text:
Download our All Government Jobs Android app to get updates on your mobile.
SSC Recruitment 2018
Total No of Posts - 54,953 Posts
Last Date 30 September
Employment Type: Central Govt Jobs
Job Location: All Over India
Name of the Post:
- Constable (GD)
- Applicants who have completed Matriculation or 10th class pass or equivalent from a recognized Institute for SSC Recruitment 2018.
Age Limit:
- Minimum Age: 18 years
- Maximum Age: 23 years
Pay Scale: Rs. 21700- 69100/-
Selection Procedure:
- Computer Based Exam(CBE)
- Physical Efficiency Test (PET)
- Physical Standard Test (PST)
- Medical Exam
Application Fee:
- General/OBC Applicants: Rs.100/-
- All Other Applicants(ST/SC/Ex-s/PWD): Nil
How to Apply:
- Eligible & Interested candidates can apply via online in Official website page at www.ssc.nic.in SSC Recruitment 2018.
Instructions to Apply:
- Log on to SSC careers page at the official website www.ssconline.nic.in
- Eligible candidates are advised to open the online application form.
- Fill your academic qualification, skill, experience, and other related information as per the instructions
- Attach self-attested copies of all relevant documents in prescribed format and size.
- Pay the application fee as per the category.
- Complete the SSC Jobs Application Form with the essential data.
- Check the Details before Submitting.
- Take a print out of SSC Recruitment 2018 online application form.
Important Dates:
- Starting Date for Submission of Application: 17.08.2018
- Last Date for Submission of Application: 30.09.2018 (Extended)
|| Important Link ||
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subset: commoncrawl


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Featuring new and previously unreleased tracks by some of my personal faves.
Click below for a listen:
Wednesday, December 5, 2012
Cycles: Cyclic Law's 10th Anniversary Sampler
Featuring new and previously unreleased tracks by some of my personal faves.
Posted by Rot at 6:00 AM
Labels: ambient, cyclic law, dark ambient
2 comments:
- Rot said...
A coworker was talking to me and heard the samples playing in the background and asked/yelled "WHAT'S WRONG WITH YOUR COMPUTER?! WHAT'S THAT SOUND?!!!"
I had to explain that it was in fact music she was hearing.
It's been a hard life.
- December 5, 2012 at 6:12 AM
- Anonymous said...
Good stuff.
Knowing me, I would of said,"What noise? I don't hear anything. Are you o.k? You don't look too good."
- December 5, 2012 at 7:33 AM
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FCE - LTER Annual Reports and Proposals
This material is based upon work supported by the National Science Foundation through the Florida Coastal Everglades Long-Term Ecological Research program under Cooperative Agreements #DEB-1237517, #DBI-0620409, and #DEB-9910514. Any opinions, findings, conclusions, or recommendations expressed in the material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.
Recommended Citation
Gaiser, Evelyn E.; Heithaus, Michael R.; Jaffe´, Rudolf; Ogden, Laura; and Price, René M., "FCE II Year Six Annual Report For NSF Award DBI-0620409" (2012). FCE - LTER Annual Reports and Proposals. 15.
Rights Statement
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This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).


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2013 Man From Snowy RIver Challenge winner Scott Bandy ~ WIDE VIEW
An old gatepost bordering a field in Allora Queensland Australia. ~WIDE VIEW~
But the man from Snowy River let the pony have his head,
And he swung his stockwhip round and gave a cheer,
And he raced him down the mountain like a torrent down its bed,
While the others stood and watched in very fear.
Relics of the past - a large wicker basket full of wool in an old sheep shearing shed in outback New South Wales Australia ~WIDE VIEW~
Wild Pony - A wild pony rescued from neglect. ~WIDE VIEW~
Dew Drops and Spiders Webs on Rusty Barbed Wire. ~WIDE VIEW~
Farm Cat in the Hay Shed
Farm Cat in the Hay Shed, an old derelict farmhouse now used for storage ~ WIDE VIEW
Long Plain Brumby ~ WIDE VIEW
Clydesdales harnessed to pull a hay cart ~ WIDE VIEW
The Old Gatepost ~ WIDE VIEW
Merino Sheep in the Shearing Shed
Woolly Merino sheep gathering in the shearing shed for haircuts! New South Wales Merino Sheep Farming Australia
Clydesdale in harness
Night Entertainment at the 2013 Man From Snowy River Bush Festival
Scottish Highland Cattle
Furry Scottish Highland Cattle preening each other in a paddock
A honey bee's final resting place on a blue-eyed daisy. ~WIDE VIEW~
Commercial trawlers lined up at the old Eden Wharf New South Wales Australia. ~WIDE VIEW~
Now derelict, the Jincumbilly Train Station sits quietly on the alpine plains in Southern New South Wales Australia. ~WIDE VIEW~


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Peaceful Evening in Wanaka
Communities and New Badges
Want to join the community and share your photos? Here's some links for you! 🙂 Google+ turned 2 years old, and they announced a new Badge Maker that you can use for your website. I thought I'd use the new badges below to re-invite you to a few of the communities we started there! These are good places for you to share your work, if you so desire. Also, as always, I am happy for you to share your work here in the comments on the blog too! 🙂
Daily Photo – Peaceful Evening in Wanaka
I had a peaceful evening in Wanaka.
There is this tree that sits out in the middle of the lake. It's so unusual. I love the way it reflects back on itself in the smooth water. I was by myself, listening to music on my iPod, and just watching the water as it would calm down then get excited, then calm down again. I swapped out lenses a few times and kept moving around to admire it from different angles. This one was one of my favorites.


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The Affordable Care Act and state fiscal pressures have spawned an array of new Medicaid cost containment and quality improvement schemes. Among the most ambitious is a health care delivery system whose components are called accountable care organizations (ACOs).
The phrase "accountable care organization" was coined in 2006 at Dartmouth University Medical School and then adopted by an advisory board to Medicare, the federal health plan for seniors. The idea — that health care providers could be enticed to join forces to provide better care at lower costs, while taking financial responsibility for the health outcomes of their patients — gained prominence during the 2009 congressional debate that led to passage of the federal health law.
Although the ACO concept enjoys strong bipartisan support and broad acceptance within the health care community, skeptics argue it relies too heavily on voluntary cooperation among health care professionals who are accustomed to working independently. Others suggest the idea is simply a new label for health maintenance organizations (HMOs), which lost some of their appeal in the 1990s because they were seen as putting profits before quality.
The 2010 national health law creates ACO incentives for Medicare, but only addresses Medicaid in a modest way. It authorizes a demonstration project for creation of pediatric ACOs within Medicaid and the State Children's Health Insurance programs, although funding is not yet available. The law does not specifically apply ACOs to the rest of the Medicaid population — pregnant women, seniors and people with disabilities, and millions of other poor adults (after the law's slated expansion in 2014).
The states, however, are moving ahead on their own. An increasing number are adapting the ACO model for Medicaid in hopes of providing less fragmented care at lower costs. Here's a primer on how accountable care organizations might work under the Medicaid program:
What makes an organization an ACO?
A standard definition for ACOs does not exist. Their parameters vary widely among the states that have developed ACO programs. But in general, accountable care organizations are partnerships of health care providers — including primary care doctors, specialists and sometimes hospitals — that agree to a set budget for serving all of the health and long term care needs of a defined group of patients. The organizations have incentives to keep patients healthy, efficiently treat those who are sick, and help patients who have chronic illnesses control the effects of their diseases. If costs fall below a set budget, ACOs share in the profits. If costs exceed the budget, some ACOs share in the losses. Budgets are set based on the overall health of the population to be served and payments are tied to quality measurements.
How are ACOs expected to improve patient care and health outcomes?
Evidence indicates that the traditional fee-for-service model of paying individual health care providers for each office visit, treatment and test has resulted in fragmented coverage and wide variances in the quality and price of health care across the country. As an alternative, ACOs are designed to encourage health care providers to work together to coordinate the care of their patients rather than racking up individual charges to treat the symptoms of their illnesses. ACOs also have incentives to anticipate the needs of individual patients and to take into account the overall health needs of the populations they serve.
For example, doctors in an ACO are rewarded for working together to treat diabetes patients with the goal of keeping the chronic disease in check and avoiding drastic procedures such as amputations that result in costly long-term care. ACOs are rewarded for preventing the onset of the disease and working with patients to manage their conditions through lifestyle changes.
How do ACOs differ from HMOs or managed care?
Managed care organizations and HMOs are third-party organizations that contract directly with doctors and other health care providers to offer care to a defined group of patients. The HMO or managed care company bears all of the risk if costs exceed a contracted monthly fee per person, and reaps all of the profit if costs come in below budget. Those incentives are used to a great extent in ACOs as well. But when HMOs first appeared on the scene in the 1970s, quality control mechanisms to monitor the ongoing health of patients had not been widely developed. Under ACOs, treatment quality and success rate measurement are at the center of the effort.
Are Medicaid ACOs the same as those created under Medicare or private insurance?
In concept, Medicaid ACOs are no different from Medicare or private ACOs. But because a majority of Medicaid beneficiaries are already covered by managed care organizations and most are sicker than the rest of the population, the details of state programs may differ from those created by Medicare and private payers. Another potential difference is that Medicaid rules allow states experimenting with ACOs to require patients to use them. Medicare ACOs are a voluntary option for patients in the states where they are being employed.
How many ACOs are operating?
So far, ACOs have been used more in dealing with Medicare patients than with those signed up for Medicaid. As of July, Medicare ACOs were serving 2.4 million people in 40 states and the District of Columbia, according to an announcement from the U.S. Department of Health and Human Services. At the moment, only a limited number of Medicaid ACOs in a handful of states are fully operational. But there is clear momentum to try the idea in other states, and more are expected to join in the experiment over the course of the next year.
Which states are pursuing Medicaid ACOs?
According to the National Academy of State Health Policy, which tracks state ACO efforts, the following states have established ACOs within their Medicaid programs:
Colorado: Accountable Care Collaborative
Oregon: Coordinated Care Organizations
Maine: MaineCare Accountable Communities Initiative
Minnesota: The Minnesota Accountable Health Model
New Jersey: Medicaid ACO Demonstration Project
The Kaiser Family Foundation also identifies Utah as being in the early stages of implementing a Medicaid ACO initiative. The Center for Health Care Strategies is helping several states, including Massachusetts, Texas and Vermont, launch ACO models.


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Meet Seattle SoundCloud Hero: Alison Doyle
After profiling our first set of SoundCloud Heroes, we continue our profiles of our newest SoundCloud Heroes who joined us at our SoundCloud Community Heroes Summit in San Francisco last weekend on April 6-8. Read our recap here.
Alison Doyle is a composer who works in the tech industry in Seattle. She creates her own piano compositions but also uses the mobile app to record just about everything, from her compositions to found sounds. She will be organizing the Global Meetup Day in Seattle on May 17 so get in touch!
What do you do? How do you use SoundCloud in your life?
I work in downtown Seattle for a consulting firm in the tech industry. Outside of work, I write and record my own piano compositions which typically consist of random sounds I've recorded around the Pacific Northwest (though lately, as far as Richmond,VA and San Francisco). I've used SoundCloud for so many things; it's a place to keep all of my music and find new music. The iPhone app has made recording literally anything possible. I've recorded piano sketches, pets being cute (woof/meow!), trains, planes, coyote howls, EVERYTHING. It's also a makeshift directory of fellow music makers. I'm a big fan of a lot of the groups people have created. It's the most accessible music + sound networking website (and in my opinion, the most artist friendly).
What are your aspirations for the SoundCloud community in your city?
I'd like people to rethink the way they use and appreciate sound. Ambiance, whether visual or audio, is important and I don't think a lot of people realize that. Dabbling in sound art is also a way for people who have no musical training to make music. A lot of the folks on SoundCloud are extremely encouraging and it has a very large community feel. I'd like to see Seattle take on this philosophy within the city itself and become a hub for cross-genre collaborations. Seattle is already a large networking and tech friendly place filled with creative types, so it only makes sense. The SoundCloud community in Seattle should be (and could be) diverse and open to any demographic. Limiting it to one style of ________________, defeats the purpose of connecting and collaborating.
What is your favorite place in the city and why?
Simple- anywhere with a spanning view of mountains and water! I don't like feeling landlocked and the ability to see miles and miles beyond the very place you're standing is something I could never do in the South or the Mid-West. Seattle, for as much hype as it gets for being dreary and dismal, is actually a gorgeous city (when you can see it). Being near water is also an opportunity to record all sorts of sounds.
What is your favorite sound and why?
I can't pick just one but around 2 am, I can hear the trains in Georgetown, planes flying, sea lions barking, and sometimes coyotes howling (or screaming in some cases). These sounds are usually accompanied by cars speeding down wet streets. I'm not sure why it's my favorite as it sometimes disrupts my REM cycle but I could never fall asleep to no sound at all.
Where else can we find you on the web?
I'm pretty much everywhere:
instagram: blackcascades
and of course soundcloud.com/alliedee
Interested in being part of this growing network of SoundCloud Heroes?
Read the program details here and apply at the link at the bottom of the post.


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It happens. Your kid gets in a snarky, whiny mood and you are stuck in the car listening to endless complaints and begging. For a brief moment you briefly recall why it is you had kids in the first place and in the next you try to figure out if you could, in fact, not get caught but dismiss both in the same moment. You love being a mother and murder is never the answer. Still the whining from the backseat continues.
Parenting 101 tells you not to give in once you've put your foot down and said no. Giving in is bad. But the kids haven't read that book yet. That would yield them entirely too many trade secrets. So they keep asking, begging, whining, grating…
Be it sarcasm, a good sense of humor, impatience, or the occasional urge to embarass my kid, I occasionally say things out of the blue just to elicit a reaction. Normally it stops the begging as well. Win-Win! So here's my top ten geeky ways to respond to my begging child.
10. Help me, Obi-Won Ka-Whiny. You're my only hope.
9. Do you know what happened to the last child that begged me? He was kidnapped by the Borg.
8. Every time you beg, a programmer loses a line of code.
7. Cruciatus! Dang it, it worked on the cat! Practice makes perfect.
6. Reverse begging: You design and build me a mom-bot, and SHE can take/give you whatever you are whining about.
5. So last night I was playing with the PS3 and found the password set. I've forgotten what I put it as though. Something about silence, golden, bribes. Eh, it'll come to me.
4. Oh my goodness! That was the forty-second time you've asked me that! It all makes sense, now. It's amazing, this clarity. Oh, that was 43, now you've ruined it.
3. Yes, I'll take you there on the Frabjous Day. You kill yourself a Jabberwocky and we'll call it even. Caloo, calay!
2. I'm sorry but the number of syllables in that request is not in the Fibonacci series. Your request is denied.
1. Because I said so. (I don't care if you are Geek or not, this one is golden and we went through childbirth. We earned our right to this one, thank you.)
Happy Geeking!


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Ave. Zacharias Tanee Fomum, P.O. Box 385, Koume/Bertoua Cameroon, Contact us here or check our FAQs portal
Our Goal
Ministry Zugriffe: 150949
- Preach the Gospel to each human being living in our generation, so that 10 billion people are reached with the gospel preached in the power of the Holy Spirit, using all means of communication (our books, Our magazines, our CDs, our DVDs, our radio, television and internet), in the most urgent way possible.
- To bring 1 billion people in 250 nations to know Jesus Christ as their Lord and Savior and be made into disciple who obey Him in all things and meet in 25 million house churches by the year 2065.
- Cooperate with God in prayer and fasting and intercession for the global revival that will tear the heavens, shake the earth, glorify Christ in our generation in order to precipitate the imminent return of our Lord Jesus Christ from heaven to meet with His Bride made ready


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"Private detective Sumi" - a full range of legal matters, confidential work anonymously.
Appealed to the private detective agency "Private detective Sumy" book service "Checking for wiretapping premises." Bug was found quickly, one was in…
Son became ill in school, received complaints that he misses lessons. Do not know what to do. Understood that it greatly affects someone, but what is…
Sometimes people want to hide from us some important information that can greatly harm us, our families, friends, work or business. But not in every situation, you can just go and ask a question on this topic.
Jealousy - this is one of the most negative feelings, which from scratch can transform any dialogue into such a storm that there can not be any talk about any relations. And this happens even when there is absolutely no reason for jealousy.
Despite the abundance of information on the activities of private detectives on the territory of Ukraine, as well as around the world, to find a truly reliable specialist who will not only perform his work for the agreed amount, but will do it 100%
Carefully check against your contact details to not making mistakes. Otherwise we will not be able to answer you. If in the course of the day with you will not be contacted by our representatives, please call on the phone mentioned on the website and let us know


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Originally posted on July 17, 2006.
David Ng asked a question:
Are there any children's books that are dear to you, either as a child or a parent, and especially ones that perhaps strike a chord with those from a science sensibility? Just curious really. And it doesn't have to be a picture book, doesn't even have to be a children's book - just a book that, for whatever reason, worked for the younger mind set.
Here is my list of childhood favourites, the books that turned me on to science - a list that reflects the time and place where I grew up:
As a little kid, I have practically memorized the 1971 translation of the 1968 book The new golden treasury of natural history by Bertha Morris Parker (under the title of Riznica Prirode). This is where I learned all the names of prehistoric creatures like Dynichtys, trilobites, dinosaurs and prehistoric mammals. This is where I learned about the Solar system and about evolution. And everything else. This is the book that started it all.
At about the same time (very early childhood), I also had and read repeatedly Our Friend the Atom by Heinz Haber, where I learned the basic physics (which I, for the most part, forgot since then).
I have already written about the importance to my naturalist development of The prince and his ants (Ciondolino) by Ricardo Vamba aka Luigi Bertelli.
I also had a couple of books by Alfred Edmund Brehm, including his most famous Brehm's Life of animals: A complete natural history for popular home instruction and for the use of schools, which I used, later in school, as a source for some early papers/reports about animals.
Then, I swallowed a number of translated books by Gerald Durrell and his Russian counterpart, Vera Caplina.
Later, I graduated to works by Konrad Lorenz and, at the age of 13, my first attempt at reading Darwin's Origin Of Species.
Finally, probably the most important kids' books I had were a trilogy by Dr.Zivko Kostic (which I see has been reissued): "Between Play and Physics", "Between Play and Chemistry" and "Between Play and Mathematics". Each of the books had a story - a bunch of kids (mostly boys!!!! - reflecting their origin in the 1950s and 1960s) having a club, meeting regularly and doing experiments or, even more often, using their knowledge to pull pranks on each other and the rest of the community.
But the story was restricted to just a few places scattered around the book. Most of each book was devoted to about 150 "experiments". I have not just read each of the books many times, but I have also tried to do many of the things described within. Math was easy - paper and pencil was all one needed for most of it. Chemistry was great fun, but it was hard to come up with chemicals (probably impossible in the here and now). So, I mostly did the physics stuff, using materials easily found around the house - some string, a glass of water, a pencil, a coat-hanger and a bottle cork. That was great fun.
More importantly, each book is broken into chapters, each chapter covering a particular topic or sub-discipline. And each chapter started with a brief and fascinating history of that field. Archimedes. Mendeleyev. Newton. They were all in there, in anecdotes and coming alive on the pages of the book.
But the greatest fun was when I got to meet the author when I was about 10 years old or so. For a kid in Yugoslavia at the time, it was equivalent of you getting to meet Carl Sagan or Isaak Asimov. My idol, in flesh and blood! And not just for a few seconds at a book signing - he came to visit us for lunch and coffee at my grandparents' summer cottage.
So I listened with awe to his stories and he answered about a zillion questions I had for him. He is still alive and my mother said she was in touch with him recently. She just bought me the three-book set of Kostic's books. They were re-issued about three years ago and are now in EVERY school library in Serbia, as well as favourite prizes to give to good students at end-of-the-year ceremonies.
Perhaps they may be fun to translate. Or, I can do something that I wanted to do for decades now - write the fourth volume: "Between Play and Biology".


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Perfected and improved for over 30 years, loved by artist and professionals everywhere, Wacom's unique digital pen technology enables precise and natural input that lets you focus on what really matters: your creations.
From the pen-tip material, carefully selected to match each writing surface, to the state-of-the-art signal noise management and pressure sensing techniques. Everything is painstakingly optimized in order to achieve the Wacom feel.


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Center for Studying Health System Change
Providing Insights that Contribute to Better Health Policy
Insurance Coverage & Costs Access to Care Quality & Care Delivery Quality Improvement & Measurement Information Technology Patient-Provider Relationships Payment Policy Chronic Conditions Public Health Health Care Markets Issue Briefs Data Bulletins Research Briefs Policy Analyses Community Reports Journal Articles Other Publications Surveys Site Visits Design and Methods Data Files
Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less?
Issue Brief No. 131
Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communicationreal-time, face-to-face or phone conversationswith patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study based on in-depth interviews with clinicians in 26 physician practices. EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records. For some clinicians, however, aspects of EMRs pose a distraction during visits. Moreover, some indicated that clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians. Given time pressures already present in many physician practices, EMR and office-workflow modifications could help ensure that EMRs advance care without compromising interpersonal communication. In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs.
Deficiencies in Real-Time Communication Persist in Clinical Setting
ffective interpersonal communicationreal-time, face-to-face or phone conversationsallows cliniciansphysicians, nurses and other practitionersto acquire nuanced information from patients and other clinicians that cannot easily be communicated in medical records, including social context, values, preferences and issues specific to complex patients.1 Better communication between patients and physicians and between primary care physicians and specialists is a key component of care coordination and leads to improved patient outcomes.2-4 Yet, patients and clinicians levels of satisfaction with interpersonal communication have declined.5, 6
Interpersonal communication includes both patient-clinician communication, which is part of an ongoing relationship, and communication between clinicians, which primarily involves discussing clinical decisions for shared patients.7 EMRs can potentially support both types of communication.
While EMRs are expected to improve information sharing, it is less clear how their actual use affects interpersonal communication. This topic is particularly timely given the recent federal push for widespread EMR adoption,8 and the need to avoid worsening already-poor communication with patients and between clinicians sharing responsibility for patients. To this end, 52 physicians and other staff at 26 small and medium-sized physician practices with commercial ambulatory EMRs in place for at least two years were interviewed in-depth about the impact of EMRs on communication with patients and other clinicians as part of a study about the overall impact of EMRs on coordination of care.9 Additional interviews were conducted with chief medical officers at four EMR vendors and four national experts active in health information technology implementation (see Data Source).
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Patient-Clinician Communication
linicians believed EMRs facilitated communication with patients in a variety of ways (see Table 1). In general, immediate access to EMR data enabled them to focus on the patient rather than gathering information from a variety of paper sources during visits. As one physician explained, because we do not have to call down the hall for a lab or test result, we spend more quality time [with the patient] in a more context-rich way. Similarly, because staff can pose questions to the physicians via the EMRs electronic instant messaging (IM) function, rather than opening the exam room door, doctor-patient communication during a visit can continue uninterrupted, at least physically.
Ease of access to information also enriched patient education during visits. For example, clinicians could pull up information from the patients record, such as the problem list, medication list and care plan, or educational information from the Internet to review on screen with patients and family members during the visit. Some respondents reported sharing copies of that information with the patient/family to reinforce their discussion.
While not real-time communication, e-mail had a perceived impact on the timeliness of interpersonal communication. Clinicians who used EMRs e-mail function with patients generally believed e-mail lowered communication barriers and improved the quality of the relationship by enhancing access between visits and reducing phone tag. Illustrating how e-mail increased the likelihood of opening doors to communication at key times, one internist reported, My favorite example is getting a letter from a doctor telling me that the patient I sent to him has a new diagnosis. we want to reach out to the patient at that moment, but well probably have a pretty high threshold for making a phone call because it starts a telephone game. Now, I will routinely send the patient an e-mail saying, 'I got this information [from the specialist who gave you this diagnosis]; Im here for you if you want to talk. I think patients love that.
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Potential Pitfalls
espondents also noted EMRs could pose challenges to interpersonal communication. For example, using a computer during a patient visit can be a distraction—as one physician put it, Its like having a two-year old in the room. As another physician observed, . there are a lot of gadgets and gizmos and that can pull us away from our objective. Instant messages, though valuable for communicating efficiently about care tasks and minimizing physical interruptions of visits, can distract clinicians from the patient if clinicians cannot adequately manage or ignore IM alerts in the exam room.
Ironically, EMRs have enabled some clinicians to engage less with patients because, relative to paper charts, so much more information is available before actually seeing the patient. As one internist said, . my concern now is that were listening less because we have more information when we walk in the room, and its not all trustworthy. Another internist, who works in both outpatient and inpatient settings, noted his fear that EMRs could greatly diminish real-time communication with patients, A lot of us feel like were already seeing it. . One of the hospitalists yesterday said 'This is great, I used the EMR before I came here. I was able to sit down with my bagel and coffee and do my rounds before I even got in.
Some physicians also observed that because of EMR design elements, the temptation to focus on filling out checkboxes in the EMR reduced the amount of open-ended questions they ask patients. There are benefits from encouraging clinicians to more routinely ask about particular elements of patients histories and ideally entering structured and coded data that is searchable. However, exclusive use of checkboxes in taking a patient history risks that subtle or nuanced symptoms might go unidentified.
Experienced EMR users cited several ways to prevent EMRs from diminishing interpersonal communication with patients. For example, several physicians remarked that showing patients portions of their records could facilitate more accurate documentation and joint decision making, while helping to avoid a sense of alienation for patients while the physician looks at the computer screen. Noting that it helps ensure complete and accurate documentation, one physicians said, Before I examine a patient, [we] sit down and look at the problem list and the medication list together. it provides a nice triangular interaction between the physician, the computer and the patient.
Communication Between Clinicians
lectronic medical records provide quick access to patient information, enabling real-time communication about patients when a physician responds to phone inquiries from other clinicians. As one primary care physician said, I know I can now so easily and quickly give information to specialists who call.
EMRs also foster a feeling among clinicians that patient information is a shared asset when they co-manage patients, as opposed to something one practice owns. A national expert commented that this improves interpersonal communication between clinicians because EMRs move physicians away from the concept that, it [patient information] is mine and you cant look at it. It should be shared for teaching and management purposes in a secure way.
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Electronic vs. Live Communication
ust as EMRs can tempt a clinician to disengage from patients, they also can detract from communication within a practice or between clinicians. The use of asynchronous EMR communication tools, such as e-mail and instant messaging where there is a time lag between responses, can be a double-edged sword, according to respondents.
On the one hand, most respondents believed that tools such as IM, taskingassigning responsibility for a particular task to a staff member via the EMRand e-mail increased efficiency for communications that do not require face-to-face interactions with staff, such as scheduling a follow-up visit. On the other hand, some respondents reported that the convenience of asynchronous communication in EMRs decreased the likelihood that real-time communication would occur when needed most, for example, during patient emergencies. One physician explained the importance of discussing with staff the types of urgent or sensitive issues that should be communicated orally, such as notifying a physician about a patients arrival at the emergency department. You have to use electronic communication when appropriate and voice when appropriate, and even paper when its appropriate, he said.
Another example was cited by one physician, People will [use electronic communication] instead of knocking on the door or walking across the hall. You might not see your partner all day, whereas in the old days, we would ask what they think.
For complicated patient situations, respondents believed nothing should replace the interactive aspects of face-to-face or phone conversations. As a cardiologist said, If I am implanting a defibrillator, the primary care physician may have some thoughts about the patients true life expectancy that might influence our decision-making process about whether the device is appropriate for the patient. we need to do a better job [of communicating orally], because we [cardiologists] cant do it without input from the physicians that understand the patients complex chronic conditions.
EMR users cited several approaches to prevent EMRs from diminishing interpersonal communication with other clinicians and staff. For example, setting clear expectations with office staff on what is appropriate for electronic vs. oral communication is important. As several respondents noted, clinicians need to remind themselves, and the students and medical residents they help train, about the importance of face-to-face or phone conversations when indicated. As an EMR vendor and practicing physician noted, The best way to ensure good coordination of care is for two physicians to speak with each other directly. You cant approach any technology solution, in as complex and risky a work environment as the practice of medicine, and have it be a substitute for appropriate human interactions.
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Other Research
thers have found that EMR and computerized physician order entry users have overly optimistic expectations regarding data accuracy and processing.10 EMRs, like paper records, may contain inaccuracies; reports of providers categorical reliance on this information highlight the need to encourage users to verify EMR information directly with patients as they would with a paper chart.
Use of an EMR has been noted in some studies to result in less face-to-face engagement with patients, making it more difficult for clinicians to focus their attention on particular aspects of patient-centered communication, such as outlining the patients agenda, exploring psychosocial and emotional issues, discussing how health problems affect a patients life, and ascertaining the timing of events needed to assess patients problems.11-13
On the other hand, a national survey of physicians14 and a study of patients15 found that EMRs in the exam room had either a neutral or positive impact on perceptions of patient-physician communication in terms of overall quality of communication about medical issues and psychosocial issues. Others have found that how computers are used in the exam room may depend on a clinicians baseline patient-communication skills before EMR adoption.16 Different findings from these studies likely reflect their measurement of different aspects of communication, but the variation points to the need to develop a better understanding of how specific aspects of interpersonal communication are influenced by EMR use.
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Policy Implications
ccording to physicians currently using commercial EMRs, the technology can both help and hinder communication with patients and other clinicians. These findings have implications for the support and training of professionals about interpersonal-communication skills in the presence of EMRs.
Insufficient communication between physicians about shared patients results in part from the lack of payment for these kind of coordination activities and related opportunity costs associated with phone or face-to-face conversations that can disrupt the flow of office visits.17 EMRs and associated electronic communication tools can help address this problem by facilitating information sharing. However, real-time communication will continue to be important in many cases, and increased use of EMRs and electronic communication, if not properly managed, may undermine interpersonal communication. To this end, policy makers might consider incentives for communication among clinicians about shared patients.
Overcoming EMR-related challenges to interpersonal communication will likely involve continued refinement of their design by vendors and use by clinicians to decrease the potential for distraction during the patient encounter. Efforts around health information technology implementation at the federal and clinical practice level might incorporate training to improve interpersonal communication skills for practitioners and medical trainees in the presence of an EMR. The modification of office processes and clinical workflows to maximize interpersonal communication while using an EMR is also likely to be helpful.
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Data Source
A total of 60 telephone interviews were conducted from January-August 2008 with 52 clinicians in primary care and specialty practices with commercial ambulatory care EMRs in place for at least two years, four national experts, and four EMR vendor medical directors. Practices, ranging in size from solo to large groups, were identified within the 12 randomly selected Community Tracking Study (CTS) markets across the United States. Respondents were asked how they felt about EMRs impact on their interpersonal communication with: 1) patients; 2) clinicians and staff within their office; and 3) physicians in other practices. We were not able to validate respondents perceptions with direct measures of actual communication, for example, by audio-taping encounters. Additional details on the methodology, including participant recruitment, data collection and analysis have been previously published.18
Funding Acknowledgement:
This study was funded by The Commonwealth Fund.
Thanks as well to the state and local physicians societies, in particular the Massachusetts Medical Society, and the state and local chapters of the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), the American Society of Clinical Oncologists (ASCO), and the American College of Cardiology (ACC), that helped us identify and contact practices in the 12 CTS markets. We are especially grateful to the numerous anonymous physicians, practice staff and experts who generously gave their time to be interviewed for this project. Their input was invaluable.
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RESEARCH BRIEFS are published by the Center for Studying Health System


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In mid-January, China captured 78 North Korean refugees as they plotted to board boats bound for Japan and South Korea. Amid major crackdowns by both Beijing and Pyongyang, the unhappy fate of those arrested is clear.
"If it is found that they were trying to go to South Korea, they get anywhere from 10 years to execution after they are sent back to North Korea," said Lim Young Sun, a former North Korean army officer who fled the North 10 years ago. "The mastermind of the operation will surely be executed."
While politicians and diplomats from Washington to Seoul are fixated on the threat of Pyongyang's nuclear programs, the arrest of the refugees was a reminder of the hunger and suffering endured by millions of North Koreans as they face another long, lean winter. The energy outlook is worsening since Washington announced a halt of fuel oil shipments, punishment for Pyongyang's alleged nuclear weapons development. On the ground level, the choices are stark — stay and suffer or flee the country, risking arrest, torture, banishment to a remote region and possible execution.
"The degree of punishment has become more severe," said Lim, director of investigations for the Commission to Help North Korean Refugees, one of several organizations here dedicated to helping the refugees. "Executions in public have decreased, but within labor camps it has increased. The situation especially within those camps is getting much worse."
The worsening plight of the vast majority of North Korea's 22 million people — and the publicity surrounding their efforts to escape — has prompted the regime to suppress them more tightly while it haggles with the international community over its nuclear weapons program. In its zeal to increase its control, North Korea counts on cooperation from neighboring China, where authorities are searching the cities and countryside for as many as 300,000 who have slipped across the border.
"My colleagues in Pyongyang told me the North Korean authorities in the Northeast are cracking down more severely than ever," said Norbert Vollertsen, a German doctor who has been crusading for human rights for North Koreans after witnessing abuses first-hand during nearly a year and a half in North Korea. "More and more high-ranking officials are in a difficult situation," Vollertsen said. "The food situation is getting worse. There are more and more power failures. They don't get any regular food supply in the countryside. They don't have any heating."
Increasingly concerned about a coup d'etat that most analysts still believe is only a remote possibility, North Korean leader Kim Jong Il has authorized "more and more security, more and more control stations," said Vollertsen. "There are soldiers all over the place."
Higher security in China
The increased security in North Korea has its mirror image in China, across the Yalu and Tumen rivers, which constitute the border. Refugees report increases in the number of Chinese policemen in towns along the borders and say North Korean police are also seen working with the Chinese to round up refugees. There are even reports of refugee detention centers near Yanji, about 30 miles from the border, in the predominantly Korean-Chinese region of Yangbian.
"They have definitely decided if possible to abolish refugees in China," said Lee Ho Tack, who runs a refugee organization here. "They are conducting an operation like a war against refugees. They are cracking down so they won't find any place to hide in China."
The Chinese and North Koreans authorities may be waging an uphill battle as North Korea's economic hardship deepens. The ultimate nightmare for China is that thousands of North Koreans will begin showing up in coastal towns and villages, overwhelming policing efforts. While many would be bound for South Korea, many others would attempt to blend into China's Korean community, raising the numbers of people vying for scarce jobs and adding to the atmosphere of defiance among Chinese-Koreans, long restive under Beijing's control.
Exactly how many Korea refugees there are in China is not known since most evade the radar, doing odd jobs to survive. However, the flow to the South peaked last year.
All told, 1,141 North Koreans made their way to South Korea in 2002, nearly double the 583 who managed to reach the South in 2001 — mostly through China but a few through Russia and then a third country. So far 2,889 North Koreans have made it to the South, a fraction of those who would rush for the border if they were free to move.
Economic motivation
Economic needs are the primary motivation. At the end of the Korean War nearly half a century ago, incomes in the North were actually higher than in the South. Since then, average income and living standards have been falling in inverse proportion to their rise in South Korea. Now, according to CIA estimates, the average North Korean exists on roughly $1,000 a year, compared with $18,000 a year for South Koreans.
Not unexpectedly, one of the greatest fears of North Korean authorities is that those who have ventured to China or Russia to earn money and then returned will have a subversive effect. "I went to Russia to work in the forest cutting trees and got some idea about the outside world," said one refugee who came here last year. "A police spy heard me asking why life was so much better there than in our country even though they told us it was a 'socialist paradise.'"
The refugee, talking anonymously for fear of retribution against the family he left behind, fled across the Yalu river into China after the police warned him he might be imprisoned for voicing such complaints.
Beginning of a crackdown?
Some refugee workers trace the start of the crackdown on both sides of the border to Dec. 5, when two pastors, the Rev. Choi Bong Il and the Rev. John Daniel Choi, from North Carolina, were tried on charges of "human trafficking" in refugees. In addition, John Daniel Choi was charged with statutory rape of refugee girls under the age of 18.
"We haven't heard about sentencing or judgment," said Douglas Shin, a refugee worker. The case marked the beginning of what the North Korean regime has said is a 100-day battle to halt the flow of refugees.
"They opened the campaign to keep the back door blocked while the crisis with Washington is going on," said Shin. "Because they have embarked on a 100-day battle, there is no more leniency, and there are more summary executions for quick disposal of people. Since the North doesn't have the facilities to handle them all, we have reports they are left in Chinese detention centers, where they treat them like dirt."
China remains impervious to demands that North Korean refugees be classified as just that, refugees, eligible for asylum in China and elsewhere.
Kim Sang Chul, an attorney who is secretary-general of the Commission to Help North Korean Refugees, led a campaign two years ago to collect 11.8 million signatures of people asking the United Nations to view all the North Koreans who had made it into China as refugees, not illegal migrants. He got no response beyond polite thanks for his time and effort.
Few succeed at embassy dash
The only way refugees in China have consistently managed to escape arrest and return to North Korea has been by making a dash for the safety of foreign embassies and consulates and international facilities outside the reach of Chinese police in Beijing and other major cities. Since a family of seven received asylum in the Beijing office of the United Nations High Commission for Refugees in June 2001, nearly 200 people have successfully used that route.
That number, however, is minuscule compared with the total for all the refugees, so the strategy, initially encouraged by Vollertsen, may have been a failure. And the dream of a boatlift of North Korean refugees, while it may come true someday, may also have only encouraged the Chinese to pursue refugees more aggressively than before.
"The Chinese government and the Communist Party of China do not like intervention by foreign powers," said Kim Sang Chul. "Therefore, they arrest as many as they can."
The arrest of the 78 who had planned to leave China by boat may get a degree of attention that China had hoped to avoid. Among the 78 are two South Korean citizens, one of them a businessman who wanted to help the refugees, the other a free-lance photographer, Seok Jae Hyun.
The Seoul Foreign Correspondents' Club, appealing to Chinese authorities for Seok's release, called his detention "an infringement on his rights and freedom as a journalist."
Even if Seok is eventually freed, however, the others will probably be sent back to North Korea. Refugees who were picked up in China just trying to make a living are likely to get six months' imprisonment in North Korea, but there is no crime worse than wanting to defect to South Korea.
"It is the severest crime," said one of the refugees who escaped last year through a foreign embassy in Beijing and did not want his name used. "Surely they will be executed. Or even if they are not shot, they will be sent to a political prison, and they will have to suffer there all the rest of their lifetimes, and they will die there."
MSNBC.com contributor Don Kirk is based in Seoul, South Korea.


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With all of the blanket cosmetics lines out there promising solutions for your every beauty need, it's refreshing to see a company like Anastasia Beverly Hills, which focuses on creating beautiful brows. The centerpiece of Anastasia's novel collection of products is the Five Piece Brow Kit, a complete set of tools focused on delivering full circle DIY eyebrow beauty.
The kit comes in a range of colors suitable to every brow color found in nature; I tried it in Caramel. The products included are:
Continue reading Makeup Reviews: Anastasia Five-Piece Brow Kit


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In today's tutorial I'll show you how to produce a memorable holiday card. Pop-up cards are normally cards that, once opened, have an element of surprise making them both memorable and fun to the reader. This tutorial takes you step-by-step through the entire process of transforming initial concept drawings through to a fully functional piece of cardboard engineering. Let's get to it!
Tutorial Assets
You'll find some files in the "source" folder, as well as outlined font versions of the InDesign artwork and the print-ready .PDF. You'll also need the following free stock images to complete this tutorial.
images and the InDesign print-ready artwork in the source folder too.
In this digital age of ecards and Flash-based cards, it's refreshing to see something a little different. If a memorable design lands on your client's desk it's more likely to get you repeat business rather than winding up in the email trashcan! With that in mind, I'll briefly explain my design process.
First I gathered together my stock images and quickly layered them up in Photoshop. At this stage I wasn't too concerned about detail, just how the core elements worked as a whole. I then sketched out two design options and after some deliberation, decided to go for the more complex design shown bottom-right.
The next stage was to figure out the folding mechanism. For this design to be feasible It would need to be printed in two parts: The folded A6 outer with a cut step and the actual pop-out graphic separate, which would be glued to the font of the step. If this was a live job I would have emailed these concepts over to my chosen printer, in case he had any suggestions for the mechanics and also costings. Another point would be sourcing a standard square envelope, because when folded the pop-out protruded.
Here's an almost complete design which I printed out and mocked up. You'll notice I've moved the main greeting to the front as most of it was obscured on the mock-up. It's worth bearing in mind that 2D designs can look completely different when actually printed.
Step 1
Create an A5 InDesign document to the size of the flat outer card (the folded size will be A6) and copy these settings, remembering to add the 3mm bleed required by your printer.
Step 2
Go to View > Grids & Guides and activate Show Guides, Snap to Guides and Smart Guides, then View > Extras > Show frame Edges. Now place a central folding guide at 105mm.
Step 3
Drag the guides origin point to meet the edge of your artboard (not the bleed) and central guide.
Step 4
Now place two more guides 20mm away from the centre guide as shown.
Step 5
At this point I decided to alter the left and right margins to correspond to the two vertical cuts. To do this, choose Layout > Margins and Columns, uncheck the chain icon and modify as shown.
Step 6
Snap the origin point back to its default position (top-left corner of the artboard). Ensure the top-left Reference Point Locater is active, then grab the Rectangle Tool (R) and snap a frame to the bleed area. Go to your Swatches tab and use the top-right fly-out menu to select New Color Swatch. Ensure the Color Type is set to Process and the Color Mode is CMYK. Now enter 0% Cyan, 100% Magenta, 0% Yellow and 0% Black. Now apply a magenta 0.5 stroke to your box with the Fill set to None.
Step 7
Add another 0.5mm stroked frame to the artboard with the X and Y co-ordinates set to 0 and the width: 148mm / height: 210mm. Select the Line Tool (/) and snap in the remaining fold and cut guides, again with a 0.5 magenta stroke. I've disabled the visibility of the guides in the screenshot for clarity.
Step 8
In this step we'll export a .PDF to use as a Photoshop guide. Press Cmd/Ctrl + E, copy these settings and click the Export button.
Step 9
Open your .PDF via Photoshop. Name it "Layered_illo", apply the following settings in the Import window and hit OK.
Step 10
Rename the default layer "Guides", then place a layer beneath it called "Solid green", set your Foreground color to # 80912b, then hit Alt/Opt delete/backspace to fill the layer content with green.
Tip: As this project is destined for commercial print, certain on-screen colors will not reproduce the same. These colors are referred to as out-of-gamut. Your monitor creates colors by mixing red, green, and blue light (RGB), whereas your printer creates color by using light-absorbing inks of cyan, magenta, yellow, and black (CMYK), these pigments are much more limited in their ability to reproduce color. To remedy this, work in RGB Mode (to have access to all filters etc.) and press Cmd/Ctrl + Y to Proof Colors – this will avoid any nasty surprises when the job is printed.
Step 11
Open "paint.jpg" from the "source" folder. Hold Shift and drag across its layer thumbnail into your working file to create a new layer and label it "Paint texture". Press Cmd/Ctrl + I to Invert to negative. Now change the Blend Mode to Soft Light to lessen the effect.
Step 12
Open "IMG_4680.JPG" from these textures. Rotate 90 degrees counter-clockwise and Invert to negative. Place above the previous layer and re-size to cover your canvas. Now set the Blend Mode to Soft Light, reduce the Opacity to 47% and name it "Distress 1".
Step 13
Open "IMG_4702-w640.jpg", repeat the rotation and add as a new layer above the previous one. Re-size, change the Blend Mode to Soft Light, but leave the Opacity at 100%. Name this layer "Distress 2".
Step 14
Place the "card.jpg" image from the "source" folder below your "Guides" and name it "Paper". Enlarge to cover the canvas and change the Blend Mode to Screen.
Step 15
Choose Hue/Saturation from the Create new fill or adjustment drop-down menu at the foot of the Layers tab. Now click the double-circle icon, so the adjustment affects all underlying layers and change the Hue value to +34.
Target the adjustment mask, set the Gradient Tool (G) to Linear in the Options bar, then Shift-drag a black to transparent gradient as indicated by the direction and length of the arrow. This will limit the adjustment to the top quarter.
Step 16
Shift-click all your layer thumbnails apart from the "Guides", then select New Group from Layers from the top-right fly-out menu in the Layers tab. Name the folder "GRAPHICS 1" Organizing your layers into folders is important, as you'll discover towards the end of this tutorial.
Step 17
Open the mountain range image. Grab the Quick Selection Tool (W) and select the sky, then use the add and subtract options to refine your selection as required.
Step 18
Press Shift + Cmd/Ctrl + I to Inverse your selection, then click the Refine Edge button in the Options bar. In the following window choose On Black (B) from the View Mode menu, this gives the best preview for unwanted pixels. Copy the remaining settings and click OK.
Step 19
You'll now see a new masked layer appear and the visibility of the original layer disabled. Zoom in and check you're happy with the results of the Refine Edge command. At this point you can modify the mask by painting with either white (to reveal), or black (to hide) using a small brush (B) set to around 50 hardness if required.
When you're happy, drag the mask thumbnail into the trash icon at the foot of the Layers tab and click Apply in the following window.
Step 20
Drag the new layer thumbnail below the "Guides", flip horizontal and position/re-size as shown. Add a mask, then use the Rectangular Marquee Tool (M) to create a selection and fill with black to hide the lower half, then label it "Mountains".
Step 21
Add a Levels Adjustment Layer, but this time deactivate the double-circle icon to clip the adjustment to just the the "Mountains" and apply these settings.
Step 22
Grab the Gradient Tool (G), then click the gradient thumbnail in the Options bar to access the Gradient Editor. Create the gradient as shown, then click the New button to save it.
Step 23
Clip a Gradient Fill Adjustment Layer to the "Mountains", then click the Gradient swatch to load your preset, use these settings and click OK. Now change the Blend Mode to Hue and reduce the layer Opacity to 60%.
Step 24
Open the "elements.pdf" from the "source" folder via Illustrator. Select the stripped triangle shape and copy to the Clipboard. Switch back to your Photoshop file and Paste. In the next window choose the Smart Object option and click OK. Transform/position over the left horizon line, then change the Blend Mode to Soft Light. Label this layer "Stripes 1", then duplicate, flip horizontal, reposition to the right and rename it "Stripes 2".
Step 25
Select the Custom Shape Tool, then use the fly-out menu in the Options bar to load the "festive_shapes.csh" from the "source" folder. Set your Foreground color to white, ensure Shape Layers are active in the Options bar, then add some small snowflakes over the sky on independent layers and label them accordingly.
Step 26
Continue to add further snowflakes, but leave some areas clear for the clouds that we'll be adding later.
Step 27
Now to add some hand-drawn elements. Open "doodles.jpg" from the "source" folder and use the Lasso Tool (L) to roughly select the first star and copy to the Clipboard.
Step 28
Paste the selection as a new layer below the "Guides", position in the sky and label it "Doodle 1". Invert, then change the Blend Mode to Screen to render the black areas invisible. Repeat this technique for the second star and name it "Doodle 2"
Step 29
Copy the first cloud shape from the "elements.pdf" and paste as a Smart Object below the "Template". Repeat this for the second cloud, Transform/position as shown and label them accordingly. Now add all your floating layers except for the "Guides" into another folder called "GRAPHICS 2".
Step 30
Add the grass texture as a new layer below the "Guides", enlarge/position to overlap the vertical cuts of the step and name it "Grass". Snap a vertical central guide, then select the Ellipse Tool (U). Ensure Paths are highlighted in the Options bar, then hold Shift and snap a large circular path to the center guide. My path is indicated red in the screenshot for clarity.
Tip: To reposition or re-size your path, simply activate it with the Path Selection Tool (A).
Step 31
Cmd/Ctrl-click the path thumbnail to create a selection. With the "Grass" layer targeted, click the Add mask icon at the foot of the Layers tab. Now fill a rectangular selection with black on the mask as well to create the base of the cut-out.
Step 32
Now clip a Hue/Saturation adjustment to the "Grass" layer and change the Hue slider to +16.
Step 33
Open the deer image. This time we'll use a slightly different method to isolate it. Set the Magic Wand Tool (W) to Tolerance of 33, check Anti-alias and uncheck Contiguous in the Options bar. Now click on the background to create a selection.
Step 34
Access the Refine Edge dialogue box, but this time choose Overlay (V) from View Mode to see the selection edge better. Copy the following settings, then click OK.
Step 35
When you're happy with the mask, delete it and click Apply in the following window as before.
Step 36
Place as a new layer below the "Guides" and re-size/position over the grass. Go to Layer > Matting > Defringe and enter 2px to eliminate any white picked up from the initial selection and name the layer "Deer". Now clip a Levels adjustment and set the Input blackpoint to 28, the midpoint to 0.88 and the whitepoint to 196 to increase the contrast. Next, clip and save a new Gradient preset as shown. Finally, set the Blend Mode of of this adjustment to Overlay and reduce the Opacity to 52%.
Step 37
Use the Polygonal Lasso Tool (L) to draw a rough shadow below the deer. Target the "Grass" layer and copy. Now target the "Grass" Adjustment Layer and paste the selection as a new layer above it. Name this layer "Deer shadow". I've disabled the visibility of the "Grass" layer in the screenshot for clarity.
Step 38
To darken the shadow, Clip a Levels adjustment and set the Output whitepoint to 102.
Step 39
Add a mask to the "Deer shadow", then drag a large black to transparent Radial Gradient to blend the right-hand side. Next, Cmd/Ctrl-click the "Grass" layer mask to load the white as a selection. Inverse the selection, then use a black hard-edged Brush (B) to remove the bottom overlap.
Step 40
Now we'll add some more graphic details which you'll find in the "source" folder. Place "scribble.jpg" in Multiply Mode below the "Deer", then paste the lined circle (also in Multiply Mode) and the white flower shape as Smart Objects and position as shown.
Step 41
Add the final star drawing below the "Deer" in Multiply Mode so the white areas become invisible and label it "Doodle 3". Place a new layer below it and label it "Doodle 3 fill", then use a small hard-edged brush to infill the star shape with # bd2709 and # 67e660. Now select the Move Tool (V) and use the arrows on your keyboard to offset the layer content slightly.
Step 42
Set your Foreground color to # 6ddc4e and add the tree from the "festive_shapes.csh" as a Shape Layer below the "Deer". Name this layer "Tree".
Step 43
Now add the final cloud behind the deer's antlers as a Smart Object and name this layer "Cloud 3".
Step 44
Grab the Elliptical Marquee Tool (M) and Shift-drag a small circular selection behind the deer's hind legs. Choose Pattern from the Adjustment Layer drop-down menu, then click the arrow next to the pattern preview. Now load the "geometric_patterns.pat" from the "source" folder via the small arrow to the right. Choose "pattern 4", set the Scale to 13% and click OK. Use the same technique to add another slightly larger Pattern Fill behind the deer's font leg, but use "pattern 18" at 25%.
Step 45
Use the Magic Wand (W) to extract the first leaf and place above "Pattern Fill 2". Label this layer "Leaf 1", Transform, then clip a Color Balance adjustment to boost the reds and yellows.
Step 46
Use the same method to add the second leaf and name it "Leaf 2", then clip a similar Color Balance Adjustment Layer.
Step 47
Extract and add the ornament below the "Guides". Re-size and position so it hangs from the deer's antler and name it "Decoration". Cmd/Ctrl-click the "Deer" layer thumbnail to create a layer-based selection, then use a small hard-edged Eraser (E) to remove the left string. Inverse the selection and erase any string above the antler. Finally, clip a Levels adjustment and set the Input blackpoint to 22, and the whitepoint to 219 to boost the contrast.
Step 48
Set your Foreground color to # bd2709, then add an elliptical Shape Layer to the right of the deer's head and name it "Red circle". Now paste the logo over it as a Smart Object, then place all your floating layers into a final folder called "GRAPHICS 3".
Step 49
Before proceeding to the next step, toggle the visibility of your folders to check they look like this, then Save.
Step 50
Now we'll make two flattened .TIFF files to place into InDesign. First switch off the visibility of the "Guides" layer and the "GRAPHICS 3" folder. Choose Flatten Image from the top-right fly-out menu in the Layers tab and click OK in the following window. Hit Shift + Cmd/Ctrl + S to Save As and name the file "background.tif".
Step 51
Re-open your layered file. Disable the visibility of the "Guides" layer and the "GRAPHICS 2" folder. Flatten again and Save As "cut_out.tif".
Step 52
We now need to create a vector path which your printer will use to punch out the pop-out graphic. Print tolerances do not allow cutting formes to align precisely to the edge of an image, so we'll leave a small border of background, rather than just plain white paper.
Re-open your layered file once more and switch off the visibility of the "GRAPHICS 2" folder. Target "GRAPHICS 2" folder and press Cmd/Ctrl + E to Merge Group. Cmd/Ctrl-click the merged thumbnail to generate a layer-based selection, then choose Select > Modify > Expand, enter 12px and hit OK.
Step 53
Use the Lasso Tool (L), set to Add to eliminate any inner holes in the selection. Now set the Marquee Tool (M) to Subtract and cut the selection back to the bottom fold guide.
Step 54
Switch to your Paths tab, then choose Make Work Path from the top-right fly-out menu. In the following window accept the default setting of 1.0px and click OK. Now double-click the path thumbnail to save it.
Step 55
Finally, go to File > Export > Paths to Illustrator and name it "cut_out.ai". You can now close your layered file without saving it.
Step 56
Revisit your InDesign artwork and name the default layer "Cutter". Delete the two outer magenta frames, then change all your horizontal magenta rules to dashed lines to represent folds (solid lines represent cuts), which I've exaggerated in the screenshot for clarity.
Add a new lower layer and name it "Artwork". Grab the Rectangle Tool (M) and snap a frame to the outer bleed. Create a new red color swatch (C:18/M:97/Y:100/K:9), color the frame with a Fill of new red and a Stroke of None. This page represents the flat outer of the card.
Step 57
Grab the Type Tool (T) and snap a frame to the bottom inner guides and enter your main message in white – I've used a commercial font called ITC Lubalin Graph BT, bit feel free to use your own choice. Press Shift + Cmd/Ctrl + C to centre the text. Hit Escape to activate the Selection Tool (V), then press Cmd/Ctrl + B to access the Text Frame Options window. From here set the Align Vertical Justification to Bottom and click OK.
It's vital when using large font sizes to adjust the spaces between individual characters. This is called kerning and should not be confused with tracking which adjusts the spacing between whole words. To kern, click between the characters you wish to adjust with the Type Tool, press Opt/Alt and tap the left or right arrow keys. Depending on which way you tap, you will see that the space between the letters is increased or decreased by 20 em in the Character Palette (an em is defined as a measure for 12-point type; a pica). In InDesign's preferences, you can set the default em spacing to something lower which will increase or decrease the spacing in smaller increments if you wish, or manually type in the kerning field. You'll see that I've tightened up the spacing between some characters by eye for a pleasing result.
Step 58
Complete the card outer by adding any relevant environmental messages / logos relating to inks and paper stock used – your printer should be able to advise you on this. Remember, the top half of your artwork will eventually be the reverse of the card, so rotate any graphics 180 degrees.
Step 59
Here's how your finished card outer artwork should look, along with a printed mock-up.
Step 60
Drag page 1 over the Create new page icon in the Pages tab, then delete all the white text and the red box on this page. Press Cmd/Ctrl + D, then navigate to your "background.tif". Now snap the placed image to the bleed guides. Next, add your holiday message as a centered block as shown, but remember to leave a space at the bottom for any hand-written signatures. This page will be the card inner.
Step 61
Type this small appearing over a pale background should be colored up with InDesign's default black and set to Overprint Fill in the Attributes panel (Window > Output > Attributes) to avoid any ink registration issues.<
Step 62
Now we need to color up the exported Photoshop path. Open your "cut_out.ai" via Illustrator and apply a 100% magenta 0.5pt stroke, Save, then check Legacy Artboard in the following window and click OK.
Step 63
Duplicate page 2 to create a third and final page, then replace the main image with your "cut_out.tif" file. Unlock and delete the guides as well as the magenta fold / cut marks on this page only. Target the "Cutter" layer and press Cmd/Ctrl + D, then place the modified "cut_out.ai" file. Snap this into position over the cut-out as shown.
Step 64
That's the artwork completed. In the final steps, I walk you through the process of producing the .PDF artwork files for your printer. First we'll tackle the cutter. Switch off the visibility of your "Artwork" layer, then press Cmd/Ctrl + E to Export. Label it "cutter.pdf" and make sure you only select pages 2-3 in the Range field, then copy the remaining settings.
Step 65
Viewed through Acrobat your "cutter.pdf" should look like this.
Step 66
Finally, we'll create the the four-color artwork. Switch off the visibility of "Cutter" and switch on the "Artwork" layer. Export again, name it "card_artwork.pdf", but this time check All Pages and Use All Printer's Marks and Document Bleed Settings.
Step 67
Viewed through Acrobat your "card_artwork.pdf" should look like this. All you need to do now is mock-up a dummy to show your printer along with the artwork and you're done!.
Conclusion and Scope
Remember, it's good practice to talk to your printer before creating any complex, cut-out artwork; he maybe able to offer invaluable advice that could save you a lot of time. Happy Holidays!


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'Creed II' goes more than the distance — it's a KO
The weight of legacy hangs heavily over "Creed II." Not just for most of the characters, who must come to grips with their own family histories. But also for the filmmakers, tasked with making a sequel to a successful spin-off of a beloved franchise. It would put any film on the ropes. Not this one.
"Creed II " pulls off a rather amazing feat by adding to the luster of its predecessor and propelling the narrative into a bright future while also reaching back to honor its past, resurrecting unfinished business from "Rocky IV" and adding a dash of "Rocky III." Pound per pound, the sequel might even be better than its predecessor.
Steven Caple Jr. replaced Ryan Coogler in the director's chair this time but there is plenty of continuity: Michael B. Jordan returns as Adonis Creed, with Sylvester Stallone by his side as former heavyweight champ and trainer Rocky Balboa. Also back: Tessa Thompson as Creed's love interest, Phylicia Rashad as Creed's mom, and Wood Harris as a coach. Max Kellerman is ringside again as color commentator.
The sequel pits Creed against man-mountain Viktor Drago, the son of Ivan Drago, who killed Adonis Creed's father, Apollo Creed, in the ring in "Rocky IV." That stirs up trauma for Rocky, who feels responsible for the elder Creed's demise. Rocky went on to avenge the death by beating the elder Drago but we also now learn what that disgrace meant for the Dragos. This film is about ghosts as much as it is a meditation on fatherhood. At one point Kellerman says the showdown between the sons of Creed and Drago is almost like a Shakespearian drama and — laugh if you must — it feels sort of right here.
Desire — or lack of it — plays a key role in "Creed II" since we meet young Adonis as the new champion, at the top. Viktor Drago is at the bottom, hauling cement in Ukraine and burning for family redemption. "My son will break your boy," Ivan Drago threatens Rocky, who sort of agrees. "When a fighter's got nothing to lose he's dangerous," he warns Creed. "Listen, that kid was raised in hate. You weren't." Dolph Lungren returns as the elder Drago and there's even an appearance by Brigitte Nielsen, who plays Drago's wife in 1985 and was a real-life wife of Stallone. (Talk about keeping it in the family.)
Caple matches Coogler's moody, gritty vision of a brutal sport conducted by mostly honorable men trying to outwit each other. There's plenty of gore, slo-mos of smashed heads and "Rocky" trademarks — the glorious montages with uplifting music as fighters prepare for their shot in the ring. (Prepare to look away if you are fans of massive truck tires — many get horrible beat downs.)
Stallone got his mitts on the script — after having had a role penning all the "Rocky" films but sitting out writing "Creed" — and teams up with Cheo Hodari Coker, creator of the Netflix superhero hit "Luke Cage." Onscreen, Stallone returns with his dark fedora and small bouncing ball, shuffling about and mumbling, allowing his sad eyes to do the bulk of his acting. It's in the small moments between crusty Stallone and cocky Jordan where the film finds its sweet spot. "What are you fightin' for?" the elder man asks the younger.
Jordan proves again that he's a film force to be reckoned with, capable of searing and savage intensity and yet also goofy softness. This time, his swagger is tested and he must overcome intense pain and anguish. Watching him get up off the canvas again and again will make even the most uncharitable viewer cheer. As Adonis, he wants to carve his own legacy away from his father's: "This is our chance to rewrite history. Our history," Creed tells Rocky.
Thompson and Rashad both temper the piles of testosterone onscreen as women who steer and guide the young Adonis. Thompson's character is battling progressive hearing loss and that is handled intelligently by the writers. There's even a scene when Adonis is punched so hard that he falls in silence and looks over at her, both connected for a moment in enveloping quiet.
The filmmakers, meanwhile, are creating their own family legacy. Both "Creed" films share the same composer (Ludwig Goransson) art director (Jesse Rosenthal), special effects coordinator (Patrick White), costumer (Rita Squitiere) and location manager (Patricia Taggart.) The films even have the same barber for Jordan (Kenny Duncan). And Coogler didn't go far — he's an executive producer.
But while a "Creed III" is almost guaranteed, there may be dangers ahead if the filmmakers choose to keep reopening old wounds or plundering story lines from the past. And the creep toward more cinematic bombast needs to be watched vigilantly (remember how nuts the last few "Rocky" films got?) Having said that, this spin-off franchise is clearly in very good hands — ones that are heavily wrapped, protected by a glove and aiming for your gut.
"Creed II," a Warner Bros. Pictures release, is rated PG-13 for "sports action violence, language and a scene of sensuality." Running time: 128 minutes. Three and a half stars out of four. MKH
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Scientists believe that thousands of years ago, megafauna like mastadons helped disperse the enormous seeds of many plants. They'd eat the seeds, and then deposit them in their wanderings. But, with those creatures millennia dead, how do these plants still survive? In one case, it due to thievery-loving rodents.
In Panama, the black palm seeds are a target of the Central American agouti, a rodent about the size of a housecat. Far too small to disperse the seeds by eating and digesting them, the agouti is still very happy to hoard and eat them. But can these little creatures disperse the seeds as far and as effectively as an enormous animal like a mammoth?
By installing radio trackers on hundreds of seeds, researchers were able to follow their progress over the course of a year, and found that there's more going on here than just the agoutis stealing and eating the black palm seeds. Instead, the rodents will take them, then bury them. Later, they'll dig them up, move them, and bury them again. Or else another agouti will come by, steal the cache, and repeat the process. So while one animal might not move a seed very far, in concert they can disperse the seeds widely.
Some 35% of the seeds moved more than 100m, 14% survived the full year, and one seed was moved 36 times over 749 meters before finally being devoured. So while people don't generally think of rodents as being good at dispersing seeds in the wilds, this time they were good enough at the job to keep a venerable species from going extinct.