text:
- Research article
- Open Access
- Open Peer Review
Real time curriculum map for internal medicine residency
- Roger Y Wong1Email author and
- J Mark Roberts1
© Wong and Roberts; licensee BioMed Central Ltd. 2007
- Received: 14 September 2007
- Accepted: 07 November 2007
- Published: 07 November 2007
To manage the voluminous formal curriculum content in a limited amount of structured teaching time, we describe the development and evaluation of a curriculum map for academic half days (AHD) in a core internal medicine residency program.
We created a 3-year cyclical curriculum map (an educational tool combining the content, methodology and timetabling of structured teaching), comprising a matrix of topics under various specialties/themes and corresponding AHD hours. All topics were cross-matched against the ACP-ASIM in-training examination, and all hours were colour coded based on the categories of core competencies. Residents regularly updated the map on a real time basis.
There were 208 topics covered in 283 AHD hours. All topics represented core competencies with minimal duplication (78% covered once in 3 years). Only 42 hours (15%) involved non-didactic teaching, which increased after implementation of the map (18–19 hours/year versus baseline 5 hours/year). Most AHD hours (78%) focused on medical expert competencies. Resident satisfaction (90% response) was high throughout (range 3.64 ± 0.21, 3.84 ± 0.14 out of 4), which improved after 1 year but returned to baseline after 2 years.
We developed and implemented an internal medicine curriculum map based on real time resident input, with minimal topic duplication and high resident satisfaction. The map provided an opportunity to balance didactic versus non-didactic teaching, and teaching on medical versus non medical expert topics.
- General Internal Medicine
- Core Competency
- Hidradenitis Suppurativa
- Tinea Pedis
- Formal Curriculum
Although accreditation bodies in North America have outlined well-established, multifaceted goals (overall direction of the education program), objectives (educationally useful elements that are rotation specific) and competencies (important observable knowledge, skills and attitudes) for residency training in internal medicine, the operational delivery of formal curriculum has been challenging for many postgraduate programs. Not only is there a tremendous and growing amount of academic content to cover during residency, but programs are also expected to teach residents all 6 general core competencies mandated by the Accreditation Council for Graduate Medical Education (ACGME) in the United States [1], or all 7 roles in the CanMEDS framework mandated by the Royal College of Physicians and Surgeons (RCPSC) in Canada [2]. All of these need to be achieved within a finite training period [3], and without extending training hours beyond the resident work hour restriction guidelines [4]. In some residency programs, formal curriculum is delivered through structured teaching opportunities such as academic half days (AHD) or full days. While these academic days may be mandatory, no standardized planning tool exists. Detailed educational planning is needed to achieve the largest possible impact, so that important topics are not missed and repetition is minimized. It is also unclear if the topics taught are actually pertinent to assessment at public internal medicine examinations, such as the American College of Physician – American Society of Internal Medicine (ACP-ASIM) in-training examination. The lack of standard methodology to manage the academic content within a busy curriculum, together with uncertainty if the content covered is actually relevant, present a double challenge for residency program directors and medical educators. Such challenge has been expressed and shared among program directors at national and international meetings.
Earlier educational studies have described the potential value of creating curriculum maps, mostly in the traditional K-12 school system [5]. A curriculum map is an educational tool that combines what is taught (the academic content), how it is taught (the teaching resources and opportunities), when it is taught (the timetable), and the measures used to assess if teaching has successfully occurred [6]. Like a road map to knowledge, a curriculum map makes the formal curriculum more transparent to all stakeholders and clarifies the relationships and links [6]. The process of establishing a map is, however, time and effort intensive. In health education, curriculum mapping has been used to help teach evidence based medicine [7], geriatrics [8], clinical nutrition [9], and computer-based virtual medical courses [10].
Curriculum mapping is a dynamic process, requiring ongoing (real time) feedback and needs assessment from the learners [11]. Ongoing feedback is commonly used in web based learning [12], which can be assessed using structured questionnaires [13, 14] or focus groups [15]. We elected to have a designated group of residents from all training years to provide feedback, as this motivates residents to actively participate in their own education.
We recently developed a real time curriculum map specifically designed for internal medicine residents, mainly because our former scheduling method for the formal curriculum resulted in numerous duplications and omissions, and sub-optimal resident/faculty satisfaction. Our map allowed us to proactively manage the logistics and relevance of formal curriculum delivery during AHD, while taking into account the specific requirements of teaching residents the non medical expert core competencies as mandated by the ACGME or RCPSC. The primary objective of this article is to describe the development of this real time curriculum map. The secondary objective is to assess the impact of implementing the map on formal curriculum planning and resident satisfaction.
The core internal medicine residency training program at the University of British Columbia (UBC) is a 3-year program with a 3-year cyclical formal curriculum. There were 72 residents in our residency program in 2003–2004 (26 in post graduate year (PGY)-1, 26 in PGY-2, 20 in PGY-3), 74 in 2004–2005 (26 PGY-1, 20 PGY-2, 28 PGY-3), and 81 in 2005–2006 (31 PGY-1, 31 PGY-2, 19 PGY-3). The bulk of the residency training experience involved clinical rotations in general internal medicine (clinical teaching units) and medical sub-specialties. Although each rotation had specific educational objectives, formal curriculum delivery was predominantly unstructured and determined by individual preceptors. The main structured teaching opportunity involved a weekly AHD program, which ran for 4 hours every Wednesday afternoon and was a mandatory component of the program. Of the weekly 4 hours, 3 hours had scheduled teaching activities (the focus of the curriculum map), with the remaining 1 hour for personal independent learning. AHD was protected time for residents and all services were expected to release them from ward and patient duties.
Curriculum Map Development
In October 2004, we assembled the first 3-year cycle of the AHD curriculum map. We retrospectively used the 2003–2004 curricular data as baseline (which became year 1 of a 3-year cycle), and prospectively planned for the subsequent 2 years (2004–2005 and 2005–2006). The map was in the form of a matrix that comprised of 20 themes, which represented 16 specialties and 4 non medical expert themes (biomedical ethics, evidence based medicine, quality improvement, teaching skills). One hour of scheduled AHD time was allotted to each topic. Topics belonging to the same specialty/theme were grouped together in consecutive rows, and the hours of AHD coverage in each academic year were plotted in consecutive columns. All topics covered were cross-matched against the list of examination objectives from each year's ACP-ASIM in-training examination. The latter information was disseminated to all program directors after the annual examinations. The topics were colour coded to indicate those that were covered and examined, those covered but not examined, and those examined but never covered. The hours were also colour coded to indicate the category of core competencies covered, which paralleled those mandated by the national accreditation bodies. The map was updated monthly by the residency program secretary on an ongoing basis. A sample portion of the curriculum map is illustrated in the Appendix. We received approval from the UBC residency training committee to develop and implement the curriculum map and disseminate our experience.
Prior to the development of a curriculum map (baseline), AHD topics and speakers were determined by 2 of the 4 chief medical residents, without cross reference to what was previously taught and when it was taught. After implementation of the map, we assessed teaching needs on an ongoing basis. The topic, format (didactic and/or interactive) and speaker selection at AHD were determined by the AHD organizing committee, which comprised of 17 members (4 chief medical residents, 2 class representatives from each of the 3 years, and an additional 2 representatives from each class who expressed special interest in medical education, and chaired by the associate program director). The committee met every 4–6 weeks for about 90 minutes, during which members used the curriculum map to formulate a list of topics that fit into a series of predetermined AHD block themes. Members suggested potential speakers for these topics, with consideration of adequate and balanced representation based on geography (teaching or community hospitals) and expertise (clinical or research), and then extended personal invitations to the speakers. The information was collated by the chief medical residents and approved by the associate program director. On an ongoing basis, AHD topics were entered into the curriculum map by the program secretary.
Curriculum Map Evaluation
Evaluation of the AHD curriculum map was conducted from 2 perspectives: formal curriculum planning and resident satisfaction. The impact of the map on formal curriculum planning was assessed by the percentage of AHD coverage that represented core competencies in internal medicine, the extent of topic duplication, the amount of didactic versus non-didactic teaching sessions, and the amount of teaching on non medical expert competencies as mandated by the national accreditation bodies. Resident satisfaction was evaluated using a structured, 5-item survey administered after each AHD for the period July 1, 2003 to June 30, 2006, which provided baseline data (2003–2004), and evaluation data in the first (2004–2005) and second (2005–2006) years after implementation of the curriculum map. Residents were asked to rate each survey item on a Likert scale from 1 (minimum satisfaction) to 4 (maximum satisfaction), with higher numeric scores representing better satisfaction.
Descriptive statistics (cumulative frequencies and relative percentages) were used to describe the content of the curriculum map. All scores from the satisfaction surveys were reported as mean ± SD. Post-implementation satisfaction scores were compared with baseline using 2-tailed, unpaired t tests, and differences were considered significant when p value < 0.05. All analyses were performed using SPSS 11.0 statistical software package (SPSS Inc. Chicago, IL).
The inaugural 3-year cycle of the AHD curriculum map included 283 scheduled hours. A total of 208 topics were covered, all of which (100%) represented core competencies in internal medicine.
Duplication of topics was minimal: most topics (163 or 78%) were covered once during the 3-year cycle. There were 30 topics (14%) that were covered twice in 3 years (e.g. general discussion on biomedical ethics, endocrine emergencies, thrombophilic conditions, HIV workshops, breast cancer, pulmonary function, etc.), and 11 topics (5%) were covered 3 times (e.g. acute coronary syndrome, diabetes mellitus, gastrointestinal bleeds, physical examination workshops, electrocardiography workshops, acid base disorder workshops, etc.) Two topics were covered 4 times in this formal curriculum cycle: sepsis/septic shock management, and the dermatologic manifestations of systemic disease. The topic on the principles of evidence based medicine was covered 5 times in 3 years.
The format of most AHD hours (241 or 85%) involved didactic activities, with the remaining 42 hours (15%) involved non-didactic teaching (such as physical examination workshops, case-based sessions, etc.). The latter increased substantially after implementation of the curriculum map, from 5 hours in 2003–2004, to 19 and 18 hours in 2004–2005 and 2005–2006 respectively.
Coverage of medical expert and non medical expert categories during academic half day classified by specialty/theme in a 3-year cycle of the formal curriculum map (2003 to 2006).
Medical Expert
Allergy and Immunology
Biomedical Ethics
Critical Care
Evidence Based Medicine
General Internal Medicine
Infectious Diseases
Maternal Fetal Medicine
Medical Oncology
Quality Improvement
Teaching Skills
All specialties combined
Specialty topic/theme coverage during academic half day in a 3-year cycle of curriculum map (2003 to 2006).
Hours (%) of topics covered and examined within specialty
Hours (%) of topics covered but not examined within specialty
Total hours (%) of topics covered across all specialties
Number of topics examined but not covered within specialty
Allergy and Immunology
1 (20)
4 (80)
5 (2)
Biomedical Ethics
0 (0)
5 (100)
5 (2)
8 (29)
20 (71)
28 (10)
Critical Care
0 (0)
12 (100)
12 (4)
0 (0)
8 (100)
8 (3)
9 (38)
15 (62)
24 (9)
Evidence Based Medicine
0 (0)
18 (100)
18 (6)
12 (63)
7 (37)
19 (7)
General Internal Medicine
4 (24)
13 (76)
17 (6)
6 (75)
2 (25)
8 (3)
4 (20)
16 (80)
20 (7)
Infectious Diseases
8 (42)
11 (58)
19 (7)
Maternal Fetal Medicine
0 (0)
9 (100)
9 (3)
Medical Oncology
6 (67)
3 (33)
9 (3)
9 (45)
11 (55)
20 (7)
4 (25)
12 (75)
16 (6)
Quality Improvement
1 (17)
5 (83)
6 (2)
9 (50)
9 (50)
18 (6)
2 (11)
16 (89)
18 (6)
Teaching Skills
0 (0)
4 (100)
4 (1)
All specialties combined
83 (29)
200 (71)
283 (100)
Resident evaluation of academic half day before, during and after formal curriculum changes introduced based on curriculum map.
Evaluation Domains
Baseline (7/1/2003 – 6/30/2004) n = 79 hours
Year 1 post curriculum map (7/1/2004 – 6/30/2005) n = 89 hours
p value for difference between Year 1 and Baseline
Year 2 post curriculum map (7/1/2005 – 6/30/2006) n = 87 hours
p value for difference between Year 2 and Baseline
3.78 ± 0.16
3.82 ± 0.17
3.70 ± 0.22
3.65 ± 0.25
3.76 ± 0.18
3.65 ± 0.26
3.77 ± 0.15
3.84 ± 0.14
3.73 ± 0.23
Presentation skills
3.72 ± 0.20
3.80 ± 0.16
3.68 ± 0.26
3.64 ± 0.21
3.75 ± 0.20
3.66 ± 0.28
We developed and implemented a cyclical curriculum map for our internal medicine residency program based on real time resident input. The map provided easy visualization of structured teaching activities that occurred at AHD, as well as an opportunity to continuously review the format (didactic versus non-didactic) and nature of teaching (medical versus non medical expert competencies). In the first 3-year cycle, all topics covered were relevant and represented core competencies, with minimum topic duplication. The curriculum map allowed any duplication to be reviewed and/or rationalized. Resident satisfaction remained high after implementing the map. These findings appear promising.
A curriculum map can identify potential gaps so that appropriate action can be taken [16]. For instance, only 29% of the scheduled hours covered topics that were actually tested in past ACP-ASIM examinations. While we recognized that our AHD should not merely cover competencies that were tested in the past, and not all competencies were testable in a multiple-choice format, we discovered a substantial number of topics that were examined but never formally covered at AHD, especially in general internal medicine, infectious diseases, hematology and rheumatology. These mirrored the same content areas where our resident performance in the ACP-ASIM examination was lower. The curriculum map may help to highlight deficiencies in topic coverage within these specialties for future educational planning.
Teaching gaps arise within the context of curricular changes, and the real time nature of the curriculum map permits ready incorporation of dynamic changes. For example, there was no specific AHD coverage of competencies on collaboration, communication and health advocacy in the first 3-year formal curriculum cycle, although we were mandated to teach these competencies by the accreditation bodies. These were relatively new areas in the formal curriculum, which required innovative and conscientious efforts to teach well. A curriculum map can help to unmask competencies that may have become hidden otherwise [17]. In the new cycle of curriculum map, we have now introduced new theme blocks to focus on competencies of collaboration, communication, health advocacy, as well as other medical content areas of palliative care and peri-operative medicine. Another example of change involved the introduction of more non-didactic, interactive sessions. The majority of our AHD activities involved didactic teaching using the classical pedagogic method of lectures, which is common in internal medicine [18]. The curriculum map made it logistically easier to track the gradual increase in non-didactic sessions. During the study period, non-didactic hours increased substantially after implementation of the curriculum map. Adult learners generally learn better with interaction, and it would be interesting to see this if the interactive, non-didactic sessions proved to be better rated than the didactic ones. Future studies with a larger sample size are warranted.
We realized that AHD could not be the only structured teaching opportunity to deliver a large internal medicine formal curriculum, and other venues such as noon-hour rounds and special retreats could be deployed to teach some competencies. We recognize omitting other educational experiences would affect the selection or distribution of topics in the AHD part of the curriculum. In the new formal curriculum cycle, we have expanded the curriculum map to include teaching at these venues. To help keep things simple and user friendly, we elected not to include topics covered during clinical rotations, although the latter was attempted in a recent study [19].
Resident satisfaction was high before and after implementing the curriculum map. The satisfaction ratings improved modestly after the initial year, suggesting residents viewed positively the changes in AHD as driven by the curriculum map. It is unclear why the same ratings returned to baseline 2 years later. Perhaps by year 2, some of the new residents were never exposed to the baseline AHD experience and therefore had no comparison. Other possible explanations include higher resident expectations after the initial changes imposed by the map, or the need for further acceptance and/or fine-tuning for the newly introduced non medical expert topics. Our observation can also be explained by the Hawthorne effect and/or regression to the mean.
Besides satisfaction scores, there are other interesting outcomes as we evaluate the impact of the curriculum map longitudinally. For instance, the score averages from public certification examinations can reflect clinical knowledge from our residents, although such confidential information is not readily accessible for the residency program. Future practice choices and career trajectories are also of interest.
Our study findings have some limitations. This is a single site formal curriculum and may not be generalizable to other institutions. We reported data from 1 formal curriculum cycle, and are therefore uncertain as to whether the same conclusions noted can be applied to future cycles. The changes in resident satisfaction ratings over time were small, probably due to the ceiling effect of the unvalidated survey. Future efforts to validate the survey will be helpful.
In summary, we developed and implemented an internal medicine curriculum map based on real time resident input. Initial evaluation of this educational tool is promising. This has potential for broader implementation by residency programs as it highlights the spatial organization and interconnections between what is taught in the formal curriculum, how it is taught, and when it is taught, all within the context of teaching accreditation requirements in a finite period of training duration. The curriculum map requires ongoing needs assessment, and creates an opportunity of engaging residents to actively participate in their own education.
A sample portion (General Internal Medicine) of the UBC Department of Medicine Postgraduate Education Curriculum Map.
Speciality and Topics
General Internal Medicine
Topics covered in Academic Half Day:
Eating Disorders
Errors as a Learning Opportunity
Ethics of Symptom Management
Evidence Based Medicine: General Internal Medicine
Fever in the Returning Traveller
Hypertension (including Isolated Systolic Hypertension)
Insurance and Introduction to Practice Management
Optimization of Drug Therapy in Patients with Liver Disease
Palm Project in Medicine
Peri-operative Medicine
Principles of Drug Therapy
Pros and Cons of Being a Community Internist
Secondary Hypertension, Laboratory Investigations of
Things They Didn't Teach You in Medical School
Topics not covered in Academic Half Day:
Anti-obesity drugs
Achilles tendonitis – from fluoroquinolone antibiotics
Atrophic vaginitis
Brain death
Calculate incidence
Candida albicans Infection
Case control study
Chlamydia trachomatis infection
Chronic catheter-assisted urinary drainage
Chronic recurrent sinusitis
Chronic venous insufficiency
Complement cascade
Compression of the lateral femoral cutaneous nerve
Contact dermatitis
Dog bite
Down's syndrome (risk for atlanto-axial instability)
Dupytren's contracture
End-of-life issues
Epidural abscess
Erythema multiforme
Fat-soluble vitamins
Garlic, ginseng and gingko biloba
Genetic Diseases
Heat stroke
Hereditary angioedema
Hidradenitis suppurativa
Innocent cardiac flow murmur
Ischemic encephalopathy
Isopropyl alcohol ingestion
Klinefelter's syndrome
Lactose intolerance
Lateral epicondylitis
Likelihood ratios
Low back pain
Male adolescent with gynecomastia
Malignant external otitis
Marked obesity
Meniere's disease
Methanol ingestion
Morton's neuroma
Number needed to treat
Obstructive sleep apnea
Patient controlled analgesia
Post-test probability
Post-traumatic stress disorder
Preventive medicine
Prostrate disease
Renal stones
Restless legs syndrome
Rhinocerebral mucormycosis
Risk reduction, absolute – number needed to treat
Rotator cuff tendonitis
Secondary syphilis
Serotonin syndrome
Serum alkaline phosphatase elevation
Sexually active homosexual man
Sinusitis as a cause of halitosis
Subconjunctival Hemorrhage
Splenectomy and medical issues
Symptomatic carotid artery stenosis
Symptomatic urinary tract infections
Systolic heart failure
Tension headache
Tinea pedis and lower extremity cellulitis
Ulnar neuropathy
Uncomplicated low back pain
We would like to thank Hazel Wilcox, Andrea Toker, and Nicole Stewart for their assistance and the members of the UBC academic half day organizing committee.
Authors' Affiliations
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- Frank JR, ed: The CanMEDS 2005 physicians competency framework. Better standards. Better physicians. Better care. 2005, Ottawa: The Royal College of physicians and Surgeons of CanadaGoogle Scholar
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- Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV: Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005, 165: 2595-600. 10.1001/archinte.165.22.2595.View ArticleGoogle Scholar
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- Harden RM: AMEE Guide No. 21: Curriculum mapping: a tool for transparent and authentic teaching and learning. Medical Teacher. 2001, 23 (2): 123-37. 10.1080/01421590120036547.View ArticleGoogle Scholar
- Green ML: Evidence-based medicine training in graduate medical education: past, present and future. Journal of Evaluation in Clinical Practice. 2000, 6 (2): 121-38. 10.1046/j.1365-2753.2000.00239.x.View ArticleGoogle Scholar
- Medina-Walpole A, Clark NS, Heppard B, Dannefer E, Hall W, McCann R: A user's guide to enhancing geriatrics in an undergraduate medical school curriculum: the ten-step model to winning the "geriatric game". J Am Geriatr Soc. 2004, 52 (5): 814-21. 10.1111/j.1532-5415.2004.52225.x.View ArticleGoogle Scholar
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- Harden RM, Hart IR: An international virtual medical school (IVIMEDS): the future for medical education?. Medical Teacher. 2002, 24 (3): 261-7. 10.1080/01421590220141008.View ArticleGoogle Scholar
- Denny JC, Smithers JD, Armstrong B, Spickard A: "Where do we teach what?" Finding broad concepts in the medical school curriculum. J Gen Intern Med. 2005, 20: 943-6. 10.1111/j.1525-1497.2005.0203.x.View ArticleGoogle Scholar
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- Scott RE, Ndumbe P, Wootton R: An e-health needs assessment of medical residents in Cameroon. J Telemed Telecare. 2005, 11 (suppl 2): S78-80. 10.1258/135763305775124911.View ArticleGoogle Scholar
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- Tipping J: Focus groups: a method of needs assessment. J Contin Educ Health Prof. 1998, 18: 150-4. 10.1002/chp.1340180304.View ArticleGoogle Scholar
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- Cottrell , et al: Using information contained in the curriculum management information tool (CurrMIT) to capture opportunities for student learning and development. Medical Teacher. 2004, 26 (5): 423-7. 10.1080/0142159042000218650.View ArticleGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6920/7/42/prepub
Pre-publication history
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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2. Office Roman sandals here
Gladiator sandals are a perennial Summer favourite, and each and every year I find myself drawn to all manner of glam glads.
I have been spending like an absolute crazed lady of late, treating myself left right and centre, and I have now settled upon THE sandals of my Summer wardrobe.
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A recent American Express (Amex) survey – titled American Express Middle East Spending Survey conducted in conjunction with market research firm YouGov across the MENA region – indicates that 65% of Lebanese prioritise spending on luxury experiences, which is above the regional average of 59%.
In Lebanon, a majority chooses to spend their money on holidays, with 54% ranking holidays their number one luxury spending priority. This is well above the regional average of 43% and contrasts with the picture of the region as a whole, where social events such as sporting activities tend to attract the most spending.
When it comes to other experiences, Lebanese rank spending on club memberships as their second-most important spending category, with 50% ranking this as important to them. According to the survey, nearly two-thirds of luxury spenders in the MENA region are now choosing to spend more of their money on enriching experiences than goods.
Commenting on the results, says: "Over recent years, we've seen a major shift in the way people spend and make luxury. Increasingly, they are focusing on buying experiences, and the memories that go with them. Our survey shows the Lebanese are very focused on holidays, choosing to relax and enjoy time away from their day-to-day lives," says Mazin Khoury, CEO of Amex Middle East.
Despite the focus on experiences, respondents in Lebanon are continuing to spend on luxury goods. Luxury food ranks as the top category of expenditure with 27% of people choosing it as their number one focus, followed by high-end electronics (23%) and designer wear and fashion (21%) making up the second- and third-preferred category of expenditure.
"Our survey shows that increasingly Lebanese luxury spending is set to enable them to explore their passions and maintain their personal wellbeing through experiential luxury. Overall, luxury spending on both goods and services is set to remain strong during the remainder of 2014 and 2015, and this supports the trends we've seen in the first half of 2014, which shows a significant increase in card-member spending," adds Khoury.


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FORT RAMON MAGSAYSAY, Nueva Ecija – The 7th Infantry (Kaugnay) Division, Philippine Army under the leadership of Brig. Gen. Hernando DCA Iriberri has just dispatched a Company (composed of 4 Officers and 97 Enlisted Personnel) to reposition at Headquarters, Philippine Army in Fort Andres Bonifacio, Metro Manila for deployment to the typhoon-stricken Vizayas Region. This is in support to the ongoing Humanitarian Assistance and Disaster Relief (HADR) Operations in the areas devastated by super typhoon "Yolanda".
This morning, November 11, 2013, a send-off ceremony was conducted at Headquarters 7ID, PA to motivate the troops, provide situation briefing and inspect HADR equipment. BGEN Iriberri told his soldiers that this will be an opportunity to help our fellow Filipinos who were struck by the devastating typhoon. Likewise, he said that the troops deployed will not only represent 7th Infantry Division but the whole organization of the Philippine Army as well.
BGEN Iriberri recalled that exactly a month ago (October 11, 2013), the onslaught of typhoon "Santi" caused significant damage to 7ID facilities and structures and is still on the process of recovering from the effects of the said catastrophe.
"Despite all of these, we remained focused in our resolve to accomplish our mission. We have just experienced the difficulties and hardships brought about by these kinds of events that is why we are determined to offer our help" he added.
BGEN Iriberri emphasized the proper attitude of the augmentation forces; they are not to engage in any form of illegal activities in the conduct of HADR in the area, and utmost patience and tolerance must be implemented in controlling the crowd of people.
Lastly, he gave his guidance prior to the deployment of forces to take good care of their health and to be security conscious at all times and to perform their task as mandated by the AFP.


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But when mental ray renderer freezes!
Although I have a very powerful computer!
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Sorry for my english!
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'51 Studebaker Starlight coupe sectioned 3 inch below the window line. '49 Merc grille in '47 Olds ...more
top bar. '52 Ford headlights, '50 Olds rear fenders with '52 Ford scoops added and with '52 Lincoln taillights. Deck lid is from a '52 Nash. Charles Lacey is the builder owner of this very nice Studebaker custom.
Do you know anything more about this Sports Custom. Please read the HAMB post on it.http://www.jalopyjournal.com/forum/showthread.php?t=662198
© 1998-2018 FOTKI INC or its affiliates.


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The Pyatthats on City Wall, [Mandalay]
Photographer: Archaeological Survey of India
Medium: Photographic print
Date: 1903
Photograph of a series of pyatthats on the city walls of Mandalay in Burma, from the Archaeological Survey of India Collections: Burma Circle, 1903-07. The photograph was taken in 1903 by an unknown photographer under the direction of Taw Sein Ko, the Superintendent of the Archaeological Survey of Burma at the time. Mandalay was Burma's last great royal capital and was founded in 1857 by Mindon Min (reigned 1853-78), Burma's penultimate king, in fulfilment of a Buddhist prophecy that a religious centre would be built at the foot of Mandalay Hill. In 1861 the court was transferred there from the previous capital of Amarapura. Its glory was shortlived however as it was annexed by the British Empire in 1886 after the Third Anglo-Burmese war, renamed Fort Dufferin, and a military cantonment was built inside the walls. The original city was built as a fortress in the form of a perfect square with the Nandaw or Royal Palace at the centre. Its battlemented walls faced the cardinal directions and were each nearly two kilometres (1.2 miles) long, surrounded by a 70 metre-wide moat on all four sides. There were twelve city gates, the main gate being the central gate in the east wall which led to the Great Hall of Audience in the Royal Palace, and five bridges spanning the moat. The gateways and multitude of bastions were surmounted with tiered wooden spires or pavilions known as pyatthats, a characteristic symbolic feature of Burmese royal and religious architecture demarcating sacred space. The eaves of the pyatthats were decorated with elaborate ornamental wood carving. This is a view looking along one of the city walls, with pyatthats at intervals. All the pyatthats had five tiers, such as the one in the foreground of this image, with the exception of the pyatthats over the central gateway in each wall, which had seven tiers because they were used by royalty. The walls and the moat were all that remained following the complete destruction of the palace and other buildings by Allied bombing raids in 1945 during the Second World War.


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By now, every business owner should know they need an online presence to succeed in the modern consumer climate. However, some business owners may not realize how important it is to develop a strategy specific to mobile viewing. In today's environment, consumers increasingly rely on smartphones and tablets to access online content. In fact, mobile browsing accounts for at least one-third of all web traffic—and in several countries, it's already surpassed desktop usage.
Business owners may imagine consumers using mobile solely for apps and games, but an important part of mobile viewing is the ability to make purchases on-the-go. With the popularity of Amazon and other convenient online one-stop shops, customers are looking to buy products on mobile devices rather than at a store or even on their computers.
If a business doesn't have a mobile strategy, it's very likely that it will lose potential customers to competitors who have an easily accessible mobile presence. Having a website is one thing, but it takes more time and energy to make sure it works on a phone and is user-friendly. Content that is not specifically designed for mobile access can be too hard to find, too small to view, or formatted in a way that's too complicated to read. Mobile platforms need clear designs such as large, "easily tappable" buttons that simplify purchasing.
The key is for business owners to make sure their website is responsive, accessible and aesthetically pleasing on all platforms: desktops, laptops, tablets, and smartphones.
Some companies take it a step further by doing more than just optimizing their websites—they also create their own apps. This can be incredibly useful if you want to build brand loyalty and keep customers coming back. Rather than a customer spending time surfing the web to find a product, he or she can open an app and quickly find what they're looking for, cutting out the noise of other search results and advertisements.
Mobile is also useful for notifying customers about current sales and coupons. Unlike a customer who receives coupons in the mail, or even by email, a mobile user gets instant updates and notifications about chances to save money. This sense of urgency and consistency helps keep the company on the consumer's mind.
Another advantage of a mobile strategy is the integration of location services. If a potential customer is on a busy street looking for a store, his or her desktop is of no use. By enabling store-locating functions on a mobile website or app, businesses make it easier for customers to find what they're looking for.
While companies should continuously invest in creating responsive tools to bring in customers, businesses also need to extend efforts into mobile advertising. As mentioned earlier, more people are viewing content on mobile platforms, which means they're seeing more ads on mobile devices. If businesses are looking to catch their audience's eyes, mobile needs to be an important part of the company's marketing strategy.
Once a company has a strong mobile strategy, it can easily initiate a social media strategy. People access social media platforms like Facebook and Instagram on their phones and tablets all the time. When users view company social pages and decide to click on the website link, they want to be transferred to a responsive page or app—not a clunky one that's difficult to navigate.
As all of these examples show, there are many business benefits associated with mobile viewing; but, for many companies today, having an online strategy is no longer enough. In order to truly be competitive, businesses must be eager to expand and improve their mobile presence. What's the most important part of your mobile strategy?


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Some of the problems cured by Ginger
Colds/Flu ---> Kills influenza virus by improving immune system's ability to fight infections. Ginger also relieves headaches.
Increases Circulation--> Increases the muscular contractions of the heart atria, there by increase in overall circulation. Ginger has been proven to prevent internal blood clots and lowers blood pressure. Ginger Root stimulates the central nervous system controlling the heart and respiratory centers. Ginger helps reduce serum cholesterol, which can slow down circulation.
Ginger Relieves Motion/Morning Sickness--> Ginger is one of the most effective herbal remedies to get rid of Motion/ Morning Sickness.
Digestive Aid - Indigestion, Stomach Ache--> Ginger Root increases production of saliva in the mouth and dramatically increases digestive enzyme amylase in the saliva to additionally aid digestion. Ginger Root also contains a very effective digestive enzyme zingibain.
Women's Health--> Ginger Root is good for the uterus as well as the intestinal tract and may ease menstrual cramps
Skin Very cleansing--> Reduces pus in infected wounds as well as boils. Clears spots caused by chicken pox and shingles. Useful for burns, sores, sunburn, ringworm, warts, herpes, athletes foot and even for dandruff.
Ginger is sometimes recommended as an alternative to aspirin for people who can not take aspirin because of its irritating effect on the gastrointestinal tract.
Ginger cures following ailments
Asthma - Adults
Athlete's Foot
Boils/ Blisters
Cold Sores
Glandular Fever
Gum Infections
Head Lice
Insect Bites / Stings
Mosquito Bites
Mouth Ulcers
Ringworm (tinea)
Skin Conditions - Antiseptic
Sore Throat
With all the benefits to the average person, ginger should be included in the diet every day. Especially for a person who are suffering from heart problems, cold/flu, stress problem, motion sickness a daily dose of ginger combined with other herbs to enhance their effectiveness is part of a sensible, healthy diet.


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Anthony Martial: Tottenham planning fresh move for Manchester United star
MANCHESTER UNITED are reportedly set to field fresh interest in Anthony Martial from Tottenham.
The France international was on the scoresheet as Jose Mourinho's men thrashed West Ham 4-0 on Sunday.
But his future at Old Trafford has been the subject of much speculation after he struggled under the United boss last season.
Inter Milan are thought to be willing to take Martial off Mourinho's hands, potentially as part of a deal for Red Devils target Ivan Perisic.
Meanwhile, reports from his homeland over the weekend suggested Tottenham are keen on securing his services this summer too.
"Tottenham want Manchester United star Anthony Martial"
United are said to have rejected an offer from Spurs and are unwilling to do business.
However, Transfer Market Web suggest that has not put the north Londoners off Martial.
Tottenham have apparently made the 21-year-old one of their main targets.
And Transfer Market Web claim they are planning to go back in for him before August 31's deadline.
Should United relent on their stance that Martial's not for sale, he's unlikely to be cheap.
Chiefs sanctioned a deal worth an initial £36m when they signed the forward from Monaco in 2015.
And a player capable of replacing him in Mourinho's squad could cost significantly more now.


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French Bakeries
I love French bakeries. There is one at every corner and they all carry fresh bread, croissants, pains au chocolat and pains aux raisin. They also have their specialties, from elaborate cakes to simple fruit pies.
I love French bakeries. There is one at every corner and they all carry fresh bread, croissants, pains au chocolat and pains aux raisin. They also have their specialties, from elaborate cakes to simple fruit pies.
For our last week-end in France, Feng and I went back on the Atlantic coast. We spent a few days with my family and left to explore St Nazaire, a few kilometers away. The town isn't pretty: it was heavily bombed during WWII and 80% of it was destroyed. It was rebuilt right after the war in a somewhat minimalist style — understand one main street and square buildings scattered around.
I love cities by night. Most change a lot and reveal a totally different atmosphere — it's like traveling. I've already shown you snapshots of Ottawa by night, Toronto, London, Paris… Here is Nantes, my hometown.
The 12 meters high mechanical elephant is made from 45 tons of wood and steel. Several times a day, it takes passengers for a walk around the Isle of Nantes, located in the middle of the Loire River. Riding it is quite expensive but it's free to just see it move around, wink, trumpet, and spray nearby photographers with water (oh well, it was a hot day).
Jules Verne, the famous French author, was born in Nantes. And today, in the warehouses of the former shipyards of Nantes, artists try to recreate a travel-through-time world which borrow from both Jules Verne's imagination and Leonardo da Vinci's passion for mechanic.
The site has two main attractions: the Great Elephant and the Marine Worlds Carrousel.
The other day, we went to see Kiss & Kill, a U.S movie. You may have heard of it: the English title is "Killers". Why did the French bother changing the original English title to another English title? No idea. Similarly, "The Spy Next Door" is "Kung Fu Nanny" here. Go figure!
This is a sleepy village 45 minutes from Nantes. Its claim to fame is the cookie factory. Other than that, there isn't much: a roundabout (French love roundabouts and even the smallest village has one), a church, a bar-tabac (a small corner store) and a news agent.
Sunset is around 10:30 pm in France right now and with the summer heat, we had plenty of time and motivation to roam around Paris at night. I have my favorite spots, they are not so original but they are lovely: le Louvre, along the Seine, the Trocadéro, the Eiffel Tower…
Once we reached the doors of Versailles, we realized we were in trouble. The lineup was so long I couldn't even find where it started. I asked how long it would take us to get tickets: at least 90 minutes. And to actually get into the Palace, we had to queue another 90 minutes. Feng walked around a bit as we tried to assess how to make the best out of the situation. I looked up at the Palace and I saw people on top of each other by the open windows. No way I'm queuing at least 3 hours for a rush visit.
We got extremely lucky with the hotel the first couple of days: we had booked online again from London with Expedia (which really should be paying me for all the times I mentioned them!). The hotel turned out to be a three stars renovated building in a quiet street, and we had the biggest bathroom I had never seen.
After London, Paris. Don't hate me for saying it, but at first sight, it felt like going from Peru to Bolivia.
I have never liked Paris. Go ahead, call me a little spoiled French girl, I'm used to it. Saying you don't like Paris usually gets hate look from people who are dreaming to visit the city of lights, and brings contempt from other French people. They shrug at me, saying: « oui mais bon… c'est Paris quand même ! ».
Aren't cities at night truly beautiful?
London didn't disappoint. Lots of lights, lots of sights, lots of amazing skylines coming alive before our eyes after sunset. Next, Paris and Nantes again…
Coming from a country which executed Louis XVI, the last king, by guillotine, I tend to consider monarchy a custom somewhat obsolete and old-fashioned although harmless if a Parliament is in place. We don't hear that much about the Queen in Canada and I've never been very interested in gossip about the Royal Family.
The many bridges crossing the River Thames are all different. The Millennium Bridge is a modern footbridge steel suspension bridge leading to the Tate Modern, while the Tower Bridge, with its two massive towers, leads to the Tower of London. The architecture of the London Bridge is more straightforward but it is interesting to watch all the throng of office workers making their way from The City to London Bridge Station at the end of the day.
Her Majesty's Royal Palace and Fortress, the Tower of London, is actually more a castle than a tower. It is among all famous for being the home of the Crown Jewels of the United Kingdom.
The castle is made of several buildings set within two concentric rings of defensive walls, and a moat, which is now dry. Currently stored in the Waterloo Barracks, the Crown Jewels are one of the main attractions.
London was a great surprise to me. I had been to England many times as a teen, first by taking the ferry across the channel and later by the Eurostar train. England to me was buying "crips" with vinegar at Woolworth, taking double-decker buses across small cities, listening to Oasis (I liked them better than Blur) and bitching about the overall gloomy weather.
While the Louvre in Paris may be more famous, London also has awesome museums. We took the opportunity to visit the British Museum and the Tate Modern and I must said I was amazed by both.
One really cool fact: these national museums were both free, although small donations were encouraged. How cool! In Paris, museums are quite expensive and it adds up pretty fast.
The tube, the subway, the underground… London wouldn't be London without it, no matter how you call it.
I usually have a love/ hate relationship with subways: while they are often the most efficient way to get around in large cities, they also receive their fair share of bad press. Dangerous, crowded, dirty, expensive, claustrophobic… not all subways are nice to ride.
The last time I was in London, not including multiples transfers at Heathrow airport, was in 1998. I had never seen the London Eye, the giant Ferris wheel set up in the capital to celebrate the millennium. It was high on my "must visit list", for both the somewhat unusual character of the landmark and the view from the wheel.
Crêpes are Brittany's specialty and crêperies can be found everywhere in Nantes. These very thin pancakes are made from flour, eggs, milk, butter, and a pinch of salt. Normally, crêpes are slightly sweeet and galettes are unsweetened: the first one is served as dessert and the second one is the main meal. They are traditionally served with very cold cider.
Happy birthday Canada… from London!
That's right: from France, we took the Eurostar (more on that later) and are now in London for a few days. And this afternoon, we stumbled upon the Canada Day celebrations in London, in Trafalgar Square — a huge (unexpected) party!
There are two big markets a week in Nantes, and they are both very busy. French do love food after all.
Fruits and vegetables are not always cheaper than at the supermarket but people have their "petites habitudes" (customs) and they enjoy shopping at the same stalls weeks after weeks. They joke, taste the fruits, complain about the price and happily bag a few pounds of this and that. So-and-so has the best meat, so-and-so has the freshest bread etc.


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This paper people is the Chris Evans, the paper toy is designed by sally. Christopher Robert "Chris" Evans is an American actor, best known for his role as Steve Rogers / Captain America in Captain America: The First Avenger and The Avengers. He will reprise the role in sequels to both films, set for release in 2014 and 2015, respectively. He began his career on the television series Opposite Sex and later transitioned to film, starring in several hits including Not Another Teen Movie and Fierce People. He was part of the lead ensemble as the superhero the Human Torch in Fantastic Four and its sequel, Fantastic Four: Rise of the Silver Surfer, both box office successes.
After filming wrapped on Not Another Teen Movie, Evans landed lead roles in The Perfect Score and Cellular, and then starred in two independent films in Chicago: Dirk Wittenborn's Fierce People, playing the sinister Bryce, and London, playing a strung-out drug user with relationship problems. He then played Johnny Storm, the superhero the Human Torch, in the 2005 comic book adaptation Fantastic Four. Evans reprised the role of the Human Torch in the 2007 sequel Fantastic Four: Rise of the Silver Surfer. That year he also starred as engineer turned astronaut Mace in Danny Boyle's science-fiction film Sunshine.
In 2008, Evans appeared in Street Kings, co-starring Keanu Reeves, and the Tennessee Williams screenplay adaptation The Loss of a Teardrop Diamond, co-starring Bryce Dallas Howard and Ellen Burstyn. The following year he appeared in the science-fiction thriller Push, with Dakota Fanning and Camilla Belle. Evans performed his own fight scenes, which took weeks to film, and was bruised during filming. Also that year, Evans was ranked 474th in Forbes' "Star Currency" rankings, based on films' global box-office performance.
In 2010, he completed filming on co-directors Mark Kassen and Adam Kassen's Puncture in Houston, Texas. The film was selected to debut at the 2011 Tribeca Film Festival as one of the Spotlight projects for the 10th anniversary of the festival. Also that year, Evans appeared in Sylvain White's The Losers, an adaptation of the comic-book series from the DC Comics imprint Vertigo. Evans then appeared in another comic-book adaptation, Edgar Wright's Scott Pilgrim vs. the World, where he portrayed Lucas Lee, one of Ramona Flowers' seven exes. Evans played the Marvel Comics character Captain America in Captain America: The First Avenger, reprised the role in the film The Avengers, and has been signed to at least two sequels to Captain America.
With actress Evan Rachel Wood, he is part of the advertising campaign for the perfume Gucci Guilty, and the cologne Guilty pour Homme.Evans is a supporter of gay rights.Chris Evans went to an acting camp known as MSSA which got him started off in his career.
You can download this papercraft here: Chris Evans Free Paper Toy Download


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My friend Richard Thieme gives the closing keynote address at the 2011 ECOMM conference in San Francisco. In this talk, he artfully summarizes and integrates the "meta-themes" presented during the prior three days of the show.
ECOMM, a 400-person invite-only conference, explores the dissolving boundaries of Telecom, IT and media industries. The balance of power between producers and consumers is shifting and the economics of "value creation" is being transformed. These shifts are being enabled by the "communications industry" itself, accelerating myriad new forms of dynamic interaction and defining a new epoch.
The result is that new uncontested spaces for innovation are emerging. How we relate to the world around us, and the connectedness of humanity are all at stake. Richard, a former Episcopal priest, global security authority, and one of the deepest multi-disciplinary thinkers I know, masterfully summarizes a larger picture of emerging interactivity, modularity, and fluidity. His juxtaposition of techno-fascism vs. human empathy is stunning (29:15 – 33:00).
"People often describe me as a futurist. But I'm not a futurist. The future is an artificial construct local to individual cultures. What I try to do is describe the present. But so many people live in the past that, to them, I sound like a futurist." – Richard Thieme


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*** Please note that our Main Phone has changed to 310-574-0415 ***
The DISC Spine and Orthopedic Institute is a collaboration of regional and world-class leaders in spine surgery, pain management, physical medicine, and orthopedic surgery. Our collective mission is to provide world-class surgical and non-surgical care for conditions involving the entire musculoskeletal system.
Our expertise in the surgical care of spinal disorders and musculoskeletal disorders spans over 30,000 surgical and non-surgical interventions, positioning the DISC Spine and Orthopedic Institute as one of the regions premier musculoskeletal institutes. Our physicians have been recognized by LA Magazine / Super Doctors, Castle Connolly, Vitals, Healthgrades, among numerous other national accolades.
The DISC Spine and Orthopedic Institute advantage includes full service consultation, diagnostic imaging, non surgical and surgical care all under one roof. Whether our client is an elite athlete, C-suite executive or a weekend warrior, our institute provides the infrastructure and medical and surgical professionals to provide compassionate, seamless, and patient-centric care.
The DISC surgical center was built over a decade ago and was the regions first outpatient surgical center committed to the delivery of outpatient surgical care of the spine. Our center exceeds AAAHC accreditation meaning that the organization participates in on-going self-evaluation, peer review and education to continuously improve its care and services. The organization also commits to a thorough, on-site survey by AAAHC surveyors, who are themselves health care professionals, at least every three years. With state of the art surgical instruments, microscopes, HEPA grade filters, and IT technology to allow for world class surgical care in the 21st century.
Board Certified Orthopaedic Spine Surgeon
Dr. Sanjay Khurana is a board certified and fellowship-trained spine surgeon specializing in minimally invasive spine surgery, motion preservation and spinal reconstruction. Dr. Khurana has been educated and trained at the premier institutions in the United States, completing his undergraduate work at UC Berkeley, doctorate of medicine and orthopaedic residency at Stanford University, and specialty spine fellowship training at the prestigious University of Miami/Jackson Memorial/Miami Project to Cure Paralysis. Dr. Khurana has been in private practice in Los Angeles for nearly 15 years, performing more than 5,000 spine surgeries, and developing a reputation as the "doctors' doctor" and one of the most respected spine surgeons regionally and nationally. He holds patents in spine surgery, has published spine surgery research in peer-reviewed journals, and has presented his research at national and international meetings. His accolades include being named to the Super Doctors list by Los Angeles Magazine for the past five years and to Castle Connolly's "Top Doctors" list in orthopaedic spine surgery. From professional athletes and C-suite executives to weekend warriors, Dr. Khurana considers it a privilege and honor to take care of his patients, providing world-class surgical care and personalized treatment.
For more information, visit Dr. Khurana's practice website at LAspinegroup.com
Board Certified Orthopaedic Spine Surgeon
Dr. Hooman M. Melamed is a highly regarded board certified orthopedic spine surgeon in the nation concentrating on disorders of the spine for adults and children. Dr. Melamed's areas of interest include minimally invasive and out-patient spinal surgery; complex cervical spine disorders; cervical/thoracic/lumbar degenerative disc disease and microsurgery; revision spine surgeries; second opinions; spine trauma/tumor; pediatric and adult deformities including spondylolisthesis, scoliosis, tumor, and kyphosis, artificial disc replacements, nonfusion technology, XLIF, stem cell therapy, pediatric and adult deformities including spondylolisthesis, tumor, kyphosis and scoliosis. He currently serves as co-director of the spinal surgery program at DISC and appears as a regular guest on "The Doctors Show" on CBS.
For more information, visit Dr. Melamed's practice website at TheSpinePro.com
Pain Management
Dr. Michael Port, a double-board certified pain management specialist with extensive trauma experience, served as medical director for DISC Sports & Spine Center, a role he held since helping to launch the center alongside founder Robert S. Bray, Jr. In his more than 15 years of practice, Dr. Port has treated thousands of world-class athletes, weekend warriors and everyday people. His personalized, highly detailed approach to pain targets very specific nerve roots, establishing a more concise diagnosis and avoiding unnecessary medication. Satisfying a career-long goal of alleviating pain and suffering, Dr. Port's techniques allow patients to return to their fullest state of health and function. He finds his greatest reward in seeing quality of life restored as a result of his work within DISC's collaborative, multi-disciplinary environment. A graduate of the Mount Sinai School of Medicine in New York, Dr. Port completed his surgical internship at the University of California, Irvine, and returned to Mount Sinai for his residency in anesthesia. He completed a Fellowship in pain medicine at The University of Southern California LAC/USC Medical Center, serving as a clinical instructor in anesthesiology while training in the medical and interventional management of acute and chronic pain, including treatment of cancer pain at The Norris Comprehensive Cancer Center. Board certified by both the American Board of Anesthesiology and the American Board of Pain Medicine, Dr. Port is a member of the California Society of Anesthesia, the North American Spine Society, the American Society of Anesthesiologists, the International Association for the Study of Pain, and the International Spine Injection Society. He is also an advanced trauma life support instructor who serves as medical advisor and active flight physician for the Los Angeles County Sheriff's Department's Emergency Services Detail/Air Five search and rescue team. With a passion for adventure, Dr. Port is an avid skier who enjoys running, working out and tennis.
Board Certified Orthopedic Surgeon
Dr. Frederic Nicola is an experienced surgeon specializing in the fields of Orthopedic Surgery and Sports Medicine. His expertise in disorders of the knee joint and in advanced techniques for cartilage preservation using minimally invasive and FDA approved techniques is unsurpassed. Dr. Nicola is a graduate of Rush Medical College in Chicago. Following his residency in Orthopedic Surgery at the University of California, Los Angeles, he underwent Fellowship Training at Johns Hopkins University and completed a Trauma Fellowship at the AO Institute in Switzerland. He has served as Vice Chairman and as Chairman of the Division of Orthopedic Surgery at Cedar Sinai Medical Center. Prior to those appointments, he served as Clinical Chief of Orthopedics at Cedar Sinai. He is a former Chairman of Orthopedics at Century City Hospital. Having served as Team Physician for the Oakland/Los Angeles Raiders since 1983, Dr. Nicola still actively maintains that role for the Raiders, performing game-day, training camp, and NFL Combine duties. As a member of the National Football League Team Physician Society, Dr. Nicola has worked as Team Physician during two Super Bowls and two Pro Bowls. He is also an experienced Ringside Boxing Physician for the California State Athletic Commission. During his career, he has treated numerous professional football, basketball, and baseball players and is frequently selected to speak for the NFL Physicians and Trainers Society as well as the American Academy of Orthopedic Surgeons. Dr. Nicola served in the US Navy during Operation Desert Storm and was the Chief of Sports Medicine at Tripler Army Medical Center in Honolulu, where he received the Navy and Army Service Medals for surgical treatment and restoration of combat and non-combat related injuries. Currently, Dr. Nicola is the Director of the Knee and Hip Institute at DISC where he continues to use minimally-invasive as well as the latest FDA approved techniques to treat disorders of the shoulder, elbow, hip, knee, and ankle. His other specialty lies in utilizing the technique of cartilage preservation to prolong the natural life of those joints.
For more information, visit Dr. Nicola's practice website at nicolamd.com
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Oakland, Berkeley, And East Bay News, Events, Restaurants, Music, & Arts
I Started Out as a Radio Disc Jocky who began DJaying on the FM Station I Built & on-the-Air '69>71 then April 2005 Jammed All… More »
Charlie Brown, Charmin Charlie, I Go Buy Charlie, Or My Professonal Stage Name "Urban Cowboy".
Urban Cowboy says:
Much More the a Cafe' with Friday Night's allway's Lot's of Fun for Everone. Great Food & Drink's. Beer & Wine Too. An Everchaging Work of Art that Changes as People Come & Go.


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On Billboard's current R&B; chart, nestled somewhere between Rihanna's latest inescapable hit and club bangers from Trey Songz, is Miguel's left-of-center gem, "Adorn."
Miguel's self-produced slow burner, with its subdued groove and emotive croons, is so different from urban radio offerings of late that it seemed destined to be swallowed by bigger records from better known acts.
But "Adorn" nabbed a spot on the charts — and has stayed there for nearly seven months.
PHOTOS: Celebrity portraits by the Times
"I remember thinking how crazy would it be if they played this on the radio," he said of the single that spent four weeks at No. 1. "None of my songs have ever sounded like anything that was going on the radio."
"Adorn's" sleeper surprise gave the L.A.-based avant-soul singer, born Miguel Pimentel, his breakout moment and set the tone for his recently released sophomore disc, "Kaleidoscope Dream." But it also signaled a much bigger change in the genre it came from.
The 25-year-old leads a wave of artists aggressively pulling away from the conventional boundaries of R&B; by championing edgier, genre-blending productions while maintaining soulful melodies.
Neglecting the beats that have propelled the genre to the top of the charts over the past decade (be it the bass-heavy hip-hop of a few years ago or the four-on-the-floor Europop of today), Miguel and acts such as Frank Ocean, the Weeknd, Mateo and Dawn Richard are cutting their own versions of alternative R&B.;
The new movement feels like the most significant stylistic change in R&B; since neo-soul rolled around in the 1990s. It was driven by singer-songwriters such as Erykah Badu, Maxwell, D'Angelo, Lauryn Hill and Jill Scott, who were seen as soul revivalists with debuts that infused jazz, funk and African elements into R&B.;
When Miguel arrived in 2010, he offered a hybrid of R&B;, funk, hip-hop, dubstep, rock and electronica — which he branded "eclec-tric" — and although his debut disc, "All I Want Is You" spawned minor hits like the sublime "Sure Thing," his modern take on classic soul was overlooked as an acquired taste.
PHOTOS: Celebrity portraits by the Times
As off-kilter as his debut was, it proved merely a teaser for the unconventional rhythms he offered in "Kaleidoscope Dream," a disc that brimmed with buzzing synthesizers, heavy melodies and psychedelic grooves. After building a following with fierce live performances, the disc opened to critical acclaim and debuted at No. 3 on the Billboard 200.
"I hope more artists who are R&B; at the core and pushing the boundaries will join me in embracing the fact that [the genre] did become a stereotype," said Miguel. "I'm proud to wave the flag for what's coming."
"Kaleidoscope Dream" quickly garnered comparisons to another fully realized disc, Ocean's breakthrough "Channel Orange." Released earlier this year, Ocean's Def Jam debut was celebrated for its eccentricities, confessional storytelling and disregard for the trends scoring radio play.
"Frank Ocean's album was an example — he wasn't making music for radio," said Fuzzy Fantabulous, producer for Big Boy's KPWR (105.9 FM) morning show and director of talent relations for Stampede Management. "It seems like everybody was trying to do the four-to-the-floor, Pitbull-type music, and I get it, they want to go overseas and tour."
Recent club-savvy releases from crooners such as Usher, Chris Brown and Ne-Yo have reflected that shift toward EDM. Rihanna, who has long teetered between urban and dance-pop, ruled radio last year with "We Found Love," produced by popular dance DJ Calvin Harris.
Both Brown and Usher were criticized for alienating core R&B; fans with more pop and dance-leaning tracks. Their albums debuted at No. 1, but sold half of what their predecessors did on the first week.
Usher said the current influx of global, electronic dance music in pop influenced his latest record, "Looking 4 Myself." He explored new textures and it worked, especially on lead single "Climax. It spent 11 weeks at No. 1 on the R&B;/hip-hop chart. He followed up with an aggressive synth-pop dance track.
"I went to Coachella. I went to Ibiza, Korea, Asia and South America. I heard all these different types of music," Usher said ahead of his album release. "As I went city to city, country to country, I would turn on the radio, see what the DJ was doing and of course paid attention to what was happening in terms of sales. Electronic music had become more relevant, and DJs had become more significant in breaking sounds.
"I wanted to get in there, that wasn't a space where a lot of artists were," he continued. "I realized this stream is moving upward. The one thing people criticized is there was a certain sound that had a certain essence that was kind of departed from soul and R&B; and that's what I'm synonymous with and I went to a very dance sound. But that's where music was going. It was a slow start for me but a quick start for the rest of the world."
Up and coming alt-R&B; singer-songwriter Mateo believes the phenomenon of the pop/dance/R&B; hybrid has reached its peak. "In order for urban singers to chart on those platforms, you gotta come out with a four-to-the-floor joint," the L.A.-based Cincinnati native said. "What I see now is an appreciation starting to build for the R&B; that used to be. There is a renaissance happening."
Mateo built an online following with a series of mixtapes, EPs and videos. He's racked up more than a million views on YouTube and landed a deal with Interscope. "Its definitely R&B;, it has soul in it," he said of his sound. "But there's elements of alternative rock, there's the big drums. I always felt like urban music didn't have the euphoric sound that you shout at stadiums."
Online discovery has played a critical role in breaking these acts, with each of them taking control of their music and bypassing traditional methods.
When Ocean grew frustrated with Def Jam he released a mixtape, "Nostalgia, Ultra," for free on Tumblr. He was already a critic's darling, a member of L.A.'s hip-hop collective Odd Future and selling out shows before "Channel Orange" hit stores earlier this year, a rarity for R&B; acts that have been dependent on radio and music videos.
Miguel rolled out "Kaleidoscope Dream" in three parts to promote the album. Fans who purchased either preview (dubbed "Air" and "Water") could use iTunes' Complete My Album program for the full record. He followed a similar method when he introduced fans to new music with "Art Dealer Chic," a series of conceptual micro EPs that he released free for three consecutive months, earlier this year. "Any kind of anticipation or newfound acceptance really comes from that," he said.
The DIY model worked for the Weeknd, who released a trilogy of free albums last year and has since teamed with a major label to reissue the set. It's also the foundation for Richard's solo career. She is launching a solo career after finding success in two different groups: urban pop girl group Danity Kane and hip-hop fusion collective Diddy Dirty Money.
Armed with a tiny team (her producer also manages her) she released an EP, "Armor On," earlier this year exclusively on iTunes. It sold more than 30,000 copies without any radio play and hit No. 1 on the iTunes R&B; albums chart and No. 4 on Billboard's Heatseekers chart.
"There [is] a transition happening," said Richard, whose debut, "Goldenheart," is due in the new year and will be distributed by indie company Altavoz Distribution. "R&B; doesn't have to be so linear. ['Armor On's' success] was a confirmation that a new kind of artist can succeed."
Devin Lazerine, founder and editor of the R&B;/hip-hop news site Rap-Up, said listeners are no longer letting radio dictate their playlists.
"There is a demand for more 'real' R&B; that is showcasing vocals and less studio effects," he said. "It's almost a response to the inundation of pop."
Fuzzy puts it more bluntly: "I'm sure radio probably frustrates a lot of artists because they hear what is going on radio. And when [certain artists] do it they get chastised for it," he said. "It's almost our fault — and their fault for compromising."
PHOTOS: Iconic rock guitars and their owners
The Envelope: Awards Insider
PHOTOS: Unfortunately timed pop meltdowns


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Chronic pain can be one of the more challenging conditions to manage, especially when it has been refractory to multiple modalities. An appreciation of chronic pain and its prevalence, along with thorough understanding of provider responsibilities, patient rights and the appropriateness of opioid analgesics for this population, are needed. Such knowledge provides a foundation for evaluating chronic pain and developing an individualized management plan. When opioids are used, prepare for both expected and unexpected results.
Chronic pain is pain without apparent biologic value that has persisted beyond the time in which normal healing should have occurred, usually 3 months.1 In 2004, chronic pain was internationally recognized as a major health care problem and a disease in its own right.2 Today, countless medical experts and health agencies contend that chronic pain should be treated with the same priority as the disease that caused it.3
History of Standards
The creation and endorsement of formal guidelines for the use of opioid analgesics in chronic pain management is relatively new. The American Pain Society (APS) and the American Academy of Pain Medicine (AAPM) issued a statement in 1996 to define when and how opioids should be prescribed for patients with chronic pain.4
Despite this formal position, pain continued to be undertreated due to fears of legal and criminal liability for prescribing controlled substances.5,6 This prompted the development and 1998 adoption of the Model Guidelines for the Use of Controlled Substances by the Federation of State Medical Boards of the United States.7 This document, which became policy in 2004, defines when opioids are appropriate for acute and chronic pain and details patient monitoring to deter drug diversion.8,9
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has issued standards on pain assessment and management. The standards, which took effect in 2001, state that all patients have the right to appropriate assessment and management of pain; that all patients should be assessed for pain and receive individualized care; that response to treatment should be monitored; and that treatment plans should be modified when necessary.10
Although the JCAHO standards provided a formal framework for pain management, they did not stipulate how appropriate management would be achieved, and a number of guidelines were subsequently issued.9-12The prevalence of guidelines and JCAHO standards today means that failing to prescribe appropriate medications constitutes undertreatment of pain and a departure from acceptable standards of practice.8
Opioid Need
An analysis of international s
And an international study that included the United States revealed that about 20% of more than 5,000 primary care patients experienced pain for more than 6 months.15 Put in everyday terms, as little as 1 in 10 and as many as 1 in 2 patients who present to a health care provider may have chronic pain.
Trends in Prescribing
Arthritis and other musculoskeletal disorders are the most frequently mentioned chronic health conditions significant enough to result in activity limitations among U.S. adults ages 18 to 64.16
An analysis of office visits and opioids prescribed for patients with musculoskeletal disorders in 1980 and 2000 revealed that office visits did not increase for these conditions. This analysis, which was based on data from the National Ambulatory Medical Care survey, also revealed that prescriptions for opioid analgesics for chronic pain doubled (8% to 16%), and the use of stronger opioid analgesics quadrupled (2% to 9%).17
The increase in opioid analgesic prescriptions is a sign that progress has been made in pain management.18-21 However, this trend has not allayed concerns that increased use of opioids would lead to more opioid abuse and addiction. As a result, studies were conducted to identify any abuse of opioid analgesics.


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Program Overview
Download the IFAD-IFPRI Partnership Program Country Briefs: Morocco, Vietnam, Ghana, and Mozambique.
The International Fund for Agricultural Development (IFAD) and the International Food Policy Research Institute (IFPRI) have joined together in a strategic program to advance innovative policies designed to help the poor benefit from climate change mitigation and improved market access.
The overall goal of the IFAD–IFPRI Strategic Partnership Program is to provide rural poor people, particularly women, with better access to new market opportunities and the capacity to take advantage of them. Access to markets for high-value agricultural products and opportunities related to climate change mitigation, such as carbon sequestration, are especially important. This goal presents two distinct challenges, but each could potentially improve incomes and decrease the vulnerabilities of the poor in many countries.
Four countries have been selected to share in this venture: Morocco, Vietnam, Ghana, and Mozambique.
1. Strengthen the capacity of partners in participating countries to analyze and address policy issues.
2. Identify, test, and evaluate innovative policy, institutional, and program options to improve access to new markets, including those for high-value commodities and climate change mitigation services.
3. Disseminate the knowledge gained, incorporating the findings into national policies and investment programs.
Market Access
Many IFAD projects work to improve linkages between small farmers and growing markets for agricultural commodities, including high-value agricultural commodities. High-value agricultural commodities are those that have a high economic return per hectare, such as fruits, vegetables, dairy products, and meat. The program aims to increase access to markets for these particular commodities among smallholders within the four target countries. Often, farmers participate in such markets by entering into contract agreements. Contract farming has proven to be an effective way to integrate farmers into domestic and international markets, but poor and less-educated farmers are sometimes excluded from this practice. The program's intent is to improve their welfare by designing contract and cooperation mechanisms that incentivize small farmers and by testing the mechanisms in the field in collaboration with private companies or rural producer associations.
Market-access activities will include:
1. assessing policies and regulations that affect small farmers' access to dynamic markets;
2. testing innovative contract farming structures and other institutional mechanisms for increasing smallholder participation in modern value chains;
3. developing and testing best practices for evaluating the impacts of market and government failures and devising innovative approaches to reduce their incidence;
4. developing a scaling-up methodology, based on agroclimatic and market-access conditions; and
5. synthesizing the knowledge gained by creating a toolbox of methods and incorporating findings into an enhanced knowledge-management system.
Climate Change Mitigation
Climate change presents enormous risks to poor people who are highly dependent on natural resources for their everyday living. Mitigation of these distressing effects has become a top priority on the international agenda. For example, payments are being made to those who agree to maintain forested land to act as sinks for absorbing excess carbon. Agriculture and the rural poor whose livelihoods are dependent on agricultural crops, however, do not currently benefit from mitigation and carbon-offset mechanisms in formal carbon markets. While afforestation and reforestation projects are eligible for carbon-emission reduction credits under the rules governing the Clean Development Mechanism of the Kyoto Protocol, the participation of agricultural projects has proven difficult due to the uncertainty present in measurements of carbon sequestration potential and reduction of GHG emissions. Furthermore, a lack of understanding of the costs related to aggregating and organizing farmers coupled with high costs of monitoring, reporting, and verification have made accessing voluntary markets very difficult.
Small farmers could potentially be rewarded for practices that are commonly considered beneficial for soil fertility and yields. Efficient manure usage, zero or minimum tillage, changes in water management, management of crop residues, and use of compost and biochar are some of the practices that not only sequester carbon and reduce emissions, but increase productivity and offer a path toward climate change adaptation. The program will assess the policies and programs that encourage the development of climate change mitigation markets for agriculture.
Climate change mitigation activities and access to carbon markets will include
1. an assessment of the mitigation potential of poor rural households and communities and the potential benefits;
2. an analysis of the policies, institutions, and structures (including nongovernmental organizations, extension systems, farmers organizations, supply chains, and producers of high-value export crops) that could aggregate farmers and facilitate their access to carbon markets;
3. the identification, testing, and evaluation of promising new approaches for involving the rural poor in the provision of agricultural mitigation and other environmental services; and
4. a synthesis of the knowledge gained in a manual of best approaches and practices that will be mainstreamed through a strengthened knowledge-management system.
Program Support
The IFAD–IFPRI program includes three predominant areas of activity:
1. Capacity building.
2. Knowledge management.
3. Development of innovation or policy networks or both.
The primary objective of the capacity-building activities, such as policy workshops, is to foster a better understanding of the link between project and policy levels. This objective will be met by improving the capacity both for research and policy analysis and then heightening understanding of the dynamics of knowledge and information use in policy processes. This will increase the capacity to identify emerging issues.
A key activity in the area of knowledge management is the development of an internet portal. This portal will be an interactive website that facilitates the full documentation of the program's activities, methods, and results. The portal will also include a question-and-answer (Q&A) forum where users receive immediate responses to questions already in the database. Inquiries that require content-specific study will require a longer response time. The portal will also encourage interactions among research teams to discuss the research agenda. It is envisioned that the portal will provide opportunities for participants to post real-time experiences related to the approaches taken.
Finally, country innovation networks will be established to serve as an open forum for policy analysis. These networks will link existing IFAD and IFPRI country and regional networks. The program will also nurture these networks, with the goal of identifying opinionmakers and in-country leaders who will promote innovation and the adoption of policy options. Though the networks will be primarily virtual, they will also allow participants to engage in face-to-face meetings and policy consultations. IFAD and IFPRI hope to identify an in-country host institution to initiate the development of the innovation and policy networks.
Program support functions will include
1. implementing focused capacity-strengthening workshops for policy analysis that will translate research on high-value commodity market or carbon market opportunities into action on the ground;
2. sharing knowledge through an open portal providing access to full documentation about program processes, methods, and results (the portal will benefit participating country professionals as well as others who are developing program interventions in nonfocus countries);
3. developing an informal network of policy analysts, policy advisers, and policymakers within the focus countries to link with existing IFAD and IFPRI networks at the country or regional level and to promote the creation and adoption of innovative policy options emanating from program research activities; and
4. developing both internal and external communications strategies to maximize synergies and impacts to ensure that relevant information reaches the stakeholders who can benefit from it the most.
For more information, read our brochure or download the IFAD-IFPRI Partnership Program Country Briefs:Morocco, Vietnam, Ghana, andMozambique.


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Make Medicines Affordable is a global campaign working in middle-income countries. After just three years, our work is now expanding into around 30 countries. Find more information on our focus countries and regions below.
Additional information on each of the countries we'll be working in will be added later in 2018.
Why focus on middle-income countries?
Less than a third of the people in need of antiretroviral treatment in middle-income countries are currently able to access it.
By 2020, the vast majority of people living with HIV (87%) will be in high- and middle-income countries. Middle-income countries are home to almost half of the world's population, and have a large and growing share of HIV infections (62%). They have even lower rates of antiretroviral treatment coverage than low-income countries.
One third of people living in middle-income countries survives on less than US$2 per day. Almost 6 million people in middle-income countries (excluding sub-Saharan Africa) need antiretroviral treatment. However, less than a third are currently able to access it.
Focus countries
Argentina has around 126,000 people living with HIV, of which fewer than 70,000 people are on antiretroviral therapy. The high prices of drugs limits the number of people who can get treatment.
In Brazil there are 780,000 people living with HIV, of which 405,000 are on HIV treatment. All patients get treatment free from the public health system which, as a result of the high price of drugs, is under severe strain.
An estimated half a million people live with HIV in Thailand. Of these people almost 300,000 are on HIV treatment under a national health insurance scheme paid for by the government.
Ukraine has over 250,000 people living with HIV, of which around 61,000 people are on antiretroviral therapy. According to the National Treatment Program over 118,000 people will be receiving treatment by 2018.
Asia Pacific
In the Asia-Pacific region, the number of people receiving antiretroviral therapy has increased to an estimated 39% of all people eligible.
Eastern Europe & Central Asia
Our campaigning in Eastern Europe and Central Asia is focused in Georgia, Kazakhstan and Moldova.
Latin America
We work in Argentina, Brazil, Colombia, Mexico and Peru, where around 1.35 million people are living with HIV, half of which are on treatment.
North Africa
Across Morocco, Tunisia and Egypt an estimated 43,600 people are living with HIV, and there is a significant treatment gap.
Southern Africa
Southern Africa is home to roughly half of the world's people living with HIV. Our work is focused in Zimbabwe, Botswana and Mauritius.
Other countries
Over 2 million people are living with HIV in India. 1.7 million are registered in the antiretroviral program, and over 600,00 are on treatment.
In Kyrgyzstan there are 8,000 people living with HIV, with around 2,400 currently on antiretroviral treatment.
El Salvador
Turning commitments and targets into reality in El Salvador. El Salvador has a HIV prevalence rate of 0.6%. An estimated...
Addressing gaps in data as a first step to securing essential medicines for people living HIV, Hepatitis C and TB....
Campaigning for optimal and increased treatment coverage in Guatemala to improve quality of life, decrease new infections and reduce stigma...
Working towards a sustainable approach for access to medicines in Georgia, particularly in light of the country preparing for Global...
Moldova's government has committed to universal access to health services following the withdrawal of Global Fund support. Over-priced medicines are...
In Malaysia there are roughly 100,000 people living with HIV, of which approximately a quarter are on antiretroviral treatment.
In Peru an estimated 66,000 people are living with HIV and according to latest reports less than half are on antiretroviral treatment.


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Aromatherapy is Powerful Therapy!
Have you tried aromatherapy? Do you know what it is? I was approached by Aura Cacia to test out a few of their popular products. Being that I know the benefits of aromatherapy for the mind and body I couldn't pass up the opportunity.
Aura Cacia began in 1982 and considered a leader in aromatherapy sales and quality — as well as a key source of expert information that has fueled the widespread awareness of aromatherapy that is seen today. Many oils are not what the claim to be, branding themselves as natural when in reality they are filled with tons of unnatural ingredients.
Aura Cacia's stands out by sourcing authentic, high-quality essential oils — dealing face-to-face with the people growing the plants and extracting the essential oil whenever possible. The oils are derived from places like Europe, the Ukraine, Oregon and Australia in order to find the best sources for their oils.
Every oil is tested to make sure it meets their high standards. This helps to guarantee that they are providing the highest quality essential oils available. Whenever possible, they offer oils that are certified organic as well.
Shannon Ousley, Director of Aura Cacia Marketing says:
"The aromatic properties of pure essential oils are a catalyst for change in our mind, body and spirit. From soothing to energizing, the unique properties of essential oils affect us in a range of ways – empowering us to find balance throughout our lives."
So what are few of benefits from aromatherapy? Aura Cacia shares the following:
Mind: Essential oil aromas stimulate the part of the brain that affects emotion. The impression of the aroma is sent directly and immediately to the limbic system where memories are stored and pleasure and emotions are perceived. When stimulated, the limbic system releases chemicals that affect the central nervous system. Serotonin counteracts anxiety; endorphins reduce pain and affect sexual response.
Inhaling essential oils can help us attain a pleasurable emotional balance. A balanced emotional state in turn can have a therapeutic effect on physical problems.
Enhance your mental and physical well-being with essential oils using direct inhalation or diffusion. Direct inhalation is great when immediate relief is needed.
Body: Essential oils are quickly absorbed through the skin, traveling around individual cells and into hair follicles, where the oils enter the sebaceous glands and mingle with the skin's natural emollients. The chemical properties of the oils can be cleansing, deodorizing, toning, or balancing.
Essential oils add an aesthetic dimension to the healing effects of massage therapy, compresses, facial steams and body and foot baths.
Spirit: A diffused aroma creates a mysterious presence in a room, then wafts away like a wish or prayer. The essential oils can be thought of as the quintessential spirit of plants, captured in a jar. Frankincense oil has been used as an adjunct to meditation and prayer for centuries. Its rich, balsamic aroma penetrates deeply into the lungs, inspiring slow, regular breathing. Try diffusing frankincense to help carry you along on your next spiritual journey.
Essential oils have positive effects on every level of being. Their unique properties enhance the mind, body and spirit. Aromatherapy is the creative and scientific application of essential oils to create beneficial changes in our lives on aesthetic, therapeutic and mystical levels.
Aura Cacia makes aromatherapy accessible with innovative ready-to-use products that let even beginners realize the full benefits of our high-quality essential oils in a variety of ways that can easily be a part of any lifestyle.
For more information visit: https://www.auracacia.com/
Disclaimer: Nadia Murdock Fit received product for this review, all opinions are my own.
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