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I have now been to one baby shower in my life–mine, last Saturday. This is what comes of living so far from close friends and family; I couldn't even go to my sister's shower. I found out months ago that my sister-in-law Peggy was planning to host a shower for me, and I was excited ever since. Peggy is a consummate host and a creative part-planner. But she's also just really warm and lovely. My husband's family (Peg is his sister) has embraced me as one of their own in a way I never thought was possible. Peggy and I were pregnant at the same time, until her third baby was born in July. Knowing that I'm not the most traditional mom and that most of my close female friends live far away, Peggy and my mother-in-law, Judy, planned a co-ed, family friendly backyard tea party. They called it "Anne-Marie in Wonderland" – my "un-shower."
It was perfect. (The weather did actually threaten a tornado at one point, but that was before the party, and the rain waited until after we were done being outside to come down!) There were incredibly generous gifts and a bin full of books that included many I knew and loved. Friends drove all the way from Philly, and my cousin took the train all the way from Brooklyn. I often have a little social anxiety at parties, but there's a magical perk to being the mom-to-be at your own baby shower–no one expects you to mingle! I sat on my "throne" decorated with beautiful hydrangea flowers and people came over to me to say hi!
We had tea, scones and finger sandwiches on beautiful china in the backyard. My friend Joseph is English and he said, "It's like my childhood on a table!" so Peggy must have done her research. There were tiny signs on toothpicks in the sandwiches that said "Eat Me" just like the signs in the original Alice illustration. Corresponding "Drink Me" signs adorned the wine and iced tea that was served before the tea got started. The warmth and welcome was just palpable.
We eventually did go inside to open gifts (and many of our male guests retreated to the basement to mix cocktails at the full bar and avoid cooing over baby gifts) and this is where I really start to tear up at the memories. I hardly knew many of the guests, who were friends and family of our baby's lovely grandparents and aunt and uncle, but as the evening progressed, I felt like they were welcoming Nathan and I (Nathan opened gifts, too!) into the Parents Club. It's hard to explain, but all the smiles and thoughtful gifts and the stories shared about putting children to bed (or not) and favorite books… it all added to this feeling like we are about to do this very difficult thing (parenting) that many have done and survived before us. They seemed so happy for us at the joys we were about to experience and good-natured and funny about the not-so-joyful sleepless nights.
I did start to cry when my mother-in-law came over with a special gift just for me; it's a series of little things, really, that are all about helping me experience childbirth in the positive, sacred way that I have planned. I had entertained the idea of throwing myself a Blessingway, a party that is much more about birth and is, admittedly, very "hippie." Knowing that, Judy had made me a necklace with special beads to wear in preparation for labor. She started a scrapbook for me, not a baby book of traditional milestones, but of words and images that represent the joy and the calm that I want to surround my family as we move forward on our little journey. She had even found a CD perfect for playing in our hospital room to keep the ambiance calm and sweet. And she wrote a card expressing feelings I share: we are so glad to have one another as family.
My baby shower weekend turned into a celebration of family. I have heard stories of awful showers with the sharing of birth stories, some of them frightening, and advice, much of it based in fear. I have heard stories of moms-to-be overruled by grandmothers-to-be who want everything this or that way. I know a family whose registry and desire to use cloth diapers was completely ignored; instead, they received cases of disposable diapers and are now finding the money to buy diaper covers themselves. I was a little nervous. Not very nervous. Just a little. There was nothing to worry about. This party fit my taste and personality so perfectly, you would have thought that the closest friends in the world had planned it. Turns out, the family I married into is as close as my closest friends (even if topics of conversation are a bit different). We know and love each other well.
I am so happy to be bringing my baby into this family. Of course, far-away family sent gifts and good wishes, and they are part of my joy. Still, there is something special, something I grew up with and would never trade, about having family just a car-ride away. I am so lucky–to have the gifts we received on Saturday, of course, but much more to have the love of such kind and generous souls.


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Steven Seagal was in Russia beforehand this ages to appear a Victory Day array as the actionable adumbrative of the US, who had, forth with abounding western countries, boycotted it over Putin's aggression of the Ukraine. Apparently Seagal backward until this weekend, back he was photographed giving an Aikido exhibition at the All-Russian Sambo Clash in Saratov.
As it is with aloof about every Aikido video I've watched, it looks like the aboriginal affair you apprentice in Aikido chic is how to do anticlimax somersaults and bandy yourself to the mat whenever your adviser touches your finger. Here's a nice .gif of what I mean. As every account aperture and Steven Seagal's official bio will acquaint you, Steven is a "7th dan atramentous belt" in Aikido (a aggressive art based on small-joint manipulation, appropriately the feel throws), and generally accustomed as "the aboriginal greenhorn anytime to own and accomplish an Aikido dojo in Japan." Alike admitting that dojo was absolutely endemic by his aboriginal wife's family.
Seagal looks appealing acceptable for 63, and I can see this exhibition actuality absorbing if he'd done it in advanced of a accumulation of bill munchers at a Hollywood arranger roundtable. Instead, he's accomplishing it in advanced of absolute athletes in a applied action action at a Sambo clash — that's a Russian aggressive art that combines
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Jacob Briscoe
I have a potential customer who builds wooden railroad models. I don't have too many details right now, other than he needs about 8-10, 4x5ish" 3D buildings. Each one is a little bit different. Some of the sides have windows and doors etc... I know we can do it with our machine, but I have no idea where to even begin on pricing. I was hoping someone with a little more expertise could give me a ballpark pricing number, or possibly direct me to a website that could help me out. Thank You in advance for any feedback!


text: Virtual Patient Simulation at U.S. and Canadian Medical SchoolsHuang, Grace MD; Reynolds, Robby MPA; Candler, Chris MDAcademic Medicine: May 2007 - Volume 82 - Issue 5 - p 446-451 doi: 10.1097/ACM.0b013e31803e8a0a Educational Strategies Free SDC Abstract Author InformationAuthors Article OutlineOutline Article MetricsMetrics Purpose "Virtual patients" are computer-based simulations designed to complement clinical training. These applications possess numerous educational benefits but are costly to develop. Few medical schools can afford to create them. The purpose of this inventory was to gather information regarding in-house virtual patient development at U.S. and Canadian medical schools to promote the sharing of existing cases and future collaboration. Method From February to September 2005, the authors contacted 142 U.S. and Canadian medical schools and requested that they report on virtual patient simulation activities at their respective institutions. The inventory elicited information regarding the pedagogic and technical characteristics of each virtual patient application. The schools were also asked to report on their willingness to share virtual patients. Results Twenty-six out of 108 responding schools reported that they were producing virtual patients. Twelve schools provided additional data on 103 cases and 111 virtual patients. The vast majority of virtual patients were media rich and were associated with significant production costs and time. The reported virtual patient cases tended to focus on primary care disciplines and did not as a whole exhibit racial or ethnic diversity. Funding sources, production costs, and production duration influenced the extent of schools' willingness to share. Conclusions Broader access to and cooperative development of these resources would allow medical schools to enhance their clinical curricula. Virtual patient development should include basic science objectives for more integrative learning, simulate the consequences of clinical decision making, and include additional cases in cultural competency. Together, these efforts can enhance medical education despite external constraints on clinical training. Dr. Huang is director, Office of Educational Technology, Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, and instructor in medicine, Harvard Medical School, Boston, Massachusetts. Mr. Reynolds is director of educational resources, Division of Medical Education, Association of American Medical Colleges, Washington, DC. Dr. Candler is director of educational technology, Division of Medical Education, Association of American Medical Colleges, Washington, DC. Correspondence should be addressed to Dr. Huang, Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, E/ES-212, Boston, MA 02215; telephone: (617) 667-8413; fax: (617) 667-9122; e-mail: (firstname.lastname@example.com). Abstract Method Results Program characteristics Case characteristics Discussion and Conclusions Acknowledgments References Economic forces and biomedical advancement have transformed the delivery of health care. The disease spectrum has shifted from acute care to chronic illness, and symptom evaluation and management often take place outside of the hospital. However, the bulk of clinical training still occurs in the hospital, where trainees are exposed to diseases often less reflective of illnesses in the general population. Pressures to shorten hospital stays have resulted in lost opportunities to interact and learn from patients. Medical students are often marginalized from the health care team rather than being engaged in the clinical decision-making process.1 Technology-enabled instruction is one means by which medical educators hope to address these challenges in clinical training. In particular, virtual patients were designed to fill gaps in clerkships by exposing students to diseases that they would not otherwise experience because of short clinical rotations and limited ambulatory care experiences. "Virtual patients" are defined as "computer programs that simulate real-life clinical scenarios in which the learner acts as a health care professional obtaining a history and physical exam and making diagnostic and therapeutic decisions."2 They should be distinguished from other forms of simulation, such as standardized patients (human actors trained to portray patients) and from high-fidelity simulators (life-sized robot mannequins). Virtual patients can be used to simulate, for example, the longitudinal care of a diabetic patient over the course of nine "virtual" years, condensed into several hours. They expose learners to rare, "do-not-miss" events that might not occur over the course of a three-month clerkship or even a three-year residency, such as a ruptured aortic aneurysm. They permit a window into procedures or conversations in which trainees may not normally participate, such as a cardiac catheterization or a primary care physician giving bad news. They portray a variety of clinical presentations for a single disease such as HIV or, alternatively, multiple diseases for the same clinical presentation, such as chest pain. They have been used to teach topics as diverse as communication skills3 and bioterrorism response.4 Several studies have demonstrated that virtual patients are well received and may improve cognitive and behavioral skills better than traditional methods do. For instance, medical students who used virtual patients to learn about acute back pain rated the learning experience more enjoyable and performed better on posttest examinations than did students who read journal articles on the same topic.5 A study assessing student attitudes in a pediatric clinical curriculum (Project LIVE) showed that students reported higher confidence in their ability to recognize abnormal findings when using hybrid CD-ROM/Internet virtual patients (either face to face or as a "virtual group") than did those in a traditional problem-based learning session.6 A follow-up Project LIVE study revealed that medical students who learned in a virtual modality with a digital video case engaged in higher critical thinking than did students using a paper case.7 Participants in a continuing medical education course who used both virtual patients and standardized patients showed equal improvements in performance and diagnostic ability compared with participants who used standardized patients only.8 In recognition of the value of simulation in medical education, the recent Liaison Committee on Medical Education (LCME) ED-2 requirement permits the use of simulated patients to meet clerkship objectives.9 Perhaps the strongest validation to date is the introduction of virtual patients for assessment in USMLE Step 3 in 1999.10 Despite persuasive evidence for the effectiveness of virtual patients, these programs are not ubiquitous in medical education. Because virtual patient programs employ complex programming and multimedia to replicate clinical environments, these resources are extremely time and resource intensive to produce, which is prohibitive to institutions that lack robust educational technology programs. At the same time, virtual patient development tends to be confined within single institutions, resulting in potentially duplicative case development and lack of access for those schools that have not developed virtual patients. In addition, as with any educational innovation, the successful integration and effective use of virtual patient programs hinges on the extent to which educators sufficiently consider curricular issues and training needs. These challenges, among others, have led to the inconsistent and ultimately limited impact of virtual patient simulation on the undergraduate medical curriculum. In response, we decided to gather detailed technical, content, and usage information regarding virtual patients developed at U.S. and Canadian schools, anticipating that dissemination of these results will promote additional collaboration among developers, increased visibility to educators, and sharing of these valuable resources. Back to Top | Article Outline Method From February to September 2005, we contacted curriculum deans at 142 U.S. and Canadian schools and asked them to report on virtual patient simulation activities at their schools or to forward our requests to educational technology directors. We sought the following general information from respondents: technical platform (CD-ROM, DVD-ROM, Internet based, workstation, or hybrid) multimedia object types (images, audio, video) browser plug-in requirements intended audience (students, resident trainees, faculty, or allied health professionals) access patterns (one time or continuous) user setting (individual or group) feedback mechanism peer-review mechanism case structure (linear or outcome branching) performance tracking access mechanism (open or password protected), and willingness to share cases. We sought the following information about individual cases: title patient demographics (age, gender, race, ethnicity) symptoms key words diagnoses funding mechanism production cost production duration, and willingness to share case metadata with others. The inventory was piloted at two medical schools and was subsequently refined. We sent e-mail requests to all 142 U.S. and Canadian medical schools, followed by targeted phone calls to nonresponders. In addition, we announced the inventory on various listserves and directly contacted virtual patient developers known to ourselves. We categorized each of the virtual patient cases into 1 or 2 of 21 possible clinical disciplines and into 1 of 17 possible basic science disciplines, if applicable. In addition, we characterized each case by clinical presentation, using the Medical Council of Canada (MCC) list of clinical presentations.11 We tabulated the virtual patient programs by delivery mechanism, embedded multimedia, Web browser plug-in requirement, intended learner audience, instructional characteristics (individualized use, presence of immediate feedback, peer review, multiple possible outcomes, and tracking of user input), accessibility, and willingness to share. We tabulated the individual virtual patient cases by clinical discipline (primary and secondary), basic science discipline, unique clinical presentation (according to the MCC guidelines), gender, age, race, ethnicity, funding source, cost, and production duration. We tabulated production characteristics (funding source, cost, and duration) by various aspects of sharing (willingness to accommodate external users, willingness to share entire software packages, willingness to share multimedia components, and willingness to allow modifications). We used a univariable logistic regression model to analyze factors associated with the willingness to accommodate external users and willingness to share the entire package. Independent variables included federal/state funding source, production cost greater than $50,000, and production duration greater than 12 months. Analyses used Stata 7.0 (StataCorp, College Station, Tex). Back to Top | Article Outline Results A total of 108 U.S. and Canadian medical schools out of 142 participated in the inventory (76% response rate). Eighty-two (76%) respondents reported that they were not producing or using virtual patients at their institution. Twenty-six (24%) medical schools responded to questions in the inventory, and 12 medical schools entered 103 cases, comprising information about 111 virtual patients, into the inventory. An average of 8.6 cases (SD 8.4, range 1–31) was entered by each of those 12 schools. Back to Top | Article Outline Program characteristics Twenty-four schools' responses addressed the technology underlying their virtual patient programs (see Table 1). The vast majority of existing virtual patient programs required an Internet connection (20 schools, representing 83%). CD-ROMs, workstation terminals, and DVD-ROMs were used in eight (33%), four (17%), and three (13%) programs, respectively. Many of the programs had hybrid delivery mechanisms. The programs were rich in multimedia, with 22 (92%) containing still images, 17 (71%) using audio clips, and 20 (83%) using video clips. A quarter to one third used more advanced multimedia, with six (25%) using three-dimensional animation and eight (33%) using Macromedia Flash animation. Of plug-in players needed to run the virtual patient programs, 15 (63%) required QuickTime player and nine (38%) required Macromedia Flash player. Table 1 Most of the virtual patient programs were developed for medical student use: 20 (83%) during the clerkship years, and 15 (63%) during the basic science components of the curriculum. Use in graduate medical education and continuing professional education was less common, being seen in only eight (33%) and five (21%) programs, respectively. None of the medical schools reported an intended allied health professional audience. The majority of the 108 schools responded "frequently" or "almost always" to the following instructional characteristics of their virtual patient programs (see Figure 1): use by individual users rather than in small groups (17 programs, 68%), direct feedback to users about their performance (17 programs, 68%), peer review of case content (16 programs, 64%), and tracking of user input (13 programs, 52%). In contrast, only five (20%) programs offered multiple outcomes contingent on learner decisions. Figure 1 In terms of accessibility, two thirds of programs (18 programs, 69%) were password protected, but nine (35%) permitted noninstitution members to register for access. Twenty-two schools (85%) were willing to share their virtual patient cases in exchange for access to other institutions' cases, and 16 (62%) were willing to share the paper-based materials used by the programs. Back to Top | Article Outline Case characteristics Analysis of clinical discipline coverage revealed that pediatrics was most frequently represented (40 cases, 39%), followed by internal medicine (30 cases, 29%), clinical neuroscience (24 cases, 23%), psychiatry (13 cases, 13%), and preventive medicine (8 cases, 8%). Remaining clinical disciplines of geriatrics, surgery, obstetrics–gynecology, dermatology, emergency medicine, and palliative care each represented fewer than 5% of cases. Only eight (8%) reported cases that included basic science coverage; three (3%) reported cases that included microbiology and immunology topics. Using the MCC examination objectives, we found that 65 of 103 cases represented unique clinical presentations; these constituted 30% of the 219 listed by the MCC. The 111 virtual patients reported by respondents were well distributed by gender (51% male, 49% female) and age (20–24 virtual patients [18%–22%] in each age category, with an average age of 34.6 years—see Table 2). Virtual patients were predominantly white (93 virtual patients, 84%) and either non-Hispanic (46 virtual patients, 41%) or reported as "not applicable" (56 virtual patients, 50%). Table 2 Of the 102 of 103 cases where production information was provided (Table 3), 56 (50%) required multiple funding sources for their development. Half (54 cases, 53%) were funded by public federal and state grants, followed by internal support mechanisms (30 cases, 29%) and medical schools (27 cases, 26%). Corporate funding sources were the exception (7 cases, 7%). Production of individual virtual patients was expensive; 35 (34%) cost more than $50,000, and 87 (85%) cost more than $10,000. Sixty-two cases (61%) required more than six months to produce, and the average production duration was 16.6 months. Table 3 We tabulated production characteristics by expressed intention to share (see Table 4). In virtual patient programs funded by either federal or state, commercial, or university grants, the majority of cases were associated with willingness to host external users on their local servers (44, 7, and 9 cases, respectively, or 81%, 100%, and 89%, respectively), but a lower percentage were willing to give away the entire program for free (20, 4, and 2 cases; 37%, 57%, and 22%, respectively). In general, willingness to share multimedia assets and to allow modifications of work was less frequent than willingness to host external users or to share the entire package, across production cost and production duration categories. Table 4 A univariable analysis revealed the factors associated with the willingness to accommodate external users. These factors included federal/state funding (odds ratio [OR], 9.1; confidence interval [CI], 3.7–22.5), production cost >$50,000 (OR, 0.1; CI, 0.1–0.3), and production duration >12 months (OR, 3.0; CI, 1.3–6.8). Factors associated with the willingness to share the entire package included federal/state funding (OR, 0.2; CI, 0.1–0.4), production cost >$50,000 (OR, 8.6; CI, 3.0–25), and production duration >12 months (OR, 0.3; CI, 0.1–0.7). Back to Top | Article Outline Discussion and Conclusions This inventory is the first formal effort to collect information about virtual patient simulation at medical schools in North America. The data support the following specific conclusions: The vast majority of virtual patients are Internet accessible, media rich, and associated with significant production costs and time. Half are supported by more than one funding source. Virtual patient programs contain desirable elements of learner-centered instruction (individualized feedback and performance tracking). Primary care fields such as internal medicine and pediatrics are well represented among virtual patient cases. Sharing is widely endorsed by medical schools. Given that most developers have expressed a willingness to share their programs, we encourage interinstitution collaboration in using virtual patients, which may, in turn, broaden funding support of these tools and advance research evaluation of virtual patients. We recognize that many barriers to collaboration exist: educators may be subject to the "NIH" (not invented here) syndrome; programs may be rigidly tailored to the specific needs of a particular course or curriculum; and collaboration and further refinement may require time and significant effort. Institutions may have restrictive intellectual property policies that limit how these resources might be used by others. A few examples of successful multicentered associations do exist6,12,13 and may serve as models for broad-based curricular integration. In addition, making case-authoring tools14,15 available can allow institutions to create libraries of virtual patients based on a common platform, which may decrease the production cost per case and facilitate sharing of content. Strategic development of new virtual patients in underrepresented topics may motivate more widespread integration of virtual patients into medical education. We recommend the creation of additional cultural competency cases, more explicit objectives in basic science content to increase integration between preclinical and clinical curricula, and the exploration of technologies and features that would allow learners the opportunity to explore the consequences of clinical decisions. In addition, development of virtual patients in acute care and surgery disciplines would result in a comprehensive body of cases to complement the entire clinical curriculum. Limitations of the inventory include the fact that it may not encompass all programs considered "virtual patients." Two points of comparison are noteworthy. The LCME annual survey in 2004 revealed that 62 medical schools (50%) responded in the affirmative that at least one clerkship was using "computer-based case simulations."16 A 2004 survey of medical schools regarding their educational technology services showed that 70 out of 88 schools (80%) responding reported using "computer-based simulations for teaching and/or assessment."17 These data show that the majority of medical schools are taking advantage of some type of computer-based simulation. We hypothesize that the discrepancy is attributable to our adherence to a single definition of "virtual patient," which reflects the more complex, media-rich programs, rather than the generic term "computer-based simulation," which encompasses virtual patients but also electronic versions of paper cases. Furthermore, although we made this distinction, we are unaware of published studies evaluating the benefit of multimedia and complex interactivity in virtual patients compared with generic, computer-based case simulations, and we are unsure about the generalizability of such studies because both categories are heterogeneous. We also specifically excluded programs purchased commercially; we examined in-house production of virtual patients as a justification for collaboration and resource sharing, which would not be permitted with proprietary software. We also uncovered in our search that virtual patients are being developed by organizations with loose affiliations to the medical schools; these organizations may not have known of the school-centered call for data. This includes efforts at teaching hospitals for residency education, even though our data suggest that hospitals are uncommon sources of funding and that virtual patients are less likely to be used for graduate medical education. We have also excluded international initiatives, though virtual patient development is particularly active in certain European schools. A second major constraint of inventories such as this one is the limited information we collected about virtual patient programs themselves; this has impact on the content analysis, the resource allocation, and conclusions regarding the perceived educational value of the programs. Our categorization of virtual patient cases is imperfect; basic sciences are poorly reflected, even though the content of some cases may somehow address basic science topics. Because virtual patients tend to be centered on symptom presentations (just as real patients are), the information we received from the case authors tended to be clinically oriented. We also lack detailed financial data that might shed light on the wide range of production costs and development times reported and indicate whether costs were predominantly associated with personnel or technical infrastructure. Finally, we are unable to make wholesale conclusions about the educational value of these virtual patients, because we are unsure how they meet course objectives and learners' needs or how they are integrated into the curriculum. The willingness of virtual patient developers to share information about their programs and to share the programs themselves may be a catalyst toward wider adoption of this technology. Although institutions may have dissimilar policies regarding ownership of curricular materials, in many cases the virtual patient developers hold leadership positions in educational technology or medical education and are therefore empowered to advance reliable statements of intention, as they did in response to our questionnaire. In addition, with the increasingly widespread adoption of other forms of medical simulation, particularly procedural and high-fidelity simulation, there exist potential pedagogic synergies to allow trainees the opportunity to practice in realistic and safe learning environments. In the face of compelling evidence that current virtual patients are effective for teaching and assessment and the likelihood that the technology will grow increasingly sophisticated and costly, we must be thoughtful about how limited, available resources are used, and we should strive in unison towards improving the education of our future physicians. Back to Top | Article Outline Acknowledgments The authors thank Roger Davis, ScD, of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center, for his statistical expertise.Back to Top | Article Outline References 1 Nutter D, Whitcomb M. The AAMC Project on the Clinical Education of Medical Students. Washington, DC: Association of American Medical Colleges; 2001. Cited Here... 2 Huang G, Reynolds R, Candler C. Virtual Patient Reference Center. Available at: (http://www.aamc.org/meded/mededportal/vp/start.htm). Accessed July 28, 2006. Cited Here... 3 Bearman M, Cesnik B, Liddell M. Random comparison of "virtual patient" models in the context of teaching clinical communication skills. Med Educ. 2001;35:824–832. Cited Here... | View Full Text | PubMed | CrossRef 4 Henderson JV. The virtual terrorism response academy: training for high-risk, low-frequency threats. Stud Health Technol Inform. 2005;111:185–190. Cited Here... | PubMed 5 Leong SL, Baldwin CD, Adelman AM. Integrating Web-based computer cases into a required clerkship: development and evaluation. Acad Med. 2003;78:295–301. Cited Here... | View Full Text | PubMed | CrossRef 6 Kamin C, Deterding R, Lowry M. Student's perceptions of a virtual PBL experience. Acad Med. 2002;77:1161–1162. Cited Here... | View Full Text | PubMed | CrossRef 7 Kamin C, O'Sullivan P, Deterding R, Younger M. A comparison of critical thinking in groups of third-year medical students in text, video, and virtual PBL case modalities. Acad Med. 2003;78:204–211. Cited Here... | View Full Text | PubMed | CrossRef 8 Triola M, Feldman H, Kalet AL, et al. A randomized trial of teaching clinical skills using virtual and live standardized patients. J Gen Intern Med. 2006;21:424–429. Cited Here... | View Full Text | PubMed | CrossRef 9 Liaison Committee on Medical Education. Accreditation Standards. Available at: (http://www.lcme.org/functionslist.htm). Accessed April 14, 2006. Cited Here... 10 Dillon GF, Clyman SG, Clauser BE, Margolis MJ. The introduction of computer-based case simulations into the United States medical licensing examination. Acad Med. 2002;77(10 suppl):S94–S96. Cited Here... | View Full Text | PubMed | CrossRef 11 Medical Council of Canada. Examination Objectives for the Medical Council of Canada's Evaluating Examination and Qualifying Examination Part I and Part II. 3rd ed. Available at: (http://www.mcc.ca/Objectives_online/objectives.pl?lang=english&loc=contents). Accessed April 18, 2006. Cited Here... 12 Fall LH, Berman NB, Smith S, White CB, Woodhead JC, Olson AL. Multi-institutional development and utilization of a computer-assisted learning program for the pediatrics clerkship: the CLIPP Project. Acad Med. 2005;80:847–855. Cited Here... | View Full Text | PubMed | CrossRef 13 Myers JH, Dorsey JK. Using diagnostic reasoning (DxR) to teach and evaluate clinical reasoning skills. Acad Med. 1994;69:428–429. Cited Here... | View Full Text | PubMed | CrossRef 14 Ruderich F, Bauch M, Haag M, et al. CAMPUS—a flexible, interactive system for web-based, problem-based learning in health care. Medinfo. 2004;11:921–925. Cited Here... 15 Zary N, Johnson G, Boberg J, Fors UG. Development, implementation and pilot evaluation of a Web-based Virtual Patient Case Simulation environment—Web-SP. BMC Med Educ. 2006;6:10. Cited Here... | PubMed | CrossRef 16 Barzansky B, Etzel SI. Educational programs in US medical schools, 2004–2005. JAMA. 2005;294:1068–1074. Cited Here... | View Full Text | PubMed | CrossRef 17 Kamin C, Souza KH, Heestand D, Moses A, O'Sullivan P. Educational technology infrastructure and services in North American medical schools. Acad Med. 2006;81:632–637. Cited Here... | View Full Text | PubMed | CrossRef © 2007 Association of American Medical Colleges


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Leaving Cert Business: 'An excellent paper, with a really great choice of questions'
An excellent paper, with a really great choice of questions, was how teacher Keith Hannigan described Leaving Cert higher level Business.
"Students will be delighted; those who studied past papers and worked hard will be richly rewarded," he said.
The short questions had "something for everyone", added Mr Hannigan, of Dublin's Institute of Education.
Section 2, Applied Business, had a topical question on enterprise and the benefits of being an entrepreneur for which "students would have been hoping", he said.
"There were also lovely questions on management activities and the Sale of Goods and Supply of Services Act. If students had practised with past papers they would have been very pleased here," he added.
Not for the first time in the 2019 exams, the environment popped up, with a Section 3 question on how companies can be more green.
"This was a great question, and nice and topical. It's lovely to see that the business subject took on the idea of how a company can be more environmentally friendly," Mr Hannigan continued.
Another topical issue touched on in this section was the EU with "a lovely question that didn't tackle Brexit head-on, but instead focused on the benefits of continuing to trade within the Eurozone," he said.
In Section 3, Part 2, Mr Hannigan thought students would have loved Q4, which focused on leadership and motivation, "a topic that they are usually strong on".
Other candidate-friendly questions here dealt with the consequences of a fall in sales in a phone company, marketing a Fitbit watch and the launch of a new fizzy drink.
Yeats College Galway teachers Shauna Mujic and Mary Kelly described it as a balanced paper, where "students were required to think on their feet and use and adapt the information they had learned".
In the Section 2, the Applied Business Question (ABQ), they thought Part C "may have thrown students as they were required to discuss the Sale of Goods and Supply of Services Act with regard to a service provider, however as with all ABQ questions, the points lie within the case study."
They said there was a "very nice mix" of long questions in Section 3, "that will have rewarded the student who can adapt their learned material".
The Yeats teachers noted the lack of mention of the 'B word' in Q3 on trading in the Eurozone, which they described "as very fair but not as topical as expected, with no mention of Brexit!".
Online Editors


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The user should be able to click on a submit or indexing button to commence the pinging in 100 entry segments.
After submit, the user entered [URL] must be appended to a server list of URLs (in a text file) that are then pinged.
A corresponding random selection of URLs should be chosen each time from the text file.
The text file will be formatted as follows (the [URL] is where the user's website will be inserted):
[login to view URL][URL]
[login to view URL][URL]/
[login to view URL][URL]
(If you require the file to be formatted in another way, then that is okay, too).
Each ping must show whether it is successful or not (although the pinged URL should be shortened so that it fits nicely within the theme pages).
The code must be protected from end users.
The page should also include a list of last 20 user URLs that have been backlinked.
The code must use minimal server resources.
The code must be supported for at least three months from installation to fix any bugs, etc.
5 фрилансеров(-а) в среднем готовы выполнить эту работу за £31
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Get rid of them.
I made a decision starting 2018, I would no longer put up with negativity in my life. That, unfortunately meant loosing some relationships and changing my mindset.
You need to create a life that vibrates love, peace, positivity and overall good vibes. WHY, would you put up with people that change and ruin your frequency? Yes, it seems harsh and you don't want to hurt anyone's feelings, I totally understand, it's a hard/harsh decision but you have to do it if you want to thrive. What and who you surround yourself with has so much to do with how much you grow and exceed in life.
Get harsh, be bold, create the life you want and fill it with people that lift you up and help you grow.
There is no room for negativity in my life. My husband and I have learned to speak as if it already is and we keep ourselves open to every opportunity imaginable. Nothing is impossible. If a door closes, we think of it as a new exciting chapter in our lives is about to start. We embrace change as much as we can and try to leave stress behind.
You are an amazing human being that has so much to offer, but, you must know your worth. You must be willing to thrive. - xo


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This listing was posted on TopUSAJobs.
Travel RN Seasonal Jobs - HealthCare Travelers
Walworth, NY
Travel Nurses Needed - All RN SpecialtiesMaine Travel Nursing AssignmentsHospitals are posting their seasonal staffing needs--Would you like to spend the fall / winter somewhere great? The Hospitals have already started posting the available seasonal travel assignments with the HCEN Network of staffing agencies. Submit your details request today and get your choice of great locations before they are gone.The Travel Nurse Season is here and it showsFor the past 5 yrs, thousands of Nurses just like you--have utilized the sites of--HealthCare Employment Network--to explore a career as a Traveling Registered Nurse. Interested in locating that perfect RN Travel Assignment Job?Looking for great compensation as well as leading benefits packages??Veteran Traveler or researching your 1st assignment options,You are in the right place.--Requested Nursing SpecialtiesCardiac Cath LabLabor & DeliveryPediatricsPCU - StepdownTelemetryMaternal-NewbornEmergency DepartmentMedical-SurgicalICU - Critical Care----Intensive CareNewborn NurseryCVICU - Cardio-Vascular--Intensive CareOncologyNICU - Neonatal--Intensive CareGeneral SurgeryPICU - Pediatric--Intensive Care--CVOR General SurgerySICU - Surgical Intensive Care--OR - RN 1st AssistantMICU - Medical Intensive CareOutpatient Pre/Post SurgeryNeuro - Intensive CarePediatric SurgeryTrauma - Intensive CarePACUWhere would you like to go Spend the winter in the warmth of Florida, Virgin Islands, Arizona, Hawaii, Southern California or many others.Spend the winter in the beautiful states of Colorado, Utah, Vermont.So many great options today's travel nurse has to choose fromASAP starts. Numerous 8,13 & 26 week--travel assignments available. Registered Nurse Licensure in the state of practiceMinimum of 2yrs recent background in your primary specialty.BLS / ACLS / NALS / PALS / CCRN / as applicableNo flagged or under investigation licenses.?Tired of always being asked to complete a lengthy application?We can appreacite that, we have been in your shoes as past "Travelers"Get the details you need from theNation's Top Staffing Agencieswith 1 free, quick & short"More Details Request"
Healthcare Travelers
July 20 on TopUSAJobs
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More About this Listing: Travel RN Seasonal Jobs - HealthCare Travelers
Travel RN Seasonal Jobs - HealthCare Travelers is a Nurse & Healthcare Registered Nurse Job at Healthcare Travelers located in Walworth NY. Find other listings like Travel RN Seasonal Jobs - HealthCare Travelers by searching Oodle for Nurse & Healthcare Registered Nurse Jobs.
Travel RN Seasonal Jobs - HealthCare Travelers is a Nurse & Healthcare Registered Nurse Job at Healthcare Travelers located in Walworth NY. Find other listings like Travel RN Seasonal Jobs - HealthCare Travelers by searching Oodle for Nurse & Healthcare Registered Nurse Jobs.


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Kitchen Design Sink No Window
By no means in the long historical past of the chandelier has there been such alternative as there is immediately. You should purchase in individual or over the web. You can scour or the junk shops in England or America or the brocante stalls in France. https://www.arcadiaca.gov/residents/home-improvement-program
Your Choice Home Improvement
Once your undertaking is underway, it's possible you'll find yourself overwhelmed or stressed out from all the activity, preserve drawing and photos of your finished project simply accessible as a way to remind your self of the sweetness that awaits you.
Home Improvement Fort Worth Tx
Bogs are available quite a lot of sizes and styles that range from extremely small to extremely giant. When you have not mastered the art of storage then small bathrooms can be annoyingly cramped. It is possible to make a tiny overstuffed bathroom look bigger with a few illusions. The fitting rest room … Read More


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Japan reports exports, trade surplus slid in March
Added 04-17-19 01:04:02am EST - "Japan's exports declined in March as shipments to China dropped more than 9%, pulling the nation's trade surplus sharply lower." - Foxbusiness.com
Posted By TheNewsCommenter: From Foxbusiness.com: "Japan reports exports, trade surplus slid in March". Below is an excerpt from the article.
Japan's exports declined in March as shipments to China dropped more than 9%, pulling the nation's trade surplus sharply lower.
It said total exports for the world's 3rd largest economy fell 2.4% from a year earlier while imports rose 1%.
Exports to the U.S., Japan's biggest single overseas market, rose slightly while imports fell, increasing the politically sensitive trade surplus by nearly 10%.
The report came as Japan and the U.S. finished launching trade talks aimed at clinching an agreement aimed at redressing that imbalance, which totaled $67.6 billion in 2018 according to U.S. figures.
U.S. Trade Representative Robert Lighthizer's office said he and Japan's trade minister Toshimitsu Motegi agreed to continue talks soon.
Post a comment.


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Manhattan Associates Builds Momentum in South Africa with Key Win at Retail Giant Foschini
South African Lifestyle and Fashion Retailer Standardizes Group Distribution Operations with Manhattan Associates
Cape Town and SAPICS Exhibition & Conference, Sun City — Global supply chain optimization provider Manhattan Associates (NASDAQ: MANH) announced that Foschini Group, one of South Africa's leading fashion and lifestyle retail chains, has selected Manhattan Associates' Warehouse Management solution (WMS) for Open Systems, to serve the group's multiple Retail Divisions, which span clothing, jewellery, accessories, cosmetics, sporting and outdoor apparel, equipment and homewares. The contract award is a joint success for Manhattan and channel partner Supply Chain Junction, a specialist supply chain consultancy focusing on the South African market. The two companies will work together on the project to provide Foschini with an order fulfilment platform to support the Group's store network extending across South Africa's nine provinces and into neighbouring countries including Namibia, Botswana and Swaziland.
With an incumbent WMS that required Foschini's own support and development, the company sought a WMS that would free up internal IT resources and that could also support business processes such as postponement, cross-docking, part order allocation and part order delivery. Manhattan's WMS has the necessary functionality to effectively handle these requirements and additionally meets virtually all other process support requirements of Foschini's diverse portfolio of retail businesses.
"The Manhattan solution positions our group strategically for the future," explained Jan Tukker, group logistics director. "We wanted our internal team to be able to respond quickly to supply chain challenges and developments by making simple system configuration changes based on best practice rather than developing new code to support processes that may have been sub-optimal. Working with Manhattan will provide us with business benefits that alternative solution providers just could not deliver."
Steve Smith, senior vice president, EMEA, at Manhattan Associates, commented, "This is another key win for us in South Africa and we're excited to be working alongside Supply Chain Junction to help Foschini and other forward-thinking enterprises pursue a strategy of supply chain optimisation. There are some interesting dynamics at play both in South Africa and in the global economy right now and the need to be competitive is more intense than ever. Whether it is the pursuit of sales growth or a means to control cost or both, we believe our constantly evolving solutions complemented by the expertise of Supply Chain Junction position us well to strengthen the supply chain operations of both local and multi-national companies operating in South Africa."


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GETDipped: Spike Lee in Air Jordan VII Bad 25 Customs
This entry was posted in GETDipped and tagged Air Jordan VII, Michael Jordan, Spike Lee. Bookmark the permalink.
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Meek Mill - Oddles O'Noodles Babies
DJ Khaled ft. Meek Mill, J Balvin, Lil Baby, Jeremih - You Stay


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Union of Bliss and Emptiness: Teachings On the Practice of Guru Yoga
Author: Dalai Lama
The origins of the instructions on this Lama Choepa (guru yoga) practice are traced back to the explanatory tantra called Vajramala, in which the visualization of the body mandala deities on the gurus body is explained according to Guhyasamaja. Since the integral practice of Yamantaka, Guhyasamaja and Heruka has great merit and advantages, Lama Choepa explains how to do it on the basis of this guru yoga practice. In this unique and clearly laid out commentary, the actual practice is explained on the basis of Guhyasamaja, the preliminaries such as the self-generation on the basis of Yamantaka, and the performing of offerings and so forth according to Heruka.


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Get Lower Monthly Dominion City Debt Payments,
Reduce Your Interest Rates or Avoid Bankruptcy.
Just fill out this short form to get started Today!
Welcome to our Dominion City debt consolidation section. Credit Card Consolidation Canada offers the finest Dominion City MB credit card settlement services including Dominion City relief loans programs and Dominion City MB card relief loans services. If you need help with a financial troubles problem then use the FREE form on the right to talk to a Manitoba credit card settlement professional who can help you regain financial control over your life once again. This is an absolutely no obligation free credit card settlement service that could end up saving you thousands in interest and bills payments.
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But what can you do when you are faced with high interest unsecure money loan debt and are struggling to make ends meet? The answer could be as simple as a Dominion City MB relief loans program. Consolidating your debt in Dominion City MB can not only lower your monthly budgeting obligations it can also help you get out of debt quicker by lowering your interest payments.
Dominion City MB card relief loans programs combine all of your high-interest bills into one account with a much lower interest rate and it could even lower your total bills payments owed each month. That means that you could have a few hundred dollars or more a month after starting the Dominion City MB credit card settlement program than you had before joining. And you can use all of this extra dollar to pay off the principle balance on your Manitoba bills even quicker. See, there is a debt-free life, and it's just around the corner when you consolidate your Dominion City debt, more.
Talk to one of the professional debt consolidation Dominion City counsellors using the form above for your free credit card settlement consultation session. They will be able to help you find a workable credit card settlement solution to your Manitoba debt problems. This credit card settlement consultation service is absolutely free and only takes a moment to fill in your Dominion City contact info so you will be in line for the next available counsellor to help you.


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Looking for Event Management Companies in Jaipur? A conference or seminar can be counted successful and booming if the guests are happy and satisfied with offers, that shows your main sales illustration that one calls it just a yearly meet. At Countrywide Events, we make sure that your events will run perfectly while we uphold the correspondence of cooperation and purpose of the meetings with our precisely designed services. Being seminar & conference organizers in Delhi, we always provide our services within a determined time frame.
We render the latest technology audio, lighting and production facilities for your seminar & conference along with striking visualizations to affect your audience. Our logistics management crew takes care of all the intricate dynamics and information of your seminar & conference from location issues right through to designate management.
We respect your views nonetheless; we consider your imagination along with our pioneer so, bring your emissary together, and let them get enthused in an amazing and inspiring environment. Without negotiating with excellence we brainstorm diverse ideas to render a sophisticated framework for sharing cognition, be it an MNC conference or a board meeting and render the previous reporting of the conferences with top-notch visualizations, venues, food, and decorations.
As a leading event management in jaipur our technique and tools work with the advanced technology and the crew is dedicated to rendering you progressive elements at the conferences to let the guests feel amazing and relaxed yet engrossed. We are involved with our experts who work and plan each & every step of organizing as per the delegations no matter how complex the necessities are. We have a wide collection of seminars and conferences management services for each of the clients to create a flawless impact and difference.
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What Is Post-Traumatic Stress Disorder?
How could PTSD affect your child?
Post-traumatic stress disorder (PTSD) is a form of psychological damage that can result from experiencing, witnessing, or participating in an overwhelmingly traumatic event. PTSD, which can occur in both children and adults, results in a "reliving" of the tragic events. Children often relive the trauma through repetitive play, upsetting dreams, or scary imaginary characters. Though its symptoms can occur soon after the event, the disorder often surfaces several months or even years later.
According to the American Academy of Child and Adolescent Psychiatry, here are some behaviors that may indicate your child is suffering from PTSD:
- Refusal to return to school
- Fearful or clingy behavior
- Regression, such as going back to thumb sucking or using a bottle
- Preoccupation with the events of the disaster
- Sleep problems, such as nightmares, screaming, or bed-wetting
- Difficulty concentrating
- Irritability
- Jumpiness
- Misbehavior
- Physical complaints, such as stomachaches, headaches, or dizziness, with no physical explanation
- Withdrawal from family and friends
- Persistent sadness or listlessness
- Decreased activity
If your child is exhibiting two or more of these behaviors, speak to your pediatrician about finding a counselor. Professional advice or treatment for children affected by a disaster can help prevent or minimize PTSD.
Sources: American Academy of Child and Adolescent Psychiatry; Marion Bilich, PhD
The information on this Web site is designed for educational purposes only. It's not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.