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Simple rib fractures are the most common injury sustained following blunt chest trauma, accounting for more than half of thoracic injuries from nonpenetrating trauma. Approximately 10% of all patients admitted after blunt chest trauma have one or more rib fractures. These fractures are rarely life-threatening in themselves but can be an external marker of more severe visceral injury inside the abdomen and the chest.
The image below depicts aortic injury, closely associated with a widening of greater than 8 cm measured at the widest points of the mediastinum.
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Aortic injury is closely associated with a widening of greater than 8 cm measured at the widest points of the mediastinum on an upright anteroposterio....
The most common mechanism of injury for rib fractures in elderly persons is a fall from height or from standing. In adults, motor vehicle accident (MVA) is the most common mechanism. Youths sustain rib fractures most often secondary to recreational and athletic activities, as well as by nonaccidental trauma.
Rib fractures may also be pathologic. Cancers that metastasize to bone (eg, prostate, breast, renal) frequently become apparent in a rib. Ribs are relatively thin compared with major long bones and are more likely to fracture when invaded by a metastatic lesion.
In a study of Japanese patients with rheumatoid arthritis who were followed over a mean duration of 5.2 years, 13.5% reported incident fractures, with rib fractures being the most common fractures in men and vertebral fractures being the most common fractures in women, followed by rib fractures.[1]
The chest wall protects underlying sensitive structures by surrounding internal organs with hard osseous structures including the ribs, clavicles, sternum, and scapulae. An intact chest wall is necessary for normal respiration.
Rib fractures may compromise ventilation by a variety of mechanisms. Pain from rib fractures can cause respiratory splinting, resulting in atelectasis and pneumonia. Multiple contiguous rib fractures (ie, flail chest) interfere with normal costovertebral and diaphragmatic muscle excursion, potentially causing ventilatory insufficiency. Fragments of fractured ribs can also act as penetrating objects leading to the formation of a hemothorax or a pneumothorax. Ribs commonly fracture at the point of impact or at the posterior angle (structurally their weakest area). Ribs four through nine (4-9) are the most commonly injured.
The thinnest and weakest portion of the first rib is at the groove for the subclavian artery.[2] The mechanism of first-rib injury in motor vehicle accidents seems to be a violent contraction of the scalene muscles brought on by the sudden forward movement of the head and neck.[3]
A single blow may cause rib fractures in multiple places. Traumatic fractures most often occur at the site of impact or the posterolateral bend, where the rib is weakest.
Due to the greater pliability of children's ribs, greater force is required to produce a fracture.
The incidence of rib fractures is dramatically underreported. More than 2 million blunt mechanisms of injury occur annually just as motor vehicle collisions, with reported incidence of chest injury between 67 and 70% of those.[4] The prevalence of rib fractures is linked to the prevalence of the underlying cause of the trauma. Rib fractures are more common in countries with higher incidence of MVAs.
Because children have more elastic ribs, they are less likely than adults to sustain fractures following blunt chest trauma. Elderly individuals are more likely to have associated injuries and complications. Children present more frequently with trauma to the underlying chest and abdominal organs without the associated rib fractures commonly seen in adults. Classically, this made rib fractures in children an ominous sign of potential high-force injury. Bruising near the fracture site is uncommon with pediatric rib fractures, seen in only 9.1% of pediatric rib fractures in one study.[5] Consider child abuse in children who lack a significant mechanism for multiple rib fractures or have fractures in different stages of healing. Children younger than 2 years with rib fractures have a prevalence of child abuse as high as 83%.
Older persons are more prone to rib fractures than younger adults[6] and, therefore, the pulmonary sequelae such as atelectasis, pneumonia, and respiratory arrest. The presence of cardiopulmonary disease also significantly increases morbidity and mortality rates in patients older than 65 years. The clinical benefits of a rib scoring system has been tested at one site for hospitalized older adults.[7]
Rib fractures are not usually dangerous in and of themselves. Patients may develop pneumonia from splinting. Morbidity correlates with the degree of injury to underlying structures.
In one study of patients with rib fractures, the mortality rate reached 12%; of these, 94% had associated injuries and 32% had a hemothorax or a pneumothorax.[8] More than half of all patients required either operative or ICU management. Average blood loss per fractured rib is reportedly 100-150 mL.
In one retrospective study of 99 elderly patients, 16% of patients (95% confidence interval [CI], 9.5-24.9%) developed adverse events, including 2 deaths.[9] Adverse events were defined as acute respiratory distress syndrome (ARDS), pneumonia, unanticipated intubation, transfer to ICU for hypoxemia, or death. Risk factors associated with these adverse events were age ≥85 years, initial systolic blood pressure < 90 mm Hg, hemothorax, pneumothorax, 3 or more unilateral rib fractures, or pulmonary contusion. These risk factors predicted adverse events with 100% sensitivity (95% CI, 79.4-100%), and 38.6% specificity (95% CI, 28.1-49.9%), and they may identify variables that might aid in identifying patients at high risk for serious adverse events if validated in a larger prospective study.
A study of rib fractures in patients younger than 21 years found that mortality increased nearly linearly for increasing numbers of pediatric rib fractures. Odds of mortality increased with each additional rib fractured in all pediatric age groups. Mortality doubled from 1.79% without rib fracture to 5.81% for 1 rib fracture and then nearly linearly increased to 8.23% for 7 fractures. Ventilator days also increased with increasing number of rib fractures.[10]
Rib fractures are the most common injury in elderly blunt chest trauma patients, and each additional rib fracture increases the odds of dying by 19% and of developing pneumonia by 27%.[11, 12]
Position of the fractured rib in the thorax helps identify potential injury to specific underlying organs. Fracture of the lower ribs usually is associated with injury to abdominal organs rather than to lung parenchyma. Fracture of the left lower ribs is associated with splenic injuries, and fracture of the right lower ribs is associated with liver injuries. Fracture of the floating ribs (ribs 11, 12) is often associated with renal injuries.
First rib fractures have often been described as having a high association with serious or lethal spinal or vascular injuries.[13] They are rarest of all rib fractures[3] and were once thought to be a harbinger of severe trauma,[14] since the first rib is very well protected by the shoulder, lower neck musculature, and clavicle.
First rib fractures were thought to require a much higher impact force to fracture than other ribs, but that theory is now in question. Until further studies are done, fractures of the first rib should raise suspicion of significant chest trauma. The presence of a first rib injury requires a multidisciplinary approach. CT of the spine and chest allows for an early diagnosis. Appropriate treatment and observation in the intensive care unit may prevent further morbidity and/or mortality.[13]
While first rib fractures have a high association with spinal fractures and are associated with multisystem injuries, the occurrence of first rib fractures is not always associated with increased morbidity and mortality.[13] Mortality rates as high as 36% have been previously reported with fractures of the first rib, which are associated ith injury to the lung, ascending aorta, subclavian artery, and brachial plexus. Other complications associated with first rib fractures include delayed subclavian vessel thrombosis, aortic aneurysm, tracheobronchial fistula, thoracic outlet syndrome,[15] and Horner's syndrome.[16]
The association of lower rib fractures with pelvic fractures has been associated with a higher incidence of solid organ injury.[17]
Isolated rib fractures in younger patients have a good prognosis. Older patients have a higher incidence of significant pulmonary complications. In one study, 16% of patients 65 years and older with isolated blunt chest trauma had some delayed adverse event, defined as pneumonia, ARDS, unanticipated intubation, need to transfer patient to ICU for hypoxemia, and death from pulmonary sequelae.[9]
Return to work or sport depends on the activity involved and the level of pain. Heavy labor and intensive training for athletes with stress fractures are not recommended for the first 3 weeks. When pain is not present at rest, the patient can begin to increase his or her activity level but this should be gradually done. Most rib fractures heal within 6 weeks. Many patients are able to resume daily activities much sooner.[18]
Virtually all nonpathologic rib fractures heal well with conservative management. Some patients are able to return to work within a few days, depending on their occupation.[18]
Description of the prehospital scene by paramedics can provide important clues to the possibility of rib fractures. After motor vehicle collisions, deformation of the steering wheel and activation of seat belts and airbags have been associated with rib injuries.
Patients with rib fracture frequently complain of pain on inspiration and dyspnea.
Rib fractures have been reported after coughing spells without other significant trauma.
Athletes with high-force, recurrent movements of the arms (eg, discus throwers) have had stress fractures of the upper and middle ribs.[19]
Consider nonaccidental trauma in pediatric cases, and take an appropriate history for that diagnosis.
Tenderness on palpation, crepitus, and chest wall deformity are common findings of rib fracture.
Paradoxical chest wall excursion with inspiration is seen with flail chest. A flail chest occurs when a large segment of ribs is not attached to the spine. These ribs are broken in at least 2 places on each rib. The paradoxical movement occurs because the middle section of the rib between the 2 fracture sites moves in response to intrathoracic pressure changes not intercostal muscle contractions. With flail chest, the detached segment of the chest wall is pulled into the chest cavity during inspiration and pushed outward during expiration. This abnormal motion increases the work of breathing and compromises respiratory function, and may necessitate intubation and ventilatory support.
Specific signs of ventilatory insufficiency include cyanosis, tachypnea, retractions, and use of accessory muscles for ventilation. Less specific signs include anxiety and agitation. Bruising near the fracture site is uncommon in pediatric rib fractures, seen in 9.1% in one study.[5]
If fracture of the lower ribs is suspected, assess the patient for abdominal tenderness and costal margin tenderness, which could raise suspicion for injury to intra-abdominal organs.[20, 21]
Causes include the following:
Laboratory studies are generally not useful for evaluation of isolated rib fractures. Consider obtaining urinalysis in cases of lower rib fractures, as hematuria may indicate associated renal injury.[20] Tests of the pulmonary function (arterial blood gas measurements) are used to determine if the lungs have been contused but do not actually test for rib fractures.
Anteroposterior (AP) and lateral chest films are used routinely to assist in the diagnosis of rib fractures, yet sensitivity as low as 50% has been reported. Delayed or follow-up radiographs can be very helpful.
Chest radiographs are much more useful in the diagnosis of underlying injuries, including hemothorax, pneumothorax, lung contusion, atelectasis, pneumonia, and vascular injuries.
Findings of sternal fracture[4] or scapular fracture[23] should increase suspicion for rib fractures.
Obtaining a rib radiograph series remains controversial, as the additional information rarely changes the clinical picture or alters treatment. Rib detail radiographs can be helpful in evaluation of the 1st and 2nd ribs and the 7th through 12th ribs. (See the images below.) Formal plain radiographs can also be useful to document abuse for legal purposes.
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Anteroposterior (AP) radiograph of an elderly female patient with severe left chest wall pain after a minor fall. This image demonstrates a left later....
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Right rib radiograph in a 48-year-old male who presented with severe right posterior chest wall pain following a fall. This image demonstrates 2 fract....
Diagnostic sensitivity is higher in rib radiographs than in chest radiographs; however, with a high clinical suspicion, treat for fracture regardless of the radiographic result.
Aortic injury, as shown in the image below, is closely associated with a widening of greater than 8 cm measured at the widest points of the mediastinum on an upright anteroposterior chest radiograph.
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Aortic injury is closely associated with a widening of greater than 8 cm measured at the widest points of the mediastinum on an upright anteroposterio....
Clinicians should obtain a skeletal survey in infants suspected of being abused. Findings consistent with abuse include the presence of multiple rib fractures in various stages of healing.
Bedside ultrasonography by emergency physicians has been described and provides rapid diagnosis with no radiation exposure.[25]
Advantages include diagnosis of fracture in unossified bone in children, and diagnosis of other rib fractures that may be missed on plain radiographs. Small preliminary studies suggest that ultrasonography may be more sensitive than chest radiography in detecting rib fractures when physicians who perform the examination are comfortable using the technique.[26, 27, 28, 29]
Ultrasound also detects costal cartilage fractures and costochondral junction fractures better than radiography. Healing fractures with callous formation and sternal fractures may also be sonographically detected.
The technique includes first clinically identifying the site of maximal tenderness, then using a high-frequency 7-MHz to 12-MHz linear transducer. The transducer is placed perpendicular to the long axis of the rib to identify the posterior surface of the rib by its distinct acoustic shadowing and then rotated 90 degrees to detect any discontinuity of cortical alignment, seen as a break in the hyperechoic rib margin.[25]
Other reported but less common sonographic signs suggestive of fracture include the following: a linear acoustic edge shadow posterior to the fracture, a reverberation artifact posterior to the fracture, and the presence of a hypoechoic hematoma. Once a rib fracture is diagnosed, ultrasonography can then be conveniently and reliably used to exclude the likely complications of pneumothorax and hemothorax.[25]
A limitation is that retroscapular ribs and the infraclavicular portion of the first rib are technically inaccessible by sonography. However, these are uncommon sites for rib fractures.[25]
Chest CT scan (see the image below) is more sensitive than plain radiographs for detecting rib fractures.[30] The modality can also provide information regarding the number of ribs involved.
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Axial computed tomography image of the chest in a patient with both anterior and posterior thoracic injuries. A fracture of the sternum (white arrow) ....
If complications from rib fractures are suspected clinically or diagnosed by plain radiographs, a chest CT scan may be helpful to document specific injuries, to characterize extent of injury, and to plan for definitive management.
An associated CT scan of the abdomen with intravenous contrast should be considered in cases involving lower rib fractures with suspected or known injury to the liver and/or the spleen.
In a study of of rib fractures in clinically diagnosed cases of child abuse, a retrospective analysis of initial and follow-up skeletal surveys and CT scans of 16 patients younger than 12 months found that 17% (18 of 105) of rib fractures were not documented on the initial skeletal survey. Those fractures not originally detected were seen only after follow-up imaging, more than half of which (11/18) were detected on a subsequent CT. Many of these were posterior (43%) or anterior (30%), and 96% were nondisplaced.[31]
Because first and second rib fractures are often associated with vascular injury, ED physicians should consider angiography for such patients, especially if symptoms and signs of neurovascular compromise are present. This is particularly important with posteriorly displaced fractures of the first 2 ribs, which have a much higher degree of association with abnormal angiographic findings than other rib fractures.
While first rib fractures previously were considered a strong risk factor for aortic injury, most authorities now believe that aortography and/or CT scan are not indicated without other evidence of injury, such as abnormal mediastinum.
A bone scan of the chest wall is the preferred instrument to diagnose rib stress fractures early in the pathologic process. Such fractures typically are not visible on plain films of the chest until very late in their healing, when they develop a visible callus.
Normal costochondral uptake in a child may be intense enough to suggest rib stippling when viewed from a posterior projection.
Any disease or lesion of a rib that results in increased bone turnover may result in positive findings in the ribs.
False-negative results may occur in patients who have recently received iron dextran injections as high levels of iron in the bone marrow interfere with the normal uptake of bone.
Although MRI is not used as a primary means of detecting rib fractures, displaced or angulated lateral rib fractures as well as posterior rib fractures can be detected by MRI.
Breathing motion can cause artifacts, resulting in nondiagnostic MRIs of anterior rib fractures.
Partial-volume effects may result in a false suggestion of a nondisplaced rib fracture.
Prehospital care should focus on airway maintenance and supplemental oxygen.
The goal of initial ED care is stabilization of the trauma patient and multisystem trauma evaluation.
Respiratory care, including use of incentive spirometry to prevent atelectasis and its complications, is often important. Holding a pillow or similar soft brace against the fracture site reduces discomfort while using the spirometer or when coughing.
Pain control is fundamental to the management of rib fractures to decrease chest wall splinting and alveolar collapse in order to clear pulmonary secretions. Isolated rib fractures, without associated injuries, may be managed on an outpatient basis with oral analgesics, starting with NSAIDs if not contraindicated and progressing to narcotics if not sufficient. A lidocaine patch for pain control has been used, but one study suggests its efficacy is no greater than placebo.[32] Other options include parenterally administered narcotics titrated to prevent respiratory depression. While rib belts or binders do control pain, they have been linked to hypoventilation, atelectasis, and pneumonia. As a result, their use is no longer recommended.
For patients with a significant mechanism of trauma, a CT of the chest and abdomen can be useful in scanning for significant related injury.
Several researchers recommend hospital admission for any patient with 3 or more rib fractures, and ICU care for elderly patients with 6 or more rib fractures. They cite the significant correlation between these findings and serious internal injuries, such as pneumothorax and pulmonary contusion.[33]
Patients with minor rib injuries able to cough and clear secretions may be discharged with adequate analgesic medications. Adequate analgesics are critical to successful outpatient management of rib fractures. In one study, 19% of patients discharged with the diagnosis of rib fracture returned to the ED for unplanned follow-up; the chief complaint was insufficient analgesia (in 56%).[34] Most patients who will develop complications will do so within 2 weeks, so a follow-up plan within 2 weeks should be made.[34, 35]
Routine follow-up chest x-rays days after the injury are not recommended. They add little besides cost to a careful clinical examination and should be performed only if indicated by clinical findings (eg, unilateral decreased breath sounds suggesting pneumothorax, persistent pain suggesting malunion or nonunion).[36]
Consider an incentive spirometer, especially with multiple fractures, as it may help avoid complications and remind the patient to avoid splinting and to take deep breaths.
One study of patients aged 65 years and older suggests that patients in this age group without risk factors may be safely discharged home. Risk factors are age ≥85 years, initial systolic blood pressure < 90 mm Hg, hemothorax, pneumothorax, 3 of more unilateral rib fractures, or pulmonary contusion. Patients without these risk factors, with isolated blunt chest trauma, did not have an adverse event in this preliminary study (100% sensitivity, 38.5% specificity).[9]
Because of the close association of rib fractures with injury to underlying structures, the ED physician may need to consult the trauma service.
Pain management specialists can be helpful for admitted patients.
Patients with isolated rib fractures who are unable to cough and clear secretions adequately should be considered for admission for 24-hour observation. Consider admission for patients with underlying lung disease or decreased pulmonary reserve. A lower threshold for admission of older persons with isolated rib fractures is warranted because of their higher incidence of hypoventilation, hypercapnia, atelectasis, and pneumonia.[9]
Specifically in the age group 65 years and older, consider admission for patients age ≥85 years, or with initial systolic blood pressure < 90 mm Hg, hemothorax, pneumothorax, 3 or more unilateral rib fractures, or pulmonary contusion.[9] Admission may also allow for observation for occult intra-abdominal organ injury.
Patients being admitted should have good pain control and, if possible, given an incentive spirometer to prevent pulmonary splinting and its resultant complications.[37] A paravertebral block is only useful for patients with unilateral rib fractures but is associated with a lower rate of systemic hypotension.[38]
Intercostal nerve blocks provide pain relief without affecting respiratory function, although risks of this procedure include intravascular injection and pneumothorax. The procedure is also limited by the duration of the block and, for patients with multiple rib fractures, the need to perform the procedure at multiple intercostal levels. Intercostal nerve block has been shown to have the advantage of providing dramatically more effective pain control than conventional medications in the initial stage of treatment of patients with thoracic injuries. It is also relatively simple to use; is not associated with neurologic complications due to nausea, vomiting, dizziness, or bleeding; and is not associated with complications from possible misjudgment observed in other measures, such as thoracic epidural injection.[39]
A meta-analysis that included 8 studies (232 patients) did not demonstrate significant benefit of epidural analgesia on mortality, ICU, and hospital length of stay compared with other analgesic modalities in adult patients with traumatic rib fractures. Mechanical ventilation with the use of thoracic epidural analgesia with local anesthetics may be beneficial, although hypotension was significantly associated with thoracic epidural analgesia. Further research and evaluation is needed regarding the benefits and harms of epidural analgesia in this population before being considered as a standard of care therapy.[40]
Patients with isolated rib fractures who are unable to cough and clear secretions adequately should be considered for admission for 24-hour observation.
Consider admission for patients with underlying lung disease or decreased pulmonary reserve.
A lower threshold for admission of older persons with isolated rib fractures is warranted because of their higher incidence of hypoventilation, hypercapnia, atelectasis, and pneumonia.[9]
Specifically in the age group 65 years and older, consider admission for patients age ≥85 years, or with initial systolic blood pressure < 90 mm Hg, hemothorax, pneumothorax, 3 or more unilateral rib fractures, or pulmonary contusion.[9]
Admission may also allow for observation for occult intra-abdominal organ injury. Patients being admitted should have good pain control and, if possible, given an incentive spirometer to prevent pulmonary splinting and its resultant complications.[37] A paravertebral block is only useful for patients with unilateral rib fractures but is associated with a lower rate of systemic hypotension.[38] Intercostal nerve blocks provide pain relief without affecting respiratory function, although risks of this procedure include intravascular injection and pneumothorax. The procedure is also limited by the duration of the block and, for patients with multiple rib fractures, the need to perform the procedure at multiple intercostal levels.
A meta-analysis that included 8 studies (232 patients) did not demonstrate significant benefit of epidural analgesia on mortality, ICU, and hospital length of stay compared with other analgesic modalities in adult patients with traumatic rib fractures. Mechanical ventilation with the use of thoracic epidural analgesia with local anesthetics may be beneficial, although hypotension was significantly associated with thoracic epidural analgesia. Further research and evaluation is needed regarding the benefits and harms of epidural analgesia in this population before being considered as a standard of care therapy.[40]
In hospitalized patients, an intrapleural catheter placement may also be used for delivery of anesthetics directly into pleural cavity. The catheter used to administer the anesthetic can be placed adjacent a thoracostomy tube at the time of tube placement.[41]
Patient-controlled analgesia pumps have also shown to be useful in hospitalized patients allowing adequate pain relief with minimal inhibition of respiratory drive.
Complications of rib fracture may include the following:
Patients with fractured ribs and vital capacity of less than 30% have been found to have a higher rate of pulmonary complications. One study found that every 10% increase in vital capacity was associated with a 36% decrease in likelihood of pulmonary complications. Patients with a vital capacity greater than 50% had a significantly lower rate of pulmonary complications.[45]
First rib fractures have often been associated with serious head injury, cervical spine injury, delayed subclavian vessel thrombosis, aortic aneurysm, tracheobronchial fistula, thoracic outlet syndrome, and Horner syndrome.[3]
A small percentage of rib fractures do not heal even though a fibrous capsule may envelope the fracture. A nonunion may present months to years after injury and can cause discomfort with respiration due to movement of the fracture site. Some patients find the respiratory restriction due to pain quite disabling.
The American College of Radiology (ACR) Appropriateness Criteria for rib fracture includes the following[46] :
Pain control remains the mainstay of treatment, usually with nonsteroidal anti-inflammatory or oral narcotic agents.
Clinical Context: First-line drug of choice for treatment of mild to moderately severe pain, if no contraindications. Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which, in turn, decreases prostaglandin synthesis.
Clinical Context: For relief of mild to moderately severe pain and inflammation.
Administer small dosages initially to patients with lower body weights, older persons, and those with renal or liver disease. Doses higher than 75 mg do not increase therapeutic effects. Administer high doses with caution and observe closely.
Clinical Context: Used for relief of mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, which decreases prostaglandin synthesis.
These agents are used most commonly for the relief of mild to moderately severe pain. Effects of NSAIDs in the treatment of pain tend to be patient specific, yet ibuprofen is usually the first-line drug of choice for initial therapy. Other options include fenoprofen, flurbiprofen, ketoprofen, indomethacin, and piroxicam.
Clinical Context: DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.
Effective in relieving mild to moderate acute pain; however, has no peripheral anti-inflammatory effects. May be preferred in elderly patients because of fewer GI and renal side effects.
Clinical Context: Combines analgesic effects of a centrally acting opium-derived alkaloid (codeine) and a peripherally acting nonopioid analgesic (acetaminophen). Indicated for treatment of mild to moderate pain.
Clinical Context: Drug combination indicated for relief of moderately severe to severe pain.
Clinical Context: Drug combination indicated for the relief of moderate to severe pain. DOC for aspirin-hypersensitive patients.
Clinical Context: Drug combination indicated for relief of moderately severe to severe pain.
Clinical Context: Drug combination indicated for the relief of moderate to severe pain.
Clinical Context: Used to achieve a desired anxiolytic and analgesic effect because easily titrated to desired level of pain control or sedation. Reversed by naloxone.
Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained fractures.


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Congratulations to all our 2017 Arizona Science Bowl Winners!
Winners from the 2017 Arizona Science Bowl will now go on to compete at the National Science Bowl in Washington, D.C., April 27– May 1, 2017
The Arizona Science Bowl is the most unique and exciting STEM competition there is! The competition consists of school teams from throughout the state. The teams are four students, one alternate, and a teacher who serves as a coach. Together, they face-off in fast-paced question and answer rounds and tested on a range of science disciplines including biology, chemistry, Earth science, physics, energy, and math. This is a regional event of the National Science Bowl and is facilitated nationwide by the U.S. Department of Energy's Office of Science.
The competition is open to teams from throughout the State of Arizona. Interested teams must pre-register starting Monday, October 3, 2016 to compete. Winners of this regional Science Bowl will advance to the National Science Bowl in Washington, D.C.
The Arizona Science Bowl events are presented by the Arizona Technology Council Foundation. Hosted at ASU West in partnership with the ASU New College of Interdisciplinary Arts and Sciences and the School of Mathematical and Natural Science.
Solugenix Corporation is a proud sponsor of this event.
Get General Information for the 2017 Science Bowl events here

subset: commoncrawl


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Asesthesia and surgery affect your entire body, so it is important for those providing your anesthesia to know as much about you as possible. Before your surgery, you may be scheduled for a visit with your anesthesiologist to review your medical history and your physical condition. This visit might be scheduled by the nurse who performs your pre-surgery phone interview.
You should bring a list of all medications that you take on a regular basis or have taken recently with you to the preoperative visit and/or on the day of your surgery. It is best to include the dose information from the medication label on your list. The dose is commonly shown in milligrams (mg). For example, 100mg stands for 100 milligrams. If a phone registration is done, have your medications handy to give the nurse.
Providing your anesthesiologist with your detailed medical history and drug list is very important. This information and the laboratory date from your tests are the basis upon which many anesthetic decisions are made.
Cigarettes and alcohol affect your body just as strongly and sometimes more than any of the medically prescribed drugs you may be taking. Because of their various effects on your lungs, heart, liver and blood, cigarette or alcohol consumption can change the way an anesthetic drug will work during surgery. It is crucial to let your anesthesiologist know about your consumption of these substances.
This is also true for "street drugs" such as marijuana, cocaine, amphetamines, etc. People are sometimes reluctant to discuss such things, but all conversations between you, your doctor and nurse are confidential. Your anesthesiologist's only interest in this subject is in learning enough about your physical condition to provide you with the safest anesthesia possible. In this case, honesty is the best and safest policy.
Please advise us if you are nursing. Since anesthesia effects your breast milk, you may be asked to pump for the first 24 hours after surgery.
Your surgery and the types of anesthesia and their benefits and risks are explained to you during this visit. Laboratory tests and prescriptions for medications, if needed, are ordered.
If you haven't met with your anesthesiologist before coming to the hospital for surgery, you will have that opportunity immediately before your surgery.


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Calor Div One South & West.
Cirencester Town 2.
Fleet Town 2.
JODY BEVAN wanted his 250th Southern League goal to be meaningful – he probably wasn't banking on it salvaging a home point for title-chasing Cirencester against basement club Fleet Town.
Bevan crashed a near-post volley from a Steve Davies cross in off the underside of the bar in the 65th minute to make the score 2-2.
It prompted a wholesale bombardment of the Fleet goal for the final 25 minutes but Ciren could not fashion a winner thanks to brilliant goalkeeping from ex-Bournemouth player Ryan Pryce and an Alamo-like rearguard action from his defence.
Nonetheless, the hosts were awarded a rather harsh penalty for handball in stoppage time which gave them the opportunity to gain a deserved win, however cruel that might have been to the Fleet battlers.
Prolific striker Lee Smith who had put away two spot kicks against Bridgwater in their previous match, stepped up, weathering some persistent sledging from at least one Fleet player along the way, before blazing his shot over the bar.
There was still time for the referee to turn down a more obvious penalty when the tireless Aidan Bennett was hauled down in the box and for one more Pryce-less save when the keeper somehow clawed another goal-bound effort out of the top corner at the end of a breathless and scintillating second half.
It had looked as if it might be plain sailing for Ciren when Ellis Dunton put them ahead in the seventh minute with what is rapidly becoming one of his trademark set piece headers from a Sean Wood corner.
Smith should probably have put the hosts 2-0 up five minutes later when a defensive slip left him clear in a one-on-one, but he sent his shot wide.
For all Fleet's lack of cutting edge up front – they never once troubled Glyn Garner in the first half – they were competing with much more passion than you would expect of a side propping up the table. And the contest between Smith and Fleet right back James Scott was the most absorbing battle of the afternoon.
After losing their momentum briefly, Ciren finished the half strongly – Steve Davies had an effort headed off the line, Joe Shepherd could not drill his shot past a mass of bodies after being set up well by a thrilling byline run from Davies and Sean Wood was unlucky when a fierce drive rose just over the bar.
Ciren's inability to finish off their opponents in the opening 45 was punished when the first Fleet attack of note cut through a static Ciren defence in the 52nd minute. Rob Carr's shot came back off the post and Pat Cox was given enough time to finish off the rebound.
Fleet's tails were now up and a shell-shocked Ciren conceded again three minutes later when a headed clearance from a corner fell to the skilful Jordan Carter almost 30 yards out and he hit the sweetest half volley past Garner to give the visitors a shock lead.
At half-time, Simba Mlambo, who had been a handful against Ciren in the reverse fixture earlier in the season, came off the bench and his pace and trickery was giving Fleet an outlet down the right flank, particularly on the counter.
However, after going behind, Jody Bevan was introduced from the bench and he was pivotal throughout the final 35 minutes as Ciren laid siege to the Fleet goal.
Bennett snatched at a good chance in the 58th minute, Pryce made the first of his fine saves in the 60th from Davies and a defender threw himself in front of a goal-bound Smith effort a minute later.
But it was that man Bevan who brought his side back level. Bennett found Davies with a glorious pass out wide and the winger's cross was met with ferocious accuracy at the near post by the Everton fan, a finish worthy of Romelu Lukaku.
Bennett was then denied a deserved goal in the 69th minute when his fierce shot was arrowing towards the top corner only for Pryce to appear from nowhere to tip it over.
Astute flicks from Bevan set both Davies and Smith through on goal in the closing minutes but again there was no way past the brilliant Pryce.
Fleet were under a relentless assault but they were playing a full part in a pulsating game and they had three chances to snatch the points themselves on the break through Cox, Mlambo and player manager Craig Davis. Ultimately, though, it was two points dropped by Cirencester who created enough chances to win a handful of games. But credit to Fleet whose quality and passion makes their lowly position in the league hard to fathom.
A memorable game, then, especially for milestone man Bevan. Cirencester Town: Garner, Mortimer-Jones, Dunton, Pritchett, Shepherd (Bevan, 56), Henry (capt), Hooper, Wood, Bennett, Davies, Smith. Unused subs: Bromley, Bond, Davidge, Pitts.
Standard MoM: Jody Bevan.


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Educating the Educators: Post Crisis Response to a Tragedy
BHS 2007 Reunion Committee: Corie Ward, Kaytlin (Mason) Painter, Lisa (Sockrider) Rockhold, and Craig Hanthorn
Thursday, April 3, 2014 at 9:00 AM - Friday, April 4, 2014 at 5:00 PM (EDT)
Who's Going
San Francisco, California
London, United Kingdom
Florence, Italy
Event Details
Student Affiliates of School Psychology (SASP) at Long Island University will host its 3rd annual Educating the Educators conference on April 3rd & April 4th 2014. This years overarching theme of discussion will be: Post-Crisis Response to Tragedy. We expect that this two-day conference will bring in a generous amount of people based on the audience that we are targeting.
The conference committee is excited to announce our lineup for the 2014 conferece:
Thursday 4/03/14 from 9am to 4:30pm:
9:00-10:00am Kelly Caci and Dr. Andrew Livanis from New York Association of School Psychology (NYASP) speaking on Hurricane Sandy
10:00-11:00am Representatives from Child Mind Institute discussing September 11, 2001
11:00-12:00pm Kim Hahne, Tom Westcott, and Mary Sue Rose of Owego Apalachin School District speaking on a long term response to tragedy over the course of a school year.
1:00-2:30pm Dr. Ray D. DiGiuseppi from MHS and St. John's University will be speaking on his developed anger scales.
2:30-4:30pm Keynote Speaker: Karla Vazquez and Tom Brant of Connecticut Association of School Psychology speaking on their personal expereinces of Sandy Hook Elementary.
Friday 4/04/14 from 9am to 5pm:
9:00-10:00am Carolyn Stoops of Chardon High School in Northeast Ohio will speak on the shooting that occurred.
10:00-11:00am Jacqui Slinger of Bluffton University (OH) to speak on the bus accident that involved their baseball team.
11:00-12:00pm Peg Healey of Colorado will be speaking on the impact the Aurora Movie Theatre Shooting had on schools.
1:00-2:30pm Kathy Sievering of Colorado will discuss Columbine High School as it relates to other school shootings she has experienced.
2:30-4:00pm Keynote Speaker: Kelly Griffin of Virginia Tech to speak on remembrance and community outreach as a part of the shooting that took place.
4:00-5:00pm Panel Discussion – Open Forum.
Issues to be discussed range from personal experiences, community involvement, coping strategies, counseling, and preventative measures. The goal of this conference is to express the importance of educating the educators and professionals to develop guidelines for when such crisis occur.
We hope that you choose to become a participant of this event and look forward to hearing from you.
Thank you for your time and should you have any questions please do not hesitate to reach out to our Conference Correspondents: Craig Hanthorn (419-236-4981 / firstname.lastname@example.com) or Sushma Meka (916-609-4089/ email@example.com).
Hotel information can also be accessed via: Indigo Hotel (Downtown Brooklyn) - Use "LIU Psychology Group" when booking for an additional discount. - Limited Rooms
**IMPORTANT: For participants registering under NYASP membership, information will be cross referenced. If you register under NYASP member and you are not a member, your registration will be revoked with no refund.
*Checks made out to "Long Island University", Memo line: LIU SASP #20500
**Cash and Checks mailed to: 1 University Plaza
Long Island University
C/O: School of Education
Attn: Dr. Andrew Livanis and SASP
Brooklyn, NY 11201
When & Where
Long Island University: Brooklyn Campus
1 University Plaza
New York,
Thursday, April 3, 2014 at 9:00 AM - Friday, April 4, 2014 at 5:00 PM (EDT)
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|Nathan McCall <n...@vervewireless.com>
|Re: cassandra not responding
|Tue, 16 Mar 2010 20:32:22 GMT
The cache is a "second-chance FIFO" from this library: http://code.google.com/p/concurrentlinkedhashmap/source/browse/trunk/src/java/com/reardencommerce/kernel/collections/shared/evictable/ConcurrentLinkedHashMap.java That sounds like an awful lot of churn given the size of the queue and the number of references it might keep for the second-chance stuff. How big of a hot data set do you need to maintain? The amount of overhead for such a large record set may not buy you anything over just relying on the file system cache and turning down the heap size. -Nate On Tue, Mar 16, 2010 at 1:17 PM, B. Todd Burruss <firstname.lastname@example.com> wrote: > i think i better make sure i understand how the row/key cache works. i > currently have both set to 10%. so if cassandra needs to read data from an > sstable that has 100 million rows, it will cache 10,000,000 rows of data > from that sstable? so if my row is ~4k, then we're looking at ~40gb used by > cache? >
|View raw message


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What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
At JotForm, we want to make sure that you're getting the online form builder help that you need. Our friendly customer support team is available 24/7.
We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you'd like help immediately, feel free to search for a similar question, or submit your question or concern.
Auto notification of missing report?Asked by glennrehn on August 15, 2016 at 07:40 PM
I think the answer is probably no but I was wondering if there's any script or set-up possible so someone could get a notification of respondents from a set list who haven't submitted a form?
JotForm Support
Can you tell us were the 'set list' will be base on? Was it on the form also?
It is possible to filter those who did not submit the form if they were not selected from the existing set list.
Example, if you have a Dropdown list of names of the expected respondents, and only those names on the list selected will be able to submit the form, then you will know who did not submit the form because the name was not selected.
You can check this user guide on how to create conditional email.
User guide: How-to-Send-Email-Based-on-Selection
Here is also a test form you can test.
Let us know if you require further assistance.
Let me use a more specific example.
https://form.jotform.com/61927143925157 is my form.
Is it possible to get an automated email at a certain time every day informing me who from the list of emails has NOT submitted a form?
thank you
JotForm Support
Is it possible to get an automated email at a certain time every day informing me who from the list of emails has NOT submitted a form?
Unfortunately no. There is no automated way to achieve this using the form only.
You can probably achieve using scheduled task in your email service. This kind of application is usually done at the back end service (in this case your email service).
You need to setup a scheduled task in the email service to send out an auto email alert base on time.
Hope this help in a way. Let us know if there is more we can assist you with.


text: NO. 22458 IN THE INTERMEDIATE COURT OF APPEALS OF THE STATE OF HAWAII CHALON INTERNATIONAL OF HAWAII, INC., a Hawaii corporation, Plaintiff-Appellee, v. MAKUAOLE (k); Heirs and assigns of MAKUAOLE (k); and heirs and assigns of the following persons: KUEULU AINOA (k); MAHEA (w); KAILIULAULA (k); KAOHIMAUNA (k), also known as Kaohimaunu; LA (k); KALUAHINUI (w); W. C. PUNAHOA (k); C. K. ANIU (k); KALAMA 1 (k); KALAMA 2 (k); KAHOOKAMALII (w); KOIEANA (w), also known as Kouamo; KALAMA PAPIHE (k); LUMAAWE HOOPII; also the following owners and occupants of adjoining lands as shown on the tax map: STATE OF HAWAII; COUNTY OF HAWAII; KOHALA CORPORATION; KOHALA NURSERY, INC.; WENDELL A. MATTOS; FRANK J. BUTLER; EDRALINE BUTLER; IRENE RUANO; LOLITA RICARDOS; CARLITO BADO; JAMES K. MARQUEZ; TERESA L. MARQUEZ; NITA LUCHETTA; PAMFILO E. VILLACORTE; MARY S. VILLACORTE; BRUNO VILLACORTE; KATHRYN B. VILLACORTE; AGAPITO C. JAVILLO; CLAYTON J. JAVILLO; ROCHELLE JAVILLO; PAUL J. ANDERSON; KAREN S. ANDERSON; DORIS H. BERG ANDREWS TRUST; UNION MILL ROAD FOUNDATION; DOES 1 through 100; and all other persons unknown claiming any right, title, estate, lien or interest in the real property described and TO ALL WHOM IT MAY CONCERN, Defendants-Appellees, and MATHILDA NOELANI BATALONA MASON, Defendant-Appellant APPEAL FROM THE FIRST CIRCUIT COURT (CIV. NO. 98-61) MEMORANDUM OPINION (By: Burns, C.J., Watanabe, J., and Circuit Court Judge G. Chang, in place of Lim, J., recused) Defendant-Appellant Mathilda Noelani Batalona Mason (Mason), appearing pro se, appeals the circuit court's March 22, 1999 Final Judgment, via summary judgment, granting Plaintiff-Appellee Chalon International of Hawaii, Inc. (Chalon), a Hawaii corporation, quiet title to various parcels of real property located in the North Kohala district of the island of Hawaii. Mason challenges the award to Chalon of title and a fee simple absolute interest to the land described in Royal Patent Grant No. 2750 (Grant No. 2750) to Kaohimauna, and Royal Patent Grant No. 2754 (Grant No. 2754) to Kalama 1. Mason also challenges the jurisdiction of the trial court to hear the matter. We affirm. I. BACKGROUND The original action by Chalon was to secure quiet title to six parcels of land in the Kohala district on the island of Hawaii. (1) In its original February 3, 1997 complaint, Chalon included all possible defendants including deceased parties so that descendants of the deceased parties would be given legal notice of the action. Various parties responded by claiming or disclaiming interest in the six parcels. Defendant-Appellee Charles L. Naone, Sr. (Naone), claimed an interest in the parcels and was later adjudicated by the court to own a 0.88 acre portion of Royal Patent Grant No. 2732 (Grant No. 2732). This portion, however, was landlocked. Chalon and Naone entered into a stipulation granting Naone a 12-foot floating easement for access and utility purposes. This easement crossed Grant No. 2732, as well as Grant Nos. 2750 and 2754. The court's March 22, 1999 Final Judgment agreed with Naone and enforced the stipulation. Mason, proceeding pro se, challenged the court's personal and subject matter jurisdiction and claimed an interest in unspecified lands as an heir of Kaohimaunu and others. Subsequent interrogatories by Chalon revealed that Mason claimed ownership of parcels within Grant Nos. 2750 and 2754. On August 10, 1998, the court entered its Findings of Fact, Conclusions of Law, Order Granting Plaintiff's Motion for Partial Summary Judgment as to Grant No. 2750. On October 12, 1998, the court entered its Findings of Fact, Conclusions of Law, Order Granting Plaintiff's Motion for Partial Summary Judgment as to Grant No. 2754. The March 22, 1999 Final Judgment ordered, adjudged, and decreed that Chalon is the owner in fee simple absolute of various parcels, including Grant Nos. 2750 and 2754. Mason's appeal challenges: (1) the court's subject matter jurisdiction; and (2) the court's determination that Chalon, and not Mason, is the owner of the parcels of land conveyed in Grant Nos. 2750 and 2754. Within those two broad challenges, Mason asserts various other sub-points. II. CHALON'S BURDEN AND APPELLATE STANDARD OF REVIEW We review a circuit court's award of summary judgment [de novo] under the same standard applied by the circuit court. Amfac, Inc. v. Waikiki Beachcomber Inv. Co., 74 Haw. 85, 104, 839 P.2d 10, 22, [reconsideration denied], 74 Haw. 650, 843 P.2d 144 (1992) (citation omitted). As we have often articulated: [s]ummary judgment is appropriate if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law. Id. (citations and internal quotations omitted); see Hawaii Rules of Civil Procedure (HRCP) Rule 56(c) (1990). "A fact is material if proof of that fact would have the effect of establishing or refuting one of the essential elements of a cause of action or defense asserted by the parties." Hulsman v. Hemmeter Dev. Corp., 65 Haw. 58, 61, 647 P.2d 713, 716, (1982) (citations omitted). Estate of Doe v. Paul Revere Ins. Group, 86 Hawaii 262, 269-70, 948 P.2d 1103, 1110-11 (1997) (quoting Morinoue v. Roy, 86 Hawaii 76, 80, 947 P.2d 944, 948 (1997)) (brackets omitted). We have also held that when making a summary judgment determination, "we must view all of the evidence and the inferences drawn therefrom in the light most favorable to the party opposing the motion." Morinoue, 86 Hawaii at 80, 947 P.2d at 948 (quoting Maguire v. Hilton Hotels Corp., 79 Hawaii 110, 112, 899 P.2d 393, 395 (1995)) (brackets omitted). Shim v. McLaughlin, 89 Hawaii 1, 2-3, 967 P.2d 1059, 1060-61 (1998).III. DISCUSSION A. The circuit court had jurisdiction to hear and render a decision on this matter. Generally, Hawaii Revised Statues (HRS) § 603-21.5 (1993) specifies the subject matter jurisdiction of the circuit courts of the State of Hawaii. It states in relevant part that "[t]he several circuit courts shall have jurisdiction, except as otherwise expressly provided by statute, of: . . . (3) Civil actions and proceedings . . . ." Id. Thus, the Hawaii Supreme Court has stated that the circuit court has jurisdiction over all civil causes of action unless precluded by state constitution or statute. Sherman v, Sawyer, 63 Hawaii 55, 58, 621 P.2d 346, 349 (1980). The action underlying this appeal was brought by Chalon under HRS Chapter 669, Quieting Title (1993), and not as an equity action as Mason stated in her brief. HRS § 669-1 states in relevant part as follows: Object of Action. (a) Action may be brought by any person against another person who claims, or who may claim adversely to the plaintiff, an estate or interest in real property, for the purpose of determining the adverse claim. . . . . (d) Action under subsection (a) . . . shall be brought in the circuit court of the circuit in which the property is situated. HRS § 669-1(d) specifically grants a circuit court jurisdiction over this type of proceeding. The parcels of land in contention are situated in North Kohala, on the island of Hawaii, and according to HRS § 603-1(3), the island of Hawaii is under the jurisdiction of the Third Circuit Court which decided this case. Mason also asserts that Hawaii is still a sovereign nation not bound by the laws of the United States or the State of Hawaii and, thus, the circuit court of the State of Hawaii had no jurisdiction to preside over the action. We disagree. Although the United States recently recognized the illegality of the overthrow of the Kingdom of Hawaii and the role of the United States in that event, "that recognition does not appear to be tantamount to a recognition that the Kingdom continues to exist." State v. Lorenzo, 77 Hawaii 219, 221, 883 P.2d 641, 643 (1994). B. The circuit court was right that Chalon is the owner of the grants of land in question. Mason argues that the circuit court erred in granting Chalon quiet title to the parcels in question via summary judgment. Generally, a "summary judgment order is reviewed on appeal under the same standard applied by the trial court." Tradewind Ins. Co., Ltd. v. Stout, 85 Hawaii 177, 180, 938 P.2d 1196, 1199 (Haw. Ct. App.), cert. denied, 85 Hawaii 81, 937 P.2d 922 (1997) (citation omitted). "Consequently, we must determine whether viewing all the evidence in a light most favorable to the non-moving party, there is no genuine issue as to any material fact and the moving party has clearly demonstrated that it is entitled to judgment as a matter of law." Id.; Hawaii Rules of Civil Procedure (HRCP) Rule 56(c); Pioneer Mill Co. v. Dow, 90 Hawaii 289, 295, 978 P.2d 727, 733 (1999). However, "an adverse party may not rest upon the mere allegations or denials of his pleading, but his response . . . must set forth specific facts showing that there is a genuine issue for trial." HRCP Rule 56(e). See also, K.M. Young & Assocs. v. Cieslik, 4 Haw. App. 657, 675 P.2d 793 (1983), reconsideration denied, 5 Haw. App. 683, 753 P.2d 253 (1984). The party opposing the motion for summary judgment must come forth with some evidentiary matters to support its position and not merely question the credibility of the moving party's evidence or witnesses. Cordeiro v. Burns, 7 Haw. App. 463, 470, 776 P.2d 411, 416 (1989). Mason argues that none of her ancestors made a contract with anyone in privity with Chalon and, therefore, Mason still has superior title over the land grants in question. This argument had possible validity if Mason offered evidence of her lineage and her ancestors' ownership of the grants in question. However, Mason has not set forth any specific evidence of her ancestral lineage or of ownership by said ancestors. On the other hand, via the affidavit of Colleen H. Uahinui, senior title officer for Title Guaranty of Hawaii, Chalon has presented evidence of a chain of title from Kaohimauna for Grant No. 2750 and Kalama for Grant No. 2754 to Chalon. Without specific evidence by Mason to refute the claims of Chalon, we uphold the circuit court in its granting to Chalon of quiet title to the disputed grants of land. C. Mason received adequate notice of the quiet title action and represented herself at the hearing on the motion. A motion for summary judgment on Grant Nos. 2750 and 2754 was filed on April 27, 1998, and the certificate of service shows Mason was served with the motion by mail on that date. On May 18, 1998, Mason filed a position statement regarding the grants. In it, she stated as follows: [Mason] claims ALL of the remaining interest of Kaohimaunu (k), also known as Kaohimauna, who died intestate and without having to convey all of his interest in Grant [No.] 2750 awarded him. . . . [Mason] states that two of the deeds allege[d]ly signed by Kaohimaunu is [sic] fraudulent. Kaohimaunu lived on his land until his death. Surviving him was his Son, Kaaohimaunu of whom [Mason] is an Heir of. [Mason] is claiming ALL of the remaining interest of Kaohimaunu original awardee and his heir of Kaohimaunu's Son. [Mason] is claiming ALSO, ALL of the remaining interest of Kalamas' interest in Grant No. 2754 awarded. . . . (Emphases in original.) Also, the transcript reveals that Mason made an appearance at the hearing on this motion on June 26, 1998. Therefore, Mason was given adequate notice of Chalon's quiet title action and, in fact, represented her own interests at the hearing on the motion. D. Mason has failed to show any evidence that error and/or fraud was committed by the court or other officers of the court. Mason questions "[w]hether the state circuit court clerk have [sic] failed to provide all of the Notice of Submissions where all of the 'Orders' were hidden inside of the Exhibits[.]" This implicit allegation is fatally non-specific, and our review of the record reveals no indication of error or wrongdoing by the state court clerk. E. With respect to all other matters discussed by Mason in her appeal, Mason presents no discernible argument. The following are two examples of matters discussed by Mason which present no discernible argument: Whether the Hawaiian Island's Treaty with Japan is in violations [sic]? Where does it states [sic] that in the treaty with Japan, that a corporation from an International Corporation named, Chalon International ,[sic] is able to own Royal Patent Grant lands in Hawaii??? . . . . [Mason] protest [sic] all of the transcripts ordered and sent into the appelleate [sic] court, because [Mason] never reviewed transcripts from Individual Court Reporters, dated August: 1, 1998, June: 12, 1998, April 17, 1998 and June: 26, 1998. [Mason] protest [sic] all of [Chalon's] Record On Appeal Volumns [sic] 1 through 7. (Emphases in original.) An appellate court need not address matters where the appellant has failed to present a discernible argument. Child Support Enforcement Agency, State of Hawaii v. Doe, 88 Hawaii 159, 174 n.20, 963 P.2d 1135, 1150 (Haw. Ct. App. 1998); Bank of Hawaii v. Shaw, 83 Hawaii 50, 52, 924 P.2d 544, 546 (Haw. Ct. App. 1996). For this reason, we decline to discuss all other matters discussed by Mason in her opening brief. IV. CONCLUSION Accordingly, we affirm the trial court's March 22, 1999 Final Judgment granting quiet title of the above mentioned land grants to Plaintiff-Appellee Chalon International of Hawaii, a Hawaii corporation. DATED: Honolulu, Hawaii, October 24, 2000. On the briefs: Mathilda Noelani Batalona Mason, Defendant-Appellant, pro se. Tom C. Leuteneker, Steven S. C. Lim, and Sherrill Atwood (Carlsmith Ball, of counsel) for Plaintiff-Appellee. Arnold L. Lum and Carl C. Christensen (Native Hawaiian Legal Corporation, of counsel) for Defendant-Appellee Charles L. Naone, Sr. 1. Royal Patent Grant No. 2732 to Kamaka – 71.70 acres Royal Patent Grant No. 2744 to Makuaole and Holani Royal Patent Grant No. 2750 to Kaohimauna – 57.75 acres Royal Patent Grant No. 2754 to Kalama 1 – 54 acres Royal Patent Grant No. 2781 to Keliilawaia – 64 acres Royal Patent Grant No. 2846 to Hoopii – 20.4 acres


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HP EliteDisplay E232e. Display diagonal: 58.4 cm (23"), Display brightness: 250 cd/m², Display resolution: 1920 x 1080 pixels. Colour of product: Grey. USB hub version: USB 2.0. Swivel angle range: -45 - 45°, Tilt angle: -5 - 25°, Height adjustment: 15 cm. Power consumption (standby): 0.5 W, Power consumption (typical): 28 W, AC input voltage: 100-240
Work smart and comfortably with the HP EliteDisplay E232e 58,4 cm (23") Monitor, a large-screen Full HD IPS display with Elite-class presentation features and ergonomic adjustability, available in a grey design that is compliant with Germany's BGI 650.Put every detail on display.- Enjoy sharp Full HD resolution for all your projects and collaborate easily with colleagues around the room with 178-degree viewing angles from IPS technology. The large 58,4 cm (23") diagonal screen gives you plenty of room for your open applications.Find your perfect fit.- Create the view that's right for you and boost your productivity with adjustable tilt and swivel and an impressive 150 mm height adjustment range. Use pivot rotation to customize portrait or landscape views.Convenient connections.- Connect to your choice of PC or device with HDMI, DisplayPort, VGA, and USB inputs. Keep your frequently-used devices right where you need them with USB connections at the display.


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Apps are about to get much costlier in India because Apple is planning to raise the price of apps on the App Store from Rs 60 per dollar to Rs 80 per dollar.
A report on 9to5Mac initially stated that only apps in the UK will be seeing a price rise owing to Brexit. However, The BBC later clarified that the price rise would affect India, Turkey and UK. Prices in UK and Turkey are expected to rise by about 25-30 percent. The updated pricing in India means that we'll see a 33 percent rise in prices.
Apple cites various reasons for this price rise including the falling value of the rupee (which currently stands at Rs 68 to the dollar), and various updates to taxation laws. The increased tax burden is being passed on to the customers.
Given the increase in prices, Apple has reportedly started offering lower price tiers for developers. That said, it must be noted that while US customers pay a fixed price for apps and services, they are also charged a service fee which is added on at checkout.
The changes are reported to take effect in about a week from now. This means that the price of the already expensive Super Mario Run will go from Rs 620 to a little over Rs 800.
Publish date: January 18, 2017 1:40 pm| Modified date: January 18, 2017 1:40 pm
App prices, App Store, Apple, Apple Store, iTunes, Super Mario Run, Super Mario Run price


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A mobile phone / PoS application that provides access to commonly used functions such as: account opening, loan application, deposits/withdrawals, balance enquiry, group transactions, mobile top-ups and basic reporting.
Sample Implementation - Provide your loan officers with UT Mobile to enable them to transact in the 'field', eliminating the need for clients to travel to the branch. Via UT Mobile and a Bluetooth printer/PoS, loan officers can print receipts, group statements, collection reports and much more.


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Marquise (1)
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by: BlackCitrus Pty Ltd • 49
All Android applications categories
by: BlackCitrus Pty Ltd • 49
ScoreCube is the ultimate live sports scores and statistics App.
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text:
Response to Hoover on Being in the World
Expand Messages
- Hoover, I get the information from the free press in the United States. If you have, a better source for me or better information on working class and the wealthy please let me use it. Do you really believe the working class would produce a theology to use against them? The present theology and ethics let our society remain stagnant, with high unemployment rates. Can't you see people are hungry? Can't you see the homeless? Can't you see the ones wondering away their day with nothing to do? Do you deny the incidents in Jenin and in Gaza? Did you not see the wholesale killing, genocide, and omnicide of Palestinians? Show me the swimming pools, the libraries, and the hospitals; Sharon is building for the Palestinians with the four billion dollars in aid from the United States working class? Show me the working conditions Arabs work in plants run by Sharon's political and business associates. Do you want to start a committee to give Sharon the next Nobel Prize for Peace? Prove to yourself Ariel Sharon is a kind, wise, caring of concern friend and neighbor to Palestine.
Copyright January 02, 2003 by Richard Radandt at richradadnt@... page 1 of 1
[Non-text portions of this message have been removed]
Your message has been successfully submitted and would be delivered to recipients shortly.


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- coupé
- or coupe noun Etymology: French coupé, from past participle of couper to cut, strike Date: 1825 1. a four-wheeled closed horse-drawn carriage for two persons inside with an outside seat for the driver in front 2. (usually coupe) a 2-door automobile often seating only two persons; also one with a tight-spaced rear seat — compare sedan
New Collegiate Dictionary. 2001.


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\nSI's 2008 NFL Scouting Reports\n\t\n\n\t\t\t\t\t\n\n\t\n\t\t\t\n\n\t\t\t\t\t\t\t\t\t\nDenver Broncos\n\nProjected Finish: 2nd in AFC West\n\n\t\t\t\n \n\n\n\n\n Dumervil had 12 1/2 sacks for an otherwise porous defense.\nDoug Pensinger/Getty Images\n\n\n2008 Schedule\n \n\n\n\n\nSeptember8 at Oakland (M)14 SAN DIEGO21 NEW ORLEANS28 at Kansas City\n\n\nOctober5 TAMPA BAY12 JACKSONVILLE20 at New England (M)26 Bye\n\n\n \n\n\nNovember2 MIAMI9 at Cleveland16 at Atlanta23 OAKLAND30 at N.Y. Jets\n\n\nDecember7 KANSAS CITY14 at Carolina21 BUFFALO 28 at San Diego \n\n\n\n\n\n\nSPOTLIGHT\n \n\n\nSelvin Young, Running Back: No one wanted Terrell Davis, Olandis Gary or Mike Anderson, either. So when Young went undrafted out of Texas in 2007, he signed with Denver and looked to those former 1,000-yard rushers for motivation. Now Young is setting his goals absurdly high: 2,000 yards rushing this season. "It's a confidence thing," he says. "You've got to speak it before you can do it.".\n\n\n\n\n
Yet another new coordinator tries to fix a defense that is vulnerable to the run -- in a division full of elite backs.
\n
Elvis Dumervil is one of the best young pass rushers in the NFL, a leader onthe field and in the locker room, the kind of ambassador whose face a franchisecan plaster on billboards all over town. But coach him at your own risk. Overthe past five seasons -- three at Louisville and then two in Denver -- Dumervil hashad five defensive coordinators. That means a different playbook to study,a different scheme to learn, a different terminology to memorize eachyear. "I should have kept a page from each one of those playbooks," Dumervilsays. "I'd have a pretty good collection by now."
\n
The high turnover rate has nothing to do with Dumervil, a 5' 11"defensive end who, by all accounts, is a coach's dream. Despite his height, orlack thereof, Dumervil led the Broncos with 121/2 sacks last season and wasan alternate for the Pro Bowl. But it can make a guy paranoid when his bosskeeps getting fired. As a rookie Dumervil watched Larry Coyer get the ax. Lastseason, Jim Bates was ushered out of town. This year, Dumervil is intent onstopping the streak and keeping Bob Slowik employed for a while.
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Slowik has stepped into one of the most precarious positions in the league.Coach Mike Shanahan helps run the offense, so when the team falters, Shanahancan blame either himself or his defensive coordinator. After last season, whenDenver ranked 30th in the league against the run, the choice was obvious."Everybody had a finger in the pie," Dumervil says. "Some weeks it was theplayers, but some weeks it was the scheme. There was too much 'If this happens,do that,' and 'If that happens, do this.' It's a lot simpler now. There's not asmuch thinking."
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Bates was doomed five games into last season, when the Broncos were giving upan average of 187.6 rushing yards. They trashed the seven-man front that Bateswas using and brought strong safety John Lynch up to help against the run. Itwas hard to tell who was making the decisions -- Bates was listed as an assistantcoach in charge of defense, while Slowik was a defensive coordinator in chargeof the secondary. But those titles were slightly misleading. "Jim ran thedefense," Slowik said. "I coached the defensive backs."
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After Bates was dismissed, the defensive backs lobbied hard for CoachSlow, citing his engagingpersonality and businesslike approach. They didn't mind that he had not run adefense since 2004, when the Packers hired and fired him in the same year. "Manytimes, I thought I would never get this opportunity again," Slowik says.
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Hiring a new coordinator is often a Band-Aid solution for a deeper problem inDenver: finding players to help Dumervil anchor the front seven. The Broncoswere 7-9 last season, only the second losing record in Shanahan's 13 years withthe team. They are talking playoffs this year, but they are in the same divisionas LaDainian Tomlinson, Larry Johnson and Darren McFadden, so they first have tostop a few sweeps. Slowik cannot rely anymore on Lynch, who asked for hisrelease and signed with New England, but Denver did acquire 308-pound defensivetackle Dewayne Robertson from the Jets. Asked his job description, Robertsonsays, "To cause havoc."
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If Robertson and Dumervil can hold the line, the Broncos should contend for awild-card spot, and Slowik should be back next year. Otherwise, Dumervil is indanger of his streak reaching six. "When you've had as many defensivecoordinators as I have, you see that they use a lot of the same terminology,"Dumervil says. "One of them says something and it reminds you of another. I liketo connect the different plays they use."
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If it seems that Dumervil is training for a second career, he is. Despite allthe upheaval he has witnessed over the past five years, he wants to be afootball coach. -- Lee Jenkins
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