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text: To get from Velletri to Zola Predosa by train you can catch one of the 13 trains that everyday travel between these two cities. The first train to Zola Predosa leaves from Velletri at 05:47 and the last train departs at 23:43. If you choose a local train the trip lasts on average 04:16 hours. For your trip from Velletri to Zola Predosa by train you can choose to leave from one of Velletri main stations: Velletri, Roma Tiburtina On Wanderio you can compare all schedules, fares and railway companies to Zola Predosa and book the best itinerary starting from Velletri.

subset: commoncrawl


text:
Episode Info Edit
Cornered is the fourth episode of the first season of The One and Only Scooby-Doo!.
Creatures made of corn haunt Coolsville.
A man is eating corn. He smells something funny, so he gets up and looks around outside. He sees a giant corn stalk. Suddenly, the giant corn stalk opens two evil-looking eyes and an evil looking mouth. The corn monster starts walking towards the man. The man screams and runs off, but he finds himself in a circle made of giant corn stalks. They all come to life. The man runs, but the corn monsters corner him. The man screams as one of the corn monsters opens its mouth to eat him.
Scooby and Shaggy are walking around Coolsville. They see the circle of giant corn stalks. Fred, Daphne, and Velma come over, and they tell Scooby and Shaggy that giant corn stalks attacked a man last night. They all look back at the circle of giant corn stalks... it is gone! A man and a woman named Mr. and Mrs. Bank walk up to the gang and introduce themselves. They tell the gang about the corn monsters. Then they walk off. Suddenly, a man named Joe comes up to the gang, riding a robot horse. He explains that he is good at making robots.
After Joe leaves, the gang decides to split up. Velma finds a trapdoor that leads underground. Fred, Daphne, and Velma go underground, and Scooby and Shaggy stay above ground. Soon, Scooby and Shaggy are looking for clues in the circle of missing giant corn stalks. Scooby discovers a bag of fries. He and Shaggy eat them and the corn stalk monsters appear and roar at Scooby and Shaggy. Scooby and Shaggy run away. Meanwhile, Fred, Daphne, and Velma are searching for clues underground. Three corn monsters sneak up on them and handcuff them. Fred, Daphne, and Velma realize that they have been taken prisoner by the corn monsters!
Meanwhile, Scooby and Shaggy are running from the corn monsters. They dress up like giant corn, and tell the other monsters "they went that-a-way," pointing left. The corn creatures fall for it and run. Scooby and Shaggy take off their costumes and make a run for it. Soon, Scooby and Shaggy are back at the circle of missing giant corn stalks. They rest there.
Meanwhile, the corn monsters are taking Fred, Daphne, and Velma somewhere. They take them inside a lab, where a cloaked man is. The cloaked man explains that he is using the corn monsters to scare people away from the hidden treasure in the circle of giant corn stalks. The man laughs evilly as he tells the corn monsters to take Fred, Daphne, and Velma to their prison cells.
Scooby and Shaggy go underground to find Fred, Daphne, and Velma. Two corn monsters appear and attack them. Scooby and Shaggy escape and continue looking for Fred, Daphne, and Velma. They discover the lab but the cloaked man isn't there. Shaggy wonders what a button does so he presses it. The cloaked man runs in and tells him to stop. The lab explodes.
Soon, Fred, Daphne, Velma, Scooby, and Shaggy have the cloaked man and the corn monsters tied up in the circle of giant corn stalks. The corn monsters are hired henchmen; and the cloaked man is Joe. Joe explains that he wanted to steal the treasure and sell it, so that he could afford to buy all the parts for a giant robot.
The next day, Scooby and Shaggy are eating corn.
"Rooby-Rooby-Roo!" cheers Scooby.
Cast and CharactersEdit
|Frank Welker
|Matthew Lillard
|Shaggy Rogers
|Grey DeLisle
|Daphne Blake
|Mindy Cohn
|Velma Dinkley
|Voice Actors
|Mr. and Mrs. Bank
- Corn Monsters
- Cloaked Man
|He could have made corn monster robots.
|Mr. and Mrs. Bank
|They knew so much about the corn monsters.
- Coolsville
Home mediaEdit
- The One and Only Scooby-Doo! The Complete First Season
- The One and Only Scooby-Doo! The Complete Series
|Previous Episode:
Mascot Monster Mayhem
|Next Episode:
Cruising with Creatures


text:
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Antonio Conte's men boast a formidable home record in all competitions and will be confident of progressing to the last four after triumphing 1-0 at the Gerland last week
The Italian champions hold a 1-0 advantage from the first-leg at the Stade de Gerland, which saw the Serie A leaders net a crucial away goal in the 84th minute through Leonardo Bonucci.
The defender's goal puts Antonio Conte's men in command of the tie, and the Old Lady should be clear favourites to qualify for the last four considering their magnificent home record.
Indeed, the return fixture takes place a year to the day since Conte's side last suffered a home defeat, which came at the hands of Bayern Munich in the second-leg of last season's Champions League quarter-finals.
The likes of Real Madrid, Napoli and Roma have all failed to win in the Juventus Stadium since that day, and Lyon coach Remi Garde, who said Lyon had a "mountain" to climb before last week's meeting, accepted his side need a "miracle" following its conclusion.
"It was a great experience for the young players [playing against Juve]," he said. "It will be tough in Turin and we will need a miracle to win in the second-leg."
The clash marks the start of an exciting run of fixtures for Lyon, who face Ligue 1 champions-elect Paris Saint-Germain on Sunday before taking on Laurent Blanc's men again in the Coupe de la Ligue final the following Saturday at the Stade de France.
But the seven-time French champions will approach that daunting triumvirate of fixtures with a number of injury concerns.
Clement Grenier is out with a groin problem, and fellow midfielder Gueida Fofana will also miss out with a similar injury.
Playmaker Yoann Gourcuff remains unavailable with an ankle problem, and Jordan Ferri - scorer of a spectacular long-range strike in Sunday's 2-1 win at Valenciennes - will likely be selected to fill the void again in a depleted midfield.
At the back, Mouhamadou Dabo has yet to recover from a hamstring issue and Miguel Lopes is out for the rest of the season with a broken leg.
Meanwhile, the hosts will be boosted by the return of Arturo Vidal after he missed the 2-0 Serie A win over Livorno at the weekend through suspension.
Defender Andrea Barzagli (calf) is still struggling for fitness, but Carlos Tevez shook off a thigh injury to play against Livorno on Monday and defender Angelo Ogbonna is available to feature for the first time in nearly a month.


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And it can create quite a few complications. From the Washington Post: A cultural shift in thinking about parenting and gender roles has led to a surge in divorced couples agreeing to more detailed shared custody arrangements that increasingly spell out how they will practice and talk about their religious faith. Agreements of the past [Read More…]
More divorces spell out religious practice in custody agreements
What we have come to: doll houses for divorce?
Oh yeah. This isn't a joke from The Onion. Kathy Schiffer has the scoop: Industrial designer Ben Forman (benformandesign.co.uk) has introduced a new dollhouse to help today's modern preschooler prepare for the inevitable unhappy changes in her family structure. It's called Detacho. Detacho families, like so many contemporary American families, can reconfigure themselves, either expanding [Read More…]
Census shows divorce rate higher in the south
Why is that? Some details: While the Bible Belt is known for its devotion to traditional values, Southerners don't do so well on one key family value: They are more likely to get divorced than people living in the Northeast. Southern men and women had higher rates of divorce in 2009 than their counterparts in [Read More…]
Irish bishop: children of divorce are "born losers"
He made that statement during an interview with a local newspaper yesterday: Many children from broken homes are born "losers" and so deprived of love that they grow up to be dysfunctional adults, according to a Catholic bishop. Bishop of Elphin Christopher Jones said that during his 17 years working in social services in Sligo [Read More…]
Divorce rate rising in rural America
The latest census figures are showing something new in parts of the heartland: divorce. From the New York Times: In the 1970s, the divorce rate was so low in this rural northwest Iowa County that it resembled the rest of America in the 1910s. Most of its 28,000 residents were churchgoers, few of its women [Read More…]


text:
Internal Injections 2Favorites [+]
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You can now enjoy this movie on your iPhone®, iPad®, or compatible Smart TV & Android devices.
Purchase Options
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Available MP4 sizes:SD 480p (2.43 GB)
DRM-free downloads offer content that is not limited by standard Digital Rights Management (DRM) access technologies. These technologies allow hardware manufacturers, publishers, copyright holders and individuals to limit the usage of digital content.
When you purchase DRM-free downloadable content, that content is available for you to download on any computer and save to a disk whenever you like. You can also download to multiple computers. There is no timeframe associated with your purchase and the content will not expire.
Running Time: 158 minutes
Released: 10/2007
Studio Name: Diabolic Digital
Series: Internal Injections
Director: Sid Knox
Categories: Cumshot All Sex Cream Pies Award Winning Movies
Description: Six scenes of cum filled, cream pie cuties! Watch Jenna Haze take it fast and hard, and get topped off with a hefty load of cock drippings!
6 Scenes from Internal Injections 2
Internal Injections 2: Scene 1 Free Preview
Starring: James Deen Aurora Snow ... More Details
Stars: James Deen, Aurora Snow
Sex Acts: Anal Sex, Deep Throating, Masturbation, Ass To Mouth, Creampie, Vaginal Sex, Oral Sex, Throat Fucking, Gapes, Blowjob
Positions: Cowgirl, Reverse Cowgirl, Standing Cowgirl, Crouching/Squatting, Missionary, Kneeling, Side Saddle, Laying, Standing
Internal Injections 2: Scene 2 Free Preview
Starring: Talon Jaclyn Case ... More Details
Stars: Talon, Jaclyn Case, Jordan Ash
Sex Acts: Deep Throating, Masturbation, Vaginal Sex, Oral Sex, 3-Way, Sloppy Seconds, Vaginal, Gapes, Fingercuffing - Vaginal, Creampie
Positions: Cowgirl, Reverse Cowgirl, Standing Doggy Style, Missionary, Doggy Style, Kneeling, Side Saddle, Laying, Standing
Settings: Bedroom
Internal Injections 2: Scene 3 Free Preview
Starring: Jenner Aliana Love ... More Details
Stars: Jenner, Aliana Love
Sex Acts: Toy Play - Vaginal, Anal Sex, Creampie, Vaginal Sex, Oral Sex, Masturbation, Toy Play - Anal
Positions: Cowgirl, Reverse Cowgirl, Kneeling, Standing Doggy Style, Laying, Missionary, Standing
Internal Injections 2: Scene 4 Free Preview
Starring: Jenner Holly Wellin ... More Details
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Sex Acts: Fingercuffing - Anal, Anal Sex, Deep Throating, Sloppy Seconds, Anal, Double Penetration, Ass To Mouth, Creampie, Oral Sex, Throat Fucking, 3-Way, Gapes, Fingercuffing - Vaginal
Positions: Cowgirl, Reverse Cowgirl, Missionary, Doggy Style, Spoons position, Kneeling, Side Saddle, Laying, Standing
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Starring: Sophia Lynn Talon ... More Details
Stars: Sophia Lynn, Talon
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Starring: Jenna Haze Tommy Gunn ... More Details
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Settings: Bedroom
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Who would ever think that a comedy about a talking horse would hold up after all this time ... well it has.
I grew up watching repeats of Mister Ed, and absolutely adored the show. Surprisingly I still do! While some of it will seem abit silly and dated, it is still an all around highly entertaining show. Just keep in mind that this was originally a childrens series, so it may not appeal to some. But if you are looking for a wholesome, funny, and sweet show to watch with your kids, then Mister Ed is definitely it.


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text:
But if you want to dine out, go to movies, have great conversations, and share a close caring relationship with a down-to-earth guy, then Walt definitely is willing.
-- I definitely am a progressive.
-- I am NOT religious.
-- I am NOT an outdoor enthusiast.
-- I do NOT spend a lot of time following sports.
-- I do NOT regularly attend events like operas, symphonies, and ballets. (To see activities that I do like see "WHAT I'M DOING WITH MY LIFE" below.)
If any of these character traits would bother a woman, she and I should definitely not interact. However, if they aren't objectionable, she should consider sending me a message.
Also, for a man and woman to become friends or lovers, they must eventually meet. And, I've found that, if they live too far apart, there is very little chance of a lasting relationship forming. Therefore, I will only start interacting with women who live within 10 miles of Forest Park, where I live.
(BTW -- The amazingly handsome guy in my photo is my pal Milo.)
Aside from reading books and magazines, watching TV, and fulfilling every wish of Milo, my Jack Russell terrier, some things that I like to do are:
Volunteering at two libraries to help people who have questions about or problems with computers, tablets, and smartphones;
Attending lectures and presentations put on by libraries and other institutions;
Discussing current events, cultural and entertainment news, advances in social sciences, religion, and politics with friends (while making sure to avoid generating arguments);
Competing in trivia contests that libraries conduct at restaurants and bars;
Dining out and going to parties with friends;
Frequently hanging out wiith my son; and
Going to movies.
I'm NOT good at spending a great deal of time watching sports or participating in many outdoor activities.
Computers and other technology;
Current events, including cultural and entertainment news;
Fiction, including popular literature, mysteries, and fantasies;
Movies of all types, including popular current films, classics, documentaries, and animation;
Politics, and;
Pop culture.
- My friends
- My dog
- My Tablet and PC
- My TV
- My books


text:
"Arnolfo di Cambio (born c. 1245 in Florence, died c. 1302 in Florence) was an Italian artist and...Arnolfo di Cambio
"Michelangelo Buonarroti (born 1475 in Caprese, died 1564 in Rome) was a Renaissance artist and...Michelangelo Buonarroti
"Nicolas Poussin (born 15 June 1594, died 19 November 1665) was a French painter. Poussin first...Nicolas Poussin
"Arrigo Paludano or Arrigo Fiammingo (original Flemish name Hendrik Van Den Broeck; born 1519 in...Arrigo Paludano
"The list of artists gives an overview of the architects mentioned in this guide, with a list of...List of artists
"Francesco Salviati 1510- 11 November 1563 was a painter from Florence. He was born as Francesco...Francesco Salviati
This category has only the following subcategory.
- [×] Sculptors (3 P)
Pages in category "Artists"
The following 7 pages are in this category, out of 7 total.


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Johannesburg, South Africa – As part of its Development Effectiveness programme, AWEPA organised a working dinner to discuss the outline of a learning programme for SADC parliamentarians on Domestic Resource Mobilisation (DRM) on 11 May 2016 in Johannesburg, South Africa.
The dinner, which brought together legislators attending a joint session of the Southern African Development Community (SADC) Parliamentary Forum Regional Standing Committee, aimed to raise awareness among these parliamentarians of the context surrounding DRM and to obtain feedback on the initial outline of a learning programme on DRM.
A welcome address was delivered by Hon. Joseph Njobvuyalema, Vice President of the SADC Parliamentary Forum, followed by a presentation by Ms. Kubeshni Govender Jones, an external consultant hired to create the learning programme on DRM. During her presentation, Ms. Govender emphasised that the new DRM Learning Programme for SADC parliamentarians would focus on developing capacity over the short to medium term.
AWEPA is currently supporting the SADC Parliamentary Forum in the development of this Learning Programme, since DRM is an area in which the Forum has previously vocalised its need for further trainings and dialogue.
The Learning Programme will incorporate existing information, data and research accumulated by the SADC Parliamentary Forum and AWEPA, essentially consolidating these materials into one, usable tool.
Placing a firm focus on natural resource revenues and taxation, the curriculum will aim to:
- Locate DRM in the context of Africa's development and the imperatives of the Sustainable Development Goals (SDGs);
- Explain the basic concepts associated with DRM;
- Raise awareness of the role of parliamentarians in the DRM process with regard to oversight legislation, constituency outreach and regional collaboration.
Background information
DRM is the generation of savings from domestic resources (both public and private) and their allocation to economically and socially productive investments. Domestic resources are important to African countries because:
- They are potentially the biggest source of long-term financing for sustainable development and the source of all state governance such as the provision of public goods and services;
- They can help strengthen fiscal institutions and long-term fiscal planning;
- They represent an exit from long-term aid dependency, and increase local ownership.
In contrast to mobilising external resources (through foreign direct investment, aid, trade, and debt relief), DRM offers greater domestic policy ownership and greater coherence with domestic needs.
- Speech by Hon. Joseph Njobvuyalema
- Presentation by Ms. Kubeshni Govender Jones
- Zambia Daily Mail: Campaigns should sensitise on need for domestic resource mobilisation


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Member since 7/11/2012
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- 1 review
Reviews & Stories
Beautiful Results - Temecula, CA
Dr. Balikian is one of the most kindest skilled facial plastic surgeon's I have ever been to. As a RN I am very picky on whom I chose for my care and I truly feel that Dr. Balikian is the best. He has performed a chin implant and a lip lift for me and I love the results! I now have the lips and chin that I have always wanted. The procedure was painless and the office staff and care I received... READ MORE


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Author | exchange4media Mumbai Bureau | Saturday, Dec 02,2006 8:39 AM
Nick has announced the launch of the Masti-Dosti Contest, an initiative where kids can win big for themselves and their friends. The contest begins from December 4 on the Masti-Dosti block from 6 pm to 7 pm, Monday to Friday. The shows aired in this block include Spongebob and Patrick, Ninja Hattori and Kenny Chee, and Munnabhai and Circuit.
Speaking on the initiative, Nina Jaipuria, Vice-president and General Manager, Nick India, said, "At the onset of the festive season, Masti-Dosti is Nick's unique way of reaching out and celebrating the 'spirit of friendship' with the kids. Over the past many months, Nick has formed a special bond with the kids and 'Masti-Dosti' is an initiative to strengthen that even further."
According to an official communiqué from Nick, ratings over the last week had placed 'Ninja Hattori' in the top slot with a path-breaking TVR of 5.12 followed by 'Spongebob Squarepants' with a TVR of 4.92 (TAM Week 46, 7 -2200 hrs, HSM 1 L +, CS, 4-9 ABC). The ratings also make Nick the most 'stickiest' channel in the kids category with the maximum time spent at 135.5 minutes (TAM Week 46, 7 -2200 hrs, HSM 1 L +, CS, 4-14 yrs ABC).
To spread the Masti-Dosti fever around, Nick would be soon launching a multi-media campaign comprising television, print and on-ground, including colourfully painted school buses and visits to the agencies by its popular characters – SpongeBob SquarePants and his buddy, Patrick.


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Enter Amount:$
Family Sustainer Sponsor
Greenbriar Children's Center, Inc. shall not discriminate on the basis of race, color, religion (creed), gender, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers, selection of vendors, and provision of services.
Greenbriar Children's Center, Inc.
3709 Hopkins Street
Savannah, GA 31405
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. No Phone Calls Please.
Douglas Reed- President
Ray Truitt
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Greenbriar Children's Center is a nonprofit organization that provides childcare, residential and family counseling services which lead to the healthy development of children and young adults and to the strengthening of families, primarily in the state of Georgia.


text:
Just returned from a 2 night stay at the hotel. The rooms are compact but have everything you need including a fridge. It was great to have a bathroom that has windows and natural light. So many hotels have bathrooms in the middle of the...More
Getting you more information on this room
Getting you more information on this room
"The view is incidental, but ask for a room away from the lift and use the stair if it is a lower floor."


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We only stayed at this hotel because we arrived in Male too late for the boat or sea plane transfer to our island. The hotel is fine, however a bit of a rip off - We ordered 2 soft drinks and 1 portion of chips by the pool and we couldnt believe the cost! It was really expensive for what it was, think about £15 or more. We decided to get the boat to Male main land for dinner to aviod being ripped off again by the hotel, we ate at Seagulls cafe which was ok, probably the best one there to choose. Male was very dark and hardly any tourists so I was a bit scared. Basically if you have to stop here its fine for a night, has a big pool and beach area, rooms were big but couldnt wait to get to the Islands and wish we didnt have to stay there but couldnt be avoided. One thing I didnt like was all the flys around the pool.
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The iconic ragtime piece by Scott Joplin is arranged here for mallet quartet by Edward Freytag.
Scored for four players, George Gershwin's Three Preludes for Piano merge early twentieth century American classical music with jazz elements, and exemplify the essence of Gershwin's signature
This piece in the style of an 1800s habanera was used in the movie classic "The Sting," although this arrangement uses the entire piece instead of just the last section.
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January 6, 2013 | Clothes & Fashion, Coupons & Savings, Grocery, Household, Kids & Baby, Pets
Looking to do some major boxing day shopping? Or maybe you just need to pick up the essential stuff for the house like cleaning products?
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Zellers is a great place to get my favorite items for great prices so I'm sad to see the one near me closed down, but this does mean major savings in the mean time!
You work too hard for your money to throw it all away on full price when you don't have to!
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This is the first time Sokka has shown disappointment about not being a bender. Before, he thought it was a waste of time.
It is heavily implied Piandao is a member of the Order of the White Lotus, the mysterious organization which Iroh also belongs, first mentioned in "The Desert". He even goes as far as to give Sokka a White Lotus Pai Sho tile as a token of remembrance.
Piandao suggests Sokka to use the name "Lee" while he's in the Fire Nation. That is the same name Zuko used while living in the Earth Kingdom during season two.
When Aang, Katara, and Sokka stand to see the falling meteor, Aang's arrow tattoo reaches past his eyebrows.
After Sokka chides the others for complaining for their lack of appreciation and before Katara comments about the steamed sea slug, the yellow insignia on Aang's forehead is missing.
When Piandao defeats Sokka, the rest of the Gang rushes to help. Toph, Aang and Katara move into their fighting stances. But Katara wouldn't be able to do anything, since she is dressed as a Fire Nation citizen, and does not have her water pouch, and there was no water around.
Aang: Toph, let's make a trench to keep the fire from coming any closer.
Sokka: (dejectedly) What should I do?
Aang: Keep an eye on Momo.
(Momo flies to Sokka and lands on his head.)
Sokka: So what, I'm just a lemur-sitter?! (petting Momo's head) There, there. Feel better?
Piandao: (on Sokka's painting) You added a rainbow...
Sokka: Is that all right? (Piandao sighs)
Katara: (Piandao reveals that he always knew Sokka was a water tribe member) Why would you agree to train someone from the water tribe?
Piandao: The way of the sword doesn't belong to any one nation. Knowledge of the arts belongs to us all.
Master: (talking to Sokka) As we trained, it wasn't your skills that impressed me. No, it certainly wasn't your skills. You showed something beyond that. Creativity, versatility, intelligence. These are the traits that define a great swordsman, and these are the traits that define you.
Katara: (to Toph on Sokka) If you miss him so much, why don't you marry him?
(uncomfortable silence)
Aang: Guess jokes don't run in the family.
Katara: Everyone's a critic.
(After Sokka got the White Lotus)
Sokka: Uh, that reminds me! Toph, I thought you might like this. Since you probably never had a chance to bend space earth before.
Toph: Sweet! … Check this out!
Katara: I don't think there is such a thing in space earth. If it's from space, then it's not really earth.
Sokka: Must you ruin everything!
Katara: (maybe just thinking this) I can't believe I missed you.
(Suddenly Toph feels somebody and sit up with a smiling face)
Toph: Sokka's coming!
Sokka: Hey guys! What are you doing?
Aang: Sokka!
Toph: You're back!
Katara: We missed you so… much!
Aang: Say something funny!
Sokka: Funny how? (Aang and Katara are laughing)
Sokka (asking from Toph): What's their deal?
Toph (Toph turns her back on Sokka): I don't know. They missed you or something. I didn't care. (Her face flushes)
Sokka: Thanks! That warms my heart. Anyway, I need some help.
(The gaang watches the falling stars)
Katara: Wow, this is amazing to watch!
Sokka: Kind of makes you realize how insignificant we are.
Toph: Yeah. If you've seen nothing once, you've seen it a thousand times.
All: Oooooo!
Sokka: Oh man, you've never not seen anything like this!
Aang: What should we do today?
Toph: I'm tapped out. I already picked my toes..twice.
Aang: Twice?
Toph: The first time's for cleaning, but the second time's just for the sweet picking sensation.
Sokka: I can't do anything.
Katara: That's not true. No one can read a map like you.
Toph: I can't read at all.
Aang: Yeah, and who keeps us laughing with sarcastic comments all the time? I mean, look at Katara's hair, right? What's up with that?
Katara (worried): What? What's wrong with my hair?
Aang: Nothing, I was just trying to-
Sokka: Look, I appreciate the effort. But the fact is, each of you is so amazing and so special and I'm...not.
Piandao is based on Sifu Kisu, the martial arts specialist for the show.
The episode was published in the book Avatar The Last Airbender: Sokka, The Sword Master.
This episode is available in the Avatar Book 3: Fire Volume 1 DVD, along with, The Awakening, The Headband, The Painted Lady, and The Beach.
Character Debuts: Piandao, Fat (Piandao's butler)
The masters castle is based in a traditional Chinese architecture style.
Aang: All I need to complete the outfit is a wind sword.
In the video game Fire Emblem: The Sacred Stones, one of the bosses weilds a weapon known as a Wind Sword.
Toph: And besides, its so hot today.
Aang: How hot is it?
Aang's statement is a direct reference to Match Game, an old game show which featured celebrities and contestants answering fill-in-the-blank questions. Possibly the show's most famous recurring bit had host Gene Rayburn reciting a statement along the lines of "It was so hot Monday morning..." to be answered by the audience, "HOW HOT WAS IT?," and complete the sentence with a playful hyperbole.
A sword made of a meteorite's ore appears in different movies, such as in the movie 'Ring of the Nibelungs/Curse of the Ring'(inspired by Das Nibelungenlied, however in the saga Siegfried's sword, the Balmung has a different origin), and in the movie 'Seven Swords', where The Transience Sword is one of the most powerful weapons.
When Iroh is working out non-stop in his cell, it is an allusion of 'Escape from Alcatraz', where even though the character played by Clint Eastwood is in a cramped, high-security cell with little food, he works out non-stop and ends up in the best shape of his life.
Sokka's Master is named Piandao, which in a reference to a type of Chinese sabre (dao) used during the late Ming Dynasty.
The calligraphy, rock sculptures and landscape paintings were all arts that a well trained samurai would also have mastered in feudal Japan.
In the hall where Sokka receives the made sword from his master, there are many patterns of the White Lotus behind the master and over the door.
Sokka's master is not only an expert swordsman but a master of calligraphy, like Broken Sword in wuxia movie 'Hero' (Ying Xong).
Sokka's sword: A Song of Ice and Fire
Sokka's sword is made out of meteorite. This is similar to Arthur Dayne's sword Dawn from A Song of Ice and Fire (a series of books by George R. R. Martin), which was also made out of a meteorite. Arthur Dayne was a famous knight and a member in the Kingswood Brotherhood of Aerys II Targaryen.
The armor Aang wears in the shop is reminiscent of Nightmare's alternate costume of Soulcalibur fame. Note the oversized claw on the left arm.
The animation of the ribbons trailing from Aang's helmet in the shopping area is reminiscent of the headbands seen in the miniseries Afro Samurai.
The fight between Sokka, and his master in the bamboo forest is usually a common fight sequence found in martial arts films.
Sokka's master telling him to pick a name such as Lee because "there's a million Lees" could be a allusion to how it is a common name in China.
Thunderbolt Iron
Sokka forges his sword from the remainders of a meteorite, a common convention in mythological and fantasy stories. In actuality, iron from meteorites has been used to make tools and weapons since the Ice Age, when it was the only iron available, and some scholars believe that the story of the forging of Zeus' thunderbolts refers to meteoric iron.
When Toph makes the third shape out of the meteorite Sokka gave her it is shaped like Nickelodeon's Trademark splat symbol
No results found.
No results found.
No results found.


text:
Search the Site
Souhegan Valley Rides
The Blue Bus has come to Mont Vernon!
Souhegan Valley Rides provides wheelchair accessible, curb-to-curb bus service for non-emergency healthcare and social servicer appointments and for other essential activities within Amherst, Brookline, Hollis, Milford and Mont Vernon, and to and from Nashua.
There is a $2.00 fare each way.
Call 880-0100 ext. 1 at least 48 hours in advance, or click here: Souhegan Valley Rides to learn more.
Sign-up for the Flyer
The Flyer is the official Town of Mont Vernon newsletter delivered to your email address.
Mont Vernon General Store
10 North Main St.
The Building Inspector issues building permits and performs site inspections.
The Mont Vernon Building Inspector is Steve Roberge.
Mailing Address:
Town Hall
One South Main Street
P.O. Box 444
Mont Vernon, NH 03057
Office Hours: The 2nd and 4th Monday of the month from 5:30pm - 6:30pm
Phone: 654-2176 (home, leave message)


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Tape Op: The Book About Creative Music Recording
Edited by Larry Crane, Introduction by Tony Visconti
Reviewed by Jonathan Sterne
Saturday, November 24 2001, 8:22 AM
Some time ago, I reviewed Tape Op, a magazine dedicated to creative, do-it-yourself audio recording edited by the well-regarded Portland studio owner and hipster engineer, Larry Crane. Since then, the first twelve issues of Tape Op have gone out of print and the magazine has gained an increasingly large following comparable to that of a punk graphic design magazine such as Emigre, equally patronized by artists and enthusiasts alike. In fact, this spring marks the first-ever Tape Op conference. It will be held in Sacramento, California.
The Tape Opbook contains the better part of the first 10 issues of the Tape Op 'zine and selections from issues 11-14. It's divided into five chapters: home recording; artists and bands; engineers, producers and studios; knowledge and techniques; and recording equipment. Though the promotional copy of the book promised that some of the printed interviews would be longer in the book than they were in the magazine, on a quick comparison with a few pieces, I didn't notice any significant differences. So I'm not sure I'd recommend shelling out for the book if you already have the complete Tape Op back catalogue. If you're new to Tape Op, however, this anthology will be a great introduction.
The book opens with an introduction by Tony Visconti, a reknown British producer who has worked with David Bowie, T Rex, Iggy Pop, and many others. Visconti attacks the nostalgia modern recordists have for the 1970s: "Recording is an art. Steadily we have been given more brushes and colors for our palette over the years. I have often been asked how we got our records to sound the way they did in the 60's, 70's and early 80's. Before I could answer, I would be told that it was all down to analog tape and vintage consoles, just fill in the blank. Nothing could be further from the truth". Viconti argues that engineers made great records in decades past because they had to fight with and overcome the limitations of crappy and unreliable equipment. And that is the Tape Op attitude: make the best recordings possible with the gear you have at hand.
Many of the chapters come in the form of interviews, which range widely across gear, technique, attitude and anecdotes. You will learn, for instance, that Guided By Voices pursued a "lo-fi" approach to recording because Bob Pollard's wife Kim would not let him spend big money in a big studio. But you'll also learn about 4-track tricks, how to make a live recording with a minimum of gear, and how little some of the great 4-track recordists actually needed to make great records. The requisite Steve Albini interview is in here mp;quot;there's no reason to fiddle around with a bunch of new, cutting-edge nonsense if it doesn't do the job as well" d you'll find interviewees both praising and lambasting new digital recording formats.
Comparing these early essays collected together with a more recent issue will also give you a sense of where the magazine has gone. Tape Op now has much more extensive letters and Q & A sections, more gear reviews (including reviews of gear that no budget home recordist could afford), and is willing to move more into the domain of professional recording. But the spirit of the magazine remains the same, right on down to the fact that you can subscribe to it for free. Tape Op is the major alternative to big corporate music production magazines, which sometimes read very much like equipment catalogues.
The Tape Op book is not, strictly speaking, an introduction to recording and studios. It is more about attitude, techniques, and experiences than a systematic guide to the home studio. People looking for a more basic introduction to recording gear and techniques should check out Bruce and Jenny Bartlett's Practical Recording Techniques, Sherman Keene's Practical Techniques for the Recording Engineer, Peter McLan's Musician's Guide to Home Recording, or Craig Anderton's Home Recording for Musicians.
Tape Op is published by Feral House


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text:
NEW YORK (AP) Stocks that were moving substantially or trading heavily Monday on the New York Stock Exchange:
McDonald's Corp., up $1.72 at $53.99
Growth in Europe, a weak dollar and an extra selling day sent February sales in stores open at least a year up 11.7 percent, more than expected.
Blackstone Group, up 25 cents at $14.83
A write-down on its investment in Financial Guaranty Insurance, and other credit issues, caused the private equity firm to swing to a loss.
Thornburg Mortgage Inc., down 98 cents at 81 cents
The struggling mortgage real estate investment trust was downgraded by Jefferies & Co. after JPMorgan last week issued it a default notice.
Nationwide Financial Services Inc., up $9.76 at $47.69
Nationwide Mutual Insurance Co., with a 66.3 percent stake in the company, bid to buy the rest for $2.2 billion in cash, or $47.20 a share.
ExpressJet Holdings Inc., down 32 cents at $1.91
Higher fuel costs and lower capacity caused a fourth-quarter loss for the airline operator after a profit the prior year.
MBIA Inc., down $1.14 at $10.85
The bond insurer told shareholders in a letter it is generating new business, but shares fell on soured views on the sector.
Six Flags Inc., down 5 cents at $1.57
Fourth quarter attendance rose, though losses from continuing operations widened, and it said its amusement parks tend to do well in recessions.
LMI Aerospace Inc., up $2.21 at $19.96
Strong airplane parts sales and engineering services revenue due to a recent acquisition, caused profit to soar 43 percent.
Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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Who doesn't love cupcakes? This cute little cupcake soap has notes of black raspberry and vanilla.
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text:
Southeastern Conference
agreements Archives
SEC Web
From the time they were 6 years old, David Greene and David Pollack have known one another. As their college football careers draw to a close in the next few weeks, they have a chance to make a few more lasting memories.
Greene is Georgia's record-setting quarterback; Pollack is the Bulldogs' All-America defensive end. They're teammates, roommates, friends from their Pee Wee football days in Snellville, Ga., and among the top players in the nation.
Although there's always a chance they could play together in the pros, Saturday's game against No. 3 Auburn, the Nov. 27 battle with Georgia Tech and a bowl game to follow could be the last three times they take the field together.
The pair have been instrumental in the recent renaissance of Georgia's program, including a Southeastern Conference championship two years ago, a repeat trip to the SEC title game last season and a No. 5 national ranking this year. The Bulldogs are 32-5 the past three seasons and take an 8-1 record into the Auburn game.
"These have been the best years of my life," says Pollack, whose 31 sacks are the most in Georgia history and sixth all-time in the SEC.
"I'll appreciate (the record) more later, but that's not why I'm playing ball. It's just been fun to play here. I've started every game since the middle of my freshman year, and I've stayed healthy."
Last week against Kentucky, Greene set a Division I-A record with his 40th victory as a starting quarterback, breaking the mark Peyton Manning set at Tennessee.
"I've always said it's the ultimate reward because (winning) is the ultimate team goal," says Greene. "That record says so much about this program."
Pollack and Greene started playing together with the Shiloh High junior football program (although Pollack played some tailback in those days).
They were teammates until the eighth grade, but a school district rezoning sent Greene to South Gwinnett High and Pollack to Shiloh.
Greene enrolled at Georgia first. While he was redshirting in 2000, he served as the recruiting host for Pollack's visit.
"I never really thought much about college ball until my senior year in high school, but when I saw (Georgia), I realized this place was the best place I've ever seen," Pollack says. "(Greene's presence) made it better, but it wasn't the sole reason for the decision."
Greene, a finalist for the Johnny Unitas Golden Arm Award as the top senior quarterback, says, "He didn't have a clue where (Pollack) wanted to go. But I think he wanted, in his heart, to be close to home, so he came here."
Greene says that although their personalities are "polar opposites" — he's the more laid-back one while Pollack is more outgoing — the two tackle life similarly.
"We don't get bent out of shape over little things or get upset, and we approach football the same way, with the same outlook."
Pollack, who does most of the cooking for the two — specializing in chicken dishes — thought hard after last season about giving up his senior year and entering the NFL draft.
"I had a chance to leave and see what's out there," says Pollack, who is a finalist for Rotary Lombardi Award (best lineman, offensive or defensive) for the second consecutive year. He has a chance to be the second player in Georgia history to be a first-team All-American three times, following running back Herschel Walker (1980-82).
"I thought about it, I prayed about it, but in the end I really didn't have a desire to leave at all.
"I think time was on my side. I've learned more about how to fend for myself this year, how to cook and take care of things. It's been a great experience, and I'm glad I got the chance to wear the red and black for another season."'
That season and even their shared lifestyle are now winding down for both.
"It's going to be a little different not having him around," says Greene.
"I already know," says Pollack, "he'll be a lifelong friend."


text:
Hot Clicks: Christina Hendricks; Athletes with their dogs
Get all previous editions of Hot Clicks here. Follow Jimmy Traina on Twitter here. Join the Hot Clicks Facebook group here. E-mail a comment, question or link here.
In honor of this week's Westminster Dog Show, here is a gallery of athletes with their dogs.


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Woo Hoo!! Day #5 is here. I am so excited to share my 25 Days of Christmas gifties with you. Each day I will share the packaging and the giftie that arrived from one of my ART friends. So, here we go..... Here is Giftie #5 from Ellen.
Rose Water & Summer Goodness (winner announced)
3 weeks ago


text:
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Capture the Spirit
Oklahoma Performing Arts, Inc.
Thursday, December 19, 2013 from 7:00 PM to 8:30 PM (CST)
Who's Going
San Francisco, California
London, United Kingdom
Florence, Italy
Event Details
PLEASE NOTE: WE HAVE RESCHEDULED DUE TO WEATHER CLOSING THE THEATRE! PERFORMANCE WILL TAKE PLACE ON THURSDAY, DECEMBER 19, 2013 at 7pm.
Let the Holidays begin with Tulsa Youth Ballet's
"Capture the Spirit"!
- "Capture the Spirit" brings infectious holiday cheer to the community
- You will enjoy the heart of the Nutcracker Suite as the 26-member all youth cast transports you into the Holidays with the Sugar Plum Fairy and spirited holiday song and dance
- A must-see for anyone wanting to experience the joys of the season!
- Photo opportunity with Nutcracker cast prior to the performance
- Purchase your tickets today!
The Nutcracker Suite and spirited holiday songs will delight viewers of all ages!
"Where every individual deserves the opportunity to develop and empower his or her character through classical arts training and community service programs and presentations."
(918) 269-8304 firstname.lastname@example.com www.OPAn2ART.org 'Like' us on Facebook OPAn2ART
How much do tickets cost?
How do we receive our tickets?
If you purchase tickets online, you must print your ticket out. It will be found in your event section on Eventbrite and you'll also receive an email confirming your purchase. You must bring a paper copy of your ticket to enter the performance.
What time does the show start? When do doors open?
The performance begins at 7:00pm. Doors will open at 6:30pm.
Does my toddler need a ticket? Do my grandparents get a discount?
Every person needs a ticket to enter (children 2 and under are free if sitting on a lap). There are no discounts for children or seniors. All tickets are $5 each.
Oklahoma Performing Arts, Inc. is a non-profit 501(c)3 organization classified as a public charity with a 509(a)2 educational status. Oklahoma Performing Arts, Inc. is formulated and focused on quality arts education, with a strong emphasis on community and service. Through our mission, we strive to encourage and enlighten various communities and organizations through the education and talents of our members.
When & Where
North Intermediate High School, Broken Arrow
808 East College Street
Broken Arrow,
Thursday, December 19, 2013 from 7:00 PM to 8:30 PM (CST)
Add to my calendar
Oklahoma Performing Arts, Inc.
Oklahoma Performing Arts, Inc, is a nonprofit 501(c)(3), also classified as a public charity under 509(a)(2), whose mission is that 'every individual deserves the opportunity to develop and empower his or her character through classical arts training and community service programs and presentations.'
Oklahoma Performing Arts, Inc. (OPA) began its nonprofit roots in 1996, establishing Tulsa Youth
Ballet in 2002,Tulsa Metro Youth Orchestra, Portico Dans Theatre in 2008 and most recently added iMErge, a program for students who are physically limmited, in 2011.
This nonprofit civic performing arts organization is formulated and focused on quality arts education, with a strong emphasis on community programs and service. OPA offers training in Dance, Voice, Acting and Orchestra. Programs and Presentations are provided by internationally trained and experienced faculty/members. Our faculty/members are either accredited and/or professionals in their industry.


text:
Here is a new Facebook feature that may be more useful than it sounds.
Facebook is allowing users to create New Year's messages for friends that will be held and delivered at midnight on New Year's Eve.
So why wouldn't you just send the messages yourself at that time? Considering the enormous room for error when sending Facebook messages on a mobile device in a crowded, dark, loud place, this makes sense. Even worse, think about the damage an errant drunk message could cause…
Anyways, here is how you can take advantage of this Facebook feature:
- Go to the Facebook Midnight Delivery page
- Authorize the Facebook Stories app
- Select the friends you'd like to send the message to, customize your message and add a photo (optional)
- Send the message and you are done!
There, now you can go out and enjoy New Year's Eve without having to worry about Facebook. Remember, always be sure to practice safe and responsible social networking!
Note: This post originally appeared on my other site The Facebook Tips Blog. Please visit the Tips Blog for a bunch more Facebook tips, tricks and tutorials.


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Hospital implementation of health information technology and quality of care: are they related?
Recently, there has been considerable effort to promote the use of health information technology (HIT) in order to improve health care quality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI) practices and strategies; adherence to process of care measures; risk-adjusted inpatient mortality; patient satisfaction; and assessment of patient care quality by hospital quality managers and front-line clinicians.
We conducted surveys of quality managers and front-line clinicians (physicians and nurses) in 470 short-term, general hospitals to obtain data on hospitals' extent of HIT implementation, QI practices and strategies, assessments of quality performance, commitment to quality, and sufficiency of resources for QI. Of the 470 hospitals, 401 submitted complete data necessary for analysis. We also developed measures of hospital performance from several publicly data available sources: Hospital Compare adherence to process of care measures; Medicare Provider Analysis and Review (MEDPAR) file; and Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS® survey. We used Poisson regression analysis to examine the association between HIT implementation and QI practices and strategies, and general linear models to examine the relationship between HIT implementation and hospital performance measures.
Controlling for
Hospital implementation of HIT was positively associated with activities intended to improve patient care quality and with higher performance on
Interest in the role of health information technology (HIT) for improving health care quality and patient safety has grown dramatically in recent years, spurred by the Institute of Medicine's 2001 report,
HITs intended to improve patient care quality and safety encompass an array of technologies, most notably electronic medical records (EMRs), computerized provider order entry (CPOE) systems, medication management systems (MMS), and picture archival and communications systems (PACS), all designed to improve the accuracy, accessibility, and timeliness of storage and transmission of patients' medical information. Two other technologies—bar coding and radio frequency identification (RFID) systems—are used to track the location and disposition of pharmaceuticals, medical equipment, surgical supplies, and patients to help ensure, for example, that medications are administered safely and correctly.
Despite the growing interest in information technology, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. A systematic review of 257 studies of the impact of HIT found few studies that have shown an impact on quality
In this paper, we report findings from a study involving
Sample design
We designed and conducted a survey in 2006 of all 4,237 short-term, non-federal, general service hospitals in the United States that had at least 25 beds, according to the 2004 AHA Annual Survey of Hospitals. Pediatric, psychiatric, rehabilitative, orthopedic, and chronic disease hospitals were excluded from the sample.
Survey content
We developed and administered two surveys, the
Hospital quality managers were asked to indicate the extent to which eight HITs had been implemented in their hospitals, using a six-point scale with the following response categories: "not under consideration;" "under active discussion but not yet budgeted;" "budgeted but not yet in place;" "in testing;" "implemented in one or more units;" and "implemented hospital-wide." The HITs included: 1) inpatient Electronic Medical Record (EMR) System, 2) outpatient EMR System, 3) inpatient Computerized Provider Order Entry (CPOE) System, 4) outpatient CPOE System, 5) Medication Management System (MMS), 6) Picture Archival and Communications System (PACS), 7) bar coding, and 8) Radio Frequency Identification (RFID) technology. In addition to assessing the extent of HIT implementation in hospitals, the
In the analyses in this paper, we recoded responses to questions asking extent of agreement so that "agree" or "strongly agree" were coded as 1 and the other three response categories were coded as 0. Similarly, we recoded responses to questions about implementation so that "used hospital-wide" and "used widely" were coded as 1 and the other three categories were coded as 0. The
General findings from the
Final sample
The sample contained 470 hospitals that submitted surveys, representing 11 percent of the 2004 population from which they were drawn. Eight survey responses failed to provide complete answers to questions regarding HIT implementation. In addition, we included in our analysis only hospitals that had a response from the CQO and responses to the CPS from at least three front-line clinicians. This reduced the final sample size to 401 hospitals. The length and complexity of the questionnaires contributed to the lower-than-desired response rate. However, as reported in Cohen et al.
In addition, to understand the extent to which hospitals responding to the survey may be different in terms of their commitment to QI, we compared sample hospitals to the population of hospitals in terms of their performance on the 15 Hospital Compare process measures for acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia (described in more detail in the next section). Using the approach described in the next section, we calculated composite measures of both overall performance on the process measures and condition-specific performance. When the overall composite measure was divided into deciles, the average hospital in the population fell into the fifth decile, while the average hospital in the sample was one decile higher in terms of quality. Similar results were obtained when analyses were conducted separately for each of the three conditions. Thus, while the differences were not large, the better performance on Hospital Compare measures among hospitals responding to the survey suggested that they may be in the vanguard of QI efforts (i.e., more likely to have embraced QI aims and to have engaged more extensively in QI activities) than non-participating hospitals.
Quality of care measures - hospital compare
Process of care measures
We developed a composite measure of hospital processes of care based on the Hospital Compare data for three conditions: acute myocardial infarction, heart failure, and pneumonia. We used data available from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website for calendar year 2005 on adherence to the evidence-based processes of care from hospitals that had at least 100 patients eligible for the sum of the following 15 process measures for the three conditions: AMI (6 measures): aspirin at arrival; aspirin prescribed at discharge; ACE inhibitor or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD); beta blocker prescribed at discharge; beta blocker at arrival; and adult smoking cessation advice/counsel; HF (4 measures): left ventricular function assessment; angiotensin-converting enzyme (ACE) inhibitor or ARB for LVSD; discharge instructions; and adult smoking cessation advice/counselling; Pneumonia (5 measures): oxygenation assessment; pneumococcal vaccination status assessment; initial antibiotic received within 4 hours of hospital arrival; blood culture performed in emergency department before first antibiotic received in hospital; and adult smoking cessation advice/counselling.
To calculate a composite measure across all 15 process measures, we used the approach recommended by CMS in its Premier demonstration pay-for-performance program for aggregating across measures within condition: sum the numerators, sum the denominators, and then calculate the ratio of summed numerators to summed denominators
Inpatient mortality rates
We applied the 3 M™ Health Information Systems' All Patient Refined Diagnosis Related Groups (APR-DRGs) software to the CMS Medicare Provider Analysis and Review (MEDPAR) File to measure patient severity. The APR-DRG software adds four subclasses to each DRG based on mortality risk. Using a reference population of 4.5 million Medicare patients from approximately 1,000 hospitals (including the
Patient satisfaction
We downloaded from the CMS website HCAHPS® data for sampled hospitals. We considered two questions from the survey:
1) How do you rate the hospital overall?
2) Would you recommend the hospital to friends and family?
For the first question, we focused on the percentage of respondents who gave the hospital a rating of 9 or 10 (the two highest ratings). For the second question, we focused on the percentage of respondents who said they would definitely recommend the hospital. We used the average response for the two questions as the measure of patient satisfaction.
Hospital quality Managers' assessments of patient care quality
This measure consisted of the response by the hospital quality manager to the question, "How would you rate patient care today at your hospital compared to what you think it should be?"
Front-line Clinicians' assessments of patient care quality
This measure consisted of the average of responses by front-line clinicians (physicians and nurses) to the question above that was asked of quality managers. We first calculated the mean assessment in each hospital and then used these means in the analysis. We preferred this approach to one that uses the individual front-line clinician response as the unit of analysis because it weights each hospital equally, as opposed to giving more weight to larger hospitals with greater numbers of front-line clinician responses. We have shown that in this sample it is reasonable to aggregate individual responses to the hospital level
Statistical analysis
For each performance measure, we used one-way ANOVA to examine the difference in the average of the performance measure by the following HIT categories: 0 or 1 (low), 2 to 4 (medium), and 5 or more (high). To identify pairs of means that differed across HIT category, we used Tukey's HSD (honestly significant difference) test.
When performing the statistical analyses for mortality, which is in the form of an O/E ratio, we took the log of the ratio before performing the analysis. When examining the performance measure "assessment of quality by front-line clinicians," we first calculated the mean assessment in each hospital and then used these means in the analysis.
To investigate the relationship between extent of HIT implementation and the performance measures, we used a General Linear Model (GLM) with the following independent variables: the HIT categories defined above, hospital structural characteristics, and the mean clinician response by hospital for the commitment and resource questions. We included the following four structural characteristics: bed-size category (25–99 beds, 100–399 beds, >400 beds), ownership type (government, not-for-profit, for-profit), urban/rural location (metropolitan county or non-metropolitan county), and teaching status (accredited member or non-member of the Council of Teaching Hospitals and Health Systems). In addition, we included as independent variables clinicians' responses to the commitment question and to the resources question, both of which might seriously confound the relationship between HIT and the performance measures. The assumption underlying inclusion of these two variables is that commitment and resources are the drivers of quality; HIT is one of the important means by which commitment and resources are translated into improved performance. This leads to our specific hypothesis: among hospitals with the same level of commitment and resources, those that have more completely implemented HIT will have higher levels of performance. However, there is an alternative hypothesis one might reasonably make: survey responders believe commitment and resources are higher when HIT is more fully implemented. That is, assessed levels of commitment and resources reflect the extent of HIT implementation. Under this assumption, commitment and resources should not be included as covariates in the model. We think the first hypothesis is the most likely and, hence, for our main analyses, we include commitment and resources in the model. Since these variables are positively correlated with extent of HIT implementation, inclusion of the variables decreases the chance of finding a statistically significant relationship between HIT and performance. When extent of HIT implementation was not statistically significant, we reran the model without these variables.
To examine the relationship between extent of QI practices and strategies used in the hospital and extent of HIT implementation, we ran a Poisson regression model with the number of practices and strategies as the dependent variable and the same independent variables as above.
We interpreted p values of less than 0.05 as indicating statistically significant differences. Survey data were analyzed using SPSS version 16.0.
Hospitals in the high HIT implementation category used an average of 4.20 practices and strategies while those in the medium category used 3.63 and those in the low category used 2.44 (p < 0.000 for differences in unadjusted means). As seen in Table
Risk-adjusted inpatient mortality was higher for hospitals with low HIT implementation compared to those with medium or high HIT implementation, with the O/E ratio for the former being 1.29, compared to 1.06 and 1.07 for the latter two, respectively (p < 0.000 unadjusted; p = 0.005 adjusted).
The HCAHPS®-based measure of patient satisfaction showed a similar finding, with low HIT implementation hospitals having a 60.5% average satisfaction score and medium and high HIT implementation hospitals having average scores of 66.0% and 67.9%, respectively (p < 0.000 unadjusted; p < 0.000 adjusted).
Quality managers' assessments of patient care quality (i.e., responses to the question of how they would rate patient care today at their hospital compared to what they think it should be) were higher for hospitals that had higher levels of HIT implementation. The average scores, on a five-point scale, for high, medium, and low HIT implementation hospitals were 3.56, 3.19, and 3.11, respectively (p = 0.001 unadjusted; p = 0.006 adjusted). For front-line clinicians' assessments of quality, differences between unadjusted means (with average scores of 3.40, 3.31, and 3.22, respectively) were significant (p = 0.032). After covariate adjustment, they were not significant (p = 0.392). However, if the commitment and resource variables were not included in the multivariable adjustment model, the difference in means by HIT category was statistically significant (p < 0.000).
The percent adherence to the composite Hospital Compare process of care measure increased with greater HIT implementation, with low HIT implementation hospitals at 81.0% adherence, medium HIT implementation hospitals at 82.6% adherence, and high HIT implementation hospitals at 85.23% adherence (p = .009). However, the differences were not statistically significant in the multivariable model either with or without inclusion of the commitment and resource as covariates.
We found a statistically significant association between the extent of HIT implementation and individual hospital quality practices and strategies that could be facilitated by HIT, plus a statistically significant association between HIT implementation and hospital performance on four of five measures of quality (though in one case, front-line clinicians' assessment of quality, the results were statistically significant only when the commitment and resources questions were not included in the model).
It is likely that HITs are enablers of quality practices and clinical QI strategies through enhanced communication, documentation, information transfer, performance monitoring, and error prevention, thus, leading to improved quality performance.
A limitation of the study is that of the performance measures associated with HIT implementation, one was based on the quality manager survey in which respondents were asked about both HIT implementation and patient care quality. This creates a common methods bias and makes it difficult to draw conclusions about causality. It is possible that respondents may have believed that patient care quality was better in their hospitals simply because their hospitals had implemented quality-enhancing HITs. However, the two publicly-available measures that showed a relationship to HIT implementation, mortality rate and patient satisfaction, are not subject to common methods bias. It is unlikely that knowledge of the hospital's performance on these measures influenced survey respondents to indicate a particular level of HIT implementation.
Another limitation is the survey response rate of 11 percent for the two survey-assessed measures of patient care quality. We cannot rule out the possibility that unmeasured, complex motivational factors may have contributed to the selective response by hospitals to participate in the surveys. As described in the Methods section, teaching hospitals were overrepresented in the sample and for-profit and non-metropolitan hospitals were underrepresented. In addition, sample hospitals, on average, performed better on Hospital Compare measures
Further research is needed to determine the generalizability of the relationship between HIT implementation and quality of care, and to ascertain the particular features of health information systems that lead to effective QI activities and quality performance. However, it is clear that, for the 401 hospitals in our study, those with higher levels of HIT implementation were more likely to engage in practices and strategies intended to improve the quality of patient care and also exhibited better performance on important measures reflecting different dimensions of quality: a clinical outcomes measure (risk-adjusted mortality); a publicly-available measure of patient satisfaction (HCAHPS®); assessment of patient care quality by hospital quality managers; and, though the evidence was weaker, assessment of quality by front-line clinicians.
For many years, the federal government and private organizations, such as the Institute of Medicine and the Leapfrog Group, have encouraged increased investment in information technologies, most notably EMR and CPOE systems, to improve patient care quality and safety. Numerous barriers to HIT implementation have been posited, among them high cost, technological complexity, decreased physician productivity, and uncertain return on investment
AMI: Acute Myocardial Infarction; AHRQ: Agency for Healthcare Research and Quality; APR-DRGs: All Patient Refined Diagnosis Related Groups; AHA: American Hospital Association; ARB: Angiotensin Receptor Blocker; ACE: Angiotensin-Converting Enzyme; CMS: Centers for Medicare and Medicaid Services; CQO: Chief Quality Officer; CPS: Clinicians' Perceptions of Quality Survey; CPOE: Computerized Provider Order Entry; EMRs: Electronic Medical Records; GLM: General Linear Model; HITs: Health Information Technologies; HITECH: Health Information Technology for Economic and Clinical Health Act; HRET: Health Research & Educational Trust; HF: Heart Failure; HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems; IHI: Institute for Healthcare Improvement; IOM: Institute of Medicine; LVSD: Left Ventricular Systolic Dysfunction; MEDPAR: Medicare Provider Analysis and Review; MMS: Medication Management Systems; ONC: Office of the National Coordinator for Health Information Technology; PACS: Picture Archival and Communications Systems; QI: Quality Improvement; QAS: Quality Improvement Activities Survey; RFID: Radio Frequency Identification; HSD: Tukey's Honestly Significant Difference.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
JR conceived the study. JR, AC, and MS contributed to the research design. JR and AC obtained funding. MS, JH, and JR were involved in the data analysis. All authors were involved in the interpretation of data and have read and given final approval of paper.
This work was supported by a grant from the Commonwealth Fund. We are indebted to Anthony Shih and Anne-Marie Audet of the Fund for their advice, support, and constructive suggestions throughout the design and conduct of the study. We thank our colleagues – Raymond Kang, Peter Kralovec, Sally Holmes, Frances Margolin, and Deborah Bohr – for their valuable contributions to the development of the >QAS, the CPS, and the database on which the analytic findings reported here were based. We also thank 3 M™ Health Information Systems' for use of its All Patient Refined Diagnosis Related Groups (APR-DRGs) software. We especially wish to thank Jennifer Drake for her contributions not only to survey development, but also to earlier analysis of survey findings relevant to this paper.
Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care
Clinical Information Technologies and Inpatient Outcomes: A Multiple Hospital Study
Health Information Technology and Patient Safety: Evidence from Panel Data
The Effect of Health Information Technology on Quality in U.S. Hospitals
Hospital Computing and the Costs and Quality of Care: A National Study
Features predicting the success of computerized decision support for prescribing: a systematic review of randomized controlled trials
Health Information Technology and Its Effects on Hospital Costs, Outcomes, and Patient Safety
The Quality March: National Survey of Hospital Quality Improvement Activities
Survey-Assessed Quality and Organizational Factors Related to Quality in Pursuing Perfection Hospitals
A Survey of Hospital Quality Improvement Activities
Estimating a Composite Measure of Hospital Quality from the Hospital Compare Database: Differences When Using a Bayesian Hierarchical Latent Variable Model versus Denominator-Based Weights.
How Well Can We Identify the High-Performing Hospital?
Strategic Action in Health Information Technology: Why the Obvious has Taken So Long
How Common are Electronic Health Records in the United States? A Summary of the Evidence
Pre-publication history
The pre-publication history for this paper can be accessed here:


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Islamabad, May 31: The capriciousness of Pakistani national politics seems to have rubbed off onto their national cricket as well. The volume and frequency of disputes between players, support staff and the management - the Pakistan Cricket Board - over the last three years, has translated into gross instability. This has in turn, placed the leadership of the team in jeopardy.
The latest casualty of this mess is another talented player and one would daresay a capable skipper who has moulded his team into a formidable unit - Shahid Afridi. The hard-hitting and strike-bowling Pashtoon was one of four Test captains changed in the space of two months last year as Pakistani cricket grappled to come to grips with its match-fixing (during the tour of Australia) and spot fixing (while Pakistan visited England) scandals, not to mention, a poor win record.
This unsavory phenomenon points to the fact that the management and captains have not reposed faith in each other. The PCB for its part is guilty of ruling with too much of an iron hand, not according either the now-sacked one-day skipper Shahid Afridi nor coach Wazar Younis much stake in the team selection process. It was an inevitability therefore that Waqar and Afridi would fall into a collision course where the key-issue of selection was concerned.
And when Shahid Afridi dared to stand up to the board, they must have interpreted his defiance as indicative of someone who had become too big for his boots. The PCB's "resolve" was prompt - Afridi was stripped off his captaincy and relegated to an ordinary team member.
Pakistan cricket will sorely miss their ODI captain, a veteran who has unleashed a whole string of batting a bowling efforts in his 15-year career, not least of which, was his wicket-taking acumen which took Pakistan to the semi-finals of the recently-concluded World Cup.
Oneindia Cricket


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Today, a federal judge in Nebraska threw out a lawsuit against the Obama Administration's proposed rules on contraception coverage. The reason was two-fold: some of the plaintiffs lacked standing because they are already exempted from the rule, and the law hasn't been implemented yet, so there's no proof that it would actually infringe on the religious freedom of institutions that oppose contraception. "...although the Rule that lies at the heart of the plaintiffs' complaint establishes a definitive, final definition of "religious employer," ... [it] is currently undergoing a process of amendment to accommodate these organizations. The plaintiffs face no direct and immediate harm, and one ca … [Read more...]
Religious Freedom: Once More, With Feeling
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Lets talk about religious freedom, shall we? It seems that the religious news feeds are consumed with the notion lately, all centered on coverage for birth control and emergency contraception. For those who haven't been following the controversy, it all stems from a new Department of Health and Human Services rule that would require employers to provide contraception in their health care plans. This new rule would apply to all employers, including schools and hospitals run by religious organizations, though churches and businesses that primarily hire people of their own faith were granted exemptions. This prompted a firestorm of controversy, particularly from Catholics, who claimed the new … [Read more...]


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The Hilton Deerfield Beach/Boca Raton hotel is nestled between Fort Lauderdale and Palm Beach and within two miles of the stunning East Coast Beaches of Florida. The Hilton Deerfield Beach/Boca Raton, FL hotel proudly stands as a distinctive hotel in Deerfield Beach. Although close to the hustle and bustle of the Fort Lauderdale and Miami venues, The Hilton Deerfield Beach/Boca Raton offers a convenient sanctuary from our neighboring cities.
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