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It has the credit of being the
first and the only centre in Rajasthan where wide range of immunological investigations are carried. The centre enjoys the status of being pioneer in establishing
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Two Farr 40s knock each other for six at the North Sails race week yesterday afternoon
Alexandra Geremia's Crocodile Rock, sharing first place at the first windward mark with John Kilroy's Samba Pa Ti, crashed into Mike Condon's Endurance to knock the latter boat out of the regatta with two races remaining today. Crocodile Rock was on port tack, Endurance was on "I cried," Geremia said, tears welling in her eyes. "I still cry every time I talk about it. The Endurance guys were so gracious. Thankfully no one was hurt."
Endurance suffered a large hole in its port side near the chainplates that anchor the mast rigging. Crocodile Rock was not damaged but dropped out, anyway.
Robbie Haines, calling tactics for helmsman Scott Harris, said, "We could have easily kept sailing, but we were wrong. We just didn't judge it right."
The incident left the Santa Barbara boat in a three-way tie for fourth with 18 points. Meanwhile, Samba Pa Ti's performance has returned to its former level of excellence with the return of John Kostecki as tactician this week. Does he make a difference?
"Is the Pope Catholic?" asked Mike Howard, a member of the rival Groovederci crew.
Kostecki, on hiatus from preparing his German illbruck team for the Volvo Ocean Race starting in September, has shepherded Kilroy and his crew around the course to two wins and a second in the three races for an eight-point lead over Peter Stoneberg's second-place Shadow.
Four other boats among the 160 competing in 15 classes have even better records of 1-1-1 — Chris Winnard's Altitude Sickness from San Diego's Southwestern YC, H.L. (Loe) Enloe and Kurt German's F-31 trimaran Merlot from Long Beach's Shoreline YC, Allan and Ron Rosenberg's Olson 30 Intense, Alamitos Bay YC, and Tom Carruthers' J/105 Incorrigible, San Diego YC.
Dave Ullman, with Pease Glaser alongside calling tactics, sailed typically solid and conservative (1-3-2) to stay atop the Melges 24 standings by three points over Argyle Campbell of Newport Beach.
How does anyone – even an Olympic silver medalist – call tactics for Dave Ullman?
"She does it – and I have the option to override her," Ullman said, smiling. "But that doesn't happen much. We just worked our way up the middle, playing the shifts."
Class rivals this week include Philippe Kahn, the Santa Cruz software developer who is in 10th place but whose Farr 40, winner of the recent Cal Cup, would have represented the U.S. if the Admiral's Cup hadn't been cancelled. Next Sunday Kahn will start his new Reichel/Pugh 75 Pegasus as one of the favorites in the Transpacific Yacht Race to Hawaii.
"He could keep punishing the Farr 40s if he wanted to," Ullman said, "but he wants to learn to sail better. Not many people would step back and do it the way he is."
In a late development on Friday, the first race of the PHRF-1 big-boat division was nullified by the race jury. Several participants requested redress because the race committee started the starting sequence a few minutes earlier than the 4 p.m. stated in the Notice of Race.
Although Dennis Conner's 50-foot Stars & Stripes finished first in that race, Oscar Krinsky's 1D48 Chayah corrected out for the win on handicap time. Neither of those boats protested. The biggest beneficiary was Mike Campbell's new Andrews 52 Victoria, which dropped out after losing its headstay near the first windward mark.
Victoria's designer, Alan Andrews, who was aboard, said, "The splice on the forestay came undone. We were just getting ready to round the mark. Mike did a good job turning downwind."
Andrews said the boat wasn't in serious danger of losing its mast because "the jib luff was supporting the rig."
Victoria went 1-2 Saturday and leads Conner (1-4) by two points.

subset: commoncrawl


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Windows Phone 8 devices are capable of connecting to LinkedIn without the aid of any additional software.
To connect a phone to LinkedIn, go to the Settings screen and follow these steps:
1. Tap Email+Accounts.
2. Tap Add an Account.
3. Tap LinkedIn
4. Tap Connect.
5. Enter the email address and password that are connected to your LinkedIn account.
6. Tap OK, I'll Allow It.


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Media International Exchange 2017.07.27
For the last two or three years, I have been finding it hard to catch a cruising taxi during my business trips to Shanghai. Earlier, it was not so difficult to do so there; I have visited Shanghai on business several times a year for the past decade. Taxis provided a cheap, easy, and convenient means of transportation in the City.
In Beijing and provincial cities, by contrast, picking up a cruising taxi was traditionally rather difficult. To be on time for a meeting in these cities, it was necessary to use a subway or hire a chauffeured car. In Shanghai, however, I did not feel that necessity, because taxis were rather easy to come by back then.
The situation changed two to three years ago. One day, I found it so hard to catch a taxi that I was late for three different meetings. I decided to hire a chauffeured car to move within Shanghai thereafter.
In the meantime, the taxi situation in Beijing has become even worse. In the past, it took ten to twenty minutes to catch a taxi after a dinner meeting. Now it is not surprising if you end up failing to grab one after one-hour's try. Subways have become the only option to travel in the City after a dinner meeting. (I often have to walk around one kilometer to get to the nearest subway station in Beijing.)
Behind this change is the widening use of smartphone-based taxi-hailing services.
For the past two to three years, it has become a common practice for Chinese city dwellers at large to use a smartphone app to hail a taxi. You can flag a taxi carrying no passengers, but to little avail. Such a taxi is often heading to the customer who called via a smartphone app. So hailing a taxi without using a smartphone app has become harder than ever.
One such app that boasts a high market share in China is offered by Didi Chuxing, the Chinese version of Uber. (Uber withdrew from the Chinese market last year.) This app allows users to hail private cars and chauffeured cars as well as taxis. Yet cash settlement is not allowed for these non-taxi vehicles, making it difficult for foreign business travelers to use them.
During a period of few hours after dinner, Chinese people use this service to catch non-taxi vehicles. They pay by a Chinese credit card or via a smartphone-based settlement app, notin cash.
These means of settlement are unavailable for foreign business travelers, because they do not have a bank account in China.
The rapid growth of such ride-hailing services in the past two to three years has made it extremely difficult to catch a taxi without a smartphone in Beijing, Shanghai, and other major cities. This represents a significant improvement in convenience for Chinese people, although it may be less convenient for foreigners with a limited range of settlement methods available.
Ride-hailing apps are only part of the story. In China, the development of smartphones' settlement functionality and the uptake of e-commerce have made economic activities by all--young and old, male and female--more oriented toward the Internet of things (IoT). In fact, IoT has permeated all levels of Chinese society, as shown by the increasingly common practices below:
●Not carrying business cards (holding a smartphone against another instead to exchange information)
●Not using Internet e-mail (using SNS on a smartphone instead)
●Not carrying cash (paying by smartphone instead)
●Not using a credit card (paying by smartphone instead)
●Shopping in e-commerce even in rural areas where there are few stores (payments made by smartphone)
●Splitting the meal bill in an instant using smartphones
●Rapid spread of Mobike, a rental bicycle service that allows users to pick a bike up and drop it off at any public parking area, with payments made by smartphone only
●Offering consumer loans based on personal creditworthiness that has been assessed using the history of smartphone-based settlements.
The quick spread of such services in China is chiefly attributable to once-prevalent inconvenience in economic activities, which can be largely divided into three types.
First, landline phones were traditionally uncommon at the household level in China. This gap has been rapidly filled with the use of mobile phones by all--young and old, male and female.
Second, city suburbs and rural areas having few stores meant that shopping was inconvenient there. This gap has been filled with a dramatic shift to e-commerce, which has significantly improved the level of convenience for consumers in areas with few stores.
Third, day-to-day fund settlements were made more inconvenient in China than in Japan by financial institutions that were inconvenient, and many bogus bills that were in circulation. This gap has been filled with the rapidly widening use of convenient and secure means of settlement via a smartphone app.
In sum, the lack of landline phones has paved the way for cellphones and smartphones, the lack of convenient stores has paved the way for e-commerce, and the lack of convenient banks has paved the way for fintech.
The phenomenon in which the emergence of innovative, next-generation technology allows societies to skip transitional technology and enjoy its fruits is referred to as "leapfrog development."
An example of this is that settlement by check has not taken root in Japan, but settlement by bank transfer has.
Leapfrog by the "Dragon," as China is often called, may be rather oxymoronic, but such leapfrog may not be emulated even by Japanese businesses that boast technological prowess.
The next leapfrog development in China will likely occur in the telemedicine sector.
China is seriously suffering from the shortage of medical institutions. Renowned hospitals in major cities are visited by several to tens of thousands of outpatients a day. The lobby of such a hospital looks more like the precincts of Shinjuku Station in Tokyo during rush hours--a scene unimaginable in Japanese hospitals.
As such, ordinary patients may not have access to satisfactory and substantial healthcare services. Untimely treatment may deteriorate their health conditions. Or it could even be fatal.
To rectify the situation soon, it is clearly insufficient just to build more hospitals in a steadfast manner. This is where telemedicine comes into play.
In telemedicine, medical exam data are sent to a hospital via smartphone for analysis. Doctors of the hospital properly analyze the data, and the hospital gives instructions needed for disease prevention. If a disease is suspected, the hospital conducts necessary examinations for diagnosis.
The full-fledged introduction of these telemedicine services such as prescribing and dispensing medicine through the process is expected to provide a fundamental solution to the dearth of hospitals in China.
Although telemedicine is currently prohibited by law in China like in Japan, given the poor healthcare situation at the moment, telemedicine must be introduced to the country in the near future. Such introduction, if it begins at all, will clearly give rise to leapfrog development on a scale that would be unimaginable in Japan.
Even in innovative industrial sectors for which a large market is non-existent in Japan, Japanese businesses can produce high-quality products and services that fit Chinese market needs, if they continue to work hard by taking advantage of their technological capabilities.
To that end, Japanese businesses must assimilate themselves into the Chinese domestic market to accurately assess the needs of Chinese businesses and individuals. Accurate assessment of market needs will be never done if the businesses remain in Japan, because at issue are innovative technologies that are not rooted in economic and social life in Japan.
Efforts to develop products that meet the needs of the Chinese domestic market are relevant not only to industrial sectors with good potential for leapfrog development; in fact, they are also relevant to traditional sectors such as automobiles, consumer electronics, food, and basic materials.
Chinese domestic needs are different from Japanese ones in these traditional sectors as well. This means that Japanese businesses must develop unique products that better meet China's needs and improve their production efficiency accordingly.
In the recent Chinese domestic market, some Japanese businesses continue to be successful in such sectors as automobiles, construction machinery, smartphones, liquid crystal panels, daily necessities with high added value, and e-commerce. They have something in common: accurate assessment of local needs, the development of products that fit such needs, and efforts to improve production efficiency in order to offer affordable prices for consumers.
In an era when the dragon superpower achieves leapfrog development, Japanese firms that dare not venture out of Japan cannot see business opportunities that such an era offers; they do not even know how to seize them.
By contrast, tremendous success and huge profits are in store for Japanese firms whose top executives frequently visit China to see local market needs with their own eyes for accurate assessment and take R&D and production efficiency initiatives from the frontline of the market.
Products and services that are common in Chinese industrial sectors that develop beyond Japan's technological levels will eventually enter the Japanese domestic market. It will not be until then that Japanese firms that do not dare to venture into the Chinese market will know what makes Japanese firms that did so different from them in terms of corporate capacity.
As Chinese market needs become more and more oriented toward high added value, different attitudes toward the China market are polarizing Japanese businesses more than ever.


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Tuesday, April 24, 2012
Why I recommend against using iUniverse
I am absolutely torn on the subject of iUniverse. In the end I must recommend against using them, and that's a real shame, because I've met many talented and dedicated people there. The good folks at iUniverse seem to outnumber the bad by a factor of two or three to one, so it seems totally unfair to judge iUniverse poorly.
The bottom line is that marketing and promotion are absolutely vital to a fledgling author's success, and their marketing and promotions departments are truly, remarkably, AWFUL. I avoided major pitfalls at several points only because I have a few friends here and there with some expertise in the area. Had I trusted iUniverse's marketing department with my money and my book, it would have been an embarrassing and hugely expensive folly, no matter how wonderful the other staff were.
You might read my earlier post regarding the specifics of their marketing department's antics.
Their sales, packaging, editing, and production organizations are genuinely good. I really wish I could reward all the winners: Kathi, Andrea, Cherry, Jade, and a dozen more behind them, with a recommendation that people use their company to self publish. Unfortunately, for the first-time author, nothing will overcome bad marketing. Ask any literary agent.
Interestingly, iUniverse has given me half a dozen or more electronic polls over the last year to sample my opinion. I've given the above feedback each time. They've never followed up. Go figure.
Ultimately, iUniverse is not a safe place for a novice author to spend their money.
Posted by Jeff Evarts at 1:27 PM 5 comments:
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Rain or shine or hurricane or blizzard, it's never a bad time to fire up one of the best gas grills on the market and start cooking.
Of course, that's only true if you've got a great gas grill in the first place. And if you're like most men, you don't want just a great gas grill, you want one of the best gas grills out there.
Choosing from the best grills that cook with gas can be a tough job. What does the perfect gas grill out there even look like? There's no need to give up, slump your shoulders, and resign yourself to another evening cooking over the skillet. We've got all the best gas grills out there, so you can choose the model right for you and get grilling!
Best Gas Grills
When you're looking for the flat-out, no-debating best gas grilling experience, you have to look first for the best gas grill to enable it.
That's what you'll get here. These are the best gas grills out there. That means, when you light the gas and get grilling, you're setting yourself up for more than just tasty meat and veg perfectly cooked, you're getting the best look, the best features, and the best design additions.
If you've got the money and the drive for great grilling, start here.
Here are the 5 best gas grills:
1. Weber 65010001 Genesis II E-210
Sleek stainless steel, huge grilling service, the ability to grill anything, and easy to put away: it doesn't get better than this gas grill.
2. Smoke Hollow VT280B1 Vector Series
If you want that smoky grill flavor but are always on the move, this is the grill to bring with you.
3. Coleman RoadTrip 285 Portable Stand-Up Propane Grill
Incredibly portable, and yet, this grill has the size and features of its bigger, less moveable cousins.
4. Char-Broil TRU
Bring some crazy technology to your charbroiling experience, and then bring it everywhere else.
5. Char-Broil Grill2Go X200 Portable TRU-Infrared
While still very portable, this has a more traditional, heavy-duty look to it.
7 Best Small Gas Grills
Big isn't always best when it comes to grills. You might think the best gas grills have to mighty and massive to be worthy of the title, but there are in fact a lot of diminutive, excellent grillers out there.
In fact, when looking for the best gas grills, you often end up choosing the best small gas grill along the way. Whether you just want the quality or it's all about the space, there's no need to make any sacrifices here. The quality is just as good, just in a smaller package.
Here are the 7 best small gas grills:
6. Cuisinart CGG-608 Professional Tabletop Gas Grill
Small enough to place on a picnic table, works with just a 1 pound tank of propane, and yet it can pack a lot of grilling power.
7. Megamaster 820-0033M
Put this one in the trunk and head out for a great grilling where it is. It's small enough but the brats turn out just how you like 'em.
8. Char-Broil Performance 300 2-Burner
On the bigger side of small, this has some of the best gas grill features for small grills, including storage for your propane tank and two burners.
9. Weber 1141001 Go-Anywhere Gas Grill
This particularly tiny option is light and capable of being set up just about anywhere.
10. Weber Q2200 Gas Grill
Love the Weber brand but can't afford a big Weber? This is one of the best gas grills out there and it's super small.
11. Blackstone 1819 Griddle and Charcoal Combo
Two different grills for two different grilling experiences, right next to each other, all at a size you can really work with.
12. Kuuma Camco 58140 Stow N' Go 125 Gas Grill
At less that fifteen pounds, you can lift this guy and take him camping with you.
5 Best Portable Gas Grills
For those of us who are always heading out to outdoors at someone else's place, having a big, lumbering gas grill (even if it's one of the best gas grills out there) isn't always the most convenient or useful thing.
That doesn't mean you need to go without, though. It just means you need to seek out the best portable gas grill. That way, your grill always comes with you, and you'll find you're invited to a whole lot more parties.
Here are the 5 best portable gas grills:
13. Cuisinart CGG-180T
The name says "petit", and it means it. This gas grill doesn't even take up a whole corner of the table.
14. Cuisinart CGG-049 Searin' Sphere 10,000
With a design that makes it look like a little black ball full of tasty meat, this grill takes of little space but still delivers the flavor.
15. Char-Broil Classic 280 2-Burner
You've got your grill, a side burner, and a place to put your cooked food...what more could you want from a portable grill?
16. Magma Products, Conniosseur Series Gas Grills
Short-legged and stainless steel, it's attractive, safe, and easy to prop up on any table.
17. Cuisinart CGG-059 Grillster 8,000
With as little as one pound of propane, you can fire this grill up anytime and anywhere you feel the need for it.
10 Best Gas Grills Under $500
You'd love to enjoy the experience and flavors of a great gas grill. The only problem? You don't have the cash for one. Turns out, that's not much of a problem at all, at least, not with this list. We've got the best gas grills under 500 for you right here. Pick you favorite, and grill away.
Here are 10 gas grills under $500:
18. MASTER COOK 3 Burner BBQ Propane Gas Grill
Stainless steel, two burners, and all kinds of propane-fueled flavor.
19. Blackstone 28 inch Outdoor Flat Top Gas Grill
A great grill, and an attractive one with that lovely red lid.
20. Coleman NXT Lite Tabletop Propane Grill
Small, portable, and affordable. All you could ask for from a gas grill.
21. Smoke Hollow VT280B1
Porcelain coated cooking grids and one burner that you can take anywhere for your grilling needs.
22. Kenmore PG-4030400L-AM 3 Burner Outdoor Patio Gas BBQ Propane Grill
The dark mocha color gives it a striking, classy look.
23. Giantex Portable Propane Gas Grill 12000 BTU
It's safe, durable, portable, and easy to use.
24. Dyna-Glo DGC310CNP-D 3-Burner Open Cart Propane Gas Grill
You don't have to settle for just one or two burners on your affordable gas grill.
25. Broil King 921557 Baron S320
You get some great little extras on this that usually cost more.
26. Pit Boss 2-Burner Portable LP Gas Grill
When you just want a quality gas grill to get the job done at a good price, this is it.
27. Char-Broil Classic 360 3-Burner Liquid Propane Gas Grill with Side Burner
When you have the space to really spread out and get your grill on, this is a great option.
How To Pick The Best Gas Grills
With all the options we've gone over in this article, it may now seem harder than ever to settle on which of the best gas grills above is the best gas grill for you.
To help you avoid a panic attack choosing between all those amazing grills, here are some steps to narrow in on your perfect new gas grill.
Here is how to pick the best gas grill:
1. Set Your Price Point
Let's start with the easiest way to narrow down your grill options: how much do you want to spend?
Some people want to go all out and buy the literally best gas grills on the market. They have the money, and their only concern is that the grill isn't too cheap. If that's you, then cut out all the more affordable options above, and focus in on where your money gets you the better grill.
Alternatively, if you're looking for a gas grill that hits a budget point ($100? $150? $200?), cut out those grills that fall outside the right number, and choose from what remains.
Whether you've got almost too much grill-buying money in your pocket or you're scraping the money together so you can finally enjoy your hot dogs again, there are grills out there that are great for you. The trick is just finding that price point and getting the best grill available that hits it.
2. Know What You Want Your Grill to Do
Some gas grills are better for a great charbroil, others are better for the open flame. Once you know how much you want to pay, you can look for which grills within that price point are particularly great at cooking up your meats and treats the way you like them.
Are you planning to cook for a lot of people or just you and one or two others? The answer there may mean you go with two burners or one. Are you planning to travel around with your grill or will it stay put? That answer tells you if you need portability or something more stable.
Do you have an expansive backyard or will you be grilling off the small patio outside your apartment? That'll let you know if you're looking at size restrictions or not.
Put all that together, and you've got a good idea what type of gas grill you need.
3. Decide if You're a Brand Guy
Most of us can name a few grill brands off the tops of our head. If you know a brand you like (maybe one that others you know has really performed), then sticking with that brand can save you a big headache choosing between too many options.
If you browse the grills above, some names are going to stick out and some may seem less familiar. Don't just get a grill because the brand is famous; get it because that brand means something to you. If you know the product lives up to its reputation, buy away.
Otherwise, if you're free of any brand preference, that opens your options up a bit more, which means you should just spend a little more time refining your preferences in Step 2 and Step 4.
4. Look for Those Extra Features
If you still have a few gas grills in mind, use the extra features as a tie breaker. If one of them has a bit of tech that tells you right when your meat's done, take that one. If one of them makes it easier to store your propane, go with that.
A lot of the best gas grills add these kinds of features just for this sort of situation, so take advantage and decide on your favorite goodies.
More Awesome Grill Buying Guide
Does gas get a pass in your household? No worries. We've got all the best grill options out there, no matter what kind of grill you need, just check these articles out:
- Join the cool kids with the best charcoal grills and enjoy all that smoky barbecue deliciousness.
- Find the best indoor grills and get all the advantages of the grilling experience and none of the consequences of braving the weather.
- Struggling to choose between charcoal and gas? Get the best of both when you purchase the best pellet grill.
In Conclusion
All the best grills out there promise the same thing: a quality cooking experience and all that great grilling flavor.
Once you get beyond the advertising, though, you'll find that each of the best gas grills out there has a little something that makes it one of the best for its own particular reason.
So, use the lists above, and find that grill that is the best gas grill for you, and then, fire it up!


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Welcome to Casa Rural Girona your ONLY ADULTS Rural Tourism in La Garrotxa
Rural House Girona Rural Tourism Garrotxa cal Carreter ONLY ADULTS
Welcome to our website. We put at your disposal our facilities, our kitchen and all our potential to enjoy a stay with us.
Our country house distributed over three floors. On the ground floor we have a large living room with direct access to the general was of the house and a quadruple room with two bedrooms with private living room with bathroom. Both the first and second floor, There is a living room and two bedrooms with bathroom. The maximum capacity of accommodation Casa Rural Cal Carreter Tourism Garrotxa It is 12 people.
L' equipment of Cal Carreter ONLY ADULTS we want to taste and for this reason we take care of the small details in everything around you in the accommodation you choose.
A Cal Carreter we have a large garden with playground, wood furniture, barbecue, pergola. You can also share our private pool. All accommodation has bed linen and towels.
We take care of your stay with suggestions of our natural environment and different areas to ensure that we have created different activities and formats according to your profile without forgetting the stove cooking healthy identifying our Rural Tourism in Girona.
Welcome to our website, Welcome to your home.
We are here to serve you.
Rural House in Girona Cal Carreter – Garrotxa
Flights must know Carter?
The different spaces Rural Rural Tourism Carreter Cal Garrotxa are the reasons of interest that you can adapt to your tastes or needs more. We offer specific products based on our Rural Tourism to approach the maximum information that can be useful.Meet our spaces and enjoy the Garrotxa
Hiking in the Garrotxa
space cyclist


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PLANNER TAIL or BOOKMARK LILY BOW Vanilla Creme Bow x Tan Leopard furry bead
This listing is for 1 MINI BOW Vanilla Creme Bow Planner Tail or Bookmark. This bow is handmade from faux leather material with an imprinted design and features beautifully coordinated beads on the opposite side as pictured. This is only available in gold hardware due to the furry leopard print bead having a gold drop.
Please see the following details regarding length selections below: •••••Planner Tail Length••••• This is a shorter length intended to tie or loop around the rings, discs or coil of your planner •••••Bookmark Lengths Based on the following insert Measurements•••• Micro: 4" Pocket (TN): 4.7" A6: 5.75" Personal: 6.75" B6: 7" Hobo/PPWeeks: 7.4" A5: 8.3" •••••Custom Length Bookmark••••• You MUST specify in the notes to seller the height of the book/insert page you will use the bookmark in. This will help me determine length needed to accommodate the beads & bow Each clip & charm is carefully handmade & slight variations will occur! I do my best to capture the true color of all items by photographing in natural light and not applying filters! Screen resolution settings may adjust actual color to display on your device. Check additional shop listings for coordinating goodies!


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FOG - For Good
- by Brian Lange. Release Date:2016-05-19 Label: Totally Gross National Product
Previous to this year's release of For Good, Fog had consistently put out work until a hiatus around 2007 brought on a side-project, Clock Ox. Andrew Broder, Minneapolis-based founder and songwriter for Fog raised $17,161 on Kickstarter from 324 backers in two months to raise money for the first Fog album in nine years, titled For Good.
Weird, droney, trippy, soothing, melodical, menacing, angelic, and most certainly experimental are just a few adjectives apropos for the Fog sound. Combining both traditionally performed instruments and turntable-derived samples, Fog is predominantly produced and performed by Broder himself, with exception to a brief three-piece setup on the outer cusp of Fog's original run.
While the record does delve into dark areas about halfway through, the initial tracks are rather fluttery with a tenor-focused voice. Perhaps this progression into a darker and deeper mood is intentional, as the tones shift into more of a bassy-baritone.
The DIY nature of the recordings definitely lends itself to a particular sound. That is not to imply it sounds cheap or amateur. The music is quite sophisticated, with intricate layers and depth. 'Sister Still' is a prime example of Broder's ability to shape and form trip-hop atmospheres that could easily stand right alongside the likes of Massive Attack.
Broder has released the song 'Trying' as the first glimpse into the record; there's an accompanying video that can be found on YouTube that is really something remarkable, a good sell on the album for fans of genre's weird and dark, but perhaps not the best representation of the record as a whole. It is fair to say that, if you enjoy this track, the album as a whole will likely appeal to you.


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Serie A: Inter Milan seek to return to winning ways against Cagliari after Champions League exit
Antonio Conte's side are second in Serie A, five points behind leaders AC Milan, with the two city rivals trying to deny Juventus a 10th consecutive league title.
Milan: Inter Milan turn their focus back to Serie A after their Champions League flop with a trip to Cagliari awaiting on Sunday following their group stage exit midweek.
"There's no time to sit and mope," warned captain Samir Handanovic with his side out of Europe after finishing bottom of their Champions League group.
Antonio Conte's side are second in Serie A, five points behind leaders AC Milan, with the two city rivals trying to deny Juventus a 10th consecutive league title.
"We have to focus on the league and the Coppa Italia," urged Handanovic.
In his second campaign, Conte now has no choice but to deliver a 19th 'Scudetto' to Inter and first since 2010.
The former Juventus and Chelsea manager took Inter to second in Serie A and the Europa League final in his first season.
A third consecutive group stage exit was a shock for Conte's expensively-assembled side, who are the top scorers domestically with 26 goals in 10 games.
Inter have spent nearly 300 million euros ($363 million) in the past two years on new signings and their exit from Europe will hit hard.
"There's a lot of regret," said Conte.
"We haven't had much luck in the Champions League given certain incidents and refereeing decisions."
AC Milan are riding high as they also target a 19th Scudetto and first since 2011.
Top scorer Zlatan Ibrahimovic could return against Parma after a muscle injury ruled him out of their last two league games.
Juventus, Lazio and Atalanta return to league action having all secured their passes to the Champions League knockout rounds.
Juventus, six points behind Milan in fourth, travel to lowly Genoa after their confidence-boosting 3-0 win at troubled Barcelona in which Cristiano Ronaldo scored twice.
"Playing like this, we have nothing to fear until the end of the season," the triumphant Portugal captain said after the game.
Seventh-placed Lazio host Hellas Verona, who are just one point behind the Roman club, with Atalanta, in ninth, hosting Fiorentina.
Tuscan side Fiorentina are hovering above the relegation zone and hoping for a first win since October 25 against Atalanta, who have taken just five points in their last six games.
Third-placed Napoli, looking for a first win in their newly-named Stadio Diego Armando Maradona, host Sampdoria.
Gennaro Gattuso's side are six points behind Milan, having scored eight goals in their last two games against Roma and Crotone.
Sassuolo host Benevento on Friday looking to regain some of their early momentum, having dropped to fifth in the table as Roma head to Bologna just a point behind Roberto De Zerbi's flamboyant side.
One to watch: Josip Ilicic
Atalanta's Josip Ilicic chases his first league goal this sesaon against former club Fiorentina.
The 32-year-old was out for two months with personal problems after the coronvirus lockdown, but got his first goal in the Champions League win over Liverpool two weeks ago.
Illcic played 105 matches with Fiorentina in Serie A between 2013 and 2017, before joining Atalanta where he had his best season last campaign with 15 league goals.
Key stats
26 - Inter Milan's league goals
16 - Points between AC Milan and Parma
5 - AC Milan's Serie A lead
1 - Juventus away wins in the league
1 - Lazio and Atalanta's home wins this season
Fixtures (all times GMT)
Sassuolo v Benevento (1945)
Crotone v Spezia (1400), Torino v Udinese (1700), Lazio v Hellas Verona (1945)
Cagliari v Inter Milan (1130), Atalanta v Fiorentina (1400), Napoli v Sampdoria (1400), Bologna v Roma (1400), Genoa v Juventus (1700), AC Milan v Parma (19h45)


text:
Lensea Technology has been in the forefront of technelogical change for 20 years. From the birth of the PC, we have been building custom software for our clientel, at a cost effective price, and on time.
As technology has changed, so has the focus at Lensea Technology. We are proud to have the ability to create custom Desktop, Web and mobile applications, as well as hardware and software support.


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Andy Murray's participation in the Australian Open has been thrown into doubt after it was revealed on Thursday he had tested positive for coronavirus.
The British former world number one was due to travel to Australia on one of a series of charter flights laid on by tournament organisers but is still isolating at home in London.
It is understood that Murray, apparently in good health, is hoping to be able to arrive in Australia at a later date.
Australian Open organisers wished the 33-year-old a speedy recovery but it was unclear whether he would still have a chance to take part.
"Andy Murray has advised that he has tested positive to Covid-19 and is isolating at home in the UK," they tweeted.
"Unfortunately this means he will be unable to join the official AO charter flights arriving in Australia in the coming days to go through the quarantine period with the other players.
"The AO fans love Andy, and we know how much he loves competing here in Melbourne and how hard he'd worked for this opportunity."
The five-time Australian Open runner-up pulled out of last week's ATP event in Delray Beach, Florida, as he wanted to "minimise the risks" in the run-up to the year's first Grand Slam.
Murray, who has slumped to 123rd in the world rankings, was handed a wildcard for the Australian Open which starts on February 8, three weeks later than normal.
The three-time major winner is hoping to make his first appearance in Melbourne since the emotional events of 2019, when he revealed the extent of his right hip problem and raised the possibility of imminent retirement.
– Keys also positive –
Murray was able to return to playing after a hip resurfacing operation but has experienced several setbacks since.
The Scot was able to play just seven official matches in 2020 because of a lingering pelvic injury, and the coronavirus-enforced suspension of the season.
More than 1,200 players and support staff are arriving in Australia from Thursday for 14 days' quarantine.
Craig Tiley, the Australian Open tournament director, has spent months trying to deal with the logistical nightmares of hosting the Grand Slam during a pandemic.
Tennis Australia said players were only allowed into the country with proof of a negative Covid-19 test prior to departure, or with approval as a recovered case at the discretion of the Australian government.
In another blow, American world number 16 and former US Open runner-up Madison Keys said she too had tested positive for Covid-19.
"I am very disappointed not to be able to play in the coming weeks after training hard in the off-season and knowing Tennis Australia and the tours did so much to make these events happen," said the 25-year-old.
"I am self-isolating at home. I look forward to being back on tour next month."
Keys made the semi-finals of the Australian Open in 2015
On Wednesday, Rafael Nadal's coach Carlos Moya said he will not attend the Australian Open due to coronavirus travel restrictions.
Nadal is aiming to clinch a 21st major title in Melbourne, which would put him ahead of Roger Federer's 20 as the most successful men's player of all time.
Meanwhile, world number three and US Open champion Dominic Thiem has had to travel to Australia without his coach Nicolas Massu who also tested positive for coronavirus.
Earlier Thursday, tennis chiefs insisted America's Tennys Sandgren was not a coronavirus risk after he sparked a flurry of concern by tweeting he'd boarded a flight for the Australian Open despite testing positive.
The world number 50 sent out a series of tweets before his departure from Los Angeles, initially saying he tested positive on Monday and would miss his flight.
It was his second positive result, having originally been diagnosed with Covid-19 in November.
But an hour later he said: "Wow I'm on the plane. Maybe I just held my breath too long. Craig Tiley is a wizard."
Tennis Australia said: "In the case of Tennys Sandgren, who has self-disclosed that he previously tested positive in late November, his medical file had to be reviewed by Victorian health authorities.
"Upon completion of that review he was cleared to fly."
Murray's Australian Open participation in doubt after positive virus test The British Journal Editors and Wire Services/ France 24.


text: Rebirth. Every now and then, you have an opportunity to take something from good to great. After two years and hundreds of user-created mosaics, it's time to step up our game. A new system of MosaicStudio software is currently in the works. More power. More devices. More features. Less hassle. In the meantime, get in touch if you'd like to commission a custom photo mosaic or partner with us. Email email@example.com for more information.


text:
How to crochet the Moss Stitch!!
- red heart with love yarn
*for the yarn visit www.redheart.com
-6.5 mm crochet hook
This pattern works with any odd number of stitches
For this sample start with chain 31.
Row 1: 1sc into the 3rd chain form hook, *chain 1, skip 1, 1sc into the next* repeat from * to * across.
Row 2: chain 2, turn, 1sc into the 1st chain-space, *chain 1, skip next sc, 1sc into the next chain-space*, repeat from * to * across.
Repeat row 2 for the pattern


text:
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text:
How did Tennessee's candidates for governor answer 3 key questions?
Five candidates for governor met Tuesday for a gubernatorial forum on education. Here are their answers to three key questions.
The State Collaborative on Reforming Education (SCORE), Belmont University, the USA TODAY NETWORK – Tennessee and the NewsChannel5 Network hosted the forum. It was held at Belmont's Curb Event Center.
Do they support in-state college tuition for students like Dreamers, who were brought to the U.S. as children and are in the country illegally?
Republican Randy Boyd: "In-state tuition is for people here lawfully. No."
Democrat Karl Dean: Yes. "They're Tennesseans. They're part of our community."
Democratic state Rep. Craig Fitzhugh: I'm the only person on this panel that has voted to do that, and I would vote to do that again."
Republican Tennessee House Speaker Beth Harwell: "I would not support it."
Republican Bill Lee: "My responsibility as governor is taking care of the people of Tennessee. It's not fair that we would offer something to an immigrant here illegally that we wouldn't offer to a citizen" of another state.
Do they support the expansion of the state's pre-K program?
Boyd: "We need to find the programs that work well and duplicate those."
Dean: He would like to see pre-K statewide and "available in all school systems."
Fitzhugh: "Under Gov. Haslam's leadership we have moved pre-K where it needs to go and I would like to see it ultimately for every single child."
Harwell: She cited "mixed results" of existing programs, wants to lean on nurturing high-quality options.
Lee: "Strong pre-K programs move the needle." He wants to "make certain that the program that we currently have is quality, and we should move on that first."
Did they send their children to public schools?
Boyd: He went to public school. His older son went to public and private schools, and his younger son went to private school.
More:After deadly school shooting in Kentucky, Tennessee gubernatorial candidates discuss safety
Dean: He went to public schools but his kids attended private schools. "We made that decision as a family."
Fitzhugh: His son and his daughter went to public school and his school-age grandchildren do too.
Harwell: "I chose to send my children to private schools here in Nashville. Now, they are in public colleges throughout the nation."
Lee: "My children were homeschooled and went to public school and private school. For me, it's not so much about the kind of school a kid goes to as it is the quality of the education they receive."


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The Root of the Behavior
There are some more dominant breeds that according to various trainers and behavioral therapists will lean on you to show their dominance. By leaning on you, the dog is invading your space as well as claiming you as his territory. Breeds such as the Perro de Presa Canario, Boerboel, American Bulldog, Husky, Bull Mastiff, Alano Espanol, Groenendael, Schanuzer, Koolie, Griffin, Irish Terrier, and Chesapeake Bay Retriever are all known to have a slightly dominating alpha personality. A dog that is more of an alpha breed, or just tends to run more alpha than most, may be leaning on you to remind you who is boss. However, it is more often believed that a dog leans on you to make a connection or for actual physical support. While the Berner can fall into the guard dog grouping, he is rarely an alpha. As a pack animal, he simply likes to be with his pack and you are his home and happy place. There is a greater chance he is leaning into you for security purposes, to remind himself that you are with him. It is also proven that a dog releases 'feel good' brain chemicals when he is in the presence of his beloved owner. Many believe that dogs have learned that physical contact feels good, and that in leaning into you he is strengthening his bond.
Encouraging the Behavior
Berners are sensitive and cannot handle a harsh word or reprimand. Admonishing him will not only hurt his feelings but will also reinforce the lean in behavior. By ignoring the behavior and then praising him for a different and more desirable behavior, you are teaching him that you are the boss. But again, as he is not an 'alpha type breed,' if you sense he is leaning in to bond and be close you can take different measures if you wish to have the behavior removed or changed. Similar to if he is trying to dominate, as he approaches stop him but turn towards him and command him to sit and stay. Then reward and praise him for obeying and lavish your love and affection. You are teaching him to come to you for affection, but to respect your boundaries. This is especially important if he is leaning on children or elderly and is causing them to fall over. All of your commands need to be gentle and loving, and you must remain consistent, as the one time you let him lean will be all it takes to re-establish the unwanted behavior.


text:
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Think Green - Biodegradable Ultra Fine Glitter
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TrackOFF Standard 18.104.22.16867 Multilingual
This post was published 3 years ago. Download links are most likely obsolete.
If that's the case, try asking the author to reupload.
Languages: Multilingual | File Size: 71.3 MB
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text: THE WAYANG KIDS is about a group of primary school children overcoming cultural and language barriers to represent their school in an international Chinese opera performance. Leading the team is a student with mild autism who has to convince his classmates, teachers and parents and ultimately himself that he deserves a role in the performance. With the support of his classmates from a very diverse background, he must show his courage and perseverance to step up and shine on stage.


text:
Yes, that was my first thought when I read about the #SundaySupper challenge this week. Five ingredients or less…. but salt, pepper, and water don't count as an ingredient. (gee, thanks!) As I started to ponder the dishes I could prepare, my mind immediately flashed to kugel.
For those of you that have enjoyed a good kugel, you know that there are many, many types of kugel. (generally, kugels are classified into one of two categories– either sweet or savory) And for each type of kugel, there are about a thousand variations on that type. Also, everyone swears that their kugel is "the" kugel recipe, so you can take it with a big grain of kosher salt when I tell you that my potato kugel recipe is "the" potato kugel recipe.
- 4 large russet potatoes
- 1 large yellow onion
- 3 eggs
- 2 Tbsp flour (can substitute matzah meal during passover)
- 1/4 cup vegetable oil, plus oil for the baking dish
- 1 tsp Kosher salt and 1/2 tsp black pepper (my "free" ingredients)
Preheat oven to 350 degrees. Peel the potatoes and grate them using a food processor. (you can grate them by hand, but a food processor is much easier!) Then, remove the skin from the onion and grate that as well. Place the potato and onion mixture into a large bowl and allow to rest for about 5 minutes. Meanwhile, in a small bowl, lightly beat the eggs. Add the 1/4 cup of vegetable oil to the eggs and mix lightly. Add the flour, 1 generous tsp of Kosher salt, and 1/2 tsp black pepper to the egg/oil mixture and combine. The mixture will be lumpy, but don't worry about that. Set the mixture aside.
Take a 13×9 inch glass baking pan and pour enough vegetable oil on the bottom of it to lightly coat the entire bottom of the pan. This is not just for "greasing" the pan, but this will help to cook and brown the outside of the kugel. Place that pan in the pre-heated oven to heat up the oil.
Now, return back to the large bowl of potatoes and onion, and drain the liquid out from the bowl. Press on the potatoes and onions to try and squeeze and drain as much of the water out of the mixture that you can. (This is very important otherwise you'll have an extremely soggy kugel! No one likes a soggy kugel.) When you've drained out as much water as you can, pour the egg mixture into the large potato/onion bowl and mix until combined.
Remove the pre-heated, oiled pan out from the oven and CAREFULLY spoon the potato mixture into the hot pan. This is the most "dangerous" part of the process because the hot oil can splatter and burn if you're not careful. Also, you'll want to make sure that your potato mixture is not "cold" because you don't want your hot, glass pan to crack. I've never had this happen, but I'm very cautious with how I perform this step.
Put the kugel back in to the oven and increase the temperature to 400 degrees. Cook for 1 hour or until the top of the kugel is golden brown.
Make sure to check out the rest of the #SundaySupper recipes. They all feature 5 or Less ingredients! For a bunch of Foodies, this is quite an accomplishment.
Breakfast, Starters, Butters and Jams:
Pa Jun or Korean Scallion Pancakes – Kimchi Mom
Homemade Instant Oatmeal – Home Cooking Memories
GlutenFree Apricot Bacon Onion and Cheese Spread or Dip – Cooking Underwriter
Caprese Bites – My Catholic Kitchen
So Simple Pizza Puffs – Hip Foodie Mom
Toast Topper #11: Allspice Peach Butter – What Smells So Good?
Strawberry Balsamic Jam – The Messy Baker Blog
Broccoli and Feta Frittata – Kwistin's Favorites
Main Dishes:
Fresh Basil and Tomato Pasta – I Run For Wine
Gulasch – Galactosemia in PDX
Spaghetti with Kale and Sausage – Dinners, Dishes and Desserts
Appley Kielbasa – The Meltaways
Shrimp Stuffed Potatoes – Juanita's Cocina
Hawaiian Chicken Sandwiches – Supper for a Steal
Sun Dried Tomato and Sausage Pasta – Small Wallet Big Appetite
Pork Loin with Port Shallot Sauce – Vintage Kitchen Notes
Chipotle Honey Lime Pork Tenderloin – Hezzi-D's Books and Cooks
Crockpot Chicken Tacos – The Hand That Rocks The Ladle
Roasted Shrimp With Chili-Lime Sauce – Magnolia Days
Peanut Butter Noodles – In the Kitchen with Audrey
Soy, Orange Juice and Red Wine Marinated Flank – That Skinny Chick Can Bake
Beef Tenderloin with Stilton Pecan Butter – Noshing With The Nolands
Herbed Butter Pork Chops – Brie's Bites
Creamy Ham Linguine – The Daily Dish Recipes
Pesto, Tomato & Feta Pizza – Momma's Meals
Quick Black Bean Burritos – Diabetic Foodie
Lumachine with Fresh Parmesan and Sun-Dried Tomato Sauce – Mama's Blissful Bites
Stuffed Shells – Cravings of a Lunatic
Potato Kugel – From Fast Food to Fresh Food
Garlic Butter Fried Rice – My Trials in the Kitchen
Goat Cheese Alfredo – Family Foodie
Roasted Moroccan Rack of Lamb – Maroc Mama
Sweet and Nutty Twice Baked Sweet Potatoes – Mama.Mommy.Mom.
Baked Sweet Potato with Maple-Jalapeno – Comfy Cuisine
Freezable Bacon Egg and Cheese Sandwiches – Big Bear's Wife
Grilled Polenta Cakes – Lovely Pantry
Nutella Ice Cream – Shockingly Delicious
Fresh Mint Ice Cream with Mint M&M's – The Girl in the Little Red Kitchen
Grilled Mango Parfait with Greek Yogurt & Silvered Almonds – Sue's Nutrition Buzz
Honey Macaroons – Pippis In the Kitchen Again
Strawberry Frozen Yogurt – Damn Delicious
Homemade Caramel Sauce – Chocolate Moosey
Easy Chocolate Chilli Fudge – Soni's Food for Thought
White-Chocolate Raspberry Puff Pastry Doughnuts – The Weekend Gourmet
Easy No Bake Peanut Butter Chocolate Bars – In The Kitchen With KP
Chocolate-Caramel Ice Cream – Basic N Delicious
Pumpkin and Chocolate Swirl Cheesecake – Baker Street
Peanut Butter Cup Popcorn – Mom's Test Kitchen
Five Most Food Friendly Wines – ENOFYLZ Wine Blog
Please be sure you join us on Twitter throughout the day during #SundaySupper. We'll be meeting up at 6:00 pm (Central) for our weekly #SundaySupper live chat where we'll talk about our favorite 5 Ingredient Recipes! All you have to do is follow the #SundaySupper hashtag, or you can follow us through TweetChat! We'd also love to feature your recipes on our #SundaySupper Pinterest board and share them with all of our followers. See you then!


text:
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text:
From several sources on Facebook (but ultimately from the Oatmeal webcomic), this item:
This is accent taking in all aspects of a variety of a language, not just the phonological aspects. In this case, phonology is barely involved (though you can imagine some of it, using stereotypes of upper-class British pronunciation)): it's all about lexical choices, register/style, and conversational topic (leaning heavily towards the sexual) — obscure, perhaps archaic, and pompously rakish.
(This is another case in which I don't really know whether the item is to be classified as a cartoon, or what.)


text:
The Emerging Challenge and Perspective of Entrepreneurs in Bangladesh -By Md. Saifullah
Today, with the rapid development of our society, entrepreneurship has become one of the most dynamic forces in the economy. It is driving the technological boom, which in its turn is driving much of the world's economic growth. This aspect makes entrepreneurship very important from macro-economic perspective. As the globalization of business becomes even more widespread, this impact will be felt even more deeply. The scope of what entrepreneurship involves, will continue to change and evolve because environment in which entrepreneurship operates, is constantly changing and evolving too.
Many of us have dreams of working for ourselves or becoming entrepreneurs. While this can be a great way to create the lifestyle you want, the reality is that entrepreneurship isn't for everyone. Successful entrepreneurship takes dedication and work, and there are challenges and sacrifices that many business owners face, especially at the beginning of the journey.
To be a successful entrepreneur one requires a great deal of resourcefulness, because as an entrepreneur, the person often runs into dead ends throughout the course of his or her career. Each and every person is born as an entrepreneur but successful entrepreneurs have the guts to take a calculated risk, have the leadership skill and the tenacity and persistence to keep going even when there are bumps in the road. Some experts might say it needs to be born with characteristics of an entrepreneur but in real anyone can become an entrepreneur. The person only needs to be brave enough to believe in him and be passionate his or her dreams. Successful entrepreneurship is the ability of looking at the bigger picture, look for an opportunity to make someone's life better, fix a vision to, and continually test assumptions. An entrepreneur has to be people-oriented. One cannot build a business on his own. An entrepreneur doesn't need a certificate to start up the journey. For instance, Steve Jobs, Bill Gates, and Mark Zuckerberg were in college when they started Apple, Microsoft and Facebook respectively. What an entrepreneur needs is a great idea and the courage accepts the challenges to execute that idea.
An entrepreneur must live a life of a gambler. In this ultra modern world entrepreneurs face many challenges to be successful. The very first challenge that a new entrepreneur faces is capital arrangement, which seems to be the ever existing challenge for all entrepreneurs. Once capital is arranged more challenges start knocking at the door. The most possible challenges can be hiring talents, marketing strategy, business growth, overcoming bureaucracy, self doubt and of all competition.
Now let's look at the picture of entrepreneurs of Bangladesh. A many current research on entrepreneurship reported that 70% of Bangladeshi students want to become an entrepreneur after completing their graduation. In fact most of the youth that are determined to be entrepreneurs doesn't wait till graduation to start up their business. In their student life whether they are in college or university even in school they start planning for their business and eventually step by step approach to their goals. Though it's good news for the economy of the country but as we know every coin has two sides. The youth of our country that start their businesses with their great idea and the enthusiasm of winning the world, very few of them in real get to survive let alone reaching the top. Why, what is the reason behind this scenario. Let's find out.
A wide range of literatures stated that carried out among 1,270 young people in Bangladesh who have at least one university degree, more than 42% participants reported the lack of fund as the major reason for not being able to start a venture. In Bangladesh funding is a big challenge for entrepreneurs in comparison to other developed country. Although an only a small funding determines the success of a venture according to various successful entrepreneurs but this small funding has become a great obstacle for entrepreneurs of our country. According to Transparency International's 2017 Corruption Perception Index ranks Bangladesh ranks 143rd place out of 180 countries, which explain the next big challenge for the entrepreneurs which is corruption. In addition, judicial system, police, public service, land administration, tax administration, custom administration, public procurement, civil society in short almost in every sector one has to offer money or valuable bribe regardless the person is willing to give or not. The youth tend to be ethical which result in giving up most entrepreneurs to try since we are a corrupted country.
The society that we are in is full of people that are mostly corrupted, demotivating, unethical, people who use their power to suppress others specially the youth in short people who are educated illiterate. Let alone supporting, our society rebuke, mocks, and torment when someone falls. It is nearly a deadly challenge to rise towards success living among these people. That's where entrepreneurs find it difficult to continue when they face these obstacles. And we all know what happens next, one coerce to leave behind all his dreams.
There is another thing that needs to put in attention is the perspective of the consumers more to say our people. The mentality of giving priority to foreign products, the thinking that the products of other countries is always better is a big challenge for entrepreneurs who want to produce a new product. Changing a mentality is indeed a greater challenge than overcoming other challenges that are mentioned. Last but not in the list Bangladesh was ranked 177 positions among 190 ease of doing business according to the World Bank (2017), this is an another challenge and a great discouragement for the new entrepreneurs of Bangladesh.
Living in a country like Bangladesh and dream to be an entrepreneur might seem a big challenge but if you are dreaming to an entrepreneur no matter you are in, challenges are ever present. Yes the challenges in Bangladesh tend to be more but the life of an entrepreneur cannot be boring without challenges. One has to be optimistic enough to believe in himself, aware enough to see problems around them, stubborn enough to keep going, and bold enough to act again and again.
The writer studies at the United International University School of Business and Economics, Bangladesh.
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Statistically significant differences were observed in mortality, complication, ostomy, and routine discharge rates between laparoscopic colectomy and open colectomy.
eTable. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Codes
eFigure. Estimated National RC Case Number by Year_Quarter
Customize your JAMA Network experience by selecting one or more topics from the list below.
Juo Y, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N. Is Minimally Invasive Colon Resection Better Than Traditional Approaches? First Comprehensive National Examination With Propensity Score Matching. JAMA Surg. 2014;149(2):177–184. doi:10.1001/jamasurg.2013.3660
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Minimally invasive colectomies are increasingly popular options for colon resection.
To compare the perioperative outcomes and costs of robot-assisted colectomy (RC), laparoscopic colectomy (LC), and open colectomy (OC).
Design, Setting, and Participants
The US Nationwide Inpatient Sample database was used to examine outcomes and costs before and after propensity score matching across the 3 surgical approaches. This study involved a sample of US hospital discharges from 2008 to 2010 and all patients 21 years of age or older who underwent elective colectomy.
Main Outcomes and Measures
In-hospital mortality, complications, ostomy rates, conversion to open procedure, length of stay, discharge disposition, and cost.
Of the 244 129 colectomies performed during the study period, 126 284 (51.7%) were OCs, 116 261 (47.6%) were LCs, and 1584 (0.6%) were RCs. In comparison with OC, LC was associated with a lower mortality rate (0.4% vs 2.0%), lower complication rate (19.8% vs 33.2%), lower ostomy rate (3.5 vs 13.0%), shorter median length of stay (4 vs 6 days), a higher routine discharge rate (86.1% vs 68.4%), and lower overall cost than OC ($11 742 vs $13 666) (all P < .05). Comparison between RC and LC showed no significant differences with respect to in-hospital mortality (0.0% vs 0.7%), complication rates (14.7% vs 18.5%), ostomy rates (3.0% vs 5.1%), conversions to open procedure (5.7% vs 9.9%), and routine discharge rates (88.7% vs 88.5%) (all P > .05). However, RC incurred a higher overall hospitalization cost than LC ($14 847 vs $11 966, P < .001).
Conclusions and Relevance
In this nationwide comparison of minimally invasive approaches for colon resection, LC demonstrated favorable clinical outcomes and lower cost than OC. Robot-assisted colectomy was equivalent in most clinical outcomes to LC but incurred a higher cost.
The application of minimally invasive procedures in colorectal surgery has been rapidly gaining acceptance.1 Laparoscopic colectomy (LC) has been shown by single-institution studies to be associated with equivalent or superior clinical outcomes in comparison with open colectomy (OC).2-5Quiz Ref IDOwing to the shortened length of stay (LOS) and decreased complication rate, LC was also associated with lower overall cost.2 However, the introduction of the laparoscopic surgical approach also highlights drawbacks such as loss of 3-dimensional view, long instruments that amplify physiologic tremors, and loss of dexterity and ergonomic discomfort for the surgeon.6 These factors may contribute to technical difficulty with the laparoscopic procedure as well as a long learning curve.7
Robot-assisted surgery could be considered an advancement of laparoscopic surgery because it aims to minimize these technical challenges with the use of robotic arms and a separate operating console.8-10 However, robot-assisted surgery has gained acceptance at a slower pace in colorectal surgery.11,12 Past research studies have focused mainly on robot-assisted total mesorectal excision for rectal cancers.12-14 To our knowledge, only limited published data exist on robot-assisted colectomies (RCs). They mainly consist of single-institution early outcome reports15-19 and retrospective comparative studies on RCs.20-22 These early results have demonstrated that RC, while being equivalent in safety and feasibility, usually incurs a higher cost, even beyond the initial purchase of the robot.
To our knowledge, this is the first comprehensive national study of minimally invasive approaches for colon resection. We reviewed the current use pattern of the 3 approaches for colectomies—open, laparoscopic, and robotic—and performed a comparative analysis of their outcomes and costs using propensity score matching.
A sample of adult patients (aged ≥21 years) who underwent elective colectomies from October 1, 2008, to December 31, 2010, across the nation was identified using the US Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). The NIS included a 20% stratified probability sample of inpatient discharge data from approximately 1040 hospitals in 44 states.
We extracted patients with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for OC or LC as shown in the eTable (Supplement). Quiz Ref IDPatients with rectal resection were not included owing to lack of separate coding of laparoscopic and open procedures in ICD-9 classification. Patients with distant metastases were also excluded for preservation of cohort homogeneity. Beginning October 1, 2008, the robot-assisted modifier code (ICD-9-CM 17.42) was used to identify robot-assisted laparoscopic procedures. Minimally invasive procedures that were later converted to open procedures were identified with the ICD-9 diagnosis code V64.41 and categorized under their original procedure. Patients admitted for nonelective procedures were excluded.
Patient characteristics included age, sex, race/ethnicity, surgical indication, median household income, and primary health care payer. The Charlson Comorbidity Index,23 a prognostic measure calculated from the presence or absence of several comorbid conditions using a weighted formula, was used as a measure of comorbidity burden at the time of surgery. Patients with missing data on sex or race/ethnicity were excluded from the analysis. Surgical indications were inferred using ICD-9-CM diagnostic codes as shown in the eTable (Supplement).
Hospital characteristics included hospital size, teaching status, location, and case volume. Hospital size, defined by the NIS database using the number of inpatient beds, was categorized into small, medium, and large. Hospital case volume was calculated as the total number of colectomies performed per hospital per year and analyzed in tertiles. Hospitals with missing values for the described characteristics were excluded.
This study was deemed exempt from review by the Johns Hopkins Medicine institutional review board. Written informed consent from patients was waived as this was a secondary data analysis using deidentified data.
The primary outcome was in-hospital mortality. Secondary outcomes included complication rates, ostomy rates, LOS, discharge disposition, overall hospitalization cost, and cost per hospitalization day. Discharge disposition was categorized as (1) routine discharge; (2) transfer to other health care facility including short-term hospital, skilled nursing facility, intermediate care, or other type of facility; and (3) other including home health care or discharge against medical advice. Overall hospitalization cost24 was estimated by multiplying total hospital charges (adjusted for inflation to reflect 2010 US dollars) by hospital-specific cost-to-charge ratios and reweighted to account for the hospitals where the cost-to-charge ratio was not available. To adjust for the influence of LOS on cost, cost per hospitalization day was calculated as overall cost divided by LOS. For robot-assisted and laparoscopic procedures, conversion to open procedure was examined as an additional outcome variable. Complications were identified using ICD-9-CM diagnostic codes for perioperative complications25 for each major organ system. Ostomy rates, conversion to open procedure, and transfusion were identified using ICD-9-CM procedure codes (eTable in Supplement).
National estimates were calculated using stratification, clustering, and survey weights in accordance with the NIS sampling design. Subtracted data were stratified by procedure type: RC, LC, and OC. For continuous variables such as age, LOS, and cost, values were presented as medians accompanied by interquartile ranges. For categorical variables, including sex, race/ethnicity, Charlson Comorbidity Index score, surgical indication, median household income, primary health care payer, hospital size, teaching status, hospital location, and national estimates of patients, number along with the corresponding percentage within each procedure were presented. The Pearson χ2 test was used to assess categorical variables, and the Mann-Whitney U test was used to assess continuous variables.
Outcome variables were examined by procedure type and included in-hospital mortality, complication rates, ostomy rate, LOS, discharge disposition, and hospitalization cost. Owing to differences between patient cohorts who underwent each respective procedure, we relied on propensity score matching to adjust for those differences.26 Two separate comparisons were performed: LC vs OC and RC vs LC. In each comparison, only patients from hospitals where both procedures were performed were included for analysis. Propensity scores were assigned for each patient based on multivariate logistic regression using both patient characteristics (ie, age, sex, race/ethnicity, Charlson Comorbidity Index score, surgical indication, median household income, primary health care payer, and resection type) and hospital characteristics (ie, size, teaching status, location, region, and case volume). The assignment was repeated twice for comparison between LC and OC and between RC and LC, and the balance of score distribution between groups was checked. We performed 1:1 fixed ratio nearest neighbor matching with replacement between LC and OC and between RC and LC. The 1:1 ratio was chosen to minimize bias without sacrificing too much power in accordance with recommendations from previous literature.27 As a measure of sensitivity analysis, exact matching between RC and LC using patient characteristics, including age (in bins of 10 years), sex, race/ethnicity, surgical indication, and Charlson Comorbidity Index score, was also performed to examine the aforementioned outcomes and cost variables. All tests were 2-sided, with the significance level set at α = .05. All data transformation and statistical analyses were performed using Stata version 12.1 (StataCorp).
Between October 2008 and December 2010, there were 48 237 elective colectomies in the NIS database that fit our inclusion criteria, representing 244 129 colectomies across the nation after incorporating NIS survey weights. Patient and hospital baseline characteristics are summarized in Table 1. The median patient age was 64 years. Patients who underwent colectomy were more likely to be female (n = 133 307 [54.6%]) and white (n = 201 089 [82.4%]). Most cases were right hemicolectomies (n = 90 838 [37.2%]) and sigmoidectomies (n = 90 171 [36.9%]). The remainder were left hemicolectomies (n = 24 423 [10.0%]), transverse colon resections (n = 11 001 [4.5%]), cecectomies (n = 8913 [3.7%]), and other types of resections (n = 17 291 [7.1%]) and were grouped together as others for subsequent analysis. The 3 most common indications for colectomy were colon cancer (n = 81 423 [33.5%]), diverticular disease (n = 77 900 [32.1%]), and inflammatory bowel disease (n = 7393 [3.0%]).
Of all the colectomies, 126 284 (51.7%) were OCs, 116 261(47.6%) were LCs, and 1584 (0.6%) were RCs. While the proportion of colectomies performed laparoscopically has experienced modest growth over the study period (45.5% in 2008 vs 47.4% in 2009 vs 48.3% in 2010), RC cases appeared to be growing exponentially (0.1% in 2008 vs 0.5% in 2009 vs 0.9% in 2010; eFigure in Supplement), although overall numbers were still small.
Significant differences with respect to the patient characteristics were observed across the 3 surgical approaches. The median age of patients receiving OC was 65 years, significantly older than those receiving LC (62 years) or RC (61.5 years). There were more women than men receiving colectomies in all 3 surgical approaches (OC: 56.0%, LC: 53.0%, and RC: 59.6%). Most patients who underwent colectomy in all 3 approaches were white (OC: 81.6%, LC: 83.3%, and RC: 76.9%). There was a significantly higher proportion of Hispanics in the RC group (OC: 4.9%, LC: 5.3%, and RC: 11.7%). The patients receiving OC had a significantly higher comorbidity burden than either LC or RC patients, as evidenced by the higher proportion of patients with Charlson Comorbidity Index scores of 3 or greater (OC: 34.1%, LC: 20.9%, and RC: 17.9%). Open colectomy patients were also more likely to have undergone surgery for colorectal malignancy (OC: 34.7%, LC: 32.0%, and RC: 28.8%). A higher proportion of the RC patients had private payer insurance (RC: 58.0%, LC: 52.8%, and OC: 42.0%), whereas OC patients were more likely to have their medical expenses covered by Medicare (OC: 50.6%, LC: 42.2%, and RC: 38.1%). Robot-assisted colectomy patients were also more likely to be wealthier, as evidenced by the higher proportion of these patients with a median household income of more than $63 000 (RC: 33.1%, LC: 31.1%, and OC: 21.5%).
No significant difference was observed in the distribution of the hospitals' size in which the 3 surgical procedures were performed. Quiz Ref IDHowever, a significantly higher proportion of RC and LC was performed at teaching hospitals (RC: 73.6%, LC: 50.5%, and OC: 47.9%). Robot-assisted colectomy was performed almost exclusively in urban regions (RC: 99.7%, LC: 92.6%, and OC: 85.6%), at higher-volume hospitals (large hospital volume, as measured in tertiles = RC: 42.6%, LC: 37.7%, and OC: 29.3%), and at teaching hospitals (RC: 99.7%, LC: 92.6%, and OC: 85.6%).
Overall, patients who underwent colectomies during the study experienced an in-hospital mortality rate of approximately 1.3% (n = 3062) and a complication rate of 26.7% (n = 65 125). While there was no obvious temporal trend of in-hospital mortality, LOS, or cost, the overall complication rate decreased from year to year (28.2% in 2008 vs 27.1% in 2009 vs 25.9% in 2010). The median LOS was 5 days with an interquartile range of 4 days. About 77.0% of the patients (n = 185 579) had a routine discharge after hospitalization, 8.7% (n = 20 890) were transferred to other health care facilities, and 14.4% (n = 34 594) were discharged to home health care.
The in-hospital mortality rate was highest among OC patients and lowest among RC patients (OC: 2620 [2.1%], LC: 442 [0.4%], and RC: 0 [0.0%]; P < .001). The complication rate was highest among OC patients and lowest among RC patients (OC: 41 888 [33.2%], LC: 23 005 [19.8%], and RC: 232 [14.7%]; P < .001). The ostomy rate was highest among OCs, followed by RCs, and then LCs (OC: 166 595 [13.1%], LC: 4102 [3.5%], and RC: 80 [5.1%]). Conversion to open procedure occurred more frequently among LC than among RC patients (LC: 14.953 [12.4%] and RC: 95 [5.7%]). Median LOS was significantly longer with OC than with RC or LC (OC: 6 days, LC: 4 days, and RC: 4 days). As opposed to transfer to another health care facility, routine discharge occurred less commonly with OC than with LC or RC (OC: 84 472 [68.3%], LC: 99 702 [86.1%], and RC: 1405 [88.7%]). Median overall hospitalization cost was the highest among RC, followed by OC, and then LC (OC: $13 911, LC: $10 782, and RC: $14 847).
Owing to differences in patient and hospital characteristics between the 3 procedures, separate propensity score–matched comparisons between LC and OC and between RC and LC were performed to evaluate the outcomes with minimized bias.
Quiz Ref IDAfter 1:1 fixed ratio propensity score matching, 115 694 LCs and 116 261 OCs were retained for comparison. The in-hospital mortality rate for LC patients (0.4%) was significantly lower than for OC patients (2.0%). Moreover, in comparison with OC, LC was associated with a significantly lower complication rate (LC: 19.8% and OC: 33.2%), lower ostomy rate (LC: 3.5% and OC: 13.0%), shorter median LOS (LC: 4 days and OC: 6 days), and a higher routine discharge rate (LC: 99 702 [86.1%] and OC: 77 584 [68.4%]) (Figure).
While the median cost per hospitalization day for LC was significantly higher than OC (LC: $2666 and OC: $2120), the overall hospitalization cost was lower for LC than OC (LC: $11 742 and OC: $13 666) (both P < .001). Outcomes and costs for LC and OC patients are shown in Table 2.
Quiz Ref IDAfter 1:1 fixed ratio propensity score matching, 1584 RCs and 1500 LCs were retained for comparison. No significant difference of in-hospital mortality was observed between RC and LC (RC: 0% and LC: 0.7%). There was no significant difference in overall complication rate (RC: 14.7% and LC: 18.5%), ostomy rate (RC: 3.0% and LC: 5.1%), conversion to open rate (RC: 5.7% and LC: 9.9%), or routine discharge rate (RC: 88.7% and LC: 88.50%). Patients who underwent RC had a marginally shorter LOS than LC patients. However, both the median cost per hospitalization day (RC: $3407 and LC: $2617) and median overall hospitalization cost (RC: $14 847 and LC: $11 966) were higher for RC than LC (both P < .001). Outcomes and costs for RC and LC patients are shown in Table 3.
To address the concern that significant differences might be concealed owing to the 1:1 propensity matching reducing the sample size of LC patients, exact matching between RC and LC on key patient characteristics was performed for sensitivity analysis. There were 1043 RC patients and 5536 LC patients retained after exact matching for comparison. Again, no significant difference was found in the mortality rate (RC: 0 [0.0%] and LC: 0 [0.0%]), complication rate (RC: 155 [14.8%] and LC: 826 [14.9%]), ostomy rate (RC: 52 [5.0%] and LC: 114 [2.1%]), conversion to open rate (RC: 61 [5.8%] and LC: 543 [9.8%]), median LOS (RC: 4 days and LC: 4 days), or routine discharge rate (RC: 944 [90.5%] and LC: 5176 [93.5%]) (all P > .05). Robot-assisted colectomy still incurred significantly higher median cost per hospitalization day (RC: $3531 and LC: $2708) and median overall hospitalization cost (RC: $14 384 and LC: $10 600) (both P < .001).
Since the first laparoscopic right hemicolectomy was described28 in 1990, LC has appeared to be equivalent to OC in both short-term quality of life4 and long-term oncologic outcomes.5 However, studies so far have been either high-volume single-institution series or those performed in the setting of clinical trials.29 Therefore, it was unclear whether similar outcomes would be observed in a nationwide population data set. Our study is important because it found that LC, in comparison with OC, was associated with a lower in-hospital mortality rate, lower complication rate, lower transfusion rate, lower ostomy rate, shorter LOS, and a higher likelihood of routine discharge. While the cost per hospitalization day was higher among LC patients than OC patients, the overall cost of LC was lower than OC, most likely owing to the shorter LOS and lower complication rate. We confirmed the study result of Alkhamesi et al2 and earlier national outcome studies of LC in patients with colon cancer and diverticulitis.30,31
Our data also show that the hospital use of LCs was evenly distributed between teaching and nonteaching hospitals and between low-, middle-, and high-volume hospitals. This implies that LC is transitioning from its early phase, when it was performed by highly trained specialists, to more widespread use.
Despite its clear benefits, laparoscopic surgery was found to be used at lower frequencies than would be expected.1 As of 2010, more than half of all colectomies (51.7%) in the United States are still performed via an open approach. This might be attributed to the higher technical difficulty and learning curve associated with the laparoscopic procedure.32-34
Robot-assisted surgery, with its relative ease of use, was introduced as a way to mitigate difficulties associated with LC. To our knowledge, to date, most of the published studies have been small, single-institution case series lacking a laparoscopic control group. They consistently demonstrated the safety and feasibility of RC.16-19,22 So far, 3 retrospective comparative studies20,22,35 and 1 randomized clinical trial36 have been published. None of them found significant differences in LOS or complication rate between RC and LC. Available literature suggests that RC, despite being a safe and feasible procedure, is not associated with a significant improvement in clinical outcomes as compared with LC.
To our knowledge, our report is the first national study comparing outcomes between RC and LC with a propensity score–matching approach. While most robot-assisted surgery patients were white, similar to findings from previous studies,37 there was a significantly higher proportion of Hispanic patients who underwent RC. This might be explained by geographical location: hospitals performing RC were concentrated in urban areas where a higher proportion of Hispanics reside.38,39 Matched comparisons between RC and LC yielded no significant differences in in-hospital mortality, complication, transfusion, ostomy, conversion to open, or routine discharge rates. While the difference in most outcomes was not statistically significant, there are some trends that appear to favor RC especially conversion to open procedures and ostomy rates. The lack of statistical significance could be partially attributable to the relative small sample sizes. Although no significant temporal trends were found in either the complication rate or the cost associated with RC during the short time span of our study, results of previous studies have been optimistic with respect to improved outcomes after the learning curve for RC is overcome.10,22 Robot-assisted colectomy is in its infancy, and it remains to be seen whether RC produces improved outcomes as technology and techniques gradually mature.
When LC was first introduced, it faced similar skepticism of its clinical benefits as RC does today.40-43 In the case of LCs, the additional complications specific to laparoscopic procedures were mitigated with increased experience, while the additional operating room cost was compensated for by a decrease in postoperative complications and LOS.2,5 Limitations of our study included the lack of standardization of the robot-assisted approach. Variability in size of incision, port placement and robot docking location,44 use of intracorporeal anastomosis,36 and use of an entirely robot-assisted approach or a hybrid approach45 could not be ascertained owing to the nature of documentation in the NIS. Another limitation was our inability to account for potential confounders that were not available in the NIS such as severity of disease and expertise level of individual surgeons. The third limitation was the short postoperative follow-up period: complications occurring after discharge could not be captured in our study.
Our study confirmed the benefits of LC over OC on a national level by demonstrating its lower complication profile and lower costs. Also, our data show that RC is at least equivalent in clinical outcomes to LC. We look forward to seeing the higher cost associated with RC decrease in the future with more prevalent use of the technology.
Corresponding Author: Nita Ahuja, MD, Section of Gastrointestinal Oncology, Breast, Melanoma, Sarcomas, and Endocrine Cancers, Department of Surgery, Blalock 685, 600 N Wolfe St, Baltimore, MD 21287 (email@example.com).
Accepted for Publication: May 2, 2013.
Published Online: December 18, 2013. doi:10.1001/jamasurg.2013.3660.
Author Contributions: Dr Ahuja had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Juo, Hyder, Haider, Camp, Ahuja.
Acquisition of data: Hyder, Haider.
Analysis and interpretation of data: Juo, Hyder, Haider, Lidor, Ahuja.
Drafting of the manuscript: Juo, Hyder.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Juo, Hyder, Haider, Lidor.
Obtained funding: Haider.
Administrative, technical, or material support: Haider, Ahuja.
Study supervision: Haider, Ahuja.
Conflict of Interest Disclosures: None reported.


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After missing out of southpaw Andrew Miller, the Houston Astros will be looking elsewhere to bolster their bullpen for the 2015 season.
The Astros have been targeting bullpen help all off-season, and may now turn their efforts to land David Robertson, as the free agent closer's chances of returning to the New York Yankees appear to have significantly dwindled by Miller's signing. The Astros have also reportedly shown interest in reliever Sergio Romo as well as other relief pitchers who may not qualify as closers.
Since Jeff Luhnow took over as the club's general manager prior to the 2012 season, they have had one of the worst bullpens in all of baseball. The Astros have the most blown saves (73) and the highest cumulative bullpen ERA (4.69) from 2012-14. They will certainly be looking to turn that around and this off-season will be a vital part of their efforts in doing so.


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Cincinnati is having one of those weeks where good news and bad news try to outdo each other.
On the positive side, good feelings remain from last week's NAACP national convention. Given the pressure to prove that the group chose wisely in holding the convention here instead of in Las Vegas, the city's reputation as being unwelcome to African Americans and the high-profile appearances by John McCain and Barack Obama, Cincinnati has a lot to celebrate.
Area political and business leaders put everything on the line to make sure NAACP attendees found Cincinnati, particularly downtown, friendly and inviting. At the same time, I was pleased to hear them avoid trying to sell the city as some sort of paradise where racial harmony comes naturally.
In fact, Mayor Mark Mallory deserves credit for honestly and publicly discussing the city's history of racial difficulties, especially the 2001 riots that boiled up after a number of unarmed black men were killed in Cincinnati Police custody. By placing this national convention in context with Cincinnati's — and urban America's — struggles to achieve economic and social equality, Mallory and other local leaders demonstrated an unusual level of maturity and thoughfulness.
Concurrent with the NAACP gathering, the outside monitor hired to track the Cincinnati Police Department's progress with improving community relations reported that he thinks the Collaborative Agreement should officially end. City police, monitor Saul Green says, have come a long way since the U.S. Department of Justice forced the department to change its ways in 2002.
Some people thought the death toll of black men in police custody was the singular sign that the Cincinnati Police Department was out of control.
If so, the fact that no one has died in custody in several years must be taken as a monumental turnaround.
The true story of the difficulties between local police and black citizens grew from small everyday interactions — traffic stops, disrespect, lack of trust — and so the true fix comes from small everyday improvements. Those are the type of improvements Green says he's seen since the ACLU asked Judge Susan Dlott in 2007 to extend the Collaborative Agreement one more year.
Around the time Green's report was released, another report tackled the ongoing problems in Hamilton County's public defender program. Actually, the Ohio legislature is to blame for not properly funding public defenders, but the report focuses on the situation here. (See Margo Pierce's related story here.)
Public defenders represent those to whom Miranda rights promise "If you cannot afford an attorney, one will be appointed for you" — but in Hamilton County these attorneys are overworked, underpaid and share computers, putting them at a huge disadvantage compared to the prosecutor's office.
These issues — race relations, police/community relations and a fair justice system — remain difficult problems with elusive solutions. For Cincinnati, perhaps it's two steps up and one step back.
Contact John Fox: [email protected]