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Once a computerized maintenance management system (CMMS) has been justified, the next step is to obtain it. But where do you start, and how do you proceed? Basically there are two alternatives. Your organization can either choose in-house development or purchase a ready-made software package — both choices of which have their own set of benefits and drawbacks.
In-house development is software developed by your own employees or contractors under your direction and specifications. The major advantages of this type of approach are increased flexibility, the ability to meet highly specialized needs, higher potential for optimal training development, adaptability to current maintenance operations, and the best linkage with existing information systems. Disadvantages include higher cost, long development time, higher potential for failure to meet expectations, narrower and less creative focus, and poorly documented notes when developers rush to finish the job.
As an alternative to in-house development, many organizations opt to purchase ready-made CMMS software, which can be selected a number of ways. You can rely solely on programs you see advertised in trade journals, or you can hire a consultant to help you determine what system best meets your needs. You can also conduct your own research, making the decision without any type of external assistance.
No matter which strategy you pursue, there are several advantages to purchasing ready-made software, including the fact that it is relatively inexpensive, requires no development time, has a shorter implementation time, provides current and updated technology, offers additional features to your proposed system, provides the required flexibility to meet your current and future needs, and offers user groups to help you get the most out of your software. However, the exact same purchase for one customer over another can just as easily result in acquisition of software that results in disappointment, delayed implementation, and end-user frustration.
So once you've made the decision to purchase a software package, how do you determine which approach is right for you? Following a structured process (Figure above) can help you best achieve your ultimate goals.
Form a team. After assigning a project leader, the maintenance manager should establish a team for the evaluation and selection of a suitable CMMS. This team should include a plant engineer, maintenance manager, maintenance employees, and representatives from the management information system (MIS), purchasing, accounting, and other departments. By getting your employees involved in the automation process, you decrease their resistance to computerization.
Determine the objectives. In the development of the needs and objectives for the new system, obtain input from all parts of the organization that will interact with it. All levels of maintenance management should have an opportunity to make their needs known and contribute to the project. This is especially true for first-line supervisors. Consult with production personnel about proposed maintenance systems since they are almost always the primary customer. Other groups include purchasing, receiving, cost accounting, payroll, and manufacturing engineering.
It's also important to make sure the system being considered is not limited to computerized versions of existing procedures. Doing so might prevent the exploration of additional features that may further improve maintenance productivity.
When determining objectives of your new CMMS, the first step is to develop a complete outline of the scope, goals, and objectives of the proposed system. First, organizations must identify the major problems that can be solved with the implementation of a CMMS. Defining current system problems will provide management with the evidence of the need to resolve them. Once your problems have been identified and defined, objectives for the new system can be set.
Identify hardware alternatives. The ideal situation is to match the hardware with the most appropriate CMMS package available. Since company policy oftentimes may dictate the use of certain hardware, this degree of freedom is not usually available to the maintenance department in many situations. Company policy or existing computer facilities may dictate that all programs reside in a central computer. In other cases, decentralized data processing may be acceptable, but the type and make of hardware may already be established. Therefore, it is strongly recommended that you work closely with an MIS group and consider their recommendations, especially with regard to technical matters.
Develop system specifications. After agreeing upon the system's outline and objectives, the next step is to comprehensively define the specific features of the new system. First, identify the major aspects of the system. Second, clearly define all significant features. Third, group the features within each subdivision into three categories of importance, including mandatory, needed, or desired.
When you begin to categorize and prioritize, make sure you consider your organization's long-range plans. What may appear as desired or needed features now may prove mandatory as your organization grows. Values can subsequently be assigned to each feature on a scale of 1 to 10. For example, mandatory features could automatically be assigned a value of 10, while needed features could be ranked from 4 to 9, and desired features from 1 to 3 (click here to see Table).
At this stage of the selection process, you should have a document outlining all the features required in your CMMS. This document, called "Systems Specifications," will be submitted to software vendors later to obtain pricing and other necessary information.
Search for CMMS vendors. By now, you probably have a good list of vendors to work with. Now is also a good time to do further research and add more vendors to your list. Review the ads, and read applicable articles in trade journals. Perform a search on the Web to find companies that develop and sell CMMS packages. How many vendors you start with depends on availability of time resource, but it's recommended that you start with no more than 10 to 12 vendors.
Conduct a preliminary screening. When the initial system's literature has been gathered, a quick preliminary review should include the following steps:
List the system name, vendor, and compatible hardware.
Quickly review the details to determine how many of your mandatory features appear to be provided by each of the candidate systems.
Eliminate systems that do not meet the majority of your mandatory features.
Once you have done this, review the top three or four CMMS candidates with the following criteria in mind:
System features — There are numerous features that the system should include — one such feature is flexibility. The software should be flexible in terms of allowing you to enter information pertaining to your organization. It should also accommodate present and future needs. Before buying a particular system, check the limitations of the system. For example, if the number of records in the database increases significantly in the future, the system's searching and reporting capabilities should not be slowed down. Another thing to consider is the system's interfacing capabilities. Essentially, the system should be capable of interfacing with other information systems. Self-sufficiency is something else to consider. Programs should be capable of direct, full use without need to consult a manual or other outside sources. The instructions onscreen should explain what the program will do and how to use it. Other things to consider include the system's security, data security, user-customizable screens, modifications, user-customizable reports, and the system's programming language.
User ease — The CMMS should be easy to learn, and come with training aids and documentation. The package should be icon and menu driven, contain input screens to enter information in an orderly manner, and provide error handling and context-sensitive help.
Vendor profile — Consider vendor qualifications. You obviously want a vendor who is both knowledgeable and experienced when it comes to CMMS. Another thing to think about is the vendor's financial strength. Since a CMMS project can be a major investment in time, resources, and money, the vendor should be established. Other things to consider are references, delivery, payment options, source code, and warranty.
Vendor support You should make sure that the vendor has a provision for demonstrating the software. Clearly, you must know that the software is going to work for you. Another aspect regarding vendor support is training. Whether this training is done at the vendor's facility or on site, this small investment can save you a great deal of money and frustration in the long run. Other things to consider include the vendor's system support, upgrade policy, and overall system cost.
Compile, compare, and select. With all of the steps of this evaluation procedure completed, you are ready to compile the results and make your final selection. Select the vendor that provides the best combination of characteristics for your particular situation. As shown in the sample Table, Vendor C should offer you the software package that best meets your needs.
The well-conceived and executed introduction of computer-based systems into the management of the maintenance function can bring about major improvement in efficiency and effectiveness of your organization. The resulting system should quickly pay for itself through savings in cost and improvements in service.
A registered professional engineer and certified plant engineer, Bagadia serves as president of PEAK Industrial Solutions in Brookfield, Wis.


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Frank Milne
Swinging between Euphoria and Despair
The 2008 global financial crisis was the worst economic and financial calamity since the Great Depression, and countries and financial institutions everywhere are still struggling with its consequences. Meanwhile, academics, analysts and pundits are studying the roots of the crisis in the hopes of averting another meltdown in the future.
Dr. Frank Milne is one of Canada's leading experts in this regard. As the BMO Professor of Economics and Finance in Queen'sDepartment of Economics, Milne was one of the financial professionals around the world who warned that some of the financial and regulatory practices of the 1990s and early 2000s would lead to catastrophe. His research and graduate training on risk management and financial stability is influencing banking policy in Canada and in his native Australia.
In a 2008 analysis of the international debt crisis for the C.D. Howe Institute, for example, Milne argued that the crisis was caused by two different types of debt funding and risk management systems operating simultaneously within the banking and financial world. One model assumed that securitization – the packaging of mortgages, credit-card debt, auto loans and other interest-bearing debt into bonds and various other asset-backed securities that could be bought and sold on the market – was a market-based system that reduced the need for standard risk-management approaches regarding the transparency of information available to buyers and sellers, uncertainty and market liquidity.The second model was the traditional one, which assumed that securitization merited the same rigorous risk-management strategies as any other investment.
Between the early 2000s and 2008, the former model, now re ferred to as a "shadow banking system," operated outside of standard bank regulations and supervision. It was successful while it lasted: the housing market, fuelled by millions of home buyers lured by low-interest mortgages and tax-deductible mortgage payments, boomed. Across the U.S., new housing subdivisions expanded rapidly. Traders, banks, insurers and investors enjoyed huge returns from the real-estate backed securities. The stock market soared.
But the bonanza was founded on an illusion. Asset-backed securities earn long-run returns only if the debt they are built around is relatively sound. Unfortunately, millions of sub-prime mortgages had been sold to people who could not pay them back because of subsequent job losses, or because they should not have been approved in the first place. Inevitably, defaults and foreclosures began to mount by the hundreds of thousands, rendering the once-valuable bond securities worthless: the institutional investors who had sunk money into them collectively lost trillions of dollars. Major investment banks and mortgage companies, such as Lehman Brothers and Countrywide Financial, went bankrupt, were sold to other banks at fire-sale prices or were taken over by government. Worst of all, millions of American investors, whose savings had been used by the banks to purchase the junk securities, lost everything while the banks that caused the crisis received large bailouts from the U.S. government.
As we now know, and as Milne observed, inadequate risk management within banks, lax regulatory oversight, widespread corruption and conflict of interest were root causes of the crisis in the U.S. and in a number of European Union (E.U.) countries. In too many cases banks and mortgage companies facilitated, or even promoted, the reckless lending to people who were obvious credit risks. Credit rating agencies gave AAA ratings to bonds they knew to be junk. Traders knew they were junk, too, but sold them to net massive profits and bonuses. People everywhere are outraged that none of the banking executives and traders who caused the crisis have gone to jail.
While the financial crisis affected Canada, tighter regula tion of its banking system helped it avoid the sort of meltdowns that occurred elsewhere. But Milne says Canadians should not be complacent. The dramatic increases in sovereign debt in the U.S. and the E.U. caused by huge fiscal stimuli, combined with looming fiscal challenges posed by the aging baby boom generation, pose a serious threat to national economies everywhere.
At the same time, Milne says a long view of economic history suggests that while things may get rough, there is cause for hope.
"The road to the future is never smooth: it is littered with booms, busts, surprises, disappointments and failures," he says. "We should adapt, looking for opportunities and encouraging our fellow citizens through thoughtful policy implementation. It is foolish to be myopic, swinging between euphoria and despair."
Profile by Alec Ross
(e)Affect Issue 3, Spring 2013
Learn more about:
Dr. Milne's research

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Robert Cyril Bollinger, Jr, M.D., M.P.H.
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Dr. Robert C. Bollinger is a professor of medicine at the Johns Hopkins University School of Medicine. He holds joint appointments in the Department of International Health at the Bloomberg School of Public Health and in the School of Nursing's Department of Community-Public Health.
Dr. Bollinger has more than 35 years of experience in international public health, clinical research and education dealing with such global health priorities as HIV/AIDS, malaria, tuberculosis, leprosy, dengue, antibiotic-resistant infections and other emerging diseases.
He is the founding director of the Johns Hopkins Center for Clinical Global Health Education (CCGHE) and the associate director for medicine of the Center for Global Health.
He also serves as director of both the Johns Hopkins Fogarty India Program—a component of the NIH Fogarty International Center—and the IMEC-JHU Partnership to advance applications in health care.
Under Dr. Bollinger's leadership of the Fogarty India Program, short-term and degree training has been provided to more than 100 visiting scientists at Johns Hopkins, and in-country training has been provided to more than 2,000 Indian scientists.
His commitment to clinician education has been honored with the Johns Hopkins Department of Medicine David M. Levine Excellence in Mentoring Award.
Dr. Bollinger's research interests include identifying biological and behavioral risk factors for HIV transmission; characterizing the clinical progression and treatment of HIV and related infections; and implementing science research projects to optimize healthcare capacity and delivery in resource-limited settings.
Dr. Bollinger is author of more than 150 peer-reviewed research publications and 15 book chapters, including the first and largest studies of risk factors for HIV transmission in India, the cloning and sequencing of the first HIV viruses from India, the only studies characterizing the primary immune response to HIV in India, and the demonstration of increased risk of HIV acquisition with recent HSV infection and lack of circumcision.
He has been invited to participate in public health training programs and expert committees, and has been consulted for his expertise by more than 15 countries.
Dr. Bollinger has served as a member of the US Presidential Advisory Council for HIV/AIDS (PACHA) and as a member of the PACHA International Subcommittee, and is a current member of the Institute of Medicine Forum on Public-Private Partnerships for Global Health and Safety.
Working with partners in more than 20 countries, Dr. Bollinger and CCGHE faculty pioneered the development and use of distance learning and their award-winning mobile health platform emocha® in resource-limited settings.
Dr. Bollinger received an undergraduate degree from Haverford College, an M.D. from Dartmouth Medical School and an M.P.H. from the Johns Hopkins Bloomberg School of Public Health. He completed his internal medicine training at the University of Maryland Medical Systems, followed by a post-doctoral fellowship in infectious diseases at Johns Hopkins.
He is board certified by the American Board of Internal Medicine in internal medicine and infectious diseases.
- Founding Director, Center for Clinical Global Health Education
- Associate Director for Medicine, Center for Global Health
- Director, Johns Hopkins Fogarty India Program
- Director, IMEC-JHU Partnership
- Professor of Medicine
Departments / Divisions
- MD, Dartmouth Medical School (1984)
- University of Maryland School of Medicine / Internal Medicine (1987)
- Johns Hopkins University School of Medicine / Infectious Diseases (1992)
Board Certifications
- American Board of Internal Medicine / Infectious Disease (1992)
- American Board of Internal Medicine / Internal Medicine (1988)
Research & Publications
Research Summary
Dr. Bollinger is committed to improving the health of people living in resource-limited nations through clinical research, education and leadership training.
He established and has sustained programs in countries throughout Africa, South and Central America, Southeast Asia and the Middle East. He currently leads the Johns Hopkins team providing technical support to the Medical Education Partnership Initiative (MEPI) in Uganda, where he has worked for more than 15 years.
In 1991, Dr. Bollinger initiated an ongoing NIH-funded Indo-US HIV research program in Pune, India, involving the National AIDS Research Institute/ICMR and the BJ Medical College. He has served as principal investigator for many NIH-supported studies and clinical trials in Pune, including the SWEN study, which changed World Health Organization (WHO) guidelines for treatment of infants born to HIV-positive mothers to prevent mother-to-child transmission.
Selected Publications
Shivakoti R, Gupta A, Ray JC, Uprety P, Gupte N, Bhosale R, Mave V, Patil S, Balasubramanian U, Kinikar A, Bharadwaj R, Bollinger RC, Persaud D. "Soluble CD14: an independent biomarker for risk of HIV mother-to-child transmission in setting of pre- and post-exposure antiretroviral prophylaxis." J Infect Dis. 2015 Oct 6. pii: jiv479. [Epub ahead of print]
Chang LW, Nakigozi G, Billioux VG, Gray RH, Serwadda D, Quinn TC, Wawer MJ, Bollinger RC, Reynolds SJ. "Effectiveness of peer support on care engagement and preventive care intervention utilization among pre-antiretroviral therapy, HIV-infected adults in Rakai, Uganda: A randomized trial." AIDS Behav. 2015 Oct;19(10):1742-51. doi: 10.1007/s10461-015-1159-y.
Sahay S, Deshpande S, Bembalkar S, Kharat M, Parkhe A, Brahme RG, Paranjape R, Bollinger RC, Mehendale SM. "Failure to use and sustain male condom usage: lessons learned from a prospective study among men attending STI clinic in Pune, India." PLoS One. 2015 Aug 13;10(8):e0135071. doi: 10.1371/journal.pone.0135071. eCollection 2015.
Moran D, Edwardson J, Cuneo CN, Tackett S, Aluri J, Kironji A, Cox J, Carroll B, Lie E, Fofana M, Bollinger RC, Ziegelstein RC, Chen CC. "Development of global health education at Johns Hopkins University School of Medicine: a student-driven initiative." Med Educ Online. 2015 Jul 27;20:28632. doi: 10.3402/meo.v20.28632. eCollection 2015.
Balagopal A, Asmuth DM, Yang WT, Campbell TB, Gupte N, Smeaton L, Kanyama C, Grinsztejn B, Santos B, Supparatpinyo K, Badal-Faesen S, Lama JR, Lalloo UG, Zulu F, Pawar JS, Riviere C, Kumarasamy N, Hakim J, Li XD, Pollard RB, Semba RD, Thomas DL, Bollinger RC, Gupta A; ACTG PEARLS and NWCS 319 Study team. "Pre-cART elevation of CRP and CD4+ T-cell immune activation associated with hiv clinical progression in a multinational case-cohort study." J Acquir Immune Defic Syndr. 2015 Oct 1;70(2):163-71. doi: 10.1097/QAI.0000000000000696.
Patil S, Bhosale R, Sambarey P, Gupte N, Suryavanshi N, Sastry J, Bollinger RC, Gupta A, Shankar A. "Impact of maternal human immunodeficiency virus infection on pregnancy and birth outcomes in Pune, India." AIDS Care. 2011 Dec;23(12):1562-9. doi: 10.1080/09540121.2011.579948. Epub 2011 Jun 28.
Chang LW, Kagaayi J, Nakigozi G, Ssempijja V, Packer AH, Serwadda D, Quinn TC, Gray RH, Bollinger RC, Reynolds SJ. "Effect of peer health workers on AIDS care in Rakai, Uganda: a cluster-randomized trial." PLoS One. 2010 Jun 2;5(6):e10923. doi: 10.1371/journal.pone.0010923.
Gupta A, Sane SS, Gurbani A, Bollinger RC, Mehendale SM, Godbole SV. "Stigmatizing attitudes and low levels of knowledge but high willingness to participate in HIV management: a community-based survey of pharmacies in Pune, India." BMC Public Health. 2010 Aug 27;10:517. doi: 10.1186/1471-2458-10-517.
Suryavanshi N, Mave V, Gupte N, Bhosale R, Sambarey P, Patil S, Sastry J, Bollinger R, Gupta A, Shankar A & The SWEN India Study Team. Contraceptive use and factors associated with postpartum surgical sterilization among HIV-infected women in Pune, India. Journal of HIV/AIDS & Social Services. 2015;14(3):21 Aug [Epub ahead of print] DOI:10.1080/15381501.2014.946548
Linas BS, Latkin C, Genz A, Westergaard RP, Chang LW, Bollinger RC, Kirk GD. Utilizing mHealth methods to identify patterns of high risk illicit drug use. Drug and Alcohol Dependence. 2015;151:250-7.
Yang C, Linas B, Kirk G, Bollinger R, Chang L, Chander G, Siconolfi D, Braxton S, Rudolph A, Latkin C. Feasibility and acceptability of smartphone-based ecological momentary assessment of alcohol use among African American men who have sex with men in Baltimore. JMIR mHealth uHealth. 2015 Apr-Jun;3(2):e67. doi: 10.2196/mhealth.4344.
Gandhi BS, Kulkarni K, Godbole M, Dole SS, Kapur S, Satpathy P, Khatri AM, Deshpande PS, Azad F, Gupte N, Bharadwaj R, Bollinger RC, Gupta A. Dengue and chikungunya co-infection associated with more severe clinical disease than mono-infection. International J. of Healthcare and Biomedical Research. 2015 Apr;3(3).
Shivakoti R, Yang WT, Gupte N, Berendes S, Rose A, Cardoso SW, Mwelase N, Kanyama C, Pillay S, Samaneka W, Riviere C, Sugandhavesa P, Santos B, Poongulali S, Tripathy S, Bollinger RC, Currier JS, Tang AM, Semba RD, Christian P, Campbell TB, Gupta A; NWCS 319 and PEARLS Study Team. Concurrent anemia and elevated CRP predicts HIV clinical treatment failure, including TB, post-antiretroviral therapy initiation. Clin Infect Dis. 2015 Mar 31. doi: 10.1093/cid/civ265. [Epub ahead of print]
Mave V, Chandanwale A, Bhosale R, Shere D, Gupte N, Suryavanshi N, Kulkarni V, Kagal A, Bharadwaj R, Joshi S, Bollinger R, Gupta A. Vitamin D deficiency and risk of postpartum tuberculosis among HIV-infected breastfeeding mothers in India. Int J Tuberc Lung Dis. 2015 Mar;19(3):302-4. doi: 10.5588/ijtld.14.0658.
Tenforde MW, Gupte N, Dowdy DW, Asmuth DM, Balagopal A, Pollard RB, Sugandhavesa P, Lama JR, Pillay S, Cardoso SW, Pawar J, Santos B, Riviere C, Mwelase N, Kanyama C, Kumwenda J, Hakim JG, Kumarasamy N, Bollinger R, Semba RD, Campbell TB, Gupta A ACTG PEARLS and NWCS 319 Study Group. C-reactive Protein (CRP), Interferon gamma-inducible Protein 10 (IP-10), and Lipopolysaccharide (LPS) are associated with risk of tuberculosis after initiation of antiretroviral therapy in resource-limited settings.PLoS One. 2015 Feb 26;10(2):e0117424. doi: 10.1371/journal.pone.0117424. eCollection 2015. doi: 10.1371/journal.pone.0117424.
Linas B, Latkin C, Westergarrd RP, Chang LW, Bollinger RC, Genz A, Kirk GD. Capturing illicit drug use where and when it happens: an ecologic momentary assessment of the social, physical and activity environment of using versus craving illicit drugs. Addiction. 2015 Feb;110(2):315-25. doi: 10.1111/add.12768.
Academic Affiliations & Courses
Courses and Syllabi
TIME: Global Health, Genes to Society, February of Year One
Activities & Honors
- David M. Levine Excellence in Mentoring Award, Johns Hopkins University Department of Medicine, 2010
Videos & Media
Recent News Articles and Media Coverage
"Leveraging Technology for Global Health," Huffington Post, Nov. 12, 2012
Patient Ratings & Comments
The Patient Rating score is an average of all responses to physician related questions on the national CG-CAHPS Medical Practice patient experience survey through Press Ganey. Responses are measured on a scale of 1 to 5, with 5 being the best score. Comments are also gathered from our CG-CAHPS Medical Practice Survey through Press Ganey and displayed in their entirety. Patients are de-identified for confidentiality and patient privacy.
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March, 2008
The goal of our research was to determine whether there are cognitive differences between performing arts and non-performing arts students, and to discover what the brain-based differences are that underlie the cognitive differences. We compared performing arts students in theater and music to students who are not involved in the performing arts. We investigated performance on a variety of reasoning tasks and investigated whether there were differences in patterns of brain activity of the students. We used functional Magnetic Resonance Imaging (fMRI) to investigate this question.
fMRI makes it possible to monitor the activity of the brain. The basic idea of fMRI is that regions of the brain that are being used in a specific mental activity will use more oxygen than regions of the brain that are not used in the task, and fMRI is sensitive to changes in oxygen uptake in the brain. Thus, fMRI is an index of how active specific regions of the brain are in particular tasks.
The hypothesis being tested in our Dana-funded research is that if performing arts students are using their brains in a different way from the non-performing arts students, then we should see differences in brain activation patterns between these different groups. It may be the case that specific regions will show increased activation in the performing arts students and that other regions may show decreased activation. Of course it may be that we see no differences between the performing arts students and non-performing arts students in the tasks that we used. The goal of the research was to obtain first ever information on this important issue and we began the research with open expectations as to what we might discover.
The focus of our research was twofold. The first was to determine the types of brain-based changes that occur as a function of being exposed to a performing arts education. The second was to postulate the brain-based mechanisms that might lead to these improvements. This second aim is particularly important since previous attempts to investigate whether the arts have important effects on the brain have not posited specific neural mechanisms that might be involved. Thus, the goal of the research was to go beyond vague and general claims about the effects of a performing arts education to testing specific hypotheses.
In particular, the research conducted in the Dunbar laboratory was to study the effects of the performing arts on key cognitive processes involved in reasoning, such as generating novel and creative concepts, and being able to map information from one context to another, very different, context. This is known as transfer. The overarching question here is whether abilities that are acquired in the performing arts will transfer to other domains. Our goal was to investigate whether education in the performing arts influences abstract reasoning ability.
We investigated whether students in theater and music reasoned differently from non-arts students and what the brain-based changes that underlie these differences might be. Another question that we investigated is whether arts students are intrinsically different from non-arts students. We investigated this question by comparing performing-arts students' genetic makeup to non-performing arts students genetic makeup. This allowed us to investigate the possibility that differences between performing arts students and non-performing arts students' might be due to underlying genetic differences that predispose students to prefer and choose the performing arts rather than other areas of education.
In the first research year, we conducted an fMRI (functional magnetic resonance imaging) investigation, comparing brain activity of theater students with non-theater students as they worked on a new variant of a widely used task of creative thinking. One common claim about the effects of training in the performing arts is that it fosters creativity. This task—The Uses of Objects task- provides a measure of divergent thinking. This task is deceptively simple: particpants are given the name of an object, such as a brick, and are asked to generate as many uses for the object as they can think of. Previous researchers have found that this task is a useful measure of creative thinking (e.g., Carlsson, Wendt, & Risberg, 2000). Furthermore, researchers have found that arts students perform differently from non-arts students; they produce more varied and creative uses than students not in the arts (see Guilford, 1967 and Hudson, 1967 for the classic study on creativity and the arts). Postdoctoral student Dr. Jinathan Fugelsang, graduate student Adam Green, and undergraduate student Raphael Lizcano were actively involved in this research.
In our research, we investigated changes in creativity using a standardized test that measures the ability to reason creatively: or the Uses of Objects task. We hypothesized that training in the performing arts should lead to increased performance on the Uses of Objects task. We investigated the Uses of Objects task in arts and non-arts students. In year 1, we focused on using Guilford's Uses of Objects test (Guilford, 1967), which we adapted for use in fMRI. In the original version of this task, participants must generate as many uses for an object as they can. Participants who generate unusual items are called divergers and those who generate standard uses are called convergers. We modified this task for the fMRI experiment that compared performing arts students with non-performing arts students. We used photographs of objects to present stimuli to the participants and we devised a button-pressing technique for responses that eliminated the need for writing a response. Of course we compared our new task to the more standard task and found good correlations between performance on the two different versions of the task. Our hypothesis was that performing arts students would generate more divergent answers than non-performing arts students and that the different groups would display different patterns of brain activation. This is a sensitive task that has been used in assessing creativity in many domains and occupations.
This first-year research provides the first fMRI comparison ever undertaken of performing arts students with non-performing arts students. We analyzed the task-related BOLD (blood oxygenation level dependent) fMRI imaging response for conditions in which participants were judging the Uses of Objects minus the materials judgments. As can be seen from Figures 1a and 1b, we found differences in activation levels between the performing arts and non-performing arts groups. Regions in the medial fusiform gyri were selectively activated for the Uses of Objects task for the non-performing arts majors and not for the performing arts majors. Performing arts majors showed increased activation in two frontal areas: the left inferior frontal gyrus and in the left superior frontal gyrus. Prior work on word generation tasks has demonstrated that the left inferior frontal gyrus is involved in generating names in language processing tasks. The finding that performing arts students have increased activation in this area suggests that they are taking a more linguistic approach to the task, whereas the non-performing arts students are taking a more perceptual approach to the task. This result is important, as our other research on scientific thinking and expertise indicates that expertise can lead to increased activation in linguistic areas that are associated with conceptual thinking (Dunbar and Nelson, in preparation).
Our work on relational reasoning indicated that a region of the prefrontal cortex, frontal polar cortex, should show increased activation in the Uses of Objects task, and we therefore conducted a region of interest analysis of the frontal poles for the Uses of Objects task. We indeed found increased activation in the frontal poles (See also, Green, Fugelsang, Kraemer, Lizcano, & Dunbar, in preparation). However, there were no significant differences between the performing arts students and our controls in activation levels. Thus, while we have found differences between performing arts and controls, these differences appear to be in areas of the brain associated with linguistic symbolic retrieval from memory, rather than mapping from one semantic domain to another. This finding is important as it indicates a more precise locus for the effects of performing arts expertise than has been previously offered.
Research in Year 2 concentrated on three main levels, prompted by the meeting of the consortium investigators in fall 2005. A goal of the research was to use many of the same tasks that other laboratories were using. Thus, we developed a battery of tasks that measure performance on attention, working memory, and reasoning that could be administered within a 1-hour period. Postdoctoral fellow James Nelson, graduate student Adam Green, and undergraduates Raphael Lizcano and Oya Nuzumlali were involved in the development of these tasks.
In a second level, a key point that arose at the consortium meeting was the need to tease apart, at multiple levels, the effects of a performing arts education on the brain. The multiple levels approach is particularly important when adults are being studied, since our adult performing arts participants may have self-selected into performing arts; differences between performing arts students and non-performing arts students may be due, therefore, to underlying trait differences rather than to the effects of a performing arts education per se. This is a centuries old question for this type of research. The problem is that if a researcher finds differences between students in the performing arts and non-performing arts students it may be due to the training in the performing arts, or to inherent genetic differences. Teasing apart these two types of reasons is notoriously difficult. One way of addressing this centuries-old conundrum is to have a measure of student's underlying genetic traits. Dr. Posner has espoused this view at the Dana meetings, and this is an important way of determining whether any differences between performing arts students and non-performing arts students is due to underlying genetic differences or to the effects of a performing arts education. With this goal in mind, my graduate student Adam Green spent the winter term of 2006 at the Sackler Institute in New York learning to conduct DNA genotyping using buccal swabs (i.e., saliva). This is a relatively inexpensive and easy to obtain technique that we used in our 2006-2007 research. Rather than postulating a genetic or an environmental approach, a third possible hypothesis is that an interaction between environmental and genetic mechanisms may be at the root of differences or between performing arts and non-performing arts students. We are currently developing a DNA-microarray technology to address this question. Using this technique we are able to determine how training in a domain influences the expression of a wide variety of genes in the human genome. Dunbar & Petitto, (in preparation).
The third component of our Year 2 research was to develop tasks that we could use to assess differences, through imaging, in brain activities of performing arts and non-performing arts students. We refined our analogical reasoning tasks and focused on the frontopolar cortex as a key area for region of interest analyses. We also refined and developed the Uses of Objects task that we have been using to assess differences between performing arts students and non-performing arts students. The new Uses of Objects task was a categorization task, in which participants assess how good each of various uses is, for a particular object. This new modified Uses of Objects task provides more data and decreased error variance in the data, resulting in a more stable measure of divergent thinking. Dartmouth acquired a new 3.0 Tesla fMRI scanner during our second research year, and in the interim before the scanner became operational, we developed our DNA genotyping skills, the cognitive test battery, and the fMRI tasks to be used in our third research year.
The goal of the third year research was to investigate differences between students studying theater compared to music, and between performing arts students and non-performing arts students. We identified a group of students in each of these categories. Based upon our prior years' research, we developed a verbal version of the Uses of Objects task that could be administered in an fMRI experiment, and developed a fine-grained version of our analogy generation task that could be conducted in a neuroimaging context. Based on our first two years of research, we predicted that we would observe differences between our groups of participants at both the behavioral and neural levels and could also determine whether differences between the groups were due to inherent genetic differences, or experience with a particular performing arts field. Postdoctoral fellow James Nelson, and graduate student Adam Green, were actively involved in this research. The third year research was conducted at three main levels:
Administering a cognitive test battery to the performing arts and non-performing arts students. The battery consisted of working memory tasks (backwards and forwards), analogy task, Uses of Objects task, language proficiency task, and a general background expertise questionnaire (based in Ericsson's work and also similar to those used by Petitto and Jonides). We tested more than 60 students (3 groups of 20 students; performing arts theater, performing arts music, and non-performing arts students).
Obtaining buccal swabs (i.e., saliva) from this set of 60 students for DNA genotyping. The DNA genotyping focused on a small number of polymorphisms (small changes in sequence) of key genes that are markers of cognitive differences (DRD4, DRD5, MAOA, COMT, 5-HTTLPR, SNAP-25, 5HT1B). The goal of this part of the research was to determine if the performing arts students differ in terms of genes known to be related to the types of psychological traits—such as attentional control and temperament—that are hypothesized to be important in performing arts students.
Conducting an fMRI study of students that we have both genotyped and tested behaviorally on our test battery. We imaged 30 students (10 in each of our 3 groups). The two tasks that we used in the 2006-2007 year were our modified Uses of Objects task and our analogical reasoning task. We hypothesized that we will see differences in activation in key brain areas, such as the frontopolar cortex, and anterior cingulate cortex.
A total of 60 participants completed the behavioral session and had buccal swabs taken for genetic analysis. Twenty participants (10 male, 10 female) were in each of three subgroups—those with theater training (average age 20.9, range 18-25), those with music training (20.1, 18-22), and those with no or minimal performing arts training (20.6, 19-22). Performing arts students were all receiving professional training, and had at least 4 years of such training and 10 total years of experience; non-performing arts student were not currently receiving training or practicing and had not had professional training, at least from age 14 to the time of the study.
Behavioral Session
In a behavioral testing session, all participants completed the following tasks: Shipley Vocabulary (Shipley, 1940), WAIS-III Digit Span Forward and Digit Span Backward sub-tests (Wechsler 1997), an in-lab multiple choice Analogy Completion task, the Group Embedded Figures Task (O'Leary, et al. 1980), a 4-item written version of the Uses of Objects task (Hudson, 1967), and a questionnaire verifying and detailing their educational background. These tests were given in rotating order; the questionnaire was always given last. At the end of the session, participants gave a buccal swab sample for genetic analysis, described later.
Two planned t-tests were done for each test score: a comparison of performing arts (PA) students vs. non-PA students, and a comparison of music vs. theater PA students. While there were no significant differences between PA and non-PA students, music students had significantly better performance on the Backward Digit Span task than theater students, and theater students had a strong statistical trend towards higher divergence scores on the Uses of Objects task (number of non-standard uses listed for all objects). See Table 1. Participants with music training showed greater ability to manipulate items in working memory, while those with theater training showed a tendency towards more divergent thinking.
DNA Genotyping Research
Buccal samples are being analyzed for genetic polymorphisms on a sample of genes thought to be associated with attention and cognition (e.g. Fosella, et al. 2002; Fan, et al. 2003) or to influence participation in a performing art (Bachner-Melman, et al., 2005). While analysis is still incomplete (23 participants have not been analyzed), initial results show interesting trends. First, for COMT position 158, the homozygous val/val genotype is prominent in our non-performing arts students (7/12), but relatively rare in performing arts students (3/25). COMT also may be related to scores of divergent thinking from the Uses of Objects task, as study participants who are heterozygous val/met show the lowest mean divergence score (n.s., p<.10). MAOA also shows trends (p<.10) for predicting performance on the Backwards Digit Span task for both Exon 14 and for promoter region polymorphisms.
fMRI Studies:
Divergent and Analogical Thinking
Nine non-PA students, eight music students, and 11 theater students underwent an fMRI session, which alternated two blocks each of an analogy verification task and a simplified Uses of Objects task. Seven participants from each group were entered into the final analysis of the Uses of Objects task (others were eliminated due to excessive movement, or due to artifacts in the MRI data). In this version of the Uses of Objects task, students were given a pair of words, and evaluated whether the first-named object could be used as the second-named object (e.g., Hose, Rope), and rated the object on a 1 to 3 scale (1= "Good use", 2 = "Fair Use", 3 = "Poor Use"). Pairs of words were chosen, based on pilot data, to provide a range of "good" to "poor" uses. Sixty pairs of objects were evaluated, with 4 seconds allotted for each judgment. Thirty fixation trials of 4 seconds length were randomly inserted (with no more than three fixation trials in a row).
For the analogy verification task, participants completed 60 trials, split evenly between valid and invalid analogies, and cross-domain versus within-domain analogies. Six seconds were allotted for the participant to rate each four-item analogy For this analogy task, at the time of writing, only six individuals had been fully analyzed, an insufficient number for meaningful comparison based on group membership or performance.
However, the analyses for the Uses of Objects task are complete. The results comparing the Uses task to fixation trials across all participants are shown in figure 2. Red regions are significant at a False Detection Rate of p<.05 and include bilateral PFC, left parietal, left inferior temporal brain regions, and cerebellar activations. The yellow areas were significant at the much more stringent threshold of Family-wise Error p<.05. Prominent is a peak activation in left dorsolateral prefrontal cortex in Brodmann's Areas 9 and 46 (peak voxel at MNI coordinates x=-56, Y=12, Z=28, 2.36 cubic centimeters volume).
Whole brain contrasts reveal no differences among differing performing arts backgrounds, but a median split of high vs. low divergence scores shows bilateral activation (uncorrected p<.001, >5 contiguous voxels), with right hemisphere activation dominated by an activation in inferior parietal cortex near the right temporal-parietal junction in Brodmann's areas 40 and 43 (peak voxel at MNI 50 -24 16, 1.54 cubic cm volume), and left hemisphere activation scattered among several smaller activations surrounding the left temporal parietal junction.
Further ROI (region of interest) analyses were done on the left DLPFC area identified in the whole brain Task vs. Fixation contrast, and also an area of anterior frontal cortex identified by Green, et al., (2006) that is active during abstract analogical reasoning (MNI:-8, 60, 31; 10mm radius sphere). However, no significant group differences were found in these frontal ROIs, nor were differences found between high and low divergent subjects (figure 3). This difference in results may be due to the fact that we switched from a version of the task where students were asked to generate Uses of Objects to a version of the task where they assessed how well a particular use fits an object.
Year 3 Research Summary and Discussion of Results
The results of our behavioral tasks indicate significant working memory differences between the music students and our other two groups of students (theater and controls). In addition, our DNA genotyping results may indicate that there are genetic differences (in MAOA and COMT) between our performing arts students and the controls. We have already collected DNA from a further set of participants that would allow us to determine whether these differences are statistically significant. Unlike our year 1 results, our year 2 results did not reveal differences between students' brain activity for the Uses of Objects task. We suspect that the differences in our task between the two years are responsible for this outcome. Our analyses of the fMRI data did not reveal differences between the performing arts students and controls. However, our fMRI analyses did reveal significant differences between students who scored high on our test of creativity and those who scored low.
The research conducted by the Dunbar laboratory was concerned with investigating whether there were differences between performing arts students (music and theater students) and non performing arts students. Four main routes were taken to investigate this question. First, we used standardized behavioral tasks such as digit span and the group embedded figures task. Second, we used behavioral tasks that tap the abstract reasoning processes thought to be stimulated by a performing arts education (generation of object uses and generation of analogies). Third, we conducted neuroimaging, using fMRI of students as they performed our behavioral tasks. Fourth, we conducted genetic analyses (DNA genotyping) of our different groups of participants. Overall, we found some differences at both the behavioral and genetic level. At the neural level we found differences between the performing arts students and non-performing arts students in our first year.
In particular we found differences in left hemisphere frontal lobe activation that are consistent with the hypothesis that the performing arts students are more likely to be engaged in the symbolic retrieval than non-performing arts students. When we modified our Uses of Objects task for our year three research, we found no differences in brain activation between the performing arts students and the non-performing arts students. This indicates that it is in the generation of novel ideas, and not the responding to novel ideas, that is the key difference between the two groups.
We plan to analyze the remaining genetic data collected to more definitively determine whether there are differences among our groups at the genetic level. A second avenue would be to increase our sample size, as our sub-group sample sizes are still quite small. A third avenue is to administer the same tasks to a more diverse population in which participants have a wider range of SAT scores and a more diverse socio-economic background. A fourth approach would be to conduct these studies of tasks on a younger population of participants, to determine whether there is a "sensitive period" for the acquisition of the mental processes involved in the performing arts. Finally, we are in the process of developing an epigenetic approach that will allow us to further deliniate potential differences between the performing arts and non-performing arts students.
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Bachner-Melman, R., Dina, C., Zohar, A.H., Constantini, N., Lerer, et al. (2005). AVPR1a and SLC6A4 Gene Polymorphisms Are Associated with Creative Dance Performance. PLOS Genetics, 1(3): e42.
Carlsson, I., Wendt, P., & Risberg, J. (2000). On the neurobiology of creativity:Differences in frontal lobe activity between high and low creative subjects. Neuropychologia, 38, 873-885.
Dunbar, K. N., & Nelson, J. K. (In preparation). Brain based mechanisms underlying the development of expertise in Science.
Dunbar, K.N. & Petitto, L.A. (In preparation). Molecular epigenisis: A new microarray based method for determining the interactions of genes and environment.
Fan, J., Fosella, J., Sommer ,T., Wu Y., Posner, M.I. (2003). Mapping the genetic variation of executive attention onto brain activity. Proceedings of the National Academy of Science, USA, 100, 7406-7411.
Fosella, J., Sommer, T., Fan, J., Wu, Y., Swanson, J.M., Pfaff, D.W., Posner, M.I. (2002). Assessing the molecular genetics of attention networks. BMC Neuroscience, 3:14.
Guilford, J.P. (1967). The Nature of Human Intelligence. New York: McGraw-Hill.
Hudson, L. (1967). Contrary Imaginations, Penguin Books, Harmondsworth, UK.
Green, A., Fugelsang, J., Kraemer, D.J.M., Shamosh, N., & Dunbar, K. (2006). Frontopolar cortex mediates abstract integration in analogy. Brain Research, 1096, 125-137.
Green, A., Kraemer, D.J.M., Fugelsang, J., & Dunbar, K. Frontopolar cortex becomes more active for more abstract analogies. Poster presented at the Cognitive Neuroscience Society (2006).
Green, A., Kraemer, D.J.M, Fugelsang, J., Dunbar, K. Frontopolar cortex and creative thinking: An fMRI study of the Uses-of-Objects task. Poster presented at the Cognitive Neuroscience Society (2007).
Hudson, L. (1967). Contrary Imaginations: a psychological study of the English Schoolboy Harmondsworth: Penguin.
Ishai A, Ungerleider, L.G., Martin, A., & Haxby JV. (2000). Representation of objects in the human occipital and temporal cortex. Journal of Cognitive Neuroscience, 12, 35-51.
Martin, A., Chao, L.L. (2001). Semantic memory and the brain: structure and processes. Current Opinions in Neurobiology, 11, 194-201.
O'Leary, M.R., Calsyn, D.A., Fauria, T. (1980) The Group Embedded Figures Test: a measure of cognitive style or cognitive impairment. Journal of Personality Assessment, 44, 532-537.
Shipley, W C (1940). A self-administering scale for measuring intellectual impairment and deterioration. The Journal of Psychology 9, 371-377.
Wechsler, D.A. (1997). Wechsler Adult Intelligence Scale (3rd ed.). San Antonio, TX: The Psychological Corporation.
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Oct. 15, 2008
NEW HAVEN, Conn. - On Friday, the Bulldogs will race at the National Invitational hosted by Penn State. This will be the squad's final competition of the regular season, and their first appearance at this meet. The men will race at 10:00 a.m. This will be the most competitive meet of the Bulldogs' schedule so far but the team is in good position to take on the challenge after finishing second last weekend at the Murray Keatinge Invitational, led by senior Murat Kayali's fourth-place finish.
This year's competitors at the Penn State National will include Yale's Ivy League rival Cornell, currently ranked No. 5 in the Northeast region USTFCCCA poll and ahead of No. 7 Yale. Cortland State, currently ranked No. 1 among NCAA DIII schools, will also race. Other strong teams include two Mid-Atlantic region squads: host Penn St. (Mid-Atlantic No. 5) and La Salle (Mid-Atlantic No. 6). These teams, however, will all have to contend with Georgetown, currently ranked No. 8 in the national NCAA poll.
At this meet last year, La Salle won the men's team title with a score of 62, while Oklahoma came in second with 89. The top individual finisher over the 5.2-mile course was Marcharia Yuof, who competed unattached.
Results will be posted on the Penn State Athletics website and the Yale Athletics website at the conclusion of the day.
Report by Bevin Peters '09, Yale Sports Publicity


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Dynamic, chilling, and captivating, Crimes and Punishments is a groundbreaking investigation game that you control. You'll take on the role of Sherlock Holmes in a realistic and finely detailed environment filled with criminals and clues. It is up to you to gather evidence over six different cases, and to question and analyze every place and person you meet. Use Sherlock's amazing detective skills to examine countless details within each scene, and see the connections come together inside Sherlock's brain! Write your own story with a variety of moral choices and outcomes. Each case has up to 8 different endings.
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text: Experience more than 2,000 years of cultural heritage at the Allentown Art Museum. This vibrant cultural center offers an exceptional schedule of exhibitions, a world-class collection, programs for visitors of all ages, and a distinctive Museum Store. The permanent collection includes superb European Renaissance and Baroque paintings and sculpture, American paintings and sculpture from the last three centuries, Southeast Asian sculpture, international textiles, decorative arts, and a library designed by Frank Lloyd Wright. Art Ways, the Museum's interactive family gallery, is themed to major exhibitions and offers a "please touch" area where families can enjoy making art together. Open Wednesday through Saturday 11 a.m. - 4 p.m. and Sunday Noon - 4 p.m.


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Keeping the Faith: Family History Research in Nashville's Religious Archives
Saturday, November 7, 2009, 9:30 am – 4:00 pm
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The cost is only $5.00 and includes a boxed lunch. Speakers include McGarvey Ice (Disciples of Christ Historical Society); Taffey Hall (Southern Baptist Historical Library and Archives); Greg Poole (Episcopal Diocese of Tennessee); Jim Havron (Tennessee Methodist Conference Archives); Jim Hoobler (Downtown Presbyterian Church); Carol Hansen (Church of Jesus Christ of Latter Day Saints Family History Center); Mary A.E. Dickerson (African American Records); and Annette Ratkin (Jewish Federation Library and Archives). To register, complete the lower portion of the informational flyer and mail, along with $5.00 for lunch, to Taffey Hall / SBHLA / 901 Commerce Street, #400 / Nashville, TN 37203. Registration deadline is October 23.
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Call of Duty®: Advanced Warfare, developed by Sledgehammer Games (co-developers of Call of Duty®: Modern Warfare® 3), harnesses the first three-year, all next-gen development cycle in franchise history. Call of Duty®: Advanced Warfare envisions the powerful battlegrounds of the future, where both technology and tactic have evolved to usher in a new era of combat for the franchise. Delivering a stunning performance, Academy Award® winning actor Kevin Spacey stars as Jonathan Irons - one of the most powerful men in the world - shaping this chilling vision of the future of war.
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--- a/OSSEval/OSSEval/utils.py +++ b/OSSEval/OSSEval/utils.py @@ -5,8 +5,6 @@ # OSSeval is powered by the SOS Open Source AGPL edition. # The AGPL requires that you do not remove the SOS Open Source attribution and copyright # notices from the user interface (see section 5.d below). -# Commercial licenses are available and do not require any SOS Open Source attributions -# or visible copyright notices but they are not permitted under this license. # OSSEval Copyright 2014 Bitergium SLL # SOS Open Source Copyright 2012 Roberto Galoppini


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Personal Perspective: The Tigers Outside My Window
I arrived in the U.S. in 1999 after being separated from my husband for three years. The marriage wasn't working -- he spent too much time and money drinking with his friends. When I spoke up about it, he became more and more abusive. Then he hit me and I decided to leave him. I didn't want my son growing up in this environment. I spoke with a cousin who was living in Chicago and she helped me get a one-way ticket there. I had studied nursing in the Dominican Republic and my goal was to certify myself as a nurse in the U.S.
But in late 2001, I began to feel very tired and noticed I was losing weight. I got tested for everything and the doctor even did an HIV test, although he said it was not something I needed to worry about since I had only had one man and never used drugs. Plus, he said people in my age group weren't at risk -- I was 47. When I came back for what I thought was a simple follow-up visit, I was told that I had HIV. My doctor referred me to a hospital that he felt would be able to help me better than he could. But I had developed a relationship with my doctor -- he took care of my son and my cousin. He also spoke Spanish and his office wasn't far from where I lived -- all of that made me feel at ease.
So when I went to the hospital, I felt lost. It was large and there weren't any doctors who spoke Spanish. Each time I went I'd see a different doctor and get a different interpreter. And there were times that I was told I couldn't be seen because there weren't any interpreters available. It was also difficult to communicate with my case manager -- she didn't speak Spanish and I had to rely on an interpreter, when one was available. But I felt I didn't need any social services, anyway. I was taking care of myself -- I decided not to waste my time. I began taking HIV medications and didn't have any problems. I had read that people had problems but I guess I was one of the lucky ones.
But then, my doctor asked that I be admitted to the hospital, and I didn't understand why. Little did I know that I would end up in the psychiatric unit for observation. The entire time I was there I had psychiatrists, interns, students, and residents asking me all sort of questions: "Are you hearing voices now? Do you hear voices inside your head, or outside? What type of voices do you hear? Have you tried to hurt yourself or others?" I responded "no" to everything. When I got out a couple of days later, no one took the time to explain why I had been admitted.
A couple of years later, a case manager introduced himself at my doctor's office. He seemed friendly so I decided to stop by and see what he had to say. We talked about how I was feeling and he asked if I would see him each time I had a doctors appointment. It soon became routine.
But the next couple of times I saw him he began to ask me those same questions I was asked when I was in the psychiatric unit. I again said that I had never heard voices in my life and that I was perfectly fine. He continued to ask if I had still heard "tigres" by my window. I said no, since I now lived on the third floor. He asked me if I heard any other animals. I was confused at first, but then I told him that "tigres" aren't animals. I explained that when Dominicans say "tigres" we are referring to young men and not any sort of animal. He asked, "So it was young men making noise at your window late at night and not tigers?" I said "Yes, they (los tigres) wouldn't let me sleep."
He then asked me if I was taking my medications. I told him I rarely missed a dose. He asked if I took my medications orally or if I had taken hot baths with the medication. I mentioned that before starting my medications, I had decided to take a medicinal bath. It was a belief instilled in me as a child, a custom I had learned from my grandmother. She was an herbalist, a spiritualist and a "curandera." We mixed our medications and herbs in a hot bath before taking them -- it was her belief that it allowed us to take medications without any problems.
The social worker seemed to understood now. He told me that my medical history belonged to me, and that it might be useful for me to request a copy. He said it would help me understand why I was placed in the psychiatric unit. When we read it, I learned that soon after I began to take my medications, one of the doctors wrote that he suspected I was "mentally retarded" or had a psychiatric illness because I was using the medications in a hot bath, when in fact I had only done this once to get my body accustomed to them (and I feel that it has worked wonders for me -- I have never had any side effects). In a later note, it mentioned that I was "hearing tigers at my window," so I was being put under psychiatric observation to rule out hallucinations, delusional ideations, or schizophrenia.
It was funny in many ways, and good to finally put all the pieces together. My case manager explained to my medical providers that I really didn't have a mental health problem, or much less that I was mentally retarded. I was doing all I needed to take care of myself, and the results of that could be seen in my viral load and CD4 counts. They had improved significantly in the first few months after I began taking medications.
I've learned that there is a need to have providers and interpreters who not only speak your language but who also are sensitive to your beliefs, customs, and culture. Sometimes it's not enough to have a person that speaks your language -- you need someone who can understand the terms and words you use. If they don't understand, they should be able to ask.
I've also learned to use different Spanish words that the interpreters can understand. There aren't many Dominicans in Chicago and none of the interpreters were familiar with the terms we use. I've since become involved with a health care interpreters project at the hospital, to allow them to include terms that might be misunderstood. I feel so much better knowing that I'm helping people so that the same thing doesn't happen to others.
And I was finally able to get certified as a nurse.
Want to read more articles in the Spring 2009 issue of Achieve_? Click here._


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Welcome to IGE+XAO Group's investors section
We are pleased to present this section dedicated to all current and prospective shareholders, to financial analysts or anyone waiting information:
Through this section you will find:
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Through all this information you will realize our willingness to communicate with the financial community but also the fundamentals which make the force of our of our Group:
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All that is left now is to wish you good reading...
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Temporary staffing has become an integral part of the German labour market and has been gradually deregulated from 1985 onwards. Especially in the last decade the country has developed one of the most attractive and buoyant staffing industries in Europe although it remains more fragmented than its French or Dutch neighbours.
As Europe's largest economy, Germany has a strong focus on manufacturing and industries with the metal and electrical sector being a major client to temporary employment agencies. Professional and skilled labour has also grown in demand, making the recruitment market a diverse one. Influential collective agreements and the temporary employment act shape the legal framework of the German staffing market, which is the fifth-largest in the world based on revenue.
The German jobs market proved to be one of the most resilient during the recent recession. Employment is high and unemployment is comparatively low, but an acute skills shortage is posing a threat to companies in the country.


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MenusCall to Book: 01245 408 820
One of the oldest pubs in EssexThe Galvin Green Man pub is thought to be one of the oldest pubs in Essex dating back to 1341, with a roaring fire, beams and well stocked bar serving locally brewed craft beers, it is a great place to come in from the cold and enjoy classic pub dishes such as Galvin deluxe burger or a hand-made pie. Dogs are welcome.
The restaurant, housed in a stunning glass orangery, serves modern British seasonal food against a panoramic backdrop of the meadow, beer garden and the river Chelmer in one direction and into the kitchen in another. Two huge roaring woodburners provide a warm respite from the winter weather.
Please note that our menus change daily so these are sample menus. If you have any allergies, please let us know in advance. We have an allergen menu available on request.
Signature Dishes


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Valencia striker Roberto Soldado says his side are confident of knocking Chelsea out of the Champions League when the pair meet at Stamford Bridge on Tuesday night.
The Spanish striker, who scored a hat-trick last-time out in the Champions League against Genk is aiming to gun down The Blues and confirm their passage to the last-16.
And Soldado believes Chelsea's problems in Europe can be exploited.
"Valencia are very confident and we will arrive in London believing that we can win this game and qualify," he said.
"We know that we only need a draw to get through, but we will be going for a win.
"That is because we know that Chelsea have a mental block when it comes to the Champions League.
"Chelsea are under so much pressure that we feel that the nerves will get the better of them when it comes to the crunch.
"They have been all over the place in the last few weeks, but looked a little better against Newcastle United."
Soldado has been heavily linked with a move to Liverpool in the January transfer window.
With Luis Suarez having played almost non-stop for most of the year, Liverpool could reportedly be tempted to splash our for Soldado to allow Suarez to have a rest.
With Andy Carroll currently misfiring, the Anfield club have been linked with a £20 million fee for the 26-year-old.


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- Tournament will be double elimination.
- Matches will be FT2, 3 Rounds.
- Losers/Winners Finals will be FT3, 3 Rounds.
- Running into disconnects or other problems mid match? The person responsible will lose the round.
- The player coming from losers finals into grand finals will have to Win two First to three sets to win the tournament.
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The headlines about the storm approaching Georgia include a tinge of panic and wonder, but the view from Monty Hamilton's Atlanta office is of streets calm and empty.
Hamilton is the CEO of Rural Sourcing Inc., a domestic IT services company based in downtown Atlanta. He reported Tuesday afternoon that it was raining, but the streets were mostly deserted as weather reports forecast freezing rain and power outages.
"It's pretty vacant right now," said Hamilton, who said the city and state were doing a lot to prepare for the storm. That's in contrast to two weeks ago when a storm paralyzed the city with several inches of snow, leaving many stranded, including Hamilton.
"We didn't prepare for it, and we didn't take it seriously, so there was a little bit of over reaction at this point in time," Hamilton said.
In advance of the latest storm, the headline writers were loaded with flare. USA Today blared, "South braces for 'mind-boggling if not historical' storm," while the Christian Science Monitor observed, "Atlanta's a ghost town ahead of winter storm." The hometown paper, the Atlanta Journal Constitution, was the most ominous of all, declaring, "Winter storm 'could be even worse' than 2000 storm that left thousands in dark for days."
In the last storm, Hamilton said when he saw the roads gridlocked at noon he waited until 5 p.m. to leave. It took him until midnight to get home, and he had to walk the last five miles. Normally, his commute is 20 minutes.
Rural Sourcing's staff will continue to be productive despite the weather. Emergency officials urged employers to have their workers telecommute, and that's what RSI will doing to continue to deliver services to clients. The company also has remote service centers in Jonesboro, Ark., and Augusta, Ga. All the offices, including the downtown Atlanta building, have backup power.
About 25% of RSI's staff came into the office Tuesday, mostly those who either live close to the office or rely on rail mass transit, Hamilton said.
For those stuck at home, "everyone has the capability to dial into clients from home, presuming there is power," he said.
Meanwhile, President Obama has already signed an emergency declaration for Georgia, while Atlanta Mayor Kasim Reed has been tweeting away, warning Atlantans that hundreds of thousands may be without power for days, and urging local residents to "telecommute where possible."


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Renewable Resources
The term renewable energy generally refers to electricity supplied from renewable energy sources such as wind and solar power, geothermal, hydropower, and various forms of biomass. These energy sources are considered renewable sources because they are continuously replenished on Earth.
The Clean Energy Finance and Investment Authority (CEFIA) offers incentives and innovative low-cost financing to encourage homeowners, companies, municipalities, and other institutions to support renewable energy and energy efficiency.
Wind Power
Harnessing the power of the wind is smart, clean and relatively cheap. Europeans have been using wind power for centuries. In the United States, farmers have used small windmills for many years primarily to pump water used for irrigation and drinking or to grind grain.
{Grasso Technical School turbine}
Grasso Technical High School Turbine
The science is simple: First, you need wind which, granted, is not in abundance everywhere. That's why engineers have created enormous propeller-like blades - some a hundred yards long - that capture even the slightest breeze. Wind farms utilize hundreds of these aerodynamically advanced windmills -- comprising composite materials and sophisticated electronics - to rotate blades and turn generators, producing bulk electrical power. Larger wind farms tend to be built in the plains, on hills and on mountains, and several states are now installing them off-shore. The electricity they produce is typically fed into the local utility grid for public and private consumption.
Smaller versions of these large rotors are available for residential use; a small home-sized windmill has rotors between eight and 25 feet in diameter and rises 30 or more feet. It can supply the power needs of an all-electric home or small business, and uses batteries to store electricity during those "dog days" when not a single breeze blows.
One of the drawbacks of wind power is that it can take an awful lot of windmills to generate enough electricity to meet our needs. Some people feel these massive wind farms are scars on our earth. In our region, attempts to build wind farms at offshore locations have been met with great opposition.
Geothermal Power
We can utilize the natural heat inside the earth to generate energy from an efficient, renewable and cleaner source. Geo-exchange technology has been utilized since the late 1940s. While many parts of the country experience broad seasonal temperature extremes - from scorching heat in the summer to frigid temperatures in the winter - the temperature a few feet below the earth's surface remains relatively constant. This ground temperature is warmer than the air above during the winter and cooler in the summer.
{Geothermal wellhead}
A geothermal wellhead
Photo Courtesy of DOE/NREL
Geothermal heat pumps (like the one pictured above) take advantage of this by exchanging heat with the earth. They are able to heat, cool and, if properly equipped, can even provide hot water. They use fans and compressors and are quieter than air-source heat pumps, though many systems combine air-source and geothermal-source pumps for added efficiency.
Geothermal systems are more expensive than standard air-source systems, but the additional cost can be realized in savings over five to ten years. Only 40,000 to 50,000 geothermal units are installed in the United States annually, but the word is getting out that it's a smart alternative.
{Solar panels on roof}
Photo Courtesy of DOE/NREL
Hydro-electric generation was once a staple wherever there was a river or fast-moving stream. Even today, enormous dams are being built across the world to rival the wonders of great U.S. civil engineering feats like The Grand Coulee and Hoover dams. In the northwestern United States, on the Columbia River alone, there are 14 major hydro-electric-producing dams in the U.S. and in Canada generating enormous amounts of electricity. Niagara Falls is the site of a powerful hydro-electric station, for example.
Even Connecticut has many small public- and privately owned hydro-electric facilities adding electricity to the regional power grid.
When it comes to producing electricity from water, the bigger the drop, the better the pop. That's why you wont find many hydro facilities in Kansas. The concept is simple: Water drops down or over propeller-like blades connected to a turbine. The turbine is connected to a generator by a metal shaft - when everything moves, electricity is generated, redirected or stored.
Consumers can choose to purchase all or a percentage of their electricity through these more natural and cleaner "green" production sources, and can even elect to produce their own electricity if they have the water rights and inclination.
Biomass Power
Creating energy from biomass - the generic term used for wood, garbage and all kinds of bulky waste that can be burned to create steam, heat and electricity - has gained popularity as an alternative to burning typical and expensive fossil fuels and a smart way to reduce dumping and adding to already over-burdened landfills.
Burning wood, of course, has been a heating and cooking staple since the days of cave men and cave women. Depending on where you live, it's still relatively easy to gather, though time consuming and bulky. It also has to be stored and cured for maximum efficiency, although aged wood can be easily purchased and delivered to your home. Modern stoves are far more efficient than stoves of the past, and wood can be purchased as small, concentrated pellets, making handling and storage easier.
Agricultural waste can become energy.
Photo Courtesy of DOE/NREL
Many manufacturers and utility companies burn waste products for energy and heat - everything from garbage and wood byproducts to waste oil and even sewage sludge - but burning has to be carefully monitored to ensure that dangerous pollutants are not released into the atmosphere or allowed to contaminate water sources. As additional motivation, the State has stepped in to offer tax incentives and grants, and excess electricity produced through these alternative energy sources is often sold to electric companies and added to the regional power grid.Additional Information
Solar Power
The sun is perhaps the most powerful energy source we know. And it's a renewable source, because the sun should be around for another 5 billion years or so.
{Solar panels}
Photo Courtesy of DOE/NREL
We have long known the secrets of passive solar heating, which is as simple as letting the sun shine in to warm our homes, businesses, pools and water. That type of heating energy can be made more efficient by using architectural and construction techniques in buildings and homes to make best use of the sun's rays during the day.
Active solar heating is also somewhat common. You've probably seen (or maybe have) big solar panels up on rooftops. We can install these photovoltaic, or solar cells, to capture the sun's rays and convert them to electricity, which can be used immediately or stored for later use. Residential solar systems are used to heat water and homes, and large, industrial-sized versions of this technology produce heat which converts hot water into steam, turning turbines that generate electricity.
Solar power is clean and we'll probably never run out. But it's very expensive to turn the sun's rays into enough usable energy for larger applications. Active solar heating may best be used as a way to supplement other fuels.
Renewable Portfolio StandardA renewable portfolio standard (RPS) is a state policy that requires electricity providers to obtain a minimum percentage of their power from renewable energy resources by a certain date.
In Connecticut, the RPS requires that by 2010, 7% of power in the state will be from renewable resources and 23% by 2020.
Content Last Updated November 2012


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State Rep. Carol Alvarado, D-Houston, retracted her blistering letter to the Susan B. Komen Foundation Founder Nancy Brinker on Friday moments after the organization changed its tune on funding for Planned Parenthood.
The Komen Foundation attracted widespread condemnation earlier in the week after it was revealed the group stopped Planned Parenthood funding for breast exams for low-income women. Some conservative critics oppose Planned Parenthood because three percent of its services involve abortion procedures.
"Our original desire was to fulfill our fiduciary duty to our donors by not funding grant applications made by organizations under investigation," the Komen Foundation said in a statement Friday. " We will amend the criteria to make clear that disqualifying investigations must be criminal and conclusive in nature and not political. That is what is right and fair."
Alvarado responded: "The Susan B. Komen Foundation has proved once again why they have always been a great partner in the women's health community. I am grateful to the leadership of Komen, specifically Ambassador Brinker, for her undeniable commitment to the promise she made to her sister so many years ago. I look forward to our continued work together.
Today's reversal of their earlier policy decision is a great step towards repairing the relationship between Komen and Planned Parenthood. I believe that together, these two groups will continue to battle breast cancer through education and prevention for women of all ages, backgrounds, and incomes."
Komen's earlier decision to stop funding Planned Parenthood's breast exam services for low income women triggered fierce opposition. Here are a few samples
From the New York Times editorial page:
With its roster of corporate sponsors and the pink ribbons that lend a halo to almost any kind of product you can think of, the Susan G. Komen for the Cure foundation has a longstanding reputation as a staunch protector of women's health.
That reputation suffered a grievous, perhaps mortal, wound this week from the news that Komen, the world's largest breast cancer organization, decided to betray that mission. It threw itself into the middle of one of America's nastiest political battles, on the side of hard-right forces working to demonize Planned Parenthood and undermine women's health and freedom.
From The Mercury News editorial page:
The Susan G. Komen Foundation revealed its true colors Tuesday, and there wasn't a hint of its trademark pink in sight. Komen put red-state, right-wing politics above low-income women's health, pure and simple, with its decision to stop giving money to Planned Parenthood to pay for breast cancer screenings.
It could be the most cowardly act by a health foundation in U.S. history


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Cadets are heavily involved in academic and cadet activities Monday through Friday.
Most weekends are left free for cadets to take passes or leaves. Those required to remain on campus for disciplinary reasons perform cadets duties throughout the weekend under the supervision of GMC cadre.
Exceptions are weekends just prior to mid-term examinations and one weekend in the Fall when college alumni are welcomed back to the campus for a full weekend of parades and orientations. All cadets are required to remain on campus during these "closed" weekends to prepare for examinations and support campus-wide activities.
Cadets involved in various clubs (such as Drill and Ranger Challenge teams) and those playing varsity football may take part in various weekend competitions during the school year.


text: Founded in 1990 in Seattle, Washington, Cutter & Buck is a go-to store for golfers looking for the most elegant, refined apparel and accessories. Since building its reputation throughout the '90s, the brand has become renowned for its sophisticated, moisture-wicking, quality clothing that look and feel at home both on and off the golf course. Look to the latest Cutter & Buck T-shirts for smart, elegant designs that can be worn everyday. Expect sports team branded shirts, golf polos and relaxed round-neck T-shirts, all underpinned by high-performance, sumptuously soft fabrics.


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Central Kansas motocross series visits Marion
Motocross racers buzzed in from out of state and all over the state of Kansas Sunday to compete in the 10th round of the Central Kansas Motocross Series at Green Acres Motocross Park in Marion.
Racers from the Marion County area who chased the checkered flag and placed in their respective classes were:
- Conner Van Curen of Peabody, 5th, 250 C Novice; 4th, PP+5 class; and 2nd, School Boy (-17years/80s-125s).
- Taven Scott of Peabody, 5th, 85cc Jr. (7-11).
- Kimber Hardey of Marion, 3rd, Open Women.
- Blane Bernhardt of Hillsboro, 1st, Trail Bike Beginner.
- David Rose of Canton, 4th, Vet C Novice (30+/125cc+).


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Secretary General of Egypt's Supreme council of Antiquities(ESCA) Zahi Hawwas slammed statements by British Professor Barry Kemp and Professor Jerry Rose, of the University of Arkansas, USA, distorting the history of pharaonic King Akhenaten and the construction of his city in Amarna.
Enough of this talk! Zahi doesn't like what we're saying.


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About Parisi Images
Parisi Image is a Cincinnati photography studio owned by award-winning photographer Sarah Parisi Dowlin. We offer purposeful photography to shape, share and celebrate the stories of your life, business and brand. Specialties include: custom photo content for workplace and business; hands-on photo coaching for small businesses owners; wedding and portrait photography; plus editorial work.


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Please note: You are viewing an archived Bucknell University news story. It is possible that information found on this page has become outdated or inaccurate, and links and images contained within are not guaranteed to function correctly.
With only a few weeks remaining before the Affordable Care Act's March 31 enrollment deadline, Bucknell students are pitching in to help uninsured Americans seeking coverage through the federal exchange website sign up.
A total of 19 students and four professors (Carl Milofsky, sociology; Brandn Green, sociology; Neil Boyd, management, and Eric Martin, management) have been accredited as certified application counselors through the Columbia County Volunteers in Medicine Free Clinic and the Centers for Medicare and Medicaid Services, enabling them to provide one-on-one assistance in signing up for health insurance on the federal health exchange website.
Green and Milofsky have also been certified by the Pennsylvania Health Access Network (PHAN) to give presentations explaining the act and the enrollment process to groups.
Each week, students spend several hours helping health-care seekers enroll through the federal exchange website, healthcare.gov, in community settings like the Volunteers in Medicine Free Clinic in Mifflinville and The Public Library for Union County in Lewisburg.
Certified application counselor and Bucknell senior Gia Ciccolo said healthcare.gov has proven as challenging to use as media commentators have made it out to be, and she believes the help she and her classmates are providing is needed.
Ciccolo has aided only one family enroll for insurance thus far, but she said that process took five hours and required several calls to the website's customer service line.
"What we're learning is that it's not that easy, even if you're good with computers," she said. PHAN Director Antoinette Kraus said Bucknell may be the first university in Pennsylvania to actively aid students in becoming certified application counselors.
PHAN is helping students gain certification at two additional institutions, Shippensburg University and Dickinson College, and Kraus said those efforts were inspired by Bucknell.
"In Pennsylvania, Bucknell is leading the way in working with students to increase on-the-ground enrollment capacity in rural communities," Kraus said. "We are excited to hear the results at the end of this open-enrollment period." Milofsky said he also is working with colleagues at Bloomsburg University to create a program based on Bucknell's organizational model.
Their efforts are in demand locally and throughout rural Pennsylvania, Milofsky and Green said. As many as 250,000 central Pennsylvania residents may be eligible to buy insurance on the exchanges, Milofsky said, but organizations in the area have done little to aid or advertise the exchange rollout.
Pennsylvania spent a total of $2 million to advertise sign-up opportunities, Green added, all of which went to groups in the state's major cities. Oregon, by contrast, spent $14 million on statewide television advertisements alone.
"Rural areas are often forgotten and overlooked segments of the American landscape," said Green, director of the Place Studies Initiative. "The ACA rollout in central Pennsylvania has followed that pattern."
Political challenges and the glitches suffered by the exchange website have also made many Americans averse to learning more about the law, Milofsky said, making the students' efforts all the more important.
"We mostly look at survey data, and the main thing is that people just have absolutely no idea what's going on," he said. "It's extremely complicated, and you have all of the political conflict going on around it which makes people just not want to deal with it. And because of that they're not getting information."
Milofsky and Green believe their students can learn from face-to-face engagement with residents of surrounding communities, and have given student application counselors the chance to conduct field research and earn course credit through their work. Eight students have enrolled in SOCI 351: Field Research in Sociology, and are recording field notes about their work in preparation for a final project report.
"This provides us an opportunity to research a fundamental change to social welfare in the U.S., to strengthen our relationship with community agencies working on health and to expose students to the nature of the health care system in a novel way," Milofsky said.
To further larger research projects, the students will also conduct follow-up interviews with clients and host focus group discussions with private insurance agents working to enroll individuals through the exchanges.
Ciccolo is one of the students earning credit for her work. She said the experience has already opened her eyes to difficulties faced by many in rural central Pennsylvania. "I'm from Boston, so I know about urban health problems, but I didn't realize the different issues that people in rural areas run into, like not having access to health care because they live so far away from providers," Ciccolo said.
Millions of Americans will surely remain without health insurance after the March 31 deadline to enroll for Obamacare without financial penalty, and the need for assistance in surrounding communities is unlikely to abate any time soon. Milofsky, Green, Boyd and Martin hope to make enrollment assistance an annual activity, similar to the aid accounting students provide citizens in filling out their income taxes.
"It has been striking to me how many students have wanted to participate outside of the class structure," Green said. "They think it's important and interesting work."


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Account Forecasting in Balance
This is for the freelancers out there. Sometimes a large business package is not what you need -- and you get bogged down trying to make it work. Mindwarp Consultancy has rolled out "Balance Guide", providing quick ongoing forecasting for less demanding accounting. May 25, 2011