text:
|Publication number
|Publication type
|Application number
|Publication date
|Apr 1, 2008
|Filing date
|Jan 18, 2005
|Priority date
|Jun 19, 2001
|Fee status
|Also published as
|Publication number
|Roger Jelliffe, William Shoemaker, David Bayard, Andreas Botnen
|Original Assignee
|University Of Southern California
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (18), Referenced by (7), Classifications (31), Legal Events (12)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation application of and claims priority to U.S. patent application Ser. No. 10/177,655, filed Jun. 19, 2002, now U.S. Pat. No. 6,896,660 which claims the benefit of U.S. Provisional Patent Application No. 60/299,578, filed Jun. 19, 2001. The disclosures of the prior applications are considered part of (and are incorporated by reference in) the disclosure of this application.
The determination of how-to treat a highly ill patient can be very difficult, especially under the chaotic and emotional conditions that may exist in the conditions surrounding around such a highly ill patient. For example, such an ill patient may be treated in the context of an emergency situation such as shock, high risk surgery, trauma and other acute conditions requiring emergency treatment. It has been found by the inventors that diagnosis errors commonly occur under those emergency conditions.
It is also difficult, especially in these emergency situations, to evaluate the timing of a given therapy. A given therapy that improves the outcome at one point may actual produce harm at a different point, or when used in the wrong amount for the wrong situation. For example, fluid therapy used at the initial phase of resuscitation may be critical. However, use of excess fluids may lead to pulmonary edema and cardiac failure. Such errors can be lethal in emergency situations. Moreover, many different injuries, shock being one, may be easy to recognize in late stage when therapy is often ineffective. If hypovolemia is inferred from tachycardia, hypotension, and falling hematocrit, these superficial manifestations of shock may be overtly corrected by transfusions, fluids, and vasopressors, but still without adequately restoring the underlying circulatory functions.
It has been found that effective resuscitation of acute life-threatening emergencies achieves optimal physiological goals as early as possible. When circulatory mechanisms are identified earlier and treated more vigorously to specified physiologic target goals, outcomes are improved.
The incidence, mortality, morbidity, and costs of life threatening illnesses and injuries are extraordinary. Among the 1.9 million deaths annually, about half are from acute illness associated with shock and lethal organ failure. There are over 34 million surgical-operations annually in the U.S., with an overall mortality of 1%, but high-risk surgical patients have mortality between 25 and 33%. Postoperative deaths are often due to adult respiratory distress syndrome (ARDS), which has an incidence of 150,000, a mortality of around 40%, consumes an average of two weeks in the ICU, and in this country costs about $1,950,000,000 annually. There are about one-half million septic patients, of whom 40% develop shock, with 50% mortality. Septic shock is the 13th leading cause of death, and the most common cause of ICU deaths. Hospital costs for septic shock are over 5 billion dollars annually.
Conventionally, shock is classified as hemorrhagic, traumatic, postoperative, neurogenic, and distributive or septic. Usually this classification is applied to the later, fully developed, clinical syndromes of shock. Analysis of circulatory mechanisms when patients are admitted to the ICU in the late stage, after organ failure has occurred, is extremely complex because of the many interacting clinical, physiological, and immunochemical problems. Over 12 separate cascades of chemical mechanisms have been described. Many of these have been considered to be the cause of shock, and major efforts have been expended to reverse them. Of the 11 or more large scale, multicenter, randomized clinical trials, only the recombinant human activated protein C (drotrecogin alfa activated) has shown improvement in mortality, which decreased from 30.8% in the placebo control group to 24.7% in the protocol group, a decrease of 6.1% (38). The many interacting immunochemical mechanisms make the problems of sorting out causal relationships more difficult, and the therapy less effective, after organ failure and sepsis have become established in the late stages of critical illness.
There are six commonly used outcome predictors: the Acute Physiology and Chronic Health Evaluation (APACHE), Glasgow Coma Scale (GCS), the penetrating abdominal injury (PATI) score, the Therapeutic Intervention Scoring System (TISS), The Revised Trauma Score and Injury Severity Score (TRISS) and the Trauma score. All of them assess categories of patients in terms of probable mortality. The are not intended to predict mortality risk for a specific single patient. Those systems are rarely used for guiding actual patient care. They find their greatest use as a tool for administrative and management research and decisions. Longitudinal scoring on successive days may reflect continuous improvement, but has no physiologic or therapeutic relevance for any specific individual patient. Moreover, none of them identify specific underlying physiologic mechanisms or problems as does the present approach. In addition, none of them considers specific therapeutic recommendations to be suggested, real-time, to the physician. Finally, none are able to recommend titration of therapy to alleviate the underlying hemodynamic problem or to achieve optimal goals.
These and other aspects will now be described in detail with reference to the accompanying drawings, wherein:
The present technique, in contrast to the above, defines techniques for detecting, and optimally correcting, for each individual patient, in a real-time manner, the initiating hemodynamic mechanisms of shock and circulatory dysfunction, in conjunction with a new outcome predictor and real-time guidance and decision support for optimizing therapy. This is very different from the above scoring systems currently in use, which provide only reports concerning prognosis.
The present invention teaches a system and machine of patient monitoring of various parameters and decision support that is guided by a stochastically analyzed operation. This operation can evaluate and optimize the therapy that is used especially in such difficult situations.
Another aspect is an outcome predictor that calculates the probability of survival for any individual patient. This predictor, in an embodiment, is based on a program of stochastic/probability analysis developed from a database that includes clinical conditions.
An embodiment determines the patients state (S) using a specified mathematical criteria, and determines patients in the database most similar to the patients state. Individualized therapy that maximizes the probability of survival may be determined from those other patient states that are closest to the patient's state.
Many or most deaths in acute illnesses are based on circulatory factors. An aspect of this application describes characterizing a patient based on hemodynamic parameters and comparing those parameters to previously obtained information in a database. While the present embodiment describes hemodynamic parameters, it should be understood that other parameters besides hemodynamic parameters can be analyzed. Hemodynamic measurements, however, may be specifically advantageous since many previous studies and clinical trials have established relationships between such hemodynamic parameters and patient results (where patient results may include survival, long term injury, or other results). Also, noninvasive monitoring technology is available in many different forms for obtaining hemodynamic measurements.
An embodiment shown in
The output parameters 110 are coupled to a processor 120, which receives the data and carries out operations using the data as described herein. The processor 120 is also associated with a database 125. The database includes various information about the patients that have been treated in the past. Again, further details on this are described herein. Both the processor 120 and database 125 can be either local, or may be remote from the patient, in which case the link that carries the data 110 may be a network connection e.g. the Internet.
The database includes information about other patients as a function of all or some of the monitored variables. The database and processor determines mathematically the state of this particular patient by finding the mathematical nearest neighbors. These mathematical nearest neighbors can also be analyzed to determine what percentage of these patients live or die, and/or how successful specified treatments on these kinds of patients have been in the past. This can be used, in turn, to make decisions about what kind of therapy might be the best kind of therapy both in the short-term and in the long term.
All measurements are preferably started with the patient's admission to the emergency department (ED). When the paramedics radio the ED that a trauma patient is coming in, the trauma team on call is alerted and is ready in the ED to receive the patient. The patient is then followed to the radiology department, the operating room (OR), the intensive care unit (ICU), and ultimately to the patient's survival or death at hospital discharge. In surgical patients, the noninvasive hemodynamic measurements are started with onset of anesthesia, continued throughout surgery, and followed in the ICU, step-down units, and hospital floors.
Monitoring element 100 may monitor the following:
Biological impedance may be measured using an improved continuous noninvasive impedance system (IQ device) has developed by Wang et al at Drexel University and marketed by Wantagh, Inc., Bristol Pa. They use noninvasive disposable prewired hydrogen electrodes positioned on the skin, three EKG leads placed across the precordium and left shoulder, and a 100 kHz, 4 mA alternating current passed through the patient's thorax by the outer pairs of electrodes. The low voltage is sensed by the inner pairs of electrodes. The voltage sensed by the inner electrodes captures the baseline impedance (Zo), the first derivative of the impedance waveform (dZ/dt), and the EKG. The EKG and the bioimpedance signals are filtered with an all-integer-coefficient method that simplifies computations and decreases signal processing time.
The signal processing technique is based on time-frequency distribution technology that provides high signal-to-noise ratios that increases the speed of signal processing and permits essentially real time operation without deterioration of accuracy. It shows the relationship between the time, frequency, and power of the signal that would otherwise be unobtainable from the standard fast Fourier transform. This is particularly important in identification of opening and closing of the aortic valve ("B" and "C" points), which are often buried in artifacts that make them difficult to identify. Variables available for display and printout include: cardiac output and index, stroke volume, Zo (baseline impedance), MAP (mean arterial pressure), HR (heart rate), systemic vascular resistance, dZ/dt max (maximum increase in impedance rate), pre-ejection period, ventricular ejection time, acceleration index, dz2/dt2, and end-diastolic volume.
Compare Pulse Oximetry with In Vitro Hemoglobin Oxygen Saturation, and to
Compare Transcutaneous Oxygen Tension (PtcO2) and Oxygen Consumption. Oxygen consumption (VO2) values may be compared with simultaneous PtcO2 at the initial baseline period, the nadir, and after resuscitation. The PtcO2 nadir occurred an average of 12.1�7.7 min (p<0.05) before the VO2 nadir, indicating that while both methods reflect tissue perfusion, PtcO2 decreases occur first, and provide an earlier warning of inadequate tissue perfusion.
Standard transcutaneous oxygen tension (PtcO2) measurements (Novametrix Medical Systems, Inc., Wallingford Conn.) will be continuously monitored throughout the observation period. Previous studies have shown well the ability of PtcO2 to reflect tissue oxygen tension. PtcO2 reflects delivery of oxygen to the local area of skin; it also parallels the mixed venous oxygen tension except under late or terminal conditions where peripheral shunting may lead to high mixed venous hemoglobin saturation (SvO2) values (18). It uses the same Clark polarographic oxygen electrode routinely used in standard blood gas analyses (15, 18-20). Oxygen tensions are determined in a representative area of the skin surface heated to 440 C. to increase emissivity of oxygen across the stratum corneum, and to prevent vasoconstriction in the local area being measured (19). Transcutaneous CO2 monitoring (Novametrix Medical Systems, Inc., Wallingford Conn.) of the skin surface will be continuously monitored by the standard Stowe-Severinghaus electrode (14) in the same sensor unit.
Covariate information may also be obtained.
The following 30 covariates may be measured: 1) age, 2) gender, 3) preoperative, intra-operative, and postoperative estimated blood loss, 4) blunt or 5) penetrating truncal trauma, 6) nontruncal (extremity) injury, 7) spinal cord injury, 8) blunt or 9) penetrating cardiac injury, 10) pulmonary contusion, 11) pelvic fracture, 12) long bone fractures, 13) head injury, 14) brain death, 15) early stage (<12 h), 16) middle stage (12 to 24 h), 17) late (>24 h) stage, 18) cardiac insufficiency (reduced cardiac reserve capacity determined by responses to standardized doses of transfusions, and fluid challenges), 19) bacterial contamination, sepsis or systemic immune response system (SIRS), 20) respiratory dysfunction or failure immediately prior to the present acute illness, 21) pre-illness renal insufficiency or failure, 22) pre-illness hepatic failure, 23) nutritional insufficiency or failure, 24) uncontrolled diabetes, 25) pre-illness essential hypertension, 26) cardiac injury, blunt or penetrating, 27) cardiac arrest, 28) pregnancy, 29) Glasgow coma score, and 30) the injury severity score (ISS).
Quantitative Assessment of Continuously Monitored Noninvasive Variables as Net Cumulative Amount of Excess or Deficit may be an important factor. While monitored values can be directly observed, many show considerable variability, which may obscure the underlying pattern. To overcome this problem, we calculate the net cumulative excess or deficit of physiological variables by integrating the areas between the curves of monitored data and selected normal or "optimal" values. This provides a quantitative measure of the overall deficit in cardiac, pulmonary, and tissue perfusion function. This may provide a more useful early evaluation of the patient's physiological responses than simply following empirical scoring systems (Apache, etc.,) which are designed only for prognostic reports. Real-time suggestions concerning the best therapeutic course of action for the patient are simply beyond their scope.
The processor 120 may carry out a program that is described in the flowchart of
Table 1 shows the different variables and how they compared in some survivors and non survivors. The variables obtained include cardiac index, mean arterial pressure, arterial hemoglobin saturation and transcutaneous oxygen.
P value
4.14 � 0.02
3.87 � 0.03
88 � 0.37
80 � 0.69
99 � 0.05
96 � 0.26
206 � 2.9
93 � 2.6
The mean values similarly show this trend:
P value
In an experiment, out of 103 patients who survived their illnesses, 98 were correctly predicted to survive the illness by comparing their values with other similar patients. Of the 48 who did not survive, 30 were correctly predicted not to survive. This compares with previous studies in which much poorer results were obtained. Thus far, using this approach, those with outcome probability is greater than 80 percent have survived, and always outcome probability is less than 35 percent have died. This can be used as a basis for determining a likelihood that the patient will survive based on the treatments and results for other patients.
In general, the specific monitored goals of therapy will be based on the current empirical findings of the survivors present in our current patient database: cardiac index>4.5 L/min/m2; systolic blood pressure>120 mmHg; pulse oximetry>96%; transcutaneous oxygen PtcO2/FiO2 ratio>200; heart rate<100 beats/min. Packed red cell transfusions will be given to maintain Hct>30% or hemoglobin concentrations>10 g/dL. The time to obtaining these goals, the amount and type of fluids will be noted.
At 210, an outcome predictor is used with the variables. The outcome predictor uses the probability of survival as being a measure of the severity of illness before and after treatment of hemodynamic problems that may contribute to the non survival pattern. Correction or failure to correct each mechanism by the specific therapy at each temporal stage during the acute illness is taken as a measure of the reversibility of the injury mechanism. Then, the predicted changes in outcome are compared with actual survival or death at hospital discharge. The specific flowchart of the outcome predictor is shown in
This state of the patient at any time is therefore defined in terms of primary diagnoses, covariates, and hemodynamic measurements. x(t) is referred to as the state vector at time t. This is defined in terms of the hemodynamic measurements, their derivatives, and their integrals.
Assuming that there are L different kinds of measurements taken on a given patient. The set may include for example cardiac index, blood pressure, pulse oximetry, transcutaneous oxygen and CO2 tensions. Each measurement I is denoted as yL. The state vector is defined as a concatenation of the value yL as well as its derivative or or each measurement type, denoted as yl, define the state vector as a concatenation of the value yl itself, its first and second derivatives yl′, yl″, and its first integral ∫yldt, as follows:
i.e., for L different measurement types there will be 4 L states. In practice, the derivatives and integrals are approximated by finite differences and sums of the time-ordered data of the database. Specifically, we will calculate the approximations.
Since not all measurements are taken at all times in the database, smoothing or fitting the measurements by interpolation will be used to place them on a single common time grid, e.g., linear spline, cubic splines, etc. The best method for smoothing, beginning with the simplest linear splines, will be examined.
The control input is one of M different control input that can be applied to the system.
Specifically, the control input, u(tk) at time tk is assumed to be drawn from the finite set,
u(tk)∈{ul, . . . , uM} (2.3)
The simultaneous administration of two or more types of therapy will be treated mathematically as a separate distinct mode of combination therapy. Hence M generally includes all single therapies plus relevant combinations of therapies, such as packed red cells and crystalloid fluids, fresh frozen plasma and transfusions.
It is convenient to think of the propagation of the patient's state xk at time tk, to his state xk+1 at time tk+1 as obeying the following nonlinear dynamical system with process noise wk and parameters p, i.e.:
x k+1 j=ƒ(x k j ,u i ,p,w k) (2.4)
For simplicity, p is discrete, and is assumed to be drawn from a finite set formed by enumerating all useful combinations of covariates,
p∈{p 1 , . . . , p M} (2.5)
Both covariates and process noise help to explain the variability of patient responses seen in the database. The covariates help to distinguish gross differences in responses due to patients with major differences in the nature of their disorders and complications. Process noise helps to explain small differences between patients with the same covariates but different responses to the same therapy. It is a measure of unmodeled dynamics, or intra-individual variability, due to other sources of variability in the system.
The outcome predictor calculates the value PC or probability of survival.
For a given state x, the survival probability is denoted by S(x), which is calculated simply by extracting the N nearest neighbor states to x of patients having the same collection of covariates p (denoted as the set {x}j=1=N (x,p)) and by calculating the fraction of them that survived. For example, if N s of the N nearest neighbor states to x survived, then the PC is given as,
S(x)=N s/N (2.6)
This quantity is equivalent to the estimated survival probability, and is a useful measure of the severity of the patient's current illness.
A stochastic controller is shown in
Step 0. Take measurements at 3 distinct successive times to calculate a nominal state x0 0 according to (2.2), and define a relevant covariate vector p0. Define k=0 to initialize the algorithm at time zero.
Step 1. Given the nominal state xk 0 and a covariate vector p0, extract the N nearest-neighbor states (denoted as {xk}j=1 N=N(xk 0,p0)) that are closest to xk 0 in the database and share the same covariates. Here, a measure of "closeness" is conveniently defined in terms of the quadratic distance,
d(x,x k 0)≡(x k 0 −x)T W(x k 0 x) (3.1)
where the weighting matrix W is taken to be diagonal,
W=diag[w 1 , . . . , w N]. (3.2)
The best choice of weighting matrix W remains to be investigated further.
Step 2. From the set of nearest-neighbors {xk}j=1 N calculate the fraction of them which survived, to define S(xk 0).
Step 3. Sort the N nearest-neighbors states into m groups depending on the type of control input u, which was applied to it (as recorded in the database). This gives the group of sets,
{u k ij ,u i}j=1 m
For example, the subgroup {xk ij,ui}j=1 m
since the state has a specific control associated with it.
Step 4. For each state xk ij in the i'th subgroup, calculate the subsequent state xk+1 ij
By moving to the next line in the database, i.e.
x k+1 ij=ƒ(x k ij ,u i ,p,w k) (3.5)
Calculate the survival probability S(xk+1 ij) associated with this new state (remember this requires extracting nearest neighbors to xk+1 ij). Define the PC associated with the i'th control as
Step 5. Apply u* to the patient, take new measurements (to define new state xk+1), set k←k+1, and go to step 2.
An important feature of the above is the ability to defined the patient's unique "state" at any given time. I the database that is used preferably is a large database with multiple timelines describing clinical and hemodynamic patterns of subsets at different conditions. The states should be described in time that elapses from the onset of illness or from admission.
Weighting criteria to specify the nearest neighbors have been based upon the clinical diagnosis, co-morbid conditions, and hemodynamic patterns of survivors vs. nonsurvivors. For example, for the series as a whole, discriminant analysis revealed significant differences between survivors' and nonsurvivors' net cumulative deficits in PtcO2/FiO2 (p<0.0001), SapO2 (p<0.005), CI (p<0.03), and the initial GCS value (p<0.0001). Further, we will use, as weighting criteria, the p values of differences in the temporal patterns of survivors' and nonsurvivors' values in each subset, for example, for subsets of patients with and without head injuries, blunt vs. penetrating trauma, truncal and nontruncal trauma, age stratifications, prior cardiac, respiratory, hepatic, and renal dysfunction or organ failure, etc. Finally, the hemodynamic responses to standardized test doses of whole blood or packed red cell transfusions given over a specified period of time (usually 1-hour) provide quantitative measures of each patient's cardiac reserve capacity. This is expressed as changes in cardiac index relative to corresponding change in PA occlusion (wedge) pressure or central venous pressure (Starling's myocardial performance curve) before and after a blood transfusion given over a one-hour period. Criteria for satisfactory vs. limited cardiac functional reserve capacity have been developed for each clinical subset and each time period.
In operation, the program has been used to evaluate individual patients states in terms of probability of survival based on initial baseline measurements. So far, all those with outcome probabilities>80 percent have survived and all those with probabilities less than 30 percent have died. At 300, the patients individual data is put into the database to determine theN nearest neighbors of the user. The survival probability is determined at 305, using the operator S. the patients are also sorted by control intervention at 310. The state response is propagated at 315, and at 320, the survival probability is calculated conditioned on intervention. Stochastic probability control is determined at 325.
The stochastic analysis and control program can be used for data mining to detect significant hemodynamic events and their relationship to therapy given. It will begin by tracing individual patient histories in the database through time, where at each instant, the "state" of the patient (see definition earlier) is computed, as well as the patient's associated probability of survival (based on nearest neighbors) before and after specific therapy. A large change, either up or down, in survival probability indicates a potentially significant role of the associated therapy. This flags the corresponding patient and time for a closer look at what is actually going on. The entire database will be processed this way, and statistics about the various significant events will be compiled. Therapeutic interventions with the most efficacy or harm can be flagged for more detailed analysis of the contribution of each therapeutic modality and each hemodynamic variable to each patient's survival or death.
Although only a few embodiment have been disclosed in detail above, other modifications are possible.
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Owner name: NATIONAL INSTITUTES OF HEALTH (NIH), U.S. DEPT. OF
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text:
A Double Victory Becomes a Home Run
On Thursday, the National World War Two Museum dedicated a P-51 Mustang. It's been restored to resemble the Tuskegee Airman fighters that escorted bombers into enemy territory.
Here is the video of the entire dedication. It's full of plenty of moments that will bring a tear to your eye-and plenty that will make your chest swell and feel proud.
Nothing makes your heart pound like hearing a P-51 Merlin engine crank up.
I'd like to add a little backstory about how this whole thing came about. I have been on the Board of Trustees for the Museum for 6 years now. My term ends in June and it's been entirely rewarding. I have been extremely lucky to have been a part of it.
The museum is a very special place. Do not miss going in person. It's not just the story of the war, it's really the story of America. I am consistently amazed what happens when families who had someone serve in WW2 visit the museum. They walk away changed.
At a board meeting, we were debating how high to build the roof on the US Freedom Pavilion. If we spent some extra money, we could build it taller-and accommodate bombers. While we were talking about it, my friend Todd Ricketts asked, "How come there isn't a P-51 in the plans? We could not have won the war without the P-51."
The museum's president, Nick Mueller instantly responded, "P-51's are very expensive. We would like to get one, and if we ever do, we are going to tell the story of the Tuskegee Airman because that story is so important for WW2, and for our country."
As the discussion proceeded, Todd whipped out his phone and showed me a photo of a P-51 that was for sale. He said, "We could buy one of these and tell that story." I said, "You could buy one."
Todd and his family did. It's a really amazing selfless act. It was important to them that this story be told.
But, getting a P-51 isn't like going to the drug store and buying a toy! It's not about simply writing a check. It took a lot of time and energy. Parts had to be found. Parts had to be refurbished. People had to research it so it was historically correct. There was a fair amount of frustration and ebbs and flows with the restoration. Todd made sure it was done.
Generations from now, people will be able to see, hear, and learn about the Airman and their double victory thanks to Todd and his family. You could do it too.

subset: commoncrawl


text:
hot stuff
Synonyms and Antonyms of hot stuff
something very good of its kind wow, that dress is hot stuff—I've never seen anything like it! Synonyms of hot stuff beaut, beauty, bee's knees, cat's meow, corker, crackerjack (also crackajack), daisy, dandy, dilly, doozy (or doozie also doozer), dream, honey, jim-dandy, humdinger, hummer, knockout, lollapalooza, lulu [slang], nifty, peach, pip, pippin, ripper, ripsnorter, snorter, sockdolager (or sockdologer), standout, sweetheartWords Related to hot stuff marvel, phenomenon, prodigy, sensation, wonder; catch, crown jewel, diamond, gem, imperial, jewel, pearl, plum, treasureNear Antonyms of hot stuff bust, disappointment, dud, failure, flop, lemon, letdown, loser, stinker, turkey
Learn More about hot stuff
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U.S. District Judge Jesse M. Furman denied the bulk of KPMG's motion to dismiss most of the claims, including all class claims, in a lawsuit accusing the firm of discriminating against female employees, elbowing women out of the partnership track and...
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text: Jay Baruchel Confirms that Nic Cage is Exactly as Weird as You think He is 6.76K Chris Wyman 07/16/10 10:39AM Filed to: Attack Of The Show Attack Of The Show Nicolas Cage Jay baruchel TV kevin pereira tweet Video Sorcerer's Apprentice star Jay Baruchel fits right in on G4TV and Attack of the Show. Kevin Pereira, mindful of Nic Cage's recent psychedelic appearance on Letterman, asks the questions that are on everyone's mind.[There was a video here]


text:
Fluke 1587/1577 Insulation Multimeters
The Fluke 1587 and 1577 Insulation Multimeters combine a digital insulation tester with a full-featured, true RMS digital multimeter in a single, compact, handheld unit, which provides maximum versatility for both troubleshooting and preventative maintenance.
- Large display with backlight
- Insulation test (1587: 0.01 M? to 2 G?) (1577: 0.1 M? to 600 M?)
- Insulation test voltages (1587: 50 V, 100 V, 250 V, 500 V, 1000 V),(1577: 500 V, 1000 V) for many applications
- Live circuit detection prevents insulation test if voltage > 30 V is detected for added user protection
- Auto-discharge of capacitive voltage for added user protection
- AC/DC voltage, DC milliVolts, AC/DC milliamps, Resistance (?), Continuity
- Filter for motor drive measurements (1587 only)
- Capacitance, diode test, temperature, Min/Max, frequency (Hz) (1587 only)
- Auto power off to save battery power
- CAT III 1000 V, CAT IV 600 V measurement category
- Included accessories: Remote probe, test leads and probes, alligator clips, (K-type thermocouple, 1587 only)
- Accepts optional Fluke TPAK™ magnetic hanging system to free your hands for other work
- Rugged, utility hard case allows you to bring everything you need for the job
- Three-year warranty
See detailed specifications on the Fluke 1587/1577 Insulation Multimeters »
Download the Fluke 1587/1577 Insulation Multimeters datasheet »


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In this guide check out how to Download Dhoom 3 Android game for PC for free & play it on Windows 10, 7/8/8.1/Mac OS.
If super bike flicks and games are to your taste then this new game for Android will take you to new heights of entertainment. Based on the eponymous Bollywood super-hit 'Dhoom 3' the game is the official launch by makers of its Bollywood variant. You can go on downloading it free from Play Store. If you want to play Dhoom-3 game on a computer instead of a smartphone device this is also possible by using the BlueStacks player for PC. Since its not likely that the game becomes officially available for PC users anytime soon using this method is possibly the only viable option as of now.
Dhoom-3: The Game Features
Echoing the theme of the movie the game brings an exciting trail of adventures that take you through bike racing and break-ins of safe-houses and banks. In the game you're the super-stunt player with high-powered bike and the mission to reach the safe-house by bypassing all hurdles on the way.
- Tons of fast-paced action events
- Play with high-tech bikes revved with Nitro-boost technology and other smart features to beat the cops and avoid being arrested
- Superb graphics and well constructed themes
- Constant updates to the game ensure performance efficiency
- Excellent layout with numerous hurdles and stunts
- See how you score best on a leaderboard that gets constantly updated
Dhoom-3: Steps to Download & Play on PC
- Download the BlueStacks app-player on your PC. Install the BlueStacks player.
- Open BlueStacks, use its 'Search' tool to locate 'Dhoom3 The Game' app
- Click on the app and follow instructions for download. Install the app once its downloaded.
For the Dhoom movie series fans this game comes as a welcome package that extends the road-racing thrills of the movie to its gaming platform.


text: Video News: United Kingdom AP Goes Inside the RNC's Office at the DNC The RNC's press secretary Kirsten Kukowski gave the AP an up close and personal tour of the RNC office at the DNC convention in Charlotte. Kukowski says the GOP wants to make sure the RNC's message stays in the voters' minds. (Sept. 4)Copyright 2012 The Associated Press © DailyMotion - Tuesday, September 4, 2012


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Vacation to Angels Camp, June 10-13, 2012, Part 1
Posted Under: Education,Entertainment,Travel
By Judy J. Pinegar
We were staying in a WorldMark Vacations Complex just west to town. On Monday morning the group (John, myself, my sister and brother-in-law, and my daughter and granddaughter) decided to visit California Caverns.
In 1849 or 1850, Captain Joseph Taylor was target practicing on a rocky outcropping and noticed that his targets were being moved by a breeze which seemed to emanate from the rocks. When he investigated this curious phenomenon, he discovered the entrance to a cave which he named Mammoth Cave.
In 1850, he opened the cave for public tours, making it the first show cave in the state of California. In 1980 the cavern was renamed California Caverns and it is now a State Historic Landmark. There are three tours at the cavern: 1) 70 minute Trail of Lights Walk Tour, 2) 2-3 hr Mammoth Cave Expedition and, 3) the challenging Middle Earth Tour taking 4 hours (crawling through very small spaces). Needless to say, with two senior citizens and a 4 year old we took the walk tour!
Early visitors included Bret Harte, Mark Twain and John Muir who wrote about this visit in "Chapter 15 – In the Sierra Foot-Hills" of his 1894 book "The Mountains of California" when it was called Cave City Cave. For 150 years, visitors have enjoyed the unique delicate beauty of the cavern's crystalline formations. Some speleothems, such as the beaded helictites found in the Middle Earth area are very rare. Others are so numerous as to be spectacular, such as the "Jungle Room's" array of stalactites.
That tour goes through passageways into large, highly decorated chambers including newly discovered pristine areas like the Jungle Room. Here you see large displays of milky white stalactites, helictites and flowstones decorate the walls and ceiling.
You may visit the website at California Caverns
Judy J. Pinegar is a writer and her articles have appeared in numerous publications.
For all your real estate needs
Email or call today:
John J. O'Dell Realtor® GRI
Civil Engineer
General Contractor
(530) 263-1091
Email email@example.com


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Reasons To Get A Cane For A Loved One
Author: Family Photographer | Category: Bariatric canes, Carbon fiber cane, Umbrella cane
If your loved one is having mobility issues due to age or disability, they might be in need of a cane to help them when they are walking or carrying out daily activities. However, there is another option that might be suitable for them which is an umbrella cane. This is a special umbrella that doubles as a cane and is perfect for the loved one in your family who likes to be independent but might need a little help with their mobility.
Whereas wooden canes or varieties with brass cane handles can hel (more…)
19 Jun 2017


text: why should i feel lonely? is not our planet in the milky way? : genesis vallejo by andreas ohlund & maria therese for styleby #30 winter 2014 model: genesis vallejo (trump)photographers: andreas ohlund & maria therese (lundlund)stylist: columbine smille (lundlund)hair: eric jamieson (bridge)make-up: linda gradin (linkdetails) 11:45 PM Nyai Kembang editorial, genesis vallejo mota, styleby magazine


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When Nothing Is All You Have to Give
EMAIL: firstname.lastname@example.com
BIBLE TEXT: Mark 12:41-44: "Jesus sat down near the collection box in the Temple and watched as the crowds dropped in their money. Many rich people put in large amounts. Then a poor widow came and dropped in two small coins. Jesus called his disciples to him and said, 'I tell you the truth, this poor widow has given more than all the others who are making contributions. For they gave a tiny part of their surplus, but she, poor as she is, has given everything she had to live on.'"
PERSONAL REFLECTION: Almost daily we are met with the rhythmic lulling of the enemy's song. "You are not smart enough, talented enough, or knowledgeable enough. You will surely fail so why even try? No one will listen. Your dreams are too big. Someone else could do a better job. They are better qualified. You have nothing to offer." Before we know it, the enemy is conducting an orchestra of fear and doubt and we take a front row seat for the show. We buy into the lie that we have nothing to give so we give just that…nothing. We keep holding out for the moment in which we will be ::fill in the blank:: enough. Our prideful desire to be enough by the world's standards, and in the eyes of others, renders us ineffective for Kingdom work. In this scripture we see that nothing is exactly what God wants us to give. Nothing is willing. It is humble. It is broken and poured out. It is emptied…easily filled. When our nothing is placed in the hands of God, solely dependent on His power, it becomes the most amazing something we could imagine. It is in our weakness that He is proven strong, in our brokenness that He can move, in our humility that He is glorified. When all we have to give is nothing, it is enough.
Recently my husband and sixteen year old son were in Bolivia with several other fellow Lifers. While there my husband spent the majority of his time with three young ladies that ranged in age from 11-15. In an effort to break the language barrier and connect with them, he would do things such as ask them their names, how old they were, and when their birthday was. They in turn asked him the same things. He told them that his birthday was May 26th. He did not point out the fact that this date was just a few days away. He simply stated the date not thinking much of it at all. A couple of days later, they met him outside with gifts in hand. What they would give would not come from a store. It would not be wrapped in a neat, shiny package wrapped with a bow. It would be unlike any gift he had ever received. Louisa gave a necklace that she can be seen wearing days before in pictures. A simple leather string with a piece of metal on the end stamped "Louisa." Alison gave the very watch off of her arm. Again, she can be seen wearing it in previous photos. Cynthia gave an old paperback Spanish Sci-Fi book. She inscribed "Happy Birthday Adam" in the binding. And there was a scarf infused with the scents of all three girls. These three girls, fatherless with mothers currently in prison, had nothing to give…but they gave anyway. By the world's standards, these gifts were nothing much. But by God's standards they were powerful. They came from humble hearts willing to be used. From minds focused on the receiver, not their own selfish pride. In their humility, God would show Himself powerful and our lives would never be the same.
I am immediately reminded of the widow and her offering. Typically, we tend to read this parable and see the lesson in the monetary sacrifice she made. More importantly this is a story about her heart, her reverence for God, and her faithfulness to serve Him. All she had could have easily fit within the palm of her frail hand. Compared to the wealthy elbows she rubbed in the temple, it was nothing. So many around her could have given more and she knew it. She could have waited till no one could see what she was giving and given in secret…ashamed of her offering. She could have waited perhaps till she had "enough" to give and given nothing at all in that moment. She could have even said to herself, "Let the others here give, their pockets are deeper." and simply walked away leaving behind those seemingly "better suited." She stood there with nothing, and yet she gave everything. Her nothing was "everything" according to Jesus. The Lord asks us to give all we have. Sometimes, nothing is all we have. And that is OK. Surrendered, our nothing becomes more than enough.
PRAYER: Lord, give us hearts like Alison, Louisa, and Cynthia…a heart like the widow. May we reach deep into our pockets, our schedules, our gifts and talents, our hearts, and surrender those things which mean the most to us. May we trust you with the sacrifice. When opportunities are put before us to serve you financially, through ministry, through our families, through our gift and talents, through simply volunteering where there is a need…may we say yes Lord! Ready to give all we have to serving you with no regard to the cost or our credentials. Remind us that You are who You say You are. Strong. Trustworthy. Mighty to Save. Worthy of our complete abandonment to Your call on our lives. That you alone fill the gap between our humanity and the supernatural. Remind us that with you our nothing is always something.
Talysa is a thirtysomething Jesus loving, husband adoring, worship leading, photography attempting, coffee guzzling, kid doting and toting, homeschool thriving, wife and mom. She has an obsession with italics, could eat her weight in Nutella, and still gets butterflies when her husband holds her hand. She and her family have been at Life Assembly since May 2011. You can find her sharing with transparency about her weaknesses and His strengths on a regular basis at: www.mcmanuspartyoffive.blogspot.com


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Graduate Admission Of Daffodil International University
March 04, 2015 | Category: Admission Circular | Posted By - Alikarim | 2 Comments
Candidates Eligibility or Criteria
- Completion of the bachelor's degree from a recognized university or an accredited institution of higher education in science, engineering or a related field.
- The applicant must have the CGPA of 2.5 or above (in the scale of 4.0), or at least second class in the bachelor's degree.
- The applicant must have completed the enlisted prerequisite courses or their equivalent.
- Applicant, not completing the enlisted prerequisite courses, will be admitted on condition that she/he completes these courses in one or two semesters.
- Evaluation of applicants for admission is based primarily on the student's academic record in relevant undergraduate coursework. Provisional admission can be given to an applicant awaiting the result of her/his bachelor's degree.
Master of Business Administration (MBA)
Students having graduation degree from any discipline are allowed to apply for admission to MBA program. For admission to MBA program a student must satisfy the following requirements:
- Students seeking admission to MBA program must have minimum CGPA 2.5 both in SSC and HSC (or any equivalent background from any group), and CGPA 2.5 or 2nd Division at bachelor level, or
- Students from English Medium background must have 5 subjects in 'O' levels and minimum 2 subjects in 'A' levels. Out of seven subjects minimum four B grades and three C grades are needed. Below C grade is not acceptable. At bachelor level, candidates must have CGPA 2.5 or 2nd division.
Executive Master of Business Administration (EMBA)
Students seeking admission to Executive MBA program must satisfy the conditions as mentioned in general admission requirements for MBA. In addition, they must have 3-4 years managerial/ professional job experience and outstanding academic records throughout their career. An executive generally has to complete at least 39 credits to earn MBA degree. The total credit hours applicable to the students studying in this program will be determined by the Director of MBA program or Head of the Department or the Dean of the Faculty.
Application Procedure
Student will be selected on the basis of past academic records and performance in admission test. Applicants finally accepted for the program will be notified of acceptance and registration within specific date. They will have to produce original certificate/testimonials and mark sheets/transcripts for all passed at the time of admission. Candidates who have completed the above formalities will have to pay the requisite admission and other fees for enrollment.
Admission going on (Summer -2015, 41th Batch)
- Last Date for Application : 04 May, 2015
- Admission Test: 06 May, 2015
Visit below link for further information of Daffodil International University:
- Admission for Undergraduate Level
- Offer Programs for Undergraduate & Graduate Level
- Tuition Fees Structure for Bachelor Degree
- Tuition Fees Structure for Master Degree
- Scholarship System of Daffodil International University
How People found this article:Admission Of Daffodil International University Graduate Admission Of Daffodil Internationa University Mba Admission On Daffodil International University Diu Admission Master Degree Programs Admission On Diu Admission On Diu
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Muhammad sani isah - posted 11 Jun, 2016
Greet DIU
hassan abukar ali - posted 26 Sep, 2015
I'm somalia citien man aged 26yrs looking for master digree of food science and nutrition thanks


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So I have mostly been making firmware and solutions for robotics systems and always have made everything myself. this has been my reality for the past 15 years. now that I am a bit more free in my programming pursuits I find that I have a hard time dealing with other peoples code. not beacuse it is bad but I am so etuck in my own ways of doing it.
At the moment I am struggling a bit with phoenix as I sometimes feel I have little control over it. This is almost guaranteed due to my lack of knowledge with it.
TL:DR Its hard for me to use frameworks , how do you deal with "Not Invented Here Syndrome"
As long as the framework or library / depencency is reasonably well documented, I don't personally have a problem with it most of the time.. but on the other hand, I usually want to minimize the number of dependencies in use for other reasons.
A rule of thumb for me would be that if I use only a small part of a dependency, or if it's a trivial one, it's probably better off implemented locally so that I've got full control over the API, implementation details, etc.
However, if it's going to be several weeks or months of work just to do something that someone else has already done, or if it's a problem in an area I know little about and that takes some serious effort to understand (not to mention understand well), I'll go for the dependency, trying to learn what I can and use it efficiently.
I can certainly see where you're coming from though.. it's always hard to let go of control!
Phoenix is barely a framework—just a bunch of Plugs pre-written for you bundled with some third party libraries like Ecto.
If you want to learn how things work deeply then go all NIH-mode and write a web app with just Plug. I don't recommend it for production use but it could be great for learning/side project. Then you'll feel more control over things as you know how they work!
Or go even further into NIH-mode and write a web app without phoenix plug or cowboy, like I am doing.
I deal with it by trying to do as much Not invented here as possible on personal projects and then you find out how hard things are without the libraries. If it wasn't that hard to achieve something without the library then NIH syndrom is not a problem. It's all balance.
On the topic of phoenix/plug I've heard a few people say phoenix is barely a framework. Maybe but both make thorough use of macros and have a not insignificant amount of indirection
Old Uncle Ben once said, "With great power comes great responsibility."
I like to think that every line of code you write is a debt. It's cool if it's for personal projects or any project that you will maintain yourself forever (or until you dump it). But for long-running projects, projects where you collaborate with people, the core technology of someone's (or your) business, most of the time it will be too much debt to handle. You owe the users of your code (be it your peers or your future replacement) many things: documentations, tests, code clarity, maintainability, etc.
Using libraries, other people have taken parts of the debts upon their shoulders, so you don't have to.
This is one of the scariest things I've ever heard anyone say about code. I write code out of , not obligation.
If you have to maintain the code in production, it's the only sane way to think about it. Or as I like to phrase it
"The only good code is deleted code."
I totally get wanting to have good code in production with all of the good qualities, such as maintainable structure, self-documenting code with sprinkles of comments for kluges and hacks for time crunches. I've seen and had to maintain ugly code in production as well. But this does not make all code intrinsically bad, otherwise what does "elegant code" actually mean?
To me, your quote "The only good code is deleted code." sounds clever but would be treated as hyperbole to teach a lesson about being lean and concise. Thinking of "each line of code as debt" I think may be a misapprehension of the concept of "technical debt", which is not talking about all code, but rather the additional work later on because a lack of investment earlier in code that makes it more maintainable.
Ahaha, indeed, as I Iooked back it was really negative. I also love to program (and Elixir keeps reminding me of that fact! ), but if the result of it involves others... the responsibility is quite huge.
A few things...
Elegant code is a myth. I'm not saying that there isn't code that is fun to write or interesting to read, but the fundamental fact of production is that the world changes and your code doesn't. Eventually the world will change enough to turn the most elegant code into a useless pile of symbols.
The only useful quality of code is how easy it is to delete and replace, because if you're not doing that, then your code isn't being run.
I think perhaps this is a bit of shadow boxing, or a mismatch in terms, because as I see it - "being easy to delete and replace" is what makes it elegant. Hard to delete code is the code that exists all over the place, is not DRY, is not documented, is badly designed, etc. Perhaps you dislike the term "elegant"
Most people do not think (often) about this, and I think the same thing is true about 'elegant code': Nearly all the nice code we write is code we marvel at ourselves, but neither our colleagues or our customers will ever know.
It is much easier to see the oversights than it is to see the good parts. Maybe that just is the way we are trained to think in today's society.
It also very commonly happens that code that I find elegant ends up being too hard for my coworkers to understand ...
@OvermindDL1: The 'habits' you describe are not very 'odd', in my opinion: The fact that you are doing things that nobody did before probably means you are doing nice, new, innovative things. Also, the sheer fact that the infinity of creatable computer programs is a really really incredibly large infinity means that it very easily happens that you are looking for something that is different.
@bobbypriambodo Yeah, debt is a very negative term. I do agree though that you are responsible for the code you write.
Back to the topic at hand:
A great saying from the game development world (I'm paraphrasing here, and unfortunately I do not remember who originally said it) is:
You can either make a game, or a game engine, but not both.
And I think this is very true. If you don't want to get bogged down in a project that is too large to maintain, it is important to focus on something. You can either build something that is a nice general (partial) solution for a large set of problems, or perfectly solve a single problem, but not both at the same time.
That being said, it is hard to work with other people's code. What helps in Elixir is that the language already nudges people in a direction of creating readable and maintainable code, which overlaps with what I like to see in code.
This is a two edged sword to look at what happens if taken to the extreme one only needs to look at js/npm ecosystem.
/me twitches...
Chad Fowler's 'Kill "Microservices" Before Its Too Late' talk (Impermanence is the key to a surviving system) caused me to run into content like this:
Edsger W. Dijkstra (1988): On the cruelty of really teaching computing science
My point today is that, if we wish to count lines of code, we should not regard them as "lines produced" but as "lines spent": the current conventional wisdom is so foolish as to book that count on the wrong side of the ledger.
Alan Cooper of Cooper Interaction Design sees planning as key to downstream dividends (2001-06-14)
One of my assertions is that code is not an asset. A lot of companies say their job is to maximize the revenue from our code base. That reflects a kind of an Old World, industrial-age thinking.
Tim Ottinger: Code is a Liability (2007-04-17)Eric Lee: Source Code Is A Liability, Not An Asset (2009-03-11)Jeff Atwood: The Best Code is No Code At All (2007-05-30)
Thomas Figg: Write code that is easy to delete, not easy to extend. (2016-02-13)
Off topic tangent:
OK, I get the issues surrounding callback hell - BUT is it just me or does a significant portion of the JavaScript community have an unhealthy attachment to nested, multi-line, inline anonymous function expressions which continues even when they are using promises? There are other ways to organize this kind of code. And the style completely ignores the decades old sentiment‡ behind the arrow anti pattern and that code should be no larger than James Lewis's head.
‡ Edward Yourdon, Noam Chomsky, and Gerald M. Weinberg (1986): Managing the Structured Techniques: Strategies for Software Development in the 1990's
It was more about dependency hell async/await and promises kindah solve the call back hell issue.create-react-app fresh app 700+ dependencies with 20,000+ files
I knew what you meant.
I was just fielding yet another example that could lead to the perception that some parts of the JavaScript community insist on independently re-discovering mistakes that have already been clearly identified by earlier software practitioners as poor practices - which can only be interpreted as flagrantly ignoring already existing software development wisdom.
... anyway while the are some Phoenix related JavaScript libraries, this doesn't directly relate to Phoenix.
this relates to the topic of NIH as an illustration of the polar opposite
Most of CRA dependencies are Babel... which is not "NIH" as it's a to-ES5 transpiler that doesn't have many alternatives. You could argue about Webpack, but I find it to be very different than Gulp, Grunt, and other Make-replacements as Webpack is essentially a replacement for the browser asset pipeline that lets you have a lot more control over it. The problem is the JS community's love for small modules, the lack of a standard library, and the way npm works/installs stuff.
If we had to install each OTP Behavior and STL module as a Hex package (and if Hex was poorly designed) we'd have similar issues.


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Counterfeit drugs, which may contain no active ingredient, a wrong active ingredient or be contaminated, are a growing health threat in the United States and worldwide, says the U.S. Food and Drug Administration (FDA).
Up to 10 percent of drugs worldwide are thought to be counterfeit, according to the FDA, while in some developing countries counterfeits may make up over 50 percent of the drug supply.
Increasingly, counterfeit drugs are being sold online, and the FDA recently issued a warning to consumers about 24 related Web sites that are reportedly selling counterfeit drugs. However, the Internet is not the only method used to sell counterfeits; fake drugs have also been obtained from reputable U.S. pharmacies.
Click here to read the rest of this article
About Dr. Soram Khalsa
As an MD, Dr Soram specializes in Integrative Medicine combining diet, nutrition, acupuncture, herbs and nutrition. Visit Dr Soram's Healthy Living Store where you'll find high-quality nutritional supplements:


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Katie Couric says she's marrying her fiance John Molner in summer 2014
Counting down the days! Katie Couric just spilled the beans on when she will be tying the knot with fiance John Molner. The veteran journalist announced the news herself while attending Howard Stern's 60th birthday party in NYC on Friday.
PHOTOS: Katie's hair evolution
"Summer!" Couric, 57, told Stern inside the Hammerstein Ballroom. When the SiriusXm disc jockey asked if he would be invited, she replied: "No, but to the party. [The wedding is] going to be family only."
PHOTOS: Celebrity weddings 2013
Couric's rep confirmed to Us Weekly last September that she and the NYC-based financier, 50, were headed to the altar. The pair has been dating for nearly two years, and went public with their relationship in spring 2012.
PHOTOS: 10 best celebrity engagement rings
"Yes it's true!" Couric confirmed via Twitter at the time. "So touched by all the kind Tweets & warm wishes-thank you! A great end to the summer & looking fwd to seeing you all Monday!!"
This will be the second marriage for the Yahoo global anchor. Couric's first husband, Jay Monahan, died of colon cancer in 1998. She is mom to their daughters Ellie, 22, and Carrie, 17.
'Bachelor' Wedding Recap: Sean Lowe, Catherine Giudici get married on live TV
Bobbi Kristina Brown and Nick Gordon 'Happily Married:' See Their Wedding Rings!
Kaley Cuoco Flashes Huge Wedding Ring With Husband Ryan Sweeting at Lakers Game


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This is a Sponsored post written by me on behalf of Allstate for SocialSpark. All opinions are 100% mine.
People live for good. Well, we all do. I mean, living for something bad is definitely not the right way to live one's life and make it meaningful.
The fortunate truth is, more good happens in life than bad. Destiny is in our hands. If we decide to livef or good, then definitely more good will happen no matter what.
Doubt and fear are the enemies and they can hinder us from what we really want to do. However, in any case, we should push off of them when possible.
No matter how bad things can become, there will always be a way to compensate and make them right and good.
I remember the time I transferred to a new home with my family. It was hard to acclimate to my surroundings considering we were the newbies there. No friends, no company.
But we had to for personal reasons and I am glad we really did. I knew that it would not be that long before we can start a new circle of friends in the neighborhood. These things can be risks and if I did not take that risk, It could have been bad.
While a normal insurance company waits for something bad to happen to do something good, not all of them has a vision like that.
Allstate Good Life makes a promise to use their good hands to do more good in the everyday lives of the people they help protect.
Their website itself features plenty of helpful tools, tips and perks plus a local agent whom people can count on for things no matter how big and small. All these to help make it easier to live a good life every day for everybody.
We all had encountered hardships in our lives. Share your thoughts by leaving a comment and tell us your stories and how you overcame them.
Check out the video above to know more about them.


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Soho, United Kingdom (PressExposure) May 16, 2013 -- London based recruitment to recruitment company GSR2R are using their new Facebook page to keep clients and recruiters up to date on the latest industry news, as well as to highlight the importance of a good balance between work and fun.Facebook offers businesses a great way to connect with the people that matter to them, and in the recruitment to recruitment industry it is vital to be able to engage with potential candidates through social media. However, Facebook, unlike LinkedIn, is not designed purely for people to use to connect to others who are related to their working life, people use it to have fun, keep themselves entertained and to catch up on news, gossip and views.
When building their Facebook presence, Cheryl Wing the innovative MD of London based rec2rec agency GSR2R was keen to show their fun and unconventional side, in addition to giving value to the recruiters in their community. This is why their posts include not only great advice and tips for recruiters and interesting links relating to industry and company news, but also some lighter and more playful updates. Every Friday, for example, they post a funny viral video just to help their contacts get into the mood for the weekend. They also introduce their team members and give a great feel for their company's philosophy and working environment.
This combination of posts about the industry, posts relating to job openings, and posts that are funny or motivational makes GSR2R Facebook account for anyone in the business to watch, even if they aren't currently concerned with finding a new role in recruitment just yet.
GSR2R are a company known for doing things a little differently and focusing heavily on the importance of enjoying work and having a good balance between professionalism and fun. They have offered a number of innovative ways to engage with people in the recruitment world. This includes free outdoor fitness classes, special complementary recruitment skills training sessions, quiz's and competitions. The entire team at gsr2r is keen for their modern and friendly approach to recruiting for the recruitment industry to show through in their social media accounts.
The Facebook page has a goal to encourage interaction, allowing contacts to comment on the posts, ask questions, respond to challenges and of course, like and share content with their friends. This offers a great way for people connected with GSR2R to find and connect with each other, making it a good page to check from a networking perspective. Networking like this in a friendly and casual way can be a great first step in building rewarding professional relationships and finding out what other people in the recruitment industry are doing.
To find out more about how rec 2 rec agencies work and how they might help you in the future visit their interactive new website.


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GraphicRiver Bi-Fold Brochure 47 6307082
Category: Print Template | Comment: ( 0 )
GraphicRiver Bi-Fold Brochure 47 6307082
Print Template \ Brochures \ Informational
Fold \ Plumber \ Pipes \ Magazine \ Print \ Pamphlet \ Service \ Wires \ Tools
Print Template - Bi-Fold Brochure 47 6307082 by Demorfoza @ GraphicRiver
Print Template \ Brochures \ Informational
Graphics Files Included: InDesign INDD ; Layered: Yes ; Minimum Adobe CS Version: CS4 ; Print Dimensions: 8.5x11 .
About this item
Home Repair Services brochure template. There are 5 easy things you can do with this brochure.
- pick your own colors, any colors,
- upload your own photos,
- change fonts,
- easily edit vector elements,
- prepare this brochure as you wish.
+ A4 + US Letter,
+ 300 dpi,
+ Unlimited color options,
+ 5mm / .250in bleeds,
+ Well organised layers,
+ Fully editable InDesign .INDD and .IDML files,
+ Photos and fonts are NOT included (links below and in Read Me file).
Fonts used.
Fira Sans – http://www.fontsquirrel.com/fonts/fira-sans
Image credits.
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Catalina (Foster) ADOPTED
This sweet girl is named Catalina. Catalina came to our facility from a shelter in Puerto Rico. Her first reaction once she touched down in Pennsylvania is that it is cold! She is timid and unsure about her environments, but with the right guidance, constant reassurance, and patience, she will open up and show you how loving she truly is. She is good with other dogs and is currently staying at Perfect Pooch, located in King of Prussia. She is up-to-date on her vaccines, spayed, and microchipped. If interested in meeting Catalina or interested in adopting, please contact Perfect Pooch at 610-337-7698 or contact our foster coordinator Mark at firstname.lastname@example.com.


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May 19, 2010, 12:37 PM EDTLaw360, New York (May 19, 2010, 12:37 PM EDT) -- As those who follow developments in electric transmission issues are aware, a 2007 Internal Revenue Service private letter ruling opened up the possibility of real estate investment trust ("REIT") ownership of electric transmission systems. Given the significant interest in transmission investment throughout the country, facilitating access to a significant pool of public equity capital through an investment vehicle that offers significant tax benefits could be a welcome development. However, until now, we are not aware of any taxpayer relying on the 2007 IRS ruling to form...
Sharyland — An REIT Pioneer?
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Thread: Amazing Day Fishing (Pic Heavy)
Amazing Day Fishing (Pic Heavy)
Had an amazing day fishing this past Saturday. For the third year in a row my brothers, dad, and I did a fly fishing weekend. My younger brother and I fish, the others have fished now three times, once each fishing weekend. The first year we tried a DIY trip based out of Fairplay CO, but it was tough for the non-fishers. Last year we stayed in Frisco and had a nice guided day on the Ark south of Leadville. This time we stayed in Nederland and had an incredible day guided on private water. Here are some highlights.
Friday we took my dad and a brother-in-law up to an alpine lake above 11,000 ft (they had just flown in from Chicago so the hike was interesting). We fished a bit before the sleet started so we headed down. Got some beautiful greenback cutthroats on beetles. Their color was incredible, I wish this picture showed it better.
Saturday we got into some amazing fish. My brother-in-law started the day with a huge rainbow.
My dad, brother, and brother-in-law got some nice fish as well.
And I enjoyed catching some on my newly finished 4wt bamboo
We landed over 50 fish in the day of fishing, I don't think any were under 10 inches and several over 5 lbs. 95% were taken on a range of nymphs though I happily fished dries for a bit of the afternoon and landed my first Snake River Cut. Also caught my first Colorado Cut, which was unexpected, and I caught my first trout over 5lbs. Most of the fish were rainbows though we did caught a couple browns in addition to the cutthroat. Had countless strikes and many, many 'long-distance releases'. Not sure if I'll top this day for awhile, though we'll happily try again next year.
Finally, here's my favorite picture from the trip and the view from the deck of the our rental house.
Thanks for looking!
Post Thanks / Like - 0 Thanks, 3 LikesArd, stimulator2, madjoni liked this post
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Re: Amazing Day Fishing (Pic Heavy)
Those fish are big! Remember William, I live all the way up here and seldom have catches like those.
Anywhere can be the land of great expectations, broken dreams, or paradise found, it's all up to you.
Life On The Line - Alaska Fishing with Ard
Ard's Forum blog, Alaska Outdoors
Post Thanks / Like - 0 Thanks, 1 Likeswilliamhj liked this post
09-05-2012, 08:54 PM #3Senior Member
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Re: Amazing Day Fishing (Pic Heavy)
Congratulations on the successful trip. There are few days in ones life where everything comes together so well and you have the memories and photos to carry you til the next one.
Great Post
DaveI was going fly fishing until my wife suggested it, now I can't tell who is outsmarting who!
Being "one with nature" requires a knowledge of what animals are living nearby and a weapon of sufficient magnitude to give you at minimum an equal chance of survival. No one has an invisible aura that animals can detect and sense your good intentions.
09-06-2012, 06:34 AM #4Member
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Re: Amazing Day Fishing (Pic Heavy)
Niiiiiice! What a trip, great pics too. Can't say I'm not a little jealous! cheers
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Re: Amazing Day Fishing (Pic Heavy)
Nice place,big fish...smiles on every face
Re: Amazing Day Fishing (Pic Heavy)
I'm jealous. Hopefully I can ditch some responsibilites this weekend and do some fishing. It is great spending time with family and friends with a fly rod in your hands.
09-06-2012, 01:10 PM #7Senior Member
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Re: Amazing Day Fishing (Pic Heavy)
Nice trip report and looks like some great fishing and spent with family.SHANNON
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Re: Amazing Day Fishing (Pic Heavy)
William: Great trip report and photos, congrats on the huge rainbows! I can imagine that hike up to the alpine lake was pretty hard on your dad and brother-in-law having just arrived from Chicago!Larry
Re: Amazing Day Fishing (Pic Heavy)
09-10-2012, 07:41 PM #10Member
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Re: Amazing Day Fishing (Pic Heavy)
Very nice fish. I am jealous. I used to live in Pinedale, WY and I miss those days.
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While I do support some of the efforts to "go green", I also think that just like anything else, we need to use caution, use our heads, and not be so quick to dismiss time tested practices.
Going green is mean!
We have all heard the expression "too much of a good thing." In January of 2012, a school district in Florida experienced exactly the opposite, too little of a good thing, as in- water. In an effort to save money, and water, the district decided to replace all of the urinals in the men's rooms with the newly popular, waterless urinals. While this seemed like a can't-miss idea at the time, has proved to be a financial nightmare. Like most new ideas before much thought is given, it seemed like a no-brainer, but ultimately is never as good as the time tested method of the present. The lack of fresh water that was no longer being flushed down the drain lines, led to a very corrosive, acidic condition inside of the pipes, causing most of them to develop leaks. To be fair, it was not necessarily JUST the fault of the waterless urinal, but the waterless urinal combined with the copper drain lines. Unlike PVC or cast iron drain lines, copper drain lines are prone to failure from one thing, high acidity. The school district is now faced with hundreds of thousands of dollars worth of damages and repairs to the walls and drain lines. Waterless urinals are now not permitted to be installed anywhere where copper drains are serving them. The very thing they were trying to save is what ultimately came back to bite them.
While I do support some of the efforts to "go green", I also think that just like anything else, we need to use caution, use our heads, and not be so quick to dismiss time tested practices.
9/2/2012 09:09:36 pm
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3/19/2012 06:26:42 am
Clearly proper research wasn't done to see if this would be a good idea. Obviously this ended up costing them a lot of money to fix and repair and must have been a nightmare. It's important to know what you are getting into before implementing a new plumbing system, especially in a public building.
3/22/2012 12:15:15 pm
This is nice post about Plumbing services.
3/28/2012 08:22:51 pm
this is very nice blog and very useful, i used this plumber.
4/3/2012 09:13:22 pm
This is nice post about Plumbing services.
4/12/2012 08:03:56 pm
I like this web site because so much useful material on here.
5/21/2012 09:16:48 am
I'm sorry, but this is a gross photo. : )
6/13/2012 01:30:10 pm
that guy is bummed!
Ginny Crandall
8/8/2012 08:21:18 am
This is terrible! Going green is great if you do it right, but this obviously was not the right way. I think that maybe they need to talk to someone about better ways to go green. A friend of mine worked for a corn export company that seemed to be on the right track with going green. Maybe they can have some sort of meeting and sort through ideas...
8/27/2012 07:35:27 pm
It is very important to know the whole system before implementing a new plumbing system to avoid problems in future.
9/10/2012 12:42:57 am
10/24/2012 11:28:02 am
This only goes to show that the district did not research more on how useful and what effects does the waterless urinals might put into. Scary as it seems, thousands of dollars will be spent because of lack of negligence.
12/10/2012 05:05:05 am
Amazing how simple it can be to communicate with people and have them understand a certain topic, you made my day.
12/13/2012 09:46:58 am
And it is very important to understand the best solutions out there to install the underground services too!
12/27/2012 03:11:15 pm
This blog made me your follower. Keep Sharing Your Valuable Information in Future!!!!
1/20/2013 11:45:28 pm
Its really amazing post about the plumbing service.
3/13/2013 05:22:08 am
Wow! I can't believe that happened! It is awful, but humorous at the same time! I guess it would have happened eventually. Good thing a regulation was put on using waterless urinals and copper pipes.
3/19/2013 02:56:36 am
Its really wonderful post. thanks a lot for sharing such an amazing post.
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Il Giardino Segreto
Via Emilia 94, 40026 Imola, Italy –
Excellent location – rated 9.6/10! (score from 70 reviews)
Rated by guests after their stay at Il Giardino Segreto.
|Room Type
Double Room
Twin Room with Private External Bathroom
It was where the mayor of Imola Ugo Tamburini (the mayor who loved photography) lived around 1860-1900. It is a very charming place and it gives you good deep feelings.
Area Info –
Closest Landmarks
- Il Duomo di Bologna 0.1 miles
- Rocca Sforzesca 0.2 miles
- Imola Circuit 0.7 miles
- Tozzoni Park 2.1 miles
- Castel Guelfo Outlet 7.5 miles
- Le Tre Corti 17.8 miles
- Commercial Center Leclerc Pianeta 18.4 miles
- Fico Eataly World 18.6 miles
- Parrocchia di San Maria Lacrimosa 19.4 miles
- Santo Stefano Church 19.7 miles
Restaurants & Markets
- Café del Grillo Cafe/Bar 0 miles
- San Domenico Restaurant 0.1 miles
- Supermercato Coop Supermarket 0.1 miles
- Mercato all\'aperto Market 0.1 miles
Natural Beauty
- Teatro Comunale Mountain 0 miles
- Rocca Sforzesa Mountain 0.2 miles
- Autodromo Mountain 0.7 miles
- Santerno River 0.7 miles
Closest Airports
- Guglielmo Marconi Airport 24 miles
- Peretola Airport 45.8 miles
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Facilities of Il Giardino Segreto Great facilities! Review score, 9.0
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Pets are not allowed.
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Free! WiFi is available in all areas and is free of charge.
Public parking is available at a location nearby (reservation is not needed) and costs EUR 4 per day.
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Any type of extra bed is upon request and needs to be confirmed by management.
Additional fees are not calculated automatically in the total cost and will have to be paid for separately during your stay.
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Universal Monsters Universe invites you to Meet The Universal Monsters!
As we head into the new week, we'd like to first thank you for following us as we covered Tiger Raid at the Tribeca Film Festival. It's a film starring The Mummy's Sofia Boutella, and while there hasn't been any word of whether it's been picked up or not, we wouldn't be surprised if it gets a release sometime after Star Trek Beyond and before/after The Mummy. With Sofia Boutella's popularity and stardom on the rise, we could easily be looking at a Gal Gadot situation with her films Triple 9 and Criminal which released around her debut as Wonder Woman in Batman v Superman. But back on to monsters!
Early on UMU's Joe did a great profile series on the actors and actresses behind our favorite Universal Monsters. He profiled everyone from the likes of Lon Chaney to Ricou Browning and Ben Chapman. They're really good if we do say so ourselves and if you love the classics, we're sure you'll really enjoy these.
Have a look below at the various people Joe profiled. Click on the name for more and we hope you enjoy.
Bela Lugosi starred in a Broadway rendition of Dracula and it was a success eventually becoming a touring production.
Ben Chapman stood 6'5′ tall which helped him get the role of the Creature.
Boris Karloff, one of the most famous faces in monster movies being worked on by Jack Pierce, one of the most famous makeup artists in movie history.
A man who has played in two Monsters movies? Mr. Claude Rains.
Elsa Lanchester – After her role as the Bride, she did not appear in another movie until 1941's Ladies in Retirement which led to many more on-screen roles throughout the following decades including a run of Disney films such as Marry Poppins, That Darn Cat! and Blackbeard's Ghost .
Lon Chaney, Jr., the man behind the fur in The Wolfman and the only actor to portray all four monsters-the Wolfman, the Mummy, Frankenstein's monster and Dracula.
Lon Chaney Sr starred in hundreds of films and his make-up skills would earn him the nickname, "The man of a thousand faces."
Ricou Browning performed in water shows before landing the underwater role of the Creature. He starred in two sequels, Revenge of the Creature and The Creature Walks Among Us.
Did you have a favorite Universal Monster? My favorite was Boris Karloff, Karloff the Uncanny as The Mummy. And I think everyone knows how much I can't wait to see Sofia Boutella as The Mummy. Make sure to let us know in the comments below because we'd love to hear from you!
(Steven Biscotti – @reggiemantleIII)


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This recipe is so simple, easy and versatile, you'll want to add it to your regular recipe rotation. You can use it on chicken, duck, fish or veggies and you can make it mild, medium or hot.
- Yield
- Makes as many as you want it to.
- Chicken breasts
- (boneless, skinless or bone-in, skin-on)
- Patak's Mild Curry Paste
- (Other brands acceptable but Patak's seems to be the most commonly available in stores, just make sure it's an oil-based jarred curry paste, heat preference is personal)
- Liberally spread the curry paste on the chicken breasts. The thicker the paste, the spicier the flavor will be. Once the breasts are covered with curry paste, grill as you would normally, being careful of flame-ups. The paste forms a lovely crust which seals in juices while providing amazing Indian curry flavor. Once the chickens are cooked through, about 10 minutes (check with an instant read thermometer - temperature should be just below 170), serve with rice and/or pita bread (Indian Nan is even better) and your favorite Indian style veggies.


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Martin University online associate degree
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Information about Martin University online associate degree, and registering for elective lectures and seminars. Which college degrees give you the best chances of entering a successful career path after graduation? Concentrating on Martin University online associate degree, for example, may give you additional focus in the admissions selection process. Check with the admissions office for assistance with prerequisites, course registration deadlines, and associates degree program requirements. Please use the form above to request admissions info for Martin University.
Research demonstrates that associates degree students go on to complete bachelor degrees at a much higher rate than those students who transfer with only a few credits. When starting your associates degree, plan ahead and be sure that you are picking courses that will be transferable to colleges and universities later on. Further, by choosing your major early, you can take the required classes needed for your degree in a community college, saving both time and up-front investment.
Look at four-year schools in your state first, to decide if any would be a good fit for you, as in-state tuition may be lower for state residents. This will outline what classes you need to take to qualify, and what minimum GPA you'll need to maintain to avoid losing hard-earned credits when you actually transfer. The following state websites provide information about the transfer process within their state. While most states are generally similar, please ask your community college advisor about the specific guidelines for your state. Beyond major requirements within the admissions department, you may consider Grand Rapids Community College class descriptions for complementary electives to your primary course of study.
Academic Program Manager
Towson University
Prior experience in college or university Admissions and/or Academic Program Advising preferred. Participate in high school college fairs.
6 days ago Admissions Rep
Miller-Motte College
The Admissions Representative also represents Delta Education accurately and compliantly at student recruitment events.
1 day ago Student Admissions
New York University
Experience working with college admissions. Management of admissions criteria, policies, and student assessment.
5 hours ago High School Admissions Coordinator
Pima Medical Institute
Attend high school college fairs. Procure high school senior leads for admission to Pima Medical Institute. Procure senior leads from presentations and forward..
1 day ago Undergrad Admissions Counselor
Yeshiva University
The Admissions Counselor will support student recruitment and participate in the admissions decision process.
5 days ago


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BIMB Puts Up $885M To Buy Out Bank Islam Shareholders
Of the total consideration, $550 million will go to Dubai Group LLC, which currently holds a 30.5 percent stake in Bank Islam, Malaysia's oldest Islamic lender. The remainder is earmarked for Malaysia's Pilgrims Fund Board, whose slightly smaller ownership interest will round...
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I have been asked if I would like to teach a gardening course this Autumn. Following the meeting yesterday I discovered that there is going to be a huge amount of paperwork to deal with and the thought is really daunting. It is a long time since I taught Adult Education courses for the local authority and had forgotten just how much extra paperwork is required to run even the simplest of classes. The two ladies that I met yesterday where absolutely lovely and really made me feel at ease which was nice. I am sitting here now working myself into a lather over the paperwork though. All I can do is take it one piece at a time and work my way through it. Annoyingly though if there aren't enough people interested in the course then it won't even run and I will have spent hours and hours prepping for sessions. I thought that I had left that all behind when I left the Adult Ed circuit. Funny isn't it how a simple phone call from a friend asking if I would be interested in running a craft club for a few weeks has snowballed. It never occurred to me that it would lead to this.
Oh! and here is the promised photo of my letter opener. I have just finished waxing it
Along the lanes I'd love to wend, near Artist's Mews, on Writer's Bend. Fragrant flowers of every hue would sparkle in the morning dew. I wish I lived in Carver's Valley, Quilter's Creek or Cross Stitch Alley. Just think of all the things I'd make, if I lived by Crafters Lake.......... If you would like to purchase one of my Wool Paintings or would like to send a picture of your pet for me to copy please leave me a comment and I will get back to you
Thursday, 10 September 2015
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Paris:UEFA opened an investigation on Wednesday into the trouble on and off the field during Lille's Champions League loss to Manchester United. Man United fans said they were crushed against high fences at Tuesday's game, and manager Alex Ferguson was furious that Lille's coaching staff waved players off the field after Ryan Giggs scored in the 1-0 win. "UEFA has officially opened an investigation into events at the UEFA Champions League first knockout round first-leg match," UEFA said. UEFA will look at whether Lille breached safety and security instructions, and alleged improper conduct of both sets of fans. The matter will be discussed at the UEFA Control and Disciplinary Body's next meeting on March 22. UEFA, led by former France great Michel Platini, has shown a hard line on security and safety issues. The governing body of European soccer recently threw Feyenoord out of the UEFA Cup for crowd disturbances. UEFA also said it would review Giggs' 83rd-minute goal, which was taken before the referee whistled play to restart and led to the near walk-off. Fans then threw objects onto the field after Giggs' goal. The match was played at the Stade Felix-Bollaert in Lens - one of the stadiums used for the 1998 World Cup - because Lille's stadium doesn't meet UEFA standards. "We cannot say now what action the disciplinary committee will take, but if they find against Lille, it could well be severe," UEFA spokesman Rob Faulkner told the BBC Web site. "The whole issue of Lille playing in that stadium will also need to be addressed." Last season, Lille played its home matches at the Stade de France outside Paris. Riot police in action Soon after the game started, some United fans were pushed against a high metal security barrier designed to keep supporters off the field. Riot police fired tear gas into the crowd, and security officials helped at least two fans over the fence to safety on the field. Ferguson said United goalkeeper Edwin van der Sar complained of double vision from the effect of tear gas. There were no reports of any major injuries but the scenes were reminiscent of the 1989 Hillsborough disaster in Sheffield, England, when 96 fans were crushed to death in an overcrowded section of the stadium. "I think some of the fans may have initially overreacted themselves to the situation in the stand but the police made the situation escalate out of control," United fan Mark Harrison said on his return to Manchester. "It was quite frightening to witness these kind of scenes." Manchester United urged fans at the game to e-mail the club to help compile a report for UEFA. "Reds officials would like to understand the sequence of events that led to an incident in the away end during the first half," United said in a statement. United said it met with UEFA and Football Association officials after the game and would submit a report to UEFA. Giggs' goal prompted angry protests from the Lille players and fans, who felt he had taken his kick too quickly without waiting for the referee's whistle. After referee Eric Braamhaar allowed the goal to stand, Lille players began to walk off the field and objects were thrown from the crowd. Some were aimed at Giggs but one hit captain Gary Neville, who left the stadium with a gash over his eye. "I have never seen anything like that before," Ferguson said of Lille's reaction to the goal. "It created an intimidating and hostile atmosphere and it was totally wrong." Lille coach Claude Puel said the team was following standard practice in French soccer. "In France, you must express a complaint after the first stoppage in play which follows the decision," he said. "It is for that reason we stopped the game." Lille president Michel Seydoux said the players' reaction was one of frustration. "If Lille had done the same thing the referee would not have allowed the goal," Seydoux said. "It was not an attempt to get the game abandoned." British sports minister Richard Caborn said stadium safety checks should be conducted weeks in advance, rather than on the day of the match. "There are a number of grounds where Champions League matches are being played that don't come up to the standard of UEFA," Caborn told London's LBC NEWS radio.
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text: Alright, with the announcement of the MGS Trilogy, specifically PW HD, I decided to DL PW PAL, because I was using the USA version this whole time. How would I go about changing my savedata's region? I don't want to have to start over. Here's my file, if someone could convert it's region. http://filetrip.net/f25316-Metal-Gear-Soli...Walugi-1-0.html