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On April 28, Dr. Paul Farmer stood before a microphone in a large conference room in Haiti's University Hospital.
Several days before, bomb blasts at the marathon in Boston, Massachusetts, had killed three people, but not a single person who made it to a hospital died. In that grim emergency, teaching hospitals made a difference, Farmer told the crowd.
"I love working at a great Boston teaching hospital, Brigham and Women's. I love being able to train the next generation of physicians and nurses. And I want Haiti to have something like it, too," Farmer said.
This month, University Hospital in Mirebalais, Haiti, took a significant step toward becoming the teaching hospital envisioned after Haiti's 2010 earthquake, which devastated the country's already-fragile medical infrastructure. On Oct. 1, the hospital's first medical residents—all young Haitian doctors—began hands-on training in pediatrics, general surgery, and internal medicine.
The application process was intensive and merit-based: 238 people applied and took an entrance exam. Of those, 45 were interviewed, and 14 were selected. Class members hail from all over Haiti. Some studied at Haiti's state medical school or private schools in Port-au-Prince; others went to the Dominican Republic. Some just graduated from medical school and completed their social service year; others have been practicing for a few years. By coincidence, the class is evenly split between men and women.
Dr. Jean-Louis Willy Fils, 29, from the northern city of Cap-Haïtien, has wanted to be a doctor for as long as he can remember. He describes surgery as his "true vocation," so to be selected for a University Hospital residency was more than he hoped for.
"One year ago, I couldn't have even imagined learning surgery in a hospital with an international standard of quality, for the good reason that such a hospital didn't exist in the country yet," Fils said. "That's the proof that great things can be done in Haiti."
Over the next several years, these 14 doctors will receive instruction from Haitian and foreign physicians—some of whom are faculty at the same teaching hospital where Farmer trained and now teaches. The curriculum for their training was developed through special working groups and designed to follow the Accreditation Council for Graduate Medical Education International's (ACGME-I) standards.
After completing orientation this month, residents will begin caring for patients as well as rotating in departments such as emergency medicine, TB/HIV clinic, and oncology. Each day, they will spend an hour in special education sessions for residents, and once or twice per week they will be on call throughout the night. They will also conduct research to improve the quality of care. The ACGME-I guidelines require they work no more than 80 hours a week, but they'll probably come close.
"The residency program at University Hospital represents the most serious attempt, to my knowledge and during my lifetime, to systematically create a critical mass of Haitian physician specialists that will have the opportunity to be fully useful to all Haitians," said Dr. Pierre Paul, PIH senior advisor. He added that he and his physician colleagues have traditionally questioned the poor outcomes of Haiti's health sector, but now feel questioned themselves about their responsibility to improve health care in Haiti. "University Hospital and its new residency program stand as formidable evidence of the efforts that young Haitian health professionals are making to restore, in a sustainable way, hope and dignity in the future of health in Haiti."
As new classes of residents begin each fall, the number of physician trainees will double and triple. And the programs will expand to include other health professionals, such as nurse anesthetists and other nurse specialists, as well as more medical specialties—such as emergency medicine—which would be the first such training program in the country.
In addition to hands-on training, the curriculum includes lessons on social medicine and the root causes of disease, such as poverty, which have been part of PIH's work since its early days in Haiti. The programs are designed to train and retain a new generation of doctors to the poor who work outside of Port-au-Prince, the traditional mecca for medical training.
"We envision a workforce of doctors, nurses, and other health professionals who are driven by medical excellence and committed to high-quality care for all Haitians," said Michelle Morse, PIH deputy chief medical officer for Haiti. "The start of these residencies brings Haiti one step closer to this vision."
The American Medical Association describes the training for doctors in the United States as "lengthy."
Four years of college. Four years at medical school. Up to seven years in a residency program and three years in a fellowship for specialists, who make up 95 percent of American doctors.
Add it up, and many doctors have had more than a decade of medical training. Much of it takes place through hands-on coaching from senior physicians in teaching hospitals with all the latest diagnostics and treatments.
In Haiti, one reason for needless sickness and death is the lack of trained professionals to provide health care. There are only 25 physicians per 100,000 Haitians. The United States has more than tenfold that number: 280 doctors for every 100,000 Americans.
In Haiti, half of doctors are generalists who have completed medical school and a social service year but no specialty training. Each year, about 450 graduating doctors compete for only about 150 residency positions.
Those residencies allow Haitian doctors to become specialists in fields such as internal medicine and pediatrics, but even those additional years of training are wanting. Most residencies are based in hospitals that are ill-equipped and under-staffed, with limited supervision by experienced doctors. Attending physicians are underpaid, leading many to spend their time in private practice, instead of teaching physician trainees.
PIH conducted a survey of Haitian residency programs to better understand the country's medical education needs. The survey found that 55 percent of residents don't have Internet access at the hospitals where they work, and 80 percent of the programs do not have an exit exam for residents.
"These residencies are operating in hospitals that are severely short on resources, from staff to equipment," Morse said. "University Hospital has electronic medical records, an emergency department, a CT scanner—it allows us to have a whole new level of quality care and training at a hospital with the appropriate resources."
Double brain drain
The lack of opportunities leads many young Haitian doctors to seek training and employment in other countries, causing a brain drain in the health workforce. A staggering 80 percent of all physicians trained in Haiti leave within five years of graduation to practice abroad. Of the doctors who stay in Haiti, most practice in Port-au-Prince, which makes it difficult for rural people to access care. The medical education programs at University Hospital aim to slow or even reverse that double brain drain—from rural to Port-au-Prince or abroad—by encouraging talented young doctors to train in Haiti and stay there to practice medicine.
Dr. Ketly Altenor, 27, hopes to return to St. Marc, Haiti, to practice medicine. Growing up there, Altenor lost her father at 12 years old, and her mother supported the family as a street vendor. Despite her family's poverty, Altenor excelled in school and earned a competitive spot at the state medical school. She graduated with the support of a scholarship from the nonprofit Haitian Education and Leadership Program, which provided housing, a stipend, and mentorship. She was accepted into the pediatrics residency at University Hospital after graduating from medical school.
"After my training I intend to return to work in my hometown, where there aren't enough pediatricians," Altenor said. "I will try to extend pediatric care to remote areas of the Artibonite region. I want to work in social medicine and really help people."
Though University Hospital's medical residencies are just starting, other training activities have occurred since the hospital opened. Since Farmer delivered his talk, or "grand rounds," to inaugurate medical education at University Hospital, staff have participated in daily continuing education sessions to improve care, from training on using ultrasound to sessions to help faculty become better teachers.
As Farmer said, "University Hospital was built to be a teaching hospital because the hypothesis, here, is that the quality of medical care will be improved whenever training and research—the 'feedback loops' that allow us to learn—occur in tandem with compassionate care."
This essay from PIH's Stephanie Garry originally apperared in the Tampa Bay Times.
The gleaming white hospital appears out of nowhere in the bustle of this impoverished city in the Central Plateau of Haiti.
It seems even more out of place when you consider what's inside: 300 beds — more than All Children's Hospital in St. Petersburg. Six operating rooms. A neonatal intensive care unit. A CT scanner, the only one available to the public in Haiti. Most important, patients. More than 10,000 have seen clinicians since the hospital opened this spring.
It's one of the few visible signs of progress since the 2010 earthquake leveled Port-au-Prince.
More than half of American households donated after the earthquake to help a poor country with bad luck. But for the most part, the grand plans of building back better have not materialized. The 1.5 million people living in tents after the earthquake are fewer, but many were forcibly evicted. A garment factory and a luxury hotel, both underwritten by aid, opened with fanfare. These milestones hardly amount to a resounding victory for the people of Haiti.
Against this disappointing effort, University Hospital stands out as a testament to how much can be accomplished in Haiti. It can teach us how to achieve rebuilding and development with effective aid that endures, and better deliver on the generosity of the American people.
The popular narrative would tell you the recovery fell short because Haiti is difficult, unstable, dangerous and corrupt. Just a few days after the quake, New York Times columnist David Brooks blamed Haiti's trouble on "progress-resistant cultural influences." It's a facile explanation of a complex place, but a lot of people found it convincing.
My experience has led me to believe something else. I lived in Port-au-Prince for nine months and now work in Boston at Partners In Health, the global health nonprofit that built L'hopital Universitaire de Mirebalais under the guidance of Brooksville native Dr. Paul Farmer. In my view, the problem lay not with the Haitians but the aid industry that came to their rescue.
The earthquake recovery was largely composed of nonprofit organizations that are more eager to please donors than the people they purport to serve. Too often, they pay lip service to working with communities while largely ignoring them in designing their programs. Many of the so-called experts on alleviating poverty had little experience in Haiti and no plans to stay long term.
I saw this firsthand during my time working for Fonkoze, an exceptional Haitian microfinance bank serving the rural poor. I attended an aid organization's workshop to create a website to help poor, rural people improve their lives with information — people who are mostly illiterate and lack access to electricity, computers and the Internet. I heard an American aid worker complaining that the luxury housing provided by her nonprofit employer didn't have enough style.
It seemed like so much money went to Haiti after the earthquake, but less than 1 percent of the $2.4 billion in immediate earthquake relief went directly to the government of Haiti.
In the longer-term recovery effort, the U.S. development agency USAID spent $1.15 billion, more than half going to American firms in the D.C. area and less than 1 percent to Haitian firms and nonprofits, according to the Center for Economic and Policy Research.
Haitians weren't in charge of the projects, but they shoulder the blame for failures. Their country is characterized as a black hole for aid.
If national systems are weak, diverting money and projects away from the government only worsens the problem. It isn't easy to work with a government that is chronically short of resources, but it's the only way to strengthen the public sector to ensure the rights of its citizens.
There are many problems with the way aid works, but at the root of it is how we view the poor and disadvantaged, and more broadly, any group of people we seek to serve.
Beneath the complexity of actors and projects, the core of the problem is a misinterpretation of poverty.
As well intentioned as they can be, both aid and charity take the subtle view that there is something inherently wrong with the people being served. Otherwise, the argument goes, why would they need our help?
In reality, disadvantaged people are systematically deprived of the basic rights that would enable them to rise out of poverty — food, clean water, decent sanitation, housing, jobs, health care and education. The ambitions of aid are often too small, focusing on modest, short-term interventions instead of the long, painstaking work of building systems to ensure rights, in partnership with the government and local institutions.
In Haiti, this denial of rights is not innocent, but the result of centuries of international interference and oppression. A couple of recent examples: Just a decade ago, on claims that Haiti's government was interfering with the elections of eight senators, the United States blocked international loans to improve water and sanitation systems. In 2010, less than a year after the earthquake, a U.N. peacekeeping force inadvertently brought an epidemic of cholera to Haiti by dumping its sewage in a major river system. Cholera has since killed more than 8,000 people and sickened more than one in 20 Haitians.
Instead of fixating on personal failings of the people of Haiti, we should work with them to build systems that ensure access to education, health care and food. The rights-based approach guides us to imagine doing more than offering castoff goods and services — the XXL T-shirts or the expired medicines or the spring break service trips. Pragmatically, a human rights approach works better because it confronts difficult, interconnected problems with significant solutions, not small, cheap interventions like chlorine for purifying drinking water or transitional shelters that, by themselves, offer little hope of lasting change.
Partners In Health, along with its sister organization, Zanmi Lasante, works to improve the quality of care in the public health system, collaborating with Haitian communities and the government to train health care workers, develop new services and improve rundown facilities, including building top-quality infrastructure.
In the case of University Hospital, the Haitian government identified the need for a national teaching hospital after the earthquake, and Partners In Health/Zamni Lasante worked alongside the Haitian Ministry of Health to design and construct the $17 million facility, with the help of many in-kind donations. Through a public-private partnership, the government and Partners In Health/Zamni Lasante will contribute to operating costs, and management of the hospital will gradually transition to the government over the next 10 years.
Partners In Health builds open-ended partnerships that don't end when the earthquake donations dry up, offering a greater chance at slow, lasting progress on entrenched problems of poverty and inequality. We call this "accompaniment," to convey a shared journey.
Developing partnerships based on empathy and pragmatic solidarity — not pity or even sympathy — is the essential first step in serving people in need.
Early on May 23, nurses and doctors dressed in blue scrubs and prepared for University Hospital's first surgical case. The instruments were sterilized, positive air pressure minimized the risk of infection, and Haitian nurses provided anesthesia. Dozens of partners — corporations, generous donors of time and money, medical professionals, and Mirebalais housekeepers — had worked together to make this day a reality. It wouldn't have been possible without years of work to strengthen the health system in the Central Plateau, so that patients could be connected to care from their homes to the hospital.
The patient was a 60-year-old Haitian woman and mother of four, diagnosed with breast cancer by a Haitian doctor. A Haitian surgeon from Mirebalais and his American counterpart worked side by side in a fully equipped operating room to perform the mastectomy. As with all work at University Hospital, procedures like this serve two purposes — first, and most important, to heal the patient with a standard of care that compares to a top-quality teaching hospital anywhere else in the world, and second, to train Haitian medical professionals to provide that kind of care. With this operation, the Haitian woman has received new hope and a greater chance of living longer with a better quality of life.
In the United States, there would be no question that a woman with breast cancer receives care — including a mastectomy — to save her life, and health facilities provide it routinely. Yet development experts debate whether this care is worth the cost in low-income countries. Should we spend the money on and invest the time in systems, with the necessary infrastructure, equipment, supply chains and drugs, to treat complex cases like cancer?
The patients in need of care and their doctors always say yes. Our role is to support them.
University Hospital was built in less than three years, long enough for the majority of earthquake responders to come and go. It will remain, serving the people of Haiti long into the future, as a testament to how much can be accomplished when you view the people you seek to help as equal partners.
Stephanie Garry is a former Tampa Bay Times staff writer who served in the Peace Corps in the Dominican Republic from 2009 to 2011. In 2011, she worked for Fonkoze in Port-au-Prince, Haiti, before joining the Partners In Health staff in Boston. Views are her own.
Since the earthquake, Partners In Health (PIH) has focused on rebuilding the damaged healthcare and health education systems in Haiti in partnership with the Haitian Ministry of Health. Constructing and opening a new national teaching hospital, Hôpital Universitaire de Mirebalais (HUM), was one huge step towards achieving this goal, and PIH is proud to share how this vision is now a sustainable reality.
It's among the most basic, most critical, and most overlooked resources needed to run a hospital: electricity. But in Haiti's Central Plateau, the flow of electricity is intermittent at best. Consider that in Mirebalais, located 30 miles north of Port-au-Prince, the power goes out for an average of three hours each day. This poses an enormous challenge to running any hospital: surgeries are jeopardized, neonatal ventilators stall, the cold chain is interrupted, and countless everyday tasks get derailed. As Partners In Health co-founder Paul Farmer noted at a recent lecture at the Harvard School of Public Health, "It's not great if you're a surgeon and you have to think about getting the generator going."
To ensure patients and staff at HUM weren't left in the dark when the 300-bed hospital opened in March, PIH and its partners looked toward the sun. Stretched across the roof of the new 200,000-square-foot hospital is a vast and meticulously arranged array of 1,800 solar panels.
On a bright day, these panels are expected to produce more energy than the hospital will consume. Before the hospital even opened, the system churned out 139 megawatt hours of electricity, enough to charge 22 million smartphones and offset 72 tons of coal. Perhaps most important is that the excess electricity will be fed back into Haiti's national grid, giving a much-needed boost to the country's woefully inadequate energy infrastructure.
"At each step of the way, we were attempting things that had never before been done in Haiti," said Jim Ansara, volunteer HUM director of design and construction and a longtime PIH supporter. In a country ravaged by deforestation, the benefit to the environment cannot be overstated: HUM's solar array has already offset more than 140,000 pounds of carbon emissions. Annually, the system is expected to save 210 metric tons of carbon emissions.
The system also carries a financial benefit. In Haiti, electricity is six times as expensive as in New England: the price per kilowatt hour is 35 cents, compared with 5.5 cents in New England. Using solar energy is expected to slash $379,000 from HUM's projected annual operating costs. It's also estimated that, overall, the hospital will create 800 jobs for Haitians. When fully operational, HUM is expected to be the largest solar-powered hospital in the world that produces more than 100 percent of its energy during peak daylight hours.
On December 4, 2012, PBS NewsHour featured a story on Partners In Health's ongoing earthquake recovery efforts in Haiti. Below, please find a transcript of the program as well as a link to the video.
FRED DE SAM LAZARO: The 2010 earthquake that devastated Haiti may still loom large in Americans' memory, but, in Haiti itself, that was at least three disasters ago, before Hurricanes Tomas last year, Isaac in August, and recently Sandy.
Each storm brought a grim reminder of yet one more ever-present disaster: the deadly cholera epidemic that started 10 months after the quake.
At the cholera ward of Saint Luc's Hospital just outside the capital, Port-au-Prince, Dr. Jackinson Davilmar says since Hurricane Sandy admissions have doubled from 20 to 40 patients each day.
DR. JACKINSON DAVILMAR, Saint Luc Medical Center (through translator): Most of the new cases are coming from further up the hill in places like Petionville where we had not seen them before. I'm not positive, but perhaps the wells there have been contaminated.
FRED DE SAM LAZARO: Experts believe cholera was brought here by U.N. peacekeepers at the time, a battalion from Nepal. Untreated sewage from this base flowed into a tributary of the ArtiboniteRiver, the major source of water for both washing and drinking.
Cholera is spread by fecal-oral contact. Two years on, 200,000 patients have been sickened, 7,500 have died from the extreme diarrhea and fluid loss. Each flood brings more contaminated water, more cases.
The epidemic prompted massive relief efforts and public campaigns on the streets and in classrooms promoting hygiene and sanitation. Fatalities have dropped from 10 percent of cases early on to about 1 percent.
Still, 600 people have died from cholera this year, many in remote areas, even those unaffected by floods. There's now plenty of awareness of cholera in Haiti. The biggest challenge for people today is distance.
As the epidemic subsided over the last few months, many treatment centers have been closed in the remote areas. So, getting to places that remain open is a huge challenge. It can take hours. And that delay can be fatal.
Sentiment Joseph, a 27-year-old mother of three, will likely recover, having made it in time to get prompt antibiotics and rehydration therapy. Her husband wasn't so lucky. He died a week earlier in their home less than an hour away by motorcycle.
SENTIMENT JOSEPH, Cholera survivor (through translator): He took ill around midnight. There was no one to care for the children, no means to bring him in. We didn't have the money to hire a motorcycle.
FRED DE SAM LAZARO: Across this spartan treatment center run by the Boston-based charity Partners in Health, other challenges were apparent from patient stories.
MAN (through translator): We don't have hygienic facilities. We treat our water, but don't have a formal latrine.
MAN (through translator): I was staying in my sister's home, and I'm not sure she treated the water.
MAN (through translator): There are 14 people living in our house. And it's very expensive to treat the water for so many people. And our only latrine was destroyed in a road-building project. So, we don't have that.
FRED DE SAM LAZARO: Cholera, not seen in Haiti for almost a century since 2010, is likely to remain for some time, says Partners in Health physician David Walton.
DR. DAVID WALTON, Partners in Health: Cholera endemic to the region, to the country is the last thing that they needed. Permanent solutions need to be put in play to be able to really stem the tide of this epidemic that is still ongoing.
FRED DE SAM LAZARO: He says cholera's persistence is a proxy for a much larger rebuilding effort that's fallen short, one that should have provided far more access to clean water and sanitation.
DR. DAVID WALTON: On a scale of A. through F., it's a D.
FRED DE SAM LAZARO: At least 360,000 people remain in crowded tent camps, he notes. Other people have rebuilt in poor neighborhoods destroyed in the quake, like this one in the hilly suburb of Petionville.
Water had to be carried in. And there are few toilets, so there's a threat of cholera.
James Sanvil lives in the U.S., but was visiting family here.
JAMES SANVIL, Haiti: There is no water, no way for them to get water down here, because there's no water came, like, down here.
FRED DE SAM LAZARO: Kevin Fussell is one of many small providers who have tried to bring relief. He's a Georgia physician who started a charity to provide safe drinking water.
His group installed clean water facilities into six schools in the central Haitian town of Mirebalais before running out of donated funds.
He says they'd like to put in many more, but have had no luck applying for funds the U.N. has for water projects.
DR. KEVIN FUSSELL, World Water Relief: They're basically trying to come up wore water solutions for an entire country. And we're working in a very small region. And they're looking for bigger global solutions.
My problem with that thinking is that three years later somebody is still thinking about global solutions, when we have real problems right here. And nothing is being done.
FRED DE SAM LAZARO: That's a complaint that's widely heard. In water and sanitation projects or anything else, there's little to show for the billions in aid that came in or was pledged to Haiti, says human rights activist Antonil Mortime.
ANTONIL MORTIME, Human Rights activist (through translator): I have talked to people in the tent camps. If you look at Cite Soleil, you can see that the situation is actually worse.
There's no change with education, with infrastructure or health care. Corruption, poverty and hunger haven't decreased.
FRED DE SAM LAZARO: Nigel Fisher, head of the U.N.'s large Haiti mission here, acknowledges the slow pace, but says there has been some progress on the massive rebuilding task, a much smaller number of tent dwellings since last year, for example.
NIGEL FISHER, Deputy special representative of the U.N. Secretary-General: If Haiti were a glass, and it's gone from being 10 percent full to 15 percent full, let's recognize that without in any way diminishing the fact that you have still got 85 percent of the glass full.
FRED DE SAM LAZARO: But Fisher says many of the problems were endemic to Haiti long before the earthquake.
NIGEL FISHER: What we're seeing is people who are in camps because of entrenched poverty. Many of these people were hidden before in slums. They're now in the open in camps.
And that is a function of underdevelopment. It's a function of weak governance. It's a function of lack of alternatives, and which these people faced before.
FRED DE SAM LAZARO: He says one of the biggest problems is that Haiti's government, crippled by the quake and a corrupt reputation, hasn't been able to lay down national priorities for the rebuilding.
That's largely been led by foreign non-government organizations, at least 10,000 of them, everything from small church groups to the large international agencies. NGOs have received more than 90 percent of all aid dollars.
DR. DAVID WALTON: The amount of redundancy with the more than 10,000 NGOs that the U.N. special envoy's office has estimated exist Haiti just leaves one wondering where all the money has gone.
And, frankly, if you look at, as they have done, where all the money has gone, hardly any of it has gone to strengthen the government.
FRED DE SAM LAZARO: Partners in Health, which has been in Haiti for 25 years, is trying to restore what it says is the appropriate role for the government.
DR. DAVID WALTON: So, 60 percent of our beds have medical gas. They also have electrical receptacles and data capacity.
FRED DE SAM LAZARO: The group raised $22 million to build a 300-bed state-of-the-art teaching hospital in central Haiti. However, it then partnered with Haiti's Ministry of Health to design and run it. It will turn over the hospital to the government in 10 years.
Dr. Walton says Haiti can never be rebuilt unless it has a strong, accountable government.
DR. DAVID WALTON: It would be so much easier for us to run it the way we wanted to run it and not coordinate with anybody but ourselves, because, hey, we're really smart, or at least we think we are.
FRED DE SAM LAZARO: And you are the guys with the money.
DR. DAVID WALTON: We are the guys with the money. And, again, NGOs don't guarantee the right of health to citizens of any country. But the government does. And we see ourselves as supporting the government.
FRED DE SAM LAZARO: President Michel Martelly cut the ribbon on the new hospital, vowing his administration will do better.
International donors, who have withheld half the $5 billion they pledged to rebuild Haiti, will closely watch how projects like this hospital fare.
For many ordinary Haitians, the goal, as one health worker put it, is to make it to the end of each day alive.
The purpose of this report is to provide a general update on the progress of Partners In Health's ongoing work in Haiti since the earthquake in January of 2010. Thanks to your generous support, Partners In Health has raised over $140,000.00 via globalgiving for our Haiti Earthquake Recovery project. We extend our deepest gratitude, on behalf of all of our patients and colleagues, for your commitment to and belief in helping poor people access quality health care.
Partners In Health and our Haitian sister organization, Zanmi Lasante ("Partners In Health" in Creole, or ZL) provide medical care at 15 health centers and hospitals across Haiti's rural Central Plateau and Lower Artibonite regions. As well as improving access to care, PIH/ZL is dedicated to raising the standard of care in rural Haiti by introducing new diagnostics and treatment regiments for both common and complex illnesses.
Hôpital Universitaire de Mirebalais (Mirebalais University Hospital)
Haiti has long been the heart of PIH's work, and today PIH/ZL is the largest healthcare provider in Haiti. By investing in public health infrastructure and the local workforce, PIH and ZL are rebuilding the health system in rural Haiti and ensuring the long-term sustainability of our efforts. In 2010, PIH/ZL conceived of Mirebalais University Hospital (HUM) in response to an urgent request from the Haitian Ministry of Health following the destruction of the national referral and teaching hospital in Port-au-Prince in the January 2010 earthquake. Beyond delivering life-saving care to a poor and underserved population of 3.3 million in Mirebalais and central Haiti, HUM will allow us to embark on an ambitious strategy to develop the capacity of Haitian clinicians (doctors, nurses, and specialists) to provide care.
As of July, hospital construction is fully complete, and the hospital will open at partial capacity in spring 2013. Additional specialty services will be rolled out over the following two years. Upon opening, HUM will offer the following services:
As a national teaching hospital, HUM is designed both to provide a new standard of healthcare in the public sector and to take a leading role in training and retaining an expanded workforce of well-trained and highly motivated doctors, nurses, and other health professionals.
Cholera prevention and treatment
The cholera epidemic had affected 553,270 people and killed 7,238 nationwide between October 2010 and June 2012. From January 2011 to May 2012, PIH/ZL treated 70,582 suspected cases of cholera at our facilities, 56,506 of whom were hospitalized, and 282 of whom died. Nationwide in Haiti, the case fatality for cholera is 1.3%; at PIH/ZL facilities it is 0.4%. After a year of fighting the outbreak with treatment, we added an additional tool to our arsenal: in April, PIH/ZL launched a pilot cholera vaccination campaign which reached nearly 50,000 people with the two-dose vaccine. Though these achievements are substantial, we are additionally buoyed by the international attention we were able to draw to the epidemic and ultimately the World Health Organization's recommendation that a stockpile of vaccines be available in Haiti
Cancer care
Building upon PIH's existing health programs and partnership with the Haitian Ministry of Health, PIH/ZL launched the first comprehensive and integrated breast cancer program in Haiti's Central Plateau and Artibonite Departments. Currently our breast cancer program is based out of Cange. When the Mirebalais National Teaching Hospital begins operating at full capacity, the program and clinical team will transfer there.
Because breast cancer is not yet a widely recognized disease in Haiti, most patients with cancer present in very advanced stages, necessitating some combination of mastectomy, chemotherapy, and/or palliative care. For women whose cancer results are positive, ZL provides chemotherapy and surgery (mastectomies, quandrantectomies, and lumpectomies) in Cange. Our current caseload includes 10 patients that are on active chemotherapy for breast cancer, and an additional 30-40 patients receiving Tamoxifen alone.
To encourage a greater awareness of breast cancer in our catchment area, our staff also coordinate extensive education initiatives at the community and clinical levels. Community awareness events held on World Cancer Day and International Women's Day shared information about breast cancer with a broad audience. Community health workers, who frequently visit patients in their homes, also receive information on breast cancer to pass along to their patients. We have already seen an increase in caseload as a result of these community outreach efforts, and expect that trend to continue as breast cancer awareness in our catchment area increases.
Rehabilitative medicine
Following the January 2010 earthquake, PIH/ZL marshaled the resources of academic and medical partners to treat the thousands of victims who lost limbs and mobility in the tragic event. We have since built upon this emergency response to develop and implement a community-based model of rehabilitative medicine that continues to provide care to earthquake survivors as well as a number of other patients who have suffered strokes or other catastrophic illnesses that have resulted in limited mobility.
Patients who have been injured or ill are evaluated and referred to the rehabilitation team where they are comprehensively managed by an interdisciplinary group of professionals, which includes physical medicine and rehab physicians, therapists, rehab technicians and rehab educators. Awareness and sensitivity to each patient's unique socioeconomic needs, personal goals, and social support is paramount in the formation of a plan that ultimately facilitates maximal community reintegration. Community-based rehabilitation and long-term accompaniment by specialized community health workers called Rehab Educators account for a significant portion of the clinical care delivered and is essential in combating harmful stigma and maximizing quality of life and reintegration.
Currently, rehabilitative medicine is offered through PIH/ZL's two largest hospitals: L'Hopital Bon Sauveur in Cange and L'Hopital Saint Nicolas in St. Marc. During FY12, PIH/ZL supported two rehab technicians, six rehab educators, and one administrative assistant who carried out 455 new consultations and 1,520 inpatient, outpatient, and community-based patient visits.
These clinical care initiatives continue to revolutionize the treatment course following catastrophic illness or injury and address the harmful notions of stigma around disability. It is through the demonstration of what is truly possible that we practice daily disability advocacy. As a ward full of onlookers stands in amazement as someone takes their first steps after injury or a community realizes what a profound impact a ramp can have on individual autonomy and access, it is apparent that this work makes an impact beyond the clinic doors. In 2013, PIH/ZL will expand rehabilitative medicine to Mirebalais University Hospital, which will include inpatient, outpatient, and community-based service delivery as well as an emphasis on clinical rotations for medical residents.
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Archives For Game Solutions
A quick cheat for Faerie Caves II: Fyora's Quest
Typing the word quaglor at any point during the game, allows you to skip a level, but any points scored will disappear.
General tips and walkthrough
And now we move onto the general tips and walkthrough section for Faerie Caves II: Fyora's Quest!
- Most levels have multiple solutions.
- Be careful where you walk because is very easy to push a boulder or balloon onto you.
- Don't carry a torch when you walk near dynamite. If a stick of dynamite goes off near another stick of dynamite, it will cause a chain reaction. Boom BOOM Bo Bo Bo BOOOM.
Group 1 Solutions
How Sonny feels when he eats Cocoa Puffs – SATISFIED
Cocoa Puffs has a great _____ flavor – CHOCOLATE
'Right ____ rain.' – AS
Cereal ___, in Neopia Central – ADVENTURE
Frosted ___ Puffs – CORN
Cocoa Puffs is a ____ come true – DREAM
Cocoa Puffs is usually eaten in a ____ – BOWL
General ____ – MILLS
___ Corn Puffs – FROSTED
Neopets ____ com – DOT
To float – HOVER
You ____ go cuckoo, too! – CAN
What you breathe – AIR
_____ helps your bones grow strong – CALCIUM
Fluffy Petpet with large mane – NOIL
A type of gem – RUBY
Pour this on your Cocoa Puffs – MILK
Group 2 Solutions
(Black + Belching) + Stir = Black + Foaming
(Black + Boiling) + Add a Lump of Felrum Jelly = Green + Still
(Black + Burning) + Add Noil Hair = Cyan + Burning
(Black + Burning) + Add Scabergy Juice = Black + Bubbly
(Black + Foaming) + Add Blue Juice = Orange + Foaming
(Black + Foaming) + Add Cactopus Juice = BANG
(Black + Foaming) + Add Froiler Juice = BANG
(Black + Frothy) + Bring To Boil = Blue + Smoking
(Black + Milky) + Add Herbs = Black + Frothy
(Black + Milky) + Simmer = Tartan + Burning
(Black + Noxious) + Add Herbs = Cyan + Noxious
Are Princesses allowed to squeal in public or scream things like 'Hey, girl!' when they see one of their friends?
No way, that's totally rude for a Princess to do
As a royal, especially when it comes to the art of conversation, it is your duty to…
Keep the conversation going
As a royal you can put your guests at ease by asking them what kind of questions?
How should you address fellow royals?
Your Majesty
How should you dress if you are a representative of your country?
Modestly and with style
How would you address an ambassador?
Your Excellency
If the conversation lags, which of the following topics will your guests be more interested in?

subset: commoncrawl


text:
Skip to Main Content
4D CT is a dynamic volume imaging system of moving organs with an image quality comparable to conventional CT, and is realized with continuous and high-speed cone-beam CT. In order to realize 4D CT, we have developed a novel 2D detector on the basis of the present CT technology, and mounted it on the gantry frame of the state-of-the-art CT-scanner. In the present report we describe the design and the results of performance evaluation of the first model of 4D CT-scanner. The X-ray detector for the 4D CT-scanner is a discrete pixel detector in which pixel data are measured by an independent detector element. The numbers of elements are 912 (channels) × 256 (segments) and the element size is approximately 1 mm × 1 mm. The data sampling rate is 900 views(frames)/sec, and the dynamic range of the A/D converter is 16 bits. The rotation speed of the gantry is 1.0 sec/rotation. The data transfer system between rotating and stationary parts in the gantry consists of a laser diode and photodiode pairs, and achieves net transfer speed of 5 Gbps. Volume data of 512×512×256 voxels are reconstructed with FDK algorithm by parallel use of microprocessors. The image characteristics such as noise, uniformity and spatial resolution were evaluated with stationary phantoms in a single rotation. Exposure dose to an object was measured with an extension of the standard measurement method of the CT dose index (CTDI). Several volunteers were scanned to explore clinical potentials. For the 4D CT-scanner, the image characteristics of stationary objects and exposure dose were almost the same to that of conventional CT. An isotropic resolving power of less than 0.5 mm was achieved for the stationary object.


text:
Mika Singh at Song Recording of Film Himmatwala - 2
Sameer, Wajid Ali, Vashu Bhagnani, Mika, Sajid Ali at Song Recording of Film Himmatwala - 2
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Mika Singh at Song Recording of Film Himmatwala - 2
Movie :
Celebrity :
Vashu Bhagnani ,
Mika Singh ,
Sajid Ali ,
Wajid Ali
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text:
Question class has_many Choices. I need to find a choice by some attribute value (usually id).
To clarify: parent record (question) is passed around different objects and methods and they search for children using different attributes and values.
I could do
question.choices.find(choice_id) but this will generate a SQL query every time.
Knowing questions usually have only a handful choices and that there will be many different searches on one parent record, I suspect it will be cheaper to load whole association and search in Ruby:
question.choices.detect{|choice| choice.id == some_choice_id}
Detect comes from Enumerable and forces Rails to load the association on first call (and use cached data on future searches). This also plays nicely with eager loading: I can do Question.all(include: choices) and will whole tree loaded with two queries and then searching is very fast. It doesn't read very well though.
It gets even more hairy if I want to simulate find! behaviour:
question.choices.detect{|choice| choice.id == choice_id} or raise ActiveRecord::RecordNotFound.new
This does exactly what I want, I'm just looking for better syntax.
Does Rails provide some sort of dynamic finders that behave this way (force loading of whole association on first query and then search this preloaded set)?


text:
The iPhone had better-than-expected sales
Make sure you're getting the best deals
Join the NASDAQ Community today and get free, instant access to portfolios, stock ratings, real-time alerts, and more!
In a bid to boost its present consumer and commercial auto
financing business,
Royal Bank of Canada
) announced the acquisition of the automotive finance and deposit
business of Ally Financial Inc. in Canada. RBC shelled out $3.7
billion for the transaction, including certain closing
adjustments. The acquisition is the largest for RBC, surpassing
the $2.16 billion purchase of Centura Banks in 2001.
The views and opinions expressed herein are the views and opinions of the author and do not necessarily reflect those of Nasdaq, Inc.
Enter up to 25 symbols separated by commas or spaces in the text box below. These symbols will be available during your session for use on applicable pages.
You have selected to change your default setting for the Quote Search. This will now be your default target page;
unless you change your configuration again, or you delete your
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text:
Outdoor Adventures Costa Rica is an EcoTourism adventure travel outfitter company offering off the beaten path Expeditions, Trekking, Multi-Sport Tours and Adventure Trips to the most popular destinations in Costa Rica.
Enjoy Costa Rica's Wonders: Arenal Volcano, the Canopy Tour, Beach, Jungle River Cruise, Rainforest, La Paz Waterfall Gardens and Whitewater Rafting. 7 nights, 6 activities with a car. Fully customizable. We specialize in Costa Rica only
A 10 Day Eco Trek Adventure Through Tropical Jungles and Native Communities.
"We don't do pre-packaged tours, because you don't have pre-packaged needs". We specialize in providing customized, high quality, culturally & environmentally responsible itineraries for independent travelers and special interest groups.
This is the best Adventure tour in Costa Rica, you will fly from tree to tree and have a birds view of the pacific ocean, we have 13 cables and 15 platforms, from ground level up to 150ft, come and discover the adventure of a lifetime!!!
Go as you please… design your own travel Schedule with Flexi-Vacations program. Flexi-Vacations in Costa Rica, specially designed for those free spirits experience Costa Rica independently following their very personal itinerary.
"We don't do pre-packaged tours, because you don't have pre-packaged needs". At Rain Forest Tours we specialize in providing customized, high quality, culturally & environmentally responsible itineraries for independent travelers and special int
LOST WORLD ADVENTURES arranges specialized tours and expeditions in South America and Central America. Our company was founded in 1986, when we pioneered our first adventure trips into Venezuela. We now arrange travel throughout Latin America.
Rent more than just a car! - With Nomad America you can rent fully off-road and camping equipped 4x4's in Costa Rica. Nomad America is your best option for an all inclusive Costa Rica Roadtrip! Explore the Real Costa Rica on your own path. Roadtrip!
Enjoy thrilling multi-day eco-adventure trip packages that include accommodations, travel, and tours. Hike a volcano, get up close and personal with jungle wildlife, and kick back on wind-sculpted white sand beaches. Pura vida.
Select your destination in San Jose Costa Rica. Browse thousands of listings for accommodations, adventures, tours and travel services.


text:
Must See Art
Richard Rosss Architecture of Authority at ACME.
Richard Rosss eerie color photographs depict the interiors of churches, prisons, mosques, interrogation rooms and other architectural sites considered to be institutions of power. Each photo focuses on the structure of an empty space, so that Rosss rooms feel haunted by our imagined idea of any preceding events or activity. Many of the settings allude to a narrative that includes violations of human rights, such as the segregation cells at Abu Ghraib, while some focus on less politically charged spaces like a school classroom. The seldom-seen interiors of immigration and customs holding rooms are particularly powerful and poignant. By offering rare glimpses into spaces that are secret or hidden, and encouraging our gaze to linger, Ross turns us into voyeurs but with a purpose. This is the first time this series has been shown and will coincide with the release of a book with the same title published by Aperture. The opening is June 30.
6150 Wilshire Blvd., L.A. | www.acmelosangeles.com | (323) 857-5942 | Through July 28
Mathilde ter Heijne, No depression in heaven (video still, 2006)Mathilde ter Heijne at Susanne Vielmetter Los Angeles Projects
Upcoming Events
L.A. Philharmonic
TicketsTue., Aug. 2, 8:00pm
Keith Reza and Friends
Wed., Aug. 3, 7:30pm
Rebels of Comedy
TicketsWed., Aug. 3, 7:30pm
King Ten
Wed., Aug. 3, 10:30pm
Nothing To See Here
TicketsThu., Aug. 4, 9:30pm
In this new work, Mathilde ter Heijne continues to investigate the role of the artist and the role of women in society by using a special-effects dummy made to look exactly like her. This time the dummy, dressed as a character from an accompanying video piece, stands and sings a Sara Ogan Gunning song about women coal miners. The real Mathilde stars in a single-channel video (based on Depression-era womens films) in which she plays both a rich and a poor character involved in a shootout. An interesting thing occurs when we realize that the poor woman is the one we are supposed to identify with and that hers is the preferred identity of the time; but it is her rich counterpart a single, independent career woman who is shot. Also shown is Women to Go, a project in which ter Heijne pairs images of unidentified women with stories of an unusual life, making them into black-and-white post cards that viewers are allowed to take with them.
5795 W. Washington Blvd., Culver City | www.vielmetter.com | (323) 933-2117 | Through July 28
Get the Theater Newsletter
Get a rundown of upcoming theater events and ticket deals in Los Angeles.
In Case You Missed It
Upcoming Events
- Cabaret (Touring)
- A Chorus Line
TicketsFri., Jul. 29, 9:00pm
"Avenue Q"
powered by goldstar
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text:
Jury: LA schools must pay $6.9M to molested boy
LOS ANGELES (AP) – A jury ruled Tuesday that the Los Angeles Unified School District must pay a boy molested by an elementary school teacher $6.9 million – among the largest awards in the history of the school system.
The decision comes as the district's attorneys were attempting to quickly settle high-profile sex abuse suits involving nearly 200 plaintiffs stemming from Miramonte Elementary School teacher Mark Berndt, who is alleged to have fed his students semen and has pleaded not guilty to 23 counts of lewd conduct.
The jury found the district liable for the repeated molestation of the 10-year-old student in 2008 and 2009 by teacher Forrest Stobbe at Queen Anne Elementary School in the city's mid-Wilshire district, the Los Angeles Times (
http://lat.ms/UPFrC5) reported.
In September 2011, Stobbe pleaded no contest to lewd acts on a child and continuous sexual abuse of a child under 14.
But the civil lawsuit was concerned only with the liability of the district.
Stobbe was a veteran teacher with a clean criminal record, but plaintiff's attorneys argued that administrators including the school's principal should have heeded complaints about Stobbe that preceded the molestation.
School attorneys argued that despite the horrible ordeal of the victim, there was no credible evidence known to the district that Stobbe posed a threat.
"We take our duty to protect our students seriously and are continually looking for ways that we can strengthen our screening and reporting processes to ensure that no child is ever hurt in this way," said general counsel David Holmquist. "Although we can't change what happened in this case, we remain committed to doing everything in our power to promote healing and improve trust with those impacted."
The ruling was especially significant with the Miramonte lawsuits looming, setting a high bar financially and demonstrating a jury's willingness to blame the district for the actions of a teacher. Berndt also had a clean record, but parents had raised concerns about the way he had photographed children.
"Some of the same issues in the Miramonte case are highlighted here," said attorney Don Beck who represented the victim's family in the Queen Anne case. "The same lack of monitoring teachers, the same lack of supervision that allowed these events to happen."
District General Counsel David Holmquist said earlier this month that he hoped to settle all the Miramonte lawsuits and legal claims by the end of January, but some attorneys and plaintiffs have recently dropped out of settlement negotiations, and a Los Angeles judge last week lifted a litigation stay, allowing the cases to move toward court.
(Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)
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text:
Manufacturing Area
Category: Diesel & Gasoline Engines (auto)
... TCH SIZES: 1PC SAE thread restoring file(8 PITCHES:126.96.36.199.16.18.20&24 TPI)WITH RED PIASTIC file HANDLE 1PC SAE thread restoring file (8 PITCHES:184.108.40.206/220.127.116.11&32 TPI)WITH RED PLASTIC FIL ... Keyword : THREAD RESTORING FILE
Category: Sewing Threads
Luminous thread is a thread that can store light in a long time. It presents white in nature light but aqua in dark. The material can shine for at least 6 hours after absorbing enough light. The lumin ...Keyword : thread | special thread | glow in dark thread | luminous thread
Luminous thread is a thread that can store light in a long time. It presents white in nature light but aqua in dark. The material can shine for at least 6 hours after absorbing enough light. The lumin ...Keyword : phosphorescent thread | glow in the dark thread | glow in dark thread | luminous thread | Photoluminescent thread
Category: Thread repair kits
New Arrival Portable DIY Impresora 3D Printer Kit Mini Laser Engraving Machine Specification: Print Parameters Forming elements: Fused deposition (FDM) Print size: 210*210*210mm Layer thickness: 0.05- ...
Category: Screw Dies
Jieng Beeing is a reliable, well-developed manufacturer of Tapping Screw thread Rolling Dies. Please refer to the file to see the specifications of Tapping Screw Rolling Dies. We offer competitive pri ...Keyword : A type
Category: Magnets & Magnetic Devices
Magnetic pots, also called cup magnets or round base magnet, consist of a magnet encased in metal, with its active magnet face exposed. Magnetic pots may have a hole, thread or screw in the center. Th ...
Category: Polypropylene(PP) Twine & Thread
a) Inner packing: shrink-wrap bag ,100pcs/bag. b) Outer packing: A4: 10bags/ctn,A3 : 5bags/ctn.. Material: PP Size: A4 Available in various sizes and colors Suitable for personalizing OEM orders ...Keyword : PP file folder
Category: Hotel and Catering
1. vanity kit: cotton swab/cotton ball/cotton pads/cotton buds/nail file/ 2. shaving kit: razor & shaving cream 3. sewing kit: thread & pin & needle & button 4. nail file: different size an ...Keyword : nail file | hotel nail file
Category: Screen Printing Machines
Advantages 1. Open design, can choose your own body color . 2. 1.75 mm extruder, suitable for more material, such as ABS/PLA/HIPS etc 2. Full metal structure, a sense of fashion and technology 3. 100 ...
Category: Electronic Components, general
Position Transducers Pivot head mounting potentiometric up to 300 mm, IP54 Series TEX TEX0150002202 Compact design and easy to assemble via pivot heads characterize this inexpensive transducer. This ...
Category: Stainless steel die castings
Cold work die steel with high hardenability, can make all kinds of mold and manufacture large tool , complex shape, cross section subjected to large impact load. For example, the complex shape of the ...


text:
Alpha Phi Sigma
Alpha Phi Sigma is the National Criminal Justice Honor Society that recognizes undergraduate and graduate students for academic excellence in the criminal justice field.
Next Meeting: Will be in Fall Semester! Have a great summer!
Undergraduate Students
To apply to The Citadel's chapter Delta Eta, students must have a declared a major, minor, or equivalent in the criminal justice or related field and must have completed three full semesters or its equivalent. Students must attain a minimum GPA of 3.2 on a 4.0 scale.
Graduate Students
Graduate students must be enrolled in a graduate program in criminal justice or a related field, have completed four courses, have a minimum GPA of 3.4 on a 4.0 scale.
Application instructions
1. print and fill out the Student Member Application
2. procure a $50.00 cashier's check made out to Alpha Phi Sigma
3. stamp and address envelope to
Alpha Phi Sigma Headquarters, Nova Southeastern University, 3301 College Avenue, J&J Moran Family Center
Bldg. 200 Room 2243, Fort Lauderdale, FL 33314
4. place in box of Dr. Brian Norris in Capers 330
Alpha Phi Sigma, Delta Eta Chapter Officers 2015-2016
President: Cadet Jose Bustos
Vice President:
Faculty Advisor: Dr. Brian Norris
Academy of Criminal Justice Sciences Annual Conference, Orlando, FL, March 2015
Nolan Bradley presents at ACJS on "Comparative Prisoners' Rights Movements: The US and Britain"
Jonathan Eveler, McKenzie Duncan, Tanner Jameson, Nolan Bradley, and Dr. Brian Norris at ACJS Conference
Col. Ted Spain (USA ret.) gives talk at the Citadel at Invitation of Alpha Phi Sigma, April 2015
Col. Spain, author of Breaking Iraq: The Ten Mistakes that Broke Iraq, addresses cadets in Bond Hall auditorium
Col. Spain and honor society members at a reception before the talk, "Policing, Courts and Corrections in Iraq: Opportunities and Limitations of Creating Institutions from Whole Cloth in a Foreign Land"
Challenge Coins from the 18th Military Police Brigade on Display at the Criminal Justice Office, 330 Capers
Alpha Phi Sigma, Delta Eta chapter patch
Created by: President Cadet Butler, Vice President Cadet Whelan, & Cadet Clyburn.
Symbols incorporated into the patch:
Top Left: The symbol for Alpha Phi Sigma.
Top Right: The colors and pattern represent the Quad, which symbolizes Citadel pride. There are 5 Quads located in each of the barracks at The Citadel, they are used for formations by the Corps of Cadets; the colors, red and white, are colors of the South Carolina battle flag. It includes the crossing of an M14 rifle and a sword; Cadet Officers carry the sword, and the M14 rifle is carried during parades.
Bottom Left: The Citadel mascot, the bulldog.
Bottom Right: The Lady of Justice, representing fair and equal opportunity within the law. In the statue's right had is the balancing scales in which she measures Truth & Fairness, in her left hand is a sword representing Power & Reason, the blindfold over her eyes symbolizes Objectivity.


text:
My husband and I stayed at Vista Linda Montana on our last night in Costa Rica. Although Interbus refused to bring us there, we easily found a taxi (less than a minute after being dropped off by Interbus) to take us there from near the airport. We were impressed with the location - what a lovely view of the valley and surrounding hillsides we had from our small balcony outside our room, and the grounds were well kept. The hostess was very friendly and accommodating. Our room was clean and comfortable, and we took advantage of ordering dinner since we knew from others' reviews that we'd be a distance from town (though we learned upon arrival we there was an option to take a bus from just outside the gate into town for little money and that ran regularly - though we did not try it out). Dinner at Vista Linda Montana was good and affordable. We also enjoyed playing fetch with the yellow lab. One caution though is that we had purposefully spent down our cash since we had just one night left in Costa Rica, but found out upon arrival that we needed to pay in cash. We scraped together our US dollars and colones and had just enough to pay for the room, dinner and even three beers, but it would have felt less stressful had we known in advance we needed to pay in cash. The hostess arranged for our taxi to the airport (including a stop along the way to get cash to pay for the taxi ride), and also made us coffee, tea and sandwiches as we were departing earlier than the usual breakfast hour. That was a great start to our long travel day! We would definitely recommend this hotel to other travelers.
- Official Description (provided by the hotel):
- Nice little cozy Hotel in Alajuela, Costa Rica. Near the airport and San Jose. Spectacular view. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Priceline and Booking.com so you can book your Vista Linda Montana 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:
- Vista Linda Montana Hotel Alajuela
- Vista Linda Montana Costa Rica/Alajuela


text:
New Ad System - Banner Top
U.S. farm sector: Unique part of economy
U.S. jobs data that most economists and investors pore over typically exclude the huge agricultural sector, hence the term "non-farm" payroll. International Business Times
To read more, click here.
New Ad System - Banner Middle
New Ad System - Banner Bottom


text:
Butter Poached Sturgeon
- 2 sliced shallots
- 1 vanilla bean split
- 1 bay leaf
- 1 tablespoon kosher salt
- 4 ounces fish stock
- 2 pounds butter, melted
- 2 pounds sturgeon fillets
- 1 bunch watercress
- 1 red onion, minced
- 2 tablespoons capers, rinsed and drained
Whisk together shallots, vanilla bean, bay leaf, salt and stock and bring to simmer. Slowly whisk in butter and warm to 145 degrees F. Place sturgeon in butter and make sure butter remains at 145 degrees F. Poach for 12 minutes. Remove from liquid and garnish with watercress, onions, and capers.
Recipe courtesy of Michael Symon
Cooking Tips
More Recipes and Ideas
Frozen Yogurt with Poached Rum Raisin Pears
Recipe courtesy of Bobby Flay
Poached Pears with Creamy Pecan Sauce
Recipe courtesy of Claire Robinson


text: I have Nextgen 2.0.59 and I need to hide 2 things: the caption that shows on the lightbox image, and the alt text or title text that shows when hovering over a thumbnail. When searching the forum on this topic I can only find old posts about old versions of Nextgen. Can someone help me accomplish this in the new version?


text:
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Dolly Parton Raps About Breasts, 'Twerking'
The 67-year-old country star shows another side of singing on "The Queen Latifah Show."
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text:
Trending articles:
- My Tweets
Read these recent posts:
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Tag Archives: tablets
Cool Tool | SMART Table
Just a letter off from 'tablet' makes a big difference – but will the new SMART Table 442i from SMART Technologies excite young learners and help them grow together both socially and academically? Pull up a chair and have a … Continue reading
Can a Child Learn to Read on His Own with a Tablet?
Presented by: BachelorsDegreeOnline.com
Posted in cool tools, trends Tagged learning to read, literacy, OLPC, tablets, tablets and literacy 2 Comments
Interview | Taking Footsteps2Brilliance with Ilene Rosenthal
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Posted in interviews Tagged children and technology, Curriculum and Learning games, edtech solutions, Footsteps2Brilliance, formative and summative assessments, Ilene Rosenthal, iPads, iPhones, iTouches, Kindle Fires, language arts, Lightspan, mathematics, Nooks, reading, Sony PlayStation, tablets 2 Comments


text:
Title: Two local authors, two book signings
Author: Cory Withers
Publisher: Topsail Advertiser
Date: 9/3/09
Two authors will be making separate appearances in Topsail Island on Saturday, September 5 to sign copies of their books. The long time Topsail Island resident BJ Cothran will be appearing at QuarterMoon Books at 708 South Anderson Boulevard in Topsail Beach to ink her appreciation to her fans on the inside of her new book.
Cothran's new book is a historical reference titled simply: "Topsail Island. (Then & Now.)" Her new book is broken up into five sections, with each one dedicated to the history of each town that makes up the island. Each page has two photographs: one from decades ago showing how an area once looked, and a current picture of the same area showing the changes that have occurred over time. Cothran not only took all of the current pictures for the book, she also writes detailed descriptions of the changes that have happened in the area. While the book is a comparison of the island, past and the present, the date to mark in the future is September 5 from 2 to 4 p.m.
Cothran will be on hand to answer questions and swap stories with people of various interests. Whether readers buy the book to learn about a past they were too young to witness, or if they are there just to remember the way it was, the book and the author will be there to share information about Topsail… then and now.
For more information contact QuarterMoon Books at 910 328 4969.
Later that evening, a different book signing will be taking place at a store that is also quite different from the more traditional stores. Events at the Gypsy Sun don't just include book readings, there are also Yoga classes, Tai Chi demonstrations and Energy Bowl performances; all among a variety of books that often can't be found anywhere else on Topsail Island.
The Gypsy Sun's guest of honor that night, Author Beverly Ferebee Heyde, will be putting her autograph on copies of her latest effort Bend in the Road - Life's Crossroads; the first in at least a two part story.
This novel follows a character named Catriona "Caty" Maclean as she leaves Scotland with her family to save themselves for the violent Jacobite Wars. As a result, they find themselves living in the Carolinas. This new life in America forces Caty to confront several of the pressing issues of the time, including slavery and frontier living. She must almost choose between two men that have shown her love. The two-hour book signing begins at 6:30 pm. The Gypsy Sun is located at 206 B North Topsail Drive. For more information, call 910 328-0328.
Both of the authors scheduled to sign books on Saturday are native Virginians, and they both now call North Carolina home. While Cothran writes history and Heyde writes fiction, they have one thing in common. They both write about what they know: home.


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Book your room at Howard Johnson Inn Daleville/Roanoke North
Get an overview of this hotelFamily-friendly motel with free breakfast and outdoor pool
Located in Daleville, this family-friendly motel is 1.7 mi (2.8 km) from The Flying Mouse Brewery, and within 6 mi (10 km) of Read Mountain Preserve and Carvins Cove. Eleanor D. Wilson Museum and Hollins University are also within 6 mi (10 km).
Property Features
An outdoor pool, a fitness center, and a 24-hour business center are available at this motel. Free buffet breakfast, free WiFi in public areas, and free self parking are also provided. Additionally, a seasonal outdoor pool, a business center, and a children's pool are onsite.
Room Amenities
All 98 rooms provide conveniences like refrigerators and microwaves, plus free WiFi and TVs with cable channels. Other amenities available to guests include coffee makers, free local calls, and safes.Would you like to give us feedback? Share it! Opens in a new window
Howard Johnson Inn Daleville/Roanoke North437 Roanoke Road I-81 Exit #150 B Daleville VA 24083
Renovations & Closures
- Swimming pool
Hotel Amenities
Hotel Amenities
In addition to an outdoor pool, Howard Johnson Inn Daleville/Roanoke North provides a fitness center and a children's pool. High-speed wireless Internet access is complimentary. This motel offers access to a 24-hour business center. Guests can enjoy a complimentary breakfast each morning. This family-friendly motel also offers an arcade/game room, complimentary newspapers in the lobby, and shopping on site. Complimentary self parking is available on site.
- 24-hour business center
- 24-hour front desk
- Arcade/game room
- Business center
- Children's pool
- Free newspapers in lobby
- Fitness facilities
- Free breakfast
- Free self parking
- Free WiFi
- Number of buildings/towers - 3
- Number of floors - 2
- Outdoor pool
- Outdoor seasonal pool
- RV, bus, truck parking
- Shopping on site
- Total number of rooms - 98
Family Friendly Amenities
- Arcade/game room
- Children's pool
- Cribs/infant beds (complimentary)
- Free Wi-Fi
- Microwave
- Outdoor pool
- Refrigerator
- Rollaway/extra beds available
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Free self parking, RV, bus, truck parking
Room Amenities
- Access via exterior corridors
- Air conditioning
- Cable TV service
- Coffee/tea maker
- Free toiletries
- Connecting/adjoining rooms available
- Free cribs/infant beds
- Daily housekeeping
- Desk
- Free local calls
- Free WiFi
- In-room safe
- Iron/ironing board
- Microwave
- Private bathroom
- Refrigerator
- Rollaway/extra beds available
- Shower/tub combination
- Television
Where to Eat
Guests are offered a complimentary hot/cold buffet breakfast each morning.
Start your morning with a free hot/cold buffet breakfast, available each day of your stay.
Nearby Things to Do
An outdoor pool and a children's pool are on site. Other recreational amenities include a fitness center.
The recreational activities listed below are available either on site or nearby; fees may apply.
- Hiking/biking trails nearby
- Golfing nearby
Hotel Policies
Check-in time starts at 3 PM
Check-out time is 11 AM
Payment types
- Pets allowed for an extra charge of USD 10 per pet, per night
- 2 per room
You need to know
Extra-person charges may apply and vary depending on hotel policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
Optional extras
- Pet fee: USD 10 per pet, per night
- Rollaway beds are available for an additional fee
Hotel Name
- Howard Johnson Daleville Roanoke North
- Howard Johnson Inn Daleville Roanoke North
- Howard Johnson Inn Daleville/Roanoke North Daleville
- Howard Johnson Inn Daleville/Roanoke North
- Howard Johnson Daleville/Roanoke North Daleville
- Howard Johnson Daleville/Roanoke North
We should mention
The property has connecting/adjoining rooms, which are subject to availability and can be requested by contacting the property using the number on the booking confirmation.


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Then, accepting the help of God and of God's signs, he allows his personal legend to guide him toward the tasks that life has reserved for him.
Paulo Coelho
Source: The Warrior of the Light
Contributed by: ~Matthew
On some nights, he has nowhere to sleep, on others he suffers from insomnia. "That's just how it is," thinks the warrior. "I was the one who chose to walk this path."
In these words lies all his power: He chose the path along which he is walking and so has no complaints.
We wouldn't worry nearly as much about what others thought of us if we recognize how seldom they do.
...in all the woods and forests, God did not create a single leaf the same as any other… People go against nature because they lack the courage to be different.
Source: Veronika Decides to Die
I don't know what to do. I only know that it's taken me years to understand that life was pushing me in a direction I didn't want to go in.
If only everyone could know and live with their inner craziness…people would be fairer and happier.
When everyone dreams but only a few realize their dreams, that makes cowards of us all.
Live. If you live, God will live with you. If you refuse to run his risks, he'll retreat to that distant heaven and be merely a subject for philosophical speculation. Everyone knows this, but no one takes the first step, perhaps for fear of being called insane.
You're someone who's different, but who wants to be the same as everyone else. And that, in my view, is a serious illness.
Copyright © 2016 Gaiam, Inc.


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By Catholic Online (NEWS CONSORTIUM)
3/30/2014 (2 years ago)
Catholic Online (www.catholic.org)
The United Nations has put the United States under a deeply critical eye, and has taken it to task for many human rights abuses. Among the items in the recent report, officials are critical about the nation's practice of jailing the homeless and sentencing juveniles as adults to life sentences to drone warfare as well as spying by the National Security Agency.
The imprisonment and trying of juveniles as adults -- who are then sentenced to life in prison was one of 26 points of concerns in regards to the U.N.'s report on U.S. human rights abuses.
By Catholic Online (NEWS CONSORTIUM)
Catholic Online (www.catholic.org)
3/30/2014 (2 years ago)
Published in Politics & Policy
Keywords: United Nations, United States, human rights abuses
LOS ANGELES, CA (Catholic Online) - The report's authors found the U.S. lacking on 25 human rights issues.
"The U.S. is adept at demanding human rights change from other governments while failing to meet international standards itself," José Luis Díaz, Amnesty International's representative at the U.N. said.
No child need ever go to bed hungry -- go here!
Díaz welcomed the U.N.'s recommendations on torture transparency as well as calls for ending the death penalty nationwide. He also called for limiting the use of solitary confinement in U.S. prisons. The U.S. "must implement the recommendations of the Human Rights Committee without delay," Díaz declared.
The report was not entirely negative. The U.N. praised some steps the U.S. government has taken, such as curbing human trafficking and a 2009 ban on Central Intelligence Agency torture and secret detention.
According to the U.N's Office of the High Commissioner for Human Rights in regards to the use of torture, the reformation of interrogation techniques does not go far enough. He called for an investigation and prosecution of members of the "armed forces and other agents of the U.S. government" allegedly involved in torturing detainees.
Díaz also urged the U.S. to shutter the detention camp at Guantánamo Bay in Cuba and transfer its prisoners.
"The state party [the United States] should ensure that all cases of unlawful killing, torture or other ill-treatment, unlawful detention or enforced disappearance are effectively, independently and impartially investigated, that perpetrators, including, in particular, persons in command positions, are prosecuted and sanctioned and that victims are provided with effective remedies," the report reads.
The U.N. also called on the U.S. to implement protections against the invasion of privacy of individuals by making public laws that allow for surveillance. The U.S. must "reform the current system of oversight over surveillance activities" by involving judicial supervision.
Concerned that "those affected have no access to effective remedies in case of abuse," the U.N. advised the U.S. to create pathways for restitution for people who have been spied on unjustly.
By David Drudge (CALIFORNIA NETWORK)
Hillary Clinton experienced a moment of honesty with the American people last night. While accepting her party's nomination, she pledged to soak the rich to thunderous applause. LOS ANGELES, CA (California Network) - Hillary Clinton wants to raise everybody's taxes. Of ... continue reading
By Marshall Connolly (CALIFORNIA NETWORK)
Apparently there's a scientific reason why people don't like Hillary Clinton. Two Yale researchers have found why she comes across as untrustworthy. Their findings also explain why Trump is popular. LOS ANGELES, CA (California Network) - About 60 percent of voters view ... continue reading
By Marshall Connolly (CALIFORNIA NETWORK)
The first night of the Democratic convention in Philadelphia was much better than the first night of the Republican convention. It was also the most dangerous one. Fortunately, the evening was masterfully handled by Bernie Sanders in particular. LOS ANGELES, CA ... continue reading
By Ken Blackwell and Ken Klukowski
Although Hillary Clinton and the beleaguered Democratic National Committee (DNC) are attempting to paint Donald Trump and Mike Pence as out of step with the country on abortion, new polling shows that a majority of Americans actually agree with Trump-Pence on ... continue reading
By David Drudge (CALIFORNIA NETWORK)
Eagle-eyed reporters are finding scandalous emails galore in the 20,000 email dump from Wikileaks. The list of sins of the DNC and Hillary Clinton continues to grow by the hour as people sift deeper and deeper into the trove of scandalous documents. LOS ANGELES, CA ... continue reading
By Kenya Sinclair (CALIFORNIA NETWORK)
What is it with Democrats and emails? LOS ANGELES, CA (Catholic Online) - After several thousand emails were leaked this weekend, the Democratic National Committee (DNC) chairwoman Debbie Wasserman Schultz was asked to resign from her position.The emails revealed the ... continue reading
By David Drudge (CALIFORNIA NETWORK)
Barack Obama may have endorsed Hillary Clinton, but his half brother is voting for Trump! The president's half brother told the New York Post he is voting for Trump because Trump "speaks from the heart." LOS ANGELES, CA (California Network) - President Obama has ... continue reading
By Kenya Sinclair (CALIFORNIA NETWORK)
Controversial emails continue to haunt the Democratic party. LOS ANGELES, CA (Catholic Online) - The emails suggested the Democratic National Committee (DNC) favored Clinton during the primary and revealed possible evidence of the DNC attempting to destroy Bernie ... continue reading
By Kenya Sinclair (CALIFORNIA NETWORK)
Ted Cruz was booed during the Republican National Convention Wednesday night when it became clear he wouldn't be endorsing Donald Trump. LOS ANGELES, CA (Catholic Online) - When the Texas senator took the stage Wednesday night, his 23-minute remarks began well.He ... continue reading
By David Drudge (CALIFORNIA NETWORK)
Donald Trump is the official Republican nominee for president. Last night, Trump was officially awarded 1,725 delegates to become the nominee. The total is well above the 1,237 required by the party rules. LOS ANGELES, CA (California Network) - America has a ... continue reading


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Music, MOOCs, and Copyright: Digital Dilemmas for Schools of Music
At first glance, the opportunity to take free online courses from some of the country's most prestigious universities sounds great. But for some educational stakeholders, these classes represent a threat to higher education as we currently know it. So, what are the risks and what are the benefits for the music field?
Inviting Possibilities for New Music and Music Education
How would you feel if you heard your own or a colleague's music mashed up with the latest Katy Perry or Kendrick Lamar track? Can you envision yourself video conferencing with a group of elementary school or university students who recently posted video clips of themselves discussing new music on YouTube or who admitted that they would like to try transforming a piece from the genre into electronic dance music? These questions hint towards possibilities that some may find problematic and that others may consider appropriate and beneficial for new music, musicians, and students.
Food Opera: Merging Taste and Sound in Real Time
The potential to link sound to food, scent, and the tactile sensations of the mouth creates an entirely new field of sensory interplay, which may be harnessed to a wide range of expressive ends. Approaches include theatrical narrative structures that might tell a story, spatial or landscape meditations that might resemble a sound installation, and ritual events such as a Passover Seder or a wedding ceremony.
The Second Performance and Beyond
Shape Notes, Billings, and American Modernisms
From Charles Seeger to his contemporaries William Schuman and Henry Cowell in the 1940s, through John Cage and William Duckworth in the 1970s and 1980s, to young composers like David T. Little and Gabriel Kahane today, the American shape-note tradition has been a steady source for reexamination and inspiration.


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I tested out a plugin, and now the plugin author appears to have my email and is sending me spam. I do not like. Is there a place I can report this, please?
I tested out a plugin, and now the plugin author appears to have my email and is sending me spam. I do not like. Is there a place I can report this, please?
Is it a plugin that you downloaded from the public repository here on wordpress.org ? If so, which plugin?
Yes, I installed it on a test site from the add new plugins page. The plugin is ShareThis or Share This. I'm in the habit of not giving plugins my email, so I'm pretty sure they harvested it from my account. I'd deleted the plugin as it wasn't meeting my needs before receiving the email spam.
Please post this topic in the ShareThis support forum.
I didn't want to mention it out in the open at all, my hope was there were proper channels to report it, because my thought was that it might be breaking a policy for hosting a plugin through wordpress.org. The other plugin doing it is Shareaholic.
Going to the support forums now.
You can report it to firstname.lastname@example.com
Hi All,
When the plugin is first installed, it directly sends a one-time notification email to the admin of the WordPress install with a link to customer support, etc. The email is designed to help the user get started.
The email is handled similar to how WordPress now sends a notification email when automatic/background upgrades are done. ie. WordPress does not harvest email addresses and neither does Shareaholic. WordPress or the plugin directly sends the email.
Related: http://wordpress.org/support/topic/are-you-pulling-admins-emails-from-their-wordpress-installs
This topic has been closed to new replies.


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Medical devices range from blood glucose test strips and stethoscopes to more complex products, such as pacemakers and joint replacements. These technologies are used in hospitals, doctors' offices, and in patients' homes to diagnose, treat, or prevent illness. Many people have benefited from such recent advances, and Americans increasingly rely on medical devices.
However, failures of medical devices over the past two decades demonstrate the need to more quickly identify problems to help ensure the safety of the public. For example, failing metal-on-metal hip replacements and implantable cardioverter defibrillator leads—used by hundreds of thousands of people to detect and correct abnormal heart rhythms—have led to significant patient harm and deaths in recent years.
Pew's medical device initiative seeks to enhance medical device safety and foster device innovation that benefits patients. Pew's initiative has three main areas of focus, including:
- Improving the current state of medical device registries—databases containing information on patients who use or are treated with a specific device;
- Supporting the adoption of a unique device identification (UDI) system to better track medical devices; and
- Fostering medical device innovation with these and other new approaches without compromising patient safety.
Our WorkView All
Unique Device Identifiers Improve Safety and Quality
Patients rely on medical devices to replace failing joints, fix irregular heart rhythms, test blood sugar, diagnose diseases, and improve their health in other ways. While millions of people use these devices on a daily basis, researchers—including those in the federal government and at private organizations—lack an efficient way to track the performance of these products and quickly... Read More
Pew Submits Comments on Medicare Payments Proposal
On June 24, Pew submitted comments to the Centers for Medicare & Medicaid Services (CMS) about the agency's proposed Merit-Based Incentive Payment System and Alternative Payment Models for eligible clinicians. In its comments, Pew encourages CMS to promote quality palliative and end-of-life care and encourages the collection and exchange of unique device identifier data to enhance... Read More
Medicare Still Lacks Crucial Medical Device ID Data
Under federal policies proposed in January, researchers, medical product innovators, and clinicians will gain unprecedented access to Medicare data that the Obama administration says will facilitate "smarter and more informed" health care decisions. Read More


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American English: /ˈpjurəˌfaɪ(ə)r/ British English: /ˈpjʊərɪfʌɪə/
Translation of purifier in Spanish:
- (of water)(of air) purificador (masculine)
Definition of purifier in:
What do you find interesting about this word or phrase?
Comments that don't adhere to our Community Guidelines may be moderated or removed.
Grammar and usage help for Spanish:
= trending


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Moodle Downtime
Moodle will be down on Aug 3, 2016 in order to upgrade Moodle from version 2.8 to 3.0.Moodle will be unavailable during this period and any changes made to courses may not be saved, even if the site and course are accessible.
Do you have questions about Distance Learning or Moodle at Wilson Community College? If so, check out the Frequently Asked Questions for answers to some of the most popular student questions.
Usernames and Passwords
Moodle, Student Email, WebAdvisor and Student Planning use the same username and password.
- First letter of first name
- First letter of last name
- Last four digits of WCC Student ID #
- Example: John Student, 0123456
- WebAdvisor and Student Planning Username: js3456
- Student Moodle and Email Username: email@example.com
- Faculty Moodle and Email Username: email@example.com
Default Password
- Uppercase first letter of last name
- Lowercase second letter of last name
- 6 digit birthdate
- Example: John Student, 5/24/1978
- Password: St052478
Users should immediately login to Password Reset at https://reset.wilsoncc.edu and click MY ACCOUNT to setup security questions and change the default password to a more secure password.
If you cannot access your account, contact the Helpdesk at 252-246-1224 or at firstname.lastname@example.com.


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Viewing comments for finedisregard« back to profile
David Pocock scores first half hat-trick against the Highlanders
Come on folks, there are hat tricks and there are hat tricks.
Why would a guy clap for himself in any language?
Pocock is a great player but he goes out of his way so that we can tell he is a white knight social justice warrior.
1 Year, 3 Months ago
Ali Williams controversially Sin Binned after colliding with Devin Toner in the air
I'm with you. I ref at the youth level and we don't allow lifting because the risk. I think what really happened in this clip is that Toner leaned away from his supporting boosters. Falling from 14 ft in the air is dangerous.
I was a 2nd rower that started off my career without lifting. Lineout jumping was an extremely important individual skill on par with being a good kicker. They've eliminated it, let's bring it back.
1 Year, 3 Months ago
Ali Williams controversially Sin Binned after colliding with Devin Toner in the air
You're 100% correct. Whenever a player lands awkwardly the ref's first reaction is to go into their pocket. The histrionics of the players gesturing with their arms up doesn't help either.
Referees' mentalities have changed a lot recently. They have more of an influence over the game than ever before. It's not a positive trend.
1 Year, 3 Months ago
Ali Williams controversially Sin Binned after colliding with Devin Toner in the air
The Suta chokehold was seriously bad news, worse the 90% of punches and 100% of shoe-ings.
Often when you have two players leaving their feet going for 50/50 ball somebody comes off worse and ends up on the ground. The slightest contact makes a player in the air lose their balance. It's just physics. Nothing in it and great catch by Toner.
1 Year, 3 Months ago
France U18s win the European Championship and give hope to the future
If it is the premier competition in Europe shouldn't the 6N be the best 6 teams?
According to the IRB Georgia is currently ranked ahead of Italy and just four spots below Scotland. I don't think they'd get hammered. Plus they've accomplished this without regular competition or a monied domestic league. Looking at their U18 team their future looks bright.
I wish Scotland was more competitive and I do want them to improve but it would be nice to see some new members in the club.
1 Year, 3 Months ago
France U18s win the European Championship and give hope to the future
My goodness look at Georgia and Portugal! Times are changing.
Maybe some day there will be a 6N with promotion and relegation? If Scotland was relegated would that be the end of the sport in the country? Georgia is knocking on the door but outside travel issues will other countries lose money by playing there?
I'd like to see some teams ascend. Scotland and Italy don't deserve their spots based on history and proximity.
1 Year, 3 Months ago
David Pocock's Turnover Masterclass against the Blues
Pocock will tell on you to the referee.
1 Year, 3 Months ago
Huge Hit From Peter Kimlin Leaves Leigh Halfpenny with more injury woe
I don't think Halfpenny will be playing rugby at 30.
1 Year, 3 Months ago
Mark Richards KO'd after colliding with the shoulder of Willem Alberts
What law would you change?
It was just unlucky. Two guys going for a 50/50 ball and one player being larger than the other.
1 Year, 3 Months ago
Unbelievable finish to rugby match after some Currie RFC quick thinking
Great stuff rugbydump. Thanks!
1 Year, 3 Months ago