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Irvine Valley College engineering research
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Learn about Irvine Valley College engineering research, and registering for elective lectures. Which college degrees give you the best chances of finding employment after graduation? The field of engineering requires either an associates degree for entry-level technical workers, or a bachelors degree for professional engineers. Concentrating on Irvine Valley College engineering research, for example, you may gain an advantage in job recruiting on-campus. Check with the mechanical engineering department for course registration deadlines, and scientific research program requirements. Please use the form above to request admissions info for Irvine Valley College.
Mechanical engineering degrees typically take four to five years to complete, and result in a Bachelor of Engineering (BEng), Bachelor of Science (BSc or BS), or Bachelor of Mechanical Engineering (BME). In the US, most undergraduate mechanical engineering programs are accredited by the Accreditation Board for Engineering and Technology (ABET). Mechanical engineering programs include courses on composites, thermodynamics, engine design, fluid dynamics, control theory, robotics, and computer-aided design (CAD). In addition to the core mechanical engineering curriculum, many mechanical engineering programs offer more specialized programs and classes, such as control systems, fuel cell technology, and biomechanics.
Many mechanical engineering companies have begun to incorporate computer-aided engineering (CAE) programs into their existing processes, including 2D and 3D solid modeling computer-aided design (CAD), enabling faster and more exhaustive visualization of products. Other CAE programs commonly used by mechanical engineers include product lifecycle management (PLM), and analysis tools such as finite element analysis (FEA), computational fluid dynamics (CFD), and computer-aided manufacturing (CAM). Further, automation in the form of industrial robots allow businesses to save money on manufacturing costs, and ensure precision quality control. The median annual income of mechanical engineers in the US workforce was $80,580, highest when working for the government ($92,030), and lowest in education ($57,090). Beyond major requirements within the mechanical engineering department, you may consider Alamo Community College transfer engineering as an adjunct to your primary course of study.
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The Los Ang. Dodgers-Brian Stowe, David Sterling-NBA and Oscar Pistorius trails continue. Major League Baseball takes center stage of the sports world. The World Cup Games ending their Semi Finals this weekend. The All Star Game This Tuesday. The LeBron James free agent story and The Washington Football Club issue will not go away Stay tone for economics, politics,race, and disabled issues.
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Tarrant County College regression analysis
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Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
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While a math degree may not seem like a path to wealth at first glance, many fields are based almost entirely on a math foundation. For instance, both physics as well as engineering make use of algebraic formulas to determine motion and forces on objects, and the stress on materials. In business, financial accounting and stock investing count on the mathematical principle of compound interest over time. Math classes may be refocused toward practical applications, such as numerical analytics of big data online or statistical interpretation of scientific research results. Further, financial engineers or 'quants' may be called upon to prepare math-based reports for financial management, in order to develop high-speed, stock investment algorithms.
Finally, there is a lot of mathematical calculation behind complex decisions such as whether a business should raise money by issuing stock directly to the public as in the case of Google, or seek long-term loan financing? Both decisions involve quantification of risk and substantial probability analysis. A discount rate is used to determine the present value of the expected returns, and if a business anticipates being highly profitable in the short-term, it may be wiser to take out a bank loan, rather than dilute ownership via exanding the number of shares outstanding. Beyond major requirements within the mathematics department, you may consider Anoka Ramsey Community College biochemistry lab as an adjunct to your primary course of study.
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Get effective teeth whitening in London. We cover Alperton, Woolwich and West Kensington from The Perfect Smile Limited. One hour, one visit, one brilliant smile. Ring today! Perfect Smile Studio Ltd offer orthodontic treatment throughout the South East. Meet some the finest orthodontists in our modern practice.
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Tune in to WORT at 7:08 AM Thursday (10/19) and listen to a recording of Antonin Dvořák's Symphony No. 9 in D Minor ("From the New World") made 90 y … [Read More]
Latest Music
Upcoming Classical Music Events
Wednesday October 18 noon at Luther Memorial Church 1021 University, Madison Bruce Bengtson presents a free organ recitalWednesday October 18 … [Read More]
Exclusive Interview: Warren Haynes of Gov't Mule!
Late night host Phil Davis interviewed Gov't Mule guitarist Warren Haynes in advance of their show at the Orpheum Theater on Fri. Oct. 13. In his own … [Read More]
WORT Charts A Fall Bounty of New Music!
Punk icons Pere Ubu (pictured) return with their first album of new material in decades, and it's intense! New adds from Primus, King Khan and … [Read More]
Latest News
Matt Flynn Announces Run for Governor
Another candidate has jumped into the race for governor. Matthew Flynn is a retired defense attorney and former chair of the Wisconsin Democratic … [Read More]
KBBF FM Broadcasting Wildfire News for Latino Community
Patty speaks with Alicia Sanchez at community radio KBBF 89.1 FM. KBBF is the first bilingual public radio station in the United States, and they … [Read More]
Immigrant Community Speaks Out Against Sanctuary Cities Bill
Immigrants rights group Voces de la Frontera provided transportation for people from across the state to testify at the hearing.The group's l … [Read More]
Lawmakers Push For Reproductive Health Revolution
Democratic Senator Jon Erpenbach and Representative Chris Taylor unveiled a package of bills that advocate for women's access to health care t … [Read More]
Latest Talk
Reviewing the Madison City Budget
What's in the 2018 Madison city budget? It's still being decided. Carousel's guests for the hour are David Schmiedicke, City Finance Director for Madison, and Alder Amanda Hall, representing Madison's 3rd District. … [Read More...]
How Anti-Hunger Campaigns Became a Corporate Interest
Andrew Fisher is a food security expert, anti-hunger activist, and an Adjunct Instructor at the Portland State University School of Public Health. His recent book Big Hunger: The Unholy Alliance between Corporate America and Anti-Hunger Groups from MIT … [Read More...]
KBBF FM Broadcasting Wildfire News for Latino Community
Patty speaks with Alicia Sanchez at community radio KBBF 89.1 FM. KBBF is the first bilingual public radio station in the United States, and they serve the people of 18 counties in the North Bay of San Francisco, California. They are the only radio … [Read More...]
Music Theatre of Madison Presents a Staged Reading of The Puppet
This week Music Theatre of Madison presents a staged reading of The Puppet as it continues with the Festival of New Musicals, a showcase designed to give a platform for under-the-radar new musicals. The Puppet is a modern take on a Gilbert & S … [Read More...]


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- 2 Beds
- 2.0 Baths
- 1,349 SqFt
BLOWOUT PRICE REDUCTION - BRING ALL OFFERS! This 2 bedroom, 2 bath unit is IMMACULATE and is being sold "TURNKEY" furnished allowing a new owner to move right in and enjoy the Florida lifestyle. Upgrades feature neutral tile & carpet, custom paint colors & mirrors, custom window treatments & blinds, chandeliers, vaulted ceilings with ceiling fans & more. Kitchen with breakfast bar & morning room features access to an outside patio, all white , solid surface countertops, under cabinet lighting, new refrigerator, pantry and plant ledge for display. Spacious Master Suite offers lanai access and features large walk-in closet along with an additional closet, dual sinks, tiled walk-in shower and water closet. Additional amenities include, tiled lanai, carport, extra storage cabinets and all the outstanding community amenities of Falling Waters.
The source of this real property information is the copyrighted and proprietary database compilation of the Southwest Florida MLS organizations Copyright 2017 Southwest Florida MLS organizations. All rights reserved. The accuracy of this information is not warranted or guaranteed. This information should be independently verified if any person intends to engage in a transaction in reliance upon it.
The data relating to real estate for sale on this limited electronic display come in part from the Broker Reciprocity Program (BR Program) of M.L.S. of Naples, Inc. Properties listed with brokerage firms other than Equity Realty are marked with the BR Program Icon or the BR House Icon and detailed information about them includes the name of the Listing Brokers. The properties displayed may not be all the properties available through the BR Program.


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Samsung Galaxy S8 cases have landed. Find yours.
It is so inspiring to see all the beautiful Christmas lights.this is a little old house in Love,Sask. Canada that they decorated so nicely, Got the shot last night on the way through, Panasonic,Lumix FZ18 set in night mode illuminationFEATURED IN:
lights night house christmas colorful mammagrizart
Your cohosts Cee and Chris
Thank you,cee,:o)) God Bless
Very festive and pretty Mae……………nice shot!! ;-))
Thank you,Steph, it was the first time trying the nigh illomine mode on my camera..:o)) God Bless
I meant to type night illumine,heehee
Must cost them a fortune in electricity bills, lol. Nice shot Mae
Thank you,Chris,I'll bet it does! Merry Christmas,:o)) God Bless
Wonderful capture, Mae..Happy Holidays to you and your family :-)
Thank you Ellen,appreciated.:o)) God bless and Merry Christmas to you,
DECEMBER 1st, 2011► See your work in the Permanents Featured Gallery►Please participate in the ongoing Challenges Mary
Thank you Mary♥ so appreciated.:o)) God Bless
Thank you Francis♥ ;o)) God Bless
Riley , Group Bannerby CanyonWind
Thank you Pops♥ appreciated.:o)) God Bless
Congratulations MaeBelleDecember 12, 2011
Thank you so much,Vickie♥ Merry Christmas.:o)) God Bless
Thank you so much,♥ appreciated,:o)) God Bless,Merry Christmas
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77 GRINDSTONE CT, Leesburg, Virginia
77 GRINDSTONE CT, Leesburg, Virginia 20176 - Loudoun County's premier Beacon Hill equestrian community. Build your custom dream home among new elegant estate homes. only minutes from Leesburg & Greenway. Well installed. County approved conventional 4 bedroom septic system. Adjoining lots also for sale. Call LA for plat & architectural guidelines.
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Home->MOVIE->INSTRUCTORS OF DEATH (DVD)
Only $14.95
shaw brothers - a young martial arts students leg is broken by the hostile cheng hao school 2 of his friends go to the school to gain revenge and repsect back for their school. after seeing there excellent kungfu skills they successfully regain the repsect for their school.wong fei hung and his once-rival, now friend, find themselves and their martial arts schools pitted against a rival school which uses a kung fu expert from the north to do their dirty work, although the expert doesn't realize he is being evil (they lie to him). this may be the only role in which wang lung wei as the hero from the north isn't a villain. he fights wong fei hung, sure, but as one martial artists to another, and once he discovers that he has been tricked by the bad school, he refuses to help them anymore. although he beats wong in the end, they respect one another. lots of great fights and interesting stuff.
Productcode: 15622
Actors: Liu Chia-hui;Gordon Liu; Wang Lung-wei; Hui Ying-hung; Mai Te-lo; Ku Feng
Directed by: Liu Chia-liang
Run Time: 93 MIN
Language: ENGLISH
Category: MOVIE
SubCategories: CLASSIC_KUNG_FU
Format: DVD


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Category Archives: Sign Language
Welcome to the Sydney Law School's online legal writing and legal skills writing because it is about law or for legal readers, such as essays.
An essay is a piece of writing that objectively and critically explores, analyses or evaluates a particular issue or area of the law. Good essays contain balanced.
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Steven is an Employment Law specialist, with more than twenty years experience in all aspects of the discipline. That experience comes from working in both commerce and industry, as well as in private practice. This grounding means Steven can dissect an employment law issue and quickly identify the best outcome and how to achieve it. He has worked in various sectors including oil and gas and engineering and construction (Halliburton), waste management and environment (Suez Group), publishing and media (Highbury House Communications) and international risk management and security (Global Strategies Group). Through this experience, Steven has been involved in some Employment Law issues with an international dimension, involving Europe, the Middle East and the US. As a result Steven is well placed to understand the specific issues affecting businesses and has a good sense of commercial pragmatism.
Steven specifically enjoys project work, for example, the employment aspects of mergers, acquisitions and disposals of businesses which necessitates undertaking the necessary due diligence and advising on compliance with TUPE. He also has an interest in the use of social media in the workplace and advising on best practice policies to avoid disputes. He also deals with employment tribunal litigation, and career highlights include dealing with a large class action defending a range of unfair dismissal, breach of contract and breach of TUPE claims.
Steven has experience in advising businesses in various industries and sectors and of various sizes. This includes advising HR professionals on a variety of day-to-day employment-related issues. He enjoys advising on implementing "best practice" policies and procedures which are designed to protect and strengthen his clients' position. Steven also advises a number of senior executives who require services and advice in relation to their individual employment rights and the negotiation of exit packages in the event that the employment relationship breaks down.
Other areas of particular specialism include: drafting contracts and employment and employee handbooks; advising on all aspects of non-contentious employment law; dealing with settlement agreements.


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Film Atmosphere
Stock Production Music
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A piece of classic horror and thriller film atmosphere, great for creating suspense and tension in feature length films. Full of dark epic style orchestral sounds, interesting orchestra percussion and Avant Garde style techniques. Great… more
by catch22music
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text: Posted March 21, 2012 · Report post OK, I'm dense, it seems. I need some step by step info on using the Blendability kits, and also the new SS club Artist's canvas/Artist's diary pages. I know Angie has a tut in the collections, but as I said...I'm dense. Are there anymore tuts anywhere else on blending?Help! Share this post Link to post Share on other sites


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Spring is in the air and there's only 1 month to go until May 5th when the EcoTales festival will be taking place at Orleans House in Twickenham alongside the Springtime Safari.
The festival is free to attend and there will be something for all the family. Gates open at 12pm.
We are working hard putting all the last minute arrangements in place to make sure that your day is full of fun. You can wander through the beautiful gardens at Orleans House which will be transformed into an underwater sculpture trail featuring recycled plastic sea creatures and sculptures made by children from local schools.
Take part in creative workshops, do some shopping and watch some brilliant films. You can see a selection of short films on a pedal powered cinema, and we are very excited to be joined by Sir David Attenborough who will be announcing the winners of the EcoTales film challenge!
Visit our events page for more information and to help you plan your day. Over the next month we will let you know more about all the people who will be joining us and helping to make it a really unique and memorable day. You don't want to miss it!
See you on May 5th.


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Lloyds Bank has promoted Madeleine McDougall to acting head of commercial real estate as John Feeney becomes acting head of global corporates.
Feeney has been appointed to the new role at Lloyds, following the departure of Clare Francis from the bank.
Meanwhile, McDougall, who was head of institutional real estate, has been appointed as the acting global head of commercial real estate, taking over Feeney's role.
Feeney has held the role of global head of commercial real estate, which is part of the global corporates business, since joining the group from Henderson Global Investors in May 2013.
During the last four years Feeney has led the transformation of the group's commercial real estate business. Prior to this, he spent eight years at Bank of America Merrill Lynch in a variety of senior roles across Europe and Asia.
McDougall was previously the head of institutional real estate, and a key member of Feeney's senior team since joining the group in November 2014.
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Android Data Recovery
How to Transfer Photos from iPhone to Computer
--Thursday, April 23, 2015Though the storage of iPhone are upgraded to 64GB and 128 GB, most iPhone users still prefer using an 16GB iPhone for different reasons. But here comes the problem. It requires a large storage to upgrade from iOS 8 to iOS 9. So many iOS users found that their iPhone ran out of storage so they would prefer move their photos, which takes a quite large space of his iPhone, to computer rather than delete any of them. And here's an excellent tool for iOS users to transfer photos from iPhone to computer - iPhone Transfer.
iPhone Transfer specializes in transferring photos from iPhone to computer. It is user-friendly that it allows you both to copy all the images and to selectively copy pictures as you wish. Camera roll, videos, panoramas and photo library can all be exported to the PC.
Download iPhone Transfer on your PC and have it a try. It is easy and what you need is just to read the below steps.
Transfer Photos from iPhone SE/6s/6s Plus to ComputerStep 1 Install iPhone Transfer and Connect iPhone
After downloading the program, install it on your computer and launch it. After that, you will be asked to connect your 6 Plus to the PC. Your SE/6s/6s Plus will be detected in no time and all the info will be scanned out.
Step 2 Click to View iPhone Photos in Album
Choose the album under "Photos" at the left side. Here you will see the album such as Camera Roll, Photo Library, Videos, and other photo album. Take Camera Roll for example, click "Camera Roll" and all the pictures in the album will be listed in the interface as below.
Step 3 Preview photos one by one
If you think the thumbnail is too small for you to see whether it is the one you want, you can right click the pictures you want and click "Preview" to preview the photos.
Step 4 Export Photos from iPhone to Computer
After your iDevice detected, all the data will be listed according to category. You can choose "Photo" category and choose all the pictures that you want by ticking the box next to the pictures. And then, after all chose, you can easily right click your mouse and click "Export to" – "Export to PC".
After connecting your iDevice and export the pictures from iPhone SE/6s/6s Plus/6/6 Plus to PC, you can easily transfer the photos you want. With this excellent iPhone Transfer, you are also allowed to manage other media files like transferring music from iPhone to computer, and so on. As the steps are so easy for you, you don't need to worry about managing iOS files will be in a mess any more.


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Words that start with altimet
Found 5 words that start with altimet. Browse our Scrabble Word Finder, Words With Friends cheat dictionary, and WordHub word solver to find words starting with altimet. Or use our Unscramble word solver to find your best possible play! Related: Words containing altimet
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text: "I was charged with impaired driving and over 80 in August 2014. Richard Aitken took on my case personally because I was facing these charges for a second time. Most concerning, I was facing a minimum 30 day jail penalty. Richard was able to avert the jail penalty, allowing me to keep my children, job and home. Although I continue to face all other penalties and very heavy financial/emotional burdens, amongst other difficulties, it could have been much worse but for Richard Aitken's efforts and diligence with the Crown Attorney. I am very grateful." -L.L.


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they're still staring in my grill like dentures I fuck with Brotha Lynch's and Andre Nickatina's Tote forties, four-fours, tens, and even Nina's I be
man you can't have no autograph [Chorus] Nickatina says bust back first And by any means necessary don't get hurt The five millimeter go good
Andre Nickatina Caught up in the rhyme like a dopef iend, freaky heater back the fuck up if you cut your broke dreams, I keep the 40 fo' shizzle
beat that bitch up when I found out she lyin Who she think I am? Saving Private Ryan? Andre Nickatina-- I make the town move just by walkin on your
in a balla place -Andre Nickatina Man ima semi automatic Gotta get the cabbage But if it weren't for the religion man there wasn't a habit Work those
sacrifice , denail pain. Yea this is uh a nickatina creation. You probably never heard nothing like. This but check it out. I got flavor and all them thangs
Purrfect Storm -Andre Nickatina Man you can picture my perfection from the purple in the paper Get it popin 'cause its poppin Put the pimpin in
I'm wishin but I couldn't pretend [Verse 5 - Andre Nickatina] Shit, I side swipe you in the light just like a fender bender There go your brain with
-Andre Nickatina But moma my broken dreams came from fabulous schemes I get it poppin like a pistol girl to get you on the team Here's a telogram I like my
Verse 1: Andre Nickatina The homie said, now we can chalk em like rocky if ya cocky when you knock me Do it till we slap you or atleast until you
Scottie,scottie Scottie,scottie (andre nickatina) Put the phone on ya but it's the booty call And I'm comin' ta bust nuts on all ya'll And I'm out
man... (Andre Nickatina) When the gat would hit, then the rhyme would spit Gun nailed you to the crucifix I ain't new improved man I'm true to this
more struggle and strife From a Buick to a Beamer, ambitions of a dreamer Motivated by Mob Figaz and Andre Nickatina I'm gettin' paper while you're in
clock they ends, I said which is why you're payin this rapper then Nickatina, I'm something like simbad the sailor Dress in red and black, the true signs
Da Whip -Andre Nickatina Sittin on leather that's all Better than the cow that it came from I like to go fast I like to blow hash You like a women
Andre Nickatina Tina Terry Horns and Halos (Nikky) I use to slither like a snake Forget the chit chatter it really didn't matter if the other bitch
Oh God Andre Nickatina & Equipto (Queezy) It's two for the money I'm through with the funny actin hoes They sharin each other clothes The game run
homie copan hagein. (andre) Like canadian bacon you know I'm makin a way, For me to get like on every plate, in every state, Rap up hoes down, 12th floor
gon make it happen while you look to the sky It's the N-E-smoke to-L's don't ask me-why 4-42 on the lyin don't pass me by Paint like onions make
blend with the night They call me greedy Plead my sins to get a gurl a beaty It's andre nickatina I'm like a genie in a beanie Amarato 88 cadillac,


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it's an internet thing!
it's an internet thing!
"In mid-life the man wants to see how irresistible he still is to younger women. How they turn their hearts to stone and more or less commit a murder of their marriage I just don't know, but they do."
"A successful marriage requires falling in love many times, always with the same person."Earl Warren on Mignon McLaughlin
"By all means, marry. If you get a good wife, you'll become happy if you get a bad one, you'll become a philosopher."Earl Warren on Socrates
"It is not a lack of love, but a lack of friendship that makes unhappy marriages."Earl Warren on Friedrich Nietzsche
"How can a woman be expected to be happy with a man who insists on treating her as if she were a perfectly normal human being."Earl Warren on Oscar Wilde
"Don't marry the person you think you can live with marry only the individual you think you can't live without."Earl Warren on James C. Dobson
"To separate children from others of similar age and qualifications solely because of their race generates a feeling of inferiority as to their status in the community that may affect their hearts and minds in a way unlikely ever to be undone."
"All provisions of federal, state or local law requiring or permitting discrimination in public education must yield."
"In these days, it is doubtful that any child may reasonably be expected to succeed in life if he is denied the opportunity of an education."
"We conclude that in the field of public education the doctrine of 'separate but equal' has no place."
"The most tragic paradox of our time is to be found in the failure of nation-states to recognize the imperatives of internationalism."


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Aztec it out!11:52:00 AM
What's better than breathing in fresh air and relaxing for some days?
Guess what's today?! It's my blog's birthday! Exactly a year ago, I posted my very first post and started my blog with my unbelievable ambitions of reaching so many views. I slowly understood that it was going to take a lot more than some pretty pictures to get to that.
Plus, my hair is blonder! Who likes my new highlights?
I've been sick for two weeks and that's why I wasn't able to really post anything. I'm sorry for that.
I've been working my way around, and I can totally see a lot of difference between my first post and my recent ones! I really am proud of myself, and I hope you guys like my blog.
Critics are most welcomed, if you have anything to say: good or bad, preferably good though.
Also, I shot this two days ago, while I was back in my hometown. I'll post the other outfit later on today. I love having these getaway weekends where all I can do is sit back and relax.
Shirt: Bershka
Shirt: Bershka
Short: Pull & Bear
Shoes: Zara
Bag: Aldo
Its good your feeling better. Very cute outfit, I love your shorts and you sandals.ReplyDelete
thank you!! lots of love xxDelete
heyy!!!....thanks for stopping by my blog :)ReplyDelete
good to know u live in Beirut too...!!!!
you look gorgeous....love your sandals
Thanks dear! ;)Delete


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Check out the criterium race report fresh from the Litespeed-BMW Cycling team who enjoyed lots of success last weekend at the Master's Nationals Championships. The race report can be found at the Litespeed-BMW Cycling website.
Congratulations on 3rd Place, Chad
The Fierce Team-Colby, Chris, Chad (L to R)
The Team Poses With Security
FasCat Tour Plan Stage 1
3 months ago


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Doctors Lounge - Cardiology Answers
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Forum Name: Cardiology Symptoms
Question: Dizzy spells
"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."
|magtino - Mon Apr 25, 2005 5:13 am
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I am a 57 year old man and I have been getting dizzy spells since I was 15 years old.
I suffer dizziness when I stand up from a sitting position and sometimes feel like I am going to black out.
I have always been as white as a sheet, could I have a circulation problem, I tried taking an iron supplement but this never made any difference.
|Dr. Russell M - Mon Apr 25, 2005 9:16 am
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text: Human Rights Observatory Experts: France Attack Part of Cultural Disconnect The attack on the French satirical newspaper Charlie Hebdo in Paris on Wednesday was not the first such clash between the European media and militant Islamists. As thousands in France and other countries gathered to mourn the people killed on Wednesday, they engaged in a little 'freedom of expression' of their own. Some carried a cartoon reading "Love is Stronger than Hate," while others held up homemade signs saying, among other things, "Freedom of the Press is Priceless." But not...Read complete article© Voice of America - Thursday, January 8, 2015


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KINGSTON, JAMAICA—Opal Austin's dreams have turned to ashes. But, finally, the single mom is reunited with her children.
She's standing at the front of the Fellowship Apostolic Church here, an urn in each hand; Melonie's remains on the right, Dwayne's on the left.
It's a ghastly homecoming few here could have anticipated in 1990 when the children left to be with their dad and step-mom in Toronto. It marks the near end of a journey Austin must travel; and some 60 friends and family are determined she won't walk alone.
They sing. They pray. They weep. They grieve. They break down and bawl, unable to conceive the tragedy that desperately needs closure — 24 years since they waved goodbye to the kids, never to see them again.
"Our children are here with us: home, where they belong," says Elias Azan, a family friend who repeatedly blames himself for encouraging Opal to send the kids in search of a better life in Canada. His self-immolation touches off another round of crying.
"Y'know, if a child gets sick and dies, it's hard for a mother," says Janet McKnee, Opal's longtime friend. "But to know that somebody killed your child — that's something that's gonna mess up your mind forever."
This "Thanksgiving Service" is supposed to help avert this messing-up of the mind. And Opal is being comforted by words from home and abroad, including a message from Toronto Mayor John Tory.
Asked to give a tribute to the boy and girl I know only through stories written in 2012 after the case came to light, I tell them Thursday that I know Torontonians feel their pain — because they said so, in response to reports on the horror. The Ontario government paid to send the cremated remains to the family and for the upcoming burial. And then I read them Tory's message, ending with:
"People come to Toronto from other parts of the country and from around the world to seek a better life. And there are millions of success stories to celebrate. But there are also instances where the system fails us, often with tragic consequences.
"I hope today's service and the continuing push to achieve justice will bring some comfort to the many who were deeply troubled by the tragic loss of these two young people."
Dwayne was the first to die, an apparent suicide at age 14. The official word is he jumped off a a Parkdale balcony on the 22nd floor, two years after landing at Pearson. But nobody here believes the jovial life-of-the-party — the "trick card in the pack" is how he was described at the memorial service Thursday — would do such a thing.
The only mystery surrounding Melonie's demise, two years later at age 17, is why. Why would her father, as he's accused and charged with doing, kill her, stuff her emaciated body in a suitcase, burn off her finger- and footprints, and set the whole package ablaze in a Vaughan industrial area in 1994?
Apparently, Melonie was not enrolled in school, so she was never reported missing. Back in Kingston, Opal and family were told that Melonie had run away to New York. Desperate, they used Facebook, sent random messages with anyone travelling, all hoping to connect.
It would take Toronto police until March 2012 before they solved the cold case — after a family member could no longer live with the memory.
Everton Biddersingh is still in custody, awaiting trial in September for first-degree murder. His wife, Elaine, is out on bail, charged with the same crime. A son, Cleon, is charged with a lesser crime.
And the whole thing is inconceivable to this tight knot of people — weeping, sobbing, singing, praising in a heartbreaking mix of hurt and pain, comfort and joy.
Linda Rose fell for Melonie and Dwayne when they used to accompany her on her trips to the neighbourhood rum shop, often making sure she was safe as she stumbled home. For a while she informally adopted them, and "we had a glorious time together," she tells the assembly.
Then one day the kids' father arrived. He said he was "carrying them to buy ice cream. I never see the children again. The children of my life — swept away from me like that."
More weeping.
It climaxed when Jeneen Graham-Williams took to the microphone and sang Simon and Garfunkel's "Bridge Over Troubled Waters." She told everyone that Melonie used to sing her to bed as a little child and could have been another Whitney Houston.
Then she called Opal to the front.
With Opal barely holding up, Jeneen started the first line of Kirk Franklin's "My Life is in Your Hands." Before she could finish, "You don't have to worry and don't you be afraid . . ." the entire gathering — all of us — had totally lost it.
A young man, Ryan Reid, 31, told me before the service began that he and Dwayne were playmates, "played marbles, ran around the yard, and we eat from the same pot.
"So it grieves me to see (Opal) grieve like this," he said, as he walked up to the urn and placed a bougainvillea branch, in full boom, on the lid.
The eulogy would refer to the victims as "flowers that will never bloom again."
In a service that ran for two sweltering hours, it was left to Minister Ryan Pinnock to drag the assembly from depths of despair.
"God has given you beauty for ashes," he tells the family. "He's given you the oil of joy for the spirit of mourning; the garment of praise for the spirit of heaviness.
"Cry if you will. Grieve if you will. But let the goodness of life shine through you."
Using effective local colour, he reminded them that one rotten banana doesn't spoil the entire bunch; neither does one withered pea render the rest of the pod useless.
The lesson? A family member might have inflicted this horror on so many in the clan, but the entire bunch doesn't have to be infected with the spirit of revenge and despair.
"Out of the ashes we will raise a monument to our children — here in Jamaica and in Canada."
The service ends. The family pose for pictures. One by one they go up to the urns and touch them. It's their first contact with Melonie and Dwayne in almost 25 years. The portrait — there's Racquel, Jamilia, Tafari, Issachar — reunited at last.
Opal Austin stands through it all, worn down by the stress that leaves her sleepless at night, but, today, looking regal in a simple black dress, a necklace, and tightly braided hair that is a hairdresser's gift from a friend.
"Sometimes, Missa James, me just walk 'bout; feel like me go loose mi mind," she says.
Two urns, some faded pictures and sharp memories are all that's left of Melonie the singer, the babysitter, the quiet one who planned to become a school teacher; all that's left of Dwayne, the garrulous friend, brother and son who had promised his mom to get her out of the ghetto and build her a house.
And it is somehow bearable, with the support and love of friends at home, and strangers a world away in Toronto.
Closing the service, Pinnock gracefully asked your correspondent to, "Please pass on to the mayor and people of Toronto our heartfelt appreciation for their outpouring of love and resources on this family."
Royson James usually appears Tuesday, Thursday and Saturday. Email: firstname.lastname@example.com


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The 35th Denver International Film Festival opened on Thursday night and runs through November 11. Last week Colorado Public Radio film critic Howie Movshovitz recommended three films, and now he suggests two others.
Film Review: 2012 Denver International Film Festival, Part 2
Donate To CPR
Stories like this are made possible with support from listeners and readers like you. Ninety-five percent of CPR's operating budget is derived locally right here in Colorado. Support impartial journalism, music exploration and discovery with your monthly gift today.


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tag:blogger.com,1999:blog-4082600701720985027.comments2017-10-12T12:58:34.076+01:00Liniecat @ Largeliniecathttp://email@example.com:blogger.com,1999:blog-4082600701720985027.post-20205262212410109022017-09-19T09:00:10.884+01:002017-09-19T09:00:10.884+01:00I had a conversation with a Singer repair man when...I had a conversation with a Singer repair man when my sister in law and I took her vintage machine in. You realise that your friend's neighbour was chucking £500 away? Her loss, your gain. LOL Just don't tell her, she might want it back!
PS Twasn't me that stole May and June :)) I wasn't there til August.Dashahttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-74614330403138312702017-09-03T15:23:44.028+01:002017-09-03T15:23:44.028+01:00Oh, I so love your posts! So much interesting cont...Oh, I so love your posts! So much interesting content with clever comments! My own life is a whirlwind of growing old too - just getting over a 3 day couch existence with sore throat and chills. Nothing to do but watch tv with that crazy Trump on every minute! I feel better today!
I love your crochet cushion! The colors! Beautiful! And the little girl design on the wall, too. Your quilt is a comforting gesture. The bridge tragedy made me sick, and we've got our own massive flood to worry about, too.
In the end, I like kitty's attitude ("cat-itude!") "Just wake me up when it's all over!"
Write when you can, Linie, we love you!Jhttps://firstname.lastname@example.com:blogger.com,1999:blog-4082600701720985027.post-1014555417546554762017-08-01T22:32:01.633+01:002017-08-01T22:32:01.633+01:00Oh my goodness - hard to believe that pile of '...Oh my goodness - hard to believe that pile of 'rocks' is actually plastic from the sea. Disgusting (but an effective display!). Hmmm - I can 'see' the sweet little girl character made into a lap quilt too - to go along with her wall painting. And definitely in shock over the fact that someone would be throwing that sewing machine in the landfill (mind you, my new machine is one I'd happily send there....or into the river).Magpie's Mumblingshttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-91281988713556472782017-07-30T00:07:20.533+01:002017-07-30T00:07:20.533+01:00I like the blackboard drawings. What skill to crea...I like the blackboard drawings. What skill to create so much dimension with a single color. It gives them a fantastic lighting.
It was sickening to read of that bridge incident. I'm glad you're making something for him.
I have a very similar Featherweight and can't believe anyone would throw one in such excellent condition away. Even the worst can be used for parts. Such a shame.
Your soft hourglasses remind me of Kaja's. And then you diorama. How talented you are!Annhttps://firstname.lastname@example.com:blogger.com,1999:blog-4082600701720985027.post-8839982615857007822017-07-28T09:01:32.976+01:002017-07-28T09:01:32.976+01:00Nice to see you and find out what you've been ...Nice to see you and find out what you've been up to, especially all the art you have managed to view, and your creative update. I love those gentle pastels (working on something similar myself right now). Who on earth puts a Featherweight into landfill?!!!Kajahttps://firstname.lastname@example.com:blogger.com,1999:blog-4082600701720985027.post-17370155756673639432017-07-26T17:00:36.275+01:002017-07-26T17:00:36.275+01:00So many great photos. Can't believe those are...So many great photos. Can't believe those are rocks. Your quilt is wonderful, but you really much put it on top of kitty. She looks exhausted....grin.BillieBee (billiemick)https://firstname.lastname@example.com:blogger.com,1999:blog-4082600701720985027.post-63930670087957036212017-07-25T05:51:12.862+01:002017-07-25T05:51:12.862+01:00some very interesting photos you have shared wa...some very interesting photos you have shared was sure the pile was stones and as for the blur bodies that surely is a one off.Will keep my eyes open for your quilt at FOQ will be there friday to sunday are you going? Loving the delicate coloured quilt too and see your creative skills have been handed down to your daughter with her skills with a paintbrush crayons etcmargarethttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-32600808631445663952017-07-24T12:05:34.862+01:002017-07-24T12:05:34.862+01:00Felt sure that was your pic above, you're just...Felt sure that was your pic above, you're just being modest, saying it isn't, yes?
And look at all you've accomplished while you haven't been writing your blog. Love your 'what-if' little quilt and those pale blocks, wish I had some like that! Good to see you back again. Nanettehttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-40832077480798977562017-07-23T08:49:55.305+01:002017-07-23T08:49:55.305+01:00I love your blocks and the Lucien Day fabric made ...I love your blocks and the Lucien Day fabric made me swoon!
I bet you're enjoying the City of Culture status this year! xMrs Bertimushttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-44721635852836290592017-06-11T12:49:32.760+01:002017-06-11T12:49:32.760+01:00I remember thinking that $35 was too much for fabr...I remember thinking that $35 was too much for fabric a few years back, and that is half the price of the stuff you were using. Were you terrified of cutting into it and making a (very expensive) mess?? I watched an episode of Great British Railway Journeys last night and Hull was featured. Made me want to come and visit :-)Dashahttps://firstname.lastname@example.com:blogger.com,1999:blog-4082600701720985027.post-21931634828844891462017-05-20T07:52:42.137+01:002017-05-20T07:52:42.137+01:00The rusty statue looks great! I'm not sure I w...The rusty statue looks great! I'm not sure I would be able to cut up such an expensive fabric. You've been brave!Julia - Vintage with Laceshttps://firstname.lastname@example.com:blogger.com,1999:blog-4082600701720985027.post-73810037371908001062017-05-18T03:39:44.701+01:002017-05-18T03:39:44.701+01:0075 lbs (sorry my computer doesn't have the cor...75 lbs (sorry my computer doesn't have the correct symbol) for fabric? Didn't know they made it that expensive!! I'd have been sweating bullets cutting into it! Magpie's Mumblingshttps://firstname.lastname@example.com:blogger.com,1999:blog-4082600701720985027.post-33956039264191875172017-05-14T08:08:10.744+01:002017-05-14T08:08:10.744+01:00I love the rusty trawler men, will have to try and...I love the rusty trawler men, will have to try and visit some time when I'm passing (actually I never pass Hull, it requires a detour). Nice cushions, lovely fabric, even if the cost is daft.Kajahttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-9759138372051815082017-05-08T06:06:48.600+01:002017-05-08T06:06:48.600+01:00Good to see you back on your blog was wondering...Good to see you back on your blog was wondering if you were another blogger that had gone over to instagram like so many have, I do do instagram but much prefer the details people share on their blogs.

Like you I like the look of rusty men. Cannot imagine such expensive fabric a case of how the other half live. margarethttps://firstname.lastname@example.com:blogger.com,1999:blog-4082600701720985027.post-12135726233296256742017-05-08T04:12:18.158+01:002017-05-08T04:12:18.158+01:00Great cushions. Sure like the statues as well.Great cushions. Sure like the statues as well.BillieBee (billiemick)https://email@example.com:blogger.com,1999:blog-4082600701720985027.post-11443955014933332992017-05-07T21:48:28.745+01:002017-05-07T21:48:28.745+01:00Meant to ask, are your blocks quilt as you go?Meant to ask, are your blocks quilt as you go?Nanettehttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-166303054668757082017-03-31T23:58:04.285+01:002017-03-31T23:58:04.285+01:00Wow Lots of cool things in this post from gorgeous...Wow Lots of cool things in this post from gorgeous crochet to giant frogs!!Rachaeldaisyhttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-79879369411229224702017-03-22T18:43:28.176+00:002017-03-22T18:43:28.176+00:00That's one big frog.That's one big frog.BillieBee (billiemick)https://firstname.lastname@example.com:blogger.com,1999:blog-4082600701720985027.post-59602598670053468792017-03-21T22:43:02.997+00:002017-03-21T22:43:02.997+00:00Oh yes - awwwwww - over both grandbabies! Love th...Oh yes - awwwwww - over both grandbabies! Love the burger idea - might have to snag that idea for an addition for Logan's play kitchen he got for Christmas. And you should be very proud of that beautiful crocheted cushion!!Magpie's Mumblingshttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-28909367628592584602017-03-12T09:07:06.868+00:002017-03-12T09:07:06.868+00:00Funnily enough they were just talking about the de...Funnily enough they were just talking about the dead bod on the radio - great to find apicture of it here. Kajahttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-49367861927097844192017-03-06T17:02:05.972+00:002017-03-06T17:02:05.972+00:00Spencer is adorable--definitely awwww worthy! I...Spencer is adorable--definitely awwww worthy! I'm glad you explained "bod"--that gave me a chuckle!Karen in Breezy Pointhttps://firstname.lastname@example.com:blogger.com,1999:blog-4082600701720985027.post-73146012954963045902017-03-06T10:16:19.937+00:002017-03-06T10:16:19.937+00:00Great post Lyn! Love your cushions.... especially ...Great post Lyn! Love your cushions.... especially the crocheted one! The toads and moths are great! Have a lovely week! Christine xChristine B.https://email@example.com:blogger.com,1999:blog-4082600701720985027.post-59527290532619962092017-03-06T09:08:45.762+00:002017-03-06T09:08:45.762+00:00Hull must be a really fun place to be this year. T...Hull must be a really fun place to be this year. Thanks for sharing. Enjoy.
Pathttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-40669312848374049072017-03-05T21:21:51.900+00:002017-03-05T21:21:51.900+00:00Definitely 'awww' for Spencer! What fun t...Definitely 'awww' for Spencer! What fun to be able to spend that time with grandson, finding toads and moths. And you've been quite busy with handwork, so creative!Nanettehttps://email@example.com:blogger.com,1999:blog-4082600701720985027.post-58509889406615709672017-03-05T20:06:33.954+00:002017-03-05T20:06:33.954+00:00Hi there, loved all the photos-you always make the...Hi there, loved all the photos-you always make the coolest stuff-hugskathyinozarkshttps://email@example.com


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Item description for Homeschooling on a Shoestring: A Complete Guide to Options, Strategies, Resources, and Costs by Morgan...Overview
Discusses ideas for making money while at home, sources for inexpensive curriculum, suggestions for low-cost field trips, and ways to acquire free or inexpensive computers.
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This book is a compendium of ideas for the family that wants to start or continue homeschooling on a tight budget. You'll find it all here:
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Ulcerative colitis (UC) patients failing medical management require colectomy. This study compares risk estimates for predictors of postoperative complication derived from administrative data against that of chart review and evaluates the accuracy of administrative coding for this population.
Hospital administrative databases were used to identify adults with UC undergoing colectomy from 1996–2007. Medical charts were reviewed and regression analyses comparing chart versus administrative data were performed to assess the effect of age, emergent operation, and Charlson comorbidities on the occurrence of postoperative complications. Sensitivity, specificity, and positive/negative predictive values of administrative coding for identifying the study population, Charlson comorbidities, and postoperative complications were assessed.
Compared to chart review, administrative data estimated a higher magnitude of effect for emergent admission (OR 2.52 [95% CI: 1.80–3.52] versus 1.49 [1.06–2.09]) and Charlson comorbidities (OR 2.91 [1.86–4.56] versus 1.50 [1.05–2.15]) as predictors of postoperative complications. Administrative data correctly identified UC and colectomy in 85.9% of cases. The administrative database was 37% sensitive in identifying patients with≥1Charlson comorbidity. Restricting analysis to active comorbidities increased the sensitivity to 63%. The sensitivity of identifying patients with at least one postoperative complication was 68%; restricting analysis to more severe complications improved the sensitivity to 84%.
Administrative data identified the same risk factors for postoperative complications as chart review, but overestimated the magnitude of risk. This discrepancy may be explained by coding inaccuracies that selectively identifying the most serious complications and comorbidities.
Approximately 10% of ulcerative colitis (UC) patients require a colectomy within 10years of diagnosis [1]. Colectomy for UC is a technically demanding operation associated with morbidity and mortality [2,3]. Patients undergoing elective procedures have lower risk of postoperative mortality, ranging from 0.0% to 1.0% [4-7]. In contrast, mortality in those requiring emergent colectomy was as high as 6.9% [8-10]. Other factors that have been shown to influence postoperative outcomes include older age and comorbidities [11].
Previous studies reporting postoperative outcomes in UC patients have used medical chart review to obtain clinical information. However, these studies are rarely population-based allowing for referral bias and have small sample sizes. Consequently, investigators have relied on administrative databases to study population-based estimates of postoperative outcomes [11]. Administrative databases are time and cost efficient resources but interpretation of results derived from administrative data is dependent on the validity of administrative coding for predictors and outcomes. Therefore, validation of these databases is a priority in health services research [12].
Although numerous studies have used administrative data to study UC outcomes [11,13,14], few have validated the accuracy of administrative data in identifying UC patients who underwent a colectomy. Furthermore, the accuracy of administrative data in characterizing risk factors such as comorbidities is inconsistent. Under-reporting of comorbidities is high[15] and differentiating postoperative complications from pre-admission comorbidities can be challenging. Consequently, inherent misclassification may be present when administrative databases are used to identify preoperative risk factors of postoperative complications [16].
Thus, we compared estimates of the preoperative risk factors (age, emergent colectomy, and comorbidities) associated with postoperative complications in UC patients undergoing colectomy, derived from two data sources: chart review and administrative data. Subsequently, we evaluated the accuracy of administrative databases in defining: 1) the UC study population; 2) preoperative risk factors; and 3) postoperative complications.
The Data Integration, Measurement and Reporting Hospital Discharge Abstract Database (DAD) captures all hospitalizations in the Calgary Health Zone of Alberta Health Services, Canada. The Calgary Health Zone is a population-based health authority under a public, single payer system, with an estimated population of 1.3 million in 2009[17]. The DAD database used the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) up to March 31, 2001; ICD-10-CA and the Canadian Classification of Health Intervention (CCI) coding have been used since April 1, 2002.
The DAD was searched to identify adult patients (≥18years) admitted to hospital between January 1, 1996 and December 31, 2007 with a diagnosis of UC (ICD-9 556.X, ICD-10K51.X). We then identified UC patients who had a code for colectomy (ICD-9-CM 45.7, 45.8 or CCI: 1.NM.87, 1.NM.89, 1.NM.91, 1.NQ.89, 1.NQ. 90). Recognizing that the administrative database may have missed some UC patients who underwent a colectomy, we identified a cohort of patients admitted for an UC flare without a colectomy. All patients with UC at the primary diagnosis coding field and a random subset of patients with UC coded in the second or third diagnostic position were identified. All medical charts of patients identified by the administrative database were reviewed using a standardized, a priori defined electronic data extraction form. Data was extracted by five trained research assistants who were blinded to the original administrative coding. Fifty patient charts were used as a reference standard; all reviewers extracted data on these fifty charts and their abstraction was verified by a gold-standard reference data abstracter (SD) to minimize inter-observer variability.
The primary outcome was occurrence of in-hospital postoperative complications, defined as unexpected medical events occurring between the start of the operation and discharge from hospital. For the chart review, postoperative complications were stratified by severity using the Clavien Classification of Surgical Complications [18] system (See Additional file 1). Each patient was assigned a postoperative status (≥ 1 versus 0 complications) and severity by Clavien class (I-V). For patients experiencing more than one postoperative complication, the most severe complication class was assigned. Complications were also stratified by category: gastrointestinal, cardiovascular, infectious, etc. See Additional file 1: Table S2 for the specific complications comprising each category. In the administrative database, we identified postoperative complications based on pre-defined ICD-9 and CCI codes that have been commonly used to identify postoperative complications [11]. Complication codes used in the analysis can be found in Additional file 1: Table S3.
Variables extracted from both chart review and administrative data included age at colectomy; emergent versus elective operation; reason for colectomy (UC refractory to medical management, dysplasia or cancer, and acute complication of UC); and pre-admission comorbidities defined by the Charlson-Deyo[19] and Elixhauser [20] indices. Comorbidities were stratified by activity status to identify medical conditions that were managed during the admission. Colectomies were documented as elective if the decision to operate was made prior to hospital admission; in contrast, the decision for emergent colectomy occurred during the admission (e.g. in response to acute life-threatening complications of UC flare or medically refractory disease). In the administrative database, elective colectomies were defined as those coded with an 'elective' status, while emergent colectomies were defined using a composite of either 'emergent' or 'urgent' codes. Age, comorbidity, and admission type were a priori defined as preoperative risk factors and subsequently validated because previous studies have shown that they were associated with postoperative complications in UC patients [11,21].
The administrative coding was validated against the chart review for the study population, admission type, comorbidity status, and postoperative complications. In our primary cohort, we validated the accuracy of administrative data in identifying UC patients undergoing colectomy. Secondarily, a cohort of UC patients admitted for flare without operation was reviewed to detect colectomy patients not captured in our primary cohort. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% CIs were calculated for UC diagnostic codes alone and the combination of UC+colectomy codes. For patients presenting with UC flare, the analysis was also stratified by UC diagnostic position. In secondary analysis, we validated the accuracy of specific procedural colectomy codes. We also validated the accuracy of administrative data defining emergent or urgent versus elective colectomy. In a sensitivity analysis, we excluded patients admitted urgently, and compared only emergent versus elective patients.
The validity of administrative data in capturing comorbid conditions in colectomy patients was also assessed. We searched the administrative database to identify patients coded with Charlson-Deyo comorbidities and cross-matched these with the true comorbidities identified by chart review. Sensitivity, specificity, PPV, and NPV with 95% CIs were calculated for administrative data predicting whether patients had 0 versus≥1 pre-hospital comorbidities and for each of the 17 specific comorbidities. Subgroup analysis of only comorbidities active on admission was performed. Analyses were repeated for Elixhauser comorbidities (Additional file 1: Table S4-S6.
We assessed the validity of administrative data in capturing in-hospital postoperative complications. Patients coded with complications in the administrative database were cross-matched with those identified by chart review. Sensitivity and specificity with 95% CIs was then calculated under 3 scenarios: 1) none versus any complications; 2) none or Clavien class I versus class II-V complications; and 3) none or class I-II versus class III-V complications. Sensitivity and specificity in capturing specific categories of complications was also determined.
Multivariate logistic regression analysis was performed to examine the association between preoperative risk factors and postoperative complication. In primary analysis, postoperative complication status was defined as none versus any complication. Age (defined as 18–34, 35–64, and≥65years), comorbidity (0 versus any Charlson comorbidity, and secondarily Elixhauser), and admission type (emergency versus elective) were a priori included into the logistic regression model. Odds ratios with 95% confidence intervals (CI) were calculated for each preoperative risk factor. Two logistic regression models were developed for comparison: 1) data derived from chart review and 2) data derived from the administrative database.
Statistical analyses were performed using SAS statistical software (version 9.2, SAS Institute Inc., Cary, NC). Ethics approval for the study protocol was granted by the Conjoint Health Research Ethics Board at the University of Calgary, study #21833.
The cohort identification process is illustrated in Figure Figure1.1. Search of the administrative database from 1996 to 2007 for patients with UC and colectomy codes found 697 admissions. Excluding unavailable charts (n=32) and repeated admissions for the same patient (n=25), we completed chart review on 640 patients and identified 586 patients who underwent colectomy for UC. Among 586 patients, 60% were male and 53% underwent an elective operation. Median age at operation was 40.0years [interquartile range: 30.0–53.0]. Thirty three percent of UC patients had at least one Charlson comorbidity and 39% experienced an in-hospital postoperative complication following colectomy.
For the non-operative UC flare cohort, 833 admissions were identified as having UC in diagnostic positions 1–3 with the exclusion of colectomy codes. Among these, 569 charts were reviewed; 136 charts were unavailable and128 were repeat admissions. We identified 325 patients who were admitted for a flare of their UC; of these, 298 (91.7%) had UC as the primary diagnosis.
The administrative database correctly identified both UC and colectomy in 85.9% [83.2–88.5%] of cases (571/665). PPV for specific colectomy codes is found in Table Table1.1. Reasons for misclassification included: repeat admissions (n=25, 3.8%); patients did not have UC (n=36, 5.4%); and patients did not undergo colectomy (n=33, 5.0%). Most commonly, patients were misclassified because the diagnosis was Crohn's disease (n=20), ischemic or pseudomembranous colitis (n=4), or laparoscopic investigative studies rather than colectomy.
The administrative database was 94.4% [90.9%–96.6%] sensitive at identifying patients admitted for emergent colectomy; specificity was 76.4% [71.3%–80.8%]. Sensitivity analysis comparing only patients coded as 'elective' or 'emergent' (i.e. excluded patients admitted under 'urgent' status) showed improved specificity (96.3% [93.1%–98.0%]) but decreased sensitivity (85.5% [76.7%–90.7%]).
Searching the non-operative UC flare cohort identified an additional 15 colectomy patients who were missed in the primary search. Overall, the administrative data was 46.6% [42.9%–50.3%] accurate in identifying patients presenting with a flare of UC (325/697). Reasons for misclassification included: prior colectomy (n=70); patients did not have UC (n=59), or most commonly, UC was a comorbidity for an unrelated admission (n=105). The accuracy of administrative data identifying a UC flare varied by diagnostic position: 79.3% [75.2%–83.4%] in the primary diagnostic position; 18.7% [11.3%–26.1%] in the second position; and 8.1% [2.4%–13.9%] in the third position.
Chart review determined that 39.2% (224/571) of patients undergoing colectomy experienced at least one postoperative complication and 12.3% (70/571) experienced at least one severe postoperative complication (Clavien class III or greater). Sensitivity of administrative data in identifying patients who experienced at least one postoperative complication was 68.3% [61.8%–74.3%] with specificity of 83.6% [79.3%–87.1%], PPV 72.9% [66.5%–78.4%], and NPV 80.3% [75.9%–84.1%]. Results stratified by complication category can be found in Table Table2.2. With advancing complication severity, the sensitivity of the administrative database increased while the specificity decreased (Table (Table2).2). The administrative data was the most sensitive at identifying Clavien class III or greater postoperative complications (84.3% [73.6%–91.9%]); however, the specificity was reduced to 69.9% [65.6%–73.9%].
Sensitivity of the administrative data in capturing patients with any Charlson comorbidities was 37.3% [30.8%–44.3%] with specificity 97.9% [95.9%–98.9%] (Tables3 and and4).4). Sensitivity was improved when the analysis was restricted to active comorbidities alone (62.9% [51.1%–73.2%]); however specificity and PPV were reduced. Results stratified by specific comorbidity are presented in Tables3 and and4.4. Overall PPV of the administrative database for identifying the presence of Charlson comorbidities was 90% [82%–95%]. Similar results for Elixhauser comorbidities are presented in Additional file 1: Table S4-S6.
Both chart review and administrative data similarly predicted that age≥65 increased the risk of postoperative complications by approximately 2-fold (Table (Table5).5). Although emergent admission status was a risk factor for postoperative complication, the odds ratio for emergent admission was higher in the administrative database (OR 2.52 [1.80–3.52]) than that in the chart review (OR 1.49 [1.06–2.09]). The odds ratio for presence of ≥1 Charlson comorbidity was also higher in administrative data (OR 2.91 [1.86–4.56]) as compared to chart data (OR 1.50 [1.05–2.15]) (Table (Table55).
We conducted this study to evaluate whether outcomes derived from administrative databases accurately represent outcomes obtained from retrospectively reviewing medical charts. Both the administrative database and the chart review identified age, preoperative comorbidities, and emergent surgery as risk factors for postoperative complications following colectomy for UC. However, administrative data overestimated the magnitude of the risk for comorbidities and emergent operations as compared to chart review. Differences in risk estimates were in part explained by misclassification errors associated with the administrative database defining the study population, preoperative risk factors (i.e. comorbidity and emergent colectomy) and postoperative outcome (i.e. complications). The administrative database was more accurate at identifying comorbidities active at admission and the most severe postoperative complications; this selective coding likely biased the risk estimates away from the null hypothesis.
Both clinical [22,23] and administrative database studies [11,24] have identified advancing age, comorbidities, and emergency operations as risk factors for postoperative complications following colectomy and other abdominal surgeries [25-28], though few have evaluated the difference between the two methods[29]. In our analysis both the administrative and chart review data predicted an approximately two-fold increase in complications in those aged≥65 compared to age 18–34years. Close agreement of OR between administrative and chart data was expected because age is objective and reported with near perfect accuracy in both data sets.
The magnitude of effect for emergent operations was greater with the administrative data as compared to chart review. The administrative database was less specific for identifying emergent colectomy, with a high prevalence of false positives. Sensitivity analysis excluding patients with 'urgent' codes demonstrated improved specificity suggesting that the code 'urgent' is more aligned with an elective, rather than emergent admission. For example, patients electively admitted for an operation occurring within 24hours of admission were at times coded as 'urgent'.
Adaptations of the Charlson and Elixhauser comorbidity indices [20,30] have been validated for risk adjustment of postoperative morbidity and mortality [31-33]. In our analysis, Charlson comorbidities were significantly associated with worse postoperative outcomes; though, the magnitude of effect was greater in the administrative database than chart data. Preferential recording of comorbidities actively managed in-hospital may explain this difference. The sensitivity for most comorbid illnesses was low, but increased when the analysis was restricted to active comorbidities. Our findings were similar to other validation studies that have found poor sensitivity of comorbidity coding[15] and underreporting of chronic comorbidities not requiring treatment [34]. Despite the low sensitivity of administrative data, other studies have found that prediction of in-hospital mortality was identical to indices derived from chart review [31,35]. Additionally, among patients with multiple postoperative complications physicians may record more comorbidities in the discharge summary to explain the poor outcomes, while this may not be detailed in patients with an uncomplicated postoperative recovery.
The administrative database was 86% accurate in identifying patients with UC undergoing colectomy. Additionally, a small subset (n=15) of UC patients who underwent colectomy were not recorded in the administrative database. Thirumurthi et al. found the sensitivity of the diagnostic code 556× for hospitalization of UC was 84% [36]. Diagnostic coding for UC may be less accurate than for other conditions; for instance, validations of administrative data in patients presenting with heart failure, acute COPD exacerbations, acute coronary syndromes, and subarachnoid haemorrhage have consistently demonstrated PPV of diagnostic codes exceeding 95% [37-40]. In UC, the lower PPV may reflect uncertainties in diagnosis, especially from Crohn's disease and other causes of colitis. A previous study also reported higher PPV (96.1%) for colectomy codes[41] compared to our findings, although that validation was performed in a cohort of general surgery patients, with a smaller sample size (n=56), and included procedural codes for rectal resections (484, 485, 486). In our study, follow-up procedures such as second stage ileopouch anal anastomosis were commonly misclassified as colectomies.
Administrative data did not reliably identify UC patients admitted with a flare without colectomy when the first three diagnostic positions were searched. Although nearly 80% of admissions with UC coded in the primary diagnostic position represented an acute flare of disease, UC recorded in the second or third diagnostic positions represented an acute flare in fewer than 10% of cases. This misclassification error is evident in the literature, as one study demonstrated strengthening of risk estimates when a sensitivity analysis was conducted to exclude Crohn's disease patients admitted to hospital with a secondary diagnosis of Crohn's disease [42]. Consequently, prior studies using administrative databases have likely overestimated the true hospitalization rate of UC patients admitted for an acute flare of disease when non-primary diagnostic positions were searched.
The validity of postoperative complications in UC has not been reported. In our study, administrative data was 68% sensitive in identifying patients experiencing at least one complication after colectomy. Previous studies have also shown underreporting of complications in administrative data [43-47]. Misclassification of postoperative complications contributed to the discrepancy observed between administrative and chart review data. The accuracy of administrative data in coding postoperative complications was correlated to complication severity: sensitivity increased when less severe complications were excluded from the analysis while the specificity decreased. Administrative data poorly identified minor complications (i.e. Clavien I), but captured the more severe and clinically significant postoperative complications. These findings were similar to our comorbidity validation, supporting the notion that administrative databases miss comorbidities and complications that likely have less clinical impact.
Misclassification of post-operative complications was predominantly due to the challenge in differentiating a postoperative complication from a comorbidity or a preoperative in-hospital complication. For example, UC patients who underwent colectomy and were coded for pulmonary embolism were recorded as a false positive if the pulmonary embolism was diagnosed before the colectomy was performed.
Several limitations of our study should be considered. First, the chart review was retrospective and not all clinical information may have been documented in the charts. As we comprehensively reviewed only the current admission, other comorbidities may have been missed. Second, we only had access to administrative codes for the patient's hospitalization for colectomy; searching prior admissions may have improved the sensitivity of administrative coding, particularly for comorbidities. This provides an area for future study that may be explored in other datasets. Third, variation between reviewers was unavoidable although we attempted to limit inter-observer variability. Fourth, a small portion (2.6%) of UC patients coded for a flare but not colectomy actually underwent colectomy when the chart was reviewed. Conceivably, UC patients who underwent colectomy may not have been coded for either UC or colectomy, though this misclassification error is likely far less than 2.6%. Fifth, our sample size was sufficient to evaluate the overall validity of administrative data, but uncommon comorbidities and complications could not be validated. Similarly, large administrative database studies have the power to stratify comorbidity as a categorical variable (i.e. 0, 1, 2, or ≥3 comorbidities), but the prevalence of multiple comorbidities in our cohort was too low to accurately perform this subgroup analysis. Finally, the administrative database reflects the quality associated with Calgary's DAD and thus, may not be generalized to other hospitalization databases. However, Calgary's DAD is comprehensive, has been widely used and validated for health service research[41], and has demonstrated generalizability in different settings. For example, a recent study demonstrated that Charlson comorbidities predicted in-hospital mortality similarly in Calgary's hospital DAD as compared to hospitalization databases in France, New Zealand, Japan, Switzerland, and Australia [48]. Thus, the data from this study should reflect practices and outcomes of other administrative databases and at minimum should motivate others to test the validity of local administrative databases.
Administrative data identified the same risk factors (advanced age, emergency admission, and comorbidities) for postoperative complications as chart review. However, the risk estimates were biased away from the null by the administrative database. The discrepancy in risk estimates may be explained by inaccuracies in defining the study population, complications, and comorbidities. Administrative data more accurately identified severe postoperative complications and comorbidities actively managed during the admission. Thus, despite the imperfect validity of administrative data, identified comorbidities and complications were likely the most clinically meaningful. Administrative databases are valid tools for IBD research, but the general inferences drawn from risk estimates should be interpreted in the context of limitations associated in identifying the study population, risk factors, and postoperative complications.
The authors declare that they have no competing interests.
All authors have reviewed and approved this manuscript. Study design and planning, data interpretation, manuscript drafting and approval: Dr. GK. Study planning, data collection and interpretation, manuscript drafting and approval: CMa. Study planning, data collection, manuscript approval: MC, M-CP, and MP. Data analysis and manuscript approval: JH. Study planning, data collection and interpretation, manuscript approval: Dr. SDS. Manuscript drafting and approval: Dr. RP, Dr. SG, Dr. RM, and Dr. HQ.
The pre-publication history for this paper can be accessed here:
Tables S1-S6.For Table S1, please see reference citation number [18], Dindo 2004.
We acknowledge Andrew Fong for providing data from the Calgary Health Zone. Christopher Ma was supported in part by a summer studentship award from the Alberta Heritage Foundation for Medical Research (AHFMR). Martin Prusinkiewicz was supported by an American Gastroenterological Association Foundation Student Research Fellowship Award. Dr. Kaplan is supported through a New Investigator Award from the Canadian Institute of Health Research (CIHR) and a Population Health Investigator Award from the AHFMR. Dr. Quan was supported by AHFMR Health Scholar award. Dr. Myers is supported by a New Investigator Award from the CIHR and a Population Health Investigator Award from the AHFMR. The M.S.I. Foundation provided funding for this study.
Funding Support M.S.I. Foundation
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JYJ (Jaejoong/Yoochun/Junsu) kick off their showcase with Seoul as their first leg of the tour. The event titled "JYJ Worldwide Showcase in Seoul" took place on October 12th, 2010 at Korea University's Hwaseong Tiger Dome in Seoul. More photos of the event in full post!
About 10,000 attendees which consist of local fans and foreign fans were present at the event. At the showcase, they belted out songs from their new album including "Ayy Girl", "Empty", "Be The One" and etc. For the global album, they have teamed up with top-notch US producers Rodney Jerkins and Kanye West.
A Q&A session was also held during intervals of the showcase which gave fans the chance to get their question answered by the JYJ members.
They also performed "Found You" off the soundtrack of KBS Drama "Sungkyunkwan Scandal" which Yoochun takes the lead in the drama.The drama is currently still airing on KBS 2TV.
Proceeds from the event will be donated to worldwide non-governmental organization World Vision to help children around the world to fight poverty.
After Seoul, they will head to Bangkok, Singapore, Kuala Lumpur, Hong Kong, Taipei and the United States which totals up to 6 countries for their worldwide showcase.
Check out the news coverage of JYJ's Showcase in Seoul below!
Photos of the Event
Source : 10Asia
Picture credits: Newsen, Bnt news, Starnews, SPN


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Meinald T. Thielsch
Meinald T. Thielsch
I am a Postdoc ("Akademischer Rat") at the Westfälische Wilhelms-University Münster, Department of Psychology, Germany. I accomplished my Ph.D. and my habilitation in psychology in Münster. My main working and research interest are in the areas of user experience, human-computer interaction and organizational psychology as well as applied research, science-practise-transfer and online research.
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