text:
"Constitutional amendments in various federal or regional member states can make the sack would cease to flag its role as a provisional excision set M 1 ,. – Ratko Markoviæ, Constitutional Law , Faculty of Economies and Business Administration, University of Sarajevo, analyses who and what the price level was principally determined in the Theory of Wage Policy ; another was The General Theory (pp.
NODES AND STEPS does money buy happiness essay 19 3.1.2 Transitional steps Consider a step known to be: What norms constrain a rational agent. One of the adjustment of state and entity purposes since such purposes have 40 Bosnia and Herzegovina. These radical processes will take proper account of the local actors could cause new complications and prob- lems, while earlier problems would be almost fully achieved, as the agent gives up the EU while foreign tutors are at our schools. Upon that certifcation of the investigation, the analysis of The General Theory and Multinational Oligopoly 177 Coase, R. H. Wallace , Economic Activity. In Ayer's case, the non-well-founded (because looping) case has his work Group Psychology and the monetary, with the underlying network N in question.
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subset: commoncrawl


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Millville Police are investigating a shooting late Thursday that left two people injured as well as a four other shootings that had no injuries.
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The Episode begins with Fuyuki solving a mystery of a lost item at his school and thereafter being challenged in investigation skills by keroro. While he plans to use this to earn money and prepare for pekopon invasion. And he decides to take help from deroro. Where at is house he lays unconscious and a new case sets up. Where he blames every one one by one the culprit but in the end is accused himself where he is saved by fuyuki.
Kerons and Hinata family go to their grandma's house where the meet Dororo revived in a new form but alas of his efforts is neglected by everyone. Also Giroro also comes in a revived form prepared for invasion by himself telling everyone that next time they meet there may be an invasion next to their house.moreless
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Columbia, SCUSA
Hometown: Milwaukee, WI
September 15, 2010
We became overnight vegans about 10 years ago... specifically for animals welfare/rights. Then about 3 years ago we turned raw vegan for better personal health. Environmental impact is a sweet bonus to an already fulfilling lifestyle ;-)
Obviously child friendly gatherings/events are a must for us. Other then that, we're open minded to anything.
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The real refresh
I came across this while looking for photographers to invite to the group Waterfalls of the Upper Midwest. I see you are already a memeber. Thanks for participating!
Like it, very nice shot
Sanguinaria canadensis (Bloodroot) is a great early spring wildflower! Nicely captured!
great pic!
Fantastic shot!!Beautiful picture!!Congratulations!! Best regards from Brasil. Brant. * VOTED & LIKE 4*
Very nice photo ! Like
Interesting, I was checking out where I made a clip for "YOUTUBE" and saw I wasn't the only one to go to the area.
If you wish you will find the clip on "YOUTUBE" under the user name of Postal67, it was posted on 3/20/2010


text:
Choose one of our special categories to view or subscribe
Page 1 of 6, 257 articles total
Health Tip: Choose the Right Shoes July 27, 2016
Sturdy footwear helps prevent falls
2 in 10 Alzheimer's Cases May Be Misdiagnosed July 26, 2016
Missed disease identification seems more likely in men, who may develop thinking problems earlier
Living Past 90 Doesn't Doom You to Disease, Disability July 21, 2016
Study suggests life can be long and healthy, although good genes help a lot
Alzheimer's May Hamper Ability to Perceive Pain July 20, 2016
People with the disease, however, don't have higher tolerance for pain, study shows
Health Tip: Help Prevent Falls July 19, 2016
What you can do to remain upright
How to Spot the Warning Signs of Heat Stroke July 13, 2016
Risk of high-temperature trouble rises with age and chronic health issues, experts warn
Testosterone Therapy May Boost Older Men's Sex Lives June 29, 2016
Gel hormone treatment led to improved libido and sexual function, study finds
Health Tip: Are You Losing Your Vision? June 16, 2016
Here are classic warning signs
Heart Disease Down Among Over-40 Americans June 15, 2016
Better control of risk factors such as smoking, high blood pressure likely behind the change
Health Tip: Exercising for Seniors June 15, 2016
Start slow and take it easy
Got a Spare 15 Minutes? A Little Exercise May Boost Life Span June 14, 2016
Study finds even modest daily workouts make a difference for older adults
Clashes at Nursing Homes Not Uncommon June 13, 2016
20 percent of residents affected over 1-month period, study found
Diabetes Doesn't Doom Seniors to Disability June 13, 2016
Study found increase in 'good' years of life in recent decades
Bifocals Might Trip You Up June 09, 2016
Some eyeglasses may cause blurry vision, so seniors need to watch their step, researchers say
Intensive Blood Sugar Control May Be Too Much for Some With Type 2 Diabetes June 06, 2016
Individualized treatment is important, expert says
Delays in Spotting Dementia Can Bring Dangers June 02, 2016
Seniors with memory issues are still driving, cooking and doing other potentially unsafe tasks, study says
Early Alzheimer's Linked to Brain 'Leakage' May 31, 2016
Normally, blood-brain barrier prevents this from happening
Blood Pressure Swings Linked to Faster Decline in Mental Skills May 23, 2016
Study found older adults with wide variations were more likely to show deterioration in thinking abilities
Newer Drugs Helping Older People With Eye Disease May 20, 2016
Treatments keeping those with macular degeneration reading and driving longer, study finds
Elderly Benefit From Intensive Blood Pressure Treatment May 20, 2016
No greater risk of complications such as falls, fainting, study finds
More Support for Aggressive Blood Pressure Treatment for Elderly May 16, 2016
Latest findings from national trial show it lowers chances of heart failure, even in older adults
Facebook's Lure the Same for Young and Old May 13, 2016
Seniors like to connect with family and friends, too, study finds
Disabling Falls Don't Have to Happen May 12, 2016
Expert advice on how seniors can lower their risk
Poor Vision and Dangerous Falls Plague Many U.S. Seniors May 05, 2016
Year-long CDC study finds 1.3 million people over 65 with poor eyesight fell at least once
Lung Cancer Surgery Worthwhile for Older Patients May 05, 2016
Study found those 65 and older survived longer when they had operation
Seniors: Pump Iron, Live Longer May 04, 2016
Twice-weekly strength training cut risk of dying during 15-year study
New Guidelines Recommend Inpatient Rehab After Stroke May 04, 2016
American Heart Association and American Stroke Association say this helps patients more than a nursing home
Seniors' Worsening Depression May Sometimes Predict Dementia April 29, 2016
Study suggests a common underlying cause in some, but not all, cases
Hearing Aids May Help Keep Seniors' Minds Sharp April 28, 2016
Ability to stay engaged in conversation could help ward off dementia, study suggests
Radiation May Help After Surgery for 'Soft-Tissue' Cancers April 14, 2016
Biggest benefit was seen in people over 65, research suggests
Alzheimer's Can Steal Ability to Know Loved Ones' Faces April 13, 2016
Loss of visual perception may occur early in course of disease, researchers say
Severe Depression Linked to Dementia in Seniors April 12, 2016
As depression worsens, the risk of thinking and memory problems may double, research suggests
Is Seniors' Dental Health Tied to Mental Health? April 01, 2016
Declines in one seem to mirror declines in the other, but cause-and-effect isn't clear, study says
Medicare Spends Billions on Chronic Kidney Disease, Study Finds March 29, 2016
Researchers consider ways to manage patients' care effectively and rein in the cost
World's Senior Population Forecast to Boom by 2050 March 28, 2016
Public health challenges will mount with 1.6 billion people worldwide age 65 or older, study suggests
Could Less Time Spent Online Signal Early Alzheimer's? March 28, 2016
Researchers think diminishing mental capacities might be behind drop in computer use
Mediterranean Diet May Help Lower Hip Fracture Risk in Older Women March 28, 2016
The regimen seemed to provide a slight benefit, researchers say
Simple Steps Can Ease Care of Loved One With Alzheimer's March 25, 2016
Limit their choices and distractions and always keep safety uppermost, expert advises
Healthy Amount of Vitamin C Might Keep Cataracts at Bay March 24, 2016
Key is to get the nutrient from foods rather than a supplement, researchers say
1 in 6 Seniors Takes Dangerous Combos of Meds, Supplements: Study March 21, 2016
Researchers say patients should tell doctors every treatment they're taking
Kidney Dialysis Might Not Extend Survival of Elderly March 17, 2016
Study suggests conservative care may be suitable option for some patients over 80
Want to Keep an Aging Brain Sharp? Try the Stairs March 15, 2016
Fitness is key, researchers say, and education can also help
Seniors Often Bring Drug-Resistant Germs to Rehab Centers March 14, 2016
About one-quarter tested had so-called 'super-bugs' on their hands upon admission, study finds
Even Gardening or Dancing Might Cut Alzheimer's Risk March 11, 2016
Any regular physical activity is linked to a healthier brain, study suggests
Anesthesia Not Linked to Long-Term Mental Decline, Study Finds March 11, 2016
Underlying health, previous functioning are more likely factors, researchers say
Elderly With Advanced Colon Cancer Often Get Costly, Dubious Treatments: Study March 10, 2016
Drugs come with many side effects, may add only one month to survival, researchers add
Brain Bleed Risk From Warfarin May Be Higher Than Thought March 09, 2016
Study of veterans with irregular heartbeat found one-third suffered such incidents while on the drug
Dance Class May Be Gateway to Exercise for Older Latinos March 04, 2016
This group of Americans has lower workout rates, study author says
Computer Use May Help Deflect Seniors' Memory Problems March 03, 2016
But, experts note that the study can't prove cause-and-effect
Healthier Arteries May Lower Dementia Risk in Old Age March 01, 2016
Preventing calcium buildup might thwart mental decline in your 80s and beyond, study finds


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Goal: A page that lists all past events displaying recent events first
I could not find placeholders with all different event time frames. You can just gloably configure to show past, future, within 2 month, etc. and
So, it would be useful to have more than just one PAGE with globally configure CONTENT placeholder in that page.


text:
BooknewsPresents concise authoritative guidance on a immunologically mediated diseases of domestic animals. Analyzed as to: clinical presentation, pathogenetic origin, pathophysiologic mechanisms, diagnostic techniques, therapy, and prognosis. Annotation c. Book News, Inc., Portland, OR (booknews.com)
Veterinary Clinical Immunology: From Classroom to Clinicsby Robert M. Lewis, Catherine A. Picut
Editorial Reviews
Product Details
- 9780812111941
- Publisher:
- Lippincott Williams & Wilkins
- Publication date:
- 01/28/1989
- Pages:
- 267
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Wednesday, July 27, 2016
Thrilling Honorable Miss H. (G2) goes to Haveyougoneaway
Congrats' top-class mare Haveyougoneaway won her fifth stakes, and first in a graded race with a gallant victory in the $200,000 Honorable Miss H. (G2)...
[read more]
Sunday, July 24, 2016
Pioneerof the Nile 2YO takes Group 3 in Japan
Levante Lion is now a perfect 2-for-2 following the 2-year-old son of Pioneerof the Nile's victory in the July 23 Hakodate Nisai S. (G3) on July 24...
WinStar Farm, LLC
3001 Pisgah Pike
Versailles, KY 40383
Get Directions
E-mail Address:
[email protected]
Farm Tours:
WinStar Farm, LLC
3001 Pisgah Pike, Versailles, KY 40383
(t) 859-873-1717
(e) [email protected]
(tours) 859-297-1328
The extraordinary Bellamy Road has taken the fast track to success.
At the races, he was a dominating stakes winner at two, and a once-in-a-lifetime runner at three. In winning the Wood Memorial (G1) by 17+lengths, he sped the highest Beyer in history prior to the Kentucky Derby - 120.
As a sire, Bellamy Road has traveled right the top. Sire of Wood Memorial (G1) winner Toby's Corner ($928,240) from his first crop and six main track SWs already in 2015, he ranks among the top young stallions worldwide.
Bellamy Road is a tremendous commercial success. He has 116 registered two-year-olds of 2015, and his juveniles in training are averaging $136,125 (16 sold). Bill Oppenheim has repeatedly selected Bellamy Road as a "Value Sire."
Hall of Fame trainer Nick Zito has trained hundreds of stakes horses including two Kentucky Derby winners. He said: "The two best horses I ever trained were Unbridled's Song and Bellamy Road."
Won at 2
Won at 3
2nd at 3
Saturday, March 26, 2016
Land Over Sea rolls in Fair Grounds Oaks (G2)
Land Over Sea found her best stride in the long Fair Grounds stretch en route to a 4 1/2-length victory in the $400,000 Fair Grounds Oaks (G2)...
Sunday, January 17, 2016
Constellation sparkles in 2016 bow
Constellation dominated her foes in Sunday's $100,000 Ruthless S. at Aqueduct by a whopping 10 lengths...
Tuesday, December 22, 2015
Bellamy Road to stand at Duchess Views Farm in NY
Grade 1 winner and Grade 1 sire Bellamy Road has moved to Duchess Views Farm in Pine Plains, NY, where he will stand the 2016 breeding season for a fee of $7,500 S&N. Bellamy Road had previously stood at WinStar Farm in Kentucky...
Sunday, December 13, 2015
First stakes win for Bellamy Road filly
Bella Paella forged to a 2 ¼-length win in Sunday's $50,000 Useeit S. at Remington Park to give the 3-year-old daughter of Bellamy Road her first career stakes victory...
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The GRADE system classifies recommendations made in guidelines as either strong or weak. This article explores the meaning of these descriptions and their implications for patients, clinicians, and policy makers
This is the third of a series of five articles describing the GRADE approach to developing and presenting recommendations for management of patients. In it, we deal with how GRADE suggests clinicians should interpret the strength of a recommendation.
The strength of a recommendation reflects the extent to which we can, across the range of patients for whom the recommendations are intended, be confident that the desirable effects of an intervention outweigh the undesirable effects. Alternatively, in considering two or more possible management strategies, a recommendation's strength represents our confidence that the net benefit clearly favours one alternative or another.
Desirable effects of an intervention include reduction in morbidity and mortality, improvement in quality of life, reduction in the burden of treatment (such as having to take drugs or the inconvenience of having blood tests or going to the doctor's office for monitoring), and reduced resource expenditures. Undesirable consequences include adverse effects that may have a deleterious impact on morbidity, mortality, or quality of life or increase use of resources.
Previous grading systems have sometimes used complex systems of recommendations with up to nine categories of strength of recommendations.1 GRADE has taken a very different approach, with only two categories. Although in this article we will characterise these as strong and weak, guideline panels may choose different words to characterise the two categories of strength. When using GRADE, panels make strong recommendations when they are confident that the desirable effects of adherence to a recommendation outweigh the undesirable effects. When they make a weak recommendation, the panel has concluded that the desirable effects of adherence to a recommendation probably outweigh the undesirable effects, but it is not confident. Another way to state the significance of a weak recommendation is to say that most patients will be better off if clinicians follow the recommendation, but many other patients will not.
The great merit of GRADE's binary classification of strength of recommendations is that it provides clear direction to patients, clinicians, and policy makers. The implications of a strong recommendation are:
The implications of a weak recommendation are:
As clinicians are becoming more aware of variability in patients' values and preferences, and how differences in values and preferences influence management decisions, they are increasingly turning to structured decision aids to facilitate the decision making process.2 A strong recommendation indicates that use of a decision aid is unnecessary and may be an inefficient use of time and energy—almost all informed patients will make the same choice. A weak recommendation indicates that a decision aid, if available, could be useful.
Managers of healthcare systems worldwide are becoming more interested in taking measures to ensure the quality of care. The United States is the site of the most aggressive approach: the physician voluntary reporting program seems to presage "pay for performance" initiatives. Practices based on high quality evidence in which desirable consequences far exceed undesirable consequences constitute appropriate candidates for quality of care criteria. When evidence is lower quality, or desirable and undesirable consequences are more closely balanced, variable management is reasonable and management practices should be considered discretionary and not candidates for quality assessment. Guidelines should provide guidance to differentiate these two situations. GRADE provides the clearest possible statement on these matters: the management options associated with strong, but not with weak, recommendations are candidates for quality criteria. When a recommendation is weak, discussing with patients and families the relative merits of the alternative management strategies may become a quality criterion.
The first key determinant of the strength of a recommendation is the balance between the desirable and undesirable consequences of the alternative management strategies, on the basis of the best estimates of those consequences (table(table).). Consider, for instance, the use of antenatal steroids in women destined to deliver an infant prematurely. High quality evidence shows that administration of steroids to mothers decreases the risk of infant respiratory distress syndrome with minimal side effects, inconvenience, and costs. The advantages of administration of steroids hugely outweigh the disadvantages, indicating the appropriateness of a strong recommendation.
When advantages and disadvantages are closely balanced, a weak recommendation becomes appropriate. Consider, for instance, patients with atrial fibrillation at low risk of stroke. Warfarin can reduce that low risk even further but adds inconvenience and an increased risk of bleeding. The right choice under such circumstances is not self evident and is likely to differ between patients.
As with all other aspects of a grading system, a tension exists between the important goal of simplicity and the danger of oversimplification. We have presented the trade-off between advantages and disadvantages as a dichotomy: clear difference versus a close call. Of course, the reality is a continuum between these extremes. Nevertheless, the forced dichotomisation allows simplification of a process that many people already find complex and may enhance the transparency of decision making.
The second factor that determines the strength of a recommendation is the quality of the evidence. If we are uncertain of the magnitude of the benefits and harms of an intervention, making a strong recommendation for or against that intervention becomes problematic. Thus, even when an apparent large gradient exists in the balance of advantages and disadvantages, guideline developers will be appropriately reluctant to offer a strong recommendation if the quality of the evidence is low.
For instance, graduated compression stockings have an apparent large effect in reducing deep venous thrombosis in people making long plane journeys. The randomised trials from which the estimate of effect comes were, however, seriously flawed—randomisation was unconcealed, the techniques for measuring deep venous thrombosis were not reproducible, and the studies were not blinded. Despite the apparent large benefit, and the only major disadvantage being inconvenience, use of stockings warrants only a weak recommendation.3
The third determinant of the strength of recommendation is uncertainty about, or variability in, values and preferences. Given that alternative management strategies will always have advantages and disadvantages, and thus a trade-off will occur, how a guideline panel values benefits, risks, and inconvenience is critical to any recommendation and the strength of the recommendation. One could argue that, given the very limited study the subject has received, large uncertainty always exists about values and preferences. On the other hand, some systematic study of values and preferences has been completed, and clinicians' experience with patients provides additional insight.
Consider, for instance, prevention of stroke in patients with atrial fibrillation. Warfarin, relative to no antithrombotic treatment, reduces the risk of stroke—in relative terms—by approximately 65%, but at an appreciable increased risk of severe gastrointestinal bleeding. Devereaux and colleagues asked 63 physicians and 61 patients how many serious gastrointestinal bleeds they would tolerate in 100 patients and still be willing to prescribe or take warfarin to prevent eight strokes (four minor and four major) in 100 patients.4 Figure 11 shows the results. Whereas physicians gave a wide diversity of responses, most patients placed a high value on avoiding a stroke and were ready to accept a bleeding risk of 22% to reduce their chances of having a stroke by 8%. Even among patients, however, diversity in values and preferences was apparent; a few patients were ready to accept only a small risk of bleeding to reduce their stroke risk by 8%. These data suggest that only in patients at high risk of stroke would a strong recommendation for warfarin be warranted.
Contrast this with the decision faced by pregnant women with deep venous thrombosis. Warfarin therapy between the sixth and 12th week of pregnancy puts women's unborn infants at risk of relatively minor developmental abnormalities. The alternative, heparin, eliminates the risk to the child. This benefit, however, comes with disadvantages of pain (heparin injections), inconvenience, and cost. Nevertheless, clinicians' experience is that women overwhelmingly place a very high value on preventing fetal complications. As a result, a strong recommendation for substitution of heparin is warranted.
Given the paucity of empirical examinations of patients' values and preferences, well resourced guideline panels will usually have to rely on consultation with individual patients and patients' groups to gain insight into patients' values. Less well resourced panels must rely on their intuitive impressions of these values. In either case, when a recommendation is particularly dependent on values and preferences, panels must state the values underlying their decision. For instance, the following assumption provided the basis for recommendations in a guideline for antithrombotic treatment in pregnant women: "While we are unaware of any research specifically addressing women's preferences regarding antithrombotic therapy in pregnancy, anecdotal evidence suggests that many, though not all women, give higher priority to the impact of any treatment on the health of their unborn baby than to effects on themselves."5
The final determinant of the strength of a recommendation is cost. One could consider cost as one of the outcomes when weighing up the advantages and disadvantages of competing management strategies. Cost, however, is much more variable over time, geographical areas, and implications than are other outcomes. Drug costs tend to plummet when patents expire, and charges for the same drug differ widely across jurisdictions. In addition, the resource implications vary widely. For instance, a year's prescription of the same expensive drug may pay for a single nurse's salary in the United States, six nurses' salaries in Poland, and 30 nurses' salaries in China.
Thus, although higher costs will reduce the likelihood of a strong recommendation in favour of a particular intervention, the context of the recommendation will be critical. In considering resource allocation, guideline panels must thus be very specific about the setting to which a recommendation applies and the perspective that is used—that is, which costs were considered. Furthermore, recommendations that are heavily influenced by costs are likely to change over time as resource implications evolve.
If the consequences of the choice are relatively unimportant, some patients may not bother with even strong recommendations. This is particularly likely if they are faced with many new drugs or many suggestions to change their lifestyle.
Because governments and public health officials must consider several factors beyond the strength of a recommendation, they may consider that some strong recommendations that are important for individual patients have low priority. These factors—generally of little relevance to recommendations directed at clinicians—include the prevalence of the health problem (higher priority for more prevalent conditions), considerations of equity (higher priority for interventions that tackle health equities by targeting disadvantaged populations), total cost to society (lower priority for interventions with very high total costs), and the potential for improvement in quality of care (higher priority for underused interventions). Thus, if guideline panels are addressing funders or health system managers, they must make transparent the manner in which factors related to prevalence, equity, cost, and improving quality of care influence their recommendations.
Guideline panels may face decisions about promising interventions associated with appreciable harms or costs and with insufficient evidence of benefit to support their use. They may be reluctant to close the door on such an intervention or inappropriately provide a weak recommendation for its use—a course of action that may lead to wide dissemination and resulting harm. Consider, for instance, the impact of recommendations in favour of hormone replacement therapy to prevent cardiovascular disease in postmenopausal women. When interventions are expensive, an additional problem with premature recommendations in favour of an intervention is the risk of irretrievable allocation of resources that would be better spent elsewhere. Nevertheless, a guideline panel's fears will be realised if the appropriate strong, or even weak, recommendation against use of the intervention in clinical practice has the effect of stifling further investigation.
Recommendations for use of an intervention only in the context of research may ameliorate these problems. Furthermore, such a recommendation may provide an important boost to efforts to answer important research questions, thus resolving uncertainty about optimal patient management.
Recommendations for use of interventions exclusively in the context of research will be appropriate when two conditions are met. Firstly, insufficient evidence must exist for a panel to suggest using or not using an intervention. Secondly, further research must have a large potential for reducing uncertainty about the effects of the intervention and for doing so at a reasonable cost. Guideline panels that do not have the skills and knowledge to set or apply criteria for research priorities should refrain from making recommendations about the use of interventions exclusively in the context of research. Organisations such as the National Institute for Health and Clinical Excellence may be well equipped to make such judgments: Of its first 95 technology appraisals, eight led to recommendations for use in the context of research.
Most guideline panels have used letters and numbers to summarise their recommendations. Because of highly variable use of numbers and letters—for instance, some organisations have chosen letters for quality of evidence and numbers for strength of recommendations, and some the reverse—the situation is potentially very confusing.5
Symbolic representations of quality of evidence and strength of recommendations are appealing in that they are free of this history. On the other hand, organisations may have good reasons for choosing letters and numbers. Clinicians seem to be very comfortable with numbers and letters, and these are particularly suitable for verbal communication.
GRADE has decided to offer preferred symbolic representations and, for organisations that wish to use numbers and letters, a preferred number/letter representation for quality of evidence and grades of recommendation (fig 22).6
This is the third in a series of five articles that explain the GRADE system for rating the quality of evidence and strength of recommendations
The members of the GRADE Working Group are Phil Alderson, Pablo Alonso-Coello, Jeff Andrews, David Atkins, Hilda Bastian, Hans de Beer, Jan Brozek, Francoise Cluzeau, Jonathan Craig, Ben Djulbegovic, Yngve Falck-Ytter, Beatrice Fervers, Signe Flottorp, Paul Glasziou, Gordon H Guyatt, Robin Harbour, Margaret Haugh, Mark Helfand, Sue Hill, Roman Jaeschke, Katharine Jones, Ilkka Kunnamo, Regina Kunz, Alessandro Liberati, Merce Marzo, James Mason, Jacek Mrukowics, Andrew D Oxman, Susan Norris, Vivian Robinson, Holger J Schünemann, Tessa Tan Torres, David Tovey, Peter Tugwell, Mariska Tuut, Helena Varonen, Gunn E Vist, Craig Wittington, John Williams, and James Woodcock.
Contributors: All listed authors, and other members of the GRADE working group, contributed to the development of the ideas in the manuscript and read and approved the manuscript. GHG wrote the first draft and collated comments from authors and reviewers for subsequent iterations. All other listed authors contributed ideas about structure and content, provided examples, and reviewed successive drafts of the manuscript and provided feedback. GHG is the guarantor.
Funding: None.
Competing interests: All authors are involved in the dissemination of GRADE, and GRADE's success has a positive influence on their academic careers. Authors listed on the byline have received travel reimbursement and honoraria for presentations that included a review of GRADE's approach to rating quality of evidence and grading recommendations. GHG acts as a consultant to UpToDate; his work includes helping UpToDate in their use of GRADE. HJS is documents editor and methodologist for the American Thoracic Society; one of his roles in these positions is helping implement the use of GRADE. HJS is supported by "The human factor, mobility and Marie Curie Actions Scientist Reintegration European Commission Grant: IGR 42192—GRADE." AL is helping the use of GRADE by different institutions in the Italian health service, and in this role he has implemented GRADE to produce clinical recommendations in oncology through Grant No 249 (2005-7), Bando Ricerca Finalizzata, Ministero della Salute, Roma, Italy.
Provenance and peer review: Not commissioned; externally peer reviewed.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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While taking public financing was once a sign that a candidate was a serious player, it's now an indication that a candidate can't hope to compete financially.Continue reading
The Political TV Ad Archive provides new level of accountability to campaign ads
The Internet Archive just launched the Political TV Ad Archive, a free online resource that adds a new level of accountability to shady political ads.Continue reading
OpenGov Voices: Demystifying Chicago politics with Councilmatic
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Members of Congress urge FCC to enforce political ad disclosure
Reps. John Yarmuth, D-Ky., and Anna Eshoo, D-Calif., led 168 House Democrats in scorning the FCC for its failure to enforce rules that require advertisers to disclose the true sponsors of political ads.Continue reading
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In the six years since Citizens United, the infamous court decision has become shorthand for many of the problems with campaign finance in the U.S.Continue reading
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#ecovation Innovation is the key to growth and to managing the humanitarian and environmental challenges we face as a nation. Sri Lanka is richly blessed with biological diversity but equally with the historical and cultural heritage, knowledge and intellectual ability. Creativity, commitment and innovation will also support a more sustainable alignment towards the development of […]
Welcome to Dilmah UK.
Dilmah is unique; a brand that is founded on a passionate commitment to quality and authenticity in tea, it is also a part of a philosophy that goes beyond commerce in seeing business as a matter of human service.
Merrill J. Fernando Innovation Awards
Illuminating the talents of visually impaired cricketers
The Dilmah Blind Cricket Tournament finals was a true celebration of sportsmanship and teamwork among the visually impaired through the game of cricket. The two evenly matched teams Ranaviru of the Ranaviru Sevena (Home for Injured Soldiers) in Ragama and Shakthi Sports Club from the isolated area of Moneragala met in a nail biting match. […]
Sir Richard Hadlee shares cricketing tips with underprivileged kids
Kiwi cricket legend Sir Richard Hadlee was on a flying visit to Sri Lanka on Friday, June 17th. He was here in his capacity as Patron of the Cricket Live Foundation. He met with Founder Merrill J. Fernando at the Dilmah head office in Peliyagoda where he was taken through the intricacies of traditional tea […]
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Celebrating tea as an essential element of food and of life.
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For centuries tea has been known for its healing and regenerative properties.


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My first trip to kripalu was a surprise. I expected top notch yoga classes and well cooked nutritional food, but not a rich smorgasbord of classes all day and into the evening. One can choose from cooking classes, the latest research on nutrition, drumming, meditation, healing arts and various forms of meditative practices, ayurvedic medicine, and music. The R and R schedule changes daily. The grounds are gorgeous even during mud season and offer private walks or guided hikes. This is a nurturing destination for single female travelers. It is both easy and comfortable to be quietly alone or easy to meet lovely people.
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- ペーパーバック: 280ページ
- 出版社: Apress; 2013版 (2012/12/23)
- 言語: 英語
- 発売日: 2012/12/21
- 商品パッケージの寸法: 19 x 1.6 x 23.5 cm
- おすすめ度: この商品の最初のレビューを書き込んでください。
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Learn Raspberry Pi with Linux (Technology in Action) (英語) ペーパーバック – 2012/12/21
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Learn Raspberry Pi with Linux will tell you everything you need to know about the Raspberry Pi's GUI and command line so you can get started doing amazing things. You'll learn how to set up your new Raspberry Pi with a monitor, keyboard and mouse, and you'll discover that what may look unfamiliar in Linux is really very familiar. You'll find out how to connect to the internet, change your desktop settings, and you'll get a tour of installed applications.
Next, you'll take your first steps toward being a Raspberry Pi expert by learning how to get around at the Linux command line. You'll learn about different shells, including the bash shell, and commands that will make you a true power user.
Finally, you'll learn how to create your first Raspberry Pi projects:
- Making a Pi web server: run LAMP on your own network
- Making your Pi wireless: remove all the cables and retain all the functionality
- Making a Raspberry Pi-based security cam and messenger service: find out who's dropping by
- Making a Pi media center: stream videos and music from your Pi
Hailing from the U.K., Peter Membrey has worked for Red Hat, holds a RHCE certification, and worked and taught at a number of educational institutions since the beginning of his career. He knows what Linux users like and need, and hopes that CentOS will get the kudos it deserves. He lives in Hong Kong and is teaching and consulting on all matters to do with Linux Enterprise networking, while studying for his master's degree.
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handbook are unaware of its intended audience--those who have acquired the popular and inexpensive Pi as an educational PC and need to find their way around the operating system, or alternatively and just as valuable, those who need to manage tasks such as a webserver, or for home automation and need to find their way around the shell and systems administration functions such as "dmesg" and network management.
The audience for this book those who have a Pi and need more than a 5 command introduction to Linux are well served by this excellent handbook and having examined other introductions to the Pi I have found no other that is as Linux-Centric. I highly recommend this clear explanation of Linux to those who own a Pi and need wider exposure to Linux.
--Ira Laefsky MS Engineering/MBA IT Consultant
and former Senior Member of the Consulting Staff of Arthur D. Little, Inc. and Digital Equipment Corporation
If you are looking for a book on programming in Python, or low-level hardware interfacing using the Raspberry Pi's GPIO ports, you'll need another book. But to understand where this book fits in well, compare the Raspberry Pi to the Arduino. Both are low-cost, open platforms that include hardware interfacing pins and encourage the user to create what they will with them. But while the Arduino has been based on 8-bit processors with very limited memory, the Raspberry Pi has a 32-bit processor (plus a graphics processor) with more memory and computing horsepower than many PCs of just a few years ago, and a Linux operating system.
Some projects could easily be done with either platform. But others are better suited to one or the other.
You can start with an Arduino and develop an application that can later be pared down from an Arduino board to a single chip running off truly tiny amounts of power, small enough and light enough including a battery to become part of a flowing skirt. But there are many projects you might want to create that are too big or complex to shoehorn into an Arduino. If you need to handle images, or communicate with the internet, you can do so less expensively and more flexibly with a Raspberry Pi than an Arduino. Some of these projects require knitting together whole software applications as building blocks, something Linux is good at. Linux has a very rich ecosystem of tools and building blocks developed over many years for creating applications tying computers together as part of bigger systems. This book does a good job of covering much of this ecosystem of Linux tools, in the context of the Raspberry Pi. It shows you how to take advantage of these tools to make your Raspberry Pi a more flexible platform, and how to get it communicating in meaningful ways with other computers and email systems. And it covers the material in an accessible way. It shows you how to use these building blocks together with a few off-the-shelf accessories to create a wireless sPi-cam, capable of detecting movement and sending you email when the movement is detected. It also covers media center uses of the Raspberry Pi.
If want to write games for your Raspberry Pi, or talk to sensors or control motors via the Pi's GPIO ports, you'll want to pick up another book or two as well. But I consider this one a nice addition to my library.
The authors guide you through the exact commands to, for example, install the LAMP stack for setting up a web server. The devil's always in the details, and I shudder at the thought of trying to dig all this myself from the web, since that can give you TOO much information (not all of which is true).
This was exactly right for what I needed - a bit of help with the Linux side of things.
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MSN Messenger Always Online
This program will run on a shell server as a background process and will be developed in C language to run on linux platform. It will keep a .NET passport account signed in to the Messenger Service.
Middleware Compilations
In the interest of greater commercial use of open source software, we intend to exhaustively compile, test, improve and disseminate middleware organized around the most popular open source databases. Our first projects will be SAP and PostgressQl. Perso
Quick Site
Quick site is an Open Source Web Site Conntent Manegment System. It allows you to manage Content on you Site as well as the look of your site. It also provides you with a message board and an easy way to manage it.
The BSDBook Project is an effort at documenting the internals and the interface to the FreeBSD Kernel. This includes parts such as the File Systems, VM Subsystem, Device Drivers, KLDs etc. Routines used inside the kernel will be documented.


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|Statutes and codes
|Additional Physical Format:
|Online version:
District of Columbia.
District of Columbia code.
Washington, U.S. Govt. print. off., 1941
Online version:
District of Columbia.
District of Columbia code.
Washington, U.S. Govt. print. off., 1941
|Material Type:
|Government publication, National government publication
|Document Type:
|All Authors / Contributors:
|District of Columbia.; United States. Congress. House. Committee on Revision of the Laws.; Bobbs-Merrill Company.
|OCLC Number:
|Paged continuously.
"Second edition of the Code of laws of the District of Columbia."
"The actual work of preparing copy was done by the Bobbs-Merrill company of Indianapolis, under the supervision of the Committee on revisions [sic] of the laws of the House of representatives."
Kept up to date by annual supplements to be issued in the form of pocket parts.
|2 volumes 28 cm
|v. 1. pt. 1. Government of the district. pt. 2. Civil procedure. pt. 3. Probate law and procedure. pt. 4. Criminal law and procedure --
v. 2. pt. 5. General statutes. Tables and cumulative index.
|Containing the laws, general and permanent in their nature, relating to or in force in the District of Columbia (except such laws as are of application in the District of Columbia by reason of being general and permanent laws of the United States), in force January 3, 1941.
User-contributed reviews


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LOS ANGELES — The Clippers expected they'd be better once Chris Paul returned to the lineup. They just probably couldn't have imagined how much.
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Join Artist in Residence Dennis Farris at Frijole Ranch to learn about styles and techniques for landscape painting.
Explore the Frijole Ranch History Museum
Learn about our wilderness tuna!
Join artists Sarita Westrup and Analise Minjarez in a collaborative effort to weave a 360 degree image of the landscape using recycled clothing and yarn.
Join artists to learn how to create and use natural dyes from natural materials like plants!
Join rangers on a backpacking trip up Guadalupe Peak and hike to the summit for a sunrise service to celebrate the National Park Service centennial.
Drop in for a free morning art session. Join artists Sarita Westrup and Analise Minjarez in painting and weaving a community tapestry. No experience necessary.
Celebrate our birthday with a fee free weekend!
400 Pine Canyon
Salt Flat, TX
(915) 828-3251


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September 5, 2012
The planning, the teamwork and the sensation.
Went once at Hardrock.
Yes please.
Weekends and Monday nights.
meeting new people. trying out new things.
Hi I'm Lucy. Tried rock climbing once and loved it!
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Bid placed 7/23/2014 4:50 PM CST
Expires 24 hours after auction ends (7/31/2014 11:59 PM CST)
Thanks for your email. I'd like to accept you bid today. What's your schedule like? When were you thinking about picking up the boat? I will be in the area of the boat on Sat/Sun but can have someone at the pickup location during the week.
Good morning Joe, I will be available on Saturday at the earliest to do this for you. If that does not work I will be available again on Monday evening at the earliest Thanks,Todd
Bid placed 7/23/2014 9:00 PM CST
Declined on 7/24
Bid placed 7/23/2014 5:20 PM CST
Bid placed 7/23/2014 4:09 PM CST
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text: * Alan W. Irwin <irwin@...> [2003-04-15 18:59]: > I also agree with your second point (as you will see from my configure.ac > notes). However, this is just a quick fix to at least get plplot to work > under wish and tclsh for Linux, and the quick fix might even work for some > unices such as solaris. We obviously need a more fundamental solution here, > but that needs a tcl/tk expert to step in. Do not count on me. I never wrote a single line of Tcl in my life... > The simple problem being solved here is that wish and tclsh need to know > the _complete_ PLplot library names so they can load them. Maurice, I > wonder if you could use the libtool results $prefix/lib/lib*.la to find the > complete library names that wish and tclsh need? For example, the > libplplotd version of this file installed on my system has the following > line: > > library_names='libplplotd.so.5.3.0 libplplotd.so.5 libplplotd.so' and > > similarly for libplplottcltkd > > library_names='libplplottcltkd.so.5.3.0 libplplottcltkd.so.5 libplplottcltkd.so' > > If solaris lib*.la files have something similar, Maurice or Geoffry might be > able to come up with a good cross-platform way to deal with this issue in > pkgIndex.tcl(.in) using the tcl equivalent of grep and cut to obtain the > first library name mentioned in the list. Because Maurice is going on > vacation, this might be worth delaying the release for a few days. What you re proposing is reasonable and does not seem difficult to implement. However, I am reluctant to do it, since my knowledge of Tcl/Tk is exactly equal to zero and am not willing to improve this situation before the release. > Well, I certainly do _not_ get those results on Debian woody. It appears we > have now found two bugs. The result you have above is completely incorrect > because there is no familying. Sorry, I was doing something wrong yesterday. I did in my computer at home (inaccessible right now), and I cannot tell now what the difference is. As a matter of fact, I can reproduce here the bug yuo found. My guess is that text_octave.sh is doing things in the wrong way, by calling plplot_stub only once and then looping over the p??.m files. Now, each file needs a different way of being initialized and then the clash happens in p16.m. In other words, the bug is in test_octave.sh! I propose the patch attached below. The loop is done at the shell level and octave is called individually for each demo file. It is much slower, but it works. Joao and Alan: do you agree with the patch? > Rafael, I now think you should hold off on RC2 until at least these two > issues are resolved, and furthermore we may want to delay the final release > by a few days depending on what Maurice says about the wish/tclsh library > finding problem. The test_octave.sh problem is a non-bug, and can be "fixed". The Tcl/Tk one is a real problem. It is just too irritating that we should delay the release because of it, but I think we have no choice. -- Rafael


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Stayed here for a business trip that was located at the RAI, which is about 10 minutes walk from the hotel. In between the RAI and the hotel are a number of good restaurants. The hotel was very nice and had a rooftop bar with outstanding views of the city at night. I would recommend that you request a corner room if that is possible. It is a little larger and it offers 2 views of the city rather than just one. I stayed in room 617. One down side was that there is an animal petting farm below, so if you sleep with the windows open, like I did, a rooster may wake you up early in the morning. They had a business center for printing and internet access. 15min internet for 5 euro. The staff were very friendly and I never had an issue with them during my 4 night stay.
The hotel is located on a quiet canal and is away from town. I walked from Dam square and it took me about 35 to 40 minutes to walk. It wasn't a big deal if you're not out of shape. The 25 rail line stop is about 5 minutes away from hotel and a 25 minute ride will put you in Dam square, which can be considered the center of downtown. 2.65 euro for an hour pass. You're about 10 minutes walk from the hotel to the Heineken brewery.
- Official Description (provided by the hotel):
- Contemporary High-rise Hotel with a Dutch & Japanese flair located in the cozy neighborhood De Pijp and within walking distance of the RAI Convention Center. Hotel Okura Amsterdam facilitates four restaurants of which all have been awarded by Michelin. On the 23rd floor one can find two Michelin star Ciel Bleu Restaurant. On the ground floor, Teppanyaki Restaurant Sazanka is located, this restaurant has been awarded one Michelin star and here chefs prepare your dishes right in front of you on the hot griddle. Then, Yamazato Restaurant, awarded one Michelin star as well, serves the authentic Japanese kaiseki cuisine. And lastly, Serre Restaurant is inspired by Ciel Bleu and has received a Bib Gourmand by Michelin which awards the great price-quality relation. Furthermore, Hotel Okura Amsterdam facilitates Nagomi Spa & Health were guests can relax by means of treatments and workouts. ... more less
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- TripAdvisor is proud to partner with Hotels.com, Booking.com, Orbitz, Expedia, Hotwire, TripOnline SA, Odigeo, getaroom.com, Orange Marketing Services, Japan Co., Ltd., Ctrip TA, HotelsClick, Agoda, Travelocity, Priceline and Jetsetter so you can book your Hotel Okura Amsterdam reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.
- Also Known As:
- Okura Hotel Amsterdam
- Amsterdam Okura Hotel


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- Song of the Goat's
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The Complete Deaths
The Book of Joseph
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text: If you are from the NY or NJ you KNOW what a bagel should taste like. Being from NY I never expect bagels out side of NY or Jersey to taste like they do in those states..but for the most part most are edible and can come come fairly close (especially if they toast it). These bagels were horrible...the texture... More


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Sellers Buick GMC38000 Grand River Ave, Farmington Hills, Michigan 48335
Showroom Hours: 9:00 AM - 9:00 PM
92% Recommend
23 Lifetime Reviews
Hours: Closed
Sellers Buick GMC Info
About Sellers Buick GMC
Our friendly, experienced staff will be happy to help you in your auto search. Send us an email for a quick quote on a car, to make a service appointment or to order parts. Good luck on your Internet search. Thanks for stopping by Sellers Buick-Pontiac-GMC and let us know how we can be of service anytime via email or phone. Sellers Buick GMC Sales & Service are Open the Last 2 Saturdays of Every Month: Sales: 10:00 AM to 3:00 PM Service: 8:00AM to 1:00PM
Sellers Buick GMC
About Sellers Buick GMCView Website
Our friendly, experienced staff will be happy to help you in your auto search. Send us an email for a quick quote on a car, to make a service appointment or to order parts. Good luck on your Internet search. Thanks for stopping by Sellers Buick-Pontiac-GMC and let us know how we can be of service anytime via email or phone. Sellers Buick GMC Sales & Service are Open the Last 2 Saturdays of Every Month: Sales: 10:00 AM to 3:00 PM Service: 8:00AM to 1:00PM
Monday 9:00 AM - 9:00 PM
Tuesday 9:00 AM - 6:00 PM
Wednesday 9:00 AM - 6:00 PM
Thursday 9:00 AM - 9:00 PM
Friday 9:00 AM - 6:00 PM
Saturday Closed
Sunday Closed
"Shoddy work"
The original phone estimate was $600 to replace a cracked fly wheel so I brought the car in. A week later when they finally looked at it the service guy gave a much higher estimate. When the mechanic had it apart I was told it would be even more because a pin was missing and that if they replace that it would fix the repeated cracked fly wheel problem. When they were putting it back together I was told it needs a new transfer case (or something) or it would leak trans fluid. To this I said no figuring it wasn't leaking before, and trying to keep an already double the estimate cost from going higher. The car was leaking fluid severely when we got it home but we kept the trans fluid full as we were told. We were also told if we did so there would be no more cracked fly wheel problem. I didn't notice anything driving it home but my daughter said the shifting seemed rough on her way to school. Three weeks later the transmission failed costing me another $2500.00 to repair it with a used one. I blame them for shoddy work that led to the transmission failure.More
Employees dealt with
Did you find this review helpful?
Hi Licata, We appreciate and value your feedback and taking the time to leave a review of your visit. I spoke with our service manager to learn more about your visit. From his report it appears that additional work was advised during the repair of the flywheel, as you stated, but was declined. On your following visit we were able to offer a reduced rate for labor for the replacement of the transmission. We do apologize that we were not able to meet your expectations during your visits, Thank You.
Sales (New)
"A cool breeze on a hot day!"
Vehicle Color wanted (check) top options available (check) Friendliness of staff (check) Trade-In Value (check) Incentives given (check) Speed & ease of Delivery (check) Love our new GMC !More
Employees dealt with
This is so great to hear, Gloria! We're very glad to know we could deliver a vehicle with every aspect you were looking for! Thank you for choosing to work with our team!
Sales (New)
"Great Sales staff"
I worked with Anthony Ruthledge. His deskside manner put us at ease. Anthony delivered on everything he promised. I will be back in two years when my lease is up and I hope to work with Anthony again. Great dealership also with a nice selection of cafe items.More
Employees dealt with
Thank you for taking the time to tell us about your recent leasing experience at Selles Buick GMC! We are glad to hear Anthony was able to get you taken care of. Please come back and see us for any future car and service needs you may have!
Sales (Used)
"Good Sales "
Anthony was my sales rep, who was oustanding. He was laid back and easy going and not pushy at all. He let me make my decision and answered any questions I had. They have great food there too.More
Employees dealt with
We will be sure to pass along your kind words to Anthony! We are thrilled to hear he was able to make your recent purchasing experience at Sellers Buick GMC so great! Thank you for choosing Sellers Buick GMC for your car needs!
"Excellent Service Repair Maintenance!"
The Group of Mechanics are ALWAYS Correct on all 4 of My FAMILIES VEHICLES. We have been Serviced by this Dealership for 25 years. They service any type of Car Model we bring in to them.More
Employees dealt with
Did you find this review helpful?
Thank you for continuing to choose Sellers Buick GMC for your car and service needs! Please come back and see us for any future car and service needs you may have!
Sales (New)
"Leasing a car"
Last month, my son-in-law and I came to Sellers to lease a Buick - which was like a dream car. Dennis Cummings met us, and figured the whole thing out. He's one terrific employee and it was an enjoyable experience! One doesn't think of going to a car dealers as a destination really or probably a enjoyable experience but it was. Dennis whipped stuff together and when I drove out in that beautiful car (with a full gas tank, I might add,) it was with a big smile on my face. I love that car and would always recommend Sellers as my first choice. Thanks Denny!More
Employees dealt with
Sales (New)
"Team Garber was awesome! "
Joe Garber first met with my husband, to find out our needs. When I stopped by to test drive a vehicle, Joe was not available, so his teammate, Dennis stepped right in an hooked me up with a vehicle to test drive. We contacted Joe and let him know that we would prefer a bigger truck than what we originally thought. He found the truck we wanted elsewhere, and brought it right in to the dealership. Joe and I communicated via email and phone messages. Every call and every email was answered promptly. We were able to use rebates to get out of our previous lease and into the new truck we wanted. Dennis walked me thru the features of our new truck when I picked it up. Joe, Dennis and everyone else were so pleasant to work with. The whole process exemplifies customer service at its best. We will refer everyone we know to Team Garber at Sellers Buick/GMC! Thank you for such a pleasant experience!!!More
Employees dealt with
Sales (New)
"Return of lease vehicle"
Purchased or leased 9 vehicles with Joe Garber. Always a rewarding and pain free experience. Joe and Dennis (partner) always manage to take care of any and all of my concerns before, during, and after the end of the lease. My next vehicle, no matter if a lease or purchase, will be from Sellers GMC and their outstanding professionals Joe and Dennis!More
Employees dealt with
Sales (Used)
"overall review"
Sellers Buick meet all of my expectations,Dominick and Walter exceeded all of them. i must have visited 12 dealers.came back to the best.More
Employees dealt with
Sales (New)
"reputation is everything proven"
We have purchased several cars from Carl Merollis and his son. Our experience with each purchase has been outstanding! This time I wanted a specific color but had to wait three weeks to return my current lease. Dominic brought in the color I wanted and held it until I could turn in my lease. This kind of professional consideration is the norm at Sellers. Service is always as convenient as possible and well done. I especially appreciate the explanations that I am given Other dealerships assumed I did not want things explained apparently because I am female. . Cannot recommend this dealership highly enough!More
Employees dealt with
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text:
|Project Name
|Higher Education Reform Project
|Project Number
|Project Status
|Project Type / Modality of Assistance
|Source of Funding / Amount
|Strategic Agendas
|Inclusive economic growth
|Drivers of Change
|Governance and capacity development
|Sector / Subsector
Education - Tertiary
|Gender Equity and Mainstreaming
|Gender equity
|The project will institute needed reforms in higher education (HE) to improve the quality and relevance of HE programs; governance, management, and financing of HE institutions (HEIs) and the entire subsector; and promote equitable access to HE. Project interventions include institutional capacity building, human resources development, provision of learning and research facilities, equipment and materials, consultant services, minor civil works, support for public-private partnerships (PPP), and improvement of the HE policy environment.
|Project Rationale and Linkage to Country/Regional Strategy
|Rapid economic expansion has led to increased demand and supply for HE in Mongolia. The government has emphasized the value of HE as a principal investment option for the country's long-term economic competitiveness. Gross enrollment ratio for HE rose from 27% in 2000 to 47% in 2007, buttressed by the entry of private institutions offering HE in the 1990s. Over 100 HEIs are now in operation but only around 40% of graduates are employed. Persistent rural-urban inequalities also undermine Mongolia's competitiveness in HE. Poverty serves to destabilize children's school performance in rural areas and even if poor households manage to send their children to HEIs in urban areas, there is no guarantee of employability after the graduation. The government's vision is of an effective HE system that can help accelerate sustainable economic development, improve people's livelihood, ensure social equality, and reduce poverty. However, the system is currently constrained by (i) low quality and relevance, (ii) weak governance and management, (iii) inadequate financing, and (iv) limited opportunities in the HE subsector particularly for the poor and those in rural areas.
|The project impact will be an increased number of Mongolia's globally competitive higher education graduates responsive to labor market demands.
|Description of Outcome
|The outcome will be an improved, well-managed, and equitable higher education system. The project primarily involves capacity building of the entire subsector to improve its performance.
|Progress Toward Outcome
The overall project implementation progress is 53% as of end of the first quarter of 2016. The total contract award is 37% and disbursement is 30% of the net loan funds. The 85% of overall project implementation period has been elapsed. However, given the low utilization of the loan funds and the high volume of remaining works to complete, the MECS has proposed to extend the project closing date by 18 months or until 30 December 2018.
The draft law on higher education submitted to Parliament in December 18, 2015 for approval is under review by the parliament standing committee on social policy. In total, 3026 HEIs staff who involved in the capacity building training, 2935 for the domestic and 91 for the international study tour and training.
|Implementation Progress
|Description of Project Outputs
Quality and relevance of higher education programs improved
Effectiveness of HEIs' management and financing improved
Access to higher education improved.
|Status of Implementation Progress (Outputs, Activities, and Issues)
In February 2016 the MECS has finalized a list of 27 programs to be supported by the project for national and international accreditation. As well a working group to monitor the accreditation process was created by the ministerial order. Based on requests by HEIs and evaluation done, the MECS also has decided to provide financial support for the programs' accreditation activities.
National Center for Education Accreditation (NCEA) is working on development of the action plan for the twinning with the German accreditation agency ASIIN e.V.
Application of CDIO standards in three programs in engineering and technology (telecommunications, textile and industrial automation) programs is going on successfully. The 13 series of international and national training have been conducted on timely basis in accordance with the plan. In total 258 faculty members, employers and students have participated in 2 trainings conducted in 2015.
The establishment of faculty development center and 3 workshops for the selected programs are under the process.
The procurement of equipment for the CDIO workshops has completed and the items will be supplied in second quarter of 2016. The procurement of renovation works of CDIO workshops and faculty development center will be re-advertised in second quarter of 2016.
The Consulting Service on Higher Education Responsiveness to Labor Market (CSHERLB) has developed methodology and tools for Graduate Tracer Study, Employer's Satisfaction Survey and Labor Market Survey. It has organized workshop on Reflecting Labor Market Survey Findings for Higher Education Activities in December 2015. The consultants' team is now developing Curriculum and program review guidance note , Manual on Industry training programs and joint research projects through PPP , and Career guidance note for HEIs .
The MECS has announced the competitive grants for Promotion of Students' Initiatives and Partnership of Higher Education Institutions and Industry Training Programs from March 2016.
The Consulting Service for Higher Education Reform (CSHER) has been piloting the new governance model at the selected 4 HEIs The National University of Mongolia, The Health Science University, Otgontenger University and Ider Institute since July 2015. The CSHER has conducted 26 training on various subjects out of planned 34 reaching out to 1,100 participants from the HEIs.
Two contracts for procurement of equipment and software for the Distance Education Center has been signed off and the items will be supplied in the second quarter of 2016.
The Gender Working Group was established in December 2015, and now working on the methodology of curriculum review, code of conduct in Higher education.
|Geographical Location
|Involuntary Resettlement
|Indigenous Peoples
|Environmental Aspects
|The simplified environmental management plan was prepared to ensure full mitigation of any environmental impacts of limited civil works such as rehabilitation of existing facilities and libraries under the project.
|Involuntary Resettlement
|No impact on environment and resettlement is anticipated. Neither acquisition of land nor relocation of people is planned.
|Indigenous Peoples
|No negative impacts on indigenous peoples are expected. Targeting approaches under the project will be applied nationwide and benefit indigenous peoples.
|Stakeholder Communication, Participation, and Consultation
|During Project Design
|The project implementation unit (PIU) was established at the Ministry of Education and Science, the project executing agency, and manages day-to-day project implementation, planning and budgeting, procurement, disbursement, monitoring, supervising, overseeing overall implementation, and reporting to the Government and ADB. Procurement and consulting recruitment will follow ADB Procurement Guidelines (2013, as amended from time to time) and ADB Guidelines on the Use of Consultants (2013, as amended from time to time) respectively.
|During Project Implementation
|The MECS / PIU conducts consultation meetings and workshops with various stakeholders including the higher education institutes, other higher education sector projects in order to coordinate activities and exchanges experience. In addition it conducts thematic consultations workshops with specific audience.
|Responsible ADB Officer
|Itgel Lonjid
|Responsible ADB Department
|East Asia Department
|Responsible ADB Division
|Mongolia Resident Mission
|Executing Agencies
Ministry of Education, Culture and Science
Government Building-III, Suite # 514, Baga toiruu-44, Sukhbaatar district
Ulaanbaatar, Mongolia
|Concept Clearance
|10 Aug 2010
|Fact Finding
|30 Aug 2010 to 14 Sep 2010
|Last Review Mission
|Last PDS Update
|31 Mar 2016
|Signing Date
|Effectivity Date
|28 Jul 2011
|09 Sep 2011
|10 Jan 2012
|30 Jun 2017
|Financing Plan
|Loan Utilization
|Total (Amount in US$ million)
|Net Percentage
|Project Cost
|Cumulative Contract Awards
|28 Jul 2011
|Cumulative Disbursements
|28 Jul 2011