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And Religious Right Fights Back
The legal battle over gay marriage is moving to the Deep South. Buoyed by federal court victories in Oklahoma, Kentucky and Virginia,fake rolex datejust oyster, gay rights activists are taking on traditional marriage laws in the very states where those laws enjoy overwhelming public support.
Take Alabama, where Paul Hard is suing the state for violating his constitutional rights to equal protection and due process following the death of his partner, David Fancher, whom he legally married in Massachusetts. Alabama has a constitutional amendment that forbids same sex marriage.
The couple, says Hard, "had every right to expect that we should be able to carry our rights as American citizens wherever we went. This is not someplace where you have your civil rights disappear at the state line."
But when tragedy struck, Hard learned otherwise. Fancher was killed in a traffic accident. Hard had trouble getting information from the hospital, the funeral home marked "never married" on the death certificate, and he's prohibited from collecting any damages from a pending wrongful death lawsuit. Hard,datejust rolex oyster perpetual fake, a Montgomery, Ala., college professor, says he had all the spousal responsibilities but none of the rights.
"I was David's spouse in every regard when it came to paying the bills, arranging his burial, picking out the marker, everything that mattered," Hard says.
"It creates two classes of people under Alabama law. Men and women who are married who are allowed to have their marriages be recognized, and for example, Paul and David, who were married but their marriage isn't recognized," says Alesdair Ittelson, an attorney with the Southern Poverty Law Center. "The United States Constitution says you can't treat people differently."
But Alabama state Sen. Scott Beason, a Republican, says gay rights activists have brought their fight to a region where they face the strongest resistance.
"The South is absolutely embedded and believes wholeheartedly in Christian principles [that marriage is between a man and a woman], so they're just taking the tip of the spear to us. And unfortunately I think we should just be left alone," Beason says. "We're not talking about something that was simply passed by the Legislature. We're talking about constitutional amendments voted on overwhelmingly by the people of the state."
More than 80 percent of Alabama voters approved the Sanctity of Marriage amendment. Similar majorities banned same sex marriages in other Deep South states, including Mississippi and Louisiana. Challenges are now pending there as well. In Mississippi, a woman is suing to have the state recognize her marriage so that she can legally get a divorce. And in Louisiana, four same sex couples are seeking equal protection and free speech in matters ranging from taxes to adoption.
"For us it's about our daughter," says Nick Van Sickels, a New Orleans doctor. They adopted a baby girl,gold rolex oyster perpetual datejust fake, but only Van Sickels is listed as her father on the birth certificate. In Louisiana, Bond has no parental rights.
"Each year we have to fill out a legal form that Nick surrenders powers so that I can make educational decisions [and] health care related kind of stuff," Bond says.
Gay right advocates like Chris Otten with the Forum for Equality in Louisiana believe the constitutional challenges in federal court have momentum.
"These laws are falling across the country,rolex datejust ii fake, and what's going to happen unfortunately for those who live in the Deep South, you can't have 47 states that allow same sex marriage and three states that hold out," Otten says.
But leaders of those states also invoke the Constitution. During a speech in California last week, Republican Gov. Bobby Jindal of Louisiana defended the rights of states to reject gay marriage as a matter of faith. He calls the legal battles an assault on the freedom of religion.
"It is a war a silent war but it is a war against religious liberty. This war is waged in our courts and in the halls of political power," Jindal says.
"What we've stepped into now is tyranny, and we're forcing states to accept something that they find morally reprehensible," Smith says.
While the legal battle over gay marriage plays out in the federal courts, some states are also looking to legalize discrimination against gay couples on religious grounds. Similar bills have been introduced in Congress.
The legal battle over gay marriage is moving to the Deep South. Buoyed by federal court victories in Oklahoma, Kentucky and Virginia,fake rolex datejust oyster, gay rights activists are taking on traditional marriage laws in the very states where those laws enjoy overwhelming public support.
Take Alabama, where Paul Hard is suing the state for violating his constitutional rights to equal protection and due process following the death of his partner, David Fancher, whom he legally married in Massachusetts. Alabama has a constitutional amendment that forbids same sex marriage.
The couple, says Hard, "had every right to expect that we should be able to carry our rights as American citizens wherever we went. This is not someplace where you have your civil rights disappear at the state line."
But when tragedy struck, Hard learned otherwise. Fancher was killed in a traffic accident. Hard had trouble getting information from the hospital, the funeral home marked "never married" on the death certificate, and he's prohibited from collecting any damages from a pending wrongful death lawsuit. Hard,datejust rolex oyster perpetual fake, a Montgomery, Ala., college professor, says he had all the spousal responsibilities but none of the rights.
"I was David's spouse in every regard when it came to paying the bills, arranging his burial, picking out the marker, everything that mattered," Hard says.
"It creates two classes of people under Alabama law. Men and women who are married who are allowed to have their marriages be recognized, and for example, Paul and David, who were married but their marriage isn't recognized," says Alesdair Ittelson, an attorney with the Southern Poverty Law Center. "The United States Constitution says you can't treat people differently."
But Alabama state Sen. Scott Beason, a Republican, says gay rights activists have brought their fight to a region where they face the strongest resistance.
"The South is absolutely embedded and believes wholeheartedly in Christian principles [that marriage is between a man and a woman], so they're just taking the tip of the spear to us. And unfortunately I think we should just be left alone," Beason says. "We're not talking about something that was simply passed by the Legislature. We're talking about constitutional amendments voted on overwhelmingly by the people of the state."
More than 80 percent of Alabama voters approved the Sanctity of Marriage amendment. Similar majorities banned same sex marriages in other Deep South states, including Mississippi and Louisiana. Challenges are now pending there as well. In Mississippi, a woman is suing to have the state recognize her marriage so that she can legally get a divorce. And in Louisiana, four same sex couples are seeking equal protection and free speech in matters ranging from taxes to adoption.
"For us it's about our daughter," says Nick Van Sickels, a New Orleans doctor. They adopted a baby girl,gold rolex oyster perpetual datejust fake, but only Van Sickels is listed as her father on the birth certificate. In Louisiana, Bond has no parental rights.
"Each year we have to fill out a legal form that Nick surrenders powers so that I can make educational decisions [and] health care related kind of stuff," Bond says.
Gay right advocates like Chris Otten with the Forum for Equality in Louisiana believe the constitutional challenges in federal court have momentum.
"These laws are falling across the country,rolex datejust ii fake, and what's going to happen unfortunately for those who live in the Deep South, you can't have 47 states that allow same sex marriage and three states that hold out," Otten says.
But leaders of those states also invoke the Constitution. During a speech in California last week, Republican Gov. Bobby Jindal of Louisiana defended the rights of states to reject gay marriage as a matter of faith. He calls the legal battles an assault on the freedom of religion.
"It is a war a silent war but it is a war against religious liberty. This war is waged in our courts and in the halls of political power," Jindal says.
"What we've stepped into now is tyranny, and we're forcing states to accept something that they find morally reprehensible," Smith says.
While the legal battle over gay marriage plays out in the federal courts, some states are also looking to legalize discrimination against gay couples on religious grounds. Similar bills have been introduced in Congress.
Cesc Fabregas heading for exit
The tricky playmaker has struggled to adapt to Conte's style of play this season and, as a result, has only featured on nine occasions for the club and hasn'tmadea Premier League start since the club's defeat to Liverpool earlier this campaign.
Oscar has been subject to interest from the Far East in the past with Jiangsu Suning and Luiz Felipe Scolari's club, Guangzhou Evergrande, both expressing the desire to sign the Brazil international.
Antonio Conte has failed to confirm whether Cesc Fabregas will still be a Chelsea player by the end of the January transfer window intensifying speculation linking the midfielder with a move away from the club.
Fabregas has fallen out of favour with Conte and has been unable to find a regular place in the Chelsea midfield following the arrival of N'Golo Kante from Leicester in the summer,value of a rolex oyster perpetual datejust replica.
The London Evening Standard reports that,1986 rolex oyster perpetual datejust replica,when asked about the Spainard's future at the club, Conte couldn't guarantee that he would still be at the club come the end of next month's window.
Virgil van Dijk is at the top of Chelsea's transfer wish list as Antonio Conte looks to bolster his defensive reinforcements for the remainder of the season, according to the Evening Standard.
The Netherlands international is quickly establishing himself as one of the Premier League's best centre backs and his superb form for Southampton this season has alerted Blues boss Conte.
Conte's recent tactical change to 3 4 3 has paid dividends for Chelsea, who currently sit three points clear at the top of the Premier League, but the Italian boss is keen expand his defensive options with three slots nowto fill in central defence.
And, with John Terry and Branislav Ivanovic's futures uncertain at the club,rolex oyster perpetual datejust cost fake, the 25 year old defender could be a suitable long term option for the Blues.
van Dijk reportedly has a 25million release clause in his current deal on the South Coast but Chelsea face competition from the likes of Manchester United and Liverpool if they are to sign him.
Click the Adblock/Adblock Plus icon,rolex oyster perpetual datejust gold fake, which is to the right of your address bar.
On Adblock click "Don't run on pages on this domain".
If you are Private Browsing in Firefox, "Tracking Protection" may cause the adblock notice to show. It can be temporarily disabled by clicking the "shield" icon in the address bar.
The tricky playmaker has struggled to adapt to Conte's style of play this season and, as a result, has only featured on nine occasions for the club and hasn'tmadea Premier League start since the club's defeat to Liverpool earlier this campaign.
Oscar has been subject to interest from the Far East in the past with Jiangsu Suning and Luiz Felipe Scolari's club, Guangzhou Evergrande, both expressing the desire to sign the Brazil international.
Antonio Conte has failed to confirm whether Cesc Fabregas will still be a Chelsea player by the end of the January transfer window intensifying speculation linking the midfielder with a move away from the club.
Fabregas has fallen out of favour with Conte and has been unable to find a regular place in the Chelsea midfield following the arrival of N'Golo Kante from Leicester in the summer,value of a rolex oyster perpetual datejust replica.
The London Evening Standard reports that,1986 rolex oyster perpetual datejust replica,when asked about the Spainard's future at the club, Conte couldn't guarantee that he would still be at the club come the end of next month's window.
Virgil van Dijk is at the top of Chelsea's transfer wish list as Antonio Conte looks to bolster his defensive reinforcements for the remainder of the season, according to the Evening Standard.
The Netherlands international is quickly establishing himself as one of the Premier League's best centre backs and his superb form for Southampton this season has alerted Blues boss Conte.
Conte's recent tactical change to 3 4 3 has paid dividends for Chelsea, who currently sit three points clear at the top of the Premier League, but the Italian boss is keen expand his defensive options with three slots nowto fill in central defence.
And, with John Terry and Branislav Ivanovic's futures uncertain at the club,rolex oyster perpetual datejust cost fake, the 25 year old defender could be a suitable long term option for the Blues.
van Dijk reportedly has a 25million release clause in his current deal on the South Coast but Chelsea face competition from the likes of Manchester United and Liverpool if they are to sign him.
Click the Adblock/Adblock Plus icon,rolex oyster perpetual datejust gold fake, which is to the right of your address bar.
On Adblock click "Don't run on pages on this domain".
If you are Private Browsing in Firefox, "Tracking Protection" may cause the adblock notice to show. It can be temporarily disabled by clicking the "shield" icon in the address bar.
Best Retirement Havens In 2015
With spiraling costs compelling more and more North Americans to retire overseas, retiring abroad has never been more attractive. But finding the right location among the myriad options available can be daunting.
That's what International Living's Annual Global Retirement Index does. Using input from our team of correspondents on the ground all over the world, we combine real world insights about climate, health care, cost of living, and much more to draw up a comprehensive list of the best bang for your buck retirement destinations on the planet.
Keep in mind that, even though only 25 countries feature on the list, all of them are worth your attention. We selected them from among all the countries in the world for their qualities as retirement hot spots, so even the lowest ranked nation on our Index is still very much an option worth considering.
Take into account, too, that ultimately no list or formula can automatically deliver the best destination for you. Only you can decide that. Only you can assess your personal preferences, needs, budget, and desires, and look at the options available to see which nation best suits your needs.
We're constantly looking to improve and refine our annual Retirement Index. On top of having access to a larger network of correspondents than ever before,used rolex submariner imitation, this year we required more (and more detailed) input from the field to make this year's results the most comprehensive to date.
Below we've included some of the top countries in the world to retire by region. You can read the full article here, which includes the scores for the top 25 retirement havens in the world in the Index.
Ecuador The World's Number 1 Retirement Haven
Ecuador wins overall this year as the best place in the world to retire. From the quaint town of Cotacachi to the vibrant capital, Quito, from Salinas by the sea to the peaks of the Andes, Ecuador's diversity is a key part of the massive appeal that sees it regain the coveted top spot on this year's retirement index.
Although prices have risen slightly in recent years, Ecuador's real estate is still the best value you'll find anywhere.
This is bolstered by the generous array of benefits the government has afforded to retirees. Over 65s get discounts on flights originating in Ecuador, as well as up to 50% off entry to movies and sporting events. Discounts are also available on public transport (50%) and utilities, with the option of a free landline if you purchase a property.
And the cost of living is low. or Canada," says International Living's Ecuador Highlands Correspondent Wendy DeChambeau. "A doctor's visit will set you back around $10, while a main course in a restaurant can be had for as little as $2.50. The bus trip from Cotacachi to Otavalo will cost you 25 cents. A couple can live well here on $1,400 a month, including rent."
You'll find world class medical facilities in big cities throughout the country, and you can catch direct flights to and from the States in Quito and Guayaquil. Good Internet is more readily available than ever. Public transportation is so efficient that many expats report not having to even buy a car. And with Ecuador having one of the most robust economies on the continent its Gross Domestic Product has grown an average of 4.54% a year since 2000 it is likely that this infrastructure is only going to improve over the coming years.
The steadily growing expat population makes it easy to integrate, as do the friendly locals and when it comes to entertainment, Ecuador offers a diverse range of options. Biking, fishing, zip lining, hiking, and rock climbing are all popular and readily available.
The country's location affords it access to a staggering variety of environments, from the vast Pacific Ocean (including the Galapagos Islands, one of the world's most important ecological sites) and the Amazon to the mighty peaks of the Andes. This diversity ensures you're guaranteed to find a climate that suits you down to the ground.
As many expats note, Ecuador delivers fresh experiences every day, making it the perfect location for someone in search of a happy and fulfilling life overseas.
Panama Best Retirement Benefits in the World
Runner up in the Index in 2015 and the best retirement destination in Central America Panama offers retiree expats the advantages of the world's best retirement program: the Pensionado visa.
"Panama wants you to come and their policies court you," says Jessica Ramesch, International Living's Panama Editor. "The Pensionado visa is available to anyone with a lifetime pension of over $1,000 a month. Discounts you can get with the visa include 20 percent off medical services, 50% off entertainment,imitation used rolex submariner, 25 percent off restaurant meals, 25 percent off air fare, and 25 percent off electricity and phone bills."
Add all this to the country's already low cost of living, and Panama is the very definition of an affordable expat haven. For under $2,000, a couple can live comfortably in a country with a well earned reputation for being expat friendly.
Thriving expat communities in towns such as Boquete,rolex submariner watch imitation, Coronado, and Pedas attest to the ease of integration and afford you plenty of opportunities to meet like minded types.
"There are active expat communities all over Panama," says Jessica. There are so many activities for expats and Panamanians, it is easy to join different groups and get out there and start meeting people. Panamanians like to meet foreigners. They like to try to practice their English on you or hear you trying to speak Spanish. You even make friends at the supermarket here."
Although a developing nation, Panama's array of infrastructure makes it easy to get (and get to) what you need. and Canadian cities. This makes Panama one of the easiest countries on our list to get home from.
The Pacific coast of Panama is world renowned for its beautiful beaches and azure waters: the definition of tropical paradise.
Sunshine is ubiquitous in Panama and gray days are rare. The evenings and mornings are pleasantly cool, and rains rarely last more than an hour. At either extreme, the weather is perfectly manageable. Unlike some other countries in the region, hurricanes do not pose a threat.
This favorable climate makes Panama a perfect place for those who love the outdoors, with plentiful opportunities for hiking, bird watching, fishing (among the best in the world), and water sports. It also has a vibrant arts and cultural scene centered on the larger towns and cities. It's one of five major hospitals spread throughout the country, although smaller facilities also provide first rate service at highly competitive prices. Because of its small size, you are never more than an hour's drive from a medical facility in Panama. The local health care system is both cheap and reputable. A visit to the doctor can set you back as little as $5.
Malaysia Great Value for Money in a Cultural Melting Pot
Malaysia comes in fourth position in the Index this year, and first position as the best place in Asia to retire to. Every year, more and more expats are waking up to the amazing opportunities Malaysia has to offer. The country has one of the most robust economies in Asia,fake vintage rolex submariner, and this is reflected in the consistently high standard of living available to locals and expats alike.
Quality of life in Malaysia is cost efficient as well as excellent. In typical expat locations such as Kuala Lumpur and Penang, high quality real estate is available for rent at a low cost. Why buy when you can rent a 1,600 square foot apartment with a swimming pool for just $850 a month?
With spiraling costs compelling more and more North Americans to retire overseas, retiring abroad has never been more attractive. But finding the right location among the myriad options available can be daunting.
That's what International Living's Annual Global Retirement Index does. Using input from our team of correspondents on the ground all over the world, we combine real world insights about climate, health care, cost of living, and much more to draw up a comprehensive list of the best bang for your buck retirement destinations on the planet.
Keep in mind that, even though only 25 countries feature on the list, all of them are worth your attention. We selected them from among all the countries in the world for their qualities as retirement hot spots, so even the lowest ranked nation on our Index is still very much an option worth considering.
Take into account, too, that ultimately no list or formula can automatically deliver the best destination for you. Only you can decide that. Only you can assess your personal preferences, needs, budget, and desires, and look at the options available to see which nation best suits your needs.
We're constantly looking to improve and refine our annual Retirement Index. On top of having access to a larger network of correspondents than ever before,used rolex submariner imitation, this year we required more (and more detailed) input from the field to make this year's results the most comprehensive to date.
Below we've included some of the top countries in the world to retire by region. You can read the full article here, which includes the scores for the top 25 retirement havens in the world in the Index.
Ecuador The World's Number 1 Retirement Haven
Ecuador wins overall this year as the best place in the world to retire. From the quaint town of Cotacachi to the vibrant capital, Quito, from Salinas by the sea to the peaks of the Andes, Ecuador's diversity is a key part of the massive appeal that sees it regain the coveted top spot on this year's retirement index.
Although prices have risen slightly in recent years, Ecuador's real estate is still the best value you'll find anywhere.
This is bolstered by the generous array of benefits the government has afforded to retirees. Over 65s get discounts on flights originating in Ecuador, as well as up to 50% off entry to movies and sporting events. Discounts are also available on public transport (50%) and utilities, with the option of a free landline if you purchase a property.
And the cost of living is low. or Canada," says International Living's Ecuador Highlands Correspondent Wendy DeChambeau. "A doctor's visit will set you back around $10, while a main course in a restaurant can be had for as little as $2.50. The bus trip from Cotacachi to Otavalo will cost you 25 cents. A couple can live well here on $1,400 a month, including rent."
You'll find world class medical facilities in big cities throughout the country, and you can catch direct flights to and from the States in Quito and Guayaquil. Good Internet is more readily available than ever. Public transportation is so efficient that many expats report not having to even buy a car. And with Ecuador having one of the most robust economies on the continent its Gross Domestic Product has grown an average of 4.54% a year since 2000 it is likely that this infrastructure is only going to improve over the coming years.
The steadily growing expat population makes it easy to integrate, as do the friendly locals and when it comes to entertainment, Ecuador offers a diverse range of options. Biking, fishing, zip lining, hiking, and rock climbing are all popular and readily available.
The country's location affords it access to a staggering variety of environments, from the vast Pacific Ocean (including the Galapagos Islands, one of the world's most important ecological sites) and the Amazon to the mighty peaks of the Andes. This diversity ensures you're guaranteed to find a climate that suits you down to the ground.
As many expats note, Ecuador delivers fresh experiences every day, making it the perfect location for someone in search of a happy and fulfilling life overseas.
Panama Best Retirement Benefits in the World
Runner up in the Index in 2015 and the best retirement destination in Central America Panama offers retiree expats the advantages of the world's best retirement program: the Pensionado visa.
"Panama wants you to come and their policies court you," says Jessica Ramesch, International Living's Panama Editor. "The Pensionado visa is available to anyone with a lifetime pension of over $1,000 a month. Discounts you can get with the visa include 20 percent off medical services, 50% off entertainment,imitation used rolex submariner, 25 percent off restaurant meals, 25 percent off air fare, and 25 percent off electricity and phone bills."
Add all this to the country's already low cost of living, and Panama is the very definition of an affordable expat haven. For under $2,000, a couple can live comfortably in a country with a well earned reputation for being expat friendly.
Thriving expat communities in towns such as Boquete,rolex submariner watch imitation, Coronado, and Pedas attest to the ease of integration and afford you plenty of opportunities to meet like minded types.
"There are active expat communities all over Panama," says Jessica. There are so many activities for expats and Panamanians, it is easy to join different groups and get out there and start meeting people. Panamanians like to meet foreigners. They like to try to practice their English on you or hear you trying to speak Spanish. You even make friends at the supermarket here."
Although a developing nation, Panama's array of infrastructure makes it easy to get (and get to) what you need. and Canadian cities. This makes Panama one of the easiest countries on our list to get home from.
The Pacific coast of Panama is world renowned for its beautiful beaches and azure waters: the definition of tropical paradise.
Sunshine is ubiquitous in Panama and gray days are rare. The evenings and mornings are pleasantly cool, and rains rarely last more than an hour. At either extreme, the weather is perfectly manageable. Unlike some other countries in the region, hurricanes do not pose a threat.
This favorable climate makes Panama a perfect place for those who love the outdoors, with plentiful opportunities for hiking, bird watching, fishing (among the best in the world), and water sports. It also has a vibrant arts and cultural scene centered on the larger towns and cities. It's one of five major hospitals spread throughout the country, although smaller facilities also provide first rate service at highly competitive prices. Because of its small size, you are never more than an hour's drive from a medical facility in Panama. The local health care system is both cheap and reputable. A visit to the doctor can set you back as little as $5.
Malaysia Great Value for Money in a Cultural Melting Pot
Malaysia comes in fourth position in the Index this year, and first position as the best place in Asia to retire to. Every year, more and more expats are waking up to the amazing opportunities Malaysia has to offer. The country has one of the most robust economies in Asia,fake vintage rolex submariner, and this is reflected in the consistently high standard of living available to locals and expats alike.
Quality of life in Malaysia is cost efficient as well as excellent. In typical expat locations such as Kuala Lumpur and Penang, high quality real estate is available for rent at a low cost. Why buy when you can rent a 1,600 square foot apartment with a swimming pool for just $850 a month?
a systematic review of trials to identify features critical to success
Data sources Literature searches via Medline, CINAHL, and the Cochrane Controlled Trials Register up to 2003; and searches of reference lists of included studies and relevant reviews.
Studies had to evaluate the ability of decision support systems to improve clinical practice.
Data extraction Studies were assessed for statistically and clinically significant improvement in clinical practice and for the presence of 15 decision support system features whose importance had been repeatedly suggested in the literature.
Results Seventy studies were included. Decision support systems significantly improved clinical practice in 68% of trials. Univariate analyses revealed that, for five of the system features, interventions possessing the feature were significantly more likely to improve clinical practice than interventions lacking the feature. Multiple logistic regression analysis identified four features as independent predictors of improved clinical practice: automatic provision of decision support as part of clinician workflow (P
Recent research has shown that health care delivered in industrialised nations often falls short of optimal, evidence based care. A nationwide audit assessing 439 quality indicators found that US adults receive only about half of recommended care,1 and the US Institute of Medicine has estimated that up to 98 000 US residents die each year as the result of preventable medical errors.2 Similarly a retrospective analysis at two London hospitals found that 11% of admitted patients experienced adverse events, of which 48% were judged to be preventable and of which 8% led to death.3
To address these deficiencies in care, healthcare organisations are increasingly turning to clinical decision support systems, which provide clinicians with patient specific assessments or recommendations to aid clinical decision making.4 Examples include manual or computer based systems that attach care reminders to the charts of patients needing specific preventive care services and computerised physician order entry systems that provide patient specific recommendations as part of the order entry process. Such systems have been shown to improve prescribing practices,5 7 reduce serious medication errors,8 9 enhance the delivery of preventive care services,10 11 and improve adherence to recommended care standards.4 12 Compared with other approaches to improve practice, these systems have also generally been shown to be more effective and more likely to result in lasting improvements in clinical practice.13 22
Clinical decision support systems do not always improve clinical practice, however. In a recent systematic review of computer based systems, most (66%) significantly improved clinical practice, but 34% did not.4 Relatively little sound scientific evidence is available to explain why systems succeed or fail.23 24 Although some investigators have tried to identify the system features most important for improving clinical practice,12 25 34 they have typically relied on the opinion of a limited number of experts, and none has combined a systematic literature search with quantitative meta analysis. We therefore systematically reviewed the literature to identify the specific features of clinical decision support systems most crucial for improving clinical practice.
Data sourcesInclusion and exclusion criteria
We defined a clinical decision support system as any electronic or non electronic system designed to aid directly in clinical decision making, in which characteristics of individual patients are used to generate patient specific assessments or recommendations that are then presented to clinicians for consideration.4 We included both electronic and non electronic systems because we felt the use of a computer represented only one of many potentially important factors. Our inclusion criteria were any randomised controlled trial evaluating the ability of a clinical decision support system to improve an important clinical practice in a real clinical setting; use of the system by clinicians (physicians, physician assistants, or nurse practitioners) directly involved in patient care; and assessment of improvements in clinical practice through patient outcomes or process measures. Disagreements between reviewers were resolved by discussion, and we measured inter rater agreement using Cohen's unweighted statistic.35A study may include several trial arms, so that multiple comparisons may exist within the single study. For each relevant comparison,fake rolex submariner date, two reviewers independently assessed whether the clinical decision support system resulted in an improvement in clinical practice that was both statistically and clinically significant. We considered effect size as an alternative outcome measure but concluded that the use of effect size would have been misleading given the significant heterogeneity among the outcome measures reported by the included studies. We also anticipated that the use of effect size would have led to the exclusion of many relevant trials, as many studies fail to report all of the statistical elements necessary to accurately reconstruct effect sizes.
Next, two reviewers independently determined the presence or absence of specific features of decision support systems that could potentially explain why a system succeeded or failed. To construct a set of potential explanatory features, we systematically examined all relevant reviews and primary studies identified by our search strategy and recorded any factors suggested to be important for system effectiveness. Both technical and non technical factors were eligible for inclusion. Also, if a factor was designated as a barrier to effectiveness (such as "the need for clinician data entry limits system effectiveness") we treated the logically opposite concept as a potential success factor (such as "removing the need for clinician data entry enhances system effectiveness"). Next,submariner rolex imitation, we limited our consideration to features that were identified as being potentially important by at least three sources, which left us with 22 potential explanatory features, including general system features, system clinician interaction features, communication content features, and auxiliary features (tables 1 and 2). Of these 22 features, 15 could be included into our analysis (table 1) because their presence or absence could be reliably abstracted from most studies, whereas the remaining seven could not (table 2).
Table 1 Descriptions of the 15 features of clinical decision support systems (CDSS) included in statistical analyses
View this table:View popupView inline
We used three methods to identify clinical decision support system features important for improving clinical practice.
Univariate analyses For each of the 15 selected features we individually determined whether interventions possessing the feature were significantly more likely to succeed (result in a statistically and clinically significant improvement in clinical practice) than interventions lacking the feature. We used StatXact55 to calculate 95% confidence intervals for individual success rates56 and for differences in success rates,womens rolex submariner imitation.57
Multiple logistic regression analyses For these analyses, the presence or absence of a statistically and clinically significant improvement in clinical practice constituted the binary outcome variable, and the presence or absence of specific decision support system features constituted binary explanatory variables. We included only cases in which the clinical decision support system was compared against a true control group. For the primary meta regression analysis, we pooled the results from all included studies, so as to maximise the power of the analysis while decreasing the risk of false positive findings from over fitting of the model.58 We also conducted separate secondary regression analyses for computer based systems and for non electronic systems. For all analyses, we included one indicator for the decision support subject matter (acute care v non acute care) and two indicators for the study setting (academic v non academic, outpatient v inpatient) to assess the role of potential confounding factors related to the study environment. With the 15 system features and the three environmental factors constituting the potential explanatory variables,ladies rolex submariner imitation, we conducted logistic regression analyses using LogXact 5.59 Independent predictor variables were included into the final models using forward selection and a significance level of 0.05.
Direct experimental evidence We systematically identified studies in which the effectiveness of a given decision support system was directly compared with the effectiveness of the same system with additional features. We considered a feature to have direct experimental evidence supporting its importance if its addition resulted in a statistically and clinically significant improvement in clinical practice.
Data sources Literature searches via Medline, CINAHL, and the Cochrane Controlled Trials Register up to 2003; and searches of reference lists of included studies and relevant reviews.
Studies had to evaluate the ability of decision support systems to improve clinical practice.
Data extraction Studies were assessed for statistically and clinically significant improvement in clinical practice and for the presence of 15 decision support system features whose importance had been repeatedly suggested in the literature.
Results Seventy studies were included. Decision support systems significantly improved clinical practice in 68% of trials. Univariate analyses revealed that, for five of the system features, interventions possessing the feature were significantly more likely to improve clinical practice than interventions lacking the feature. Multiple logistic regression analysis identified four features as independent predictors of improved clinical practice: automatic provision of decision support as part of clinician workflow (P
Recent research has shown that health care delivered in industrialised nations often falls short of optimal, evidence based care. A nationwide audit assessing 439 quality indicators found that US adults receive only about half of recommended care,1 and the US Institute of Medicine has estimated that up to 98 000 US residents die each year as the result of preventable medical errors.2 Similarly a retrospective analysis at two London hospitals found that 11% of admitted patients experienced adverse events, of which 48% were judged to be preventable and of which 8% led to death.3
To address these deficiencies in care, healthcare organisations are increasingly turning to clinical decision support systems, which provide clinicians with patient specific assessments or recommendations to aid clinical decision making.4 Examples include manual or computer based systems that attach care reminders to the charts of patients needing specific preventive care services and computerised physician order entry systems that provide patient specific recommendations as part of the order entry process. Such systems have been shown to improve prescribing practices,5 7 reduce serious medication errors,8 9 enhance the delivery of preventive care services,10 11 and improve adherence to recommended care standards.4 12 Compared with other approaches to improve practice, these systems have also generally been shown to be more effective and more likely to result in lasting improvements in clinical practice.13 22
Clinical decision support systems do not always improve clinical practice, however. In a recent systematic review of computer based systems, most (66%) significantly improved clinical practice, but 34% did not.4 Relatively little sound scientific evidence is available to explain why systems succeed or fail.23 24 Although some investigators have tried to identify the system features most important for improving clinical practice,12 25 34 they have typically relied on the opinion of a limited number of experts, and none has combined a systematic literature search with quantitative meta analysis. We therefore systematically reviewed the literature to identify the specific features of clinical decision support systems most crucial for improving clinical practice.
Data sourcesInclusion and exclusion criteria
We defined a clinical decision support system as any electronic or non electronic system designed to aid directly in clinical decision making, in which characteristics of individual patients are used to generate patient specific assessments or recommendations that are then presented to clinicians for consideration.4 We included both electronic and non electronic systems because we felt the use of a computer represented only one of many potentially important factors. Our inclusion criteria were any randomised controlled trial evaluating the ability of a clinical decision support system to improve an important clinical practice in a real clinical setting; use of the system by clinicians (physicians, physician assistants, or nurse practitioners) directly involved in patient care; and assessment of improvements in clinical practice through patient outcomes or process measures. Disagreements between reviewers were resolved by discussion, and we measured inter rater agreement using Cohen's unweighted statistic.35A study may include several trial arms, so that multiple comparisons may exist within the single study. For each relevant comparison,fake rolex submariner date, two reviewers independently assessed whether the clinical decision support system resulted in an improvement in clinical practice that was both statistically and clinically significant. We considered effect size as an alternative outcome measure but concluded that the use of effect size would have been misleading given the significant heterogeneity among the outcome measures reported by the included studies. We also anticipated that the use of effect size would have led to the exclusion of many relevant trials, as many studies fail to report all of the statistical elements necessary to accurately reconstruct effect sizes.
Next, two reviewers independently determined the presence or absence of specific features of decision support systems that could potentially explain why a system succeeded or failed. To construct a set of potential explanatory features, we systematically examined all relevant reviews and primary studies identified by our search strategy and recorded any factors suggested to be important for system effectiveness. Both technical and non technical factors were eligible for inclusion. Also, if a factor was designated as a barrier to effectiveness (such as "the need for clinician data entry limits system effectiveness") we treated the logically opposite concept as a potential success factor (such as "removing the need for clinician data entry enhances system effectiveness"). Next,submariner rolex imitation, we limited our consideration to features that were identified as being potentially important by at least three sources, which left us with 22 potential explanatory features, including general system features, system clinician interaction features, communication content features, and auxiliary features (tables 1 and 2). Of these 22 features, 15 could be included into our analysis (table 1) because their presence or absence could be reliably abstracted from most studies, whereas the remaining seven could not (table 2).
Table 1 Descriptions of the 15 features of clinical decision support systems (CDSS) included in statistical analyses
View this table:View popupView inline
We used three methods to identify clinical decision support system features important for improving clinical practice.
Univariate analyses For each of the 15 selected features we individually determined whether interventions possessing the feature were significantly more likely to succeed (result in a statistically and clinically significant improvement in clinical practice) than interventions lacking the feature. We used StatXact55 to calculate 95% confidence intervals for individual success rates56 and for differences in success rates,womens rolex submariner imitation.57
Multiple logistic regression analyses For these analyses, the presence or absence of a statistically and clinically significant improvement in clinical practice constituted the binary outcome variable, and the presence or absence of specific decision support system features constituted binary explanatory variables. We included only cases in which the clinical decision support system was compared against a true control group. For the primary meta regression analysis, we pooled the results from all included studies, so as to maximise the power of the analysis while decreasing the risk of false positive findings from over fitting of the model.58 We also conducted separate secondary regression analyses for computer based systems and for non electronic systems. For all analyses, we included one indicator for the decision support subject matter (acute care v non acute care) and two indicators for the study setting (academic v non academic, outpatient v inpatient) to assess the role of potential confounding factors related to the study environment. With the 15 system features and the three environmental factors constituting the potential explanatory variables,ladies rolex submariner imitation, we conducted logistic regression analyses using LogXact 5.59 Independent predictor variables were included into the final models using forward selection and a significance level of 0.05.
Direct experimental evidence We systematically identified studies in which the effectiveness of a given decision support system was directly compared with the effectiveness of the same system with additional features. We considered a feature to have direct experimental evidence supporting its importance if its addition resulted in a statistically and clinically significant improvement in clinical practice.
Clive Palmer ordered to attend Queensland Nickel hearings amid pancreatitis recovery
Clive Palmer is recovering from a severe case of pancreatitis which his legal team said prevented him from giving evidence to the Federal Court on Tuesday, but a judge has ordered him to attend on Wednesday.
Mr Palmer's GP Reza Madah was ordered to appear before Justice John Dowsett on Tuesday afternoon to explain why the former MP was a no show.
Mr Palmer was due to be questioned by the Special Purpose Liquidators of Queensland Nickel about the whereabouts of his globetrotting nephew and former refinery director Clive Mensink.
Dr Madah said Mr Palmer was rushed to hospital in March but after several days of care discharged himself against recommendations,used rolex submariner fake.
He had since been suffering from pain and "his condition fluctuates", Dr Madah told the court.
But when asked if Mr Palmer's medical condition was bad enough to prevent him from physically attending court,fake rolex submariner vintage, Dr Madah conceded it was not.
"Physically he could attend with assistance," Dr Madah said.
Dr Madah was shown a live interview Mr Palmer conducted with a national breakfast television program on May 1 where the hosts commented on how well he looked after losing 58 kilograms.
He agreed there was no evidence of confusion or forgetfulness during the interview.
"Life's more enjoyable, you can go for a walk, talk to people so it's a disciplined approach and what you put in is what you get out," Mr Palmer said during the television segment.
In light of the doctor's evidence, Justice Dowsett decided against adjourning the public examination and scheduled Mr Palmer to attend on Wednesday afternoon.
Mr Palmer's barrister Andrew Boe originally said Dr Madah was not available today because he was in surgery,rolex submariner female imitation, but said it was not a "tactic" in anyway.
Mr Boe had also asked the judge to conceal the affidavit because of concerns Mr Palmer might be embarrassed if his medical issues were made public.
Despite not being able to attend court, Mr Palmer's social media account was active on Tuesday morning, with the businessman posting several federal budget related items to his Twitter account.
Where in the world is Clive Mensink?In respect of Mr Mensink's whereabouts, Mr Boe contended it was outside the scope of public examination powers for his client to be questioned about it.
But Tom Sullivan QC, who is acting for the special purpose liquidators, refuted that, saying it was well within the law "particularly when they have gone overseas and are avoiding contact".
In March, two warrants were issued for Mr Mensink's arrest for failing to appear at court.
At the time,imitation rolex submariner gold, his lawyer said he had been unable to contact his client, who is on a year long overseas holiday, so he might not be aware he was required in court.
Clive Palmer is recovering from a severe case of pancreatitis which his legal team said prevented him from giving evidence to the Federal Court on Tuesday, but a judge has ordered him to attend on Wednesday.
Mr Palmer's GP Reza Madah was ordered to appear before Justice John Dowsett on Tuesday afternoon to explain why the former MP was a no show.
Mr Palmer was due to be questioned by the Special Purpose Liquidators of Queensland Nickel about the whereabouts of his globetrotting nephew and former refinery director Clive Mensink.
Dr Madah said Mr Palmer was rushed to hospital in March but after several days of care discharged himself against recommendations,used rolex submariner fake.
He had since been suffering from pain and "his condition fluctuates", Dr Madah told the court.
But when asked if Mr Palmer's medical condition was bad enough to prevent him from physically attending court,fake rolex submariner vintage, Dr Madah conceded it was not.
"Physically he could attend with assistance," Dr Madah said.
Dr Madah was shown a live interview Mr Palmer conducted with a national breakfast television program on May 1 where the hosts commented on how well he looked after losing 58 kilograms.
He agreed there was no evidence of confusion or forgetfulness during the interview.
"Life's more enjoyable, you can go for a walk, talk to people so it's a disciplined approach and what you put in is what you get out," Mr Palmer said during the television segment.
In light of the doctor's evidence, Justice Dowsett decided against adjourning the public examination and scheduled Mr Palmer to attend on Wednesday afternoon.
Mr Palmer's barrister Andrew Boe originally said Dr Madah was not available today because he was in surgery,rolex submariner female imitation, but said it was not a "tactic" in anyway.
Mr Boe had also asked the judge to conceal the affidavit because of concerns Mr Palmer might be embarrassed if his medical issues were made public.
Despite not being able to attend court, Mr Palmer's social media account was active on Tuesday morning, with the businessman posting several federal budget related items to his Twitter account.
Where in the world is Clive Mensink?In respect of Mr Mensink's whereabouts, Mr Boe contended it was outside the scope of public examination powers for his client to be questioned about it.
But Tom Sullivan QC, who is acting for the special purpose liquidators, refuted that, saying it was well within the law "particularly when they have gone overseas and are avoiding contact".
In March, two warrants were issued for Mr Mensink's arrest for failing to appear at court.
At the time,imitation rolex submariner gold, his lawyer said he had been unable to contact his client, who is on a year long overseas holiday, so he might not be aware he was required in court.
Chinese firms to ramp up investment as costs rise
HONG KONG: Official investment figures may be feeble, but exporters at China largest trade fair say they are ploughing more money into robotics, industrial automation and new product development to offset rising costs.
At the Canton Fair, which kicked off this weekend for companies in the household electronics, decorative materials and building sectors other sectors follow later in the month more than 80% of companies quizzed by Reuters said they would be spending more next year.
That would represent a significant shift if matched throughout China economy. Official data on Wednesday showed private sector investment in fixed assets in the first nine months grew just 2.5%, picking up from a record low of 2.1% in the first eight months.
Kison Van said his company, Ningbo Cixi Import and Export Holdings, which makes fans and heaters, needs to develop three to four new products every year to stay competitive.
important to continuously invest in R because once a new product comes out,fake womens cartier tank, you see it everywhere at the Canton Fair, said Van, one of tens of thousands of salesman at a fair that sprawls over 1.2 million square metres, almost twice the size of the world largest mall.
More than 65% of the 103 exhibitors polled by Reuters in China southern city of Guangzhou expect to boost spending by up to 20% in 2017,fake calibre de cartier price, while 16.5% expect to raise spending by more than 20%.
That will be welcome news to leaders in Beijing, as China private companies, which make up the bulk of exhibitors at the fair, are a crucial engine of growth for the economy, unlike the largely inefficient and indebted state owned sector.
Chinese growth slowed to a 25 year low of 6.9% last year, and third quarter figures released yesterday put it on track for about 6.7% this year.
Economists say the country mid sized private companies are the primary source of investment,copy cartier ballon bleu gold, innovation and productivity growth. Heavy machinery manufacturers at the fair said they spend over 30% of their investment capital upgrading production lines each year, while many building materials and household equipment makers said they were pumping money into automation.
China is achieving average annual growth of 18% in research and development (R spending, compared with just 1.4% across the rest of the world upper middle income countries, according to the Unesco Institute for Statistics.
While most exporters surveyed aim to boost spending, around 20% said they planned to cut investment. Other sectors that may be under pressure as global growth slows, such as textiles and apparel, will feature later at the fair, which runs until Nov 4. China is increasingly moving to modernise its manufacturing industry with robotics and automation, driven in part by a shortage of skilled workers and rapidly rising wages that threaten to erode its appeal as a low cost workshop to the world. Reuters
do a better job than workers; the quality is more stable, said Zhejiang Momali Sanitary Utensils Co general manager Selina Song.
Song said,fake cartier watches ballon bleu, however, that a drop in sales was slowing the company push to boost automation.
Some economists said new and emerging sectors such as high end manufacturing equipment would see more room for development.
because these sectors get the government support.
They still see more room to grow despite slowing economic growth globally, said Nomura China economist Wendy Chen, who is based in Shanghai.
Liu Qian, deputy general manager of Nanjing Panda Electronics Import Export Co, said investing in robots and automation was crucial, given wages had doubled in five years.
Several Chinese provinces have slowed or halted increases to minimum wages this year, as companies face pressure from rising expenses and weakening global demand, something that is also prompting more companies to shift sales to within China.
Liu acknowledged it would take longer for some companies to break even, given the size of the initial capital injection in automation and robots.
China is aiming for a top 10 ranking in automation for its industries by 2020 by putting more robots in its factories, according to the International Federation of Robotics (IFR).
Torpedo Hsu, sales manager at heavy machinery transmissions maker CMEC, said the company plans to invest 10 to 20 % more in spending next year, which it hopes will lead to a pick up in orders after an expected 10 % fall in export orders this year.
HONG KONG: Official investment figures may be feeble, but exporters at China largest trade fair say they are ploughing more money into robotics, industrial automation and new product development to offset rising costs.
At the Canton Fair, which kicked off this weekend for companies in the household electronics, decorative materials and building sectors other sectors follow later in the month more than 80% of companies quizzed by Reuters said they would be spending more next year.
That would represent a significant shift if matched throughout China economy. Official data on Wednesday showed private sector investment in fixed assets in the first nine months grew just 2.5%, picking up from a record low of 2.1% in the first eight months.
Kison Van said his company, Ningbo Cixi Import and Export Holdings, which makes fans and heaters, needs to develop three to four new products every year to stay competitive.
important to continuously invest in R because once a new product comes out,fake womens cartier tank, you see it everywhere at the Canton Fair, said Van, one of tens of thousands of salesman at a fair that sprawls over 1.2 million square metres, almost twice the size of the world largest mall.
More than 65% of the 103 exhibitors polled by Reuters in China southern city of Guangzhou expect to boost spending by up to 20% in 2017,fake calibre de cartier price, while 16.5% expect to raise spending by more than 20%.
That will be welcome news to leaders in Beijing, as China private companies, which make up the bulk of exhibitors at the fair, are a crucial engine of growth for the economy, unlike the largely inefficient and indebted state owned sector.
Chinese growth slowed to a 25 year low of 6.9% last year, and third quarter figures released yesterday put it on track for about 6.7% this year.
Economists say the country mid sized private companies are the primary source of investment,copy cartier ballon bleu gold, innovation and productivity growth. Heavy machinery manufacturers at the fair said they spend over 30% of their investment capital upgrading production lines each year, while many building materials and household equipment makers said they were pumping money into automation.
China is achieving average annual growth of 18% in research and development (R spending, compared with just 1.4% across the rest of the world upper middle income countries, according to the Unesco Institute for Statistics.
While most exporters surveyed aim to boost spending, around 20% said they planned to cut investment. Other sectors that may be under pressure as global growth slows, such as textiles and apparel, will feature later at the fair, which runs until Nov 4. China is increasingly moving to modernise its manufacturing industry with robotics and automation, driven in part by a shortage of skilled workers and rapidly rising wages that threaten to erode its appeal as a low cost workshop to the world. Reuters
do a better job than workers; the quality is more stable, said Zhejiang Momali Sanitary Utensils Co general manager Selina Song.
Song said,fake cartier watches ballon bleu, however, that a drop in sales was slowing the company push to boost automation.
Some economists said new and emerging sectors such as high end manufacturing equipment would see more room for development.
because these sectors get the government support.
They still see more room to grow despite slowing economic growth globally, said Nomura China economist Wendy Chen, who is based in Shanghai.
Liu Qian, deputy general manager of Nanjing Panda Electronics Import Export Co, said investing in robots and automation was crucial, given wages had doubled in five years.
Several Chinese provinces have slowed or halted increases to minimum wages this year, as companies face pressure from rising expenses and weakening global demand, something that is also prompting more companies to shift sales to within China.
Liu acknowledged it would take longer for some companies to break even, given the size of the initial capital injection in automation and robots.
China is aiming for a top 10 ranking in automation for its industries by 2020 by putting more robots in its factories, according to the International Federation of Robotics (IFR).
Torpedo Hsu, sales manager at heavy machinery transmissions maker CMEC, said the company plans to invest 10 to 20 % more in spending next year, which it hopes will lead to a pick up in orders after an expected 10 % fall in export orders this year.
battered southern Philippines
Monday ET), the National Disaster Risk Reduction and Management Center reported.
The tightly packed but powerful storm threatened to bring devastating flash floods and landslides. High winds could blast some homes into sticks, uproot trees and cut power for days, government officials warned.
The storm weakened slightly as it moved west across Mindanao during the course of the morning, the Philippine Atmospheric, Geophysical and Astronomical Services Administration said. There were no immediate reports of casualties.
The storm, dubbed "Pablo" in the Philippines,replica ladies tank watches, had blown up into a super typhoon at one point Monday, with sustained winds greater than 240 kph the equivalent of a Category 5 hurricane in the Atlantic Ocean, the Joint Typhoon Warning Center reported.
That wind speed is two and a half times the top winds of Severe Tropical Storm Washi, known in the Philippines as Sendong, whose heavy rains set off landslides that swept away entire villages in the same region a year ago.
"Many emotional people in (Mindanao) trying to prepare for Pablo with Sendong fresh in their minds," Carin van der Hor, the Philippines director for the children's charity Plan , wrote Monday on Twitter.
In the fishing village of Hinatuan, officials had warned coastal and island residents to evacuate to government shelters in the final hours before the storm hit, CNN affiliate ABS CBN reported.
At sea near the storm,copy cartier watches santos, waves reached as high as 52 feet, according to the Joint Typhoon Warning Center. On land,cartier santos 100 mens watch replica, the outer bands of the storm had already begun to bring intense rain and high winds to coastal communities before landfall was made, according to the National Disaster Risk Reduction and Management Council.
Government agencies had moved millions of dollars worth of relief supplies into position for quick delivery to storm hit regions and put emergency crews, the military and hospitals on standby.
School classes were suspended in many cities, and at least 80 flights were canceled, according to the disaster agency.
The threat to Mindanao comes just weeks ahead of the first anniversary of Washi,calibre de cartier fake, whose heavy rains set off flash floods in the middle of the night that swept away entire villages. More than 1,200 people died and hundreds of thousands were left homeless, prompting a humanitarian crisis.
Stormy weather in recent months also has caused death and destruction in other areas of the Philippines, where poor infrastructure leaves many communities highly vulnerable.
Severe flooding in the region of the capital, Manila, killed more than 80 people in August. And Tropical Cyclone Son Tinh left at least 27 people dead after sweeping across the central Philippines in October.
Monday ET), the National Disaster Risk Reduction and Management Center reported.
The tightly packed but powerful storm threatened to bring devastating flash floods and landslides. High winds could blast some homes into sticks, uproot trees and cut power for days, government officials warned.
The storm weakened slightly as it moved west across Mindanao during the course of the morning, the Philippine Atmospheric, Geophysical and Astronomical Services Administration said. There were no immediate reports of casualties.
The storm, dubbed "Pablo" in the Philippines,replica ladies tank watches, had blown up into a super typhoon at one point Monday, with sustained winds greater than 240 kph the equivalent of a Category 5 hurricane in the Atlantic Ocean, the Joint Typhoon Warning Center reported.
That wind speed is two and a half times the top winds of Severe Tropical Storm Washi, known in the Philippines as Sendong, whose heavy rains set off landslides that swept away entire villages in the same region a year ago.
"Many emotional people in (Mindanao) trying to prepare for Pablo with Sendong fresh in their minds," Carin van der Hor, the Philippines director for the children's charity Plan , wrote Monday on Twitter.
In the fishing village of Hinatuan, officials had warned coastal and island residents to evacuate to government shelters in the final hours before the storm hit, CNN affiliate ABS CBN reported.
At sea near the storm,copy cartier watches santos, waves reached as high as 52 feet, according to the Joint Typhoon Warning Center. On land,cartier santos 100 mens watch replica, the outer bands of the storm had already begun to bring intense rain and high winds to coastal communities before landfall was made, according to the National Disaster Risk Reduction and Management Council.
Government agencies had moved millions of dollars worth of relief supplies into position for quick delivery to storm hit regions and put emergency crews, the military and hospitals on standby.
School classes were suspended in many cities, and at least 80 flights were canceled, according to the disaster agency.
The threat to Mindanao comes just weeks ahead of the first anniversary of Washi,calibre de cartier fake, whose heavy rains set off flash floods in the middle of the night that swept away entire villages. More than 1,200 people died and hundreds of thousands were left homeless, prompting a humanitarian crisis.
Stormy weather in recent months also has caused death and destruction in other areas of the Philippines, where poor infrastructure leaves many communities highly vulnerable.
Severe flooding in the region of the capital, Manila, killed more than 80 people in August. And Tropical Cyclone Son Tinh left at least 27 people dead after sweeping across the central Philippines in October.
Associate Professor Adrian Dyer
Adrian Dyer is a vision scientist and photographer seeking to understand how the representation of an image is created, and can be used to interpret the complex world in which we live. interests centre on understanding how visual systems learn perceptually difficult tasks. This work involves both using human psychophysics and imaging studies, as well as experimenting with how the miniature brain of a bee can form visual representations to make decisions in complex environments. interests
Colour visual processing by honeybees: solutions for decision making in complex environments (DP0878968) is a collaboration with Professor Marcello Rosa.
Project summary: Honeybees are a cost and time efficient animal model for testing how information is processed in a miniature brain containing less than 0.01% of the number of cells found in a human brain. Bees use their ultraviolet, blue and green colour vision to efficiently find flowers in complex environments. This project investigates how colour information is processed by bees, and develops computer models to evaluate how novel solutions might be applicable for robotic vision. The model also allows for testing of how environmental factors, like changes in climate, might affect the way in which bees choose to visit certain flower types, including plants that have important environmental and economic impacts.
Organization and plasticity of visual processing in a miniature brain (DP0987989) is a collaboration with Dr David Reser.
Project summary: To recognise objects a brain must have an internal representation of most likely object appearance. Two ways in which brains may posses this information include a hard wired template system, and/or the neuroplasticity to learn novel objects. Recent investigations on honeybee vision show that this animal can learn to recognise very difficult objects, although currently we do not know how the miniaturised bee brain manages these tasks. This project will reveal changes that occur in the processing of visual objects by the bee brain with increasing experience, with potential applications including robotics or building interfaces between sensors and biological systems.
Batty, C.,Dyer, A.,Perkins, C.,Sita, J. (2016). Seeing animated worlds: Eye tracking and the spectator's experience of narrative In: Making Sense of Cinema: Empirical Studies into Film Spectators and Spectatorship, Bloomsbury Publishers, New York, United StatesDyer, A. (2016). Seeing through a bees' eye: how do pollinators finds flowers in complex environments? In: Unlikely: Journal of the Centre for Creative Arts, 1, 1 10Shrestha, M.,Lunau, K.,Dorin, A.,Schulze, B.,Bischoff, M.,Burd, M.,Dyer, A. (2016). Floral colours in a world without birds and bees: the plants of Macquarie Island In: Plant Biology, 18, 842 850Dyer, A.,copy cartier santos 100,Howard, S.,Garcia Mendoza, J. (2016). Through the eyes of a bee: seeing the world as a whole In: Animal Studies Journal, 5, 97 109Dyer, A.,Streinzer, M.,Garcia Mendoza, J. (2016). Flower detection and acuity of the Australian native stingless bee Tetragonula carbonaria Sm. In: Journal of Comparative Physiology A: Neuroethology, Sensory, Neural, and Behavioral Physiology, 202, 629 639Koethe,calibre de cartier chronograph fake, S.,Bossems, J.,Dyer, A.,Lunau, K. (2016). Colour is more than hue: preferences for compiled colour traits in the stingless bees Melipona mondury and M. quadrifasciata In: Journal of Comparative Physiology A: Neuroethology, Sensory, Neural, and Behavioral Physiology, 202, 615 627de Brito Sanchez, M.,Serre, M.,Avargues Weber, A.,Dyer, A.,Giurfa, M. (2015). Learning context modulates aversive taste strength in honey bees In: The Journal of Experimental Biology, 218, 949 959Avargues Weber, A.,Dyer, A.,Ferrah, N.,Giurfa, M. (2015). The forest or the trees: Preference for global over local image processing is reversed by prior experience in honeybees In: Proceedings of the Royal Society B: Biological Sciences, 282, 1 9van der Kooi, C.,replica ballon bleu cartier watch,Dyer, A.,Stavenga, D. (2015). Is floral iridescence a biologically relevant cue in plant pollinator signaling? In: New Phytologist, 205, 18 20Garcia Mendoza,fake cartier de calibre, J.,Dyer, A. (2015). UV digital imaging: new perspectives for quantitative data analysis in forensics In: Forensic science : new developments, perspectives and advanced technologies, Nova Science Publishers Inc, New York, United States
Designing green spaces for biodiversity and human well being. Administered by Monash University. Administered by University of Oslo. Administered by Monash University. Administered by Monash University.
Adrian Dyer is a vision scientist and photographer seeking to understand how the representation of an image is created, and can be used to interpret the complex world in which we live. interests centre on understanding how visual systems learn perceptually difficult tasks. This work involves both using human psychophysics and imaging studies, as well as experimenting with how the miniature brain of a bee can form visual representations to make decisions in complex environments. interests
Colour visual processing by honeybees: solutions for decision making in complex environments (DP0878968) is a collaboration with Professor Marcello Rosa.
Project summary: Honeybees are a cost and time efficient animal model for testing how information is processed in a miniature brain containing less than 0.01% of the number of cells found in a human brain. Bees use their ultraviolet, blue and green colour vision to efficiently find flowers in complex environments. This project investigates how colour information is processed by bees, and develops computer models to evaluate how novel solutions might be applicable for robotic vision. The model also allows for testing of how environmental factors, like changes in climate, might affect the way in which bees choose to visit certain flower types, including plants that have important environmental and economic impacts.
Organization and plasticity of visual processing in a miniature brain (DP0987989) is a collaboration with Dr David Reser.
Project summary: To recognise objects a brain must have an internal representation of most likely object appearance. Two ways in which brains may posses this information include a hard wired template system, and/or the neuroplasticity to learn novel objects. Recent investigations on honeybee vision show that this animal can learn to recognise very difficult objects, although currently we do not know how the miniaturised bee brain manages these tasks. This project will reveal changes that occur in the processing of visual objects by the bee brain with increasing experience, with potential applications including robotics or building interfaces between sensors and biological systems.
Batty, C.,Dyer, A.,Perkins, C.,Sita, J. (2016). Seeing animated worlds: Eye tracking and the spectator's experience of narrative In: Making Sense of Cinema: Empirical Studies into Film Spectators and Spectatorship, Bloomsbury Publishers, New York, United StatesDyer, A. (2016). Seeing through a bees' eye: how do pollinators finds flowers in complex environments? In: Unlikely: Journal of the Centre for Creative Arts, 1, 1 10Shrestha, M.,Lunau, K.,Dorin, A.,Schulze, B.,Bischoff, M.,Burd, M.,Dyer, A. (2016). Floral colours in a world without birds and bees: the plants of Macquarie Island In: Plant Biology, 18, 842 850Dyer, A.,copy cartier santos 100,Howard, S.,Garcia Mendoza, J. (2016). Through the eyes of a bee: seeing the world as a whole In: Animal Studies Journal, 5, 97 109Dyer, A.,Streinzer, M.,Garcia Mendoza, J. (2016). Flower detection and acuity of the Australian native stingless bee Tetragonula carbonaria Sm. In: Journal of Comparative Physiology A: Neuroethology, Sensory, Neural, and Behavioral Physiology, 202, 629 639Koethe,calibre de cartier chronograph fake, S.,Bossems, J.,Dyer, A.,Lunau, K. (2016). Colour is more than hue: preferences for compiled colour traits in the stingless bees Melipona mondury and M. quadrifasciata In: Journal of Comparative Physiology A: Neuroethology, Sensory, Neural, and Behavioral Physiology, 202, 615 627de Brito Sanchez, M.,Serre, M.,Avargues Weber, A.,Dyer, A.,Giurfa, M. (2015). Learning context modulates aversive taste strength in honey bees In: The Journal of Experimental Biology, 218, 949 959Avargues Weber, A.,Dyer, A.,Ferrah, N.,Giurfa, M. (2015). The forest or the trees: Preference for global over local image processing is reversed by prior experience in honeybees In: Proceedings of the Royal Society B: Biological Sciences, 282, 1 9van der Kooi, C.,replica ballon bleu cartier watch,Dyer, A.,Stavenga, D. (2015). Is floral iridescence a biologically relevant cue in plant pollinator signaling? In: New Phytologist, 205, 18 20Garcia Mendoza,fake cartier de calibre, J.,Dyer, A. (2015). UV digital imaging: new perspectives for quantitative data analysis in forensics In: Forensic science : new developments, perspectives and advanced technologies, Nova Science Publishers Inc, New York, United States
Designing green spaces for biodiversity and human well being. Administered by Monash University. Administered by University of Oslo. Administered by Monash University. Administered by Monash University.
Car Leasing Contract Features
As the car becomes a daily necessity in many consumers' lives,van cleef arpels copy alhambra necklace, there is a growing need for car leasing options to ease the financial burdens of the consumer. Purchasing a car is not easy for most average consumers; the total car cost is way too expensive for the consumer to fork out in one lump sum. Hence, car leasing options are a great avenue to owning a car; at least in possessing one for convenience.
There is a plethora of car leasing companies in the market today that offer a variety of car leasing contracts. This is to cater to the different needs and wants of the various categories of consumers. However, most car leasing contracts have similar features although some car leasing contracts may offer a better deal than others with good negotiation and timing.
Some car leasing contracts offer a 2 hour delivery on standard models while others offer 4 hours on standard light commercial vehicles. This depends on the availability of the stock; a fast selling model may require a longer waiting list.
Most car leases allow a certain number of free miles on different car models,replica van cleef arpels necklace; there are car leases that offer 2800 miles free for the first 28 days with unlimited mileage. This allows the customers to enjoy the use of the vehicle to its fullest. Other available features with car leases include the safety checking and valet maintenance service every 28 days; this is usually applied to light commercial vehicles that are heavily used in the business operations where frequent traveling and deliveries are expected.
Different car leases would offer different termination approaches,van cleef imitation alhambra necklace; some allow their consumers to end the lease earlier with an early settlement of outstanding fees while others may impose a small charge as compensation. Different leasing companies have their own computation methods on an early car lease contract termination where daily rates may be applied,van cleef and arpels imitation necklace.
Some car lease contracts allow the consumers to return the leased vehicle at any time they desire after the stipulated commitment period which could be 3 months, 6 months or 12 months. There is no need to give advanced notice to the leasing company if this clause is stated in the leasing contract.
The car leasing contract includes flexibility in payment depending on the financial status of the consumer. These features can be negotiated to offer the best of leasing contract to the consumer.
As the car becomes a daily necessity in many consumers' lives,van cleef arpels copy alhambra necklace, there is a growing need for car leasing options to ease the financial burdens of the consumer. Purchasing a car is not easy for most average consumers; the total car cost is way too expensive for the consumer to fork out in one lump sum. Hence, car leasing options are a great avenue to owning a car; at least in possessing one for convenience.
There is a plethora of car leasing companies in the market today that offer a variety of car leasing contracts. This is to cater to the different needs and wants of the various categories of consumers. However, most car leasing contracts have similar features although some car leasing contracts may offer a better deal than others with good negotiation and timing.
Some car leasing contracts offer a 2 hour delivery on standard models while others offer 4 hours on standard light commercial vehicles. This depends on the availability of the stock; a fast selling model may require a longer waiting list.
Most car leases allow a certain number of free miles on different car models,replica van cleef arpels necklace; there are car leases that offer 2800 miles free for the first 28 days with unlimited mileage. This allows the customers to enjoy the use of the vehicle to its fullest. Other available features with car leases include the safety checking and valet maintenance service every 28 days; this is usually applied to light commercial vehicles that are heavily used in the business operations where frequent traveling and deliveries are expected.
Different car leases would offer different termination approaches,van cleef imitation alhambra necklace; some allow their consumers to end the lease earlier with an early settlement of outstanding fees while others may impose a small charge as compensation. Different leasing companies have their own computation methods on an early car lease contract termination where daily rates may be applied,van cleef and arpels imitation necklace.
Some car lease contracts allow the consumers to return the leased vehicle at any time they desire after the stipulated commitment period which could be 3 months, 6 months or 12 months. There is no need to give advanced notice to the leasing company if this clause is stated in the leasing contract.
The car leasing contract includes flexibility in payment depending on the financial status of the consumer. These features can be negotiated to offer the best of leasing contract to the consumer.
Best Cars To Buy Used Under 5000 Dollars
Top 10 Used Cars Under $5000These days it seems that everything is expensive,van cleef and arpels clover copy necklace, and that includes cars and the fuel they use to operate. Many people are delaying purchasing new cars or are choosing to hang on to older vehicles. However, there are still some very nice cars and trucks available that you can buy for under $5,000. Here is my list of the best cars to buy used under $5000.
Important Factors In Choosing Cheap Used Cars
The main things to be concerned with when choosing a used car costing under $5,000 are the safety of the vehicle, the gas mileage it gets, age of the vehicle, the condition of the vehicle, and how much longer it is likely to operate after you purchase it.
For example, if you were to find a 2003 Honda that was in good shape, low mileage, etc., then it could be a better deal than a 2011 Honda that had been in an accident and was in bad shape. However, you have to take into consideration that an older model car most likely won have a warranty,van cleef knock off necklace alhambra, so be sure to have it checked out by a reliable mechanic before buying it.
You also have to consider your own lifestyle and the type of vehicle that you need. For example, if you are single and don need to worry about carrying around a lot of things, you can go with a small car, but if you plan on hauling anything, you may need a truck and if you have a family, then you need a larger car, van or even an SUV.
Here is a listing of the 10 best used cars under $5,000 in no particular order:
The Honda Civic is a small model of car that you can find for between $2,000 and $5,000. It is said to have one of the least expensive records for repair and durability and it is rated for good gas mileage with between 31 and 35 mpg average for models in the 1990s. It has a B15 series engine, available manual transmission, and customers rated it highly for low maintenance costs, comfortable ride, and ability to go over the 100,000 miles of usage milestone and still go strong, in fact, one customer noted that his 1994 Civic had more than 200,000 miles on it and was still going great.
Honda has always seemed to rank highly in quality and fuel economy for smaller cars. In this range, you can find quite a few Accords that cost between about $2000 and $5,000 at dealerships, car auctions and other locations. The Accord is a bit bigger than some of the other offerings from Honda, so it could also work for a family. The Honda Accord has a V6 engine, and these are well known for being durable. In fact, statistics on these cars back to 1991 show high customer satisfaction ratings and high ratings for safety and reliability.
Another Honda also makes the list of best cars under $5,000, as it can be purchased for between $3,500 and $5,000. This model is considered to be very economical and long lasting. It is rated highly by customers for its reliability, and many say it lasted more than 100,000 miles of usage. Even the older models manage to get in the 30s for gas mileage, which is comparable to some of today vehicles.
This car is considered to be a very frugal four door sedan that handles well during bad weather due to its all wheel drive feature, which helps to make it a safe car to own. It is said to need a bit more maintenance than some of these lower priced cars, but it is still considered to be a good buy if you keep it maintained well. It can be purchased for between $4,000 and $5,000. You can get them in manual or auto transmission and they are considered very fun to drive, almost like a sports car.
If you need a pickup truck, the Ford Ranger is a good choice for between $2,000 and $5,000. The maintenance is considered to be low cost and some owners even do some of the repairs and maintenance on their own. The models in these year ranges are four cylinders. Its reliability for things like the brakes, heating and cooling, transmission, startup and charging, etc., are rated highly by customers. Plus, it got four stars in safety ratings by the NHTSA.
Ford Mustang, 1999 2003 The Ford Mustang is also considered a good used car for between $3,000 and $5,000 and you can get some good buys in the 1999 to 2005 years. It has a high rating for satisfaction,van cleef and arpels replica clover necklace, appearance, performance, and horsepower. Ford considers it one of their most popular models.
The Audi4 is another great car you can find under $5,000. These cars are well known for being luxurious, comfortable, attractive, and fun to drive. It can be found in both manual and auto transmission versions. It also has a turbo charged four cylinder engine. It is highly rated for its transmission, heating and cooling system, and its steering and suspension. Several owners stated in their review of this car that they had had it for multiple years and even though it had over 100,000 miles on it that it was still going strong.
Volkswagen Golf, 1998 The Volkswagen Golf is also a great buy at between $2,800 and $5,van cleef clover knock off necklace,000. It has a 2.0 liter four cylinder engine with 115 horsepower and 122 pound feet of torque and 3,200 rpm. It comes in either five speed manual or four speed auto transmission and the fuel mileage runs between 23 and 30 mpg.
The Ford Focus is considered to have good performance, and has a four cylinder engine available in auto or manual transmission. It gets mileage in the 10 to 30s range of miles per hour as rated by EPA standards.
The Honda CR V models are one of the few SUVs that you can find for under $5,000. These may be harder to find, or may have high mileage on them, but they are still considered to be good buys for families who need the room. It has a two liter four cylinder engine with 146 horsepower and 133 pound feet torque, a four speed auto transmission or a five speed manual one. It is rated highly for good suspension, heating and cooling, starting and charging, transmission and available accessories.
These are just some of the best cars to buy used under $5000. If you an interested in buying any of these used cars then I would suggest you look online for them first.
Top 10 Used Cars Under $5000These days it seems that everything is expensive,van cleef and arpels clover copy necklace, and that includes cars and the fuel they use to operate. Many people are delaying purchasing new cars or are choosing to hang on to older vehicles. However, there are still some very nice cars and trucks available that you can buy for under $5,000. Here is my list of the best cars to buy used under $5000.
Important Factors In Choosing Cheap Used Cars
The main things to be concerned with when choosing a used car costing under $5,000 are the safety of the vehicle, the gas mileage it gets, age of the vehicle, the condition of the vehicle, and how much longer it is likely to operate after you purchase it.
For example, if you were to find a 2003 Honda that was in good shape, low mileage, etc., then it could be a better deal than a 2011 Honda that had been in an accident and was in bad shape. However, you have to take into consideration that an older model car most likely won have a warranty,van cleef knock off necklace alhambra, so be sure to have it checked out by a reliable mechanic before buying it.
You also have to consider your own lifestyle and the type of vehicle that you need. For example, if you are single and don need to worry about carrying around a lot of things, you can go with a small car, but if you plan on hauling anything, you may need a truck and if you have a family, then you need a larger car, van or even an SUV.
Here is a listing of the 10 best used cars under $5,000 in no particular order:
The Honda Civic is a small model of car that you can find for between $2,000 and $5,000. It is said to have one of the least expensive records for repair and durability and it is rated for good gas mileage with between 31 and 35 mpg average for models in the 1990s. It has a B15 series engine, available manual transmission, and customers rated it highly for low maintenance costs, comfortable ride, and ability to go over the 100,000 miles of usage milestone and still go strong, in fact, one customer noted that his 1994 Civic had more than 200,000 miles on it and was still going great.
Honda has always seemed to rank highly in quality and fuel economy for smaller cars. In this range, you can find quite a few Accords that cost between about $2000 and $5,000 at dealerships, car auctions and other locations. The Accord is a bit bigger than some of the other offerings from Honda, so it could also work for a family. The Honda Accord has a V6 engine, and these are well known for being durable. In fact, statistics on these cars back to 1991 show high customer satisfaction ratings and high ratings for safety and reliability.
Another Honda also makes the list of best cars under $5,000, as it can be purchased for between $3,500 and $5,000. This model is considered to be very economical and long lasting. It is rated highly by customers for its reliability, and many say it lasted more than 100,000 miles of usage. Even the older models manage to get in the 30s for gas mileage, which is comparable to some of today vehicles.
This car is considered to be a very frugal four door sedan that handles well during bad weather due to its all wheel drive feature, which helps to make it a safe car to own. It is said to need a bit more maintenance than some of these lower priced cars, but it is still considered to be a good buy if you keep it maintained well. It can be purchased for between $4,000 and $5,000. You can get them in manual or auto transmission and they are considered very fun to drive, almost like a sports car.
If you need a pickup truck, the Ford Ranger is a good choice for between $2,000 and $5,000. The maintenance is considered to be low cost and some owners even do some of the repairs and maintenance on their own. The models in these year ranges are four cylinders. Its reliability for things like the brakes, heating and cooling, transmission, startup and charging, etc., are rated highly by customers. Plus, it got four stars in safety ratings by the NHTSA.
Ford Mustang, 1999 2003 The Ford Mustang is also considered a good used car for between $3,000 and $5,000 and you can get some good buys in the 1999 to 2005 years. It has a high rating for satisfaction,van cleef and arpels replica clover necklace, appearance, performance, and horsepower. Ford considers it one of their most popular models.
The Audi4 is another great car you can find under $5,000. These cars are well known for being luxurious, comfortable, attractive, and fun to drive. It can be found in both manual and auto transmission versions. It also has a turbo charged four cylinder engine. It is highly rated for its transmission, heating and cooling system, and its steering and suspension. Several owners stated in their review of this car that they had had it for multiple years and even though it had over 100,000 miles on it that it was still going strong.
Volkswagen Golf, 1998 The Volkswagen Golf is also a great buy at between $2,800 and $5,van cleef clover knock off necklace,000. It has a 2.0 liter four cylinder engine with 115 horsepower and 122 pound feet of torque and 3,200 rpm. It comes in either five speed manual or four speed auto transmission and the fuel mileage runs between 23 and 30 mpg.
The Ford Focus is considered to have good performance, and has a four cylinder engine available in auto or manual transmission. It gets mileage in the 10 to 30s range of miles per hour as rated by EPA standards.
The Honda CR V models are one of the few SUVs that you can find for under $5,000. These may be harder to find, or may have high mileage on them, but they are still considered to be good buys for families who need the room. It has a two liter four cylinder engine with 146 horsepower and 133 pound feet torque, a four speed auto transmission or a five speed manual one. It is rated highly for good suspension, heating and cooling, starting and charging, transmission and available accessories.
These are just some of the best cars to buy used under $5000. If you an interested in buying any of these used cars then I would suggest you look online for them first.