral Gables.


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17 Warning Signs Proving That Your Vacation Is Epic failure
May 15, 2016
We all love to take a rest from the struggle that is life and go to places where we can forget that rest of the human race exists. But seeing that African rainforest aren't a very hot destination, you might just settle for Hawaii. Ha! But sometimes, your vividly laid plan backfires and you are left with no choice but to accept that your vacation was a big failure. Just like these people did.
Hey there guys, go to Hawaii!
1. When you have to share rooms with others.
2. When you had to have all your stuff.
3. When creepy people won't leave you alone.
Source: photos.ellen.warnerbros.com
4. Then, there's this person whom you should avoid at all cost.
5. Have some bourbon, lady.
Source: thechive.com
6. When grandpa passes away.
Source: thevirallane.com


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See your Hagerty program guide for a complete description of benefits.
TO YOUR POLICY TODAY or call us toll free 888-348-9369.


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Starbucks fires Kraft as distributor
Published 10:00 pm, Wednesday, November 3, 2010
Starbucks recently fired Kraft Foods as its distributor of packaged products, according to an cryptic announcement that followed reports of earnings increases Thursday.
Seattle-based coffee company said it terminated its 12-year relationship with Kraft one month ago for reasons that will not be disclosed.
"Since 1998, Starbucks packaged coffee has been distributed to grocery stores and other outlets by Kraft Foods," according to a statement from Starbucks. "A month ago Starbucks informed Kraft of its intention to end that distribution arrangement. The details and timing around any transition will be subject to further private dialogue."
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The statement continued: "Starbucks intends to work closely with Kraft to ensure an orderly transition, putting an emphasis on ensuring their mutual customers are well served. Starbucks intends to keep the discussions with Kraft private and will not be providing further details or comments at this time."
That was the second announcement from Starbucks on Thursday. The company revealed earlier in an earnings report that its fourth-quarter revenue nearly doubled.
Revenue in that quarter rose rose 17.2 percent to roughly $2.84 billion.


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Mosin Nagant ring type safety pull
Has anyone tried one of these ring type safety pulls?
Thinking about buying a few if I get good feedback on them.
It may make using the safety easier, but it looks overly large and clunky to me. It also looks like it would snag on stuff pretty easily.
Is Russian rifle.
Is for shooting.
Is not needing safety.
My MN's are range shooters, never think much about a safety it's just load, send home and squeeze, ice shoulder when done...;)
Have heard stories about taking the safety off and going boom...for various reasons...but have never had the need to use it...
I guess it could have a use (the ring), just not for me...:cool:
The trigger pulls are so heavy i dont think it needs a safety.
What? I engage/disengage my mosin safety with my thumb. I thought that's the way it's supposed to be done...
You mean to tell me there are some men not manly enough to do this while shooting one of the most ultimately manly rifles? Blasphemy.
Side note: no, I'm not kidding. Every mosin I've ever handled I've been able to manipulate the safety with the thumb of my firing hand. I know I CAN'T be the only one. And I don't exactly have gorilla hands either.
You'll knock your teeth out if you use the girly type that needs help w/ the safety. BTW, never used the "Safety"
WHAT? My Mosins have a safety? Safety on a Mosin-Nagant, to me, is not having a round in the chamber. The Russians and Soviets believed that the most important safety on weapons was located between the ears of the bearer of the firearm.
not tried it, i can engage the "safety" on mine ok, its the design of the safety itself that is the problem, it can slip to the fire position with a good bump. however, if you do get one and try it, please let us know how it workks
Hard Hard Hard Safety Mosin Nagant 1944
Mine is a real bugger, too. I can't pull it back at all. I'm an old geezer, but still...bolt is clean, too. I've had it all apart, soaked it, wiped it, oiled it ... all that stuff. I even took it to work and had a young guy try it. He was able to get the safety engaged, but then almost could not get it back into the fining position. I know I don't need it, just wish it operated easier. Any suggestions?
Thanks, Mike G. Thomasville GA
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ATD2011 Jim Coleman Semi: New Jersey Swamp Devils vs. Guelph Platers
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Location: Brooklyn
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Originally Posted by
As great and under appreciated a player as Henri Richard was - Trottier is better as an all around player.
Overall, yeah Trotts is probably a bit better than Henri. At even strength? I'm not so sure.
Middleton is a very good all around player, smart and a smooth skater - not unlike the player he faces off against, Phillips.
Yeah, they are similar . Both are great complimentary players for a first line (I think Phillips gets a little bit of an edge here though). I wouldn't want either to be the primary triggerman on a top line though, which is what you have Rick doing.
And while Maurice is a more talented goalscorer than Gillies any day of the week by a large margin, Gillies will be trying to set off that temper with physical play and harassing defensive play. We want an ATD riot and Richard suspension! Or at least some nice PP opportunities from Gillies provoking the Rocket.
Come on now. You know that Gillies wasn't an agitator. He was a defensively responsible power forward who played with dignity. I'd be worried about someone like Tikkinen getting to Richard, not Gillies.
I think this makes it officially the most repeated line of the draft, but I still believe that Robert is an almost perfect compliment to MacLeish.
His strengths work to fill MacLeish's weaknesses - Robert is just a notch lower than I would have preferred in an ideal world as a pure playmaker rather than primarily as a puckwinner that he is..
I like the MacLeish / Robert combo. I think it works. But it provides significantly less secondary scoring than NJ's 2 secondary scoring lines.
I also find Ogrodnick is being woefully underrated by the crowd here. He was a very good offensive player playing for very bad teams (Dead Wings). I was genuinely surprised when I drafted him that many here on a history board didn't even know who he was when he played primarily in the 80s.
Ogrodnick was 3rd in goals and 3rd in points among left wingers during the span of his 13 year career - behind only Goulet and Propp - in a similar number of games.
Ugh. There were only four notable LWs who played this whole period - Ogrodnick, Propp, Goulet, and Tonelli. Ogrodnick is barely ahead of Tonelli or 4th, and Tonrlli isn't drafted for his (regular season) offense alone like Ogrodnick.
Ogrodnick was 14th in Goals per game and 15th in Points per game over his career
among left wings
who played at least 200 games. In an extremely poor era for left wings to boot.
Not to mention that Ogrodnick is a triggerman without a playmaker to get him the puck in prime scoring position.
Looking at our defense I think they are very close even in construction with a primary puck mover and primary physical type guy on each line.
Similar in construction, yes.
I think the gap between Coulter and Ramsey gets possibly exaggerated by the big war years for Coulter, and relative anonymity of a defensive guy like Ramsey playing for the 80s Sabres. I agree he is better though, but Ramsey isn't actually my second best defenseman all around - that is Desjardins.
What big war years for Coulter? Are you thinking about Pratt? Coulter played at the same time as Eddie Shore and Earl Seibert. I know Desjardins is your 2nd best guy but I think he's more comparable to Pratt in terms of talent and role than he is to Coulter.
Boyle I agree with you has been a bit underrated in his career but you keep pushing..
I don't think it's a stretch to say that Boyle has clearly surpassed Steve Smith by now in terms of overall impact. He's much better than your bottom pairing guys, as well.
Poor Turk Broda. Hands down a premier money goaltender in the history of hockey until he is on my team.
Eh... Forgetting about Patrick Roy? Regardless, I have a lot of respect for Broda's work in the playoffs. That's why I'm graciously giving you a very small edge in goal for the playoffs,, despite Gardiner's likely superior regular season resume and the fact that he was outstanding in the playoffs, as well.
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