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Welcome to ADC
The Austin Diagnostic Clinic is a multi-specialty medical clinic serving Austin and Central Texas.
About ADC
We are an established and independent medical provider. We have been caring for Central Texas patients since 1952.
Our Vision
We strive to be the premier multi-specialty clinic providing compassionate care and excellent service.
Our Mission
To prevent and treat disease within a caring community.
ADC is an independent medical group formed by physicians to enhance patient care through collaboration and innovation. This cooperative spirit promotes excellence by providing medical services to the communities we serve.
We are committed to maintain and improve the health of the patients we treat. As a premier, health care delivery system, we strive to provide excellence in healthcare through a wide range of services in multiple locations that is both cost-effective and accessible.
ADC works to provide an environment favorable to the satisfaction, growth and effectiveness of our team and volunteers.
Our Values
- We are dedicated to the wellness of our patients through excellent service in a friendly environment.
- We will treat our patients and their families as our own.
- We will collaborate in a fashion that promotes teamwork, resulting in quality care that takes advantage of up to-date and cost conscious methodology.
We want to provide you and your family with quality healthcare. How can we help you today?
Medical Specialties
Our doctors practice in 21 medical specialties. Find a primary care provider for your whole family or a specialist to address specific health concerns or disease.
We offer women's health services through our OB/GYN providers and our Menopause and Osteoporosis Center to keep you healthy throughout all stages of your life.
Our specialists also practice in
- Allergy
- Cardiology
- Dermatology
- Endocrinology
- Family Practice
- Gastroenterology
- Hospitalists
- Internal Medicine
- Menopause and Osteoporosis Center
- Nephrology
- Neurology
- Ob/Gyn
- Ophthalmology
- Otolaryngology (ENT)
- Pediatrics
- Physical Medicine & Rehabilitation
- Podiatry
- Pulmonary Disease & Sleep Medicine
- Rheumatology
- Surgery
- Urology
Health care services
We offer a wide range of in-house services so you don't have to worry about coordinating records and information with outside offices.
ADC EasyCare is your medical provider for same-day, after-hours and weekend care for those urgent concerns that cannot wait.
Diabetes management and nutrition services help you learn to manage your condition without losing quality of life. Our weight loss and health risk management program helps you shed weight and so that you can lead your best life.
In-house imaging, lab, pharmacy and our own outpatient surgery center means just about everything you need is in one group.
Our Doctors
We have more than 120 doctors who provide both primary care and specialty care for our patients.
Whether you need a family doctor or a specialist to treat a complex medical issue, we have someone who can help.
ADC providers are also up-to-date on the latest advances and technologies in medicine. Many use those advanced technologies in their practices.
Several of our doctors also appear on the Texas Monthly Super Doctors® and Best Doctors, Inc.® lists and on the Patients' Choice Awards each year for excellence in their fields.
Our Locations
We have seven clinic locations across the Austin area.
- Main Clinic – Located inside North Austin Medical Center, just south of Parmer Lane at MoPac Expressway.
- Cedar Bend – Family practice, Pediatrics and EasyCare, located across the street from our Main Clinic location on Cedar Bend Drive.
- Westlake – Inside the Cielo Center on South Capital of Texas Highway, south of Lost Creek Boulevard
- Circle C – This stand alone clinic is located at the southwest corner of Loop 1 and Slaughter Lane, near the Alamo Drafthouse Slaughter.
- Steiner Ranch – This clinic is located in the Quinlan Crossing shopping center off RM 620 North.
- Round Rock – Located off of Old Settler's Boulevard.
- Lakewood – Our Outpatient Surgery Center and business services are located at this facility.
Find maps, driving directions, and a list of the specialties offered at each clinic in the Locations section.
ADC's providers accept a wide range of insurance plans, including Medicare.
Check this list to find out what insurance plans are currently accepted, but be sure to also check with your plan provider about coverage, referrals and which providers participate in your health plan.
Need to update your insurance with ADC? No problem!
You can manage your patient account through MyADC or find more answers in our billing section.
ADC's electronic medical records system helps our doctors become your team of medical providers, working together to keep you and your family in the best of health.
With MyADC – our patient portal – you can access your medical records, lab reports, and request appointments so you can stay on top of your health anytime, anywhere.
You can also:
- Message the doctor's office
- Receive lab results
- Pay your bill
- Update personal information
- Update insurance
MyADC is available to established patients. Ask your doctor or provider how you can sign up today.
Your Healthy Life
Summer Safety Tips
Brenna Gerdelman, MD, family practitioner at ADC Steiner Ranch shares summer safety tips with KXAN's meteorologist Natalie Ferrari.
How to prevent Zika while traveling
Travel Clinic director Crystal Cherico, RN shares Zika prevention tips. Including what to do if you are pregnant and what kind of insect-repellent to use.
july, 2016
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26jul4:00 pm- 5:00 pmHRM Tuesday Information Session
Event Details
Come join us to learn
Event Details
Come join us to learn more about how our medically supervised meal replacement program can help you lose weight.
Attend this free one-hour session!
We will discuss how the program works, including:
- Diet Options
- Program phases
- Cost
- Insurance
- Class start dates
Sessions are held weekly at our north location at 12221 N. Mopac Exwy, Austin, TX 78758, 3rd Floor North Entrance inside the North Austin Medical Center. You will need to attend before you can join our program. Please call 1-512-901-4540 to sign up or online.
(Tuesday) 4:00 pm - 5:00 pm
Health Risk Management - Weight Loss512-901-4540


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Few Toronto, Ontario hotels can match the quality and convenience of the Toronto International Airport hotel. We offer full-service meeting facilities and award-winning catering. Guests enjoy hotel features like our heated bathroom floors and 24-hour Fitness Centre. Our 24-hour airport service and hotel amenities make this area hotel a top selection for vacationers and business travelers.
Business Services
- On-Site Business Center
- Business Center is open 24 hours a day
- Printer
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Entertainment & Recreation
- Your exercise routine doesn't need to stop while you are away from home. Our Fitness Center is open 24 hours and features LifeFitness cardio equipment and weights as well as maps of local jogging trails. Enjoy swimming in our heated indoor pool.
- Indoor Pool
- Heated Indoor Pool
- Indoor Pool Hours of Operation: 5:00 AM to 11:00 PM
- Cocktail Lounge
- Tanning Beds
Health & Fitness
Complimentary Fitness Center
Expanded facility open 24 hours per day, includes a universal weight machine, free weights, LifeFitness treadmills, exercise bikes and elliptical trainers.
Hours of Operation: 12:00 AM to 12:00 AM
Fitness Centre Equipment:Stair Stepper, Treadmill, Elliptical Machines, Free Weights, Stationary Bicycle
Fitness Centre Type:EXTENSIVE
Housekeeping & Laundry
- Daily Housekeeping
- Full Service Housekeeping
- On-site Guest Self-Laundry Facilities
- Hours of Operation: 12:00 AM to 12:00 AM
- Dry Cleaning Pickup/Laundry Valet
- Same-Day Dry Cleaning
Internet Services
- Standard wired internet service is free for all IHG® Rewards Club members
- Wireless Internet Available in Rooms, Suites, Business Centre, Public Areas and Meeting Spaces.
- Standard Wireless internet service is free for all IHG® Rewards Club members
Added Value
- Concierge Services
- Wake Up Calls
- Foreign Currency Exchange
- Private Limousine Service
- Porter/Bellman
- Doorman
- Baggage Hold
- Gift Shop

subset: commoncrawl


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Club Organic
Organic food store has fresh organic fruits and vegetables, frozen food section, large selection of products in bulk staples.
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Link to this page from your site. Entry info.
Return to Montreal Vegetarian Restaurants & Health Food Store Listings
Business Owners, if you see an unfair review, read this.
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Has Club Organic closed, shut down, moved, or changed? Please use the Update Form.
This page has been viewed 633 times since Oct 2007.


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This is The Way The World Ends.How everybody doin?
If you wanan know more about be go to myspace.com/assmunch .
Or you can just send me a friend request on XBL (TwoTonTommy721).
I am a pretty cool guy, i guess, I have a loving girlfriend (Melanie) and I am a proud Halo Fanboy...
I'm a Halo fan body mainly becuase I love the story of it, it's not the graphics or the gameplay that dioes it for me, but just the story. Sure those togerthings are great and Bungie does an amazing job at those but I think that if your gunna be into a video game be into it for the story of it.
Same thing with me and Music, I like Songs becuase of the beats and rythnm, not the lyrics, And I also liek songs .Not Artists, becuase changes are not every song done by an artist or band is gunna be amazing to you, so yeah... Thats all for now.
Thanks for reading... Tom
My Contributions
- Title
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- What now?!?!?.. I'm Yoda!
My Games
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The Atlantic City area had its fourth snowiest January on record and South Jersey may see even more of the white stuff next week.
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IEEE membership options for an individual and IEEE Xplore subscriptions for an organization offer the most affordable access to essential journal articles, conference papers, standards,
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Experiments clarifying the features of the MTL structure contributing to current gain and circuit delay will be described and conclusions for the design of optimum structures offered.
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Florida 55 Plus (55+) Retirement Communities and HomesSave This Search
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The "Sunshine State" is by far the most popular destination for retirees in America. Blessed with a warm climate and an almost dizzying number of recreational choices, Florida attracts so many seniors (and other new residents) that it is consistently one of the fastest-growing states in the U.S. As recently as 2005, one Florida county (Flagler) had the highest growth rate in the country, and 14 made the list of the hundred fastest-growing counties.
It's not hard to understand the appeal Florida has on newcomers: an extensive and varied coastline featuring wide, sandy beaches, mangrove swamps, and the famous Keys. With a tropical/subtropical climate that encourages gardening, sun-worship, and year-round golf, Florida is filled with exciting urban areas such as Miami, Tampa, and Orlando. Historical sites like St. Augustine and Cape Canaveral are intriguing aside a surprising amount of quiet, purely rural countryside in the central and northern parts of the state.
The famous Everglades in the south, numerous theme parks and sports and extensive parks and preserves featuring boating, fishing, and aquatic activity, have all helped transform Florida from a sleepy Southern backwater to a booming state in little more than a century.
Making Friends In Retirement
Many retirees, upon beginning their new life, find out they've neglected one important aspect of retirement planning: who will they spend it with? The answer to that question may affect their quality of life more than anything else. Read more...
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RetireNet.com visitors represent 40 percent of the adult population and possess more than 70 percent of the country's wealth. The 50-plus audience will grow 20 times more than the 18-49 demographic in the next five years! Read more...
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Winter Warm Up: Communities in the Southeast
With hints of Spring in the air after what seems like an endless winter, warm weather communities are seeming more and more attractive to retire to. Why live in an area where you look forward to a few short summer months, when you can live in warmth year Read more...
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Scholars discussing first Spanish capital of Florida in SC
Apr 15, 2016 3:30 pm
Scholars from across the nation are in Beaufort discussing the first capital of colonial Spanish Florida, which was in South Carolina, not Florida. This month marks the 450th anniversary of the foundi...
Florida's job growth slowed down in March
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Florida's job growth is slowing down although the state's unemployment rate still dipped slightly. State officials say Florida's unemployment rate dropped to 4.9 percent in March. That's lower than th...
5 Fantasy 5 players win jackpot worth $46,008.15 each
Apr 15, 2016 2:20 pm
Five "Fantasy 5" tickets had all five winning numbers to each earn a jackpot of $46,008.15 each. The Florida Lottery said Friday that two of the winning tickets were purchased Miami and the ...
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They are the land mines of the sea, killing long after being forgotten. Abandoned or lost fishing gear, including traps, crab pots and nets, litter the ocean floor in coastal areas around the world. M...
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The barefoot farmer oversees three teenage workers as they attack weeds with spades in a sunbaked field of peanut plants, a vital cash crop often grown on Haiti's marginal farmland. If he's lucky, Fra...
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South Florida police officer accused of touching 2 boys
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A South Florida police officer is accused of inappropriately touching two boys. The Broward Sheriff's Office arrested Coconut Creek police officer Daniel Rush on Thursday. He's charged with custodial ...
Kerry says Cuba should let anyone visit via cruise lines
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A Cuban law that bars anyone born on the island from returning by ship is discriminatory and should be eliminated, Secretary of State John Kerry said Thursday. Kerry said the policy discriminates agai...
Kerry says Navy ship could have fired on Russian planes
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Free electric shuttles to return to downtown Tampa
Apr 15, 2016 7:40 am
Free electric shuttles will soon return to downtown Tampa. The Tampa Bay Times (http://bit.ly/22xHBrF) reports that the city council on Thursday approved spending $560,000 for a demonstration project ...
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Preview: Kelly Plantation
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A golf and waterfront community. "I truly believe that my golf course at Kelly Plantation is special. The site has given us the opportunity to create one of the most challenging and enjoyable golf experiences in Florida.
Community Lifestyles: All Active Retirement Communities and Homes, 55+ Retirement Communities and Homes, Golf Course Communities and Golf Course Homes


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|Historical fiction
Mystery fiction
|Named Person:
|Dante Alighieri; Oliver Wendell Holmes; Ralph Waldo Emerson; Dante Alighieri; Ralph Waldo Emerson; Oliver Wendell Holmes
|Material Type:
|Fiction, Audio book, etc.
|Document Type:
|Sound Recording
|All Authors / Contributors:
Matthew Pearl; Boyd Gaines
|OCLC Number:
|Compact discs.
|Read by Boyd Gaines.
|5 sound discs (ca. 6 hr.) : digital ; 4 3/4 in.
|Matthew Pearl.
The members of the Dante Club fight to keep a sacred literary cause alive, but their plans fall apart when a series of murders erupts through Boston and Cambridge. Only this small group of scholars realizes that the gruesome killings are modeled on the descriptions of Hell's punishments from Dante's Inferno. With the lives of the Boston elite and Dante's literary future in America at stake, the Dante Club members must find the killer before the authorities discover their secret. Dr. Oliver Wendell Holmes and an outcast police officer named Nicholas Rey, the first black member of the Boston police department, must place their careers on the line to end the terror. Together, they discover that the source of the murders lies closer to home than they ever could have imagined.
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Related Subjects:(13)
- Dante Alighieri, -- 1265-1321 -- Appreciation -- Fiction.
- Holmes, Oliver Wendell, -- 1809-1894 -- Fiction.
- Emerson, Ralph Waldo, -- 1803-1882 -- Fiction.
- Boston (Mass.) -- Fiction.
- Authors -- Fiction.
- Insects -- Fiction.
- Dante Alighieri, -- 1265-1321.
- Emerson, Ralph Waldo, -- 1803-1882.
- Holmes, Oliver Wendell, -- 1809-1894.
- Art appreciation.
- Authors.
- Insects.
- Massachusetts -- Boston.


text:
This is your resource to discuss support topics with your peers, and learn from each other.
I started getting support emails last night. I just updated my pb OS and sure enough all of my Qt apps close instantly after the splash screen closes.
Is anyone else having this issue(s)?
I am just heading out the door on my way to the airport for a 3 day buisness trip (what timing), will have to fire up the debugger later to see what's happening...
Thought I would post here first and see if anyone else has figured out what's happening...
RIM, any chance we can get a warning for the update untill this gets sorted?
Nothing has changed in any of my Qt apps. You were probably using something in your apps that did change (an API or something in descriptor file maybe?).
You will know soon enough when you check out your logs/log file though.
I have no problems with my Qt-Apps after update. I also use some other native functions from NDK.
04-23-2012 03:43 PM - edited 04-23-2012 03:51 PM
OK, thanks for the input guys.
These are pretty straightforward Qt apps that dont use any odd API's or anything so not sure what could be the problem. I pulled them all from the store until I can figure out what's happening, likely not till I get home tomorrow night.
2 are Qt widget based apps and 4 are qml apps that use the symbian qml components that I ported over to QNX.
The problem is that I packaged these before the Qt bb SDk was released that supported debugging on device(I used the old git hub Qt port for these apps). I will have to change the pro and xml files now so I can deploy from the SDK and use the debugger to see what's happening...
Here is what my pro and descriptor look like for one of the qml apps, maybe somthing will stand out to those in the know?
# Add more folders to ship with the application, here folder_01.source = qml/ECalc_USA folder_01.target = qml DEPLOYMENTFOLDERS = folder_01 # Additional import path used to resolve QML modules in Creator's code model QML_IMPORT_PATH = TARGET = E-CalcUSA QMAKE_LFLAGS += '-Wl,-rpath,\'./app/native/lib\' ' package.target = $${TARGET}.bar package.depends = $$TARGET package.commands = blackberry-nativepackager \ -package $${TARGET}.bar -arg -platform -arg blackberry \ -arg -platformpluginpath -arg ./app/native/lib/platforms \ blackberry-tablet.xml $$TARGET \ -e qml qml \ -e icon.png res/icon.png \ -e ssLandscape.png res/ssLandscape.png \ -e ssPortrait.png res/ssPortrait.png \ -e $$[QT_INSTALL_LIBS]/libQtCore.so.4 lib/libQtCore.so.4 \ -e $$[QT_INSTALL_LIBS]/libQtGui.so.4 lib/libQtGui.so.4 \ -e $$[QT_INSTALL_LIBS]/libQtOpenGL.so.4 lib/libQtOpenGL.so.4 \ -e $$[QT_INSTALL_LIBS]/libQtNetwork.so.4 lib/libQtNetwork.so.4 \ -e $$[QT_INSTALL_LIBS]/libQtDeclarative.so.4 lib/libQtDeclarative.so.4 \ -e $$[QT_INSTALL_LIBS]/libQtSql.so.4 lib/libQtSql.so.4 \ -e $$[QT_INSTALL_LIBS]/libQtSvg.so.4 lib/libQtSvg.so.4 \ -e $$[QT_INSTALL_LIBS]/libQtScript.so.4 lib/libQtScript.so.4 \ -e $$[QT_INSTALL_LIBS]/libQtXmlPatterns.so.4 lib/libQtXmlPatterns.so.4 \ -e $$[QT_INSTALL_PLUGINS]/platforms/libblackberry.so lib/platforms/libblackberry.so QMAKE_EXTRA_TARGETS += package # The .cpp file which was generated for your project. Feel free to hack it. SOURCES += main.cpp HEADERS += settings.h # Please do not modify the following two lines. Required for deployment. include(qmlapplicationviewer/qmlapplicationviewer.
pri) qtcAddDeployment() OTHER_FILES += \ blackberry-tablet.xml
<?xml version="1.0" encoding="utf-8" standalone="no"?> <qnx xmlns="http://www.qnx.com/schemas/application/1.0"> <id>com.snappyappz.ecu_pb</id> <filename>E-CalcUSA</filename> <name>E_Calc USA</name> <versionNumber>1.0.0</versionNumber> <buildId>10</buildId> <description>Common electrical calculations in a snap!</description> <copyright>2012</copyright> <initialWindow> <systemChrome>none</systemChrome> <transparent>false</transparent> <autoOrients>true</autoOrients> <aspectRatio>portrait</aspectRatio> </initialWindow> <publisher>SnappyAppz.com</publisher> <permission system="true">run_native</permission> <category>core.games</category> <icon><image>res/icon.png</image></icon> <splashscreen>res/ssLandscape.png:res/ssPortrait.p
ng</splashscreen> <!--<env var="QT_DEBUG_PLUGINS" value="1"/> --> <env var="LD_LIBRARY_PATH" value="app/native/lib"/> <env var="QT_QPA_FONTDIR" value="/usr/fonts/font_repository/liberation"/> <env var="QT_QPA_PLATFORM_PLUGIN_PATH" value="app/lib/platforms"/> <env var="QML_IMPORT_PATH" value="app/native/qml/imports"/> <env var="QT_PLUGIN_PATH" value="app/native/lib"/> </qnx>
04-23-2012 03:47 PM - edited 04-23-2012 03:49 PM
Are the Qt apps you guys have using the old git hub port too?
I am currently making a proper pdf reader for the playbook and the OS update seemed to make no difference with that app in its current state. However I am using the latest Qt4.8.1 source from git along with the new bb Qt SDK... Just thinking out loud here...
I tested using the PlayBook port of Qt Creator and my app launched without error:
Let us know once you get a chance to do some testing if you need help digging into it!
OK, thanks!
This may be a stupid question, please bear with me...
Is there a way to deploy just the bar file (the one I submitted to the store) with the Qt bb port Garett linked to above and get debugging output with the included Qt creator? This would save me some time and likely give an accurate indication of what's going on with those packages...
04-23-2012 05:17 PM - edited 04-23-2012 05:18 PM
I can't reproduce the problem, they work fine when deploying with the latest 4.8.1 libs and theQt creator linked to above... Its just the packages on the store done with the old port that dont work anymore.
I guess I will just repackage them with the latest 4.8.1 and update them all...
If any of you RIM developers have any hints as to what broke here I would be interested in what happened, some kind of binary break I suppose?
I will gladly supply the offending bar packages if anyone is interested.
04-23-2012 07:42 PM - edited 04-23-2012 07:44 PM
Can you grab logs/log first from the failing package first?
Just use a debug token on your app and use blackberry-deploy to -getfile.
It could be something very simple (most likely since it works for everyone else).


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Bryan M. Wolfe
| November 28
View the 'Top Apps This Week' courtesy of the new iPhone #Homescreen app
The #Homescreen app is available to download on the App Store.
Bryan M. Wolfe
| November 26
Following the launch of the iPhone 6 and iPhone 6 Plus, an App Store record falls
The App Store saw record downloads in October.
Bryan M. Wolfe
| November 24
Quest for Revenge offers a dark and gloomy fantasy adventure for iOS device owners
Quest for Revenge could be your next favorite role-playing game for iOS.
Joe White
| November 22
After 3 long years, Kairosoft's Game Dev Story finally gets an update
The much-loved Game Dev Story has received a bug fixing update.
Joe White
| November 22
Brushstroke 2.0 brings iPhone 6 support, new styles, additional colors and more
Brushstroke has received a major update optimizing the app for the iPhone 6.
GravityLine gets updated for the iPhone 6, iOS 8 and goes free for a limited time
GravityLine, the fun arcade app, has received a much appreciated update.
Grand Theft Auto: San Andreas gets optimized for Apple's iPhone 6 and iPhone 6 Plus
Rockstar Games has updated its popular Grand Theft Auto: San Andreas for the iPhone 6 and iPhone 6 Plus.
Impressive Replay video editor for iPad launches later today
Replay, an impressive video editor for iPad, is launching on the App Store later today.
Joe White
| October 16
Square Enix's Hitman: Sniper soft-launches in Canada
Hitman: Sniper is now available to download on the Canadian App Store.
Joe White
| October 4
Disney pulls Tiny Death Star and Star Wars Assault Team from the App Store
Disney has yanked two of its popular "Star Wars" apps from the App Store.
Joe White
| October 4
Amazon updates its Kindle app for the iPhone 6 and iPhone 6 Plus
Amazon's Kindle iOS app is now optimized for Apple's latest iPhones.
Joe White
| September 29
Get productive with Darsoft's PDF Productivity Pack app bundle for iOS
Take control of PDF files on your iOS device with Darsoft's PDF Productivity Pack.
Joe White
| September 29
Quip gets connected, launches 'Integrations' for services including Twitter, Dropbox
Quip Integrations promises to make the popular iOS app even better.
Joe White
| September 27
Get notified with Ping, a strange new app from the developers of Secret
Ping is an app that promises to keep you notified in a new way.
Joe White
| September 27


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Aeria Games has just released some new teaser information for their upcoming sci-fi MMOFPS, Repulse. The exciting game, which is set to enter closed beta testing in early 2012, features twitch-based combat, and uses the Jupiter EX Engine. There are a number of gameplay modes for players to try in Repulse, including Deathmatch, Capture the Flag, Invasion, and more.
Another in Aeria Games' Repulse is the ability to change classes. Players will be able to freely test out different abilities as they switch between the Sniper, Engineer, and Assault classes.
Interested players can find out more information, as well as sign up for the closed beta test, at http://repulse.aeriagames.com. In the meantime, please check out these Repulse screenshots!


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[Watch] Here's What Happens When Your Side Chick Crashes Your Wedding
It's a scene out of a Tyler Perry movie.
Nicki Minaj told MTV News that, though the video for the song "Fly" featuring Rihanna has been done for over a month, she wanted to delay its release so that her girl RiRi can remain in heavy rotation before the video drops.
"We both kind of dropped at the same time...I want to let her stuff have a moment and do its thing, dominate radio," said the Harajuku.
We hope the Young Money star doesn't get any ideas about delaying the video for "Super Bass," a video she said will be filled with "eyecandy."
It's a scene out of a Tyler Perry movie.
A few fellow students have taken to Instagram displaying an appalling lack of remorse


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1908 $10 Motto PR65 NGC....Click the image to load the highest resolution version.
Beautiful Gem Proof 1908 Motto Indian Head Eagle1908 $10 Motto PR65 NGC. This is an important proof issue, as the first one to showcase Augustus Saint-Gaudens' Indian Head gold eagle design. Fortunately for type collectors, it is also the most readily available proof issue of the series. There were 116 proofs struck in this year, and we believe that the number extant lies somewhere in the range of 40-55 coins.
It is always a treat for this cataloger to examine the surfaces of a matte proof survivor such as this one, which has obviously been carefully preserved for nearly a full century. Struck with unmistakable proof sharpness, this Gem exhibits the fine grain surface textures which, surprisingly, were not liked by most contemporary numismatists. The color is a light khaki-peach shade which is imbued with reddish overtones. The surfaces are virtually flawless--leading one to wonder whether the piece may even be conservatively graded at this level. Census: 11 in 65, 28 finer (6/07). (Registry values: N7079) (NGC ID# 2AME, PCGS# 8890)
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15% of the successful bid (minimum $9) per lot.
Revised Edition by James L. Halperin, Mark R. Borckardt, Mark Van Winkle, Jon Amato, and Gregory J. Rohan, with special contributor David W. Akers
The Coinage of Augustus Saint-Gaudens is an issue-by-issue examination of these two artistically inspired series of gold coins.
Each date and mintmark is reviewed with up-to-date information, much of which has never been previously published. The book is based on
two extraordinary collections: The Phillip H. Morse collection and the Dr. and Mrs. Steven L. Duckor collection.
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Big Deal Store: The Funky Feather
The Funky Feather is the place to be in Arab, Alabama!! Laser tag, laser frenzy, games, & Dream Catchers Grille. EAT – PLAY- RELAX
Starting Monday, May 16th @ 10 am, get a $20 certificate for only $10 while they last in our Big Deal Store. Coupons are good for food or laser tag and can only be used once per visit. You must use the entire 20.00 coupon in one visit.
The Funky Feather is located at 2423 Old Huntsville Hwy NW in Arab.
Mon-Thur: 11:00 am – 10:00 pm
Fri-Sat: 11:00 am – 12:00 am
Sun: 12:00 pm – 8:00 pm
The Funky Feather is is also open for birthdays and corporate functions. Join us for a great meal and a great experience. We specialize in gourmet burgers, wings, sandwiches and such. We also have large screen TV's throughout the facility, come and catch a game with us!!
Our laser tag arena is designed with fun in mind. This state of the art, 3000 square foot, two-story, urban themed arena, is sure to get your heart going. Play as an individual or as part of a team.
(256) 217-9731
Check out the website at: http://Thefunkyfeather.com Like us on Facebook…THE FUNKY FEATHER
Big Deal Store: Snead Cafeteria
Starting Monday, July 4th @ 10 am, save 50% from the Snead State Cafeteria in the Big Deal Store!
Serving the finest in Southern Cooking, the Snead Cafeteria on the campus of Snead State Community College is open to the public Monday-Friday and Sundays 10 am-1:30 pm. Weekdays you can choose from 3 different entrees, a variety of delicious veggies, a salad bar and homemade desserts.
Folks from all over the area make the Snead Cafeteria their destination for Sunday lunch due to the bountiful buffet!
All food is dine in or carry out.
Snead Cafeteria 220 Walnut Street in Boaz
*Limit 1 discount per party per visit*
Big Deal Store: Lion's Den
The Lion's Den in Sardis is back open for business, under the new ownership of Brian and Angela Carnes!
Stop in and try the daily lunch special which feature an entree and your choice of 1, 2 or 3 sides. Baked chicken, chicken and dressing, country fried steak and hand breaded chicken fingers are just a few of the entree choices.
The Lion's Den offers rib-eyes on Thursday & Friday nights and Fridays are also, catfish night.
The Lion's Den in Sardis, open Sun-Wed 10:30 am-2 pm, Thurs & Fri 7 am-8 pm & Saturday 7 am-2 pm.
Starting Monday, June 6th @ 10 a.m. get a $20 Lion's Den certificate for only $10 in our Big Deal Store while they last.
Purchase yours today!
Big Deal Store: Boaz Cafe
Home cookin' at it's finest!
Stop by Boaz Cafe and try one of their daily lunch specials that fills you up and is easy on the wallet too.
Don't forget we also have a "Dinner to Go Family Pack" which includes 4 meat orders, 2 pints of side items and 4 bread items, for only $20.99.
Starting Monday, July 25th at 10 a.m., get a $20 Boaz Cafe certificate for only $10 in our Big Deal Store while they last.
Boaz Cafe is open Monday- Friday, 10:30 a.m. until 7 p.m.
*Limit 2 per party per visit* *Not good with any other discounts or coupons*
Big Deal Store: Momma Goldberg's Deli
Starting Monday, May 9th, save 50% off Momma Goldberg's Deli in Boaz.
Need a pick-me-up for lunch?
Have you tried one of Momma Goldberg's signature sandwiches or specialty salads? Soups, nachos, desserts, a children's menu and more await you at Momma Goldberg's Deli.
Momma's Love, Turkey Delight, Big Momma, Big Daddy, Build-Your-Own Sandwich, Build-Your-Own Salads, kids menu, specialties and more!
Open Sunday – Saturday 10:30 a.m. – 9 p.m., check out their webpage at www.mommagoldbersdeli.com
Get a $20 certificate for only $10 starting Monday, May 9th @ 10 a.m.
*Big Deal certificates can not be combined with any other special promotions or offers*
The Big Deal Store: Wintzell's Oyster House
Starting Monday, June 13th at 10 a.m. save 50% off Wintzell's Oyster House in Guntersville in our Big Deal Store!
Wintzell's Oyster House on the lake in Guntersville invites you to drop by and try our low country boil with connecta sausage, corn on the cob, red potatoes, and shrimp spiced just the way you like it.
Check out the online menu! Serving fresh seafood since 1938.
Wintzell's on Hwy 431 in Guntersville, located directly on the lake. Visit our online menu at wintzellsoysterhouse.com
**Certificate not good for purchase of alcohol**
Big Deal Store: 278 Restaurant
Starting Monday June 27 th, at 10 a.m. save 50% off Carnes 278 Restaurant in Gadsden!
New ownership with a full service staff!
Carnes 278 Restaurant is a family style restaurant specializing in great southern cooking and service. 278 is open for breakfast and lunch, 7 days a week. Catering and private parties are also available. Daily specials can be found on their Facebook page. HERE
For catering, call 256-492-6868
Big Deal: Dales Bar-B-Q
Starting Monday, June 20th at 10 a.m., save 50% Dale's BBQ in our Big Deal Store!
It's almost time for the summer birthdays, family reunions and cook-outs by the pool! What's better than a plate full of award winning Bar-B-Q from Dale's in Boaz?
They cook it S-L-O-W but serve it fast…BBQ baked potatoes, BBQ nachos, BBQ plates, desserts and more!
Get a $20 certificate for only $10.
Catering available, call 256-593-1168. Dale's BBQ, on the curve behind McDonald's, Mill Street in Boaz.
Big Deal Store: Juju Grill
Monday, March 7th at 10 a.m. save 50% off Juju Grill in our Big Deal Store.
Buy a $20.00 Juju Grill certificate for only $10.00 while they last!
Juju Grill, an American Asian grill in Boaz, is now open for lunch and dinner. Let Cory, our hibachi chef, serve up some sizzling food on the grill. The Japanese food you love without the expensive price.
Check us out on Facebook at www.jujugrill.com. *can not include alcohol and gratuity on certificate*
Big Deal: Legghorn's of Guntersville
Starting Monday, May 30th, at 10:00 a.m. get 50% off certificates for Legghorn's of Guntersville!
Family friendly restaurant…delicious chicken tenders, burgers, wings, BBQ and a complete menu of delicious sides! Legghorn's offers catering, delivers orders to offices for lunch, wide variety of items, specialty sandwiches like the Ranger and Rooster Bullet, and locally owned and operated. Legghorn's of Guntersville is located at the foot of the mountain Guntersville beside Foodland.
Restaurant hours are Monday through Saturday 10:30 am- 9:30 pm and Sunday from 10:30 am- 3:00 pm.
**Limit 1 per party per visit**


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During the holiday season, oftentimes people get so busy and distracted with our million and one things to do on our lists, we forget to stop and think about the less fortunate. This year I wanted to team together with all Serena employees to make a real and transparent difference. To unite in helping to build a home for a family in need.
We accomplished this through the charity organization, New Story, who funds life-saving homes, turning tent slums into sustainable communities for families livingRead More
As enterprise IT begins to adopt DevOps practices, questions and issues emerge about how to best implement the culture, process, and tools to deliver on the promises of faster business innovation at a lower cost. How do you transform the current state? The Enterprise IT landscape is complex, sophisticated, dynamic, and frequently chaotic. Unlike Internet startups, you are dealing with a large, diverse set of heterogeneous infrastructures glued together across many teams and locations that use many different tools and processes to develop and deploy software.Read More
Much is being written about, found and reported on the Volkswagen AG emissions scandal. As a long time practitioner of software change and configuration management practices, events such as these become teaching moments from which we can all learn.
An average vehicle today contains around 60 microprocessors to run electric content – four times as many as a decade ago. More than 10 million lines of software code run a typical vehicle's sophisticatedRead More
We have started the planning for xChange 2016 at last! So here's what we know:
We are delighted to have been recognized as a leader in Enterprise Service Management in Research In Action Selection Matrix.
Of particular note,Read More
Bringing customers together to share experiences and comment on the latest ideas and technologies from Serena is one of the primary ways we guide and shape product direction. If you are in the Bay Area on November 5th you should join us and be part of this informative day:
High-Level Agenda
One repository or many … the answer is neither
One of the most commonly asked questions these days is "Should all our source code be in one repository?" This is a complex question and leads to a somewhat interesting set of answers.
Before we get to that lets try and understand the question a little more and find out why customers asking this? In IT we like to centralize and optimize. Gathering all the code in one place is seen as the next logical set of distributed data ripe for centralization and optimization. All in one place means we can manage access better,Read More
In the next few weeks Serena is going to be announcing important new versions of our ALM, Release and Deploy solutions.
Ever since Serena's CEO, Greg Hughes, introduced the concept of "Move Fast Without Breaking Things" at our User Conference in Washington DC in February, we have seen an overwhelming acknowledgement from our customers and partners that this is the perfect encapsulation of what modern application development and deployment means to them.
For Highly Regulated Large Enterprises (we callRead More
As the leader in deployment automation, Serena is a proud sponsor of the Jenkins User Conference 2015 World Tour. Come visit us at our booth and meet our experts in DevOps, CI/CD and enterprise release management.
Network Learn Explore @ theRead More
DevOps turned five last October, and while five years seems like a long time in terms of the technology adoption lifecycle, DevOps and Continuous Delivery still seem perched on the Enterprise IT chasm. The Pragmatists get it. They are under pressure from the business to deliver business value faster, better and more cheaply and the Visionaries and Early Adopters have proven that Continuous Delivery fits the bill.
The problem is that Enterprise IT canRead More


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The #Tesla #Powerwall being installed in #VT by @GreenMtnPower. Learn about #EnergyStorage https://t.co/CrjuVLe7AP
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Did you know scope 3 emissions make up 86% of an average company's total emissions? Learn more about how scope 3 emissions are produced, and how to mitigate your organization's impact.
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SpaghettiOs Pasta
Helping kids grow healthy and strong is a full-time job. Why not let SpaghettiOs Pasta give you a hand? SpaghettiOs Pasta is the perfect lunch option because:
- It's fun: those fun, slurpable Os you loved as a kid in a signature sweet sauce.
- It's easy: ready in minutes and no tangling with knife and fork. It's the neat round spaghetti you eat with a spoon!
- It's healthy: SpaghettiOs Pasta is a healthy kids' entrée with essential nutrients, a full serving of vegetables, and fiber in every bite.


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After the Bell
Before the Bell
Jim Cramer's Daily Booyah
Midday Bell
Top 10
Winners & Losers
HEP SHLX PBCT are going ex-dividend tomorrow, Thursday, July 28, 2016
Cramer sees Micron Technology getting back to $15 and urges caution on Holly Energy Partners.
The markets really need to see the financials, technology and healthcare sectors to move as they make up the bulk of our economy, says Jim Cramer.
HEP TCP OKS are going ex-dividend tomorrow, Thursday, April 28, 2016
©1996-2016 TheStreet, Inc. All rights reserved.
Action Alerts PLUS is a registered trademark of TheStreet, Inc.


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XL Dbh Collective Funny T Shirts
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Funny t-shirts, tank tops, sweatshirts, phone cases and art prints make you laugh awkwardly, wonder aimlessly and catch some fun attention.
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- Llamas in Pajamas by dotsofpaint
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- Nope by vomaria
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Teen Boys' Health
In this article
Most teens don't want to talk about masturbation. Even though it might feel embarrassing to talk about it, many teens do it.
In fact, more than half of 14-year-old boys admit they've masturbated. That means at least one out of every two of your guy friends has done it -- even if they won't admit to it. (About half of the girls in your class are doing it, too.)
Recommended Related to Teen Boys
The Facts about Puberty (for Guys)
"I'm getting hair in places I've never had hair before ... My voice is changing ... I think I've grown another inch overnight." This happens to every guy (and girl - but differently). It's the time when you physically stop being a boy and begin to transform into a man. It's when hormones in your body take over and cause things to change, grow, and develop. It's called puberty. Technically speaking, puberty is your body's way of transforming you into an adult, all for the sake of reproduction...
Read the The Facts about Puberty (for Guys) article > >
Here are some honest answers to questions you might have been too embarrassed to ask about masturbation.
What happens when I masturbate?
When you masturbate, you release sexual tension. You'll have what's called an ejaculation. Ejaculation is the release of semen from the penis. Semen is made up of fluid and sperm.
You may not ejaculate every time you masturbate.
Can masturbation hurt me?
Masturbation will not harm your body. Many teens have heard strange but untrue rumors about what it can do, such as:
- You'll go blind.
- You'll become mentally ill.
- It will stunt your growth.
- You'll grow hair or warts on your palms.
- You'll never have normal sex with another person.
- You'll run out of sperm and won't be able to have children.
- Other people will know just by looking at you.
None of these things is true. Masturbation won't hurt you and no one will know that you're doing it unless you tell them.
About the only risk to masturbation is that it might irritate the skin of your penis. You can reduce that risk by using a lubricant such as lotion or K-Y Jelly.
Is it bad or dirty to masturbate?
Masturbation isn't bad or dirty. It's a normal part of your sexuality. You shouldn't feel any guilt or shame about doing it. Feeling guilty about masturbation can make you think badly about yourself. And that can be unhealthy.
Is it OK not to masturbate?
Whether or not you masturbate is up to you. There is nothing wrong with choosing to do it or not to do it.
Can I catch an STD if I masturbate?
You can't catch a sexually transmitted disease (STD) from masturbating. You also do not lose your virginity by masturbating.


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Pokemon Mystery Dungeon: Blue Rescue Team
For the first time ever, the player is a Pokemon, speaking and interacting with other characters in a world populated only by Pokemon! Features a deep, involving and dramatic story brings the player into a world of Pokemon not seen or experienced before. Strategic battles enhance the adventure. Randomly generated dungeons make every mission unique. One day the player awakens to find that he or she has been turned into a Pokemon. The land is being ravaged by natural disasters so the player decides to form a rescue team with a partner Pokemon. The player can interact with many different Pokemon on various missions while trying to uncover their true purpose and destiny. An engrossing story of adventure, redemption and, most of all, friendship.
If you're stuck in Pokemon Mystery Dungeon: Blue Rescue Team, ask your fellow GameFAQs members for help.
|Most Popular Recent Questions
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World Jul 01, 2013
EU officials 'targeted' by U.S. spying
The European Union was targeted by Washington's vast Internet spying program, which also involved bugging its offices in Brussels and the U.S., a German magazine says.
|« Jun
|Aug »
The European Union was targeted by Washington's vast Internet spying program, which also involved bugging its offices in Brussels and the U.S., a German magazine says.
The ruling Liberal Democratic Party is attracting more voters ahead of the Upper House election, according to the latest opinion poll.
The ruling Liberal Democratic Party reveals itself to be the sole opponent of abolishing nuclear power at a policy debate involving nine major political parties.
Matsuzakaya, the oldest department store in Tokyo's famous Ginza shopping district, closed Sunday for a total makeover and will reopen as a large commercial complex in four years. Under a block-wide redevelopment project, the venerable 88-year-old, seven-story department store will be replaced in fiscal ...
Wedged into a secure, windowless basement room deep below the Capitol Visitors Center, U.S. District Court Judge John Bates appeared before dozens of senators last month for a highly unusual, top-secret briefing. The lawmakers pressed Bates, according to people familiar with the session, to ...
No country in the world is immune from unrest arising from poverty and inequality, according to World Bank President Jim Yong Kim. The protests in Brazil, Turkey, and elsewhere show that even governments that have made significant efforts already cannot let up in programs ...
"You'll be joining us in hell soon!" Slovenians liked to joke as neighboring Croatia prepared to enter the European Union, the first new member in six years and only the second from the former Yugoslavia. In truth, most of the 10 Eastern European countries ...
The campaign has a flashy website and official logo T-shirts and signs. Prominent Democrats have endorsed it and written $25,000 checks. Its paid operatives and volunteers have set up shop in a suburban strip mall office that last housed the regional campaign headquarters for ...
Sydney on Sunday bid farewell to what has been termed a transport "white elephant" — a futuristic monorail that has looped the center of the Australian city for almost a quarter of a century. The New South Wales state government announced in March that ...
Indian doctors have successfully completed a second round of reconstructive surgery on the skull of a baby suffering from a rare disorder that caused her head to nearly double in size. The four-hour-long surgery on the skull of 1-year-old Roona Begum was carried out ...
Three "super-Earth" planets have been found orbiting a nearby star at a distance where life could exist in theory, according to a record-breaking tally announced by the European Southern Observatory. The three are part of a cluster of as many as seven planets that ...
There is real debate over whether Edward Snowden is a whistleblower for civil rights violations or a traitor who has harmed U.S. national security.
Disturbing rumors are spreading that, sometime this fall, there will be a large-scale purge of reformist members from the Chinese Communist Party.
If Washington wants to build a fence to keep back the dangers of cheap labor, the fence should run from Virginia to Texas — not along the Mexican border.
Recent victories by Hezbollah militiamen in Syria will not save the regime of Bashar Assad. They could presage the political sunset for Hezbollah's leader.
Even with unspectacular growth of a little more than 6 percent a year, India's economy could become about as big as America's economy by 2050.
Elsewhere in the world, the kind of sōsenkyo (総選挙, general election) that fires up public interest and garners media attention is one where political parties compete for national office. In Japan, however, the sōsenkyo of aidoru gurūpu (アイドルグループ, idol group) AKB48 tends to grab ...
Buffalo stroll undisturbed, pausing occasionally to wallow in the grass and caked dirt, while prairie dogs yip intermittently as they dive into their holes and pop out again to survey the landscape. This northern stretch of Badlands National Park, known as Sage Creek Wilderness, ...
"The Ravine of Goodbye," a Japanese film by director Tatsushi Omori, won the Special Jury Prize at the 35th Moscow International Film Festival that ended Saturday, while "The Particle," a drama by Turkish director and writer Erdem Tepegoz, won the best film prize. "The ...
If there's a home run derby during this year's All-Star Series, odds are it won't be half as exciting as the one Wladimir Balentien and Tony Blanco are currently staging on a near-nightly basis during the regular season. The Tokyo Yakult Swallows' Balentien, and ...
Big man Kosuke Takeuchi had 23 points and 11 rebounds to guide the Japan men's national basketball team to an 88-61 victory over the Philippines at Yoyogi National Gymnasium No. 2 on Sunday. Hayabusa Japan completed a three-game sweep in the exhibition series, in ...
Brazilian striker Marquinhos helped Yokohama F. Marinos reach the semifinals of the Nabisco Cup at the expense of his former club on Sunday in a 3-1 win at home to holders Kashima Antlers. Yokohama went through 5-1 on aggregate, and Kawasaki Frontale also completed ...
Shunichi Nemoto homered and drove in four runs and Daichi Suzuki went 4-for-5 with three RBIs as the Chiba Lotte Marines walloped the Fukuoka Softbank Hawks 11-3 on Sunday afternoon. The Pacific League-leading Marines matched a season high with 17 hits and improved to ...
Kenzo Shirai, a 16-year-old high school sophomore, won the floor exercise on Sunday at the national apparatus championships. Shirai won with a score of 15.900 points at the meet which is used to select members for Japan's team for the world championships in Antwerp, ...
Women's world champion Japan was overpowered 4-2 away to Germany in the final exhibition match of its mini tour of Europe on Saturday. Norio Sasaki's team, which drew 1-1 away to England on Wednesday, twice came from behind through goals from Shinobu Ono and ...
When Bill Cartwright arrived in Japan to take over as the Osaka Evessa's new coach in January, he embraced the adventure of experiencing the culture and traveling around the country. But the longtime NBA player and former Chicago Bulls head coach said in an ...


text:
Phoenix church enourages 1-1-1 prayer
A Phoenix church is asking anyone who has a spare minute to use it to pray for someone else.
Shiloh Community Church believes that people everywhere need prayer.
"Somebody's in need," said Pastor Jason West. "Somebody that you want to reach out to, somebody who just needs to hear the love of God."
So West is making this request:
"We're asking everybody, if they could, to consider praying for one person, for one minute, everyday at one o'clock, leading up to Christmas. That's why we're calling it 1-1-1."
West said the idea of the 1-1-1 prayer started in Korea. He first heard of it from a church in California.
"It's been spreading throughout the world, and it's very simple," he said. "It's just trying to get people back to the routine of praying for one another."
West first announced the 1-1-1 prayer idea to his congregation during last weekend's services.
"Just imagine what would happen if everyone in the city just started praying? At one o'clock. Just start praying for somebody in need! What kind of prayer movement could start in this city and around the world?"
West believes that the effort may lift someone's spirits this holiday season by letting them know that someone cares enough to pray for them for one minute, every day at 1 p.m.
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text:
Trannies Have No Place to Pee
When it comes to breaking the law in Miami, no place is sacred. The greasy claw of crime will dig its fingernails in anywhere. Churches and synagogues? Be damned. Schools and hospitals? Fair game.
That apparently doesn't stop at the bathroom door. Our classy city's latest claim to fame: The least queer-friendly, most hate-crime-prone public restrooms. According to safe2pee.org — a site that maps secure spots for transgender folks to tinkle — Miami has the fewest safe toilets of all major U.S. municipalities.
On the safe2pee.org homepage, the group calls "harassment, violence, and discrimination" in the loo "a very real problem facing many in our society." It allows users to post addresses of gender-bending potties, where GLBT ladies and gents can squat freely together. Some are not marked with girl/boy signs. Others are labeled unisex.
Cities such as San Francisco and Las Vegas have more than 100 "gender-free" listed venues, which are mostly restaurants and bars. In Miami, however, there are only three. (That doesn't include Miami Beach.)
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It would be a stretch to call the three listed johns in the Magic City intentionally queer-friendly. The list includes toilets at an Amoco gas station on NW 36th Street, a CVS in Pinecrest, and an office building on SW 57th Avenue with "no receptionist." Three pretty, um, shitty options.
As controversy rages in Gainesville — over allowing transsexuals to use either sex bathroom — Riptide thought we'd pay the trio of Miami powder rooms a visit. We hoped to congratulate each business on its courageous social activism. But the gas station no longer existed and the office was empty.
When a woman at the Pinecrest CVS answered the phone, she sounded bored. "How many gender-free bathrooms do you have?" we wondered innocently.
Chomping a piece of gum, she answered, "Gender what?"
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text: Hi Bo, thanks a lot for the patch, it looks good at the first sight. I'll give it some testing soon. Michal Bo Stendal Sørensen wrote: > Hi Everybody, > > I was very glad you had included the copy method in the latest releases, > but needed recursive copy for a project. > > A patch to support recursive copy has been included in this mail. > > I have only testet it with copy, but should work fine with move to. > > Please write if you have any questions. > > Regards, > Bo Stendal Sørensen / bss >


text:
The shortened version of 'it's a small world', usually used while talking on a Disney chat site.
"It's such a shame that IASW is closed til next year. There goes every great no-cameras before-closing makeuout opportunity til it reopens."
by PrettyMissBHP November 07, 2007
Trending Now
Top Definition
In a sexual way. Opposite of NIASW (not in a sexual way)
Person 1: I love him.
Person 2: IASW?
Person 1: No, NIASW.
Person 2: IASW?
Person 1: No, NIASW.
by Reggie J July 14, 2008


text:
How to Cite this Article: Hu C-H, Liu Y-F, Yu J-S, Ng Y-Y, Chen S-J, Su P-H, Chen J-Y. 2012. A MID1 gene mutation in a patient with Opitz G/BBB syndrome that altered the 3D structure of SPRY domain. Am J Med Genet Part A 158A:726–731.
Research Article
A MID1 gene mutation in a patient with Opitz G/BBB syndrome that altered the 3D structure of SPRY domain†
Version of Record online: 9 MAR 2012
DOI: 10.1002/ajmg.a.35216
Copyright © 2012 Wiley Periodicals, Inc.
American Journal of Medical Genetics Part A
Volume 158A, Issue 4, pages 726–731, April 2012
Additional Information
How to Cite
Hu, C.-H., Liu, Y.-F., Yu, J.-S., Ng, Y.-Y., Chen, S.-J., Su, P.-H. and Chen, J.-Y. (2012), A MID1 gene mutation in a patient with Opitz G/BBB syndrome that altered the 3D structure of SPRY domain. Am. J. Med. Genet., 158A: 726–731. doi: 10.1002/ajmg.a.35216
- †
Publication History
- Issue online: 23 MAR 2012
- Version of Record online: 9 MAR 2012
- Manuscript Accepted: 5 DEC 2011
- Manuscript Received: 11 AUG 2011
- Abstract
- Article
- References
- Cited By
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text:
See referenced original series article on pages 638–43, this issue.
Cytopathology fellowship outcomes assessment
Milestones and Evaluation Toolboxes
Version of Record online: 16 JUL 2013
DOI: 10.1002/cncy.21326
© 2013 American Cancer Society
Cancer Cytopathology
Volume 121, Issue 11, pages 605–609, November 2013
Additional Information
How to Cite
Davey, D. D. and Wasserman, P. G. (2013), Cytopathology fellowship outcomes assessment. Cancer Cytopathology, 121: 605–609. doi: 10.1002/cncy.21326
Publication History
- Issue online: 13 NOV 2013
- Version of Record online: 16 JUL 2013
- Manuscript Accepted: 30 MAY 2013
- Manuscript Received: 23 MAY 2013
- Abstract
- Article
- References
- Cited By
The Accreditation Council for Graduate Medical Education (ACGME) is responsible for oversight of pathology residency and fellowship organizations in the United States. Residents must have successfully completed their training in an ACGME-accredited or Royal College of Physicians and Surgeons of Canada-accredited residency to be eligible to take the American Board of Pathology (ABP) examinations.[1] For subspecialties like cytopathology, only ACGME-accredited fellowships are accepted. The ACGME is undergoing major restructuring with a shift to continuous accreditation and outcomes assessment, the "Next Accreditation System" (NAS).[2] With the NAS, site visits will be extended to 10 years for those individual pathology and fellowship programs that are performing well. The episodic "biopsy" model for accredited programs will be replaced by annual data collection, and program information forms will be replaced by self-studies. Each ACGME review committee will monitor the program data and trends and will determine whether the program needs to submit additional data or take action. The annual data will include resident and faculty surveys, case log information, scholarly activity, and educational milestones data.
The Milestones project is the keystone of the NAS, requiring discernible developmental stages in attaining proficiency at established times during training. The educational milestones are based on the six ACGME competencies, planned in a systematically progressive framework.[3] Milestones for the pathology resident are now posted in draft form on the ACGME website,[3] and those for cytopathology fellows are in draft form but not published at this time. Each milestone is arranged in numbered levels, with level 1 representing most fellows at the beginning of training, level 4 representing the graduating fellow target, and level 5 being aspirational or representative of a cytopathologist in practice several years. The fellow interpretive and diagnostic knowledge milestones at level 4 will most likely be worded to state that fellows accurately diagnose most cytology samples. The ACGME revised program requirements for cytopathology that are effective July 1, 2013 specifically state that cytopathology fellows must demonstrate diagnostic proficiency and that they must demonstrate competence in the application of additional diagnostic adjuncts, including molecular testing.[4] Fellows must evaluate at least 2000 cytology specimens, including 500 gynecologic specimens; these may include cases interpreted by the fellows in addition to study sets and shared cases. Fellows must also demonstrate competence in performing and immediately assessing fine-needle aspiration specimens, and the requirements specifically recommend that programs monitor the degree of agreement between immediate evaluation and final diagnosis.[4] The ACGME will likely require that fellows maintain and program directors monitor case log data for fine-needle aspiration procedures performed by the fellow. However, additional types of logs, including case assessment and agreement logs, may be useful in evaluating competencies and milestones. Each program will be required to establish a clinical competency committee, which must provide objective assessments of competencies based on the cytopathology fellowship milestones, and to report these data to the ACGME on a semiannual basis.
The criteria proposed by Chebib et al in this issue of Cancer Cytopathology form a solid core set suitable for use as an assessment toolbox in cytopathology education.[5] These criteria are potentially robust indicators of a fellow's proficiency, because they are based on well defined national benchmarks and evidence-based data. Implementation of these objective assessment methods across programs could favor the establishment of a database of program's performance. In their article, the authors discuss the use of gynecologic cytology reporting rates and interobserver variability to assess and monitor cytopathology fellow performance. Specifically, the ratio of atypical squamous cells (ASC) to squamous intraepithelial lesions (SIL) (the ASC/SIL ratio) and the human papillomavirus (HPV)-positive rates in various interpretive categories were calculated and compared with faculty ratios and rates.[5] The data were collected and calculated for 5 consecutive fellows and then compared with faculty data. Although substantial agreement between fellow and faculty interpretations was demonstrated, the agreement was best for those cases interpreted as atypical squamous cells of undetermined significance (ASC-US) by the fellows. It is noteworthy that the ASC/SIL reporting rates tended to be lower for fellows than for faculty, and 33.2% of cases interpreted as negative by the fellow and ASC-US by the faculty were positive for HPV. Other potentially useful indicators of trainees' performance, also highlighted by Chebib et al, are the ratios between negative for intraepithelial lesion or malignancy (NILM) and high risk-HPV (hr-HPV)-positive (NILM/hr-HPV) (expected, 4%-8%) and between low-grade SIL (LSIL) and hr-HPV-positive (LSIL/hr-HPV) (expected, from >80% to 90%).[5]
There are 2 potential sources of bias in the cytology workflow that could impair the objective performance assessment of fellows. One source of bias is the ability to obtain the results of HPV status at the time of rendering an interpretation. The other is the built-in influence of the cytotechnologist's initial evaluation. Efforts should be made to specifically circumvent these potential sources of bias. A likely solution is to use anatomic pathology information systems that allow the documentation of the fellow's interpretation before the case continues with its traditional screening path. In addition, these information systems have the capability to collect and analyze these statistics. The longitudinal case-based evaluation of diagnostic competency model, as described by Ducatman and Ducatman, describes a valuable method with which to circumvent the inevitable biases intrinsic to our specialty.[6] This model's objectives, among others, are to increase systems accountability, decrease differences in practice, and teach residents and faculty to use an evidence-based method of practice-based learning. The effectiveness of this model resides on several rules, such as the resident's review of a significant number of cases, faculty grading of each case consistently and fairly, and stable grading criteria.
Studies like these are critical to the literature, because they provide program directors with ideas of how they can best implement the new ACGME program requirements and assess both resident and fellow milestones through the use of objective methods. Cytopathology fellowship programs may face challenges in collecting appropriate data, because some laboratory computer systems may not currently be collecting fellow interpretations or may not provide a mechanism to quantify data. Some programs may choose to develop manual logs that each fellow can maintain either continuously or at certain time points. We suggest that programs make efforts to collect and quantify some data before the semiannual evaluation of milestones. Such data will provide both fellows and program directors with objective measures on where improvements may be needed. To use the ASC/SIL ratio to monitor fellow performance effectively, the faculty members also need to have relatively stable reporting rates and high interobserver reproducibility. This may be a challenge for those programs with many busy faculty members who have many clinical and teaching responsibilities. Case reviews by both faculty and fellows at a multiheaded microscope are useful. Cytologic-histologic correlation is another method to hone interpretive skills and improve interobserver reproducibility. Finally, blinded review of gynecologic cytology slides through both intralaboratory and interlaboratory programs can help laboratories assess accuracy of screening and interpretative processes.
The ASC/SIL ratio is a measure of the tendency of a cytologist to make an ambiguous diagnosis relative to a diagnosis of certainty.[7] The ASC/SIL ratio can vary according to patient population. An elevated ASC/SIL ratio may indicate a greater readiness to classify minor atypia as ASC-US. However, it also may indicate a reluctance to make a definite interpretation of low-grade or high-grade SIL. In the experience of the authors, novice cytopathologists often have higher ASC/SIL ratios than those with several years' experience. Although there is always a tendency by pathologists to call cases atypical if there is uncertainty, junior pathologists may encounter uncertainty more frequently as they attempt to protect themselves from adverse patient care outcomes and avoid false-negative cytology results. The finding by Chebib et al of lower ASC/SIL ratios for fellows compared with faculty is somewhat surprising.[5] The average fellow ASC/SIL ratio of 1.15 is lower than the average ratio observed in questionnaires compiled by the College of American Pathologists.[8] This is probably because of the bias presented by the cytotechnologist interpretation. Regretfully, adequate data were not collected to enable an assessment of the changes in interpretation from primary screener, to fellow, to faculty pathologist. A low ASC/SIL ratio also could represent the over calling of LSIL or the under calling of ASC-US because of the lack of sign-out responsibility by the fellow. Are the fellows attempting to simulate the practice setting in which they are ultimately responsible for patient care, or are they relying on the faculty pathologist to set the appropriate cutoff of sensitivity for the laboratory?
Some studies have demonstrated a valuable correlation between the ASC/SIL ratio and the hr-HPV—positive/ASC-US rate, allowing for useful advice to individual cytologists on how to improve the quality of cytologic interpretations.[7] These indicators measure unrelated aspects of performance. The hr-HPV–positive/ASC-US rate is an objective measure of the risk of dysplasia. The ASCUS-LSIL Triage Study (ALTs) documented an hr-HPV–positive/ASC-US rate of 50.6% and considered this indicator as a benchmark for the performance assessment of cytology laboratories.[9] The hr-HPV–positive/ASC-US rate for fellows averaged 46.4%, which is similar to the ALTS data but higher than data from many community laboratory settings, which have a larger spread in patient age. The findings in the study by Chebib et al may have been biased by data early in the fellowship year, when fellows lack the diagnostic competence and knowledge to set an optimal negative/atypical threshold. Monitoring the ASC/SIL ratio and hr-HPV–positive/ASC-US rate at different times during the fellowship year may help address this question.
Of greater concern is the possibility that fellows in many programs either are not able to, or choose not to, exercise a graduated responsibility role. Allen recently published a commentary on this topic; we consider this is a "must" article for any residency or fellowship program director.[10] According to core ACGME program requirements, residents and fellows must be granted progressive responsibility and authority.[4] Cytopathology fellows should exercise graduated responsibility, including reaching an independent diagnosis, with appropriate indirect and direct supervision. If fellows do not believe that they are making the tough interpretive calls during their fellowship programs, then they will be hampered in effectively adjusting to independent practice.[10] Program directors should insist that fellows make decisions on cases and query them regarding the impact of their decisions on patient care and safety. Fellows who have a tendency to under call cases compared with faculty either could be dangerous to the public or may not be taking graduated responsibility seriously. Thus, as faculty supervisors, we need to attempt to discern these 2 possibilities and counsel the fellow appropriately. For cervical cytology specimens specifically, the screening interval is now less frequent, and patient safety is an important consideration. HPV cotesting provides an additional safety net when performed in appropriate age groups but will not be applicable to all patients.
High-performing individual residency and fellowship programs will have less frequent site visits under the NAS, but sponsoring institutions will have Clinical Learning Environment Review (CLER) site visits more frequently.[11] The ACGME has established the CLER program as a key component of the NAS with the goal of promoting safety and quality of care by focusing on 6 areas essential to the security and excellence of care that residents will provide throughout a lifetime of practice after the completion of their training.[12] The 6 areas of residents' assessments include patient safety, quality improvement and care transitions, resident supervision, duty hour oversight, fatigue management, and enhancing professionalism. The rationale of CLER is to produce both national metrics on residency and fellowship programs and institutional characteristics that will have a beneficial and valuable effect on quality of care and patient safety, not only within the educational setting but also after graduation.[2] Residents and fellows will need to be integrated into each institution's patient safety programs and quality-improvement projects. Pathologists, especially cytopathologists, have more experience than most specialties in quality improvement. Our fellowship programs can demonstrate achievement of milestones through specific quality-improvement monitors and quality-improvement projects, such as the study by Chebib et al.[5] These efforts will help our laboratories and sponsoring institutions achieve success during the CLER visits.
All educational assessment toolboxes must fulfill what a high-quality evaluation process needs: reliability, validity, ease of use, resources required, ease of interpretation, and educational impact.[13] These assessment tools should be field-test validated to factor in variations in local context and implementation processes, factors that can limit accuracy and comparability. Any assessment toolbox needs to incorporate and define the specific criteria and meaningful outcomes for the achievement of competency at precise, established intervals as fellows progress through their training, following the recommendation of the Milestones project. Specific thresholds or acceptable targets should be clearly demarcated for each indicator and for each to-be-defined developmental step. What are needed are objective outcomes and clearly defined time targets during the fellowship indicating expected objective results to assess educational impact. Local and national assessment benchmarks will need to be generated by the active collaboration of members of the cytology community through their respective national and international associations. An effort should be made to create reproducible data among the various groups of observers and institutions. This diverse information could be pooled and analyzed over time to allow for the establishment of national databases of individuals' and programs' performance. The ultimate goal is to be able to align specific outcomes with objective assessments, incorporating significant feedback to draw valid inferences about the learning process. The outcome of this competency-based training process should generate proficient cytopathologists who are well equipped for independent practice, protecting the health of the public by introducing quality assurance and reducing medical error.[14]
No specific funding was disclosed.
Dianne Davey is an unpaid volunteer member of the Pathology Residency Review Committee for the Accreditation Council for Graduate Medical Education (ACGME).
- 1American Board of Pathology. Requirements for subspecialty certification. American Board of Pathology website. Available at: http://www.abpath.org/BofISubspecialtyCert.htm. Accessed May 1, 2013.
- 2The Next GME Accreditation System—rationale and benefits. N Engl J Med. 2012;366:1051–1056., , , .
- 3The Pathology Milestone Project, April 2013 Draft. Accreditation Council for Graduate Medical Education Next Accreditation System website. Available at:http://www.acgme-nas.org/milestones.html. Accessed May 1, 2013., , , et al.
- 4Accreditation Council for Graduate Medical Education (ACGME). ACGME Program Requirements for Graduate Medical Education in Cytopathology, effective July 1, 2013. Available at: http://www.acgme.org/acgmeweb/ProgramandInstitutionalGuidelines/Hospital-BasedAccreditation/Pathology.aspx. Accessed May 1, 2013.
- 5Using the ASC:SIL ratio, human papillomavirus, and interobserver variability to assess and monitor cytopathology fellow training performance. Cancer Cytopathol. 2013;119:638–643., , , .
- 6Longitudinal case-based evaluation of diagnostic competency among pathology residents: a statistical approach. Arch Pathol Lab Med. 2006;130:188–193., .
- 7Using the rate of positive high-risk HPV test results for ASC-US together with the ASC-US/SIL ratio in evaluating the performance of cytopathologists. Am J Clin Pathol. 2008;129:97–101., , , .
- 8Practices of participants in the College of American Pathologists interlaboratory comparison program in cervicovaginal cytology, 2006. Arch Pathol Lab Med. 2010;134:331–335., , , et al.
- 9Comparison of 3 management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst. 2001;93:293–299., , .
- 10Graduated responsibility for pathology residents: no time for half measures. Arch Pathol Lab Med. 2013;137:457–460..
- 11The clinical learning environment: the foundation of graduate medical education. JAMA. 2013;309:1687–1688., , .
- 12
- 13
- 14Physicians' professional responsibility to improve the quality of care. Acad Med. 2002;77:973–980..


text: Are You Feeding Your Kids Enough Cholesterol?Hamilton Nolan8/08/12 9:39amFiled to: ParentingHealthCholesterolFoodKids These Days24EditInvite manuallyPromoteDismissUndismissHideShare to KinjaToggle Conversation toolsGo to permalink In the fabled "golden age" of America, parents were able to rest easy knowing that their kids would have good schools to attend, safe neighborhoods in which to play, and ample cholesterol-enriched food to consume as they grew. No more. Schools are hell; parks are weed-infested; and children just like yours are eating food severely lacking in precious cholesterol. Is your child's internal reserve of cholesterol at risk?Another small stumble in the slow-motion collapse of America's Global Superiority. From the WSJ: The study showed that 8.1% of children and adolescents ages 6 to 19 had elevated total cholesterol levels between 2007 and 2010, a decline from 11.3% who had high cholesterol between 1988 and 1994... The proportion of children and adolescents who had any type of cholesterol problem-involving too little "good" cholesterol or too much of the "bad"-fell to 22% in the 2007-10 period from 27% in the 1988-94 period. "Good" and "bad" cholesterol?? This is America. We don't distinguish between "good" or "bad" taste, or "good" or "bad" wars, do we? Meanwhile the Chinese are hardening their children's arteries into veritable steel pipes. American parents: I blame you. We all do. Advertisement [WSJ. Photo: James Emery/ Flickr]Reply24 repliesLeave a reply


text: A Bachelor of Science in Planning (B.S.P.) will prepare you for positions in government agencies, private companies, planning departments or engineering firms, but you can also use it to launch your graduate studies. As part of the program, you will discover both the diversity of the profession and appreciate its broader purpose. Research opportunities and studio credits will deepen your classroom experience. Rowan's program has a special focus on sustainable community design, land conservation, and the specific planning practices and challenges of the region.


text:
The standards-driven push for project-based learning and collaboration may inadvertently penalize introverted students who prefer to work quietly on their own, some educators say. An estimated one-third to one-half of the U.S. population identifies as introverted.
Mass shootings in the United States have tripled since 2011, according to Harvard University researchers. And as of late October, 29 shootings took place in K12 schools this year.
Since 2013, 156 shootings had rattled nerves, and had injured or killed students and staff members in both K12 schools and colleges, according to the nonprofit Everytown for Gun Safety Support Fund. In some cases, a gun was fired but no one was injured, the group reports.
Schools can be reimbursed for providing many general health services—a new benefit thanks to a change in federal law.
The Centers for Medicare & Medicaid Services announced the shift in December 2014, but many districts miss out on this source of federal funding that can lead to improvements in student health, experts say.
Many districts hesitate to integrate social media into district policies because administrators fear cyberbullying, class distractions or other negative consequences. But administrators embracing the new tech tools say social media enhances student and community engagement.
A first-of-its-kind, 50-city analysis of public education finds that while academic progress remains flat in most urban areas, underserved students in some parts of the country are gaining access to more rigorous learning.
Disproportionate suspension rates for black students and disabled students have created a national "discipline gap," making it more difficult for these students to succeed academically, according to the Center for Civil Rights Remedies at UCLA
Several months into the school year, many districts nationwide still face the worst bus driver shortage in recent years. Some are offering signing bonuses and increased wages to attract more people to the job.
Only 6 percent of school bus contracting companies nationally had enough drivers this year, compared to 15 percent with no shortage in 2014, according to a survey from School Bus Fleet magazine. Nearly 30 percent of respondents said they had a "severe or desperate" shortage of bus drivers this year.
Regular access to a computer varies for students around the world.
Some countries, such as Australia, the United Kingdom and the United States, boast less than two students for every computer at school.
Others, such as Turkey and Tunisia, have 45 and 53 students for every school computer, respectively.
Recent surges in charter enrollment—and reported scandals—have led some states to pass new laws that seek more accountability from the schools, their administrators and their sponsors.
Forty-three states and the District of Columbia have enacted laws permitting charter schools to operate. In 2013-14, 2.57 million students enrolled in charters nationwide—up from 1.29 million in 2007-08, according to the National Alliance for Public Charter Schools.
Mastery trumps class time in competency-based education models now catching on in more U.S. classrooms—from New England to the Midwest to Alaska.
Students must show they grasp a concept fully before they can move on to the next unit. Those who get a low grade or score can't advance until extra instruction by a teacher reveals that students demonstrate comprehension, says Susan Patrick, president of CEO of iNACOL.
The organization promotes the new approach through its ComptencyWorks initiative and provides support to schools making the transition.