text:
On Sunday night, September 27, the moon passes through the earth's shadow to create what is known as a Total Lunar Eclipse.
Achieving the Dream announced today that Delta College earned Leader College distinction—a national designation awarded to community colleges that commit to improving student success and closing achievement gaps.
The Delta College Planetarium and Learning Center in downtown Bay City will host a free public event on Saturday, September 19 from 7-10pm to celebrate the 5th Annual Observe the Moon Night.
Delta College Exceeds Grant Expectations and Places Over 100 in Local Full-Time Positions
Walking on water, 60-second ice cream and objects floating in mid-air are just some of the marvels of science that will be seen at the 3rdannual Dow Great Lakes Bay Regional STEM Festival. The Dow Chemical Company and Delta College are teaming up again with nationally-known Mind Trekkers of Michigan Technological University to present the STEM Festival at Delta College on September 25 and 26.
Delta College is one of 12 colleges and universities to receive a gold ranking in the new Veteran-Friendly School program, created by the Michigan Veterans Affairs Agency.
Delta College is pleased to announce that Lt. Robert Battinkoff, formerly of the Flint Township Police Department, has joined Delta College as the Director of the Public Safety Department.
Special program at the Delta College Planetarium
Midland resident and Delta College Psychology student, Lyndsay Smokovitz, was awarded first place in the American Psychological Association's Student Presentation Contest, which recognizes innovative and high quality electronic presentations by community college psychology students. Second and third places were awarded to students in Ohio and California.
Delta College has appointed Scott Schultz, Professor of Physics, as its Director of the STEM Talent Institute. The new position, funded by the Rollin M. Gerstacker Foundation of Midland, will be responsible for coordinating the many STEM initiatives currently underway at Delta.
Delta College joins Michigan community colleges to offer training program that teaches in-demand skills while providing a paycheck.
Delta College and Michigan State University (MSU) have partnered to offer regionally relevant agricultural training programs for careers in some of Michigan's highest demand industries. Students will benefit from dual enrollment at both institutions with all courses delivered in the Great Lakes Bay Region.
The Michigan ACE Women's Network announced its 2015 recipients of the Distinguished Woman in Higher Education Leadership Award.
A unique partnership between Delta College and General Motors is helping to breathe new life into Herbert Henry Dow High School's automotive program in Midland.
Delta College will be offering in-district residency status to all veterans who are funding their educations through the G.I. Bill®. Currently, there are about 300 students using their military educational benefits to attend Delta College.
1961 Delta Road, University Center MI 48710 |
989-686-9000 | email@example.com
Delta College is an Equal Opportunity Organization, committed
to excellence through inclusiveness and diversity.
Copyright © 2013


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Real Madrid 3-2 Man City: Why City left Bernabeu empty-handed
Leading 2-1 with less than three minutes to go, Manchester City looked set to become only the third English side to beat Real Madrid at the Bernabeu.
But instead of beginning their Champions League campaign with a famous victory, Roberto Mancini's men were left to rue what might have been.
Karim Benzema's equaliser was quickly followed by Cristiano Ronaldo's dramatic last-gasp winner, leading to a sliding celebration from Real boss Jose Mourinho.
What went wrong for City in their first match in Group D?
BBC football pundit Robbie Savage, speaking on BBC Radio 5 live, analysed a remarkable night.
Real run riot down City's right
Maicon was not at the races at all in the first half at right-back. He was a passenger and it was like City were playing with 10 men. Cristiano Ronaldo kept cutting inside him.
Ronaldo's reign
Cristiano Ronaldo's winner for Real Madrid was his 39th Champions League goal - only three fewer than the entire Manchester City squad - in 81 appearances.
In the second half, Vincent Kompany looked at what was happening and came across to that wing more. Ronaldo did not have the beating of Kompany and he started to get frustrated.
But, even so, Marcelo was allowed to come inside more and more, as he did for his goal.
For the Real Madrid winner, City let Ronaldo move inside too easily. He went past Pablo Zabaleta as if he wasn't there.
Zabaleta, who replaced Maicon, needed to stop Ronaldo at source. He was on the bench for most of the game watching Ronaldo take apart Maicon and didn't learn. He should have seen what was happening.
Did City's formation put them under pressure?
It was too easy at times for Real Madrid, especially in the first half. With the 4-3-2-1 formation that City play, with two holding midfielders in Javi Garcia and Gareth Barry, it meant the Madrid full-backs could go forward.
English wins at the Bernabeu
Arsenal won 1-0 in a Champions League second-round clash in 2006, with Thierry Henry scoring the winner
Liverpool also won 1-0 in the first leg of a Champions League second-round tie, when Yossi Benayoun scored their winner in 2009
If Mancini wants to play Garcia and Barry - plus Yaya Toure in that position behind Carlos Tevez - he has to go out in the transfer window and buy a Xabi Alonso-type player to do that job.
At the Bernabeu, whenever Garcia or Barry got on the ball, there were men all around them. Madrid were pressing all over the pitch.
City were over-run, especially early on, and Real made changes, bringing on Mesut Ozil, Luka Modric and Karim Benzema when they fell behind.
A heavy price for a late lapse
In terms of chances created, Madrid deserved to win the game but, having led with less than three minutes to go, City should have got at least a point.
"What a fantastic game. Sometimes it doesn't go like that in the group stage, but that was incredible. Even the draw probably wasn't good enough for Madrid. Man City were so close to making a superb start but they know this is going to be a tough group. Every single point will be fought for."
Madrid would have scored at least once in the first half if it wasn't for Joe Hart, who was brilliant, but City were terrific in the second half.
After Edin Dzeko scored, they could have gone 2-0 up when Yaya Toure missed a decent chance.
With a 2-1 lead, they just have to keep the ball. They have experienced and fantastic players who know that - and who can do it too.
It made it a great game to watch but City have to start learning in the Champions League. They were great at times but that was such naive defending.
When Madrid were ahead, there was no way they were giving the ball away.
Comment number 180. Posted by army42on 21 Sept 2012 01:43
@ Gaeldom: No interest in the Champions (s'?) League? Probably the best footy this side of the EPL one could watch. Love it!
ABC.....Anybody But Chelsea....or..Anybody But City (Man.)!!
Cheers, Army
Comment number 179. Posted by HT-Hotspuron 21 Sept 2012 01:03
Man City have NEVER been and NEVER will be a big-club. They ARE however a rich-club. With the players excessively high wages, they managed to attract some "big" players and so practically bought the Prem trophy last season. But let's face it - even money can't always buy you a top quality team but it can buy you some pretty classy individuals!
Comment number 178. Posted by Gaeldomon 20 Sept 2012 15:05
Am I the only person, who has absolutely no interest in the "Champions" league, whatsoever? I know that supporters of competing teams, will be passionate about it and I fully understand that.
However, as a supporter of football, in general, I detest what has simply become a competition for making rich clubs even richer, for adding to UEFA's coffers and giving more revenue to TV companies.
Comment number 177. Posted by Alden Dunneon 20 Sept 2012 12:22
Why the hell is anybody interested in the opinions of Robbie Savage, a hacker who achieved nothing, much the same as Andy Townsend. And who cares what that pudding Adrian Chiles thinks or says. Until they start seeding the actual 'Champions' of the strongest countries, this competition will always be a benefit comp for yesterday's outifits.
Comment number 176. Posted by BLUE STUon 20 Sept 2012 11:40
Savage right on the button. Maicon was woeful, no pace, skill or interest.. Poor buy? City like rabbits in the headlights for 30 minutes, then slowly became the team we know, contributing to a terrific game and we should be proud of them. If Hart and Kompany had not lost communication for a moment, the talk would be a great result with City laying down a marker for the rest to worry about.
Comment number 175. Posted by Keith95aon 20 Sept 2012 11:30
127. average40
Too much information ...
"Robbie, can you please stop"
was all you needed to say.
"When Madrid were ahead, there was no way they were giving the ball away."
Comment number 174. Posted by Going Down Fightingon 20 Sept 2012 10:41
Real Madrid are an outstanding team with possibly the best manager in the world. Any other English club who gets drawn against them in the knockout stages at the Bernabeu will probably take a much heavier beating. Man City should avoid defeat in the return match at the Etihad.
Comment number 173. Posted by Daveon 20 Sept 2012 10:31
I thought that Balotelli should have played as City had difficulty holding the ball up. If I were Mancini, my team would be (if everyone was fit):
Richards Kompany Nastasic Clichy
Toure Y. Garcia
Tevez Balotelli Aguero
Comment number 172. Posted by Eduard_Streltsov_Goalson 20 Sept 2012 09:16
All this user's posts have been removed. Why?
Comment number 171. Posted by Preamble101on 20 Sept 2012 07:39
Why is rating not working again?
You must sign in to rate comments

subset: commoncrawl


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Pa. Lawmaker: Gay State Rep. Shouldn't Have Come Out
A Republican Pennsylvania state senator says Rep. Mike Fleck (R) will likely lose his seat this week in the state's House of Representatives because he came out as gay in 2012, the Huffington Post reports.
Fleck was first elected to the Pennsylvania House of Representatives in 2006 but made headlines in 2012 when he came out of the closet.
Now, Pennsylvania State Senator John H. Eichelberger Jr. told the Altoona Mirror that if Fleck "had just gone about his business and people thought he was a homosexual or heterosexual or whatever, there wouldn't be a problem."
Eichelberger added that many people thought Fleck was gay before he made his announcement and they weren't bothered by it.
"A lot of people thought that Mike was a homosexual," Eichelberger told the mewsaper. "He didn't announce it and it was OK. The feeling from many people is, he put them in a very uncomfortable position" by coming out.


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The $500 annual award is funded by the generosity of Maryann Macinko is named after George Macinko, who taught in the Geography Department for more than thirty years. Dr. Macinko taught a variety of courses with a particular emphasis on conservation and environmental studies, and with his wife has been very active in the local community. This award is given each year to a junior who has done well in classes and displays the potential to become a lifelong geographer.
Congratulations are extended to the following students who have received an award:
Read an update of recent activities in the Department of Geography. Letter from the Chair, Dr John BGeographer Honored For A Lifetime Of Achievement
Emeritus faculty member George Macinko was honored as the College of the Sciences Faculty/Staff of tGeographer Speaks To Rotary Clubs About ISIS
On February 5, 2015, Elaine Glenn spoke about the Islamic State in Iraq and Syria (ISIS) to a Rotary


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Eric Mathieu (Smile)
We have release a new version of posh. Here are the enancements :
- New capture tool, in the 'Add widget' bar, to capture an area of a web site inside a widget
- New digest tool to send, at a defined frequency, a digest mail of the group activity (new articles / comments / members)
- Possibility to add articles in group by sending an email at a defined email address
The 3.4.3 is now available on the homepage of the posh project, and not only in the files section. Thanks !


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YIELD: Makes one 12-inch pizza
- 1 1-pound frozen white bread dough piece, thawed
- 3/4 cup packed chopped fresh dill
- Olive oil
- 7 ounces soft mild goat cheese (such as Montrachet), crumbled
- 1/2 cup chopped red onion
- 4 ounces smoked salmon, cut into 1-inch pieces
- 1/4 cup brine-cured olives (such as Kalamata), pitted, halved
Let dough rise in warm draft-free area until doubled, about 1 hour.
Preheat oven to 450°F. Butter 12-inch-diameter pizza pan. Knead dough briefly on floured surface. Sprinkle 1/4 cup dill over and knead dough until dill is well incorporated. Roll out dough on lightly floured surface to 12-inch round. Transfer to prepared pan. Build up edges of dough to form rim. Brush dough lightly with olive oil. Sprinkle 1/4 cup dill over, then goat cheese. Top with onion. Bake until cheese melts and crust is golden brown, about 20 minutes. Sprinkle smoked salmon, olives and remaining 1/4 cup dill over.
my notes
Nutritional Info
- Calories220
- Carbohydrates24 g (8%)
- Fat9 g (14%)
- Protein10 g (20%)
- Saturated Fat4 g (19%)
- Sodium470 mg (20%)
- Polyunsaturated Fat1 g
- Fiber1 g (6%)
- Monounsaturated Fat4 g
- Cholesterol12 mg (4%)


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Apparently knocking out Joe Schilling can earn you headlining status. Hisaki Kato will meet Melvin Manhoef in the middleweight main event of Bellator 146 on Nov. 20 at WinStar World Casino in Thacker read news >>
Bellator MMA has finalized its upcoming "Warren vs. Davis" fight card with the announcement of four additional "Prelims" bouts, one of which will feature Ryan Couture. Barring injury or illness, Bell read news >>
Bellator MMA will return to the WinStar World Casino in Thackerville, Oklahoma, on November 20th for a fight that puts the explosive Hisaki Kato and the dangerous Melvin Manhoef on a collision course read news >>
Expect to see some middleweight fists flying in November's Bellator 146 main event.Filed under: Bellator, News read news >>
A welterweight bout between Brennan Ward and Dennis Olson is the latest addition to next month's Bellator 144 main card.Filed under: Bellator, News read news >>
MMAjunkie Radio kicks off at 1 p.m. ET (10 a.m. PT) with guests Eric Albarracin, Eric Del Fierro and Victor Henry.Filed under: News read news >>
If you're at the SAP Center in San Jose, Calif., on Sept. 19th, which way are you going to look? When Bellator MMA and GLORY kickboxing announced their joint "Dynamite 1" card on Sept. 19, 2015 in Sa read news >>
Ultimate Fighting Championship (UFC) dished out its post-fight sponsorship payouts -- courtesy of Reebok -- to all 22 fighters competing on the UFC 191: "Johnson vs. Dodson 2" pay-per-view (PPV) even read news >>
The line up for Bellator MMA's card on Sept. 25, 2015, at State Farm Arena in Hidalgo, Texas, has been updated again with new fights announced at Heavyweight and Bantamweight. The ever expanding line read news >>
Lightweight Nazareno Malegarie had three chances to win a tournament under Bellator's previous leadership regime, so when he was cast on "The Ultimate Fighter Brazil 4," his hopes were high for a fre read news >>


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LINCOLN, Neb. (AP)—Roy Helu Jr. was getting better for No. 24 Nebraska as the game went on, and by the third quarter he was nearly unstoppable.
With Helu running for two of his three touchdowns and 95 of his 152 yards in the quarter, the Cornhuskers broke open the game and went on to a 49-3 victory over Florida Atlantic on Saturday night.
Helu put to rest any concerns about hamstring problems that bothered him last season and in preseason practices. He also showed he's quite capable of being the Huskers' featured back in the wake of Quentin Castille's dismissal for breaking team rules.
"In the first quarter I was impatient with my reads," Helu said. "The feeling was good in the third quarter. The type of offense we're trying to become, you saw it in the third quarter."
If Helu keeps running like he did against the Owls, it will make things much easier for quarterback Zac Lee.
Lee took his most meaningful snaps since 2006, his last year of junior college, and passed for 213 yards and two touchdowns in his first start.
Lee got sharper after a fumbled snap led to a three-and-out on Nebraska's first series. He threw touchdown passes of 28 yards to Menelik Holt and 49 yards to Curenski Gilleylen and led a 15-play, 82-yard drive that Helu finished with a 1-yard run.
"There was a little bit of anxiety, but that faded pretty quickly," Lee said. "Once you throw a couple passes, it's back to playing football."
The Huskers opened Bo Pelini's second season as head coach with the program's 24th straight win in an opener, the longest streak in the nation.
"You play that first game, and it gives you a benchmark, an idea where you are," Pelini said. "I saw some good things out there. We got to play a lot of guys. But I also found out we have a lot of work to do. We were sloppy at times and not real crisp."
The Huskers were at their best in the third quarter, thanks to a defense that forced three turnovers by FAU's Rusty Smith.
Smith, the Sun Belt Conference's all-time leading passer and the preseason offensive player of the year, couldn't establish any rhythm. He was intercepted by Matt O'Hanlon and Prince Amukamara, and he fumbled a snap.
"I'm sure they went into halftime concerned about how they looked against us," FAU coach Howard Schnellenberger said. "They put it into overdrive, and I asked our guys to put it into overdrive, but we didn't have enough juice in the tank. It's a very bitter loss for us. It's the first one that I've had with this program that is tougher to handle than others because I expected more out of this football team that what I got at this juncture."
Helu uncorked his run of the night on a 44-yard touchdown, cutting back after starting to his left and breaking out of the grasp of FAU safety Rod Huggins.
"That's Roy—great player, great runner," Lee said. "The thing we saw tonight was how strong he is, breaking tackles, making moves. He's going to be that guy for us. We're going to rely on him and get him the ball."
Over the past five regular-season games, Helu has rushed for 662 yards on 86 carries, an average of 7.7 yards.
Helu, who went over 100 yards for the fourth time in six games, also had a 7-yard TD run in the third, when Nebraska rolled up 185 of its 490 yards.
Lee completed 15 of 22 passes, with one interception, before giving way to freshman backup Cody Green early in the fourth. Green ripped off a 49-yard run before scoring Nebraska's last TD from a yard out.
The game also marked the much-awaited debut of freshman Rex Burkhead, who ran for 39 yards and an 8-yard touchdown.
Alfred Morris led the Owls with 85 yards.
The Owls' 3 points were the fewest against Nebraska since the Huskers' 21-3 win over Kansas State in 2006 and the fewest in a Nebraska opener since 1994.
Nose tackle Ndamukong Suh said the defense was in midseason form with one exception. The Huskers allowed 122 yards rushing.
"Rate our defense? B-minus," Suh said. "There were a couple breakdowns, and that let them get some momentum. When we're point on, we're getting three-and-outs. There were some lax places that we need to clean up."
Head to Head - Week 1
|Total Yds
|Pass Yds
|Rush Yds
|First Downs
|Time of Poss.
|Florida Atlantic


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Olym-Picks: Which Summer Games events to watch on Friday, Day 14
Not sure you want to watch all that the Summer Games has to offer? Here are a few events you may not want to miss (Team USA is sure to take a win in basketball! Again!). If you want to watch them live at nbcolympics.com (if you're not in the U.K.) or just wait for the prime time digest on NBC is up to you.
Men's basketball -- USA vs. Argentina (watch live at 1:00 p.m. PT, 4:00 p.m. ET)
Yeah, yeah, yeah. We all know Team USA is gonna win.
Men's and women's BMX (watch live at 7:00 a.m. PT, 10:00 a.m. ET)
The women's semifinals start at 7:00 a.m. PT, the men's at 7:08 a.m. ET, and finals happen at 8:30 a.m. PT and 8:40 a.m. ET respectively. Anything could happen, as BMX at the London Olympics has been marked by crashes -- more than 20 on Thursday alone. Because the course in London has big jumps and tight corners, it's shaping to be one of the most difficult in the world.
Rhythmic gymnastics (watch live at 4:00 a.m. PT, 7:00 a.m. ET)
In the individual all-around competition rotations 3 and 4 will compete with the clubs and ribbon; in the group competition, nations will perform with three ribbons and two hoops.
Men's and women's track & field (watch live at 11:00 a.m. PT, 2:00 p.m. ET)
Don't miss the finals in the men's pole vault, women's hammer throw, women's 5000m, women's 1500m, women's 4x100m relay and men's 4x400m relay.
Men's water polo - USA vs. Spain (watch live at 6:20 a.m. PT, 9:20 a.m. ET)
The men aren't in a running for a medal anymore, but they'll battle Spain anyway to get their ranking. Sigh.
2007 | Comedy | PGSummary: Newlyweds Nick (Ice Cube) and Suzanne (Long) decide to move to the suburbs to provide a better life for their two kids. But their idea of a dream home is disturbed by a contractor (McGinley) with a bizarre approach to business.Director: Steve Carr
Cast: John C. McGinley, Ice Cube, Nia Long, Aleisha Allen
2008 | Science Fiction | PGSummary: Animated series continues the story of Obi-Wan Kenobi and Anakin Skywalker as they battle the Emperor Palpatine, Count Dooku and General Grievous, but also takes time to explore other smaller characters in the Star Wars universe.Director: George Lucas (creator)
Cast: Tom Kane, Dee Bradley Baker, Matt Lanter
1997 | Crime | RSummary: Quentin Tarantino adaptats an Elmore Leonard novel into this story of a few increasingly desperate people scraping to get by.Director: Quentin Tarantino
Cast: Pam Grier, Samuel L. Jackson, Robert Forster
2013 | Thriller | RSummary: Based on the true story of Daniel Lugo (Mark Wahlberg) a Miami bodybuilder who wants to live the American dream. He would like to have the money that other people have. So he enlists the help of fellow bodybuilder Adrian Doorbal (Anthony Mackie) and ex-convict, Christian bodybuilder Paul Doyle (D...Director: Michael Bay
Cast: Mark Wahlberg, Dwayne Johnson, Anthony Mackie, Tony Shalhoub
2013 | Drama | RSummary: Leonardo DiCaprio and Jonah Hill have boundless energy in the story of a real-life commodities crook who earned millions through scummy small-time stock trades.Director: Martin Scorsese
Cast: Leonardo DiCaprio, Jonah Hill, Margot Robbie
1993 | Sports | PGSummary: Emotionally powerful sports classic featuring Sean Astin as a skinny high school kid with big football dreams and the determination to make his way towards his dream team at Notre Dame.Director: David Anspaugh
Cast: Sean Astin, Jon Favreau, Ned Beatty
1996 | Crime | RSummary: Jerry, a small-town Minnesota car salesman is bursting at the seams with debt... but he's got a plan. He's going to hire two thugs to kidnap his wife in a scheme to collect a hefty ransom from his wealthy father-in-law. It's going to be a snap and nobody's going to get hurt... until people start ...Director: Joel Coen
Cast: William H. Macy, Frances McDormand, Steve Buscemi, Peter Stormare
1995 | Mystery | NRSummary: Denzel Washington plays an out of work WWII vet who takes the wrong job and is soon neck-deep in a mess of politics, murder, and jazz in '40s Los Angeles.Director: Carl Franklin
Cast: Denzel Washington, Tom Sizemore, Jennifer Beals
2013 | Comedy | NRSummary: Insanely funny comedy show created by Amy Schumer, who stars in brilliantly funny sketches about sex, city living, dating, and friendship.Director: Daniel Powell, Amy Schumer (creators)
Cast: Amy Schumer, Kevin Kane, Mike Houston
Let Streaming Genie help you.


text:
The All A Dream Crewneck Sweatshirt in Navy
Sale $32.95
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The Street Vault All A Dream Crewneck Sweatshirt in Navy
Rep LA and hip hop culture with The All A Dream Sweatshirt from Street Vault. This crewneck sweatshirt by Jeepney features a multicolored graphic on the front.
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text:
Lobster season log, day 1
Likely to be good season
Jimi Olsen 7:30 p.m., Oct. 9
Posted October 25, 2011
Case of the Missing Canine
"She basically got caught up in an emotional dog rescue. That's what this was," said the defense attorney. "Miss Vukov, yes, took the dog." Although Trina Vukov took the dog without permission, she had no ...


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Kiva Lending Team: Doug and Jenn's Wedding
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This team is for us and our wedding guests to come together and make loans through Kiva.
Location: Marquette Park, Gary, Indiana Team website
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Town Square
In Concert with Irene Sharp, Cello, and Steven Lightburn, Piano
Original post made by csma, another community, on Jun 12, 2008
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Mademoiselle Colette, now open in downtown Menlo Park
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text:
DEFINITION of 'Director Rotation'
The cycle by which board members serve and vacate their positions. A policy regarding director rotation, or rotation of directors, may be included in a corporation's corporate governance policy and can specify the term that each member serves as well as the number of board positions that will be up for reelection each year.
BREAKING DOWN 'Director Rotation'
An example of a typical director rotation policy can be one that specifies that one-third of the directors will "retire by rotation" - vacate their positions - leaving them open for new directorship each specified period. The directors that have served the longest will be included in the one-third to retire by rotation. Directors are typically elected at the corporation's annual meeting.
Board Of Directors - B Of DA group of individuals that are elected as, or elected to act ...
BoardroomBesides the general definition as a meeting room in an office, ...
Outside DirectorAny member of a company's board of directors who is not an employee ...
Inside DirectorA board member who is an employee, officer or stakeholder in ...
Chair Of The Board - COBThe most powerful member on the board of directors who provides ...
Employee Stock Option - ESOA stock option granted to specified employees of a company. ESOs ...
Evaluating The Board Of DirectorsCorporate structure can tell you a lot about a company's potential. Learn more here.
Active Trading Fundamentals
Evaluating A Company's ManagementFinancial statements don't tell you everything about a company's health. Investigate the management behind the numbers!
Fundamental Analysis
The Basics Of Corporate StructureCEOs, CFOs, presidents and vice presidents: learn how to tell the difference.
6 Reasons to Donate Your Car to CharityIt's no longer a free ride, but there are still tax benefits to doing so.
What Does Vesting Mean?Vesting is the process of accruing non-forfeitable rights.
What's a Conglomerate?A conglomerate is a corporation that's comprised of several different independent businesses.
Investing Basics
Breaking Down Optimal Capital StructureAn optimal capital structure shows the best balance of debt to equity a company can have in order to minimize its cost of capital.
What is a Preemptive Right?A preemptive right allows select shareholders to buy newly issued shares in their corporation before the general public.
Explaining the Balanced ScorecardA balanced scorecard is a metric that measures a business' performance.
Investing Basics
What is a Public Company?A public company has sold stock to the public through an initial public offering (IPO) and that stock is currently traded on a public stock exchange.
Do ETFs have a board of directors?Yes. An exchange-traded fund (ETF) is a type of security that tracks a basket of assets or an index (such as an index fund), ... Read Full Answer >>
What is the difference between a president and a chief executive officer? Can there ...In general, the chief executive officer (CEO) is thought of as the highest ranking officer in a company while the president ... Read Full Answer >>
How do modern companies assess business risk?Before a business can assess or mitigate business risk, it must first identify probable or likely risks to its bottom line. ... Read Full Answer >>
Why has emphasis on corporate governance grown in the 21st century?Corporate governance refers to operational practices, management protocols, and other governing rules or principles by which ... Read Full Answer >>
What impact did the Sarbanes-Oxley Act have on corporate governance in the United ...After a prolonged period of corporate scandals involving large public companies from 2000 to 2002, the Sarbanes-Oxley Act ... Read Full Answer >>
Why should investors research the C-suite executives of a company?C-suite executives are essential for creating and enacting overall firm strategy and are therefore an important aspect of ... Read Full Answer >>


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22 Times Birthday Boy Usher Made Us Smile view
Quarterback Crush Alert: Hunks On and Off The Field view
Happy Birthday, Will! 25 Photos that Prove Will Smith Only Gets Finer With Age view
Show: "Private Practice"
Character: Dr. Sam Bennett
The accomplished actor...
The accomplished actor delivers as an internal medicine specialist on the spin-off of the cult addiction "Grey's Anatomy." Chances are Dr. Diggs won't need a stethoscope to hear our hearts beat whenever he lights up the screen.
See these Hollywood Hotties »
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text:
Aaron Rodgers
Aaron Rodgers and Ryan Braun Are No Longer Business Partners
Green Bay Packers quarterback Aaron Rodgers and suspended Milwaukee Brewers slugger Ryan Braun are business partners no more. Braun is out!
Sep 6th
Here's Aaron Rodgers' New State Farm Commercial
Green Bay Packers quarterback Aaron Rodgers has a new State Farm commercial and it features a couple of our old friends. Here's the video.
Sep 6th
Aaron Rodgers is Confident in his Tackles
No one seems to have any confidence in the Green Bay Packers starting tackles. No one except Aaron Rodgers and Ted Thompson, that is.
Sep 5th
Aaron Rodgers Will Not Be Changing His Style
Green Bay Packers quarterback Aaron Rodgers doesn't care what you think about his leadership style, Greg Jennings. And it isn't going to change.
Sep 4th
Aaron Rodgers is Tops
Greg Jennings is going to love this. A panel of so-called experts have voted Green Bay Packers quarterback Aaron Rodgers as the best player in the NFL.
Aug 30th
Aaron Rodgers is You, USA
Aaron Rodgers is the Green Bay Packers quarterback. He's also the United States of America. Just take a look at him at the Welcome Back Luncheon. Classic.
Aug 29th
Aaron Rodgers Likes Peanut Butter on His Burger
Green Bay Packers quarterback Aaron Rodgers has a burger and it's got peanut butter on it, among other disgusting combinations. Only available until Friday.
Aug 28th
Here's Marshawn Lynch Bear Hugging Aaron Rodgers
Seattle Seahawks running back Marshawn Lynch gave Green Bay Packers quarterback Aaron Rodgers the business after last night's game. Here's video.
Aug 24th
Charles Woodson Sticks By Aaron Rodgers
Charles Woodson is a stand-up guy and he still has former Aaron Rodgers' back, even though he's not longer a member of the Green Bay Packers. Solid.
Aug 17th
Is This Donald Driver Criticizing Aaron Rodgers?
Was Donald Driver just criticizing Aaron Rodgers? It kind of sounds like it. Driver says Rodgers doesn't protect his receivers when they screw up. Hmmm…
Aug 15th
Aaron Rodgers is in Midseason Form
Watch Aaron Rodgers fire a ball 50 yards downfield into a basket because he's a bad, bad man. Always in midseason form.
Aug 9th
Here's Aaron Rodgers on the Cover of SI
Aaron Rodgers will be on the cover of Sports Illustrated next week, at least in some areas. Rodgers gets the regional cover, while Peyton Manning gets the national.
Aug 8th
Aaron Rodgers Does Not Like Being Lied To, Ryan Braun
Packers quarterback Aaron Rodgers talked about the elephant in the room — how he feels about liar and cheater Ryan Braun — saying he was disappointed.
Jul 26th
That Guy Who Bet Aaron Rodgers About Ryan Braun Wants His Money
Aaron Rodgers bet a year's salary to some guy on Twitter that Ryan Braun was clean and now that guy — Todd Sutton — is coming to collect. Or something.
Jul 24th
Jordan Rodgers is a Free Agent…
Aaron Rodgers' little brother Jordan Rodgers was cut by the Jacksonville Jaguars yesterday. Should big brother lobby to get him a spot in Green Bay?
Jul 23rd
Like Us, Aaron Rodgers Probably Regrets Defending Ryan Braun
Ryan Braun was suspended by MLB for violating the league's drug policy on Monday. Packers quarterback Aaron Rodgers probably regrets defending him so adamantly right now.
Jul 22nd
Aaron Rodgers is No. 1, Says Ron Jaworski
The annual Ron Jaworski quarterback rankings are out and guess who's No. 1. Go ahead, guess. Yeah, of course it's Green Bay Packers quarterback Aaron Rodgers.
Jul 22nd
Mike Ditka Really Likes Aaron Rodgers
Hey, Mike Ditka, who is the one quarterback you'd like to have played with or coached? Ditka says that guy is Green Bay Packers quarterback Aaron Rodgers.
Jul 13th
Aaron Rodgers was Partying in Hollywood Last Night
Packers quarterback Aaron Rodgers was partying in Hollywood last night and it looks like he got drunk. He was also none to pleased to be caught on camera.
Jul 10th
Aaron Rodgers is Sixth-Best Player, According to Peers
Green Bay Packers quarterback Aaron Rodgers is not the best player in the NFL, according to other NFL players. He's only the sixth best. Here's a look.
Jun 28th


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Courtesy of Deloitte, the BDLA is returning for 2015/16 and promises to nurture and inspire more sporty students than ever before.
The BDLA Returns - Apply Here
Have a long journey down to the BUCS Surfing Championships at Fistral Beach, Newquay? Don't worry! We've pulled together a playlist filled to the brim with classic surfing songs.
2015 #BUCSsurf Champs Playlist
Lee Bartlett, professional surfer and BUCS Surfing Championships commentator, speaks of his successful career as a professional surfer and of the growth of the annual BUCS event.
Profile: Professional Surfer, Lee Bartlett
From October 5 - 11th October, 59 universities delivered footballing activity during Girls' Football Week. You can view our review and see the live coverage of all activity throughout the week here!
Girls' Football Week Review 2015
Latest tweetsFollow
@BUCSsport13-Oct-2015 08:27
#BUCSgolf Cornelius Kobrock (Royal Holloway) and Brad Barnes (B'ham, pic) start a frosty Round 2 @LittleAstonGolf http://t.co/WiplImDGy8
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@BUCSsport12-Oct-2015 22:55
#BUCSgolf Beautiful autumnal scenes @LittleAstonGolf today. Rounds 2 and 3 coming tomorrow. http://t.co/xS07leLe7P
@BUCSsport12-Oct-2015 17:34
RT @DC15_x: Cheeky slo-mo "beat the bin" challenge the other day @BUCSsport ?????????? http://t.co/uwxD5hPstU
@BUCSsport12-Oct-2015 17:17
RT @UniofHertsAU: @BUCSsport Our #GFW15: 5 sessions, 89 attendees (76 unique) & media coverage: http://t.co/YHQiXjnCUJ #WeCanPlay http://t.…
@BUCSsport12-Oct-2015 15:55
RT @LEEDSGryphon: Our #UniGirlsCan team stating what inspires them to keep moving ???? @ThisGirlCanUK http://t.co/pyaFD0TAJk
@BUCSsport12-Oct-2015 15:49
The #BUCSsurf Champs get underway this Friday! We caught up with Pro Surfer, @Lee_Bartlett: http://t.co/b9Ae9UW8eu http://t.co/OTKVDDbqyO
@BUCSsport12-Oct-2015 15:42
RT @SurfFistral: Are all you #students ready for the @BUCSsport #surfchamps this weekend #surfing #fistralbeach
@BUCSsport12-Oct-2015 15:25
#BUCSgolf Harrie Llewellyn (Exeter) completes the final group, driving from 1st tee @LittleAstonGolf @UofExeterSport http://t.co/nLcHwn3JPo
@BUCSsport12-Oct-2015 14:44
#BUCSgolf Clear blue skies over @LittleAstonGolf for round 1 earlier. Perfect conditions for quality student golf! http://t.co/5pizuqE2NN
@BUCSsport12-Oct-2015 12:50
@CardiffUniSport @cardiffuni Hat tip to the groundsperson! #BUCSWednesday
@BUCSsport12-Oct-2015 12:04
Just two days to go! Tweet us your first fixture using #BUCSWednesday http://t.co/bP7BPnrgar
The BUCS Surfing Championships start on the 16 October, to give you a glimpse of what's to come here's footage from a previous event - it's set to be another swell year!


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Submit Your Paper
Enter your login details for Canadian Journal of Ophthalmology below. If you do not already have an account you will need to register here.
Canadian Journal of Ophthalmology Editorial Board
Phil Hooper, MD, FRCSC
Section Editors
Cataract & optics
Iqbal Ike K. Ahmed, MD, FRCSC
Cornea & external disease & refractive surgery
Clara C. Chan, MD, FRCSC, FACS, DABO
Yakov Goldich, MD
Simon P. Holland, MB, FRCSC
Chris Rudnisky, MD MPH FRCSC
Ezekiel Weis, MD, FRCSC, MPH
Michael Walter, PhD
Yvonne M. Buys, MD, FRCSC
Low vision
Samuel N. Markowitz, MD, FRCSC
Medical Education
Kathy Cao, MD, FRCSC, MEd (candidate)
Edsel Ing, MD, FRCSC
Ocular oncology
Hatem Krema, MD, MSc, FRCSEd
Oculoplastic surgery
Peter Dolman, MD, FRCSC
Ophthalmic & general pathology
Valerie White, MD, MHSc, FRCPC
Pediatric ophthalmology
Robert K. Koenekoop, MD, PhD, FRCSC
Michael O'Connor, MD, FRCSC
Retina & vitreous
Thomas G. Sheidow, MD, FRCSC, M Math
Matthew T.S. Tennant, BA, MD, FRCSC
Mili Roy, MD, FRCSC
Translational vision science & technology
Neeru Gupta, MD, PhD, MBA, FRCSC, DABO
International Advisory Board
Cataract & optics
Randall Olson, MD
Salt Lake City, UT, USA
Cornea & external disease & refractive surgery
Prashant Garg, MD
Banjara Hills, Hyderabad, India
Satish Srinivasan, MBBS, FRCSEd, FRCOphth, FACS
Ayr, Scotland
Keith Barton, MD, FRCP, FRCS
London, UK
Mansoor Sarfarazi, PhD
Farmington, Connecticut, USA
Dimitrios Kourkoutas, MD, PhD
Athens, Greece
Low vision
August Colenbrander, MD
Novato, California, USA
Andrew Lee, MD
Houston, TX, USA
Ocular oncology
Brian P, Marr, MD
New York, NY USA
Oculoplastic surgery
Daniel S. Morris, MBChB, MFSEM(UK), FRCSEd(Ophth)
Cardiff, Wales, UK
Ophthalmic & general pathology
Paul Hiscott, PhD
Liverpool, UK
Pediatric ophthalmology
Elias Traboulsi, MD
Cleveland, Ohio, USA
Retina & vitreous
Kevin J. Blinder, MD
St. Louis, Missouri, USA
Sunir J. Garg, MD, FACS
Philadelphia, Pennsylvania, USA
Marc D. de Smet, MD
Lusanne, Switzerland
Translational vision science & technology
Robert N. Weinreb, MD
La Jolla, California, USA


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Welcome to WebmasterWorld Guest from 126.96.36.199
Forum Moderators: werty
I've tried all your workarounds - restarted my computer, cleared cache/cookies. Guess what? Your system is broken! Fix it!
*Hint: De-select broad match for the empty box if you don't want to pay for every single search made on MSN (Which would still be peanuts)
The only solution I see for MS is to incorporate ads coming from MSN AdCenter directly into Vista's web-related applications?! They should increase the license fee dramatically while in the same time offer a completely free version of an "ad-supported" Vista. This is the only approach they can apply to cope with this tiny search activity they have now. As far as I can see, they have about 4-7% of what Google has as search queries.
I've found this to be true as well. However, MSN Tech Support also has no idea why their product is doing this.
If you think of it, this is classic Microsoft: Get it to market as fast as you can, then start work on the patches.
My hope is that whatever patches they're considering come out before the Vista launch - because personally, I plan to cash in on Microsoft's continued monopolistic fiendishness.
Whilst initially frustrating, I think the UI sans the bugs will turn out to be fairly user friendly, though I do feel there is probably a few too many clicks required to edit ads.
The most important improvement required in my opinion is in the reporting of stats. I would like to see my up to date daily spend on the first page as in Adwords. I believe this to be of utmost importance to most users.
Other than getting used to the different interface, it's been just great. My only real gripe is the lack of "real time" (at least within a few hours) acurate reports. This should be their priority right now.
I think that thier interface could use some improvement , however, it's very workable.
I had to look at an invoice to see this because the reporting wouldn't load. I really don't know how Microsoft of all companies can't manage to make a simple site that operates correctly.
I got an e-mail back today basically telling me I can't trust the system to work right. That's the official support, to tell me their system doesn't work. Why did they take this thing out of beta?


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FDA attempts to stem sale of andro
Updated: March 11, 2004, 6:52 PM ETAssociated Press
WASHINGTON -- The government will crack down on the steroidlike supplement taken by Mark McGwire, telling companies Thursday to quit selling androstenedione unless they can prove it's not dangerous.
Commonly called andro, the product is a steroid precursor -- the body uses it to make testosterone.
That means it poses the same health risks as directly using an anabolic steroid, the Food and Drug Administration says in warnings telling 23 manufacturers to cease their production.
"Anyone ...
Read full story
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Japan News
China and Japan REALLY Don't Like Each Other
Sep 04, 2013
A recent survey of Chinese and Japanese citizens views of each other's countries found that 92.8 percent of Chinese respondents hold unfavorable views of Japan, a startling 28 percent rise from the year before. Similarly, 90.1 percent of respondents in Japan had an unfavorable or relatively unfavorable view of China, compared with 84.3 percent last year. For both countries, these figures were higher than in the previous nine annual surveys conducted.
East Asia: Leaving Post-War Angst Behind
Aug 15, 2013
Irrational nationalism is driving an ever-deeper wedge between Japan, China, and South Korea. All three countries face considerable economic challenges which will be better tackled together, instead of picking at the old wounds from World War II, argues Northeast Asia associate Shihoko Goto in The Globalist.
Business as Usual? U.S.-Taiwan Relations Amid Changing Realities
Aug 07, 2013
U.S.-China relations continue to play a key role in defining power politics in the Asia-Pacific region. This difficult relationship also remains central to how other countries define and pursue their own national interests. On Aug. 6, public policy scholar Yeh-chung Lu argued that he U.S. policy of rebalancing toward the region is likely to continue to shape the Asia-Pacific security equation in the years to come, including Taiwan's security environment.
Japan's Self-Inflicted Wounds
Aug 07, 2013
Misspoken words by senior politicians are aggravating Japan's already fragile relations with its Asian neighbors. Their departure would be the first step in right direction, argues Northeast Asia associate Shihoko Goto in the National Interest.
The Expanding Indo-Japanese Partnership
Aug 05, 2013
Asia Program Public Policy Scholar K. V. Kesavan discusses this year's Indo-Japan summit and the expanding Indo-Japanese Partnership.
Senate Committee on Foreign Relations Investigates China's Water Challenge
Jul 24, 2013
Dr. Elizabeth Economy from Council on Foreign Relations testified before the Senate Foreign Relations Subcommittee on East Asian and Pacific Affairs and talked about China's water challenge and its implications for the U.S. rebalance to Asia.
Testing Time For Japanese PM – Analysis
Jul 24, 2013
Wilson Center Scholar K.V. Kesavan and Scholar Intern Julien Teel co-authored a piece on whether any change will happen with Japan's upcoming Diet Upper House elections.
Changing South Korea-China equations and Japan
Jul 10, 2013
Inter-state relations in the Northeast Asian region have changed drastically in recent years thanks to the rapidly evolving new equations among China, Japan and South Korea. The visit made by the newly elected South Korean President Park Geun-hye to Beijing in the last week of June highlighted the changing strategic equations between South Korea and China.
Moving towards a stronger India–Japan partnership at the Tokyo summit
Jun 28, 2013
Wilson Center Public Policy Fellow K.V. Kesavan writes how the India–Japan partnership has matured into an important component of the new security and economic architecture of the Indo-Pacific region.
Abe Brings Japan Political Stability, But at High Cost
Jun 26, 2013
Northeast Asia associate Shihoko Goto discusses how a lack of political opposition to Japanese Prime Minister Shinzo Abe may hamper the country's growth in the longer term in World Politics Review. http://www.worldpoliticsreview.com/articles/13053/abe-brings-japan-political-stability-but-at-high-cost


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Our study aims to assess the influence of data quality on computed Dutch hospital quality indicators, and whether colorectal cancer surgery indicators can be computed reliably based on routinely recorded data from an electronic medical record (EMR).
Cross-sectional study in a department of gastrointestinal oncology in a university hospital, in which a set of 10 indicators is computed (1) based on data abstracted manually for the national quality register Dutch Surgical Colorectal Audit (DSCA) as reference standard and (2) based on routinely collected data from an EMR. All 75 patients for whom data has been submitted to the DSCA for the reporting year 2011 and all 79 patients who underwent a resection of a primary colorectal carcinoma in 2011 according to structured data in the EMR were included. Comparison of results, investigating the causes for any differences based on data quality analysis. Main outcome measures are the computability of quality indicators, absolute percentages of indicator results, data quality in terms of availability in a structured format, completeness and correctness.
All indicators were fully computable based on the DSCA dataset, but only three based on EMR data, two of which were percentages. For both percentages, the difference in proportions computed based on the two datasets was significant.
All required data items were available in a structured format in the DSCA dataset. Their average completeness was 86%, while the average completeness of these items in the EMR was 50%. Their average correctness was 87%.
Our study showed that data quality can significantly influence indicator results, and that our EMR data was not suitable to reliably compute quality indicators. EMRs should be designed in a way so that the data required for audits can be entered directly in a structured and coded format.
Keywords:Data quality; Clinical quality indicators; Electronic medical record; Clinical audit; Patient data; Reuse; Secondary use
Over the last decades, it became possible and increasingly interesting to measure the quality of health care to implement quality improvement activities and to strengthen both transparency and accountability [1]. In this context, both legally mandatory and voluntary quality indicators [2] for various kinds of diseases and interventions have been released by governments, patient and scientific associations as well as insurance companies. The computed results are used for performance comparisons between health care institutions. As such comparisons have potentially serious implications, including influencing the choices of patients and insurance companies, indicator results should be reliable.
Ideally, clinical quality indicators are computed inside hospitals based on data recorded during the care process and stored in the Electronic Medical Record (EMR). In the United States, the meaningful use [3] of EMRs is put forward as a national goal, which includes the electronic exchange of health information as well as the computation and reporting of clinical quality measures [4]. This meaningful use reduces the registration burden for care providers and furthermore enables the unobtrusive measuring and monitoring of indicators in real-time, allowing for timely intervention.
Next to this development, national and international medical data registries proliferate [5], which are frequently used to quantitatively compare performance between health-care institutions. Due to various barriers that impede the reuse of data [6], many care organisations still collect the data for quality registers manually [7]. This labour-intensive process might lead to the undesirable situation that the data in registers differs from source data in an EMR.
In the Netherlands, "Zichtbare Zorg" [8] developed amongst others a set of 11 evidence-based colorectal cancer surgery indicators, which is computed based on the register of the Dutch Surgical Colorectal Audit (DSCA) [9]. The DSCA has been set up in 2009 to measure and to improve the quality of colorectal cancer surgery, serving as both national and international role model. All Dutch hospitals that perform colorectal cancer surgery submit data to the DSCA register. Ideally, data should be submitted (semi-)automatically, but in practice surgeons often enter it manually via a web form. The data is often submitted at the end of a reporting year, impeding timely feedback.
This study aims to assess whether the set of quality indicators can be computed automatically based on EMR data and to investigate barriers to succeed. Hence, we compared quality indicators computed based on our EMR data to the same indicators computed based on manually abstracted data for the DSCA register, and performed a data quality analysis to explain any differences.
Patient data
We used two data sources of a department of colorectal cancer surgery in a university hospital: manually abstracted data for the DSCA register and structured data from the EMR.
The DSCA dataset consists of 212 variables, including demographic information, diagnoses, procedures, results of pathological examinations and clinical outcome. Attending surgeons enter the required data, either manually with the help of a web form, which takes 15 to 20 minutes per patient, or with a spreadsheet. In most hospitals the data is entered via the web form. In our hospital, the responsible surgeon preselects the patients for whom to submit data from the database containing all surgical procedures. He then browses structured and unstructured data such as pathology reports for the respective patients to identify as many of the required variables as possible. All patients of our hospital for whom data has been submitted to the DSCA in 2011 were included.
For this study, we regarded the DSCA dataset as the current reference standard. We deliberately do not refer to it as gold standard because we cannot exclude all possibility of errors due to manual data entry. However, surgeons have reported to enter the data carefully. Also, the data is monitored by the DSCA by an annual comparison to the dataset of the Dutch Cancer Registry. Its reliability seems to be high: A recent comparison showed that data has been submitted to the DSCA register for 94% of the patients in the Dutch Cancer Registry. Most data items correspond well, with discrepancies being mainly due to differing interpretations and definitions [10]. For example, anastomotic leakages are only registered in the DSCA if they caused a re-intervention, while the Dutch Cancer Registry handles a broader definition.
Regarding our EMR, several source systems that contain information on patients, diagnoses, operations, admissions, encounters, pathology reports, endoscopies and medications periodically insert data into our data warehouse. Diagnoses are encoded in ICD-9-CM, and surgical procedures in codes from a Dutch procedure classification consisting of nearly 40,000 codes. All patients who had an operation in 2011 have been extracted from the data warehouse. In the following, we refer to this dataset as EMR. All patients from the EMR who seemingly should have been submitted to the DSCA in the reporting year 2011 due to a recorded surgical resection of a primary colorectal carcinoma were included.
Patient matching
In absence of patient identifiers, the patients for whom data has been submitted by our hospital to the DSCA in 2011 are matched with the patients from the EMR based on their gender, year of birth and operation date as well as sets of procedures that they underwent.
The Institutional review board of the Academic Medical Centre at the University of Amsterdam waived the need for informed consent, as individual patients were not directly involved. The use of the data is officially registered according to the Dutch Personal Data Protection Act.
Quality indicators and their computation
We used the set of colorectal quality indicators released by a governmental quality of care program called "Zichtbare Zorg" for the reporting year 2011. The set consists of 8 thematic indicators, 3 of which comprise two related indicators denoted as e.g. 8a and 8b, resulting in a total of 11 indicators: 9 process indicators, 1 structure indicator and 1 outcome indicator (see Table 1). The process and outcome indicators are percentages computed based on the definitions for numerators and denominators of each indicator. The structure indicator 8a ("How many surgeons does the team include and how many of these surgeons carry out resections on primary colonic carcinoma patients?") is not designed to be computable based on the EMR. Therefore, we did not include it in our study. Of the remaining 10 indicators, the DSCA indicator 1 and the circumferential resection margin indicator 6a measure the percentage of patients for whom data has been submitted to the DSCA. As we do not expect submission of data to the DSCA to be recorded in the EMR, we exclude the numerators of these indicators. The 8 fully and 2 partially (i.e. only the denominator) included indicators have been formalised with our previously developed indicator formalisation method CLIF [11] to enable their automated computation, for which the obtained queries are run against the respective datasets. The queries are published on figshare [12].
Table 1. Zichtbare Zorg indicators for 2011 translated from Dutch to English
Outcome measures
Quality indicators
The first outcome measure is the computability of quality indicators, and the corresponding results. Numerators and denominators of indicators are computable if all required items are available in a structured format.
As in [13] and [4], we analysed the accuracy of quality indicator results computed based on EMR data by measuring sensitivity and specificity. We also measure the positive predictive value (PPV) and the negative predictive value (NPV) as well as the positive likelihood ratio (PLR) and the negative likelihood ratio (NLR).
Whether the difference in proportions was significant has been tested with Bland's and Butland's method to compare proportions in overlapping samples [14]. A p-value < 0.05 was considered significant.
Data quality
We analysed the quality of the 14 data items required to compute the set of quality indicators (Operation date, Year of birth, Procedure, Operation urgency, Primary location/Diagnosis, cT score, pN stage, pM stage, Examined lymph nodes, Circumferential margin, Colonoscopy, Chemotherapy/Medication, Meeting date and Radiotherapy start date). The first quality dimension we analysed is availability in a structured format, as unstructured data cannot be used directly to automatically compute quality indicators. For data items that are available in a structured format, we focus on the quality dimensions completeness and correctness[15]. Completeness is measured as the percentage of items that should be recorded for each patient (such as the operation urgency, as all included patients have been operated) that are indeed available in the respective dataset. Items that do not necessarily apply to all patients, such as the start date of preoperative radiotherapy, are excluded, as a missing value might be due to the fact that the patient was indeed not treated with previous radiotherapy, but it might also be the case that the start date has not been recorded. Items explicitly recorded as 'unknown' are regarded as absent, diminishing completeness.
We measure correctness by checking whether data items recorded in the EMR are consistent with the corresponding items in the DSCA dataset with regard to the indicator definitions, i.e. whether they have the same effect on the indicator results. For example, a date for a multidisciplinary meeting is considered correct if both dates are before or both dates are after the operation.
Finally, encountered problems regarding data quality are categorised.
Patient matching
As shown in Figure 1, 75 patients are included for the reporting year 2011 in the DSCA dataset, and 79 in the EMR. Following the matching strategy, it was possible to match all 75 DSCA patients with patients in the EMR. Sixty-three of these patients were also selected by the query to compute the indicators based on the EMR dataset, while 12 patients were not selected. Manual inspection showed that 4 of these 12 patients had no relevant diagnosis recorded in the EMR. A fifth patient was recorded with a colonic carcinoma and a resection of rectum, but the query against the data warehouse selected patients with a colonic carcinoma and colectomy or a rectum carcinoma and resection of rectum. For the remaining 7 patients, the diagnosis date was after the (elective) operation date, so that a relationship between diagnosis and operation could not be assumed.
Figure 1. Matching of patients included in the DSCA dataset, selected from the EMR and included in the EMR.
Sixteen patients from our EMR dataset could not be matched to the DSCA dataset because they were selected incorrectly due to incorrect (e.g. tumours that were classified as non-malignant based on the pathology examination) or imprecise (e.g. recurrent carcinomas) diagnosis codes or despite missing relations between the diagnosis and the procedure in the EMR dataset.
Computation of quality indicators
Table 2 shows the indicator results computed based on the DSCA dataset, as well as fully computable indicators and denominators based on the EMR data. The chemotherapy indicators 5a and 5b as well as the radiotherapy indicator 7 could not be computed, as the required carcinoma's stage was not available in a structured format.
Table 2. Indicator results based on both datasets
Comparison of selected patients
Table 3 shows the comparison of selected patients for all fully computable indicator elements.
Table 3. Patients selected based on the two datasets
Outcome measures
Quality indicators
All 10 indicators were fully computable based on the DSCA dataset. Eight of these indicators should in principle be fully computable based on EMR data, but in practice this was the case for only three indicators. For the two indicators (multidisciplinary meeting and imaging) that are percentages, the difference in proportions computed based on the two datasets was significant.
For 4 indicators, only the denominators were fully computable, because the data items defining the quality of care measured in the numerator, such as the number of examined lymph nodes, were not available in a structured format.
Data quality
The results of the data quality analysis are given in Table 4. Fourteen data items are required to compute the set of quality indicators. All of these items are available in the DSCA register, and 8 in the EMR, with the remaining 6 only being available in free text. The pathology reports contained in the EMR comprise required data such as the number of examined lymph nodes, the circumferential margin and the pathological stage of the carcinoma only in free text. The clinical stage of the carcinoma is equally unavailable, although it might be present in free text sources that we did not have at our disposal, such as conclusions of physical or radiologic examinations or endoscopies, or contained in referral letters. It is contained in a structured format in the Dutch Cancer Registry, but the goal of our study was to focus on the data in our EMR.
Table 4. Data quality
For data items that should be recorded for each patient, the average completeness is 86% for the register's dataset and 50% for the EMR. The average correctness of data items in the EMR is 87%.
Catalogue of encountered problems
In our case study, quality indicators could not be computed reliably based on the EMR data due to the general problems as enlisted in Table 5.
Table 5. Catalogue of encountered problems
Our results show that EMR-based indicator results significantly underestimate the quality of care compared to the same indicators computed based on manually abstracted data for a national quality register. Reasons were unavailable, incomplete and incorrect data items as well as missing relationships between diagnoses and procedures in the EMR. In particular, detailed data that reflects whether a patient's treatment met the ideal standard of care was often incomplete in the EMR.
Comparison with other studies
The use of EMRs has increased rapidly in the recent years, making trustworthy reuse of data [18] an important challenge and research question. Worldwide, EMR-based quality measures [19] are increasingly employed, and new standards [20] such as eMeasures to automatically derive quality measures from EMRs are introduced.
Many researchers have compared results computed based on different data sources. Both Kerr et al. [21] and Parsons et al. [22] found that EMR-derived measures can underestimate performance in comparison to manual abstraction. Kern et al. [4] found that a "wide measure-by-measure variation in accuracy threatens the validity of electronic reporting". Likewise, results of quality indicators computed based on administrative data have been compared to results computed based on manually abstracted EMR data. MacLean et al. [23] found that the EMR allows for a greater spectrum of measurable quality indicators, while summary estimates computed based on both data sources did not differ substantially. Tang et al. [24] found a significantly higher percentage of patients that have been identified to be relevant by manual selection.
Ancker et al. observed that "secondary use of data […] requires a generally higher degree of data integrity than required for the original primary use" [25]. It has been suggested that reliable and valid quality indicator results are only achievable based on accessible and high-quality data [26-33]. Likewise, it has been shown that data quality issues are common in data warehouses and electronic patient records [34-36].
Limitations of this study
Our case study included one hospital and one year of data with a relatively small sample size, and it is questionable to what extent the situation in our hospital is generalisable to other hospitals. However, the sample size was sufficient to show that data quality can significantly influence computed quality indicator results, which should be independent from the respective location.
Recommendations/future work
Based on the encountered problems, we compiled a set of recommendations to improve the quality and (re)usability of EMR data.
Availability of structured data
Data to determine the quality of care is particularly valuable, and hospital information systems should be set up in such a way that this data is available, accessible and usable for quality measurement and further use-cases. To obtain structured data, synoptic reports, i.e. predefined computer-based forms to record relevant procedures and findings in a structured, standardised format, have been shown to be advantageous [37-39]. A standard way to encode medical free text is the use of Natural Language Processing tools. However, as most tools are developed for English, further research is required to handle Dutch [40].
Correctness of data items
Multiple data entry is unnecessary, error-prone, tedious and time-consuming. Data should be recorded only once, in an adequate quality. The quality might be risen by making those entering data aware of its possible reuses. Also, local quality improvement strategies from the literature [7,41] could be applied. To submit data to the DSCA under such improved circumstances, required items could be preselected automatically from the EMR, checked by the one responsible and be submitted to quality registers or other authorised parties. If the data needs to be edited, changes should be applied locally before the data is shared with external parties.
Longitudinal view of patient history
As patient referrals are common and hospital alliances are likewise to proliferate in the future, it must become common practice to exchange data securely and automatically. Patients are likely to become active managers of their health, increasingly enabled to share their data with their caregivers.
Relations between diagnoses and procedures
To reuse clinical data, the relations between diagnoses and procedures must be traceable. To be able to automatically select only examinations that have been carried out in the context of a certain diagnosis, such relations should be recorded.
Level of detail
Patient data should be recorded as detailed as necessary for quality indicator computation and further foreseeable use-cases, such as the recruitment of patients for clinical trials, decision support, the early detection of epidemics or general clinical research. This might seem time-consuming, but will likely reduce the workload in the long term, as each data item has to be recorded only once. To further reduce the workload, the process should be supported by advanced data entry methods and interfaces.
Only data that is represented meaningfully - ideally in standard codes from comprehensive controlled clinical terminologies - can be reused automatically. Terminologies such as SNOMED CT can support the "Collect once - use many times" paradigm [42], which stands for the idea that data is captured only once and can be reused thereafter for a variety of purposes. Controlled terminologies can allow for meaning-based retrieval, for example by aggregation along hierarchical structures, or based on relationships between codes. An advantage of standard terminologies is that they are integrated in the National Library of Medicine's Unified Medical Language System Metathesaurus, which contains mappings between terms across multiple terminologies.
This study showed that data quality can significantly influence indicator results, and that our routinely recorded EMR data was not suitable to reliably compute quality indicators. To support primary and secondary uses of data, EMRs should be designed so that a core dataset consisting of relevant items is entered directly and timely in a structured, sufficiently detailed and standardised format. Furthermore, awareness about the (re)use of data could be risen to ensure the quality of required data, and local data quality improvement strategies could be applied. Data could then be aggregated for different uses, according to various definitions. This strategy likely leads to an increased volume of high-quality data, which can ultimately serve as a basis for physicians not only to monitor but also to deliver the best possible quality of care.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
KD, RC, AtT and NdK conceived and designed the study. KD conducted the analysis and wrote the first draft of the paper. PT entered and interpreted the data. All authors reviewed the manuscript and approved the final version. KD is guarantor for the study.
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Pre-publication history
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Most people have no notice at all. They just know they "got um". http://www.lpsteamers.com/sex.html
[Edited by spotts on 08-25-2005 at 01:59 PM]
My doctor gave me six months to live, but when I couldn't pay the bill he gave me six months more.
Walter Matthau
Those are dungeoness crabs arent they? Yumy yumy yumy I got crabs in my tummy...
Millions of individuals making their own decisions in the marketplace will always allocate resources better than any centralized government planning process. -- Ronald Reagan
That ding-dong on the boy crab don't look like the Washington Monument. It looks like the Bennington Monument.
I got to get away!!!!
Originally posted by coolwhip
Those are dungeoness crabs arent they? Yumy yumy yumy I got crabs in my tummy...
Bite your tongue boy! Dems Maryland Blue Crabs.
"The crabs you eat today, slept last night in the Chesapeake Bay!"
Government is a disease... ...masquerading as its own cure
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What could be more fun than trick-or-treating? Trick-or-treating at the Zoo, of course! Each year hundreds of families dress in their Halloween best and enjoy the autumn splendor of the Zoo. With trick-or-treat stations, costumed characters and special treats for the animals, ZooBoo is an experience your family won't soon forget. Follow the fun on social at #ZooBooSPZ
Trick-or-treaters will use their ZooBoo guide to help them navigate through the Zoo in search of puzzle pieces. Trick-or-treating at the Zoo is a fun, educational and inspirational experience for all ages. Stop by the ZooShop to receive a small goodie bag filled with palm oil-free treats—your End Prize for stopping at all 10 trick-or-treat stations.
Our animals will be in on the fun, too, enjoying pumpkin treats throughout the day: otters at 11 a.m., polar bears at noon and elephants at 1 p.m.
Be sure to bring your camera for the fantastic photo ops in the Scarecrow Village, located at the Event Tent, and let kids explore our Creepy Crawly Zoo in the ECO Center.
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Memory Care Unit Dedication and Open House
Germantown Home is hosting a dedication and open house for our Memory Care Unit on October 7 with former Eagle and Congressman Jon Runyan.
Germantown Home Resident Celebrates 103rd Birthday
Germantown Home resident Gracie Connor recently celebrated her 103rd birthday with family and friends.
NewCourtland Seniors Crocheting Prayer Shawls for Terminally Ill
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Pamela Parker | April 26, 2000 | Comments
In a bid to reach the college crowd and other young fans of alternativerock, Napster Inc. -- the maker of thepopular, but controversial, file-sharing software -- on Wednesday committed$1.8 million to sponsor a concert tour featuring Limp Bizkit.
In a bid to reach the college crowd and other young fans of alternative rock, Napster Inc. -- the maker of the popular, but controversial, file-sharing software -- on Wednesday committed $1.8 million to sponsor a concert tour featuring Limp Bizkit.
The tour, featuring bands Limp Bizkit and Cypress Hill, is set to begin on July 4 in Chicago. It will visit 24 venues, seating 3,000 to 5,000 people, in 10 cities over four weeks.
"We are very excited to have the opportunity to work with great bands that have such passionate music fans, like Limp Bizkit," said Shawn Fanning, the 19-year-old founder of Napster.
Napster has been very controversial in the music industry, because it enables the easy sharing of MP3 files, which is often done without regard to copyright violations. The company has also raised the ire of network administrators on college campuses, because the popular program was expending a significant amount of Internet bandwidth.
Moreover, it has seriously angered some well-known artists, such as Metallica and rap artist Dr. Dre. Last week, Metallica sued Napster and some schools for copyright infringement.
This week, Dr. Dre raised the bar by going after both the company and university students who are using them. In response, the artist is asking that the court shut down Napster and award damages of $100,000 per illegally copied work, or as much as $10 million.
Pamela Parker is a former managing editor of ClickZ News, Features, and Experts. She's been covering interactive advertising and marketing since the boom days of 1999, chronicling the dot-com crash and the subsequent rise of the medium. Before working at ClickZ, Parker was associate editor at @NY, a pioneering Web site and e-mail newsletter covering New York new media start-ups. Parker received a master's degree in journalism, with a concentration in new media, from Columbia University's Graduate School of Journalism.
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Re: "Well, what did Obama check off for the Census? If he checked black, he lied!"<quoted text>
Well, what did Obama check off for the Census? If he checked black, he lied!
Oh, if you tear off the corner of a dollar bill, so long as you have at least 75% of the bill remaining, it is still worth it's face value. If you have 75% or less, it is worth less than it's face value. As far as movies go, I take them with a gain of salt.
Yes, he did, but then we do not know how he filled out the census form, nor do we know how Romney or Ryan or Bush filled it out---and we don't care, and I don't care how Obama filled out the census form, but you do (which says something about you).
Here, btw, is the census form, and as you can see it allows someone to check off multiple races or to write in the name of "some other race."
But, getting back to the birth certificate: Obama's published birth certificate is still accurate, as the officials in Hawaii of BOTH parties have confirmed.


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Norwich - Despite a difficult year for many hospitals nationwide, The William W. Backus Hospital achieved a 9.22 percent operating margin of revenues over expenses in fiscal 2013 by curtailing costs and reducing waste.
"Fiscal 2013 was a brutal year in our industry, but in the midst of a challenging and tumultuous health care landscape, we remain strong," Anthony Joyce, chairman of the hospital's board of directors, said at the annual meeting Wednesday.
This annual meeting was the first in the hospital's 120-year history to be open to the press, and also the first since its affiliation with Hartford HealthCare in August. Continuing its long-standing pattern of financial health, Backus generated a $25.4 million operating margin that was almost twice the amount it set for its goal at the beginning of the fiscal year, which ended Sept. 30.
Total revenues of $275.2 million were about $8 million less than the previous year, but the operating margin remained strong by "bending the cost curve and making some difficult and sometimes painful" decisions to cut expenses, Joyce said. Among these, the hospital last week announced layoffs of 10 senior and mid-level management positions and elimination of more than a dozen other jobs through vacancies and retirements.
Elliot Joseph, president of Hartford HealthCare, said challenges facing hospitals include the "dramatic reduction" in government payments for health care, declining demand and increasing cost-consciousness by patients.
"Consumers will increasingly look for value in health care," he said, noting that doctors are now being asked by patients regularly how much a particular test or procedure will cost, a question they rarely heard until recently.
Statewide, he said, patient volume fell about 3.5 percent in the past year. At Backus, inpatient admissions fell from 10,974 in 2012 to 10,573 in 2013, while inpatient and same-day surgeries also declined. Emergency Department visits, however, increased by almost 10,000 patients, to 78,842 in 2013.
As part of Hartford HealthCare, Backus is one of five acute care hospitals and several affiliated organizations that will work together to control costs and improve quality, Joseph said, to ensure that the Hartford, central and eastern Connecticut regions have a "sustainable, local, affordable health care system."
"Health care is too expensive," Joseph said. "But there is enough money in the health care system to do this right" through redistribution of resources.
While the hospital received several awards in 2013 for various quality measures, David Whitehead, president and chief executive officer of Backus, said the most significant achievement was a new routine of 15-minute "daily safety huddles" each morning. Patient care and administration leaders gather to discuss what happened in the last 24 hours and how to respond to ensure that the hospital continues to provide exceptional care, Whitehead said.
"It's the best thing we've ever done," he said. "It allows us to make rapid cycle changes. It's been a whole cultural change." The hospital also embarked on a "Safety Starts with Me" program for staff to reduce errors and improve patient safety.
In the coming year, the hospital is planning to create a center for preventive medicine and begin a "Backus Delivers" campaign that would include sending health coaches out into the community to work with patients one on one.
"We're moving from sick care to health care, from volume to value," Whitehead said. "It's the only bottom line that matters."
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