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Timing of dialysis initiation in AKI in ICU: international survey
- Charuhas V Thakar1Email author,
- James Rousseau1 and
- Anthony C Leonard1
DOI: 10.1186/cc11906
© Thakar et al.; licensee BioMed Central Ltd. 2012
Received: 3 October 2012
Accepted: 13 December 2012
Published: 19 December 2012
Initiating dialysis in acute kidney injury (AKI) in an intensive care unit (ICU) remains a subjective clinical decision. We examined factors and practice patterns that influence early initiation of dialysis in ICU patients with acute kidney injury.
An online survey presented nephrologists (international) with three case scenarios with unstated predicted mortality rates of < 10%, 10 - 30% and > 30%. For each case the respondents were asked 4 questions about influences on the decision whether or not to initiate dialysis within 24 hours: Q1, likelihood of initiating dialysis; Q2, threshold of BUN levels (< 50, 50 - 75, 76 - 100, > 100 mg/dl) considered relevant to this decision; Q3, magnitude of creatinine elevation (two to three-fold increase; greater than threefold increase; absolute level > 5 mg/dl regardless of change) considered relevant; Q4, a rank order of the influence of five parameters (BUN level, change of creatinine from baseline, oxygen saturation, potassium level, and urine output), 1 being the most influential and 5 being the least influential.
One hundred seventy-two nephrologists (73% in practice for > 5 years; 70% from the U.S.A.) responded to the survey. The proportion of subjects likely to initiate early dialysis increased (76% to 94%), as did the predicted mortality (p < 0.001). The proportion of subjects considering early dialysis at a BUN level ≤ 75 increased from 17% to 30 to 40% as the predicted mortality of the cases increased (p < 0.0001). The proportion of subjects choosing absolute creatinine level to be more influential than relative increment, went from 60% to 54% to 43% as predicted mortality increased (p < 0.0001). Rank-order analysis indicated that influence of oxygen saturation and potassium level on dialysis decision showed a significant change with severity of illness, but BUN level and creatinine elevation remained less influential, and did not change with severity.
Severely ill patients were more likely to be subjected to early dialysis initiation, but its utility is not clear. Rank-order analysis indicates dialysis initiation is still influenced by "imminent" indications rather than a "proactive" decision based on the severity of AKI or azotemia.
Acute kidney injury (AKI) requiring dialysis is a serious complication in patients admitted to intensive care units (ICUs) and is associated with increased morbidity, mortality, and costs of care [1–3]. The timing of the initiation of dialysis following AKI in the ICU is a subjective clinical decision. By using lower level of azotemia as one of the surrogates for early dialysis, observational studies have shown that timing of initiation may be associated with a survival benefit [4–8]. The recently published clinical practice guidelines for AKI - Kidney Disease: Improving Global Outcomes - propose a stage-based management of AKI, in which consideration of dialysis is recommended in patients experiencing stage II/stage III AKI (AKI stages based on the Acute Kidney Injury Network classification). In practice, however, indications for dialysis in AKI are usually based on medically untreatable complications, including azotemia, hyperkalemia, oliguria/volume overload usually leading to hypoxemia, and severe metabolic acidosis [9]. Additionally, decision of dialysis initiation varies with the overall clinical severity of illness of the patient [10]. Even though the timing of dialysis initiation in AKI has been a subject of clinical interest and a potential area for prospective investigation [11], physician practice preferences and perceptions about early dialysis initiation in AKI are not well understood. Surveys regarding renal replacement therapy in AKI have focused largely on either availability or preferences of different modalities of acute dialysis in the ICU [12–14]. There remains a gap in our knowledge regarding how physicians use the clinical information while making their decision regarding timing of dialysis initiation.
We conducted an international survey of nephrologists about factors that may affect early initiation of dialysis in ICU patients with AKI. We assessed whether differences in clinical severity of illness across different case scenarios would influence physicians' interpretation of objective biochemical information. We examined whether certain biochemical indicators are more influential than others in making the determination of dialysis initiation. We also surveyed physicians about their opinions and perceptions about the potential benefit versus harm of early dialysis in the ICU.
Materials and methods
An online survey was created and distributed to nephrologists practicing in the US, Canada, or other countries. The nephrologists were asked questions concerning the early initiation of dialytic intervention in patients with AKI in the ICU and the influence on those decisions of various biochemical parameters. Three clinical case scenarios were created (cases A, B, and C); the clinical and laboratory characteristics of the cases were designed such that the predicted hospital mortality rates for cases A, B, and C were less than 10%, 10% to 30%, and greater than 30%, respectively. APACHE III (acute physiology and chronic health evaluation III) criteria were used to determine predicted mortality after considering the clinical and laboratory characteristics in each case scenario.
The description of the cases included detailed clinical and laboratory information. For all three cases, we provided baseline values of blood urea nitrogen (BUN) and serum creatinine. We also provided information on the following laboratory parameters (as recorded on the day of renal consult): level of BUN, serum creatinine level, serum potassium level, and urine output in the previous 24 hours. Of note, the baseline values were similar across all three cases, as were values on the day of consult. Thus, the differences across these cases were based primarily on severity of illness (predicted mortality). This allowed us to determine how the physicians may use the biochemical information in the context of the clinical condition of the patient.
The survey included questions on four areas: Q1 - subjective likelihood of initiating dialysis within 24 hours for each case scenario. Dialysis was considered as 'early initiation' if, given the clinical case scenario, the respondent would initiate the therapy within 24 hours; Q2 - threshold of BUN levels (less than 50, 50 to 75, 76 to 100, and greater than 100 mg/dL) considered in making this decision; Q3 - magnitude of creatinine elevation relative to baseline (two- to threefold increase; greater than threefold increase; absolute level greater than 5 mg/dL regardless of change) considered important; Q4 - a rank ordering of five biochemical parameters in order of their importance to the decision to initiate dialysis in each of the case scenarios (BUN level, change of creatinine from baseline, oxygen saturation, potassium level, and urine output), 1 being the most influential and 5 being the least influential. Toward the end of the survey, we asked questions that were related to characteristics of survey respondents, their practice settings, their training/experience, and their perceptions/practices about early dialysis in AKI in the ICU.
The survey was developed in collaboration with experts from our local institution. We planned the survey around the focus of presenting explicit case scenarios with different severity of illness. The University of Cincinnati Institutional Review Board approved the survey document and the study. Disseminating it to the nephrologists within our local institution, we confirmed the face validity of the survey. The steps of extraction and interpretation were refined internally, prior to external dissemination, and demonstrated that there was 100% re-test validity to the answers. To distribute the survey, we used the following avenues: (a) Nephrology Now web-based portal, (b) the renal field advisory committee of the Veterans Health Administration, (c) the training program directors at academic institutions, and (d) publicly available contact information for nephrologists (local/regional/state). The survey was activated online in fall of 2010, and after few automatic reminders, it was closed in spring of 2011. Data extraction of response and analysis was conducted after the survey was closed to new respondents.
Statistical analysis
The survey questionnaire was developed by using an online tool, which had been tested internally, within our institution, to ensure the clarity and validity of the questions asked (see Additional file 1 for the survey document). We calculated and reported the frequencies of responses to each of the four questions by all 172 respondents. Significance tests were conducted by comparing case responses to the most severe and least severe case and using a reduced sample of 119 respondents who had addressed all 24 items on the survey. For these comparisons, the response options were collapsed into dichotomies: for the first question, very likely and somewhat likely (likely) versus somewhat unlikely and very unlikely (unlikely); for the second question (regarding BUN threshold), less than 75 mg/dL versus greater than or equal to 75 mg/dL; for the third question, relative increment in creatinine versus absolute level of greater than 5 mg/dL. McNemar's test was used to compare the proportion of respondents answering in each direction on each of the three questions. For the fourth question, we calculated mean rankings for each parameter for the respective case scenarios (1 being most important and 5 being the least important), and compared the scenarios by using a paired t test. We also compared, by chi-square test, the characteristics of respondents on the basis of whether they answered the first question as likely (somewhat and very likely combined) or unlikely (somewhat and very unlikely combined) to initiate early dialysis. A two-tailed P value of less than 0.05 was considered significant.
Characteristics of survey respondents
Proportion of respondents
Age, years
≤ 40
> 60
Years in practice
< 10
> 20
Type of practice
Fellowship program at practice location
Percentage of consults in intensive care unit
< 25%
> 50%
Proportion of time devoted to clinical activities
< 50%
> 75%
Country of practice
We compared the characteristics of respondents who answered the first question as likely (very likely or somewhat likely combined) for initiating early dialysis with those who responded unlikely (somewhat unlikely or very unlikely combined) for each of the three cases. The only statistically significant difference was found to be the country of practice; those who noted their practicing location to be the US responded that they were less likely to initiate early dialysis as compared with those in practice outside of the US (P = 0.041).
For the 119 respondents who answered all 24 items on the survey, the proportion of subjects saying they would be likely (very likely or somewhat likely) to initiate early dialysis increased from 76% in the least severe case to 94% in the most severe case (P < 0.0001). The proportion of subjects considering early dialysis at a BUN level of not more than 75 mg/dL also increased from 17% in the least severe case to 40% in the most severe (P < 0.0001). The proportion of subjects choosing absolute creatinine level over the relative increment in creatinine in their decision to initiate early dialysis went from 60% in the least severe case to 43% in the most severe (P < 0.0001).
Survey responses for early initiation of dialysis in acute kidney injury in the intensive care unit
Case A
Case B
Case C
Consider initiating early dialysis
91 (76%)
107 (90)
112 (94%)
28 (24%)
12 (10%)
7 (6%)
Urea level, number (percentage)
< 50 mg/dL
1 (1)
6 (5)
13 (11)
50-75 mg/dL
19 (16)
30 (25)
46 (39)
76-100 mg/dL
48 (40)
46 (39)
28 (24)
> 100 mg/dL
51 (43)
37 (31)
32 (27)
Creatinine elevation
2-3 times baseline
15 (13)
28 (24)
37 (31)
> 3 times baseline
32 (27)
27 (23)
31 (26)
> 5.0 mg/dL
72 (60)
64 (54)
51 (43)
Biochemical parametersa
Blood urea nitrogen
3.9 (1.2)
4.0 (1.1)
4.1 (1.1)
3.8 (1.3)
3.9 (1.2)
3.9 (1.2)
Urine output
2.7 (1.2)
2.7 (1.1)
2.7 (1.0)
2.6 (1.2)
2.1 (1.3)
1.8 (1.3)
1.9 (1.2)
2.3 (1.1)
2.5 (1.0)
We report the results of a survey of nephrologists regarding their practice of and perceptions about initiating early dialysis in patients with AKI in the ICU. The survey results indicate that physicians tend to decide on early dialysis for the more severely ill patients in the ICU. The results also suggest that the decision for dialysis initiation is influenced more heavily by complications of AKI - that is, hyperkalemia, volume overload, and so on - than by measures of severity of kidney injury.
Very few studies have examined survey questionnaires focused on issues arising from AKI. Ricci and colleagues [14] analyzed a survey given to attendees of a nephrology conference in Vicenza, Italy, to study practice patterns in the management of AKI in critically ill patients. The survey found that practitioners used multiple definitions of AKI. Over 90% of respondents used continuous renal replacement therapy (CRRT) as one of the modalities in the ICU; however, the treatment prescription showed significant differences among specialists. The most commonly prescribed dose was 35 mL/kg per hour, although this survey pre-dated the most recent clinical trials examining the optimal dose of dialysis in AKI. Of the participants, 90% said that they used RRT for non-renal indications, and 60% admitted the lack of scientific evidence as a limiting factor in its use.
In another study, Overberger and colleagues [13] surveyed clinical trial sites before patient enrollment in a Veterans Affairs/National Institutes of Health trial to assess patterns of clinical practice of RRT use in patients with AKI. Intermittent hemodialysis (IHD) and CRRT were the most commonly used modalities of therapy. IHD was most commonly provided on a thrice-weekly schedule, with only infrequent assessment of the delivered dosage of therapy. Most practitioners reported that they did not dose CRRT on the basis of patient weight, yet the average prescribed dosage of therapy corresponded to a weight-based dosage of 20 to 25 mL/kg per hour. In another survey, Hyman and Mendelssohn [12] surveyed (by mail questionnaire) all adult academic and community-registered Canadian nephrology centers about approaches to dialysis in AKI. Comparing contemporary dialysis methods with those of 5 years ago, they reported the largest increase was in CRRT (26% versus 9%). Both IHD and peritoneal dialysis as modalities for AKI decreased in utilization. In 2002, the predominant CRRT methods used venovenous access (80%), whereas 5 years earlier arteriovenous was the most common (52%). The survey found that, notwithstanding a lack of definitive evidence of superior outcomes with CRRT compared with other modalities, the utilization of CRRT dramatically increased for the treatment of AKI in Canada. More recently, in a study of well-conducted surveys, Clark and colleagues [15] examined the factors that would prompt respondents to initiate RRT for AKI. This study indicated that potassium level and pulmonary edema were the most common triggers for prompt initiation, and over 90% of respondents favored a prospective clinical trial to determine optimal timing [15].
Our study contrasts with these prior reports in that we studied the question of timing of dialysis initiation rather than utilization of a specific modality. First, we designed a unique survey focusing on specific case scenarios but did not provide an explicit measure of severity of illness or predicted mortality - this was left for the survey respondent to consider in their decision making, as they answered the questions. Thus, we were able to assess physician propensities to initiate early dialysis based on each case scenario. The data indicate that a greater proportion of respondents were likely to initiate early dialysis in patients with higher severity of illness. Second, across all three case scenarios, we provided survey respondents with the same biochemical parameters that are usually considered when making decisions regarding initiating dialysis. In this part of the survey, we observed that the BUN level at which dialysis would be initiated was lower in patients who were more severely ill. Interestingly, the majority of respondents assigned greater importance to the absolute level of creatinine (> 5 mg/dL) than to a relative elevation of creatinine as the factor affecting their decision to initiate dialysis. Finally, for each case scenario, we asked nephrologists to rank the clinical parameters on their degree of influence on the decision to initiate early dialysis. Hyperkalemia and hypoxemia took precedence over indicators of azotemia in influencing dialysis decisions across the spectrum of illness severities. Hyperkalemia was most influential in deciding dialysis initiation in the less severely ill case, whereas hypoxemia was most influential in the high severity of illness case.
This suggests that patients who are more severely ill are more likely to be subjected to the intervention of 'early dialysis'. It is speculated that these patients are unlikely to experience a survival benefit despite such an intervention. The present study also indicates that the decision to initiate dialysis is most influenced by parameters that represent more urgent indications to initiate dialysis rather than a proactive decision based on the degree of kidney injury or anticipation of therapy and that the association between the timing of dialysis initiation and factors related to non-renal organ dysfunction (for example, volume overload leading to pulmonary edema) needs more detailed investigation.
As an additional note, since APACHE III may not accurately predict mortality in subjects with AKI and AKI-specific predictive models consistently show a reverse relationship between serum creatinine level at dialysis initiation and outcome (for example, because of malnutrition, dilution, short duration from insult to renal complications, or severe critical illness), we assessed parameters in our clinical scenarios to predict 60-day mortality on the basis of the ATN (Acute Renal Failure Trial Network) study [16]. We observed that, had they been initiated on dialysis on the day of laboratory data provided, the first two case scenarios would have had a less than 10% predicted mortality but that the third case would have had a greater than 30% predicted mortality.
Our survey respondents represented a broad spectrum of nephrologists from the US and from other countries, a wide distribution of years in practice, and a variety of practice settings. Notably, 53% of respondents indicated that, based on the current level of evidence, there is no benefit in initiating early dialysis in AKI; moreover, 35% of respondents indicated that, based on the present evidence, they believed that the risk of early dialysis initiation outweighs the benefit. However, 46% of respondents indicated that they frequently initiate 'early dialysis' in an ICU patient with AKI, and 73% of them indicated that they would not have any reservation in enrolling patients in a clinical trial that examined early versus late initiation of dialysis in AKI. This shows that a lack of evidence or clear consensus is partly responsible for the inconsistencies in the perceptions and practice with regard to timing of dialysis initiation; on the other hand, it may suggest that this decision is complex and is associated with a reasonable degree of subjectivity.
There are limitations to our analysis. The sample is not large, and the mode of distributing our survey may have led to a selection bias in potential responders. However, considering the self-identified characteristics of the respondents, we believe that the sample is representative of the spectrum of practicing nephrologists, primarily within the US. Our survey was taken only once by each respondent; thus, we cannot say whether the same respondent would have consistently chosen the same responses.
Survey respondents were more likely to initiate early dialysis in those individuals who are more severely ill; but its beneficial effects in these patients are unclear. Parameters most influential in determining dialysis initiation were complications of AKI, such as hyperkalemia and hypoxemia due to volume overload, whereas the degree of severity of kidney injury or markers of azotemia played a less important role in the early dialysis decision. About half of the respondents said that the current evidence to support the benefits of early dialysis is weak, and 1 in 3 respondents thought that early dialysis might actually be harmful. Based on the survey, we conclude that the timing of dialysis initiation remains a clinical decision, one that is affected more by subjective assessment of severity of illness than objectively measured parameters of azotemia; its true impact on patient outcomes needs prospective investigation.
Key messages
Patients who are more severely ill are likely to be subjected to early initiation of dialysis in AKI in the ICU, but the utility of this practice remains unproven.
Parameters of azotemia at which dialysis is initiated change with severity of illness.
The BUN level at which dialysis is initiated depends on the severity of illness of the patient; absolute level of creatinine is more influential than relative increase in serum creatinine.
Rank-order analysis indicates that dialysis initiation may be determined by 'imminent' indications rather than a proactive decision based on the degree of azotemia.
Over half of the survey respondents indicated that the evidence to support early initiation of dialysis is weak, and 1 in 3 respondents believed that initiating early dialysis may be harmful.
acute kidney injury
acute physiology and chronic health evaluation
blood urea nitrogen
continuous renal replacement therapy: ICU: intensive care unit
intermittent hemodialysis
renal replacement therapy.
The authors acknowledge the assistance of the Nephrology Now website and of the renal field advisory committee of the Department of Veterans Affairs, which facilitated the distribution of the online survey. The study was funded by internal revenue support.
Authors' Affiliations
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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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Blind Children's Learning Center Annual Golf Classic
At Johnson Gray we have become very involved with the Blind Children's Learning Center (BCLC) over the last half decade. This year was especially memorable to us over here at JGA, our very own Hunter "the soccer guy" was bestowed a great honor from BCLC. He was awarded the "Purple Jacket" for person of the year and we couldn't be more proud, even though we had to ask him not to wear it to offsite client meetings. We had many of our clients and friends out this year for the event and even some of Hunter's old teammates from the LA Galaxy came out to support the cause.
The Clinton-Trump Debate was Ratings Gold
Ratings from the first presidential debate of 2016 surpassed the lone debate in 1980 between Jimmy Carter and Ronald Reagan, which amassed 80.6 million viewers, to become the most-watched debate in the sixty-year history of televised presidential debates.
Even though final ratings have not yet been posted, it is estimated that the debate averaged 81.4 million viewers across 11 different channels, with NBC posting drawing the most, due in part to "NBC Nightly News" anchor Lester Holt's position as moderator. This number does not include PBS, which averaged 3 million additional viewers, or C-SPAN, which is not rated.
While the debate did not have commercials, the expected large audience inflated ad prices for pre- and post-debate coverage, with one media buying agency saying the price for a 30-second spot ranged from $170,000-$250,000.
An added wrinkle to the rating is the increased dovetailing of politics and the web. While this is obviously nothing new, it has hit a fever pitch this election cycle. More than just trending topics, Facebook and Twitter were used during the Democratic and Republican debates to generate questions, a practice that will continue during the presidential debates.
YouTube users have uploaded over 200,000 videos related to the 2016 election per-day since the GOP and Democratic conventions in July and users have watched more than 110 million hours of related content.
More important to any of these contributions, however, is the presence of live streams of the debate. Facebook Live, Twitter, Yahoo!, YouTube, Buzzfeed and several other online outlets. While the embrace of the internet by the political world has been a mixed bag so far, but the ability to have access to the debates anywhere – and thus have no excuse not to watch it – is one major boon of the accord.
These streams do not count towards viewership ratings, so while the television ratings for the debate just scraped by the previous record, the actual number of viewers is sure to receive a bump as well.
The Great Viking Conquest of 2016
950 years after the end of their reign, the Vikings are rising up again and conquering Europe.
Or at least their lineage is. The Icelandic soccer team is making major noise in the UEFA European Championships, and not just because of their post-game Viking chant.
Things have certainly changed since 1066. Rather than chiseling runes onto wooden planks and sending word of their heroic victories by ship, the battles are televised and watched by a whopping 99.8% of their countrymen.
But the results are similar. Iceland's boys in blue have ripped through Europe, defeating the Netherlands, Turkey, Czech Republic, Portugal and, most recently, England. They are now in the quarterfinals.
Making the story even more spectacular: the country's population is a mere 330,000. For comparison, that is 1/200th of England's 53 million. Iceland is the smallest nation to ever qualify for a major soccer tournament. And their countrymen are behind them, with 8% of Iceland – 27,000 people – traveling to France to watch them play France on Sunday, July 3rd.
Be sure to tune in to ESPN to cheer on the Vikings. Until then, get hyped up with their post-game Viking chant.
California Greenin'
In less than two weeks, the 2016 Advanced Clean Transportation (ACT) Expo will be held in Long Beach, CA. The expo allows fleets to discover hundreds of cost-saving, clean transportation solutions, all under one roof.
Green solutions have been gaining ground on traditional gasoline or diesel in recent years due to technological advances, lower costs, more stringent regulatory standards and consumer demand for corporate citizenship.
Natural gas has been one of the fuel alternatives experiencing the most growth and the trend is likely to continue. In the next decade, natural gas vehicles are expected to exceed $35 million in total sales. It is extremely versatile and can be used to power everything from cars to ocean liners while releasing significantly lower emissions than traditional fuels without sacrificing power.
Even better, natural gas is sustainable and improving. Two years ago, renewable natural gas (RNG) – derived from biomethane – accounted for just 10% of the natural gas used in California. Today, over half of the natural gas within California is renewable. Public transit, in particular, is rapidly implementing RNG. For instance, the Orange County Transportation Authority will soon have all of its 500-plus fleet of buses running on RNG.
This jump in adoption is due, in part, to companies like Agility Fuel Systems that are revolutionizing the technology used in natural gas systems. Johnson Gray Advertising will be helping Agility deliver their message on the merits of clean-burning natural gas at the ACT Expo, as we have for several of their other creative and marketing needs.
March Madness and the Courts of College Basketball
March Madness is just getting started and this year the NCAA is giving the basketball courts an infographics-bend. In an attempt to better serve the channel-flippers hopscotching between four different channels, each site will be bordered with a different color scheme. The courts will indicate the host city and venue, which round the tourney is in, the venue's logo and a new mid-court March Madness logo.
The court borders will change as the tournament progresses, as will the mid-court logo. The NCAA has not unveiled the logos for the later rounds yet, so there is no telling what sort of wrinkles these designs will entail.
The JGA office has been in a basketball mindset all week, so we've also been passing around some of the cooler court designs in college basketball.
It is a shame Oregon will be playing on a neutral court instead of their court in the middle of a forest.
Florida International University plays their ball on the beach.
And then, perhaps we're biased, but the entire office agrees that Northern Kentucky University's court takes home the trophy.
It Feels like Summer in Laguna Beach
It is beautiful out in Laguna Beach today. This is such a great time of year because the beaches aren't too crowded and the locals get to enjoy the warm weather and clear skies during their lunch breaks without getting bowled over by throngs of tourists.
And Liam the Lifeguard agrees.
The Petersen Museum Showcases Alternative Power Vehicles
In 2015, Los Angeles' renowned Petersen Automotive Museum underwent an extensive $90 million renovation. Far more than just a new coat of paint, the overhaul comes with several new features: a restored and upgraded collection of historically significant American and european classics, groundbreaking race cars and vehicles with Hollywood ancestry.
Included in the process, the museum introduced a state-of-the-art "Alternative Power" gallery which will showcase past attempts at creating vehicles that run on electric power, such as natural gas, hydrogen, electric and more. It will also display contemporary efforts at driving the adoption of green energy sources.
Johnson Gray has teamed up with several such companies, including Agility Fuel Systems – a natural gas fuel system manufacturer for heavy-duty tricks, buses and specialty vehicles – as well as the University of California, Irvine, whose National Fuel Cell Research Center develops fuel cell technology to power vehicles.
When the Mad Men Were Mad Boys
A British designer recently uncovered a relic from advertising's budding youth. While sifting through his recently passed grandmother's belongings, he found a copy of "The Ad-Man's Desk Book", a book published in the 1940s that belonged to his art director grandfather.
The book reaches back to a time when direct mail was novel and "increasingly popular". It champions the "growing importance" of color in advertising.
Vintage advertising is always fascinating, so it makes sense that the methods of achieving the results would follow suit. The book includes examples of Ben Day dots (a staple of mid-20th century comic books and of pop artists, such as office favorite Roy Lichtenstein) as well as several sample layouts.
And that is just a small sampling. Several more of the scans from the book can be found here.

subset: commoncrawl


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Reditelj: Michael Bay
Godina: 2009 | Trajanje: 150 minŽanrovi: Action , Adventure , Sci-Fi
Glavne uloge: Shia LaBeouf , Megan Fox , Josh DuhamelDržava: USAJezici: English , Spanish
Opis : Sam Witwicky leaves the Autobots behind for a normal life. But when his mind is filled with cryptic symbols, the Decepticons target him and he is dragged back into the Transformers' war.
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text: 000 AXUS74 KBMX 161340 AAA DGTBMX ALC001-005>011-015>021-027-029-037-047-051-055-057- 063-065-073-075-081-085>093-101-105>127-211430- Drought Information Statement National Weather Service Birmingham AL 740 AM CDT Thu Feb 16 2017 ... Drought Conditions Improve Some Across Central Alabama ... SYNOPSIS...The latest U.S. Drought Monitor indicates that Extreme Drought conditons are no longer found across Central Alabama. Moderate to Severe Drought now covers areas roughly north of a line from near Livingston to Clanton to Lafayette. Remaining areas in south-central Alabama are indicated to be abnormally dry or near normal. The Drought Monitor classifies drought within one of these five categories: D0...Abnormally Dry D1...Moderate Drought D2...Severe Drought D3...Extreme Drought D4...Exceptional Drought CLIMATE SUMMARY... Some rainfall occurred during the past week with most cumulative totals generally averaging less than one inch with localized higher amounts. This was not enough to provide major changes to the drought conditions found across Central Alabama although some improvement has occurred with Extreme Drought no longer indicated in Central Alabama. Some Precipitation Amounts (inches) for Central Alabama from January 1st through February 15th... Birmingham 8.94 Montgomery 13.00 Anniston 9.48 Tuscaloosa 10.24 Calera 10.18 Troy 15.69 Normal Precipitation expected (inches) and Departure From Normal (inches) January 1st through February 15th... Birmingham 7.21 +1.73 Montgomery 7.47 +5.52 Anniston 7.18 +2.30 Tuscaloosa 8.18 +2.06 Calera 8.43 +1.75 Troy 6.91 +8.78 AGRICULTURAL IMPACTS... The last United States Department of Agriculture (USDA) Report issued November 28th indicated that agricutural interests had been significantly impacted by the drought with many ponds and streams reported to be drying up at that time. Cattle producers were also supplementing livestock with hay, feed supplements and water hauled from elsewhere. Many farmers had been unable to plant winter crops due to the drought. More recently, many small streams and ponds used for cattle have seen levels increase due to the recent rainfall that has occurred. Recent reports from the USDA indicate that hay is still an issue in some areas but the recent rain has helped to stabilize winter pastures that have been planted. Cattle were reported to be in fair condition. FIRE DANGER IMPACTS... The Fire Danger Risk has diminished across Central Alabama with Keetch-Byram Drought Indices (KBDI) below 100 across most of the area. Values above 500 indicate a Severe Fire Danger. While the statewide Burn Ban has been rescinded, there remains concern that many pine trees could be infested with pine beetles and die due to the drought that has plagued the state. The State Forester continues to urge people that are doing any outside burning to follow safety precautions such as not leaving any fire unattended and having the proper equipment and personnel to control the fire. This is based on information from the Alabama Forestry Commission. HYDROLOGIC SUMMARY AND OUTLOOK... The latest USGS Stream Gauge Data indicates that stream flows have decreased again and are currently running near to below normal at most sites for this time of year. Periodic rainfall will need to occur for stream flows to remain at near normal or above normal levels as we move toward the spring season. Most major reservoir pool levels have remained fairly steady during the past week and remain near their normal winter levels. Listed below are current levels for some of the major reservoirs across Central Alabama and those from February 9th: Reservor Level for 02/16/17 Level for 02/09/17 WEISS 561.4 561.1 NEELY HENRY 507.0 507.1 LOGAN MARTIN 461.9 462.0 LAY 396.2 395.8 MITCHELL 312.1 312.0 JORDAN 251.6 251.6 R.L.HARRIS 787.1 787.1 MARTIN 483.0 483.2 SMITH 505.8 505.1 BANKHEAD 254.7 254.1 HOLT 186.7 186.0 SOCIAL IMPACTS... Pools are near their normal winter levels at most major reservoirs and have remained fairly steady during the past week. Voluntary and mandatory water restrictions are still in effect in some areas but some restrictions have been lifted or eased recently. PRECIPITATION AND TEMPERATURE OUTLOOK... Dry weather has returned to Central Alabama in the wake of a cold front that moved across the area mid-week. Mostly dry weather will prevail across the area through Friday. However enough moisture will return to the area over the weekend with small chances for rain returning mainly Friday night and Saturday morning. High pressure will then build into the area into early next week keeping conditions mostly dry into Wednesday. The Two Week Outlook...from February 21st through March 1st... calls for above normal temperatures and above normal precipitation transitioning to near normal. The Longer-Range Outlook for the remainder of March through May is for above normal temperatures and equal chances for above normal or below normal precipitation. The latest Seasonal Drought Outlook through May indicates that drought conditions are expected to improve or end across much of Central Alabama. UPDATE STATEMENT... The next statement will be issued around Thursday February 23rd.


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MMACanada.net caught up with UFC 158 winner Darren Elkins after his victory over Antonio Carvalho. watch video >>
Darren Elkins talks about defeating Antonio Carvalho at UFC 158, whether he thought the stoppage was early, his featherweight winning streak, how he feels about fighting top 10 opponents, and much mo watch video >>
UFC featherweight Darren Elkins speaks to the media after his win over Antonio Carvalho at UFC 158, if he agreed with the stoppage, what Carvalho said to him after the fight and improving to 5-0 in t watch video >>
UFC featherweight Antonio Carvalho discusses his controversial loss to Darren Elkins at UFC 158, what he discussed with referee Yves Lavigne after the fight, the stress going into this fight and his watch video >>
Darren Elkins talks about his decision win over Chas Skelly at UFC 196, his move to Team Alpha Male, mohawks, and much more. Subscribe: http://goo.gl/dYpsgH Check out our full video catalog: http: watch video >>
UFC Fight Night Dublin Post Fight Media Scrum Darren Elkins talks unanimous decision win over Robert Whiteford at UFC Dublin UFC Fight Night: Holohan vs. Smolka UFC Fight Night Dublin UFC Dublin watch video >>
UFC featherweight Darren Elkins talks about his UFC Fight Night 27 decision win over Hatsu Hioki. watch video >>
MMACanada.net caught up with Antonio Carvalho to discuss what went wrong in his bout last night at UFC 158 in Montreal. See what the Canadian had to say. watch video >>
UFC featherweight Antonio Carvalho opens up about the stresses he puts on himself in the cage, striving for perfection, his last fight with Rodrigo Damm, where he stands in the featherweight division watch video >>
PLEASE SUBSCRIBE & CHECK OUT MORE VIDEOS at http://www.mmainterviews.tv Get 25% off at http://www.Proboxingsupplies.com if you call and mention MMAinterviews! Get $10 off preworkout supplements Bod watch video >>
MMA H.E.A.T.'s Karyn Bryant talks with Darren Elkins after his win over Deigo Brandao at UFC 146. Be sure to visit http://www.MMAHEAT.com for more interviews and MMA content. Nós falamos Português watch video >>
Antonio Carlos Junior talks about his decision win over Marvin Vettori at UFC 207, what he would like to improve on, and much more. Subscribe: http://goo.gl/dYpsgH Check out our full video catalog watch video >>
Darren Stewart discusses his controversial TKO finish over Francimar Barroso at UFC Fight Night 100, his thoughts on his experience fighting MMA outside of Europe, competing a couple of days after hi watch video >>
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STARmeterSEE RANK
Down 1,114,943 this week
Ernst Udet (1896–1941)
Ernst Udet was born on April 26, 1896 in Frankfurt on Main, Germany. He is known for his work on White Hell of Pitz Palu (1929), Wunder des Fliegens: Der Film eines deutschen Fliegers (1935) and Storm Over Mont Blanc (1930). He was married to Eleanor 'Lo' Zink. He died on November 17, 1941 in Berlin, Germany. See full bio »
Born:in Frankfurt on Main, Germany
Died:(age 45) in Berlin, Germany


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HB Racing Spur Gear (46T)
HB Racing
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This is a replacement Hot Bodies 46 Tooth Spur Gear, and is intended for use with the HPI WR8, WR8 Flux, Hot Bodies Lightening 10 and Lighting Stadium 10 Sport vehicles.
This product was added to our catalog on January 18, 2013.


text:
Peanut Butter-Banana Ice Cream Bites makes an enticing flavor trio, and mean you can treat your sweet tooth to two ... or three.
Makes 1 1/2 dozen
Recipe Time
Prep: 30 Minutes
Cook: 8 Minutes
Freeze: 48 Minutes
1/2 cup butter, softened
1/2 cup creamy or crunchy peanut butter
1/2 cup sugar
1/2 cup firmly packed light brown sugar
1 large egg
1 1/2 cups all-purpose flour
1/2 teaspoon baking soda
1/2 teaspoon baking powder
1/4 teaspoon salt
1 pint vanilla ice cream, softened
1 banana, chopped
1. Preheat oven to 350°. Beat first 4 ingredients with an electric mixer at medium speed until blended. Add egg; beat well.
2. Combine flour and next 3 ingredients; add to butter mixture, blending well. Shape dough into 1-inch balls on ungreased baking sheets. Gently flatten with a fork dipped in sugar, making a crisscross pattern on each. Bake 8 minutes. Remove to wire racks to cool.
3. Combine ice cream and banana until well blended. Scoop 1 rounded tablespoon ice cream onto 1 cookie, and top with another cookie, pressing lightly to make a sandwich. Freeze 45 minutes or until firm.
June 2014


text:
An iron spray that protects hair from hot tools up to 450° F / 232° C.
ThermoSeal Technology: Dual-action, heat-activated technology locks in moisture & locks out humidity. Forms a protective barrier around every hair strand to fight frizz and help straight or curly hair styles last longer. Reduces breakage by 80%.


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By Competitor.com, Published Sep. 16, 2013, Updated Sep. 18, 2013 at 5:27 PM UTC
Mothers worked hard, but all the hard work left little time to play.
Start your FREE subscription to Competitor Digital today!
Get our monthly digital magazine, weekly running content & exclusive offers delivered to your inbox.
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An area pond teems with life.
Marie Butler of Cecilia celebrated her 90th birthday on May 14, 2010, with a lunch celebration attended by all of her children and immediate family. Formerly of Hardinsburg, Mrs. Butler has four children, seven grandchildren, 13 great-grandchildren and 14 great-great-grandchildren.
The Mihelic family, who volunteers at Warm Blessings meal kitchen, recently spruced up the grounds at the kitchen, at 609 E. Dixie Ave. in Elizabethtown. Pictured planting flowers along the roadside are Cody and Caitie with their father, Don, in the background. An evening meal is served at Warm Blessings at 5 p.m. Monday through Thursday for anyone needing this service. Showers and washer and dryer use are available on a limited basis by calling 763-9276 for an appointment.
By Shirley Pond
Question: My mother still lives alone, but she is getting older and is starting to need a little assistance with some things. She values her independence and does not want to live with us. We are considering assisted living. How do we pay for assisted living?
Answer: Assisted living is a wonderful option for seniors. It serves as a bridge between independent living at home and a nursing home.
By LINDA IRELAND
Landmark News Service
An apparent accidental drowning last Saturday took the life of a Hodgenville woman.
Deborah K. Pendleton Dever, 45, was found unconscious in an outdoor swimming pool about 4 p.m., according to LaRue County Deputy Coroner Wesley Warren.
Dever was home alone at the residence off Campbellsville Road, Warren said. Her husband of almost 25 years, Jimmy, found her in the pool when he got home from work.
By KELLY R. CANTRALL
Joanne Barrow's bicycle has a part on its steering column that reads, "Ready to Suffer?" If it will help people who are suffering much more, Barrow says she is.
Mike and Joanne Barrow of Elizabethtown are about to embark on the Underground Railroad Bicycle Tour, which will take them along the route that slaves used to escape to the north. The tour raises money for the International Justice Mission, which fights human trafficking and sexual slavery.
Larry Vance, pastor of Vine Grove Baptist Church, was the guest speaker at the June 1 meeting of the Elizabethtown Rotary Club. Pastor Vance is also known as Chaplin Vance since he serves as the Chaplin of the Hardin County Jail, a volunteer position that he has held for more than 30 years. He spoke to the Club about his experiences in the Jail Ministry all those years and how his ministry is not only to the inmates but to their families and sometimes the victims.
Four members of Rotaract (Young Rotarians) have taken on the project of building the shed for Hardin County Habitat for Humanity's current house. The team is learning new skills and understanding how things go together to make a building. Their efforts are part of the Lowe's sponsored Women Build House at 319 Guthrie Place. Habitat's goal is to have as much woman participation in the construction as possible on the house. The whole project is women friendly. Visit www.hardinhabitat.com for information about the project.
Elizabethtown Lions Club President Travis Langdon presents a check to Terry Taylor, team leader at Big Brothers Big Sisters of Kentuckiana. The program's slogan is "Little Moments, Big Magic." Supporting Big Brothers Big Sisters is a way to take a leading role in transforming the lives of children.
Copyright © 2017
The News-Enterprise is your source for local news, sports, events and information in Elizabethtown, KY, Hardin County and the surrounding area.


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Novartis, commercial strategy for success
This interactive case study has been developed for students to apply their knowledge about how to develop a sales strategy and a commercial plan. It takes a practical approach and includes two interactive exercises that simulate the strategy set by students based on Novartis Spain challenges in 2008. The first exercise is the Launch of Exforge in Spain, and the second one is the Launch of Rasilez, Galvus & Eucreas in Spain. In both exercises, students have to plan the commercial and... More
Material Type: Case Study
Technical Format: HTML/Text
Date Added to MERLOT: August 23, 2010
Date Modified in MERLOT: June 02, 2011
Submitter: Martin Rodriguez
Keywords: Commercial plan, Pharmaceutical, Novartis, Pharma, Promotional activities, launch, Marketing plan, launching, Sales Force
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Primary Audience: College General Ed
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Graphs, Matrices, and Designs
Festschrift in Honor of Norman J. Pullman
By (author) Rees
Edited by Rolf S. Reese
Format: Paperback
Normal Price: $440.00
Your Price: $396.00 AUD, inc. GST
Shipping: $7.95 per order
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Graphs, Matrices, and Designs by Rees
Book DescriptionExamines partitions and covers of graphs and digraphs, latin squares, pairwise balanced designs with prescribed block sizes, ranks and permanents, extremal graph theory, Hadamard matrices and graph factorizations. This book is designed to be of interest to applied mathematicians, computer scientists and communications researchers.
Buy Graphs, Matrices, and Designs book by Rees from Australia's Online Bookstore, Boomerang Books.
Book DetailsISBN: 9780824787905
(279mm x 216mm x 18mm)
Pages: 344
Imprint: Marcel Dekker Inc
Publisher: Taylor & Francis Inc
Publish Date: 25-Sep-1992
Country of Publication: United States
Books By Author Rees
Facilitator Excellence, Paperback (July 1998)» View all books by Rees
Today's organizations are using teams to carry out tasks and solve problems. To get the job done, your managers and team leaders need to communicate and cooperate.
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Import invoices from mysql database into Quickbooks
- Status Completed
- Budget $250 CAD
- Total Bids 1
Project Description
Hello, we are an online retail company looking to further integrate our e-commerce site with our Quickbooks application. We are looking for someone to help us import invoices and payments from our mysql database into our Quickbooks application (preferably using the web connector tool and not IIF files). All coding must be made in PHP.Get free quotes for a project like this
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Celyn Villa bed and breakfast in Carmel, just 2 miles from Holywell, Flintshire, North Wales. A warm welcome, a comfy bed and a great breakfast. 4 star, 'a real home from home'. However some people still use the old name of 'Clwyd' for the county which can be very confusing for visitors. But there will be a warm welcome, however you found us!
We have three rooms available. Two doubles and a twin (which can be configured as a Queen if booked direct). We also have an extra single bed we can put into our Rose Room for an extra adult or child. All have sea views and are tastefully decorated and furnished to make your stay as enjoyable as possible. Based in Carmel, just two miles from Holywell, Celyn Villa was built around 1855 and has been the Vicarage (Manse) to the local chapel and the village post office. Its main claim to fame is that the aunt of Emlyn Williams (Welsh dramatist and actor 1905-1987) ran the Post Office here during the 1930's and it is said that he was a regular visitor. Located in a quiet village in North East Wales but with easy access to the A55, Celyn Villa is a great base for exploring North Wales including historic Conwy, Llandudno and Snowdonia, sunny Prestatyn as well as medieval Chester, historic Liverpool or why not visit many of the attractions or castles in Flintshire (Clwyd) .
Holywell is famous for St Winefriedes Well where pilgrims have been visiting since the 7th century and we are also close to Pantasaph Friary. A great overnight stop if you are walking the Wales Coastal Path. or travelling to Ireland by ferry. The market town of Mold is close by as is Flint which is just two and half hours by train from London Euston.
- Single, Double and Twin Rooms (extra bed available)
- Tea, coffee, biscuits, TV, hair dryers, toiletries in all rooms
- Large guest lounge to relax in
- Free WiFi
- Off road parking and secure lock up for cycles
The 'Celyn Breakfast' is prepared using locally sourced ingredients where possible including lovely freshly laid eggs and gold medal winning Welsh sausages. If its just poached eggs on our home made toast that you prefer that's fine too. Vegetarian and restricted diet options if required, with notice please. Let us know if you have any dietary requirements like gluten or dairy free.
There are several pubs offering good food, we will be happy to recommend places to eat locally.
Prices are £60 for single occupancy and £75 for double occupancy. Families can book adjoining double and twin rooms or we can put an extra bed in the Rose room for one child. Phone direct for special offers.
To book phone us on 01352 710853 or email us at firstname.lastname@example.com. Alternatively, you can check availability and book online.


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post #11 of 13 Old 09-30-2013, 10:51 PM
I was hoping jaysee, or someone else with that level of expertise would have gotten back to you by now. Any ammonia at all is cause for concern. Combine that with 40 Nitrates, (50 being the limit in most references I've found, though, personally, I wish they all said 20 for a limit), & your fish may actually be in pain, which would curb their appetites. Corys are especially affected by ammonia, nitrites & nitrates, or any pH swing, that might accompany spikes in those. If it was me, I would do a 50% water change, trying to keep the water you put back in as close to the tank temp as possible, though a degree or 2 higher might be better, making sure to dose well with anti-chlorine before adding your water of course, using Prime especially if you have it; a lot of people seem to like it best from what posts I've seen.
post #12 of 13 Old 09-30-2013, 11:42 PM
Yeah, ammonia and nitrite will stress fish and stressed animals do not eat, so that makes sense. Nitrates are not something that concerns me. mine are routinely "high" like that. In any event, water changes would be good. you said you have been doing them, but what exactly have you been doing?
125 - BGK, chanchito cichlid, pictus cats, silver dollars, palmas bichir
125 - cichlids (severums, bolivian rams, chocolate), rainbows ( turquoise, red), loaches (angelicus, zebra, kuhli and horseface), plecos (BN, RL and clown), denison barbs, tiretrack eel, pearl gouramis, betta
90 - Congo tetras, african knife, upside down cats, spotted ctenopoma, kribensis, delhezzi bichir
2.5 - betta
90 - Congo tetras, african knife, upside down cats, spotted ctenopoma, kribensis, delhezzi bichir
2.5 - betta
post #13 of 13 Old 10-01-2013, 03:47 PM Thread Starter
I performed a 40 % water change the day before I tested the tank. I will be performing another 40 % change as soon as I get home today. As strange as it sounds, I've never had 0 ammonia in any of my tanks. Its always been 0.25 or higher ( When Cycling).
And before that I would do 20 % water changes once a week.
What is prime and where may I aquire it?
And before that I would do 20 % water changes once a week.
What is prime and where may I aquire it?
Please click so they will hatch and grow :)
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Torino winger Omar El Kaddouri says his team did not deserve to lose to Roma in the manner they did last night.
The Granata conceded an injury time winner to fall to a 2-1 defeat at Stadio Olimpico and the Moroccan believes the side merited more.
"I'm sorry that we lost like that in the last minute," El Kaddouri told the media. "We didn't deserve it, it was exactly the same as what happened against Napoli.
"The boss told us we should be happy and satisfied with our performance.
"Unfortunately we were just lacking a decisive touch in the final third. If we had had it the result would have been different."
Keep up to date with the latest news and action from Spain's Primera Division with Football Espana - from the team behind Football Italia.


text:
- Doctors
- Nova Scotia
- Halifax
- Family Doctors
- Dr. Deanna Swinamer
You may also like
Dr. Howard Conter
Ratings for Dr. Deanna Swinamer
Very good and efficient with our family 👪 members.
Dr Swinamer took me on as a patient when I was without a primary care physician after my doctor of many years retired, and his replacement had also left (having been unable to diagnose my disease for a year). Within a week I had been diagnosed by Dr Swinamer, and beginning effective treatment. I find her empathetic and respectful of my opinions, which are sometimes not what she would like to hear! Love her!
Deanna is always a pleasure to see, and I never have to wait, she organizes her day extremely well.
Dr. Swinamer is an amazing physician. When she asks how you are doing, she genuinely means it. She is the true definition of a family physician-all of my family see her. She even asks about them but will still keep things professional and confidential. She has called me personally to tell me something instead of having her staff call to book an appointment to go back to see her. She trusts my medical judgements (not a medical professional) and I obviously trust hers. Love her to pieces!
Dr. Swinamer is an amazing family doctor and I feel so lucky to have her. She is completely thorough, compassionate, understanding and supportive. I have really needed her in the past six months and she has been nothing but attentive, supportive, and kind. She is a smart, strong woman who I completely trust my healthcare with. She even agreed to take my mother on as a patient when I asked because I was concerned about some health issues she was having. Once when I was having major sinus issues she managed to get me in to see a specialist THAT DAY. Unheard of. Her staff have also helped me to get in in a rush when I really had a rebound of symptoms. I know how lucky I am. I vote her the best of the best.
I am so thankful to have her as my doctor. Very understanding and supportive. There is hardly any waiting time before the appt.
Dr Swinamer is amazing. I started going to her 3 years ago to join my hubby to make her our family dr since we're expecting. She's so real, I love it. She has great bedside manner, and knows her stuff - and will refer you elsewhere if need be! She even takes a few minutes at the end to chat about just life in general. My hubby's entire family sees her. And actually, she was the dr who diagnosed his father with a fatal disease when doctor after doctor dismissed his cough for smokers cough. Unfortunately it was too late to save him, but the family holds her in a high place.
Consider yourself very very blessed if Dr.Swinamer is your GP. She agreed to take me on as a patient when my regular GP did not handle my depression/anxiety in the manner I wanted. Dr Swinamer recognized how much pain I was in and immediately took measures to make sure I was on the road to recovery. She really goes above and beyond. When your in her office, her main concern is getting you better ASAP. She even gave me her personal phone number if I ran into any problems. She's also extremely personable and gentle and takes an interest not only in your medical issues, but your personal life. She truly is one of the best. Her staff is also very friendly and helpful. Bottom line: I have the utmost confidence in Dr.Swinamer.
shes very discouraging or any alternative medicine I've tried. I find her cold and unfriendly and generally not very helpful, very oriented toward giving me drugs for stuff.
I have been seeing Dr. Swinamer since she moved from Calgary to Halifax (10 years?). She is the most friendly, caring, respectful, easy-going, professional,knowledgeable doctor. She takes time to know her patients and when you see her out and about in town, she always comes over and speaks to you. You can talk to her about anything. She is an excellent listener. She usually knows the answer but quickly refers to specialists when she does not. She is equally good with my baby as myself. She is very punctual but addresses concerns thoroughly. She is excellent when there is an emergency with your health-- not leaving things to the on-call Dr., but called me herself to follow through. Her receptionists are great also-- will fit you in to see her that day more often than not if there is a real concern. I feel very blessed to have her and would recommend her to anyone. The world needs more doctors like Dr. Swinamer.
Dr. Deanna Swinamer's Credentials
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text:
Hatred, destruction, torture and pain
So much flesh for me to maim
Ripping the skin from off your face
Making you part of my new race
Fleashless beings without a soul to sell
Satan refuses us access to hell
God has gone with a slam of the gate
Trapped on earth forever with hate
Wondering around so endlessly
Converting victims like you and me
© Copyright 2017 ERcubed. All rights reserved.
Status: Finished
Genre: Poetry
Again...holy crap!
more chills!
Possible script idea?
zombielicious! (a few typos. can be edited. click on portfolio, then edit) the every line rhyme is usually too much, but here there's plenty going on that i doesn't matter. good job.
Sounds like one of the games my kid plays!
Short Story / Literary Fiction
Short Story / Flash Fiction
Poem / Humor
Paste the link to picture in the entry below:
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Hot Links
Hot Links
Faculty Spotlight: Sara Gramata
For the tenth FCIP Teaching and Assessment Spotlight, we recognize Sara Gramata, Lecturer and Clinical Instructor from the Quinlan School of Business.
Related Links
Universal Design Presentation & WorkshopUniversal Design principles, applied to course design and delivery, assist learners with a diverse set of characteristics. Creating an inclusive learning environment is one aspect of social justice that should be important to us as Jesuit educators. Join us Thursday, February 23 for a dynamic presentation on the elements and application of Universal Design presented by Dr. Karen Myers of St. Louis University. Dr. Myers will also be providing a workshop in the afternoon; please sign up separately for the afternoon session.
Assessment Certificate ProgramEvery curricular/co-curricular program plays a unique role in preparing our students to lead extraordinary lives; it's important to tell the stories of how we impact our students and how our students in turn impact the world. We build our stories using details gathered through assessment of student learning and experiences. We tell our students how they can expect to grow as learners by engaging in our programs. We then collect evidence of how well we deliver on these expectations, reflect on how we will act on these findings, and work to continuously improve our programs. To build capacity around good practice in assessment, Loyola and DePaul have partnered to offer free workshops focused on the assessment cycle (e.g. writing learning outcomes and designing assessments). The workshops are open to all faculty, staff, and graduate students and may be taken independently or to complete the Assessment Certificate Program (ACP).


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The Fenwick Fellowship is awarded annually to Mason faculty members to pursue a research project that uses and enhances the University Libraries' resources while advancing knowledge in her or her field. The competition is open to tenured and tenure-track or multi-year appointment term faculty members at Mason and provides one award of up to $5,000 for research materials and assistance, along with the use of an office in Fenwick Library for one academic year. Each year the Fenwick Fellow application guidelines are announced during early Spring Semester. Applications are usually accepted March through April. All submitted applications contain a brief proposal and curriculum vitae along with a signed acknowledgement and approval from the applicant's department chairperson.
Application contents include:
- A project summary and information about the central problem to be addressed
- Evidence of the applicant's previous work in the general area
- Research methodologies to be used.
- Explanation of why research space in the library is needed
- A budget, broken down to show specific materials and/or services to be purchased with the award
- Expected results of the fellowship
A six-member selection committee reviews the applications and selects one to recommend to the University Librarian. An announcement of the winner is made at the start of each new academic year to the university community. The following Spring after the completed fellowship, University Libraries sponsors a public Fenwick Fellow lecture.
See the current and past Fenwick Fellows and their projects.


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Home Sports Tickets Handball EHF Champions League
EHF Champions League Tickets
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text:
The Word Made Plain: The Power and Promise of Preaching
Harris grounds black preaching in the self-understanding of the historic black church and its most prominent preachers, from Martin Luther King Jr. to Samuel Proctor. Harris also explores the hermeneutical and aesthetic dimensions of preaching, especially at the intersection of sacred text and the broader culture. He then lays out the specific distinguishing characteristics of black preaching, including verbal cadence and rhythm, use of gestures, and, most thoroughly, the narrative model of the sermon. His last chapter, ''Preaching Plainly,'' provides specific instructions on how to put the sermon together employing this model.
- This Item is Not Returnable
- This product ships separately within 10 business days of placing your order
- Format Paperback
- Height 8.5
- Publisher Fortress Press
- Pages 178
- Width 5.5
- Publication Date Jul 14, 2004
"Harris has done his homework. He has exceeded other homileticians by not only unpacking the nature of Black preaching, but also in what others have not done as well: He has related this theory of the art to a wide and interdisciplinary gamut of philosophers and scholars to show what the world at large can appreciate and learn from this noble heritage of the African American church."
— Gayraud S. Wilmore, Professor Emeritus of Church History, Interdenominational Theological Center, Atlanta
"Black preaching in all its powerful dimensions comes alive in this work. It testifies to Dr. Harris's genius as a homiletician in the best tradition of the African American church. But The Word Made Plain also speaks to the kind of homiletic power and artistry needed in the pulpits of churches everywhere today."
Lewis V. Baldwin, Vanderbilt University
"James Harris does a marvelous job of describing preaching as a dialogical experences: he encourages preachers to discover the complex in that which is apparently simple, to simplify the complex, and to make it all plain through application."
Paul Scott Wilson, Emmanuel College, University of Toronto
Table of Contents
- The Preacher's Self-Understanding
The Black Church and Self-Understanding
The Selfhood of the Preacher: The Example of Martin Luther King Jr.
The Self in Community
Sermon: Everybody's Talking (Luke 4:31-37)/23
- The Preaching of the Elders: Princes of the African American Pulpit
John Malcus Ellison: The Personality and Interpretive Mind of the Preacher
Samuel DeWitt Proctor: The Ethical Dimensions of a Sermon
Miles Jerome Jones: On Being an Authentic Preacher
Sermon: From Talk to Testimony (Mark 8:27-30)/44
- The Sermon as Interpretation
The Polyvalence of the Sermon
The Deep Symbolism of Plain Words
Textuality and Dialogue Preaching
Understanding and Response
Interpretation of Novels as a Hermeneutical Discipline
Sermon: The Power of God (Ephesians 1:18-23)/71
- The Sermon as Art
Beyond the Limits of Reason Alone
Nommo and Kuntu: Word and Style in Preaching
Embodied Preaching: Gestures
A Soulful Sound: The Aural and the Oral
Rhythm and Cadence in Preaching
Style Switching
Sermon: Second Chances (Jonah 3:1-3a)/95
- The Sermon as Story
African American Preaching as Imagination
Telling the Story: Narrative Structure in Sermons
Cultural Origins of Storytelling
Sermon: When Jesus Was in the House (Mark 2:1-5)/119
- Preaching Plainly: How to Put the Sermon Together — The Harris Method
Preaching and Worship
The Word Made Plain
The Preacher and the Biblical and Congregational Text
Developing the Sermon
Sermon: A Question of Identity — Choes, Self, and Other (Luke 8:22-25)/140


text:
Pocket beagle
Explorează subiecte asemănătoare
Pocket Beagle Puppies | Pocket Puppies on Beagle Puppies Cute And Adorable Beagle Puppies For ...
Miniature beagle on the grass
Love this little baby. Think I need a Pocket Beagle
English Pocket Beagles 2 Love pocket beagle pups. Lots of intelligence in a small package, combined with loving, sweet dispositions in a diminutive body. They are not the diggers and noise makers that their larger cousins are. Their soft melodious voices are seldom heard.
Bashful Beagle! …
Adorable cute beagle puppy in hands ~ The Animals Planet
Silver and White Pocket Beagle from Pocket Beagles USA.com
From @faya_the_beagle: "Hi my name is Faya " #cutepetclub by: @cutepetclub
What Is a Pocket Beagle | What is your favorite Queen Elizabeth Pocket Beagle color?
Miniature Pocket Beagle Puppies for sale in Greater Manchester, North West :: Dogs and Puppies


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Style and function have come together in these economical Port Authority Dry Zone custom polo shirts.
This classic Gildan logo t-shirt is available in a variety of different colors. Made of 100% preshrunk heavyweight cotton. 5.3 oz.
A high quality compact Bluetooth promotional speaker that allows you to share your music anywhere.
Clean sound and bass is delivered by the Atlas Promotion Headphones.
The holidays taste so much better after you have given this custom candy in a festive gift box to clients, coworker and business associates.
Ideal executive gift made of leather business card case and matching promotional USB 2.0 2GB flash memory drive and convenient brass barrel black ink pen all with your logo.
A beautiful gift box filled with delicious gourmet custom candy that is ideal for sharing any time of the year.
The vented windproof canopy construction on these custom umbrellas can withstand wind gusts up to 55 MPH!
Convenient zippered custom picnic set holds up to 3 bottles of wine and cutting board and utensils.
A hot promo mug from the name brand Zippo line is great for a company gift or tradeshow giveaway.
An aluminum cube-shaped promotional speaker that works with most Bluetooth/wireless enabled devices is perfect to keep in the home or office.
Promotional Cooler Bag and Grill including the grill! A unique, attention-getting promotional gift!
Made of microfiber and leatherette, this promotional jewelry case is a fun promotional gift for any woman.
Elegant glass photo frame personalized coasters featuring your logo laser engraved on wood holder.
Recipients will devour the 12 mini gourmet chocolate chip custom cookies packed inside a retail style brown box topped with a ribbon.
Sip your favorite hot or cold beverages from this stainless steel custom tumbler gift set that comes with 2 packages of Ghiradelli cocoa.
A great promotional gift set that is both delicious and will promote your logo throughout hot summer days.
Keep everything you need for your next business meeting stored in the custom portfolio that features your debossed imprint.
Having a holiday party? Celebrating a special holiday with your clients? Help promote these special days with the right promotional products from ePromos. From Christmas to St. Patrick's day ePromos has all the promotional items you need to celebrate the holidays right.


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By Molly Born Pittsburgh Post-Gazette
A section of Harts Run Road east of Route 8 in Hampton is closed this morning because of a water main break.
Hampton police said the main thoroughfare is closed between Clearview and Woodland roads, about a tenth of a mile. The break occurred around 5:45 a.m. near the intersection of Harts Run and Middle roads.
Crews are on scene, but the heavily used road is expected to be "closed for a while," police said. It's too early to tell how long the repair will take, according to the Hampton Shaler Water Authority.mobilehome - breaking - Transportation - neigh_north
Molly Born: email@example.com or 412-263-1944 or on Twitter @borntolede.
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The Original Hostess Ho Ho's are manufactured by Hostess and have become increasibly difficult to find.
First created in San Francisco, Hostess Ho Ho date their history back to 1967 when a local bakery decided to take a chocolate cake and enrobe it in rich milk chocolate in the hopes of making a sweet product sweeter. Like many great discoveries, this simple combination lead to the creation of one of the most popular snack foods of all times which has been bringing joy and has been a lunch box staple for over 45, yes 45, years!
PLEASE NOTE that as of November 16th, 2012, we are not certain whether we are going to be able to fufill Hostess orders due to the possibility of the company closing. We are still taking orders but apologize in the event that they are not able to be filled.
Hostess Ho Ho's Hostess Ho Ho's are one of the best selling snack foods of all times. Shop our amazing selection of Hostess Snacks here!
- Price: $12.98


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Your home ought to reflect your personality, ideas, lifestyle and tastes. Therefore, your home deserves to be treated by a modern home interior decorator who can devote passion and care, turning your home into the ultimate expression of you. Elegant Living Spaces is the creation of Maria, an award winning interior designer and decorator in Toronto backed by decades of experience. Elegant Living Spaces will turn your home décor in to a gem by using the existing space, reshuffling, moving, changing and introducing new furniture and accessories. Maria can introduce elegance to your home, room, condo, cottage, office, garden, patio and deck with her modern home décor ideas. Contact us today.
elegant living spaces
17 Ronan avenue, Toronto, ON M4N 2X8
Phone: 647 241 3705
Ad ID: 9967


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Saturday Morning Massacre
A dark and bloody parody about a Scooby-Doo-like team of paranormal investigators and their devoted dog..
A dark and bloody parody about a Scooby-Doo-like team of paranormal investigators and their devoted dog..
A pothead kid's show cartoonist in Los Angeles spends a weekend trying to sleep with his visiting house guest – a woman from New York who he met on Chatroulette.
Gene spends his days canvassing about childhood obesity and the billions of dollars wasted each year on junk food subsidies. Gene meets Titty, an emotionally-arrested 19-year-old who has successfully sued his own father to win back a large inheritance, getting himself disowned in the process. Gene discovers that Titty has an ongoing online relationship with the beautiful agoraphobic Ginger, who is an animal activist. Gene convinces Titty to make a pilgrimage to meet Ginger. Gene quickly begins to fall for the enigmatic Ginger, despite the fact that his goal was to deliver her up to his new friend Titty. But Ginger has no intention of being delivered up to anybody. [Synopsis courtesy of SXSW Film Festival]
A grad student in theatre directs a group of undergrads in an adaptation of a 1980s young adult novel, altering them all in unexpected ways.


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As Mr. Obama recognized the Japanese losses at Hiroshima and the event that caused them, there is a resonance for Americans who are remembering their own losses this Memorial Day weekend. Read More »
Home / Tag Archives: Nagasaki
Book Review: The Last Train from Hiroshima: The Survivors Look Back by Charles Pellegrino
Individuals who survived both the atomic bombing of Hiroshima and of Nagasaki help frame history of the events and their aftermath. Read More »


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Please see txt. attch.
Clyde Crockett z5
In a message dated 5/15/1999 8:19:57 PM Central Daylight Time, email@example.com writes:

<< Savory's Greenhouse in Edina is one of the oldest and most famous hosta

growers in the country >>

You must heed John's post. Savory's is absolutely a fabulous hosta nursery.

tel#=612 941-8755. ( I think the Area Code has changed for many suburbs of Minneapolis. It may be 651.) They sell great plants, many of them are their hybrids.

The late Bob Savory was one of the greats and Dennis(son) and Arlene(widow) are carrying it on in the great tradition it has always been. (Edina is a lovely suburb.)

You might want to 'phone Bob Olson to get other suggestions.612 920-8327.

Just a short drive south in Albert Lea is the nursery of the Minks.

114 The Fairway, 56007. Tel #= 507 373-5290.

Clyde Crockett z5


text: HD-2 Message to Listeners of Nighttime Classical on HD-2 By WRTI Staff • Mar 10, 2016 If you listen to our nighttime Classical Music programming on HD-2 or the All-Classical Web Stream, we want you to know that you may be hearing some repeated programming over the next two to three weeks. New! On WRTI's All-Classical Stream and HD-2: 'Russian Accents' and 'Edinburgh Festival' By Joe Patti • Jan 9, 2013 As the Los Angeles Philharmonic broadcast season comes to an end January 11th, two new programs will take the Friday 8 pm slot on WRTI's All-Classical stream and HD-2 over the next eight weeks. From January 18th through February 8th, "Russian Accents: Rachmaninoff, Stravinsky and the Piano" showcases the piano music of Sergei Rachmaninoff and Igor Stravinsky, as recorded in live performances by Alexander Toradze and members of the Toradze Piano Studio.


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Lent begins soon! Celebrate the Easter season with our free Lent & Easter devotions.
Originally the name of the southernmost hill on which the Canaanite fortress-city of Jebus was located. It was conquered by David around 1000 B.C. and renamed Jerusalem. Situated on the borders of Judah and Israel, it became David's capital. As the city expanded, the name Zion came to be applied to the whole city.
1Ch 11:4-5 pp 2Sa 5:6-7
Early mention of Zion Ge 14:18
Early attempts to take control of Zion Jos 15:63 pp Jdg 1:21
Considered an impregnable fortress in David's time 2Sa 5:6 pp 1Ch 11:4-5 See also 2Sa 5:8
Captured by David 2Sa 5:7 pp 1Ch 11:4
Zion, established by David as his new capital and renamed 2Sa 5:9 pp 1Ch 11:7
Further strengthened by David 1Ch 11:8 pp 2Sa 5:9
The location of David's palace 2Sa 5:11 pp 1Ch 14:1
The new resting place for the ark of the covenant 1Ch 15:1-16:6 pp 2Sa 6:1-23
Isa 33:20 See also 2Ki 19:20-21 pp Isa 37:21-22; Isa 4:3; La 1:4-8; Joel 2:32; Zep 3:14-16
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A couple of months ago, the Dutch luxury department store Maison de Bonneterie came up to me and asked me if I wanted to do a collaboration with them. Back then, we were not really sure what it was going to be, but we definitely wanted to do something with the windows. And so we decided that I could style, and eventually also model, their Things We Love for Autumn campaign. I collected 22 looks from the new collections, 11 for my boyfriend – who was happy to do the male part of the modeling – and 11 for me. We shot the whole campaign at the end of August with the amazing photographer Reinier van der Aart and those pictures are now hanging in all Maison de Bonneterie windows in Amsterdam and The Hague. I have to say it is super cool, but at the same time kind of weird to see myself hanging there, I mean those pictures are not the smallest!
Then I got my own little baby, my own window. I decided it had to show a little sneak peek from behind the scenes of our collaboration. The result is kind of a Pinterest board with backstage images – shot by Lisa Galesloot – from the shoot and a cool little window that showcases the bracelet I made to celebrate the whole thing.
Speaking of that bracelet… The idea for it came to existence when I was moving in together with my boyfriend. Our style is pretty much a simple mix of everything we bump into and I am slightly obsessed with all things industrial. When my dad came help us hang up our old Czechoslovakian factory lights, he needed me to get him what is called a shackle/harp closure. Until that day I had never heard of it before, but the minute I saw it, I knew that was going to be my bracelet.
The bracelets are available HERE in gold, silver and rose gold for 79 euros a piece. They are limited edition (there is only a 100 in each color) and they are all numbered. I hope you like them!


text: Adjustable strap system, high impact should pads with foam inserts, removable arm guards and quick release buckles mark another solid 661 product. Features: Adjustable quick release set buckles. Removable arm guards. Hi-impact shoulder pads with additional foam inserts add protection. Unlike other deflectors that lay flat against your chest. The Defender features a raised zone area creating a pocket of protection. Adjustable strap system lets you fine tune the Defender to any shape or size. The special TAF Total Airflow System is designed to keep you cooler with channels that allow air to circulate around you. Height: 41 54 Weight: 65 -120lbsCheck stock and price


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Framed Art Print
Springby Oekie
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Choose from a variety of frame styles, colors and sizes to complement your favorite Society6 gallery, or fine art print - made ready to hang. Fine-crafted from solid woods, premium shatterproof acrylic protects the face of the art print, while an acid free dust cover on the back provides a custom finish. All framed art prints include wall hanging hardware.
Hurray, it's spring! Every starting over again. The grass is green and skies are blue. Oekies come outside to play. You want to join?
®oekie + ©ankepanke.nl Please don't copy, edit or use my work without my permission. And if you do (get my ok), always credit me. Thanks!


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Spin off from bug 564471. We fire a state change event when we receive an obs_documentCreated, which indicates that a document has become editable. We should fire and event when a document becomes uneditable.
Fires only one state change event currently -- for the "on".
Created attachment 448511 [details]
manual test file
Running this with trunk on Windows, using accprobe, I see worrisome details about the accessible objects from the events. Worrisome states include 'defunct', and/or 'invalid' when turning designMode one and off. Possibly spin off bugs await.


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More Videos...
Super car driver idiots [NO pics, only videos]
I got bored with all the "super car crashes"-videos here on YouTube that only contained PICTURES, CRAPPY MUSIC or/and clips of pure racing cars on official racing events. This compilation DOES NOT include pure racing cars on official racing events - only real life FAILures on the STREETS, made by people with more money than driving skills... (Though, even the best car drivers can crash too of course.) Notice 1: The "Dodge Ram" may not be a super car, but still it's a SRT10 with the 8.3L Viper V10 which produces 510hp. Pretty super for a pick up, don't you think? It has more power than several of the cars in this video. The intention with this video was to show that skills doesn't come with money. Notice 2: Tire is the preferred spelling in the U.S. and Canada. Tyre is preferred in most varieties of English outside North America. And I'm from Sweden. So please think outside your box (country), you who claims "tyre" is incorrect spelling.
Fatal crash Golf 2.Turbo
Street racer films his own fatal crash Just because you drive a suped up Volkswagen with a bunch of racing stickers and a loud stereo doesn't actually qualify you to race a Porsche.
AUDI R8 Vs Z06 C7 - WHICH IS FASTER?!? - SUPERCARS
AUDI R8 V10 Vs. Z06 C7 V8 - SUPERCARs YESTERDAYS VLOG ► https://www.youtube.com/watch?v=xHjwEz-AfLQ&index=12&list=PLp8BmukTTg9uLlh3 QYCtuprV5okqcoTdE SUBSCRIBE FOR DAILY VLOGS! ►► http://bit.ly/1o0q4Lk Follow me on Twitter to stay updated when I post! https://twitter.com/Lance210 Instagram: https://instagram.com/Lance210/ Facebook: https://www.facebook.com/itsLance210 Vine: https://vine.co/Lance210 Snapchat: itsLance210 FAN MAIL: PO BOX 5087 1265 HURFFVILLE RD DEPTFORD NJ 08096 Business Email: firstname.lastname@example.com
The full story of what happened to my Audi R8... :( It sucks and I still hate myself for letting it happen but I wanted to let you all know the truth. ► NEW Ali-A Merch! • Store - http://AliAShop.com ► Follow me! • Facebook - http://facebook.com/AliAarmy • Twitter - http://www.twitter.com/OMGitsAliA • #AliAapp (iOS) - http://tinyurl.com/9u5h3d8 • #AliAapp (Android) - http://tinyurl.com/bz8kjbs • Host your own Minecraft servers here: http://gizmoservers.com ("AliA" 20% off) • Cheapest games - https://www.g2a.com/r/AliA • The headset I use - http://bit.ly/1dXHELh • How I record ALL my gameplay: http://e.lga.to/a Subscribe for more videos! - MoreAli-A --- Video uploaded by MoreAliA ( More Ali-A )


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Re: how to go to Pumakale?
I've answered a couple of your other queries but find it hard to know what you really want to do and give good advice. If you only have a day and a half in Kusadasi you need to work out what your priorities are. Do you want to see Ephesus? Pammukkale or both?
The Pammukkale trip is really a full day. By the time you get there, walk through Heirapolis to the travertines and back (cars cannot get very close now), perhaps swim in the Cleopatra pool and get back the day will be quite full. Tours usually leave at 8.30 back about 6ish but you will be returning in the dark at that time of year and that will have used up one of your days in Kusadasi. There is still all of Ephesus to see in a half day which is really a bit short.
I haven't found anything about how long you are spending in Turkey or what you have planned for other places. This is probably a bit of a left field suggestion but maybe if you have surplus days in Istanbul, fly to Denzili on a day trip and see Pammukkale that way. It may turn out to be a very cost and time effective way. You get a taxi from the airport to the travertines and back.
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