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Top Docs
Meet our 2010 Top Hospitalists.
Welcome to our third annual Top Hospitalists issue. Our requests for nominations—sent out last spring and summer—asked for hospitalists who are making notable contributions to the field, whether through clinical skills, innovation, community involvement, improved work flow, patient safety, research, teamwork, leadership, mentorship or quality improvement. Readers enthusiastically responded to the charge: This year we had the largest number of nominations yet. We heard from supervisors and peers, administrators and mentors. The breadth and depth of candidates spoke to the impressive work being done in U.S. hospital medicine, making the decision to pick only 10 far from easy.
ACP Hospitalist's editorial board members reviewed the nominations and selected the Top Hospitalists, who are profiled on the following pages. These physicians are innovators and teachers, mentors and researchers, leaders and hospital medicine pioneers. Some have distinguished themselves by helping younger physicians get ahead, while others are making great strides in patient safety and care transitions. All have contributed enormously to the field of hospital medicine. We're excited to recognize the work of these extraordinary individuals. We hope you enjoy reading about them—and we look forward to receiving your nominations for next year's honorees.
(ACP Hospitalist's Top Hospitalist feature is not considered part of the ACP National Awards Program.)
Successful office practice opens door to second career as hospitalist
Thomas M. Braithwaite, FACP
Age: 54
Medical school: University of South Dakota School of Medicine, Sioux Falls, S.D.
Residency: University of Iowa, Iowa City
Current titles: Associate professor of medicine, Sanford School of Medicine, University of South Dakota (USD), and medical director, Sanford Clinic Hospitalists, Sanford USD Medical Center, Sioux Falls
If hospital medicine had been a career option in 1985, Thomas M. Braithwaite, FACP, would have signed up right out of residency. As it turned out, he's confident he's had the best of both worlds—18 years of private practice followed by a chance to build a hospitalist program from the ground up.
"I loved general medicine; I didn't leave because I was burned out or frustrated," said Dr. Braithwaite, who left his Sioux Falls internal medicine practice in 2003 to help develop and run a hospitalist program at Sanford USD Medical Center with then-colleague Robert Houser, ACP Member. "I was just very excited and intrigued by the hospital environment. I loved the acuity and working with patients and families in crisis. That's my fuel."
Under Dr. Braithwaite's leadership, Sanford's program has grown to 12 hospitalists with plans to expand to 16 by the end of this year. While working a full clinical schedule, Dr. Braithwaite created compensation and incentive programs, modified work schedules and established the hospitalist program as the primary teaching service for USD.
"He worked tirelessly to develop the foundations of the program as it currently exists," said Ken Aspaas, ACP Member and Sanford's chief medical officer, who recruited Dr. Braithwaite to start the hospitalist program. The two were once partners in the same private practice.
One of his first priorities as medical director was to "cement the group's value to the hospital and the region," said Dr. Braithwaite. That meant integrating hospitalists into the strategic structure of the hospital and establishing a leadership role in quality efforts and protocol development.
Dr. Braithwaite now chairs the hospital's clinical practice committee, a multidisciplinary group whose past initiatives include developing an inpatient anticoagulation service to standardize practice across the hospital.
"We now have written, set protocols so that patients are treated in the same way," said Dr. Braithwaite. "By having one team managing the majority of anticoagulation, we are beginning to reduce complications."
At the same time that Dr. Braithwaite was working overtime to build a sustainable program, he faced even tougher challenges in his personal life. Seven years ago, he was diagnosed with non-Hodgkin's lymphoma. Chemotherapy pushed the disease into remission for five years but he's since relapsed twice and last summer underwent a stem-cell transplant, forcing him to step down as director and take a medical leave of absence.
Years of dealing with a serious illness changes the way you practice medicine, even if you have always been a caring physician, he said. He's become sensitized, in particular, to "the difficult and excruciating nature of waiting" and to the pain and discomfort caused by many common tests and procedures.
"When you've gone through countless bone marrows and CAT scans and biopsies and procedures you understand, because you've laid there on that cold table, you've had to sit there for hours with your arms above your head in an uncomfortable position, you've had your backside plunged with a needle to have a bone marrow or a spinal tap done," he explained. "All these things that I've ordered countless times, I've been through to some extent."
Working at the hospital has been difficult or impossible at times when his disease flares up, but it is also one of the things that keep him going.
"Having something you feel called to do in front of you is a powerful force," said Dr. Braithwaite. "It's one thing that lets me look ahead when what I'm going through at present is a little dreary and difficult."
Changing behaviors with evidence and information
Damanjeet K. Chaubey, FACP
Age: 48
Medical school: Lady Harding Medical College, Delhi, India
Residency: Danbury Hospital, Danbury, Conn.
Current title: Chief of hospital medicine, Danbury Hospital
Damanjeet K. Chaubey, FACP, is a strong proponent of checklists, but takes issue with how they are often used to treat common conditions like pneumonia, stroke or chronic heart failure. Doctors tend to want to just check all of the boxes, even when it's not necessary, she said.
"Care plan pathways and order sets are not mandatory tests, but are what a patient with pneumonia, for example, might need," said Dr. Chaubey, chief of hospital medicine at Danbury, a 371-bed regional facility and teaching hospital affiliated with medical schools at Yale University, the University of Connecticut and the University of Vermont. "What often happens is you check all the boxes without looking at what really needs to be done or what a patient really needs."
Dr. Chaubey teaches her staff of 23 hospitalists to resist that kind of thinking in order to prevent unnecessary testing and keep costs in check. Along with the hospital's chief medical officer, she was a key member of a Diagnosis-Related Groups (DRGs) cost-efficiency council to delve into what drives the cost of care. By comparing evidence-based recommendations with what was actually ordered for individual patients, the council determined that physicians often order tests reflexively.
"We found that the physicians, including the house staff, were ordering unnecessary testing or blood work," said Dr. Chaubey. "If they wanted to know what a patient's potassium was, for example, they would recheck it even if it was normal the day before. We're subjecting patients to things they don't need."
Better communication and collaboration supported by easily accessible information are key to changing that mindset, said Dr. Chaubey, who is known among colleagues for her ability to build consensus on quality and safety measures.
"We need to train our physicians to think more judiciously and review data, which may be available but scattered around. You have to strengthen systems and make information available to help doctors in their decision making," she said.
Dr. Chaubey worked with the hospital's information technology department to help develop a regional health information exchange that links primary care physicians, specialists and hospitalists across the community. Its aim is to strengthen information exchange during transitions of care.
"If I admit a patient, I can view which prior as well as outpatient testing has been done," she explained. "If this patient just had an echocardiogram or CAT scan, even if it wasn't at our hospital, that information will help in reducing unnecessary testing."
To reduce other physicians' unnecessary use of tests, Dr. Chaubey and her colleagues collected historic data, research evidence and input from specialists. They then solicited feedback from frontline physicians on their prescribing and ordering patterns and provided them with corresponding data on whether or not their decisions were supported by evidence.
"When we provided data and showed them a reason for doing or not doing something, they started to question the relevance of the status quo and became receptive to new ideas," said Dr. Chaubey.
Still, change happens gradually, she conceded. Some physicians resist taking the extra time to think through whether a test is really needed, but most eventually come around, she said: "If you understand the rationale, it will eventually become your normal process."
Dr. Chaubey's quality and safety projects are numerous and varied. Recent initiatives include developing treatment protocols for the hospital's observation unit, which sees about 2,300 patients per year, and developing a new model of work rounds where hospitalists lead interdisciplinary teams of residents, interns, medical students, nurses and case managers in using safety checklists. She also implemented a model for night coverage involving collaboration among hospitalists, physician assistants and house staff, and leads the team providing palliative care services at her hospital.
"I am involved in many safety and quality improvement measures in the hospital," she said. "How to deliver high-quality care in a safe environment in a cost-efficient way is truly what hospital medicine is about."
Instilling appreciation for art of the physical exam
Jasminka M. Criley, FACP
Medical school: University of Rijeka, Croatia
Residency: Vanderbilt University, Nashville, Tenn.
Current titles: Associate residency program director for internal medicine residents and director of inpatient services for graduate medical education, St. Mary's Medical Center, Long Beach, Calif., and associate clinical professor of medicine, University of California Los Angeles School of Medicine
Jasminka M. Criley, FACP, was nearing the end of a busy shift when a 52-year-old man was admitted to the emergency department after being treated for five days at another hospital for asthma exacerbation. Further examination revealed that the patient had acute aortic regurgitation, but doctors had missed the signs early on—apparently because no one had performed a careful bedside exam.
Dr. Criley came to a correct diagnosis by questioning the patient, who admitted that he had felt chest pain. Removing his shirt to perform a chest exam, he revealed a midline chest scar and a diastolic murmur. What had started as a routine asthma case turned into a much more serious dissecting aortic aneurysm requiring immediate surgery—but too late to save the patient's life.
"Once you see something like that you never forget it," said Dr. Criley, who was a young hospitalist at St. Thomas Hospital in Nashville at the time. "It captured for me why I am interested in clinical skills teaching and particularly the cardiac exam."
Years later, Dr. Criley often tells the story during rounds with medical students and residents at St. Mary's Medical Center as a cautionary tale about taking shortcuts, like failing to remove a patient's shirt for a chest exam. She is a strong advocate of bedside rounds and using virtual patients as tools in teaching students how to identify and interpret clinical bedside findings.
Students who witness an unusual case during bedside rounds are much more likely to remember it than if they had read about it in a book, she said.
A recent teaching session was a case in point. Dr. Criley asked a group of residents to find a patient's point of maximal impulse. Two teams of students and residents pointed to the area where the heart should be on the left side of the chest but were surprised when they were told to examine the prominent pulsation on the patient's right side. It turned out that the patient had advanced lung disease causing right ventricular hypertrophy, an enlarged right heart, and right parasternal and subxiphoid heave.
"Often in medicine we think something should be there so we assume it is," said Dr. Criley. "Showing this case at the bedside was extremely useful. A thousand words could not explain what it was teaching, and it will stay with those trainees forever."
Students in Dr. Criley's cardiac examination course also learn that a careful exam sometimes eliminates the need for additional—and costly—tests.
"For a heart exam there are two forks: Figure out if it is benign and doesn't require further testing, or detect and direct the patient on the right road to being diagnosed," she said. "If you spend a little more time, you may not need that chest X-ray or echocardiogram."
Dr. Criley has been involved in many quality improvement projects, including efforts to decrease falls, improve medication reconciliation at discharge, and facilitate handoff communication. She also serves on the hospital's patient safety and utilization committees and helped evaluate and implement a more evidence-based process for ordering brain natriuretic peptide tests.
The best part of her job, however, is the opportunity to teach and mentor students and residents, she said.
"Mentoring is listening and learning what a person's goals are and pulling in resources to help them where they want to go," said Dr. Criley. "It's a lot like patient care—listening and finding out what's important to the patient helps you craft a better plan of care."
Teacher's best reward is seeing students succeed
Jeanne M. Farnan, ACP Member
Age: 34
Medical school: University of Chicago
Residency: University of Chicago
Current title: Assistant professor of medicine and course director for clinical skills and transitions to internship, Pritzker School of Medicine, University of Chicago
Jeanne M. Farnan, ACP Member, feels a surge of pride whenever one of her first-year medical students interviews a patient for the first time or delivers his or her first research presentation. For a clinician-educator like Dr. Farnan, student achievements are tangible proof of a job well done.
"As physicians, the one thing we don't have is a product," said Dr. Farnan, a hospitalist at the University of Chicago (UC) Medical Center. "What is so wonderful about teaching and mentoring is being able to work with someone over the course of time and watch them grow and change and accomplish things."
Since joining the faculty at the University of Chicago's Pritzker School of Medicine in 2006, Dr. Farnan has established a reputation as a valued teacher and mentor for students and residents. One recent student review described her as "one of the best attendings I have worked with on general medicine ... she provided me with the autonomy to make my own decisions while being quietly available at any time if needed."
"I've always had an interest in education," said Dr. Farnan, who started at UC as an undergraduate. While drawn to inpatient care during residency, she wanted to develop a niche in education so enrolled in a two-year hospitalist scholars program in order to combine a fellowship in hospital medicine with a master's degree in health profession education.
She is now course director for the clinical skills curriculum, which is required coursework for first- and second-year medical students on doctor-patient communication and physical examination skills, and the fourth-year transitions to internship curriculum. She co-directs two fourth-year electives: case studies in cross-cover, and the sub-internship clinical case conference. She is also a clinical preceptor for second- and third-year medical students and supervises residents and students on the general medicine ward, among other roles.
In addition, Dr. Farnan is a member of an accomplished research group, collaborating with other faculty at UC including Vineet Arora, FACP, and Holly Humphrey, MACP, in the areas of handoffs and clinical supervision. Their research on resident supervision is the basis for a training workshop for attending physicians on how to be more effective supervisors, which was presented at the 2010 Society of Hospital Medicine and Accreditation Council of Graduate Medical Education annual meetings. They have also created and implemented an innovative curriculum on handoff education and designed a handoff simulation for fourth-year students in preparation for residency.
Dr. Farnan and her team implemented the study "Handoff education and evaluation: piloting the observed simulated handoff experience (OSHE)," published in the February 2010 Journal of General Internal Medicine. She and her team are now helping the University of Michigan and other institutions implement OSHE at their hospitals.
More recently, Dr. Farnan has been investigating how digital media will affect professionalism in the digital age. Her interest was sparked after a medical student posted a music video parody on a website that included the UC and medical school logos, which brought complaints from some alumni and students.
"We made it into an educational project where we tried to assess beliefs that students had about professional responsibility regarding their behavior on the Web," said Dr. Farnan. As a result of that research, discussion of projecting a digital image is now included as part of the first-year curriculum on professionalism. Dr. Farnan is now working on a qualitative study on patient-physician interactions via social media.
Education will always be a common thread running through her research and clinical activities, she said, but working directly with students is her passion.
"Having house staff and medical students around to reinvigorate the entire enterprise here keeps us constantly moving, constantly thinking and reevaluating," she said. "It staves off the complacency one could get if you were just singly focused on your own career."
Teaching residents to count costs
V. Susan George, FACP
Medical school: National University of Singapore
Residency: Saint Vincent Hospital, Worcester, Mass.
Current titles: Director of the hospitalist service, Saint Vincent Hospital; assistant professor of medicine and associate program director of the internal medicine residency program, University of Massachusetts Medical School, Worcester
How do you liven up a potentially dry resident seminar on cost-effectiveness? V. Susan George, FACP, hit upon a strategy that plays into doctors' competitive natures: Make it a contest.
Several times a year, Dr. George moderates a match between teams of residents during morning report at Saint Vincent, a 350-bed community-based teaching hospital. Knowing that residents often order laboratory and radiological tests without an idea of actual cost incurred, she asks the teams to list the tests they would order for a hypothetical patient and add up the costs. The winning team is the one that has the lowest tab, while still ordering the necessary tests to correctly diagnose and manage the patient safely.
"It teaches them that every test they order and everything they do for the patient must be justified by evidence-based medicine," said Dr. George. "There should be no reflexive ordering of labs or radiological studies."
The contest is one of the ways that Dr. George combines her interest in quality improvement and patient safety with her love of teaching. She also conducts monthly patient safety rounds during which she reviews the circumstances surrounding mortality, morbidity or near misses that occurred on the medical service in preceding months.
"I ask them to think about what we did wrong—was it a failure of barrier systems to prevent error, or was it a skill-based or knowledge-based error?" she said. One incident, for example, involved an intern who hesitated to consult the on-call cardiologist on an abnormal electrocardiogram. The incident led to the hospital installing an electronic EKG system that all cardiologists can access from home to confirm whether or not a test is normal.
"Residents often bring up problems with processes that we might not be aware of," she noted. "It helps us to create a safer environment for our patients, and the residents feel like valued members of the team. I always make sure that when we go back over [the incident] the next month, I close the loop by updating them on what we did to correct the problem."
As testament to her teaching skills, the hospital's 75 residents last year selected Dr. George for the John J. McKeever Award, recognizing her as the outstanding medical educator of the year.
"Her evaluation database is populated with enviable comments from students and residents, who perennially rank her in the top 5% of the faculty here," said Anthony L. Esposito, FACP, chief of Saint Vincent's department of medicine and the colleague who nominated Dr. George as a top hospitalist. "Not only is her fund of knowledge and clinical acumen stellar, but she relays information and patient care expertise in a thoughtful, humble and engaging manner."
Soon after joining Saint Vincent Hospital in 2007, Dr. George was asked to help set up a hospitalist program. Under her watch, the program has expanded from two to 10 full-time hospitalists, increased the average number of daily encounters from 20 to 60 patients, and decreased length of stay by 50%. With those results, it's not surprising that she was named 2009 Physician of the Year by the hospital's senior administration and 600-physician medical staff.
As chair of the hospital's Department of Medicine Performance Improvement Committee, Dr. George was instrumental in the hospital achieving nearly 100% compliance on all Joint Commission core measures and implementing standardized anticoagulation, pain control and stroke management programs.
Dr. George has also successfully engaged community physicians and convinced many to sign on with the hospitalist group, in part by emphasizing the importance of communication and customer service.
"I hold my group responsible for holding up our end of the communication," she explained. When a patient is admitted, his or her primary care physician receives a fax alert along with contact information for the attending hospitalist. The attending then follows up to keep the physician informed of the patient's progress, especially at the time of discharge. The primary care physician receives the discharge summary and discharge instructions in real time.
"Once a primary care physician has an unpleasant experience, as in not being involved or informed of their patient's care, they would hesitate to use our service," said Dr. George. "I have to keep reminding my team that we need to provide excellent customer relations and deliver outstanding patient care to stay ahead of the game."
Discharge initiatives shorten LOS, improve transitions
Allen L. Johnson, ACP Member
Age: 46
Medical school: University of Wisconsin Medical School, Madison, Wis.
Residency: Virginia Mason Medical Center, Seattle
Current title: Physician director, PeaceHealth St. Joseph Medical Center, Bellingham, Wash.
Reducing the average length of stay seemed like an intractable problem when Allen L. Johnson, ACP Member, assumed leadership of St. Joseph's hospitalist program about a year ago. Then Dr. Johnson had a breakthrough: What if you could lower the overall average by focusing on the small percentage of patients at the top end of the curve?
"The bulk of our curve is people staying from one to seven days and that isn't going to change much," said Dr. Johnson, who leads a team of 14 full-time-equivalent hospitalists at St. Joseph, a community hospital that is part of the PeaceHealth System with facilities in Alaska, Washington and Oregon. "What became evident is that there are outliers who are here for 20-30 days" who are driving up the average, he said.
Dr. Johnson approached the problem by creating a multidisciplinary discharge group that brought clinicians together with social workers, administrators, ethicists and psychiatrists. The group collaborates on how to handle logistically difficult patients, and patients whose behaviors may lead to difficulties with ongoing care and discharge plans.
One group idea was to craft standard policies for managing patients' behavioral issues that could make their conditions worse and prolong their stays. For example, the group developed a protocol on what to do when an intravenous drug user on IV antibiotics for endocarditis tries to leave the hospital or sabatoges his or her care while in the hospital.
"We've tried to set boundaries that are fair and consistent to try to change that behavior instead of having a doctor come up with different rules every day," said Dr. Johnson.
The group also solves problems with difficult discharge scenarios. In one case, they enlisted a senior administrator to use a higher level of communication to expedite an interstate transfer to another facility.
So far, the group seems to be having an impact. St. Joseph's average LOS has dropped from 4.5 to just under 4 days since the program began.
Dr. Johnson has also introduced a standardized discharge summary to improve the transition from hospital to primary care. The template includes a checklist of 20 elements that were vetted by hospitalists and primary care physicians in a pilot project at St. Joseph's.
"I met with primary care physicians to see what they were looking for and tried to develop a template in response to what they needed at time of discharge," said Dr. Johnson, who worked on the project with PeaceHealth hospitalists in Oregon as part of a four-month PeaceHealth leadership training program. In a post-pilot survey, 64% of primary care physicians said they preferred the new format while 100% of participating hospitalists said it improved patient care.
Dr. Johnson, who spent 10 years as an emergency physician before becoming a hospitalist, is now working with the trauma surgery department on creating a medical trauma team to stratify trauma patients based on specific criteria. The goal is to identify and redirect patients to the medical service who are at low risk for needing surgery, in order to take pressure off the trauma team.
Like many of his projects, the trauma initiative brings together different departments and specialties with a common goal of improving efficiency. Often, said Dr. Johnson, just getting people to communicate is the key to improving care.
"It all feeds into the idea of co-management" and transitions of care, said Dr. Johnson. "A lot of times in medicine, it's the simple things that need to happen, not the complicated or esoteric."
Blood management, preop innovations bring national recognition
Ajay Kumar, FACP
Age: 40
Medical school: Bangalore Medical College, India
Residency: St. Vincent's Charity Hospital, Cleveland
Current titles: Assistant professor of medicine and medical director of the Internal Medicine Preoperative Assessment, Consult and Treatment (IMPACT) Center and blood management, department of hospital medicine, Quality and Patient Safety Institute, Cleveland Clinic
Several years ago, Ajay Kumar, FACP, and his colleagues on Cleveland Clinic's blood utilization committee were faced with the challenge of how to reduce blood use without sacrificing the quality of patient care. Their solution may have seemed obvious in the business world but was fairly radical for medicine: Make doctors accountable and establish reasonable parameters for blood use.
"With the support of leadership, our team came up with a policy that all blood needs to be given with authorization, with staff names attached at the time of order entry," said Dr. Kumar, who joined the clinic as a hospitalist in 2004. By tracking and analyzing orders, raising awareness and creating a patient-centered blood management program, the Cleveland Clinic was able to reduce overall blood use by 10% in 2007-08, and has made steady progress since.
"Our case load has gone up but not our blood use," said Dr. Kumar. A key to the project's success was assessing why doctors were ordering blood products and whether the order was justified by the patient's hemoglobin level. That analysis allowed the organization to develop a comprehensive, data-driven program that helped change the culture for the institution's 2,000 physicians, 900 residents and several hundred mid-level providers.
The project is just one of the innovations Dr. Kumar has led or participated in at Cleveland Clinic over the past five years. He also oversees the clinic's Internal Medicine Preoperative Assessment, Consult and Treatment (IMPACT) Center, where he has streamlined documentation, improved patient flow and worked to improve a clinical triaging algorithm.
The IMPACT Center, staffed by 5.5 full-time hospitalists, two nurses and administrative staff, was designed to help prevent postsurgical complications by evaluating patients undergoing noncardiac surgery to assess risks and make evidence-based recommendations to the surgical team. Nearly 17,000 patients were seen at the clinic last year, said Dr. Kumar.
Dr. Kumar oversees a systematic approach to the preoperative evaluation process based on algorithms. Patients recommended for surgery are scheduled for the IMPACT Center and, if needed according to algorithms, lab and imaging tests. The center provides a patient-centered approach to preoperative evaluation.
The system has not only lowered the risk of postsurgical complications but also reduced surgical delays and cancellations, said Dr. Kumar. The IMPACT Center's administrative staff tracks the progress of each patient and alerts physicians if any test results are missing so that problems can be resolved before the day of surgery.
Dr. Kumar has continued to improve the IMPACT Center's processes by, for example, creating task forces in specific areas such as preoperative testing and preoperative management of anemia. "I want the IMPACT Center to be known as one of the best preop centers in the country," he said.
He also co-led a team to create and implement a secure, flexible sign-out system at Cleveland Clinic. The system, which was presented as a best practice at the 2010 Joint Commission Annual Conference on Quality and Patient Safety, provides a standardized platform to pass patients' relevant information at shift changes.
Dr. Kumar's vision is to establish an integrated patient-centered blood management program throughout Cleveland Clinic's health system (it is now in two of the eight hospitals), and put the issue on the national health care agenda. To that end, he directed a national Blood Management Summit at Cleveland Clinic in 2008, and is directing another summit in November to spread the word to other institutions.
"I like to bring people together from different areas to talk about a common objective," said Dr. Kumar. "If you are able to convince people of the reasons for change, you can get them on board."
Insulin program boosts glycemic control and hospital prestige
Kendall M. Rogers, FACP
Age: 36
Medical school: University of New Mexico (UNM) School of Medicine, Albuquerque
Residency: UNM Hospital
Current titles: Chief of hospital medicine, UNM Hospital, and associate professor, UNM School of Medicine
Three years ago, Kendall M. Rogers, FACP, went into a meeting planning to approve a new insulin order set and came out an hour later in charge of a hospital-wide glycemic control initiative. While he says he may have been a "reluctant leader" at first, Dr. Rogers built the program into one of the hospital's most successful quality improvement efforts.
"We've taken a hospital that was in the lowest quartile in terms of national standards and made it into a top-performing hospital in glycemic control," said Dr. Rogers, who has grown the hospital medicine division from four to 17 hospitalists since becoming chief in 2007. Recently, UNM was rated in the top 10 for glycemic control among 575 hospitals, according to the 2009 RALS report, which collects and tracks hospital blood glucose data.
As with most of Dr. Rogers' projects, the success of the glycemic control program hinged on teamwork. Multi-disciplinary teams—composed of pharmacists, diabetic educators, physicians and nurses—met regularly to go over data and develop protocols while a glycemic control "SWAT team" spent one hour a week identifying patients who were out of control and investigating what went wrong.
The results are impressive: In two years, the hospital cut its severe hyperglycemia rate by 36% and the hypoglycemia rate by 55%. Dr. Rogers now serves as a mentor to 10 other hospitals through the Society of Hospital Medicine's Glycemic Control Mentored Implementation Program and he's leading an effort to enroll 100 additional hospitals.
"Everything we try to do around hospital medicine is creating a team-based approach to care," said Dr. Rogers. Besides glycemic control, he has created multidisciplinary teams around nurse-physician communication, VTE prophylaxis, transitions of care, and creation of many clinical order sets.
The nurse-physician communication initiative brought together nurses, pharmacists, midlevels and hospitalists to develop guidelines for effective communication, such as providing nurses with cell phones and developing algorithms for how nurses should escalate calls to contact attendings. One of the most successful aspects of the project was implementing electronic physician documentation to improve communication among the entire clinical team, said Dr. Rogers.
"If you look at most hospitals, the primary communication method for doctors and nurses is through orders, but orders have no context," he explained. "They don't tell a nurse what the physician is thinking or what they are trying to prevent through that order."
The new system makes electronic handoff sheets accessible to physicians, nurses and case managers so that everyone uses the same record and can make appropriate changes or notes. Standardized templates for the handoff sheet and progress notes include information such as code and nutrition status, VTE prophylaxis and plans for discharge.
"If a nurse sees that a patient's discharge destination is home and she knows that the patient hasn't been out of bed for three days, she is prompted to let physicians know that home may not be a realistic destination," Dr. Rogers said. "That's really helped us with the discharge-planning process."
Dr. Rogers also leads a one-month elective for internal medicine residents focused on leadership, health policy, quality improvement and information technology. Now in its sixth year, the course is so popular that the university plans to extend the content to all residents. As co-chair of the Medical Education Task Force for the American College of Physician Executives, Dr. Rogers is also working to incorporate these topics into medical school and residency curriculums nationwide.
"I teach them all the things I didn't learn during my residency," said Dr. Rogers. "Hospitalists, and all physicians, are naturally looked to as team leaders but they receive next-to-no training. We are creating a culture of leadership."
Helping residents put QI into practice
Anjala Tess, ACP Member
Age: 38
Medical school: Washington University in St. Louis School of Medicine, St. Louis
Residency: Beth Israel Deaconess Medical Center, Boston
Current title: Associate director of internal medicine residency training program, Beth Israel Deaconess Medical Center
When surveys at Beth Israel Deaconess Medical Center found that patients felt shortchanged on face time with their doctors, Anjala Tess, ACP Member, and a team of residents decided to investigate with a time-motion study. Their conclusion: Residents could be much more engaged in patient care if they weren't spending so much time planning discharges.
"After a resident called out the problem, we asked a group of nurses to help us figure out how to offload some of that work from interns," said Dr. Tess. The eventual result was a new program, spearheaded by Dr. Tess and administrator Sarah O'Neill, MBA, that has become a cornerstone of Beth Israel Deaconess' discharge process from the medical floors.
For the new discharge program, staff nurses contact a patient's primary care physician prior to discharge, make follow-up appointments, verify insurance, update medical records and ensure all clinicians get the necessary paperwork. The system not only has saved time for residents but improved accuracy because the nurses are familiar with referral networks and how to link patients with the correct physicians for follow-up.
"No one who uses the service can imagine what life was like before it existed," said Melissa L.P. Mattison, ACP Member, a colleague who nominated Dr. Tess as a top hospitalist. "Now patients receive better care and inpatient physicians are using their valuable time to care for patients rather than make phone calls to schedule follow-up appointments."
The new program encapsulates Dr. Tess' teaching philosophy: The best way to engage residents in quality improvement is to show them how it applies to their everyday practice.
"Residents tend to take on a passive role in terms of improving the system because they're so busy doing the clinical work and managing patients that they're not really thinking actively about the system around them," said Dr. Tess. "We want to empower residents to speak up and participate in the change process."
Dr. Tess helped design and now leads Beth Israel Deaconess' Stoneman Quality Improvement elective, a three-week course that teaches residents how to apply lean methods to increase efficiency and value, and allows them to participate in actual quality improvement projects at the hospital. Dr. Tess also co-leads a weeklong retreat with Dr. Julius Yang on quality improvement for residents and nurses.
"It's like a conversion experience," said Dr. Tess of the retreat. "It fundamentally changes the way the residents think about the health care system and their role within it. At the end of the retreat and the elective we find that we get many more requests from residents to look at something differently."
Dr. Tess also leads an elective course for residents that focuses on the business side of hospital medicine.
"I felt like residents didn't have a sense of the finances of medicine and the structure of a hospital," she said. As a result, six years ago she put together a three-week elective that pulled together all of the business principles involved in running a successful hospitalist program.
The course is structured similarly to a business plan competition, with teams of residents competing to come up with the best proposal for either rescuing a struggling hospitalist program or building one from scratch. After doing fieldwork in community hospitals, the teams pitch their ideas to a faculty panel that chooses the winner based on the quality of the team's mission statements and financial and organizational plans.
"It's like a business case study but it really crystallizes for people why jobs are structured the way they are and why hospitals do things the way they do when they start programs," she said. "It's all stuff that I learned on the fly."
Clinical specialty paths attract 'career hospitalists' to Henry Ford
Peter Y. Watson, FACP
Age: 38
Medical school: Wayne State University, Detroit
Residency: Henry Ford Hospital, Detroit
Current titles: Division head of the division of hospitalist medicine, Henry Ford Hospital, and assistant professor of internal medicine, Wayne State University School of Medicine
Hiring 35 hospitalists in less than five years is a major feat, but Peter Y. Watson, FACP, is gearing up for an even bigger challenge: keeping all those new recruits happy. For Dr. Watson, that means providing a path for career hospitalists to learn and grow without leaving the five-hospital Henry Ford Health System.
"I don't want to make the position about the schedule and just coming to work, but about a professionally fulfilling experience no matter how long they are with us," said Dr. Watson, who has grown Henry Ford's hospitalist division from 14 to 49 hospitalists since becoming the group's leader almost five years ago. "We want to create a structure where they will continue to be challenged."
To achieve those goals, Dr. Watson has expanded the division's clinical portfolio to create new opportunities for physicians while meeting the emerging needs of the hospital. For example, the division recently took over the advanced heart failure service, providing an opportunity for hospitalists to acquire skills in advanced heart failure and inpatient transplant management.
"It creates a whole new dimension in the group that provides a more interesting clinical experience for them," he explained. Besides cardiology, hospitalists can choose to follow tracks in preoperative service, general inpatient medicine or inpatient geriatric care.
The system attracts physicians because of the opportunity to become experts in a particular area of practice, he said, and also establishes the hospitalist group as a diverse unit with a variety of skill sets and leadership opportunities.
"That has paid dividends for the hospital because we are able to support all of these services that either our Detroit campus or our regional campus hospitals require," said Dr. Watson, who oversees the full-time hospitalist service at the main Detroit campus and three out of the other four area hospitals in the Henry Ford Health System.
Dr. Watson has also helped introduce collaborative rounds in several of the hospitals, a system of regular, structured collaborative communication among inpatient staff, including nurses, case managers, hospitalists, residents and other members of the care team. The idea is that teams that communicate and work collaboratively—as opposed to individuals working in parallel—will improve patient care and lead to better outcomes.
The collaborative model is in line with Dr. Watson's goal to foster a teaching environment where established hospitalists cultivate independent thinking skills in junior and senior residents in order to help them transition from intern to supervising resident to full-time staff member.
"Teaching critical thinking and how to manage patients independently is extremely important," said Dr. Watson. "We've been working on how to teach that kind of understanding when we're rounding with residents."
Dr. Watson plans to continue growing the hospitalist service according to the needs of the system. He may eventually have hospitalist services at all five Henry Ford hospitals with expanded staff at the Detroit and West Bloomfield campuses. Ultimately, he said, growth isn't just about numbers but developing a sustainable infrastructure for fulfilling the system's clinical, educational and research missions.
"We've made a remarkable transformation from a small group of highly skilled clinicians to a group that cares for patients at four different hospitals on a 24/7 basis," he said. "That's given us even more opportunities to create an environment for staff to come here and have an identity."


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It's playoff and tailgating season and hot wings are always a favorite.
There are several cooking methods that you can do for wings: deep fried, baked, grilled, smoked. All depends on what you are comfortable with and where you are cooking them.
For any method there are some basics that we usually do. If fresh (not frozen) wings we will marinade them in a zip bag with some hot sauce, usually All Spice Cafe Cayenne Habanero Sauce, which has the classic Buffalo wing flavors. Massage the sauce into the wings, close the bag and let rest in the refrigerator or cooler for about an hour or so.
We usually do them either in the oven or on the grill. We season them with just salt and pepper, maybe a little bit of garlic powder. If in the oven, be sure to put them on a rack with a sheet pan underneath to catch the drippings. You want the drippings to fall and not cook the wings in their juices. Flip them a few times to evenly cook (time varies depending on cook method and heat level) until cooked through.
A few minutes before they are done, pull them off and sauce them – we will put the wings in a large bowl, coat and toss with our sauce of choice – and then put them back on the grill or in the oven for a final few minutes to finish. We do this to not have such a messy wing and let the sauce flavors cook into the wing.
Of course we have carrot and celery sticks to go along with the wings. Blue cheese dressing is the usual dipping sauce for the veggies but we want a little twist, so we use Creamy Balsamic Vinaigrette sauce.
Don't forget to put extra hot sauce out on the table for those who need more.

subset: commoncrawl


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It all began with a leisurely hike through the woods in Jackson Hole, Wyoming. Then a trip to Alaska with a new camera, lenses and a website (so that my mom could track our journey from home while she battled cancer) resulted in more incredible encounters with wildlife as well as the beautiful scenery in Western Canada and Alaska led to a number of great images.
My love of the outdoors and passion for capturing unique glimpses of nature has resulted in trips all over the globe. After timidly showing my photos at my 2 law offices with incredible responses and 2 Art Walks, I was encouraged to explore further the art of nature photography. I've had the good fortune to travel to some wonderful parts of the planet including the Southwest and safari in Tanzania amongst a pride of lions!
From the beaches in Mexico, to the wildflowers in the desert, the geography of southern Utah, the bears in Alaska and the lions in Tanzania, I invite you to enjoy my images of Nature Exposed.
Tags Art Galleries OldTown
- Cross Streets: Craftsman Ct. & E. 5th Ave
- Working Hours: Monday: 9am to 6pmTuesday: 9am to 6pmWednesday: 9am to 6pmThursday: 9am to 6pmFriday: 9am to 6pmSaturday: ClosedSunday: Closed


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Here's what people are saying about Covenant IT Services.
"Les is the most expert, honest, reliable, reasonable, personable and results oriented computer and software consultant and repair service provider I have ever hired for the past 16 years. Les does what he says he will when he will, on time and with excellence that I have never experience in computer service.
Les is the best in this field with high integrity and outstanding results for a reasonable price. I highly recommend Les for any computer related service you may want if you want excellent and honest results!
Bill Newman
President, Seacoast Counseling Centers
Les and I once shared a cubicle at Lucent Technologies. He has since serviced my personal computer several times. Les keeps up with the latest PC trends and issues. He is a solid, honest, down-to-earth, practical guy who will provide cost-effective options. I have no problem recommending his work and have done so to personal friends." April 23, 2010
Patty Cheng
Business Analyst/ Materials Systems Engineer , Lucent Technologies
worked directly with Les
We have very much appreciated the prompt, professional service rendered by Covenant IT Sevices of Haverhill, MA. Les Hamlett returns our phone calls in a timely manner and is here addressing the problem the same day. With six computers for two businesses in one building, when we need service, we need it done fast and right. Covenant IT Sevices delivers.
Jane Weber
Business Manager
Kingdom Contract Flooring
"I have worked with Les for many years in many different situations and I can tell you, you will not find a nicer person than Les. Les is a hard worker, an honest individual, a good friend and a great family man. Les would give you the shirt off his back without asking if you need it. A throw back from the old days when you built your customer base on trust and hard work. And, he still makes house calls and his rates are untouchable. Please do yourself, your family and your friends a favor, when you have a problem with your computer system, phone system or video phone system, call Les and Covenant IT Sevices first. You won't be sorry!" September 2, 2009
Glen Waning
Glen Waning and Sons Electric
"I recently hired Les to work on my laptop computer. He is so easy to work with and stays in touch. He is a wonderful person to deal with and was able to correct the problems quickly and had the computer back to me very quickly. Thanks, Les!" September 20, 2009
Virginis "Ginny" Stevens
Stella Blue, Inc
"Les's tagline says it all "Honest, Reliable & Affordable...Our Covenant to You." I rely on my computer daily to keep my graphic design company up and running, and I feel better knowing that Les is just a phone call away when problems arise. Les is definately 'more' when it comes to computer repair services." October 29, 2008
Betty Denise
BD Design
"Thank you. I was in no hurry, but I sincerely appreciate the high level of service you demonstrated. I would not hesitate to recommend you to anyone in need of IT support. My computer is working wonderfully, I contacted Logitech support about my keyboard and mouse not working with my Bluetooth, seems they are both still under warranty and they are going to send me a new keyboard and mouse with wireless USB access free of charge, even though it may be an internal computer issue and not actually their devices. A wonderful thing for sure. Once again thank you for everything."
Bob D
Deerfield, NH


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We've known for a long time that human children are the best learning machines in the universe.
Alison Gopnik
I was very privileged to hear Julian Grenier speak today at Everton Nursery School and Family Centre at their National Conference 'Tuning into Children's Play'. My studio, Taylor Simons Design, have been working with Everton on a number of projects including their brand identity and marketing materials and Lesley Curtis, head of the centre kindly asked me to attend.
Although I'm not an Early Years Practitioner, the work we've been engaged in has given me an insight into Early Years Education at it's very best. The centre has recently achieved an outstanding Ofted result and their work in the areas of Heuristic Play and Forest School is quite simply remarkable.
I took many thoughts and ideas away from Julian's brilliant keynote, but what stays with me was the Ken Robinson talk for the RSA, 'Changing Education Paradigms'. I urge you to take the time to watch the video yourself. A must for any designer or divergent thinker.


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The phrase "medical negligence" refers to the injury or damage suffered by a patient due to the fault of a medical practitioner. People trust doctors and visit them to treat their medical symptoms. The doctors, in most instances, try to deliver the best treatments to their patients. However, in some instances, the doctors make unintentional errors which prove to be dangerous for the patients. Even if the error is minor, the patient can suffer from life-threatening injuries or permanent physical damages. The doctors can definitely put logical arguments against their errors. They can say that they are human beings and human beings are not flawless and can commit mistakes. No matter how logical the statement seems to be, it would not alleviate the patients' sufferings. The patients thus can go ahead and file a medical negligence case against the doctor. They can seek the assistance of the medical negligence solicitors in filing the case. Yes, the expert solicitors cannot relieve the pain and emotional sufferings of the clinical negligence victims, but they can certainly provide their helping hands and help the victims to win the deserved compensation.
Now, the question is: when to approach a medical negligence solicitor? As soon as the patient comes to know that he has been the victim of the doctor's error, he should venture out to file a compensation claim against the doctor. If the patient is not in a position to approach a lawyer, he should ask his family members or close friends to file a lawsuit against the concerned medical practitioner. However, in order to convince the medical negligence solicitor to represent the case in the court, the patient needs to show him authentic medical documents substantiating the mistake committed by the doctor.
In the United Kingdom, a lot of fake medical negligence cases are filed. The UK government, highly worried about the fake cases, has emphasized that the solicitors must check the authenticity of the cases and then takes the cases. Checking the "validity" of the cases is a must to prevent the filing of false lawsuits.
There are many medical negligence solicitors providing their services in the United Kingdom. With so many UK solicitors claiming to provide the best-quality services, it is often difficult for you to choose a particular service-provider. A thorough research on the internet, however, can help you to come in contact with a reliable lawyer. You need to check the website of the lawyer, get information on the performance of the solicitor and find out his success rates in dealing with medical negligence cases.
What amount of compensation can be expected in a clinical negligence case? It is very difficult to estimate the exact amount of compensation to be received by a medical malpractice victim. You can approach your medical negligence solicitor and ask him to provide you with an approximate estimate of the amount of compensation to be expected in your type of case. The solicitor would go through the details of the similar types of cases and would check the amount of compensation paid in those cases to finally provide you with a rough estimate. Other than medical negligence claims, the medical malpractice lawyers also have the ability to handle accident at work claims.
Tags: medical negligence claims, medical negligence solicitors


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Welcome to Hogworts.
Party attendees were students at Hogwarts. The Birthday Girl was named, "Student of the Month."
There were many potions on display. Some silly, some creepy but the students mostly enjoyed mixing their own potions.
We transformed our living/dining room into a banquet hall.
I'll do another post on just the food but in the meantime, here are pics of the bubbling punch
chicken legs, mashed potatoes and carrots
and the cake.
The kids played a very competitive game of Quidditch.
The students enjoyed learning about "Herbology."
Of course we did the traditional Pinata and opening of gifts too.
All the students went home with handmade owl goody bags full of treasures.
Stay tuned for futute posts on all the food, the decorations, the games, and all the handmade details. My sister spent months doing research and creating all the handmade details that made the day so special. It really paid off with an amazing event that the niece and all her friends will remember for years to come.


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We can probably all agree that in general, it's good to be grateful. And if probed, we can probably all pull out one or two things that warrant saying "thanks". But why does it matter? And why does it matter for a learning company?Read More
1120 Centre Pointe Drive, Suite 800
St. Paul, MN 55120


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Yamaha Music (Russia), LLC is the largest manufacturer of musical instruments in the world. In search of a reliable and professional partner in the field of translations, we opted for the Moscow Navigator translation bureau. One of the crucial circumstances that influenced our decision was the possibility of translation, making-up and printing at the same place within a single production cycle. Since then, for a few years of our joint cooperation, dozens of projects have been successfully completed. On the ground of this positive and practical experience, Yamaha Music (Russia), LLC recommends the Navigator company to all interested organizations as a reliable, professional and modern translation agency.
JVC_SNG, LLC has been working closely with Navigator, LTD for 4 years. During this period, a significant amount of works on translating, making-up and printing advertising materials for our products has been done. We express our sincere gratitude for high-quality performance of all our orders, strict observance of all obligations and creativity in solving the tasks.
We would like to express our full satisfaction with the obtained results, as well as very responsive attitude towards our needs from the managers of your organization.
Taking into account the significant experience accumulated in our cooperation, we can surely recommend the Navigator translation bureau to all interested organizations as a highly professional and reliable partner in the field of translations. We hope that our future cooperation will be equally fruitful. We wish you continued development and success!
The International Publishing House «MediaBusiness» would like to thank Navigator, LTD for the high level of professionalism and responsibility during fulfillment of their responsibilities and a surprisingly favorable moral environment during execution of our orders. We would especially like to acknowledge existence of an individual approach, trust and responsive attention towards our company, as well as the ability to execute orders in the shortest possible time with excellent results. We wish Navigator, LTD success along with new opportunities and hope for further mutually beneficial cooperation.
We would like to express our respect and gratitude for participation in the 1st International Conference «International and Russian investments: issues, attraction, protection» that took place on June 2nd 2010 and was initiated and organized by World Organization of Creditors.
WOC believes that one of the main purposes of its activities is to assist local and foreign creditors and investors in protection of their property rights and legal interests, as well as to reduce financial and investment risks for investors in Russia and CIS countries.
I know Vyacheslav Polyakov for more than 10 years. He participated in several projects for manufacture of technical, service and promotional products. Vyacheslav successfully manages Navigator, LTD, it is a reliable company. They do their job well and meet the deadlines.
I would like to recommend Vyacheslav Polyakov as a good partner and talented professional.
Vladimir Tchaikovsky Motorcycle sales and marketing manager
Moscow office of Pioneer Europe NV extends gratitude to Navigator for successful cooperation in the field of translations from foreign languages, desktop publishing and subsequent publication of technical and promotional materials of the company. In the process of work Navigator proved to be a professional team, capable of completing a task effectively and within the specified timeframe, giving useful advice and accommodating the customer.
Moscow office of De'Longhi (Italy) extends gratitude to Navigator for long-term cooperation in the field of prepress and publication of corporate technical and promotional materials. Special thanks for solving problems associated with prompt translation from foreign languages. We look forward to further cooperation.
Moscow office of CASIO Europe GmbH extends gratitude to Navigator for a long successful cooperation in the field of translation from foreign languages, desktop publishing and subsequent publication of technical and promotional materials of the company. In the process of work Navigator proved to be a team of professionals, capable of expedient completion of tasks within the specified timeframe, accommodating all customer's wishes and recommendations.
To whom it may concern: I've known Vyacheslav Polyakov for many years (since 2000). He coordinated several of our projects of translation of maintenance, technical and promotional documentation for Yamaha equipment and Mercedes Benz accessories. I highly appreciate the efforts in preparation (translation) of training materials for first Yamaha Motorcycle training courses in Russia involving a large number of specific technical terms. Vyacheslav is one of the most experienced and competent experts, who managed projects for translation and prepress of our materials in a number of organizations. The work was always performed with good quality and within the schedule. I recommend Vyacheslav as a reliable partner and an extraordinary, proactive specialist.
Bekhoff automation GmbH office extends gratitude to Navigator for a long-term successful cooperation in the field of translation of technical and promotional materials, as well as for consistent high quality of work, friendliness and professionalism of managers and translators. During the period of cooperation Navigator has established itself as a reliable partner, who is paying close attention to the customer needs and wishes, being able to successfully tackle complex, creativity-focused challenges.


text:
Contact Us
+1 604 683 3996
+1 604 683 3998
You can contact us any way that is convenient for you. We are available via fax, email or telephone. You can also use our contact form.
Email us with any questions or enquiries, or use our contact form. We would be happy to answer your questions.


text:
Informational Site Network
Ancient History.ca
Arbor Day.ca
Artificial Flower.ca
Arts Craft.ca
Auto Game.ca
Auto Suggestion.ca
Babies Names.ca
Baseball Game.ca
Basketball Game.ca
Bugs Insects.net
Business Letter.ca
Canadian Stories
Car Price Guide.org
Card Trick.ca
Catholic Prayer.ca
Children Stories.ca
Christmas Story.ca
Cricket Game.ca
EBooks For Free
Election Game.ca
Fiction Stories.ca
Fishing Game
Football Game.ca
Forensic Medicine.ca
Free Jokes.ca
Games Kids Play.ca
Genghis Khan
Give Up.ca
Golf's Game
Handwriting Analysis.ca
Heavy Metal Music.ca
Herb Gardens.ca
Home Dentistry.ca
Home Gardening.ca
Home Made Cookies.ca
Home Medicine.ca
Home Plumbing.ca
How to Draw.ca
Ice Hockey Game
Insane Asylum.ca
Intelligence Test.ca
Learn Camping.com
Left Hand.ca
Martin Luther King.ca
Math Puzzle.ca
Military Training.ca
Mind Reading.ca
Mix Martial Arts.ca
Money Investing.ca
My Dreams.ca
Mystery Stories.ca
News Stories
Overcoming Fear.ca
Palm Readings.org
Pet Stories.ca
Playing Card Games.net
Postal Stamps.ca
Psychic Research
Romance Stories.ca
Scary Stories.ca
Sea Stories.ca
Soccer Game.ca
Speaking Writing.com
Steel Making.ca
Stories Poetry.com
Sustainable Farming.ca
Tax Sale Property.org
Tea Leaf.ca
Tennis Games.ca
The IChing
Urban Myths.ca
Wall Decor.ca
Wedding Stories.org
White Magic.ca
Wine Cultivation.com
Wood Workings.ca
Work Rights.net
World Maps.ca
World Wars.ca
Science Fiction
Science Fiction Stories
Western Stories
Other Chapters or Short Stories
Following A Crooked Trail
Camping With Old Man Trouble
At The End Of The Road
The Cullisons
Laura London
A Bear Trap
Bad Medicine
A Rehearsed Quarrel
Stick To Your Saddle
At The Round Up Club
Luck Meets An Old Acquaintance
An Initialed Hat
Kate Uses Her Quirt
Ain't She The Gamest Little Thoroughbred?
Two Hats On A Rack
Anonymous Letters
A Message In Cipher
The Friends Of L C Serve Notice
Cass Fendrick Makes A Call
A Compromise
An Arrest
A Conversation
A Touch Of The Third Degree
Bob Takes A Hand
A Clean Up
The Prodigal Son
Cutting Trail
A Good Samaritan
Loose Threads
Following A Crooked Trail
Part of:
Crooked Trails And Straight
Across Dry Valley a dust cloud had been moving for hours. It rolled into
Saguache at the brisk heels of a bunch of horses just about the time the
town was settling itself to supper. At the intersection of Main and La
Junta streets the cloud was churned to a greater volume and density. From
out of the heart of it cantered a rider, who swung his pony as on a half
dollar, and deflected the remuda toward Chunn's corral.
The rider was in the broad-rimmed felt hat, the gray shirt, the plain
leather chaps of a vaquero. The alkali dust of Arizona lay thick on every
exposed inch of him, but youth bloomed inextinguishably through the grime.
As he swept forward with a whoop to turn the lead horses it rang in his
voice, announced itself in his carriage, was apparent in the modeling of
his slim, hard body. Under other conditions he might have been a college
freshman for age, but the competent confidence of manhood sat easily on
his broad shoulders. He was already a graduate of that school of
experience which always holds open session on the baked desert. Curly
Flandrau had more than once looked into the chill eyes of death.
The leaders of the herd dribbled into the corral through the open gate,
and the others crowded on their heels. Three more riders followed Curly
into the enclosure. Upon them, too, the desert had sifted its white coat.
The stained withers of the animals they rode told of long, steady travel.
One of them, a red-haired young fellow of about the same age as Curly,
swung stiffly from the saddle.
"Me for a square meal first off," he gave out promptly.
"Not till we've finished this business, Mac. We'll put a deal right
through if Warren's here," decided a third member of the party. He was a
tough-looking customer of nearly fifty. From out of his leathery
sun-and-wind beaten face, hard eyes looked without expression. "Bad Bill"
Cranston he was called, and the man looked as if he had earned his
"And what if he ain't here?" snarled the fourth. "Are you aiming to sit
down and wait for him?"
"We'll cross that bridge when we come to it," Bad Bill answered. "Curly,
want to ride up to the hotel and ask if Mr. Dave Warren is there? Bring
him right down if he is."
"And say, young fellow, don't shout all over the place what your business
is with him," ordered the previous speaker sulkily. Lute Blackwell, a
squat heavily muscled man of forty, had the manner of a bully. Unless his
shifty eyes lied he was both cruel and vindictive.
Curly's gaze traveled over him leisurely. Not a muscle in the boyish face
moved, but in the voice one might have guessed an amused contempt. "All
right. I won't, since you mention it, Lute."
The young man cantered up the dusty street toward the hotel. Blackwell
trailed toward the windmill pump.
"Thought you'd fixed it with this Warren to be right on the spot so's we
could unload on him prompt," he grumbled at Cranston without looking
toward the latter.
"I didn't promise he'd be hanging round your neck soon as you hit town,"
Cranston retorted coolly. "Keep your shirt on, Lute. No use getting in a
The owner of the corral sauntered from the stable and glanced over the
bunch of horses milling around.
"Been traveling some," he suggested to Bad Bill.
"A few. Seen anything of a man named Warren about town to-day?"
"He's been down here se-ve-re-al times. Said he was looking for a party
with stock to sell. Might you be the outfit he's expecting?"
"We might." Bad Bill took the drinking cup from Blackwell and drained it.
"I reckon the dust was caked in my throat an inch deep."
"Drive all the way from the Bar Double M?" asked the keeper of the corral,
his eyes on the brand stamped on the flank of a pony circling past.
Bad Bill turned away and began to unsaddle. He did not intend to volunteer
any information, though on the other hand he did not want to stir
suspicion by making a mystery for gossips to chew on.
"Looks like you been hitting the road at a right lively gait."
Mac cut in. "Shoulder of my bronc's chafed from the saddle. Got anything
that'll heal it?"
"You bet I have." The man hurried into the stable and the redheaded
cowpuncher winked across the back of his horse at Bill.
The keeper of the stable and the young man were still busy doctoring the
sore when Curly arrived with Warren. The buyer was a roundbodied man with
black gimlet eyes that saw much he never told. The bargain he drove was a
hard one, but it did not take long to come to terms at about one-third the
value of the string he was purchasing. Very likely he had his suspicions,
but he did not voice them. No doubt they cut a figure in the price. He let
it be understood that he was a supply agent for the rebels in Mexico.
Before the bills were warm in the pockets of the sellers, his vaqueros
were mounted and were moving the remuda toward the border.
Curly and Mac helped them get started. As they rode back to the corral a
young man came out from the stable. Flandrau forgot that there were
reasons why he wanted just now to be a stranger in the land with his
identity not advertised. He let out a shout.
"Oh you, Slats Davis!"
"Hello, Curly! How are things a-comin'?"
"Fine. When did you blow in to Saguache? Ain't you off your run some?"
They had ridden the range together and had frolicked around on a dozen
boyish larks. Their ways had suited each other and they had been a good
deal more than casual bunkies. To put it mildly the meeting was likely to
prove embarrassing.
"Came down to see about getting some cows for the old man from the
Fiddleback outfit," Davis explained. "Didn't expect to bump into friends
'way down here. You riding for the Bar Double M?"
There was a momentary silence. Curly's vigilant eyes met those of his old
side partner. What did Slats know? Had he been in the stable while the
remuda was still in the corral? Had he seen them with Bad Bill and
Blackwell? Were his suspicions already active?
"No, I'm riding for the Map of Texas," Flandrau answered evenly.
"Come on, Curly. Let's go feed our faces," Mac called from the stable.
Flandrau nodded. "You still with the Hashknife?" he asked Davis.
"Still with 'em. I've been raised to assistant foreman."
"Bully for you. That's great. All right, Mac. I'm coming. That's sure
great, old hoss. Well, see you later, Slats."
Flandrau followed Mac, dissatisfied with himself for leaving his friend so
cavalierly. In the old days they had told each other everything, had
talked things out together before many a campfire. He guessed Slats would
be hurt, but he had to think of his partners in this enterprise.
After supper they took a room at the hotel and divided the money Warren
had paid for the horses. None of them had slept for the last fifty hours
and Mac proposed to tumble into bed at once.
Bad Bill shook his head. "I wouldn't, Mac. Let's hit the trail and do our
sleeping in the hills. There's too many telephone lines into this town to
suit me."
"Sho! We made a clean getaway, and we're plumb wore out. Our play isn't to
hike out like we were scared stiff of something. What we want to do is to
act as if we could look every darned citizen in the face. Mac's sure
right," Curly agreed.
"You kids make me tired. As if you knew anything about it. I'm going to
dust muy pronto," Blackwell snarled.
"Sure. Whenever you like. You go and we'll stay. Then everybody'll be
satisfied. We got to split up anyhow," Mac said.
Bad Bill looked at Blackwell and nodded. "That's right. We don't all want
to pull a blue streak. That would be a dead give away. Let the kids stay
if they want to."
"So as they can round on us if they're nabbed," Blackwell sneered.
Cranston called him down roughly. "That'll be enough along that line,
Lute. I don't stand for any more cracks like it."
Blackwell, not three months out from the penitentiary, faced the other
with an ugly look in his eyes. He was always ready to quarrel, but he did
not like to fight unless he had a sure thing. He knew Bad Bill was an ugly
customer when he once got started.
"Didn't mean any harm," the ex-convict growled. "But I don't like this
sticking around town. I tell you straight I don't like it."
"Then I wouldn't stay if I were you," Curly suggested promptly. "Mac and I
have got a different notion. So we'll tie to Saguache for a day or two."
As soon as the older men had gone the others tumbled into bed and fell
asleep at once. Daylight was sifting in through the open window before
their eyes opened. Somebody was pounding on the bedroom door, which
probably accounted for Flandrau's dream that a sheriff was driving nails
in the lid of a coffin containing one Curly.
Mac was already out of bed when his partner's feet hit the floor.
"What's up, Mac?"
The eyes of the redheaded puncher gleamed with excitement. His six-gun was
in his hand. By the look of him he was about ready to whang loose through
the door.
"Hold your horses, you chump," Curly sang out "It's the hotel clerk. I
left a call with him."
But it was not the hotel clerk after all. Through the door came a quick,
jerky voice.
"That you, Curly? For God's sake, let me in."
Before he had got the words out the door was open. Slats came in and shut
it behind him. He looked at Mac, the forty-five shaking in the boy's hand,
and he looked at Flandrau.
"They're after you," he said, breathing fast as if he had been running.
"Who?" fired Curly back at him.
"The Bar Double M boys. They just reached town."
"Put up that gun, Mac, and move into your clothes immediate," ordered
Curly. Then to Davis: "Go on. Unload the rest. What do they know?"
"They inquired for you and your friend here down at the Legal Tender. The
other members of your party they could only guess at."
"Have we got a chance to make our getaway?" Mac asked.
Davis nodded. "Slide out through the kitchen, cut into the alley, and
across lots to the corral. We'll lock the door and I'll hold them here
long as I can."
"Good boy, Slats. If there's a necktie party you'll get the first bid,"
Curly grinned.
Slats looked at him, cold and steady. Plainer than words he was telling
his former friend that he would not joke with a horse thief. For the sake
of old times he would save him if he could, but he would call any bluffs
about the whole thing being a lark.
Curly's eyes fell away. It came to him for the first time that he was no
longer an honest man. Up till this escapade he had been only wild, but now
he had crossed the line that separates decent folks from outlaws. He had
been excited with liquor when he joined in this fool enterprise, but that
made no difference now. He was a rustler, a horse thief. If he lived a
hundred years he could never get away from the disgrace of it.
Not another word was said while they hurried into their clothes. But as
Curly passed out of the door he called back huskily. "Won't forget what
you done for us, Slats."
Again their eyes met. Davis did not speak, but the chill look on his face
told Flandrau that he had lost a friend.
The two young men ran down the back stairs, passed through the kitchen
where a Chinese cook was getting breakfast, and out into the bright
sunlight. Before they cut across to the corral their eyes searched for
enemies. Nobody was in sight except the negro janitor of a saloon busy
putting empty bottles into a barrel.
"Won't do to be in any hurry. The play is we're gentlemen of leisure, just
out for an amble to get the mo'ning air," Curly cautioned.
While they fed, watered, and saddled they swapped gossip with the
wrangler. It would not do to leave the boy with a story of two riders in
such a hurry to hit the trail that they could not wait to feed their
bronchos. So they stuck it out while the animals ate, though they were
about as contented as a two-pound rainbow trout on a hook. One of them was
at the door all the time to make sure the way was still clear. At that
they shaved it fine, for as they rode away two men were coming down the
"Kite Bonfils," Curly called to his partner.
No explanation was needed. Bonfils was the foreman of the Bar Double M. He
let out a shout as he caught sight of them and began to run forward.
Simultaneously his gun seemed to jump from its holster.
Mac's quirt sang and his pony leaped to a canter in two strides. A bullet
zipped between them. Another struck the dust at their heels. Faintly there
came to the fugitives the sound of the foreman's impotent curses. They had
escaped for the time.
Presently they passed the last barb wire fence and open country lay before
them. It did not greatly matter which direction they followed, so long as
they headed into the desert.
"What we're looking for is a country filled with absentees," Curly
explained with a grin.
Neither of them had ever been in serious trouble before and both regretted
the folly that had turned their drunken spree into a crime. Once or twice
they came to the edge of a quarrel, for Mac was ready to lay the blame on
his companion. Moreover, he had reasons why the thing he had done loomed
up as a heinous offense.
His reasons came out before the camp fire on Dry Sandy that evening. They
were stretched in front of it trying to make a smoke serve instead of
supper. Mac broke a gloomy silence to grunt out jerkily a situation he
could no longer keep to himself.
"Here's where I get my walking papers I reckon. No rustlers need apply."
Curly shot a slant glance at him. "Meaning--the girl?"
The redheaded puncher nodded. "She'll throw me down sure. Why shouldn't
she? I tell you I've ruined my life. You're only a kid. What you know
about it?"
He took from his coat pocket a photograph and showed it to his friend. The
sweet clean face of a wholesome girl smiled at Curly.
"She's ce'tainly a right nice young lady. I'll bet she stands by you all
right. Where's she live at?"
"Waits in a restaurant at Tombstone. We was going to be married soon as we
had saved five hundred dollars." Mac swallowed hard. "And I had to figure
out this short cut to the money whilst I was drunk. As if she'd look at
money made that way. Why, we'd a-been ready by Christmas if I'd only
Curly tried to cheer him up, but did not make much of a job at it. The
indisputable facts were that Mac was an outlaw and a horse thief. Very
likely a price was already on his head.
The redheaded boy rolled another cigarette despondently. "Sho! I've cooked
my goose. She'll not look at me--even if they don't send me to the pen."
In a moment he added huskily, staring into the deepening darkness: "And
she's the best ever. Her name's Myra Anderson."
Abruptly Mac got up and disappeared in the night, muttering something
about looking after the horses. His partner understood well enough what
was the matter. The redheaded puncher was in a stress of emotion, and like
the boy he was he did not want Curly to know it.
Flandrau pretended to be asleep when Mac returned half an hour later.
They slept under a live oak with the soundness of healthy youth. For the
time they forgot their troubles. Neither of them knew that as the hours
slipped away red tragedy was galloping closer to them.
Camping With Old Man Trouble
For A Good Reason
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Powerful yet affordable – that's Freight2020 Driver Mobility.
You will be amazed at the power and ease of Freight2020 Driver Mobility, the free-to-download mobile app which revolutionised the affordability of mobile system interactivity in the Australian road freight transport industry. Drop us a line if you'd like to take Freight2020 Driver Mobility for a test drive on your own mobile device. We'll send you the download instructions, as well as the password for your access to demo data.


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The most important instruction you never heard at the OBGYN's office: A pregnant woman should not kiss a toddler on the mouth. It's a quiet fact that Lisa Saunders is trying to shout to the world. "When Elizabeth was born, she had a very small head," remembers this Mystic mom who had another young daughter and ran a licensed daycare. "The moment I saw her, I knew something was wrong." The baby's severely damaged brain was a result of congenital CMV, cytomegalovirus, which passes from a woman to a fetus through the placenta. Now, this writer and passionate advocate for awareness, is asking legislators to make Connecticut the second state in the nation, after Utah, to require public education and testing of CMV.
"It's beyond words, really, to have that kind of shock when you're all excited," says Saunders, who was seriously depressed and distraught after the birth. "All I could think about was her diagnosis, her prognosis….but, I gradually started seeing her and I just fell in love with her." Saunders always wonders if warnings and knowledge about this virus would've changed her daughter's path.
"The interventions are simple," explains Dr. Brenda Balch, a pediatrician with a specialty in hearing loss prevention. "When you're pregnant, it's 9 months of being more cautious in regards to the spread of disease." For adults and children, CMV is a common virus transmitted by person to person contact, causing mild, flu-like symptoms.


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Most of use has been used to Async Programming from the beginning day of Java when dealing with UI. Swing use one thread to draw the graphic and event handling. Hence, when the system is busy processing the event, the UI virtually hang. To avoid this, we were told to keep the handling event code as simple as possible. If we feel that the work will take long time to run, we must let it executed in another thread.
However, as Java Swing become less and less popular nowadays, most developers do not need to deal with asynchronous programming that often any more and the word "asynchronous" seem more related to web protocol.
Still, asynchronous programming is not only applicable to UI. Lots of logic on server side benefit tremendously from proper use of AP. Scheduling, Input/Output processing and background processing all requires developers to process work in a separate thread to avoid blocking of main thread or long waiting.
With the trend of hardware developers introducing multiple cores CPU and high bandwidth network, Asynchronous becoming more and more important in programming.
Let's cover three most popular scenarios of Asynchronous Programming
1/ Fire and forget
The simplest form of Asynchronous Programming is to create a runnable object that contain the business logic and create a thread to run it. Your main thread can happily terminate after this. For example, client send a request to server to start a background process. The triggering of background process complete and the response is sent back to client.
2/ Collaborate of work
In the second scenario, you need to spawn multiple threads to complete a heavy task but your main thread cannot exit without the task completed. For real life example, we can think of spamming emails to all of your clients. The work is huge but separable and can be done concurrently. The simplest way to do things is to create one array of runnable objects and create one thread to execute each of them. However, this simple method is strongly un-recommended as we may not know the amount of runnable we need to create. Therefore, we may create unknown amount of threads, which may throw exceptions (whether due to out of memory or limit file handler, depend on which threshold reach first). The better solution in this scenario should be usage of thread pool executor and submit all your runnable into array blocking queue. With this strategy, executor will only use a fixed amount of thread to execute your code and the thread can be reused to execute other tasks.
Recently, Java introduce a fork and join framework. It suppose to out-perform Executor method above with Divide and Conquer problems. I will cover it in another article.
3/ Scheduling
The simplest way for Scheduling is to start-up a thread, do some work and sleep for a while, then repeat the process again. I would not recommend this as well because Executor seem to be a better option. Even a single thread executor still give you more power as you can schedule with fixed interval rather than fixed delay (sleep actually provide you a fixed delay rather than fixed interval of execution). If you use some of the scheduling framework like Quartz, it is even more recommended as you have a declarative style of scheduling rather than coding.
In a similar scenario, when you need to schedule a work in the future but not repetitive, executor still a better choice. In this case, you create a FutureTask object that wrap around the piece of code that you need to execute in the future and submit it to the executor. This work well and clean. Spawning a thread to wait for the time to come to execute the task is unforgivable.
1/ Know how to deal with multi-thread issues
To write better AP code you should understand the common issues with Asynchronous. Asynchronous is effectively multi-thread; hence, suffer from all multi-thread issues like deadlock and thread safe. You should pay attention to your runnable object. There is no point to create multiple thread to do the work concurrently if your runnable object have a long synchronize block and even can cause deadlock.
2/ Control the amount of threads and reuse as much as possible
Thread is expensive to create. Hence, please use it responsibly. It is highly recommended that you always know exactly how many threads is created by you are running at any moment. Using thread pool allow you to limit the amount of thread and reuse the object to execute new task.
3/ Avoid sleeping/unproductive time
Not all the threads are active all the time. It is quite often that a thread wake up, check for a condition to execute and if the condition not exist, go back to idle. In this case, there may be wasting time if the condition is ready but your thread is not executed. The basic guideline is to try to minimize this wasting time. There are two methods to detect if a condition is matched, polling and callback. With polling, you constantly check with the fixed interval to see if the condition is matched. With callback, you have the luxury of waiting until someone wake you up to do the work.
For most of the time callback give you less delay. Therefore I would advise you to use callback if possible. Still, kindly remember that callback may not guaranteed that you will be notified immediately if there are more than one listener register them selves to the event. Some of the event handler framework that I have seen sequentially execute listener codes in a single thread. Because of this, you may need to wait for some other listeners to complete before being notified. In worst case, your callback mechanism may perform worse than polling.
As you may already know, thread have it own stack memory to store local variable, method and return value. As a direct consequence, thread when executing a method will not be available for any other task, even if you put it to sleep. Unless this method is completed, it is likely that your thread is not available to reuse.
In the earlier day, most of server implement thread per connection for HTTP 1.1. Needless to say, this approach put heavy burden for server and inefficient, especially when the user only make a request in a while. Today, most of popular web servers serving thread per request rather than per connection. The threads are provided by HTTP thread pool, which have a upper limit on the amount of the HTTP threads it can issue. The Http Thread is blocked from the time the request constructed and pass to HTTP Servlet until the servlet return a response. With the knowledge of how thread allocate memory above, this seem to be the limit until recent breakthrough in Java API.
The problem to solve is the blocking of HTTP thread when waiting for a long process to run until getting a response. Even if we try to put the long running process to a separate thread, the http thread is still blocked, waiting to render the response; hence, no benefit can be seen. Because of this, changes have been made to make the HTTP thread reusable when the long running work is happening on the background. On this matter, I want to discuss two strategies that widely adopted in the market as in Servlet API 3.0 and Play framework.
Servlet API 3.0 is a set of API. Therefore, it attempt to fix the problem with introducing of new API. Oracle provide this example to illustrate the usage of AsyncContext
AsyncContext aCtx = request.startAsync(req, res); ScheduledThreadPoolExecutor executor = new ThreadPoolExecutor(10); executor.execute(new AsyncWebService(aCtx));
The doGet/doPost method can return immediately after constructing the AsyncContext. However, a response has not been generated here. When the Asynchronous task is completed, it render the response and the web container finally response to user request. I think this API is clean but it impose a limit on sharing code between the original doGet method and the asynchronous task. If there is anything you want to share, it must be passed as parameter to AsyncWebService constructor.
Play framework follow a different approach. As the byte code executed is enhanced by Play framework, it do not bother to do much on introducing new API to solve the problem. Here is a sample I create using Play framework
public class Application extends Controller { public static void index() { String welcome = "synchronous text"; Promise<String> welcomeJob = new Job<String>(){ public String doJobWithResult(){ try { Thread.sleep(5000); } catch (InterruptedException e) { e.printStackTrace(); } return "async text"; } }.now(); String awaitResult = await(welcomeJob); renderText(welcome + awaitResult); } }
Look at the code above, you only see one method index() that render the response. However, what really happen after byte code enhancement if the split of the method to 2 methods, before and after await(). The two methods are perfectly available to be executed by different HTTP Thread. It is interesting that Play manage to restore the thread state perfectly and I can use the local variable "welcome" that I create on the other thread. This is quite amazing.


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Dictated by marketing?
Actually I misunderstood your need I think. What I recommended is just a multimeter. If you had another price I would recommend other brands too but IMHO the B257s is the best bang for the buck in the $150 range. You want a multimeter that has LCR and ESR? Or are you looking for just an LCR/ESR meter?Yago has posted a link to the best buy in LCR meters IMHO.
This is popular and great value for money, BUT be aware that it can easily be damaged if you try and measure some still energised or charged:You would still need a good multimeter (such as that which Lightages)http://www.ebay.co.uk/itm/DE-5000-High-Accuracy-Handheld-LCR-Meter-With-TL-21-TL-22-TL-23-DER-EE-/331432433527?pt=LH_DefaultDomain_0&hash=item4d2ae99777
Another vote for a Brymen for working on mains. Unfortunately, the DE-5000 is not suited for in-circuit testing IIRC (test voltage too low?), so you'd be better off finding a cheap in-circuit ESR meter or kit on eBay (Bob Parker clone or other).
]You should also note that your $150 budget would just cover a BM257s from either Franky or TME. But it won't take a huge additional amount to get an ESR unit suitable for in-circuit testing (~$30 for an example that ships to Italy). Cheaper if you're willing to skip an enclosure.
my old (chinese) multimeter died some days ago so it's time to get another one.
If you want to try fixing this old one, start a new topic under Repair and I will try to make suggestions?
I think it's not worth try to repair an ultra-chinese multimeter, maybe just for fun:)Actually it's not completely dead, but gives false readings.
It is up to you. I'm just offering to help because right now I'm interested in all aspects of a multimeter including repair.If you are getting false readings, some multimeters give high readings when the battery gets weak. You can always try a new battery first.
caius:The real question I think is:Do you really need inductance measurement?If not, then do you really need and LCR meter for accuracy if it can't do ESR in circuit?If the answer is no to both, then forget the all in one multimeter, get a proper multimeter and just get an ESR meter for in circuit.
You could get a Uni-T UT139C for $50, and something like this too and stay under your budget. The UT139C is a very good buy too.
Edit: Oops, just remembered that have an in circuit ESR tester. Just get a BM257s and you will be happy. That is unless you need the inductance function. If so, then get the Amprobe.
I open again this thread asking about UNI-T UT61E.I'm more oriented to this instead UT139C after having compared specifics.Am doing the right thing?


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Track Improvements to be Made on Union Pacific's Line Through Southwest Kansas and Texas/Oklahoma Panhandles
Railroad to Invest Nearly $17 Million on Track Maintenance between Bloom, Kansas and Stratford, Texas
Omaha, Neb., May 20, 2008 In order to enhance our customer service and improve our presence in the community, Union Pacific Railroad is investing $16.8 million this year on track improvements between Bloom, Kan., and Stratford, Texas.
When the project is complete, crews will have removed and installed 122,000 ties, spread 98,000 tons of rock ballast to ensure a stable roadbed and replaced road surfaces at 144 crossings. Work will begin on these projects May 23 and is scheduled to be completed by late August.
These improvements are part of the $1.6 billion Union Pacific plans to invest in 2008 to maintain track across its more than 32,300-mile system. This extensive investment in the railroad's track helps ensure Union Pacific has the capability to offer quality, safe and cost-effective service to meet our customers' current and future transportation needs. Following track improvement projects, communities benefit from smoother road crossing surfaces. Trains do not occupy crossings as long because they can operate more efficiently.
About Union Pacific
Union Pacific Corporation owns one of America's leading transportation companies. Its principal operating company, Union Pacific Railroad, links 23 states in the western two-thirds of the country and serves the fastest-growing U.S. population centers. Union Pacific's diversified business mix includes Agricultural Products, Automotive, Chemicals, Energy, Industrial Products and Intermodal. The railroad offers competitive long-haul routes from all major West Coast and Gulf Coast ports to eastern gateways. Union Pacific connects with Canada's rail systems and is the only railroad serving all six major gateways to Mexico, making it North America's premier rail franchise.
For further information, contact Mark Davis at (402) 544-5459.
The statements and information contained in the news releases provided by Union Pacific speak only as of the date issued. Such information by its nature may become outdated, and investors should not assume that the statements and information contained in Union Pacific's news releases remain current after the date issued. Union Pacific makes no commitment, and disclaims any duty, to update any of this information.


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|What I wore: Sunnies Gelato: Black c/o Polette Eyewear, dress: Bella Dahl c/o, vest: Black Swan c/o sold out: similar style, Booties: Daniella High Heel Bootie Elliot Lucca c/o , earrings: Rebecca Minkoff, Photo Credit: Dr Photo
Yesterday I rounded up a few outfits that were in the running for Thanksgiving but today, I am giving you a head to toe sneak peek of the look I chose! Cozy, chic and most of all holiday friendly- this Bella Dahl shirt dress had quickly become one of my favorite dresses in my closet and I just love how it pairs with this faux fur vest. Throw on a pair of booties and a few of your favorite accessories and you have yourself a Holiday look that is not overly fussy yet right on point when it comes to style.


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Medzome Life Sciencez
Plot No. 47, Industrial Area Lodhimajra
Baddi-174101, H.P.
Medzome Life Sciencez (ISO 13485:2016 certified) is a rapid diagnostic kits manufacturer at Baddi,
Himachal Pradesh (http://medzomelifesciencez.com/). Our highly qualified team of globally experienced scientists is aggressively involved in the development of novel products.
The Medzome is seeking persons for following jobs-
JOB Position: Marketing & Sales Manager
Eligibility: Graduate with a marketing experience especially in the field of rapid diagnostic kits/drugs, are encouraged to apply.
Expectations: National and International travelling as per the requirement of the Medzome and computer knowledge
Salary: Rs. 3 Lacs/annum + ESI + Travelling + Incentives
JOB Position: Marketing Executive
Eligibility: Young, self motivated person with good communication skills who likes travelling Expectations: Travelling as per the requirement of the Medzome and computer knowledge
Salary: Rs. 1.5 Lacs/ annum Basic + ESI + Travelling+ Incentives
JOB Position: Scientific Associate
Eligibility: Individual holding degree in B.Sc./B Pharma, have scientific aptitude, self-motivated with good communication skills and basic computer knowledge
Expectations: Working in Research and development.
Salary: Rs. 1.8 Lacs/annum Basic + ESI + Travelling
Application Procedure: A letter along with detailed CV (specifying e-mail-id and mobile number) must be sent at email@example.com OR firstname.lastname@example.com by 25th April, 2018
Selection: The interview date to the selected candidates will be informed through e-mail and telephone.
No lodging/boarding shall be provided during interview
HR-Medzome Life Sciencez
Contact: 87279-72227


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Beginning Farmer of the Year Award
Angelic Organics Learning Center and the Upper Midwest CRAFT farmer alliance launched the Beginning Farmer of the Year award in 2013 in order to celebrate and promote new farmers growing for our local and sustainable food and farm economy. The winner of this award selects the Mentor Farmer of the Year, honoring an experienced farmer who generously provided mentoring at some time during their first ten years of startup. Beginning in 2016, these awards have been sponsored by the collaborating Farmer Alliances in Routes to Farm, serving beginning farmers across the greater Chicago foodshed. Each nominee must be a member of at least one of the Farmer Alliances on routes2farm.org. The winner of the Beginning Farmer of the Year Award and the Mentor Farmer of the Year will be announced at the Good Food EXPO in Chicago in March.


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Contact Us
Do you have a house to Sell? Are you ready to Buy? Are you upside down on your home and need a short sale specialist?
There are five ways to contact us
1. Call us : 303-551-9000 or toll-free at 1-866-697-3564
2. E-mail Us : firstname.lastname@example.com
3. Live Chat Click here
4. Meet at our Office:
ReLogic- Colorado
4785 Tejon St #300
Denver Co 80211
ReLogic Brokerage- Arizona
1301 W Broadway Rd. Bldg B
Mesa AZ 85202
ReLogic- Nevada
10161 Park Run Drive #150
Las Vegas, NV 89145
5. Meet at your home , or the local coffee shop. Coffee's on us.