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Definition Edit
The tunneled password protocol is
|[a] protocol where a password is sent through a protected channel. For example, the TLS protocol is often used with a verifier's public key certificate to (1) authenticate the verifier to the claimant, (2) establish an encrypted session between the verifier and claimant, and (3) transmit the claimant's password to the verifier. The encrypted TLS session protects the claimant's password from eavesdroppers.[1]


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Supplemental oxygen does not prevent postoperative nausea and vomiting after gynecological laparoscopy
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Postoperative nausea and vomiting are among the most common and distressing side effects of general anesthesia. Supplemental intraoperative 80% oxygen reduces postoperative nausea and vomiting following open and laparoscopic abdominal surgery. However, this benefit has not been observed in other patient populations. We undertook this study to evaluate the effect of 80% supplemental intraoperative oxygen on the incidence of postoperative nausea and vomiting following ambulatory surgery for laparoscopic tubal ligation.
Following Research Ethics Board approval, 304 subjects were enrolled into one of two arms of a randomized prospective controlled study. The intervention group (n = 147) breathed 80% oxygen and the control group (n = 145) breathed routine 30% oxygen (balance medical air) while both groups were receiving a standardized general anesthetic. Nausea was assessed as: none, mild, moderate, or severe; vomiting was any emetic episode or retching. Any assessment either greater than none (nausea) or greater than zero (vomiting) was considered positive.
The incidence of postoperative nausea and vomiting up to 24 hr following surgery was 69% in the 80% oxygen intervention group and 65% in the 30% oxygen control group (P = 0.62). There were no differences in nausea alone, vomiting, or antiemetic use in the postoperative anesthetic care unit or at any time (pre- or post-discharge) up to 24 hr after surgery.
This trial of 304 women did not demonstrate that administering intraoperative supplemental 80% oxygen during ambulatory surgery for laparoscopic tubal ligation prevented postoperative nausea or vomiting during the initial postoperative 24 hr compared with women who received routine 30% oxygen.
L'oxygène supplémentaire ne prévient pas les nausées et vomissements postopératoires après une laparoscopie gynécologique
Les nausées et vomissements postopératoires sont parmi les effets secondaires les plus courants et pénibles de l'anesthésie générale. L'oxygène peropératoire supplémentaire à 80 % réduit les nausées et vomissements postopératoires après les chirurgies abdominales ouvertes et par laparoscopie. Toutefois, ce bienfait n'a pas été observé dans d'autres populations de patients. Nous avons entrepris cette étude afin d'évaluer l'effet d'oxygène peropératoire supplémentaire à 80 % sur l'incidence des nausées et vomissements postopératoires après une chirurgie ambulatoire de ligature tubaire par laparoscopie.
Après avoir reçu l'approbation du Comité d'éthique de la recherche, 304 patientes ont été enrôlées dans deux groupes d'une étude prospective randomisée et contrôlée. Le groupe intervention (n = 147) a respiré de l'oxygène à 80 % et le groupe témoin (n = 145) a respiré de l'oxygène normal à 30 % (air médical équilibré), et les deux groupes ont reçu un anesthésique général standardisé. Les nausées ont été évaluées selon l'échelle suivante : aucune, légères, modérées, ou graves; tout épisode émétique ou haut-le-cœur a été considéré comme un vomissement. Toute évaluation rendant des résultats plus élevés que 'aucune' (nausées) ou 'zéro' (vomissements) a été considérée positive.
L'incidence des nausées et vomissements postopératoires jusqu'à 24 heures après la chirurgie était de 69 % dans le groupe intervention (oxygène 80 %) et de 65 % dans le groupe témoin (oxygène 30 %) (P = 0,62). Il n'y a pas eu de différence dans les nausées seules, les vomissements ou le recours à des antiémétiques dans l'unité de soins anesthésiques postopératoires ou en tout temps (avant et après le congé de l'hôpital) durant les premières 24 heures après la chirurgie.
Cette étude portant sur 304 femmes n'a pas démontré que l'administration peropératoire d'oxygène supplémentaire à 80 % pendant une chirurgie ambulatoire de ligature tubaire par laparoscopie a prévenu les nausées et vomissements postopératoires pendant les 24 premières heures par rapport à des patientes recevant de l'oxygène à 30 % utilisé normalement.
Nausea and vomiting are among the most common and distressing adverse effects of anesthesia. Surgical patients report that they are more fearful of postoperative nausea and vomiting (PONV) than of postoperative pain.1 Although some anesthesiologists administer pharmacologic prophylactic antiemetics at the time of surgery, there has been limited success with the available therapeutic agents, and PONV remains a significant problem.2 Administration of intraoperative supplemental oxygen has been proposed as a non-pharmacological inexpensive and safe way of addressing PONV.3,4
In 1999, Greif et al. reported that supplemental oxygen reduces the incidence of PONV in patients undergoing open colon resection.3 These investigators later showed that administering supplemental intraoperative 80% oxygen for more than 1 hr in subjects undergoing gynecological laparoscopy reduced PONV by 50% compared with subjects breathing 30% oxygen.4 They hypothesized that the biologic mechanism of supplemental intraoperative oxygen was due to prevention of intestinal ischemia from surgical stress and bowel manipulation during intra-abdominal procedures.
Although these reports were intriguing, more recent studies have shown that administering supplemental intraoperative oxygen does not benefit patients by reducing PONV during abdominal and non-abdominal types of surgery.5, 6, 7, 8, 9, 10, 11 The relevance of these findings with respect to gynecological laparoscopic procedures is unclear, since only one of these subsequent studies involved subjects undergoing gynecological laparoscopic procedures6 where the beneficial effects of supplemental oxygen had been previously observed.4
To help elucidate the potential benefit of supplemental intraoperative oxygen in this high-risk population, we hypothesized that administering intraoperative supplemental 80% oxygen, compared with administering 30% oxygen, would reduce the incidence of postoperative nausea and/or reduce vomiting by 50% among women for up to 24 hr following ambulatory laparoscopic gynecological surgery of short (less than 1 hr) duration.
Following IWK Health Centre Research Ethics approval and individual written informed consent, 304 subjects were enrolled in this prospective randomized double-blind study. Eligible patients included women undergoing ambulatory laparoscopic tubal ligation who were American Society of Anesthesiologists (ASA) status I or II. Exclusion criteria included the following: request for preoperative benzodiazepines, diabetes, gastroparesis, obesity (Body Mass Index [BMI] > 37), current breastfeeding, nausea/vomiting or antiemetic therapy, current opioid/cannabis use, or known substance abuse within six months of enrolment. Patients were also excluded if they had a previous history of PONV lasting >24 hr where prophylactic antiemetic therapy was indicated or where postoperative admission was required.
Study protocol and blinding
Following endotracheal intubation, patients were allocated to receive routine 30% oxygen or supplemental 80% oxygen along with balanced fresh gas flow, i.e., compressed medical air, Oxygen (O2) 18–23% in Nitrogen (N2) (N2/O2) not nitrous oxide (N2O). Opaque sealed envelopes contained the computer-generated random assignments, and the seal was broken following induction of anesthesia. The attending anesthesiologist was not blinded to group assignment for safety and ethical reasons. Patients, investigators, study personnel making outcome assessments, surgeons, and postanesthesia care unit (PACU) nurses were blinded to group allocation. Cardboard shields positioned over the fresh gas oxygen/air flow meters ensured blinding of the intraoperative surgical and nursing teams.
Patients did not receive preoperative sedation. General anesthesia was administered according to a standardized protocol. Following preoxygenation with 100% oxygen for 2 min, anesthesia was induced with midazolam 0.02 mg · kg−1iv, propofol 2.0–3.5 mg · kg−1iv, succinylcholine 1.5 mg · kg−1 and/or rocuronium 0.5 mg · kg−1iv, and fentanyl citrate 1–3 μg · kg−1iv. Following endotracheal intubation, anesthesia was maintained with desflurane 4–8% end-tidal concentration. Unless contraindicated, a non-steroidal anti-inflammatory drug (NSAID), ketorolac 30 mg, and reversal, neostigmine 50 μg · kg−1 and glycopyrrolate 0.10 μg · kg−1, were given intravenously on case completion. Two minutes before extubation of the trachea, oxygen concentration was increased to 100% for patient safety.
During post-anesthetic recovery, all patients breathed supplemental oxygen 2 L · min−1 via nasal prongs for 30 min. Additional supplemental oxygen was administered if necessary to maintain SpO2 > 92%. Analgesia consisted of intravenous morphine 2–4 mg in PACU or oral acetaminophen with codeine 325 mg/30 mg in the post-recovery unit to provide subjects with satisfactory analgesia. Intravenous ondansetron 4–8 mg was administered as rescue medication for patients who vomited or experienced nausea for more than 15 min. Patients with persistent nausea or vomiting received intravenous diphenhydrinate and/or dexamethasone as second-line therapy.
Outcome assessments
Blinded observers assessed nausea and vomiting episodes at 30-min intervals from patient admission to the PACU until hospital discharge. Each subject rated her nausea on a four-point scale as: none, mild, moderate, or severe.3,4 Once discharged home, subjects recorded nausea severity and vomiting episodes in diaries for 24 hr postoperatively. Study nurses recorded these data by telephone interview at the completion of 24 hr. Morphometric and demographic characteristics of subjects in both treatment groups were recorded. Additional subject factors with potential to influence the primary outcome, such as previous PONV, smoking history, coexisting systemic diseases, concurrent medications, and alcohol use (more than one drink per day) were also documented. Anesthesia duration, total intravenous fluid, and all intraoperative and postoperative drugs (up to 24 hr postoperatively) were recorded.
Statistical analysis
The primary outcome, defined prospectively, was the incidence of nausea and/or vomiting over the initial 24 postoperative hours. Any score of nausea or vomiting greater than "none" was regarded as "positive". Secondary outcomes included in-hospital and post-discharge nausea and vomiting scores (evaluated separately), the incidence and total dose of postoperative antiemetics administered, time to oral intake, and time to discharge home. Univariate analyses were performed on dichotomous variables using the Chi square statistic, whereas the maximum severity scores for nausea and for vomiting were analyzed using the Mann–Whitney U test. Potential confounding factors were compared between the two study groups with unpaired two-tailed t tests or Chi square analyses. Group allocation and potential confounding variables having a univariate P value <0.15 were entered into a generalized mixed-effects regression model for stepwise regression. Factors contributing with a P value <0.05 were retained in the model. Results are presented as means ± standard deviation (SD), medians (interquartile ranges IQR), percentages, and odds ratios (95% confidence intervals). P values <0.05 were considered statistically significant.
The required sample size was determined prospectively. The baseline incidence of PONV for this calculation was obtained from a previous unpublished study in 88 patients undergoing ambulatory laparoscopy at the IWK Health Centre. The study demonstrated a 30% incidence of PONV, as indicated by antiemetic usage, and a 60% subjective nausea rate, and these findings agreed with previously published rates.4 Therefore 138 patients in each group provided 85% power to detect a 50% reduction in any PONV (antiemetic use 30–15% [n = 138 per group] or subjective report 60–30% [n = 42 per group]) by the active treatment group with a two-sided α error of 0.05. To allow for 10% anticipated dropouts, the total study included 152 women in each group.
One subject had incomplete post-discharge data collection at 24 hr. These data were retained, however, as the primary outcome event was counted only once, irrespective of when and how frequently it occurred in the initial 24 hr. Also, this subject was positive for the primary outcome event prior to discharge; therefore, further data recording (i.e., complete 24-hr data) would not have impacted this result.
Subject demographics by group randomization
Routine oxygen (n = 145)
Supplemental oxygen (n = 147)
Age (years)
35.4 (6.6)
36.8 (5.6)
Weight (kg)
70.1 (15.5)
72.7 (15.3)
Body mass index
25.5 (22.5–30.4)
26.4 (23.3–31.4)
Prior general anesthesia (%)
Prior mild PONV (%)
Prior motion sickness (%)
Smoking (%)
Ethanol consumption (%)
Oral contraception use (%)
Comparison of intraoperative and postoperative variables and outcome assessments by group randomization
Routine oxygen (n = 145)
Supplemental oxygen (n = 147)
Surgery duration (min)
21.0 (7.75)
22.3 (9.93)
Anesthesia duration (min)
42.6 (8.91)
45.3 (11.38)
Intraoperative fentanyl (μg)
148.0 (50.15)
157.5 (48.21)
NSAIDs used (%)
Neostigmine used (%)
Desflurane per case (mL)
26.6 (15.69)
27.7 (16.23)
Crystalloid fluids (mL)
891.6 (229.80)
850.8 (239.78)
Comparison of postoperative anesthesia care unit variables by group randomization
Routine oxygen (n = 145)
Supplemental oxygen (n = 147)
Time in PACU (min)
83.0 (28.5)
81.6 (25.3)
Aldrete score
9 (8–10)
9 (8–10)
Aldrete score ≥7
Time in post-PACU (min)
25.3 (17.5)
26.4 (19.6)
Systolic BP (mmHg)
131.5 (14.8)
132.9 (16.6)
Diastolic BP (mmHg)
81 (11.9)
80 (13.3)
HR (beat · min−1)
87 (16.7)
86 (16.8)
SpO2 on arrival
98 (96–99)
97 (95–99)
RR on arrival
16 (12–20)
16 (12–20)
PACU iv fluids (mL)
412.9 (213.5)
416.1 (263.6)
Total iv fluids (mL)
1316.8 (366.4)
1270.8 (375.3)
PACU analgesia use
10.0 (5.8)
10.5 (6.4)
Acetaminophen (% use)
PACU rescue
Antiemetics (% use)
Comparison of post-discharge analgesia and antiemetic consumption by group randomization
Routine oxygen (n = 145)
Supplemental oxygen (n = 147)
Opioid usage (%)
Total morphine dose (ME)
2.7 (4.3)
3.0 (4.3)
Used non-opioid Rx (%)
Combined opioid and non-opioid Rx usage (%)
Any antiemetic usage (%)
Comparison of all postoperative nausea and vomiting outcomes by group randomization
Routine oxygen (n = 145)
Supplemental oxygen (n = 147)
Early 0–6 hr
Nausea (%)
52.8 (76/144)
49.0 (72/147)
Vomiting (%)
31.3 (45/144)
35.4 (52/147)
Any combined (%)
56.9 (82/144)
53.7 (79/147)
Late ≥ 6–24 hr
Nausea (%)
31.9 (46/144)
34.7 (51/147)
Vomiting (%)
24.3 (35/144)
20.4 (30/147)
Any combined (%)
37.5 (54/144)
37.4 (55/147)
Nausea (% > none)
39.3 (57/145)
33.3 (49/147)
Vomiting (% > 0)
13.1 (19/145)
10.2 (15/147)
Nausea (% > none)
57.6 (83/144)
57.1 (84/147)
Vomiting (% > 0)
2.8 (4/144)
1.4 (2/147)
Primary outcome
% Any nausea and/or vomiting in first 24 hr
65.3 (94)
68.7 (101)
Regression analysis among patients who experienced the primary outcome any PONV in the initial postoperative 24 hr
Previous PONV
Surgery time
In hospital morphine equivalents
Total 24-hr morphine equivalents at home
Nausea is defined as "a subjectively unpleasant sensation associated with awareness of the urge to vomit".12 Vomiting is brought about by contraction of abdominal muscles, descent of the diaphragm, and opening of the gastric cardia to produce expulsion of gastric contents from the mouth.12 These events are controlled by the "emetic centre" located in the lateral reticular formation close to the tractus solitarius in the brain stem.13,14 The vomiting centre receives afferent stimuli from the pharynx, gastrointestinal tract, mediastinum, higher cortical centres (visual centre and the vestibular portion of the eighth cranial nerve), and the chemoreceptor trigger zone in the area postrema.13, 14, 15, 16, 17, 18, 19, 20 The mechanism of postoperative nausea and vomiting includes vestibulo-cochlear stimulation, triggering of the central chemoreceptor trigger zone, and local gastrointestinal mechanisms.
Both Greif et al.3 and Goll et al.4 hypothesized that supplemental intraoperative oxygen may attenuate bowel ischemia from surgical stress and bowel manipulation during intra-abdominal procedures. Both are thought to release intravascular serotonin that may promote PONV by its action on the chemoreceptor trigger zone. Serotonin receptors are found in high concentrations in the area postrema of the brain stem.21, 22, 23 Unfortunately, the plasma half-life of serotonin is only a few minutes. As a result, the hypothesis proposed by Goll et al.4 that intestinal ischemia releases intravascular serotonin to induce PONV has never been investigated directly with plasma serotonin measurements. Without such studies, one can neither confirm nor refute their proposal.
Previous studies evaluating supplemental intraoperative oxygen for the prevention of PONV have demonstrated conflicting results. In the first prospective randomized controlled trial investigating the antiemetic properties of supplemental intraoperative oxygen, Greif et al. allocated subjects to 80% intraoperative oxygen or 30% intraoperative oxygen and for 2 hr after surgery.3 They found that the incidence of PONV was reduced from 30% in subjects allocated to 30% oxygen to 17% in the group administered 80% oxygen.
The same group of authors subsequently showed that PONV was reduced from 44% (30% oxygen group) to 22% (80% oxygen group) when supplemental oxygen was limited to the intraoperative period in patients undergoing gynecological laparoscopic surgery.4 Later studies in subjects undergoing breast surgery, ambulatory gynecologic laparoscopy, thyroidectomy, laparoscopic cholecystectomy strabismus, or dental surgery failed to demonstrate any benefit from supplemental intraoperative oxygen on PONV.5, 6, 7, 8, 9, 10, 11 A recent meta-analysis of 1729 patients from ten studies has been published (since the conduct of this trial but prior to this current study publication) synthesizing the data from the aforementioned studies. Regardless of the type of surgery, the meta-analysis did not demonstrate any overall effect from supplemental intraoperative oxygen on PONV.24 Concerns regarding unbalanced patient characteristics and co-interventions have limited the validity of earlier randomized controlled trials that showed a benefit of supplemental oxygen on the reduction of PONV. These later studies may be limited by sub-therapeutic levels of supplemental oxygen.5
Our study adds further to this evidence and clearly demonstrates that supplemental intraoperative 80% oxygen, compared with routine intraoperative 30% oxygen, does not reduce the incidence of PONV during the initial 24-hr period among women undergoing laparoscopic gynecological surgery. No benefit was observed in any "subgroup" time periods, including immediately following surgery in the PACU (pre-discharge), time after discharge from hospital (post-discharge), early PONV (0–6 hr), or late PONV (>6–24 hr). Furthermore, supplemental oxygen did not improve PONV in women who had isolated nausea or vomiting.
Our study supports observations made by Purhonen et al. who investigated a similar group of subjects having ambulatory gynecological laparoscopy.6 With a smaller sample size (n = 100) and an intervention of 80% oxygen supplementation, which was continued postoperatively for 1 hr, they observed an overall incidence of nausea and vomiting of 62% in the 30% oxygen group and 55% in the supplemental 80% oxygen group during the first postoperative 24 hr (P = 0.49). Regardless of the mechanism of PONV, our study and that of Purhonen et al.6 provide compelling evidence to refute the results of Goll et al. who first suggested that supplemental intraoperative oxygen prevents PONV in women undergoing gynecological laparoscopic surgery.4
Identification and development of decision trees or scores to predict risk of PONV have been elucidated by Apfel et al.25 Risk factors identified to predict PONV include female gender, prior history of PONV, or prior history of motion sickness, non-smoking, and postoperative opioid use. Our regression analysis amongst those subjects who experienced the primary outcome revealed that younger age, prior history of PONV, longer length of surgery, and higher opioid administration in hospital were predictive of PONV and supports these previous works. Other factors that may be considered predictive, including history of ethanol consumption, BMI, and contraceptive use, did not predict risk of PONV in our current study. Interestingly, lower postoperative opioid consumption predicted risk of PONV and may signify that patients recognize that opioid pain medications may worsen nausea or that patients are not tolerating oral intake.
In conclusion, our randomized controlled trial did not demonstrate any clinical benefit of high inspired oxygen concentration (80%) on the incidence of PONV following short ambulatory gynecological laparoscopic surgery. Identification of individuals at high risk of PONV, such as younger women or those with a previous history of PONV, and finding strategies to reduce postoperative opioid dose become important when considering management of intraoperative and postoperative nausea and vomiting.
Supported in part by Dalhousie University Clinical Academic Enrichment Funding, IWK Health Centre Research Category B Funding, and IWK Health Centre Summer Research Studentship Funding. Dr. D.M. McKeen and coauthors would like to thank Faye Jacobson RN Research Coordinator, the IWK Department of Gynecology, and the PACU/OR nursing staffs for their help in the conduct of this trial.
Financial disclosure
The authors do not report any potential conflicts of interest.

subset: commoncrawl


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Rawtenstall Tel: 01706 253530
NelsonTel: 01282 731415
PadihamTel: 01282 644600
Seasonal Flu Clinics are now bookable for the following dates:
Rawtenstall 24 Sept 08:30 - 13:00
Padiham 01 October 09:00 - 12:00
Nelson 08 October 08:30 - 13:00
Heatwaves can be dangerous, especially for the very young, the elderly or those with a chronic disease. Prolonged exposure to very high temperatures can mean the body is unable to reduce its own temperature, causing dehydration and heatstroke, which can be fatal. In particular, hot temperatures overnight make it difficult for the body to cool.
The Heat Health Watch Service operates in England from 1 June to 15 September each year, in association with Public Health England.
The Met Office forecasts day-time and night-time maximum temperatures, which are monitored regionally. When certain heat thresholds are passed, a warning is issued and sent to relevant NHS, social care, local and national government professionals, well as being displayed on our website. This enables organisations, frontline staff and individuals to take action to minimise the impact of the heat on peoples' health.
The practice is currently offering a new audiology service from the Padiham and Nelson sites - ask at reception for further information. Over 55 year old can ask to be referred into the service for Free NHS hearing aids.
we have added a link under clinics and services for patient who require patient transport services to get them to the hospital for an appointment - Patient Transport Services
Follow link on right side of home page and down load your personalised child immunisations due date planner to help and assist in planning when they are due and to make an appointment for your child continuing immunisation schedule.
Over the last 18 months East Lancashire CCG has been working alongside patients, carers and wider stakeholders like doctors and pharmacists to develop a vision for how they would like GP services to develop in future. Our vision is for GPs and partner organisations to work together more closely; to provide quality joined up care; with equal access to services wherever you live in East Lancashire. Together we came up with a simplified system to provide appointments in the practice, on the phone, online and in patients' homes as required. Further information in document below.
Surgery times are site specific and appointment times vary across all 3 sites. The practice is able to offer pre bookable appointments up to 6 weeks in advance and also some same day appointments for urgent requirements.
If an appointment is not available at a preferred site you may be offered one at our other sites at an alternative time.
Please note that the last appointment in the afternoon is 1 hour before we close, i.e. close 19:30 last appointment is at 18:20.
The GP Out-of-Hours Service is for anyone who requires medical advice and treatment when the practice is closed (evenings, weekends and bank holidays). The service provides urgent and immediately necessary advice and treatment from a GP or nurse practitioner to people who are unable to wait until the next day to see a GP. It is not an alternative to seeing your own GP during surgery hours.
The service is accessed via a dedicated telephone number: 111
The service operates from 2 main locations:
Patients are reminded that if they urgently need medical help or advice but it is not a life threatening situation they can access a 24 hours Nurse Advice and Health Information Service by telephoning NHS 111.
Out-of-hours services are generally busy so please think carefully before asking to see a doctor and only do so if you genuinely cannot wait until the surgery re-opens.
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Frankfurt: Lucio set a record for most minutes without committing a foul at the World Cup in Brazil's quarterfinal match against France. Lucio was not called for a foul in Brazil's first four matches and had not allowed a free kick after 25 minutes against France in Frankfurt. He entered the match needing 23 minutes to surpass the mark set by Paraguay defender Carlos Gamarra, who in 1998 spent 383 minutes without allowing a free kick. No foul play Aside from goalkeepers, Lucio was the only player yet to commit a foul after playing at least 360 minutes - or four matches - in this year's tournament. Gamarra played four matches and an additional 23 minutes of extra time without committing a foul in 1998. He also didn't get called in four games in 2002. Lucio and the rest of Brazil's defenders allowed only one goal in four matches in Germany - against Japan in the first round. Only Switzerland, which was eliminated by Ukraine on penalty kicks in the second round, did not concede any goals at this World Cup. (AP)
Topics : Football Brazil Ghana Italy
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The front row for the Formula One Grand Prix of Bahrain consists of two Germans but it was not the world champion who took the pole. Instead it was Keke's son!
Mercedes driver, Nico Rosberg will be the leading man after securing pole position ahead of the FIA Formula One 2013 Bahrain Grand Prix tomorrow.
"For the first time this season everything went perfectly today and that's a great feeling," smiled Rosberg. "Pole position feels like a kick start for me and it's a great achievement from everyone in the team."
The German impressed with his performance throughout the qualifying session and was rewarded with the ultimate prize in becoming the pole sitter for the race.
Rosberg admitted, "We still had some work to do after the practice sessions yesterday and the team had a busy night to turn it around. Thanks to them for the quickest car out there today. The race tomorrow is a different story and we're very aware of that. It will be difficult, especially with the rear tyres, and we know that other teams were stronger than us on the long runs on Friday."
Rosberg has notched up the statistics for the team as they have now achieved their 200th front row start in the sport for the Mercedes powered car.
Rosberg's fellow countryman, Sebastian Vettel failed to match his pace in the final seconds of Q3, but will still line up on the front row of the grid in a respectable second place for Red Bull.
Vettel said, "I'm not disappointed with that. Well done to Nico, it was a strong lap and it was all his today. When I crossed the line I saw I was second on the screen and didn't know how much I was missing to pole as the lap was fine."
The three time champion added, "We managed to save some tyres throughout qualifying and it will be about tyre degradation tomorrow, so we'll see what happens. It's good to start from the front."
Ferrari's Fernando Alonso completes the trio of drivers in the most desirable grid slots following the highly competitive top 10 qualifying shootout. "It's really good news that once again we managed to do well in qualifying, which is our Achilles Heel!" said the Spaniard.
Rosberg's team mate, Lewis Hamilton already had his fair share of problems before qualifying began. The 2008 World Champion had severe left rear tyre wear towards the end of final practice and the team then chose to change the gearbox which resulted in a five place grid penalty. Hamilton initially qualified in fourth place but after taking the penalty in account it now means that he will start in ninth place.
"It wasn't the best of days for me but big congratulations to Nico. Back to back pole positions for the team is great and Nico did a really good job out there. I couldn't quite find the pace today and with losing five places from changing the gearbox, we've got a tough challenge ahead starting from ninth place," said Hamilton.
Vettel's team mate, Mark Webber is another of the usual front runners that faces a penalty but his was as a result of causing a collision with Toro Rosso driver Jean-Eric Vergne during last weekend's Chinese Grand Prix. Webber crossed the line at the end of Q3 in fifth place but will start from seventh place on the grid.
"I would have like to have got a bit more out of the car in that session and been a bit further up, but seventh with a penalty isn't the end of the world," said Webber. Alonso's team mate, Felipe Massa appeared slightly off the pace of his closest rivals in qualifying after finishing in sixth place, but due to Webber and Hamilton serving their penalties the Brazilian driver will be promoted to fourth place.
In addition to the surprise pole sitter at the front of the field in the form of Rosberg, there was also a shake up through the rest of the top 10 with the appearance of both Force India drivers. Paul Di Resta was the first of the two as he qualified in seventh position. Due to the two penalties facing Webber and Hamilton, Di Resta will begin the Grand Prix from fifth place. The Scotsman will still be ahead of his team mate, Adrian Sutil though. The German ended Q3 in eighth place but will move up to sixth place for the race tomorrow and will accompany Di Resta on the third row of the grid.
Lotus Renault's Kimi Raikkonen will be in between the two top 10 drivers in their penalty positions, as the former World Champion qualified in ninth place but will be in a Webber and Hamilton sandwich as he begins his race from eighth position.
Raikkonen commented: "It wasn't the easiest qualifying session after a weekend which hasn't been the easiest so far either. Yesterday it was difficult at times to find the balance with the car and I found that again today. This morning it felt good and we didn't do too bad in free practice, but we didn't quite get it right this afternoon. My lap wasn't great, but it's a long race so we'll just have to see what we can do tomorrow."
McLaren's Jenson Button was one of the few drivers who qualified in the top 10 not affected by the two penalties which have caused a shakeup in the grid. The Englishman will line up in the 10th and final point scoring position as the Grand Prix gets the green light tomorrow.
Today's qualifying session may have only been just to decide the starting line-up for the grid, but it certainly did not disappoint in terms of competitiveness that was delivered in the closing stages of Q3. If the action seen at this point in the race weekend is anything to go by, it is likely that the main event will have even higher levels of expectation tomorrow.
Not only are some drivers out of their usual places, but there are also the midfield runners in the mix who could cause a few problems for those like Webber, Hamilton, Button and Raikkonen who will be aiming for the front of the field.
Rosberg is one man though who is already there on his own merit and he will not be likely to give up his first place without a fight. Rosberg does have Vettel to contend with first of all though and he is one driver in particular that is used to leading from the front and will undoubtedly be keen to get back on top.


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Offering a variety of sports facilities and entertainment, the Sol Polynesia apartments is located near the beach (50-400 metres) and is a pleasant villa complex in the resort of Katoro. Entertainment is arranged during the day and in the evening, and a special club for children runs during the summer school holidays for ages 5 to 17 years.
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Virginia Uranium Mining Development Potential
By Dave Brown - Exclusive to Uranium Investing News
Virginia mining and environmental officials were questioned by a committee from the National Academy of Sciences regarding the state's ability to regulate uranium mining if a 1982 state ban is lifted. As early as September of 2009, the state of Virginia was targeted by the current administration as having great potential for producing clean power from wind and nuclear sources.
Opponents have concerns that the statements of the department heads indicate that the state does not have sufficient resources to properly oversee mining of the largest uranium deposit in the United States. Environmentalists and some local residents have opposed tapping the Pittsylvania County deposit because they are fearful the mining and milling will foul the air, rivers, streams and reservoirs with radioactive tailings scattered by torrential rains or hurricanes. Uranium mining in the U.S. has taken place in the more arid western regions like Wyoming, and this would be the first on the East Coast.
The meeting was the second all-day session held in Virginia by the panel of scientists, mining experts and environmental officials. Members are expected to complete their findings in December on the consequences of Virginia ending its ban on uranium mining.
For his part the state Governor issued a press release yesterday, "We must generate more of our electricity from our domestic resources. That means utilizing a diverse portfolio of fuels, including nuclear, coal, oil and natural gas, as well as biomass, offshore and onshore wind, and solar. At the same time we must also maintain reasonable energy costs and a reliable, consistent supply. This Administration is focused on balancing these two important considerations."
The timing of terminating the ban comes amid a global nuclear power renaissance and a 119-million-pound deposit near the North Carolina border that Virginia Uranium Inc. wants to mine. Virginia Uranium Inc.values the Virginia ore deposit to potentially be worth $8 billion to $10 billion, and maintains the mining can be done safely, and provide hundreds of jobs in an economically depressed area of the state.
Virginia Energy Resources Inc. (CVE:VAE), is a strategic partner in the asset and is also exploring uranium projects in Saskatchewan, Quebec and Labrador with some exposure to coal properties in Western Canada. Some of the company's most important and active exploration projects are its uranium properties in the Otish Basin of Quebec, and its Murphy Lake and Hatchet Lake uranium properties in the Athabasca basin, which are held in a 50-50 joint venture with Denison Mines (TSE:DML).
The directors of the Virginia Department of Mines, Minerals and Energy and the Department of Conservation and Recreation also spoke before the committee. The committee also accepted a study from Virginia Beach that concluded the water supply of the state's largest city could be threatened if a historic storm lashed the area where the mining would occur.
The National Academy study is one of at least several looking at uranium mining. A legislative committee has approved $200,000 for a socio-economic study, and local studies are also planned or under way.
Spot market price continues to strengthen
The spot market price for uranium continues to grow higher, and is currently in the range of $73.00 per pound, up $0.75 from the end of last month. Delivery timing continues to be a significant factor in the spot uranium market, as near-term supply remains extremely thin. According to uranium market consultants Trade Tech, some active participants temporarily withdrew from the market to analyze the sharp increase in uranium prices reported in recent weeks relative to their own positions. However, by the end of the week buyers and sellers were returning to the market. Five transactions were concluded over the course of the week with the marginal difference between active buyers and willing sellers narrowing, as both sides exhibit increasing tolerance to close the gap between offers and bids in order to successfully conclude transactions.
Virginia Uranium Mining Development Potential originally posted on uraniuminvestingnews.com


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And yet, the minute came when she cast aside all solicitudes and hesitations.
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Having made vain all my friends' cautions and solicitudes, I must not hope for miracles in my favour!
Among all these solicitudes, it was a great thing that one particular anxiety vanished in a day.
early 15c., from Middle French solicitude (Modern French sollicitude), and directly from Latin sollicitudinem (nominative solicitudo) "anxiety, uneasiness of mind," noun of state from past participle stem of solicitare (see solicit).


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The newest 2,000-yard rusher is probably the only athlete who represents running better than anyone else and that too without a shoe deal!
Impossible? Not really! Today when our famous players totally endorse various huge sport brands from top to toe, Adrian Peterson was capable of providing us one of the best highlights of the NFL season without a shoe contract.
Vikings running back Adrian Peterson on Sunday led the way with 199 yards rushing on 34 carries, becoming the seventh man to surpass 2,000 yards rushing in a season as he finished just nine yards behind the record of 2,105 logged by EricDickerson of the Los Angeles Rams in 1984.
Pretty unbelievable that Adrian Peterson goes all season without a shoe deal.— darren rovell (@darrenrovell) December 31, 2012
An adidas source tells me that they have no contract with Adrian Peterson. Was wearing company's shoes without a deal.— darren rovell (@darrenrovell) December 31, 2012
But ESPN's Darren Rovell tweeted on Sunday night that Peterson, who heroically chased Dickerson's all-time rushing record did it without a shoe contract.
Last time Adrian Peterson had a logo (Nike) on his cleats in a game? December 24, 2011, when he hurt himself vs Redskins.— darren rovell (@darrenrovell) December 31, 2012
He also tweeted that the last time Peterson ran with a brand was a year ago, in his final game of 2011.
Interesting that Peterson switched to ADIDAS because if you zoom in on his feet on some game photos, you can see a blacked out swoosh.— darren rovell (@darrenrovell) December 31, 2012
An adidas source tells me that they have no contract with Adrian Peterson. Was wearing company's shoes without a deal.— darren rovell (@darrenrovell) December 31, 2012
Rovell also actually revealed on Twitter that Peterson wore Adidas shoes all through this season but kept the logo hidden under a tape.
Paul Swangard, managing director of the Warsaw Sports Marketing Center explained the reason behind Adrian's act by saying "The shoe market is weak. And experts back that up. Only a handful of players are getting meaty deals. NFL players don't tend to move the needle like in other sports. There are not as many deals as people think."
So, after a distressing injury last year, Peterson decided to go without a contract.
All we can say is that one thing is for sure; Peterson's achievement is now definitely bringing him towards lots of contracts and opportunities.
Hope we don't see him with his taped shoes anymore!


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An updated version of Beta tapes, DVDs or "Dorky Vacuum Dimples" were invented in 1969. DVDs are based primarily on "magnetic radio-active vacuum tube (with cheese!)" technology. When played on a standard Laser Disc player, they emit sound and video waves through the air which find the nearest TV and hijacks it permanently.
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© 1998 Optical Society of AmericaFull Article | PDF Article
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I am menopausal and intercourse is very painful. My vagina feels like it's on fire. I am 58. Would vaginal rejuvenation help?
Doctor Answers 12
The vaginal dryness and burning you are experiencing is probably due to low estrogen levels in your blood and your vagina. Oral estrogen, topical or estrogen patches will increase your risk for heart attack. There are VAGINAL slow release formulations (E string or Vagifem) that could be used because there is very little absorption into the body but enough to help decrease your vaginal irritation. ThermiVa would be another option to treat your problem. This consists of 3 treatments in the office where a small smooth probe is inserted in your vagina to heat the tissues and improve collagen content. Women have had an improvement with lubrication and sexual satisfaction after the procedure.
Learn more: http://www.estring.com/
Burning with intercourse
It does sound like atrophic vaginitis is the cause of your problem, very common in post-menopausal women. I would consider ThermiVa treatment for this (Radiofrequency Treatment) as has been shown by recent studies to actually improve the health of the vaginal walls and decrease vaginal atrophy symptoms. It is essentially a risk-free procedure and completed in an office setting. Typically takes 3 treatment sessions to have best results. This is also called non-surgical vaginal rejuvenation. Surgical rejuvenation is not necessary and would not help your symptoms.
Best of luck to you,
Dr Robert D Moore
Cosmetic Vaginal Surgeon/Urogynecologist
Atlanta-Beverly Hills-Dubai
Pain with intercourse
There are many potential causes and I would first recommend a second opinion. There are a variety of non-surgical and non-medical interventions. However, it is important to first evaluate and exclude other possible causes.
You might also like...
Atrophic vaginitis
Your problem is most likely due to something called atrophic vaginitis, a condition that occurs due to lack of hormones. You're not going to fix this unless you get to the cause of the problem, i.e. lack of estrogen. At your age, you are better off going on hormone therapy. I would recommend you see someone who prescribes bioidentical hormone therapy, and this is not associated with an increase in heart disease (it's actually less) and stroke (it's transdermal). The other options are expensive and not long term treatments for your condition, plus you don't get the other benefits of BHT. See link below. Good luck.
Learn more: http://www.truemd.com/health-wellness-procedures-dallas/hormone-pellet-therapy/
You're a perfect candidate for FemiLift or MonaLisa laser vaginal resurfacing
CO2 laser resurfacing of the vagina is an excellent option for treating your symptoms without hormones. It's typically done as a series of 3 sessions spaced 4-6 weeks apart followed by an annual booster session. Effects are seen quickly after the procedure. More info below:
Learn more: https://www.realself.com/article/laser-vaginal-tightening-star-born
Post Menopausal Vaginal Dryness
You are the perfect candidate for laser vaginal rejuvenation. The CO2 light will cause micro injury to the vaginal mucosa (lining) which will then stimulate the vaginal wall to get thicker, moister and more elastic again. My patients have all felt less itching, more moisture and less pain post treatments. I would definitely give this a try.
Leslie Kardos MD
Learn more: http://pacificgynsurgicalgroup.com
Everything you need to know about "rejuvenating" the dry, postmenopausal vagina for great sex
Hello "Debra,"
There are several excellent ways to "rejuvenate" your viable but aging vagina to enjoy sex ("...the most fun you can have without laughing") for years & years to come (no pun intended..!) Here they are:
1. Vaginal estrogenization (sometimes a combination estrogen & testosterone cream used as well on the opening.) After good estrogenization (usually takes ~ 3 months), progressively larger dilators may be used to slowly stretch the vagina if there's narrowing. Takes 3-6 months total. Cost total time est. $150 - $200+ doctor's fees. Estrogen available via FDA- approved or compounded gels, creams, oils, suppositories and
self-retaining long-acting (3 months) vaginal rings. UNEQUIVALENTLY, the fact that you have had a heart attack DOES NOT preclude estrogen therapy, especially vaginal therapy, and probably systemic therapy, but it must be low dose and transdermally or transvaginally.
2. DHEA suppositories 6-10 mg ~ every other night usually produces effects on vaginal skin similar to estrogen. DHEA ("Prasterone") is compounded by knowledgeable practitioners. Dilators still may be necessary (as above) for vaginal quite tight to begin with. Time frame as above. Cost est. same as above. Need a practitioner savvy in compounding.
3. The new oral medication ospemifene ("Osphena") 60 mg nightly has been shown to produce effects similar
to ##'s 1 & 2 above. Same deal if you need to stretch. Same time frame. Est cost (hugely dependant on whether your insurance will pay for this) ~ $150-$600.
4. The newest (and presently most "...stylish" ) method is either fractional CO2 laser
("Femilift" or "Mona Lisa Touch"-- SAME technology)- or radiofrequency- RF- (ThermiVa). Both are administered as 5-minute virtually painless laser or RF intravaginal treatments with 3 treatments over 3 months. RF is purported to last ~ 1 year (has to be repeated annually.) Laser has been purported to last twice as long; even longer (?2-3 years) especially if you have a "touch-up" at the 1-year anniversary of your last treatment. Results begin to be seen after 1month; average person has quite acceptable results after second month. Unknown whether dilation still necessary as above (not enough data.) Cost for series of treatments ~ $2000- $3500 for Thermi and ~ $2500- $3300 for Laser series (Our office charges $2800). Quicker, less personal responsibility, but more expensive. (...see weblink below for FemiLift info, and other areas of the site, especially blogs, for great menopausal info...)
I have been providing FemiLift fractional CO2 laser therapy for > 1 1/2 year, and am quite happy with the results, but then, in properly selected patients I am also quite satisfied with results ##'s 1, 2, & 3 above. The "gold standard" for "rejuvenating" an atrophic vagina remains intra-vaginal estrogen. Yes, these new technologies are fancy and the rage (the machines cost the doc ~ $60-80,000 so they are vigorously promoted by the docs who bought them!), and it appears that they (evidence-based) are excellent therapies, but the other stuff also works for 90% of women...
**Of course, all of these things "rejuvenate (in the truest sense) the vagina. For the dryness on the outside, instead of water-based lubricants, why don't you try either a light vegetable oil or a silicone based lubricant such as "Wet Platinum" or "Pink Silicone. Neither of these will dry out or become "tacky," and are so fun to "play" with, mutually applying them to your mutual sexual organs . Have fun!!
MOST IMPORTANT is to see a practitioner (preferably a North American Menopause Society "Certified Menopause Practitioner") who is savvy in all things menopausal and can knowledgeably give you a CHOICE. You have several choices in Chicago and of course I could always see you in Davis..!
Best wishes,
Michael P Goodman MD
Davis, CA, USA
Learn more: http://www.drmichaelgoodman.com/femilift/
Vaginal Rejuvenation for Vaginal Atrophy
Hello debra11658,
Thank you so much for your question. Although we appreciate your photo to adequately address your concern a thorough examination by a well trained gynecologic/urogynecologic surgeon would be recommended to fully assess your options regarding your concerns. Based on your history and complaints it sounds as though you are experiencing classic "vaginal atrophy" which affects many menopausal women worldwide. Estrogen therapy is extremely effective at helping to reverse these changes to allow more comfortable sexual encounters, increased vaginal moisture, relief from burning and itching etc. However there are those who either cannot use hormone therapy as well as those who choose not for a variety of reasons. It is this group of women that the non-invasive treatments for vaginal atrophy (ThermiVi, Mona-Lisa Touch, FemTouch) were intended to help. They have been shown to be very effective at helping "restore" the vaginal cellular structure to a more pre-menopausal state when estrogen was more abundant in your body. The expected end effect would be more pliable vaginal tissue that is thicker with more moisture all of which can minimize discomfort during sex. Best wishes.
Vaginal "health"
You are the perfect candidate for MonaLisaTouch vaginal laser "rejuvenation" since you are menopausal, have not had a vaginal delivery, and have limitations on sexual penetration etc. However, seek another opinion on estrogen/testosterone options since the vaginal estrogen cream may work for you. Your blood level of estrogen doesn't really change with limited use. The vaginal opening and canal will continue to shrink in depth, diameter over menopausal time and lubricants will cease to be adequate. What is your age?
Your symptoms are most likely related to vaginal atrophy. We have seen some excellent results in situations like yours with use of ThermiVa device. It is worth to try it given no side effects related to the treatment. Hope this helps
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.


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- "You read, Captain Sparrow? I mean, for pleasure?"
"Yes I do, Mr. Beckett, when I can find books to take on voyages with me."
"What kinds of things?"
"Poetry, history, biography...I like learning about the world."
"Some of his plays, most of his poetry."
- ―Cutler Beckett and Jack Sparrow
William Shakespeare (26 April 1564 (baptised) – 23 April 1616 ) was an English poet and playwright, widely regarded as the greatest writer in the English language and the world's pre-eminent dramatist. He was often called England's national poet and the "Bard of Avon". His surviving works, including some collaborations, consist of about 38 plays, 154 sonnets, two long narrative poems, and several other poems.
Shakespeare was born and brought up in Stratford-upon-Avon. At the age of 18, he married Anne Hathaway, with whom he had three children: Susanna, and twins Hamnet and Judith. Between 1585 and 1592, he began a successful career in London as an actor, writer, and part owner of a playing company called the Lord Chamberlain's Men, later known as the King's Men. He appears to have retired to Stratford around 1613 at age 49, where he died three years later. Few records of Shakespeare's private life survive, and there has been considerable speculation about such matters as his physical appearance, sexuality, religious beliefs, and whether the works attributed to him were written by others.
Shakespeare produced most of his known work between 1589 and 1613 . His early plays were mainly comedies and histories, genres he raised to the peak of sophistication and artistry by the end of the 16th century. He then wrote mainly tragedies until about 1608 , including Hamlet, King Lear, Othello, and Macbeth, considered some of the finest works in the English language. In his last phase, he wrote tragicomedies, also known as romances, and collaborated with other playwrights.
Many of his plays were published in editions of varying quality and accuracy during his lifetime. In 1623, two of his former theatrical colleagues published the First Folio, a collected edition of his dramatic works that included all but two of the plays now recognised as Shakespeare's.
In the 1730s, Captain Jack Sparrow had read books that he would take on voyages, including some of William Shakespeare's plays and most of his poetry. Shakespeare would be a matter of discussion in Jack's young adult life, during his first meeting with Cutler Beckett. Sparrow's First Mate Robert Greene also liked to read some of Shakespeare's books.
- The Price of Freedom (Mentioned only)


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This city hotel is ideal for business travellers and comprises a total of 295 rooms. Facilities on offer to guests at this air-conditioned establishment include a lobby area with a 24-hour reception and check-out service, a hotel safe, a currency exchange facility, a cloakroom and lift access. It has a cafe, a restaurant and a disco as well as WLAN Internet access. This hotel provides a large multi-functional conference room and a conference centre in conjunction with the Fushan International Exhibition Centre and two neighbouring hotels. The centre can accommodate thousands of visitors at one time and the travel department is on hand to offer top quality service and deal with all kinds of travel arrangements. Guests can also take advantage of the room and laundry services and there is parking for those arriving by car. Moreover, there is a bicycle hire station on the premises.
This hotel is conveniently situated in the commercial centre, just a few steps away from the Fushan International Exhibition Centre. It is 10 minutes by car from Xiamen railway station and Gaofen Airport.
The comfortable and luxurious rooms are well-equipped. All come with a shower/bathtub and a hairdryer and offer a king-size or double bed. They are equipped with a direct dial telephone, satellite TV, Internet access, a safe, a minibar and a fridge. Furthermore, an ironing set, centrally regulated air conditioning and individually regulated heating are provided in all accommodation as standard.
Guests can unwind with a massage or spa treatment.
The Dragon & Phoenix Hall, located on the 3rd floor of the hotel, serves the finest selection of Fujian and Cantonese cuisine in an elegant setting and is the perfect location for a business banquet or social gathering.
American Express, Diners Club, JCB, MasterCard and VISA are accepted at this hotel.
Room Facilities:
Direct dial telephone
Satellite cable TV
Internet access
Mini fridge
Iron and board
Double bed
King size bed
Central airconditioned
Individual heating
Wheelchair accessible
Disabled bathroom


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A resume has about 10 seconds in front of a recruiter before they decide whether you're a good candidate for an interview. Providing all pertinent information, such as a college education, gives you an advantage over an applicant without this. Adding a Bachelor's degree on your resume shows the recruiter that you not only finished college, but also completed coursework in the field you're applying for.
Open your resume document in a word processing file. If you don't have a current resume, begin one with your name, address and phone number. After writing your objective, skills and work history, add your educational experience.
Scroll down to the end of your resume and type "Education," usually in all caps and bold font. List your college history under this header.
Type the college's name, date of attendance and your degree type on the first line. Add your GPA if it was 3.0 or above. List all colleges attended, with most current college first.
Include any classes or activities that relate to the jobs you desire. Use the same list formatting that you used for your work experience.
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Essentials: TOEFL - Test Of English As A Foreign Language
Read our guide to the TOEFL test, including the different TOEFL formats, the test structure and more...
Read our guide to the TOEFL test, including the different TOEFL formats, the test structure and more...
If you want to undertake an undergraduate or postgraduate course in English, you will be asked to take an English proficiency test to make sure you have the required English language skills necessary for the course. TOEFL is one of the most relevant standardised tests in English Language.
Note: This is just a quick guide to TOEFL. You can read our full guide to TOEFL here.
TOEFL stands for Test of English as a Foreign Language. The TOEFL exam is offered both as a paper-based (PBT) or internet-based (iBT) test. Its main purpose is to measure your ability to understand spoken and written English and to recognise appropriate written English structure at a university level.
The TOEFL test is recognised in over 130 countries by more than 7,500 colleges and other institutions around the world.
It was initially developed to measure the English proficiency of international students wishing to study at US and Canadian colleges and universities. Therefore, its testing format is heavily weighted to multiple choices, suiting the American university examining system (although nowadays most UK universities also accept it). Candidates will also notice that the language is closer to American English than British English, which is why it might be more beneficial for those wishing to study in America.
Not sure which test to take? Compare TOEFL with IELTS with our guide.
The PBT and iBT forms of the TOEFL test vary very slightly. Both forms of the test consist of four sections:
You will be asked to read a few passages of university-level articles and answer some questions presented in Multiple Choice format (MCQ). The questions are design to assess your reading comprehension, key facts, vocabulary and style.
In this section you are given few extracts of conversations or conferences. All these refer to university life like a conversation between a student and a teacher, or a lecture in a class. The questions are MCQs and question you about details, suggestions and vocabulary. These are very natural and informal as you can hear interrupting words like 'uh' or 'urmm' while they are talking.
This involves speaking into a microphone while being recorded. Later, an examiner will listen to your answers and mark you accordingly. Two questions will be more of a personal style, like asking about your town or your favourite teacher. Another two questions will see you condense information from a text/conversation while offering opinions. Further questions will just ask you to summarise information from a short conversation.
Finally, there will be two short essays to write for the TOEFL exam. For the first exam, you are given broad topics such as, 'How has the internet changed our lives?' or 'If you changed one thing in your country, what it would be?'
In the second one, you'll need to analyse material from a text or lecture and you will have to produce an argumentative essay, analysing the information given.
The Reading and Listening sections are scored by computer with a score range of 0 to 30. The Reading section has 36-56 tasks based on reading passages from academic texts and answering questions. The Listening section has 34-51 tasks based on listening to lectures, classroom discussions and conversations, and then answering questions.
Find more information on how to prepare for the exam here.
A TOEFL test will vary slightly depending on where you are from and where you are taking the test. Approximately it costs $160-$250.
The amount you will have to pay for the exam varies considerably depending on where you are planning to take your test. Find out how much a TOEFL test is where you are.
Read more:
Find out more about the TOEFL test on the official ETS website.
Paul Ellett is the editor for Hotcourses Abroad. His role is to plan, produce and share editorial, videos, infographics, eBooks and any other content to inform prospective and current international students about their study abroad experience. When he's not thinking about student visas in Sweden and application deadlines, Paul is an avid fan of comedy podcasts and Nicolas Cage films.


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Author | NULL | Monday, Jan 01,1900 8:35 AM
STAR is keen on Hathway Cable & Datacom to reach a truce with rival multi system operator (MSO) INCablenet in a bid to increase revenue collection from cable operators.
Rajan Raheja-promoted Hathway and the Hinduja-owned INCablenet had met at Star office in Mumbai late last week to discuss how the MSOs can end their fight and come to an agreement on respecting each other's territories and last mile cable operators.
INCablenet and Hathway subsequently had a meeting with their respective distributors, pursuing them to increase declarations of their subscriber base of paid connectivity by around 25 per cent. Alarmed by the arm twisting, distributors of the two MSOs are planning to have a meeting to press forward their demands.
Distributors of INCablenet have already formed a seven member committee to put up an proposal to the management before making a commitment on increasing their collections for last mile cable operators. They are meeting on Monday and are expected to demand a prime band allocation to run their own cable channels. They also want to be permitted to run a few channels as compensation to the 25 per cent increase in connectivity they have to declare at Rs 50 per subscribers. Hathway also had a similar meeting with their distributors.
According to industry sources both INCablenet and Hathway have already agreed to exchange movies from their libraries to run their cable movie channels, CVO and CCC.


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Secure VoIP for free internet talk in privacy by encrypting voice communications
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Supported Windows Vista


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Anyone who has used a treadmill or hit the weight room with focus, passion and determination to get in shape has most likely run into "that" guy or gal either running or working out next to them.
This person is the epitome of bothersome when you take a moment to think about the sole purpose of the gym, and why we are all there. It also is one of the reasons people end up quitting the gym and going home until next year's New Year's resolution.
So how exactly do you practice proper behavior within the confines of the gym?
First, you have to understand truly why you are there.
Getting fit, losing weight and altering your lifestyle shouldn't doesn't have to include grunting, bumping and sharing a personal conversation for all to hear.
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Pacific Warriors
Open Season
Season 1 Episode 1
Hawaii's peak kayak fishing season kicks off. Andy and Rob tackle sharks and hunt for a huge tuna; Boogie and Jason battle off-shore currents at Kaena Point; Jon Jon sets out to catch a 500lb marlin; and freediver Kimi pursues an elusive octopus.
- 43 min
- Premiered 10/23/2015


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Bangalore: India 'A' stormed into the final of the N K P Salve Challenger series cricket tournament with a comprehensive 59-run victory against India 'B' in the last league match on Saturday.[an error occurred while processing this directive]The second successive victory for India 'A', following its two wicket win against India Seniors on Thursday, was powered by a five wicket haul by off spinner Sarandeep Singh who wrecked the middle order of India 'B'.India 'A' will take on the senior team, which is placed second in the league table with a win and a loss, in the final on Sunday.India 'B', which was restricted to 230 in 38.4 overs in response to the 289 of India 'A', lost both its matches and crashed out of the tournament.Mohammad Kaif was the highest scorer for India 'B', making a fine 69, while Hrishikesh Kanitkar and Vijay Bhardwaj contributed 47 and 43 runs respectively. But none of the other batsmen with the exception of wicketkeeper Pankaj Dharmani, who scored 13, could even reach the double figures.Besides Sarandeep, who finished with figures of five for 57 from his 10 overs, Ajit Agarkar claimed three wickets for 55 runs.Earlier, put into bat, India 'A' had set an imposing target for its opponents thanks to useful contributions from all the top order batsmen. India 'B' lost its first two wickets for only 12 runs with Agarkarstriking in the very first over by having opener Sridharan Sriram caught by V V S Laxman at the second slip for two. Dinesh Mongia, who had scored a brilliant century in Fridays game against India Seniors, was also dismissed cheaply, run out for two.It would have been three for 13 had Ajay Ratra not dropped Kaif, on six, off Zaheer Khan. Kaif and Kanitkar then added 113 runs for the third wicket to bring their team back into the chase.But Sarandeep dismissed both of them in quick succession and it was adownward slide after that as India 'B' kept losing wickets at regularintervals.Kaif whose 69 came off 68 balls and included five fours and a six holed out in the deep to Sitanshu Kotak. Kanitkar followed him soon after making 47 that included three boundaries.Sarandeep also sent back Bhardwaj who was the only other substantial scorer of the innings.Earlier, opener Connor Williams led a fine batting display by India 'A' with a solid 73 off 91 balls that was studded with seven fours and a six. Williams put on 63 runs of the first wicket with Sangram Singh who contributed 39 runs and was also associated in healthy partnerships with Laxman (28) and Rohan Gavaskar (45) before being caught in the deep by Devendra Bundela off Kanitkar.Yuveraj Singh scored a quickfire 48 off 40 balls to pep up the innings.For India 'B', skipper Anil Kumble claimed two wickets for 47 runs while Arjun Yadav and Kanitkar took one wicket each.PTI
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In which Jason and Soren Bowie of Cracked.com discuss the trailer for Snow White and the Huntsman.
Hi Soren. Welcome to this review of Snow White and the Huntsman. From the looks of it, the quickest route to being fairest of all is soaking in a bathtub full of milk. Of course, some of us have always known that prolonged milk-on-skin contact will result in excessive fairness, both the physical and moral kind. Which is why progressive courtrooms across the country have installed mandatory milk-soaking tubs to ensure fairness in all jury trials. Whether members of the jury wear shower caps and utilize comically overlong back scrubbers is at the discretion of the presiding judge, who is usually a breastfeeding baby in a powdered wig.
Of course, here in Georgia we just brought our milk-soaking tubs up from the courthouse basement, where they were being utilized as emergency Dukes of Hazzard memorabilia storage bins. And now we keep our life-size cardboard cutouts of Boss Hogg in the same closet we keep our beer koozies and keychains featuring Izzy, the official mascot of the Atlanta 1996 Summer Olympics.
Incidentally, the original script for the 1957 version of 12 Angry Men called for the characters to deliver their lines from claw-foot bathtubs filled with milk, but this version was scrapped when the producers realized Don Knotts was still alive, and needed his claw feet for walking on.
See, this is exactly why striving for fairness gets a bad rap. In your rush to simplify the process of achieving fairness, you yourself have not been very fair. Bathing in milk isn't the silver bullet everyone hopes it will be, becoming the fairest is hard goddamn work and I'm sick of people trying to cut corners. Yes, soaking in a bathtub of milk is important, but that doesn't mean you can neglect stealing souls through young maidens' mouths until their hair falls out. And you certainly can't forget to eat the hearts of other ambitious fairness seekers. It makes me so mad that people don't realize that fairness is a lifestyle choice. If you think eating human hearts is going to be fun every time, then you're crazy. But you have to tough it out, making it as routine as brushing your teeth if you ever want to see any change when you look in your mirror/ reflective hooded guy friend.
Incidentally, I'm impressed at the mirror's Minority Report levels of prescience. Snow White isn't even fair yet, but at some indeterminate moment in the future, she will turn that shit on like a switch. It's strange that a sentient being that can see into the future would use that power for gossip. Bickering over who's going to be pretty a year from now seems arbitrary when you can predict things like world wars and electricity. Or maybe the mirror can only predict future fairness and beauty, but is blind to every other crucial step in humanity, in which case I no longer care about Snow White, all of my pity is reserved for that poor goddamn mirror.
Wait, what? You're supposed to eat hearts and consult psychic mirrors to become the fairest of all? I've been eating mirrors and consulting hearts. And I couldn't even afford regular hearts, I had to go with pig hearts. Surprisingly, the pig hearts were pretty good at figuring out who was the fairest of all. Unfortunately, they were only able to apply this power to pigs. So, if you're looking for the hottest pig in the land (Hint: It's Miss Piggy in a Princess Leia metal bikini), eat your heart out. Literally?
For my money, if you want to find the most attractive pig, you need to go check out what spiders have written in their webs above the pigs down at the county fair. Ever since Charlotte's Web, pigs have used spider webs as a kind of Facebook/Craigslist dating service, relaying their status updates and personal ads via a collective of exhausted web-writing spiders!
Some of the more unsavory pigs have been using the spider webs as more of an Adult Friend Finder type of service. Just look for the pig in chaps underneath the web that reads "SPP (Single Pink Pig) seeks partner for BDSM and Choking". Guess this would be in the P4P section of the county fair. And it would explain why a farmer in overalls stands next to the pig and warns you that some pigs will try to direct you to websites that contain malware. Good luck, cam-site endorsing pig.
Far be it from me to judge a pig's sexual proclivities. Whatever you're into is fine by me, pig. You Ashley Madison pigs should be ashamed of yourselves, though. Cheating on your pig wives! Come to think of it, are pigs monogamous to their wives? Do pigs respect the institution of marriage?
I think pigs respect marriage. Isn't animal husbandry a thing that happens on farms? I'm no expert but I always assumed that was the union of two horses, or goats or whatever. Pigs wouldn't be any different, in fact they probably adhere to a more old-fashioned concept of marriage than any other animal. They prefer the dominance of the husband and the subjugation of the wife. That would explain why we always call on their species when accusing someone of sexism and misogyny. You never hear the name "open-minded pig" being tossed around during a debate about gender roles. It's sad really, pigs need to wake up and realize it's 2012 already.
I guess I'm not surprised to hear that Miss Piggy is the fairest of all the pigs. They're a species that bathe in their own excrement so really the only one that's wearing a dress sort of wins by default. There was an entire episode of Muppet Babies where they reenacted Snow White and Miss Piggy was forced to play the evil queen. She made a few sincere attempts at murdering Skeeter who was cast as Snow White, but they left it ambiguous whether or not she really intended to eat Skeeter's heart. It was a very tense episode. Meanwhile Nanny just napped through it all. She was a terrible nanny. I'm sure there are some parallels you could draw between the neglect Nanny shows all those babies, and the neglect the Queen showed Snow White as a child. I'm not going to do it, but I'm sure they're there.
You're right to condemn Nanny as a terrible caretaker. But who among us can shoulder the burden of responsibility for regular babies without craving a nap, much less Muppet Babies? The fact that there are Muppet Babies at all indicates they are the product of some reproductive process, that there was a conception and a birth. What act of lovemaking produced these felt infants? Or was it love at all? Probably not, since they were abandoned by their parents. Who is running around having all this casual sex and deserting the resulting Muppet offspring? Probably some horny teenage Muppets. Put a condom on, Muppets!
Except for you, Animal. You seem free of sexually transmitted diseases. Most drummers are, right? Anyway, in the words of Baby Animal, it is time to "Go bye-bye!" May your pigs be faithful to their wives, and may your Muppet Babies be placed in good foster homes, and never interfere with your carefree muppet sex.


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S6E03 - After Eight
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This week kicks off with stories of car crashes and alternative realities. Everton reviewed, lots of praise heaped on Lamela, Crystal Palace game previewed, will Townsend get a good reception? Windy gives a half-time update on the youth and loanees. Will Kevin Wimmer ever usurp Jan Vertonghen? How valuable is Christian Eriksen to Spurs? We then discuss ENIC, lucky shirts and just what would we do to win the Champions League? Alex From Bristol, Flav, Ricky and Thelonious Twitter: @lovetheshirt Facebook: facebook.com/thefightingcock Instagram: @thefightingcock
Aug 16, 2016, 04:33 PM


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In today's Catholic Daily Roundup, top stories include Prince Charles saying climate change contributed to the civil war in Syria, the pope starts his first trip to Africa, and a possible miracle occurs after the pope blessed a one year old with a rare tumor.
"One does not make the world more human by refusing to act humanely here and now." (Pope Benedict XVI)
Today's Gospel: "I tell you truly, this poor widow put in more than all the rest; for those others have all made offerings from their surplus wealth, but she, from her poverty, has offered her whole livelihood." (Luke 21:3-4)
In the News:
- Sweeping overnight raids failed to trap one of Europe's most-wanted men, leaving Belgium's capital essentially on lockdown Monday for a third straight day.
- U.S. pharmaceutical giant Pfizer and Irish rival Allergan Monday announced a record-breaking $160-billion merger, the largest in health-care industry history and the biggest yet using a controversial tax-saving strategy.
- Britain's Prince Charles said that climate change could be one of the causes of the civil war in Syria, terrorism and Europe's refugee crisis.
Pope Francis and church news:
- Pope Francis makes his first visit to Africa this week, starting on Wednesday when his delegation will visit Kenya, then Uganda and the Central African Republic.
- During Pope Francis' visit to Philadelphia in September, one of the children brought to the popemobile was Gianna Masciantonio, a 1-year-old with a rare brain tumor. Last week, her parents said that the tumor has shrunk significantly.
- At their annual fall meeting in Baltimore, the U.S. bishops voted to issue a new introductory note and make limited revisions to their quadrennial statement on political responsibility. But while the vote was overwhelmingly in favor, it was not without controversy.
CACG would like to equip lay Catholics with the resources necessary to promote the common good in their communities. That's why we have the Catholic daily roundup. You can sign up for this short and digestible daily e-mail here.
We always appreciate your support to continue our work into 2015. Please invest in us today.


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Admire the most beautiful places of Porto Viro and add them to your basket. YAMGU will create your trip considering distances, opening hours and weather.
The Museum is located in two farm houses of 19th century, situated on the sides of an entrance gate leading to the Court. The building on the left hosts the ethnographic section, with the reconstruction of a farm house with a tavern attached. The building on the right hosts the naturalistic section and the history of Cappello's Court.
The Museum is still new, it is growing thank to the villagers' contribution, they make it more and more complete with objects and with their experiences of life. Some typical environments of the farmers from Polesine have been rebuilt in the ethnograph