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Clinical/Basic Science Research Article
Daily versus weekly evidence reports for orthopaedic surgeons in India
A mixed-methods study
Kheterpal, Sunita BSc, MSca,∗; Busse, Jason W. DC, PhDb; Baxter, Pamela RN, MScN, PhDc; Sonnadara, Ranil MSc, PhDd; Bhandari, Mohit MD, MSc, PhDe
aGlobal Health Office, Faculty of Health Sciences
bDepartment of Health Research Methods, Evidence and Impact, Michael DeGroote School of Medicine
cSchool of Nursing
dDepartment of Surgery
eDivision of Orthopaedic Surgery, Department of Surgery, Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
∗Corresponding author. Address: Faculty of Health Sciences, Global Health Office, McMaster University, 1280 Main St. West MDCL 3500, Hamilton, Ontario, L8N 3Z5, Canada. E-mail address: sunita.kheterpal@gmail.com (S Kheterpal)
Dr M.B. is Founder and Editor-in-Chief of ORTHOEvidence. He holds shares in ORTHOEvidence.
The other authors have no conflicts of interest to disclose.
Source of funding: Nil.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
OTA International: December 2019 - Volume 2 - Issue 4 - p e029
doi: 10.1097/OI9.0000000000000029
There is a dearth of research regarding the impact of evidence-based medicine (EBM) tools, such as evidence summaries, in developing countries. The goals of this study were to: investigate accessibility, use, and impact of an online EBM knowledge dissemination portal in orthopaedic surgery in India; explore whether receiving daily targeted evidence summaries results in more frequent use of an EBM tool compared with receiving general weekly reports; and identify and explain the barriers and benefits of an online EBM resource in the Indian context.
Forty-four orthopaedic surgeons in Pune, India, were provided free access to OrthoEvidence (OE), a for-profit, online EBM knowledge dissemination portal. Participants were subsequently randomized into 2 groups—1 group received daily targeted evidence summaries while the other received general weekly summaries. This study employed an explanatory sequential mixed methods design that incorporated 2 questionnaires, OE usage data, and semi-structured interviews to gain insight into the surgeons' usage, perceptions, and impact of OE.
There were no observable differences in OE usage between groups. OE was deemed to be comprehensive, practical, useful, and applicable to clinical practice by the majority of surgeons. The exit survey data revealed no differences between groups' perceptions of the OE tool. semi-structured interviews revealed barriers to keeping up with evidence that included limited access to relevant medical literature and limited incentive to keep up with current evidence.
Neither frequency of delivery (daily versus weekly) nor targeted versus general content affected the use of evidence summaries. Facilitating uptake of current evidence into clinical practice among Indian orthopedic surgeons may require additional components beyond dissemination of evidence summaries.
Evidence-based medicine (EBM) involves integrating individual clinical expertise with the best available evidence from scientific literature.[1,2] Patient values and preferences are also incorporated into EBM to promote shared decision-making between patients and clinicians.[1,3] Implementing an evidence-based approach has strong advantages, such as increased cost-effectiveness, by minimizing clinical practices that have limited proven benefit.[4–7]
Failure to use evidence from research to make informed decisions is evident among healthcare providers, managers, and policy-makers, across all disciplines of care around the world.[6,8–10] The practice of EBM is further constrained in developing countries due to its inherent complexity, misperceptions, absence in medical curricula, and limited awareness among clinicians.[4] In resource-poor countries, there is limited access to databases/computers/Internet, limited literature relevant to local realities, and inadequate library facilities.[7,11–18] In an effort to improve healthcare quality and physicians' decision-making to promote optimal outcomes for patients, the use of EBM to inform healthcare practice has emerged as both a national[6] and international priority.[19–22]
South Asian countries, in particular, have demonstrated limited uptake of EBM.[4,23] Given the often large patient load among Indian physicians, clinicians have limited time and incentives to stay up-to-date with the latest breakthroughs and innovations; consequently, they may not always provide optimal care.[6]
One major barrier to implementing EBM in orthopaedic surgery specifically is the lack of summarized evidence that is available in a useful and acceptable format.[24] The objectives of this study were to: investigate the accessibility, use, and impact of an online EBM knowledge dissemination portal for orthopaedic surgeons in India, explore whether receiving daily targeted evidence summaries results in increased usage of an EBM tool when compared to receiving general weekly reports, and identify and explain the barriers and benefits of an EBM resource in the Indian context.
At the Sancheti Institute of Orthopaedics and Rehabilitation (SIOR), a private orthopaedic hospital in Pune, India, approximately 54,000 patients are seen as outpatients, while 5,500 are seen as inpatients annually.
To be eligible for the study, participants had to be orthopaedic surgeons in training or in practice, full-time employees of the SIOR, and able to read and write in English. Ethics approval from McMaster University's Hamilton Integrated Research Ethics Board Student Research Committee and the SIOR's Ethics Committee was obtained.
Orthopaedic surgeons (n = 44) at the SIOR were provided free access to OE (www.myorthoevidence.com), a for-profit and online EBM knowledge dissemination portal. OE gathers high-impact peer-reviewed journal articles, summarizes them, and then sends out Advanced Clinical Evidence (ACE) reports to subscribers via email.[25] ACE reports are approximately 1 to 2 pages and provide a study overview by answering the following questions: Why is the research needed now? What is the principal research question? What are the important findings? What should I remember most? How will this affect the care of patients?
For the benefit of the surgeons participating in this study, their access to OE continued for a total period of 2 years.
3.1 Explanatory sequential mixed methods design
This study employed an explanatory sequential mixed-methods design, incorporating 2 questionnaires, OE usage data, and semi-structured interviews in order to gain insight into the surgeons' usage and perceptions, as well as the impact of OE. The sequential explanatory mixed methods study design occurred in 2 distinct phases. Quantitative data was first collected and analyzed using an initial survey, exit survey, and participants' OE usage data. The quantitative data and its analysis provided a general understanding of the research question.[26] The quantitative data then guided purposeful sampling for the qualitative phase.[27] Qualitative data collected through semi-structured interviews was analyzed in order to better understand the quantitative findings. The qualitative data specifically aided in refining and explaining the statistical results by exploring participants' perceptions about OE in depth.
3.2 The OrthoEvidence intervention
Stratified random sampling was used to distribute the study participants. Participants were stratified into their respective professional occupations—surgical resident trainees, attending physicians (consultants), and visiting fellows. Participants were then randomized into a group receiving daily targeted ACE reports directed toward SIOR's orthopaedic practice, or a group receiving general weekly ACE reports. Stratification by level of training ensured that an equal number of surgical resident trainees, consultants, and visiting fellows were in each arm of the study for comparison purposes. See Figure 1 for a flow diagram of study participants.
Flow diagram of study participants.
Participants in both groups received free, full online access to the OE website and could use the site as they pleased. Both groups also received newsletters presenting newly uploaded evidence or recent interviews that were sent out by the OE company to their subscribers at least once a week; these newsletters were not specific to the SIOR. See Table 1 for demographic information of the participants.
Surgeons' demographic information
The researcher attended daily morning rounds to determine which ACE reports would be suitable for surgeons based on the cases presented. Cases that were more controversial were noted along with the reason for admission, diagnosis, and/or treatment plan. Relevant ACE reports specific to these cases were sent to surgeons receiving daily targeted mailers. For example, there was a great deal of discussion around surgical and non-surgical management of clavicle fractures. Thus, every couple of days, at least 1 clavicle fracture ACE report was included in the daily targeted mailers.
ACE reports were sent to surgeons receiving daily mailers via a newsletter. Each newsletter included 9 ACE reports with a minimum of 1 report for each sub-specialization department at the SIOR including pediatrics, trauma, knee, spine, hand and shoulder, hip, ortho-oncology, rheumatology, and general orthopaedics. ACE reports with low risk of bias scores (above 6/10 scores) based on OE's methodological quality assessment of recent articles (published within the last five years), high reported quality scores (above 17/20), author-verified ACE reports, high user scores (above 7/10), sample sizes with greater than 50 participants, randomized controlled trials and meta-analysis, were preferable to include in the daily ACE report newsletters sent to surgeons.
4 Outcome measurements
4.1 OrthoEvidence usage statistics
Individual participants' usage data (open and click rates) were tracked through the OE database and MailChimp to determine whether receiving daily targeted evidence summaries led to more frequent use of the OE service compared to only receiving weekly general newsletters. The number of newsletters sent to each participant, the percentage of newsletters that were opened through the participant's email (open rates), the percentage of reports that were clicked within the newsletters for each participant (click rates), and the specific reports that were accessed were tracked. During the trial period, surgeons receiving daily targeted mailers received 21 daily mailers in addition to the 14 general mailers for a total of 35 mailers. Surgeons receiving general weekly mailers received 14 general mailers which were sent by OE.
The main analysis was descriptive in nature and the secondary analysis using Mann–Whitney U tests was exploratory. The data was not normally distributed. Thus, results were reported using median values and interquartile ranges. Mann–Whitney U tests were conducted to determine if there were differences in the open and click rates between the group receiving daily targeted mailers and the group receiving weekly general mailers. A threshold P value of ≤0.05 was used to determine the significance of the results.
4.2 Exit survey
All participants were surveyed about their experience with OE after a minimum of 3 weeks of having access to the product. OE use between the 2 groups was compared through self-reported data on the number of ACE reports reviewed, average time spent on OE, method of accessing OE, and ease of access to OE within the SIOR. Participants provided their perception of ACE report comprehensiveness, practicality, usefulness, efficiency, and applicability in practice on a 5-point Likert scale from strongly agree to strongly disagree. Surgeons also rated whether they felt better informed to make clinical decisions and whether they believed their patient care had improved as a result of knowledge gained from ACE reports. They were asked whether they took action to put any of the new knowledge they gained from ACE reports into practice by actively discussing reports with a colleague or changing patient care decisions. Descriptive analyses were used to report these results.
5.1 Baseline survey results
An initial baseline survey was used to obtain information about surgeons' educational background, current use of medical literature, use of mobile technology, and the SIOR's Internet access.
Approximately 64% (n = 28) of survey respondents had access to computers connected to the Internet within the SIOR. Every surgeon that had access to these computers reported having difficulty browsing the Internet on them. All respondents used some form of mobile device (laptop, tablet, or cellular mobile phone). Furthermore, all respondents owned and used a smartphone within the SIOR. However, for 59% (n = 26) of survey respondents, connecting their smartphone to the Internet and browsing websites while in the SIOR was only sometimes or never possible depending on the location and connection. Connecting to mobile apps within the SIOR was also only sometimes or never possible depending on the location and connection for 61% (n = 27) of respondents. See Table 2 for a comparison of the 2 groups' access to Internet.
Surgeons' access to Internet
Three quarters of respondents (75%; n = 33) said they accessed medical literature online while 73% (n = 32) also said they used textbooks. Only 39% (n = 17) said they read journals in paper form. Medical literature was read weekly by 52% (n = 23) of respondents while 66% (n = 29) read 1 to 3 scholarly journal articles in the week. Notably, 64% (n = 28) of individuals stated that their current method of keeping up to date with new research was inefficient. Interestingly, 3 quarters of the group (75%, n = 33) stated that their current method of staying up to date with research still improved their patient care. See Table 3 for a comparison of the 2 groups' access to medical literature.
Surgeons' access to medical literature
5.2 OE usage data results
Each individual's average open rate and click rate was captured for the 30-day study period. There was no difference between the 2 groups in terms of "open rates" (the percentage of newsletters that were opened through the participant's email) and "click rates" (the percentage of reports that were clicked within the newsletters for each participant). See Table 4 for comparison of open rates and click rates between groups.
Comparison of open and click rates between groups
Based on usage data over a 1-month time span, it was found that providing daily targeted evidence summaries to orthopaedic surgeons did not enable more frequent use of OE compared to providing weekly orthopaedic evidence summaries.
5.3 Exit survey results
An exit survey was used to compare the experiences and perceptions of surgeons receiving daily targeted ACE reports and those receiving general weekly reports. No difference was found between the 2 groups' time spent reviewing literature in online journals, method, and ease of accessing OE. Most surgeons said they were reading 1 to 3 ACE reports weekly for 30 minutes or less and were accessing OE through their smartphones. However, the majority of respondents were only sometimes able to load the OE website without problems depending on their connection and/or location within the SIOR. See Table 5 for a comparison of the 2 groups' usage of OE.
OrthoEvidence self-reported usage
Overall, the survey found that OE ACE reports were perceived to be comprehensive, practical, useful, and applicable by most surgeons at the SIOR. Moreover, three-quarters of the group agreed that ACE reports had improved their efficiency and ability to keep up with new research. For more than half of the group, their confidence in medical decision-making and their perception of improved patient care also improved as a result of ACE reports. Surgeons were actively engaging with OE by reading and discussing ACE reports. See Table 6 for a comparison of the 2 groups' perception of OE.
Surgeons' perceptions of ACE reports
5.4 Semi-structured interview results
Nineteen semi-structured interviews were conducted with 8 surgical residents, 9 attending surgeons, and 2 visiting fellows. Thirteen of the interviewees were surgeons receiving daily targeted mailers while 6 were receiving weekly general mailers. Data were analyzed by the principal investigator using an edit organizing style in order to identify meaningful units and to organize these into themes.[28]
The semi-structured interviews revealed some barriers to keeping up with evidence as well as challenges faced using OE. The problems mentioned in accessing relevant literature were a result of limited Internet connection, lack of time to access information, and minimal access to medical journals.
"The most important problem today is browsing. You don't know what to look for and you end up wasting a lot of time reading unrelated things…because focused information is something which we lack in medicine…" (Attending Surgeon).
Limited incentives to keeping up with the literature were indicated to be due to limited decision-making powers for trainees for patient-related care, a textbook-based residency curriculum (instead of one that also incorporates findings from peer-reviewed primary and secondary literature), a lack of research methods' knowledge, and limited context-specific research.
"Our exam patterns fit the textbooks. People read to pass their exams. If they start reading journals, they'd flunk their exams. The entire system needs to be turned around…" (Attending Surgeon).
Facilitators to using OE included the instruction and coaching provided by the researcher, as well as the overall convenience of the pre-appraised ACE report summary format, which was easily accessible through a mobile device. The majority of surgeons agreed that ACE reports were relevant because they provided support for surgeons' decision-making. Some residents found OE useful when trying to understand certain surgical techniques and practices at the SIOR especially when they were in doubt. ACE reports also allowed the residents to better understand the surgery and its outcomes, leading to an increased knowledge base for future decision-making in the treatment of their patients.
Surgeons reported actively discussing new literature as it emerged and actively incorporating this evidence into their practice. For example, as a result of relevant ACE reports, the trauma team at the SIOR came together more frequently to discuss recent research emerging in their field from other groups. Subsequently, management of clavicle fractures shifted from nonoperative treatment to operative treatment. Surgeons also began prescribing combinations of Vitamin D, Vitamin K, and calcium to patients suffering from osteoporosis because an ACE report showed that calcium supplements would be better absorbed this way. Many attending surgeons explained that OE would be useful for doctors all over India who lack access to journal articles because receiving ACE reports through OE could help them stay up-to-date.
Given that there was no difference found between the 2 groups in terms of OE usage, it was concluded that sending daily targeted mailers did not enable more frequent usage of the OE service compared to providing weekly orthopaedic summaries over a 1-month time span. The study elicited barriers to the incorporation of EBM into surgical practice in India.
The barriers faced by surgeons in accessing medical literature (limited access to relevant literature and limited incentive to keep up with literature) are in line with studies from around the world.[6–8,11,12,15,22,23,29–36] The pre-appraised ACE report format facilitated surgeons' use of OE and helped them keep up to date with literature. This finding is in line with research that demonstrates that increased convenience of access to reliable and applicable high quality research makes information-seeking more likely to occur and ultimately be successful.[37]
Trauma surgeons noted that prior to having access to OE, the team was not actively discussing recent literature. But as a result of relevant ACE reports that everybody could access, the emergency department team was coming together to share their perspectives and discuss new research on a more consistent basis. Overall, OE helped the SIOR's surgeons to rethink, reassess, and redefine procedures related to fracture care in the trauma department.
The majority of surgeons agreed that OE ACE reports were comprehensive, practical, useful, and applicable for clinical practice. They also improved efficiency and ability to keep up with new research while helping to assist surgeons in making medical decisions. Surgeons described changing trauma practices as a result of information provided in OE ACE reports and active team discussions. These findings point toward the potential for knowledge dissemination portals that are easy to access, to help surgeons implement EBM in practice. The practice of EBM and the use of web-based EBM tools in India may be promoted by: improving Internet access, and integrating EBM into training programs and surgical culture.
6.1 Improving Internet access
Many of the barriers in accessing OE and generally keeping up with the literature stemmed from an overall inability to connect to the Internet at the SIOR. This means that the use of any online tool will likely be limited as a result of the inability to access the Internet within the hospital. If surgeons at the SIOR were having difficulty connecting to online tools, then many healthcare facilities in India with fewer resources will likely have more difficulty and thus, barriers to access. Investments to allow for reliable and fast Internet are needed for online EBM tools to be accessed throughout India.
6.2 Integration into residency curricula and surgical culture
The best way to embed evidence into good clinical practice in India is to change surgical culture in general, for example, by training attending surgeons to serve as appropriate EBM role models for students.[38] It would be beneficial for the SIOR's residency curriculum to provide a research methods course at the beginning of their training to familiarize students with EBM concepts. EBM training should be led by attending surgeons who can focus on day-to-day case studies as examples.[39,40] Instilling habits early on through experiential and culturally supported ways of learning can ensure that EBM is practiced successfully by individuals and surgical communities alike.[8,12,39,41–43]
All interviewees agreed that OE should be added to a resident's toolbox as a reliable learning tool. Furthermore, a weekly reading program or journal club can be integrated into residency curriculum to promote the practice of EBM.[44] The reading program could include the weekly dissemination of 1 high-impact article to surgeons, which would be followed by group discussions. Providing an opportunity for residents to lead these meetings can foster greater learning and collaboration.[44] Incorporating an EBM competency section into academic exams may also promote physicians to read current literature.
6.3 Study limitations
This study focused on a high-tech, private hospital in India and thus as a single-center study, it limited the generalizability of the findings beyond the context in which this study was conducted. Government hospitals in India are even more overloaded with patients and have very limited resources; they are at greater risk of being out of date with new practices and procedures.[6] The study's findings present the best-case scenario of the implementation, usability, and capability of an EBM knowledge dissemination tool such as OE because the SIOR possessed high-quality resources in comparison to other Indian hospitals.
The small sample size of 44 surgeons enrolled in the study reduced the statistical power of the study. The results trended in the anticipated direction with the median open rate and click rate being higher for the group of surgeons receiving daily targeted mailers compared to the group receiving weekly mailers (14.3% vs. 0% for open rates, and 4.8% vs. 0% for click rates, respectively). However, the small sample size left the study vulnerable to finding no difference in effect. A larger trial might have found significant differences.
Determination of where the participants' EBM knowledge came from was also a confounding variable—a causal relationship between OE articles and changing clavicle fracture practices could not be made given that this could have occurred due to an accumulated effect. Given these limitations, it was a pragmatic study which added OE as a resource onto what surgical residents may otherwise have been exposed to.
A similar study may be conducted on a larger scale across one Indian state as a cluster randomized trial to avoid contamination, using hospitals as the unit of randomization. Some hospitals would get weekly, general mailers while other hospitals would get daily, targeted mailers.
Although surgeons at the SIOR expressed positive attitudes toward OE as a knowledge-dissemination portal, it was not used to its full potential given numerous barriers. It is likely that other online EBM resources will face similar accessibility challenges. The capacity to use mobile applications such as OE within high-tech centers like the SIOR is available; however, without adequate investments in high-speed Internet, the full potential of such programs cannot be attained.
While providing the appropriate evidence-based resources through adequate Internet access is necessary, a paradigm shift in the overall methods of training future surgeons is crucial, especially with regard to the integration of EBM. Suitable training for senior role models and residents is needed for them to serve as key opinion leaders to ensure the sustainable integration of EBM practices into Indian surgical culture. Future studies should explore whether providing OE directly improves concordance between evidence and practice and whether it leads to better outcomes for patients over a longer period of time.
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evidence-based medicine; evidence-based orthopaedics; knowledge dissemination portal; knowledge translation; mixed methods; pre-appraised resources; qualitative study; residency training
Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.
Daily versus weekly evidence reports for orthopaedic surgeons in India: A mixed-methods study
OTA International2(4):e029, December 2019.
evidence-based orthopaedics
knowledge dissemination portal
pre-appraised resources
qualitative study
residency training
evidence-based medicine, evidence-based orthopaedics, knowledge dissemination portal, knowledge translation, mixed methods, pre-appraised resources, qualitative study, residency training
Articles in PubMed by Sunita Kheterpal, BSc, MSc
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Other articles in this journal by Sunita Kheterpal, BSc, MSc
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What a coincidence that the #AgeLimitJudgement is being delivered on Holy Thursday. Will the constitution be desecrated, tortured and crucified again a third time in the manner of the parliament and Constitutional Court? Still, we relent not. Soon the Constitution will resurrect!
Hon. Justice Mugamba: "The Constitutional Amendment Act 2018 is hereby struck down for having been passed in violation of the Constitution & the rules of procedure of Parliament."
Justices of the Supreme Court In #Uganda resume afternoon session of the petition against the #Agelimitjudgement Constitutional court ruling 2018.
Lady justice Stella Arach Amoko: Mr. Mabirizi is a law graduate who did not go to LDC. He shouldn't seek to study law from the bar among qualified advocates. That's why he is not sitting among them.
Chief Justice Bert Katureebe breaks off the Court session for lunch. The session will resume at 2pm.
Hollup a second, who made Bart Katureebe the chief justice?!
If u answer that correctly then you should know he's ruling.
"...the decision of the Constitution Court is upheld and each party will bear their costs," ruled Chief Justice Bart Magunda Katureebe.
Prince Izimba Gologolo Chief of Kigulu, urges his people in the Busoga sub region not to discard demonetized banknotes and coins but rather take them to tourist sites such as museums in order for the younger generation to benefit from them in terms of historical education.
VIDEO: Odonga Otto on #AgeLimitRuling: If the judiciary doesn't make a good decision, we are in the same boat. We will definitely sink together.
Political and Human Rights activist, medical doctor by training, farmer and businessman.
After 10mins on air, via 106 Mubende Fm Radio, the Station was sorrounded by heavily armed police offrs &switched off from the mast!
This is a repeat of what happened in Kabale &Jinja. In Mbarara, we couldn't even get to the radio. We're still inside.
Ugandan senior opposition figure @kizzabesigye1 has just been arrested.
Mr Besigye was giving a radio interview on Mubende FM- the station was switched off.
Similar scenes took place in Jinja last week where Mr Besigye managed to evade the police.
MUBENDE: Dr @kizzabesigye1 Arrested! Police in Mubende have banged the doors to Mubende FM and arrested Dr. @kizzabesigye1! The truck has parked outside radio. People have surrounded the radio and closed the gate from outside. Now Police is stuck inside!
Dr. @kizzabesigye1 walked to the car by Police and residents of Mubende surrounding the radio!
Can you date your best friend's Ex?
This reminds me of the Doctor Sali Days....aren't these the guys the eat supper twice and midninght tea.??
Earlier today we were live on Magic FM talking about nothing else but Evoke night.
The results are in! 6 finalists; 3 deejays, 3 dance groups. 1 million at stake. Will this be #TheRebirth of the next big star?
Ugandan newspaper, comes out every Wednesday first published 25 March 2004.
1 Aero beach Entebbe Easter carnival 2 Uganda museum 3 Mubende 4 Fort Portal Gardens 5 Bwera Vienna hotel Easter weekend on fire but where are we gonna meet ??????
Justice Stella Arach-Amoko dismisses petitioner Male Mabirizi Kiwanuka's preliminary objections regarding claims he was unfairly treated by being asked not to sit at the bar with practising counsel.
Lady Justice Stella Arach Amoko concludes her ruling by dismissing the #AgeLimit appeal, exonerating the speaker of @Parliament_Ug @RebeccaKadagaUG, and asks the parties to meet their legal costs.


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Amsterdam Airport Schiphol (AMS), Amsterdam
Amsterdam to Manama distance (AMS to BAH)
Distance between Amsterdam (AMS) and Manama (BAH)
Distance from Amsterdam to Manama (Amsterdam Airport Schiphol – Bahrain International Airport) is 2970 miles / 4780 kilometers / 2581 nautical miles.
Amsterdam - Manama
How far is Manama from Amsterdam?
There are several ways to calculate distances between Amsterdam and Manama. Here are two common methods:
Estimated flight time from Amsterdam Airport Schiphol (AMS) to Bahrain International Airport (BAH) is 6 hours 7 minutes.
The time difference between Amsterdam and Manama is 2 hours. Manama is 2 hours ahead of Amsterdam.
IATA Code: AMS
ICAO Code: EHAM
Coordinates: 52°18′30″N, 4°45′50″E
Bahrain International Airport
City: Manama
IATA Code: BAH
ICAO Code: OBBI
Coordinates: 26°16′14″N, 50°38′0″E
Amsterdam to Manama flight map.
Amsterdam (AMS) → Manama (BAH).
Airlines that fly between Amsterdam (AMS) and Manama (BAH)
Related distances from Amsterdam (AMS)
Amsterdam to Dammam distance (AMS to DMM)
Amsterdam to Doha distance (AMS to DOH)
Amsterdam to Al-Hasa distance (AMS to HOF)
Amsterdam to Asalouyeh distance (AMS to PGU)
Amsterdam to Bushehr distance (AMS to BUZ)
Amsterdam to Kish Island distance (AMS to KIH)
Amsterdam to Lar distance (AMS to LRR)
Amsterdam to Shiraz distance (AMS to SYZ)
Amsterdam to Bandar Lengeh distance (AMS to BDH)
Amsterdam to Kuwait City distance (AMS to KWI)

redpajama_set_name: RedPajamaCommonCrawl


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Now order some medicines on Netmeds.
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I was introduced to computers at a very early age by my Dad who brought home a Hewlett Packard Series 80 from work and I remember playing a downhill skiing game on it. We had a series of home computers from the early 80s (Sinclair ZX Spectrum 48KB, Amstrad CPC 6128) and I used to tag along to the Central Electricity Generating Board (CEGB) computer club in Bristol. The most notable alumni of that club was the late Sir Terry Pratchett who used me as a hat stand for his trademark black fedora.
A computer science degree followed and then I embarked upon a career within IT consultancy.
In early 2005 I was in discussions to join Opsera, a start-up that was going to build a CMS, when Alfresco came out of stealth mode. One quick pivot later and the plan was to build an information management appliance based on Alfresco. So I'd poked around with the earlier preview releases of Alfresco, but started in anger with version 0.6 in September 2005.
Opsera became the first Gold Alfresco partner in the UK. The Enterprise Services division was later acquired by Ixxus, an Alfresco Platinum partner, in September 2010. Ixxus was acquired by Copyright Clearance Center in May 2016.
Having spent the previous 9 months on a Microsoft-based data warehouse programme, one of the biggest hurdles in learning Alfresco was getting my head around the Spring Framework application wiring. Inspecting the runtime behaviour to be met by a call stack full of e.g. Proxy$54 required a different approach to understanding a code base!
I'm proud of having been able to share a lot of my knowledge primarily through Alfresco conference presentations and helping to influence Alfresco's technical direction, but in hindsight from 11 years of involvement of Alfresco, the idea that I'm most proud of was to expose Alfresco as an IMAP server. Small legal firms were an initial target for the information management appliance and those users lived in Outlook. I proved the concept in late 2005 on Alfresco 1.0 and it later became the OpsMailManagerproduct. Alfresco ultimately commoditised the idea when basic IMAP support was included in Alfresco 3.2.
At Ixxus, we took the decision 5 years ago to specialise on providing content solutions to the publishing market. Consequently, we have developed a range of Ixxus Publishing Modules that augment Alfresco and have won various awards from Alfresco e.g. Solutions Partner 2013-2015. The most common use case is for helping publishers create, approve and publish their content-centric products. As Chief Scientific Officer I am mainly involved in higher level discussions & architectural decisions, though I do get the occasional deep dive.
I learnt Alfresco the hard way at the bleeding edge and tracking the commits, but I have to say that Jeff Potts' ECM Architect blog is a good read.
I'm a big advocate of Open Source which has always been one of the appeals of Alfresco. However, with great power comes great responsibility; or just because you can, doesn't mean you should!
I'm currently doing quite a bit of pre-sales work that will hopefully result in some new customers both for Alfresco and Ixxus.
It's a tough call, but a recent favourite was a customer project in 2014 that involved rolling up my sleeves to work on encryption at rest development for AWS S3. Amazon had just released Server-Side Encryption with Customer-supplied keys (SSE-C) so meeting the customer need required modifying upstream open source libraries as well as extending the Alfresco S3 Connector. This was the topic of one of my BeeCon presentations earlier this year.
I think my earliest contributed patch to Alfresco was to fix the CIFS code to support multi-homed servers. That resulted from some network traffic inspection to see why we couldn't map a network drive to Alfresco when it was running on a Linux server as opposed to a laptop.


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Home Guest Column Building Brands in Post-COVID Era: A Consumer Behavior Perspective
Building Brands in Post-COVID Era: A Consumer Behavior Perspective
The dizzying speed with which COVID-19 pandemic swiped the world has not only affected the health and general wellbeing of the global humanity but also taken the world economy frighteningly to the downhill journey. Since every walk of economic as well as social life has been so severely impacted globally by this unexpected catastrophe
The dizzying speed with which COVID-19 pandemic swiped the world has not only affected the health and general wellbeing of the global humanity but also taken the world economy frighteningly to the downhill journey. Since every walk of economic as well as social life has been so severely impacted globally by this unexpected catastrophe, it would be unthinkable to imagine that marketing domain in general and branding and consumer behavior in particular would remain unscathed. The dynamics of demand is poised to alter at least in the short run. The job losses would force majority of consumers to practice self-imposed austerity. Producers may need to re-customize their products to survive. As an obvious and major psychological toll of the pandemic of this scale and scope, the consumers would more than ever before are likely to remain risk averse.
However, in parallel, some new trends in supply, delivery and marketing as well as in demand and consumption have consolidated if not emerged completely as new. The Covid-19 certainly intensified adoption of digital platforms in every possible aspects of transactions from placing demands, delivery of goods and services and clearing payments. One clear indication of this is the rise in number and volume of transactions on amzon.com online shopping platform during last one month. Therefore, for the producers and sellers too, the one way to stay afloat in this changed marked dynamics is to fully understand the digitally-driven consumer behavior and also to be able to adopt state-of-the-art leveraging technology. Accordingly, the marketing and branding enterprises, too, need to contextualize their creativity and output in the same breath. They may actually need two distinct strategies to survive through the Covid-19 crisis and to compensating prosper beyond that.
Firstly, the new consumer demands emanating from the changed scenario are not catered to nor are being satisfied fully through the current offerings by marketers. In a crisis situation like these, two kinds of consumer need viz., need for affiliation and need for change are inevitable. These associate needs arise from the free time due to imposed social distancing. Customers during lock down are looking for experiences that are newer and varied to escape inherent monotony of limited social interactions and movements.
It is exactly where the creativity and ingenuity of marketers are put to test. Now, they have to discern and uncover ways and means to reach their existing and prospective consumers who are forced to be confined within four walls at least for some more time.
Secondly, after all, the efficacy of all the promotional tools and marketing communications is going to be determined by the level of psychological connect and social bonding that graduated from short-run acquaintance to sustained loyalty in the long run. As an immediate fallout of this pandemic, a sudden spurt in the buying and consumption of at least daily essentials like groceries, medical supplies and supplements in the short-run spurned by panic buying. However, consumers may exhibit a 'wait and watch' attitude" for buying of consumer durables and luxuries. For instance, when a number of malls and branded chain stores of Chinese city of Wuhan, the epicenter of the coronavirus spread, were reopened last week, low foot falls were recorded and reported. It certainly an indication that it may take time for consumer's confidence to revert to normal after such psychologically exhausting magnitude of the pandemic.
Besides, when the consumers are allowed to pivot from the status quo, they tend to try out new consumption patterns and test out new things in the altered conditions. For instance, there would be steep spike in demand for newer and emergent teaching-learning processes as both the teachers and the taught are left with no other choice. Likewise, other examples are soliciting advice of medical professionals and legal consultants online which earlier consumers were hesitant.
Changing Perceptions and New Learning
In the post-COVID consumer psychology, brand perceptions are bound to change when marketers strategically attempt to bring about positive impressions in consumers towards brands they promote and make such impression sustainable for the long-run competitive advantage. Consider for instance 'Facebook' providing free digital training to SMEs in Singapore or 'Heineken' donating to Red Cross or the Indian Brand 'Amul' promoting hygiene and social distancing by using different posture and a renewed positioning through altered logos, symbols, and artifacts in their promotional contents.
Research evidences suggest that it takes 66 days for the altered behavioral patterns of consumers to become a new habit. This finding is going to act as a powerful pointer for marketers engaged in designing marketing communication strategies. Hence, sales communication experts and consultants suggest marketers to apply the 'Tri-component Attitude Model' comprising of cognitive (knowledge), affective (evaluation), and conative (behavior) components in all their future market-focused messages.
Enhanced Digital Marketing Presence
In the emergent context, the digital marketing apparently has increased potential to track and unearth the psyche of the consumers by leveraging the power of data analytics. Most consumers today are glued to TV, active on social media, and tend to view long videos online. Any data, statistics, and analytics related to consumer home-bound activities would provide insights into their changed consumption habits for effective targeting. For instance, millennials today do not wish to watch whatever is aired in general but prefer to be selective in the choice of ads that are put up on medium they use. Hence, brands should search for and focus on alternate means such as YouTube, FB, etc. Small businesses can make use of more affordable yet powerful Twitter, WhatsApp, FB, etc., for commercial purposes all the more now than ever before.
Those brands may achieve better mileage that are able to craft messages that are value oriented and compassionate. Social Listening can help track the changes in consumer perceptions and preferences forming their new attitudes. Companies who invest their time and money to keenly observe and follow signals available on social media through comments both favorable and critical, stand to gain.
This crisis creates an opportunity for brands to instantly go virtual which in a normal scenario would have taken years. Brands need to think like as a customer and try to assess the emotional upside they may be experiencing in these turbulent times. Societal Marketing Perspective maintains that companies are better off in a stronger, healthier society that incorporates ethical behavior and social responsibility. Hence, brands should not focus on short term gains but see how they emerge as socially responsible.
Brands can explore opportunities even in times of adversity by strengthening their social media presence. Making an intelligent use of data and analytics would help marketers take evidence-based decisions in the realm of consumer behavior. For instance: about seventy percent of the content online in US newspapers and articles these days has the word COVID (Rajesh Chandy, Prof. Marketing-London Business School). It is important for brands to be able to assess with the help of analytics, whether the use of term COVID and its context is actually helpful in market communication. At present, what the marketers should be focusing on is not just surviving during crisis but maintaining consumers' perceptions through successful positioning strategies for building and sustaining a credible brand image far beyond the crisis.
By Roshee Lamichhane
Author is Assistant Professor (Marketing) and takes courses in the area of Services Marketing and Consumer Behavior. She writes frequently for local newspapers such as The Kathmandu Post and Republica, as well as for monthly Journals such as New Business Age in the area of Marketing, Supply Chain, Consumer Behavior, and Employability. She can be reached at Lamroshee@gmail.com. Her twitter id is @RosheeLC.
Roshee Lamichhane
Corona Crisis
the most crisis situation
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I specialize in obstetrics and gynecology. This inspiring and fulfilling area of medicine is truly rewarding. I am here for patients and their families during the birth of a child, one of the most exciting times in their lives. I enjoy getting to know the women that I care for over time, helping them through the different stages in their lives. I believe in providing compassionate, personalized and evidence-based patient care.
I have been a part of Ohio State since beginning medical school, and I've enjoyed every step of the way. I'm surrounded by great people and the resources I need to provide specialized, up-to-date, high-quality care.
In my free time, I enjoy reading, traveling, baking and playing tennis.
Dr. Soma is excellent! She is very knowledgeable but pleasant and caring at the same time.
the appointment seemed quick as usual but my follow up phone call was cold. I felt as though she didn't care about me as a person and was just reading off of a script. I'm sure it was a bad day but she shouldn't have called if she couldn't take her time with me and express some empathy.
I was a new patient of Dr. Soma's. She did a wonderful job answering all my concerns during the early stages of my pregnancy.
Dr. Soma is friendly & knowledgeable.
The doctor treated me as if I was a paycheck and nothing more. She clearly didn't want to be and she didn't explain things clearly. Told her that I was new and she still didn't care to explain why for anything.
As of 12/20/2018, Dr. Soma has reported no relationships with companies or entities.


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1889: The first executions in French-occupied Tunis	2015: Eight drug smugglers in Indonesia
1634: Mikhail Borisovich Shein, for failing to take Smolensk
April 28th, 2015 Headsman
On this date in 1634, the Russian general Mikhail Borisovich Shein was executed on Red Square for losing to the Poles.
Shein (English Wikipedia entry | Russian) was an accomplished boyar officer who had made his bones during Russia's Time of Troubles.
During the Time of Troubles — 15 war-torn years following the end of Ivan the Terrible's dynasty — the neighboring Polish-Lithuanian Commonwealth had eagerly exploited Russia's chaos, invading Russia, backing an imposter who tried to claim the throne, and at last settling for tearing off a chunk of territory in war.
By the 1630s, Russia had her shit back together under the first Romanov tsar, and when the Polish king died in 1632 saw an opportunity to return stripe for stripe on its opportunistic neighbor.
This was the Smolensk War, so named because the recapture of that city was its primary objective. Shein, the respected elder military statesman who had lost Smolensk to a Polish siege twenty-odd years before, was just the man to lead the campaign.
The span of time tested by the 1632-1633 Russian siege was not merely that measured by the larder of Smolensk's vastly outnumbered garrison — but that of Poland-Lithuania's unwieldy succession process. Although the successor king was self-evident, the span required for his actual election left a six-month interregnum: nothing compared to the Time of Troubles, but perhaps enough for a frontier reversal.
But as it happened, Shein could not force Smolensk's capitulation in 1633 and by the latter half of that year a superior Polish army was arriving. By October of 1633, a year after the Russians had begun hostilities, not only was the siege of Smolensk broken, but the Russian camp itself was encircled by the Poles. Having no prospect of a relief force such had just delivered his enemies, Shein could not hold out for even a single Friedman Unit and soon surrendered. He received liberal terms: the Russians had to abandon their artillery, but Shein's army returned to Moscow unharmed, with its standards.
The Surrender of the Russian Garrison of Smolensk before Vladislaus IV Vasa of Poland, by an unknown Polish artist (c. 1634)
Having seen their jolly war of choice come to such a humilitating pass, the Moscow boyars received their defeated commander in a rage. A tribunal vengefully condemned Shein, his second-in-command Artemii Vasilevich Izmailov, and Izmailov's son Vasili, to death for treason and incompetence in command.
(According to Nancy Kollmann, a German scholar present in Russia in 1634 recorded that the execution took the men by surprise, as they had been led to believe that they would receive a last-minute commutation.)
In even the most slightly longer term, the debacle proved to be only a minor strategic setback. Poland was unable to follow up its victory with any inroads on Russian soil. That June, the two belligerents came to a peace restoring the status quo ante bellum — and they managed to pass a whole generation before they fought again.
1876: Louis Thomas, gallows builder - 2020
1494: Joan Boughton, "old cankered heretic" - 2019
1708: William Gregg, spy of slob - 2018
1909: A triple execution in Chalco - 2017
1770: King David Hartley, Yorkshire coiner - 2016
1876: The slave Francisco, Brazil's last execution - 2014
1899: Not J.M. Olberman, spared by Oregon's governor - 2013
1945: Hermann Fegelein, Eva Braun's brother-in-law - 2012
1882: George Henry Lamson, aconitine poisoner - 2011
2010: Zheng Minsheng, child-stabbing doctor - 2010
1772: Johann Friedrich Struensee, the doctor who ran Denmark - 2009
1945: Benito Mussolini, his mistress, and his aides - 2008
1793: Adam Philippe, Comte de Custine
1635: Hans Ulrich Schaffgotsch, man in the middle
1689: Karposh, Macedonian rebel
1824: Agustin de Iturbide, Emperor of Mexico
1403: Thomas Percy, Earl of Worcester
998: Crescentius the Younger
1698: The Streltsy executions begin
Entry Filed under: 17th Century,Capital Punishment,Death Penalty,Execution,History,Military Crimes,Nobility,Public Executions,Russia,Soldiers,Treason,Wartime Executions
Tags: 1630s, 1634, april 28, mikhail shein, moscow, red square, smolensk


Improve the form and function of your home without having to spend an arm and a leg.
These quick and easy remodel ideas are a great way to give your space a facelift without having to spend a lot of money. Although they are cheap upgrades, we guarantee you they will look anything but.
Want to spruce up a corner of your home without having to splurge on major works? Consider this faux wainscot trick. Simply add thick boards onto your walls, mimicking the look of wainscots before painting the entire section over. You now have yourself a quick and easy DIY upgrade.
We very rarely look up when we enter a room. Apart from housing our lights and fans, ceilings don't get a second thought. This year we suggest you give them a little TLC with the addition of paint, wallpaper, or intricate plaster ceiling. This addition will change the entire character of your room.
This project is a triple win. Not only will you be upgrading the aesthetic of your home, you'll be doing it while on a budget and you also get to save prime floor space in what could be an already small home! Barn doors are a trendy addition to homes, and a quick trip to Ikea will get you all your supplies.
Not a fan of wallpaper but still want a unique wall design? Create eye-catching designs using stencils and paint. Stencils come in hundreds of patterns, and you could even make your own. Before committing to the design, you can test them out on scraps of drywall. This could end up being a great family activity to take on in the new year.
Most homes these days come with an open floor plan and although they are a great layout for the most part, it can result in grievances, especially when you need a quiet space or want to avoid cooking smells. Add a glass panel door with hinges as partitions to divide your space. This way you can maintain privacy when needed and open them up when you're entertaining company.
Want professional help? Click on the 'Request Quote' button on the images to receive free quotations from Malaysian interior designers.


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Goodyear Tire & Rubber Company: Follow-On Equity Issue
by Susan Chaplinsky, Warren Estey,
Goodyear Tire & Rubber Company: Follow-On Equity Issue ^ UV2555
#UV2555
Susan Chaplinsky
Warren Estey
Darden School of Business
Source: Darden School of Business
This case explains marketing process for follow-on equity offerings, the direct and indirect costs of issue, and the long-run performance of equity issuers. Students use analysts' projections from which to estimate the intrinsic value of the company's share-including the cost savings from the VEBA and financial improvements over the next several years. It is appropriate for use in corporate finance courses covering the topics of capital raising, equity financing, capital structure, costs of financing, funding alternatives, investment banking, and valuation. It presents the classic profile on an equity issuer-a firm whose stock price has risen to new heights in recent months. Will the issue lead to additional value that creates opportunities for shareholders, or is it a sign the firm is overvalued? The case explores the thinking of a prominent investment manager who had accumulated a large stake in Goodyear and who did not see the need for Goodyear to make an equity issue at this time. The company's position was that the high stock would allow it to further strengthen its balance sheet and pursue international growth opportunities. Students are asked to decide what the investor should do with respect to the current offer-buy, sell, or hold.
Product #: UV2555
Goodyear Tire & Rubber Co.--1988
By Timothy A. Luehrman,
The Travails of Rubber: Goodyear or Badyear?
By Tom Nicholas,
Apollo Tyres: Investment Decision Dilemma
By Varun Dawar, Rakesh Arrawatia,
Tariffs on Tires (A)
By Peter Debaere, Joonhyung Lee,


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How Are Golfers Selected to Play in the Ryder Cup?
Activities Sports & Athletics
Golfers in the Ryder Cup - this is Team Europe in 2014 - are selected via a combination of point lists and captain's picks. David Cannon/Getty Images
by Brent Kelley
Brent Kelley is an award-winning sports journalist and golf expert with over 30 years in print and online journalism.
Ryder Cup player selection guidelines for Team USA are determined by the PGA of America, and those for Team Europe are determined by the European Tour.
In broad strokes, the team-building process works like this: Both sides use the same selection method — most of the team qualifies automatically via points lists, and the remaining spots are filled at the discretion of the respective team captains. In the case of points lists, players accumulate points over periods specified by the PGA or Euro Tour.
Each Ryder Cup team consists of 12 golfers.
It's important to note that the specifics of the selection methods can change (and often have) from Ryder Cup to Ryder Cup, at the discretion of the European Tour and PGA of America, respectively.
How Europe's Ryder Cup Team Is Selected
For Team Europe, the specific player selection process involves maintaining two separate points lists: the World Points List and the European Tour Points List.
The World Points Lists tracks golfers who are eligible to play for Team Europe and is based on the number of world ranking points earned by those golfers. The European Tour Points List is based on money earned by Team Europe-eligible golfers playing on the European Tour.
The European side uses two points lists because some European golfers play in the United States on the PGA Tour, while others play primarily on the European Tour.
For both lists, points earned in the year of the Ryder Cup are weighted more heavily than those earned in the previous (non-Ryder Cup) year. (The lists can be viewed on rydercup.com — select the Team Europe option.)
Team Europe's 12-player roster is filled out this way:
Top 4 players from European Points list
Four highest-ranking players on World Points list not already qualified via the Euro points list
Four captain's picks
How the USA's Ryder Cup Team Is Selected
For Team USA, one points list is maintained, and it is based on money earned in major championships, WGC tournaments and regular PGA Tour events (opposite field tournaments are not counted). Also note that regular PGA Tour events award points only in the year of the Ryder Cup.
The points list covers most of the two years between Cups, and money earned in majors and other PGA Tour events in Year 2 (the year the Ryder Cup is taking place) is weighted more heavily than earnings from the first year.
Team USA's 12-player roster is filled out this way:
Top 8 players from the American points list
Four captain's selections
Looking Ahead to the 2020 Ryder Cup
What You Need to Know About the Presidents Cup Golf Tournament
This Is the Ryder Cup Format and How It Works
Remembering the Charismatic, Major-Winning Golfer Seve Ballesteros
Golf's Biggest Events: All About The Solheim Cup
What You Need to Know About Golfer (and Broadcaster) Paul Azinger
Jose Maria Olazabal, 2-Time Major Golf Championship Winner
It's All Related: Brothers, Fathers + Sons, More Ryder Cup Relatives
What You Need to Know About Golfer Mark O'Meara
What You Need to Know About the 2019 Solheim Cup
How Big Bomber Dustin Johnson Became a Major Champ in Golf
Dive Into the History, Year-End Top 50s of Men's World Golf Rankings
Why Billy Casper is One of Golf's Most Underrated of All-Time
Fivesomes Allowed: Meet the World Golf Hall of Fame's Class of 2017
The Zozo Championship: New PGA Tour Golf Tournament in Japan
What You Need to Know About Golfer Colin Montgomerie


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Sappy Christmas Movies: The Ultimate Gift (Now With South American Rebels!)
While there are many wonderful, heartwarming Christmas movies out there, there are probably ten times as many sappy ones out there that your wife, mother and grandmother binge watch each year (mostly one Hallmark and Lifetime). In this seasonal series, we take a look at the blech of the blech.
The Ultimate Gift (2006)
IMDB Description: "A deceased billionaire leaves his spoiled adult grandson a series of odd tasks to perform in order to receive "the ultimate gift," with the resentful grandson having no idea what that might be."
Cast: Wow is this movie loaded (except for the two main characters, unfortunately). James Garner plays the dead billionaire (seen on tape), while Brian Dennehy is Gus, the gruff ranch hand with a heart of gold. There's also Abigail Breslin just before Little Miss Sunshine (which I bet she wishes came out before she showed up here). Bill Cobb and Lee Meriwether are also in this as the lawyer and his assistant. For those who don't know who Lee Meriwether is:
Yep, it's Catwoman!
Plot Summary: I'm kicking off this series with just a doozy of a movie that actually was in theaters, but now typically shows up on Hallmark Channel annually. This isn't 100% a Christmas movie, but it's a big enough presence to include it.
The movie is based on a book by former Olympic weightlifter Jim Stovall (seriously, every article about this movie reminds us that Stovall is a former Olympic weightlifter, because apparently that adds credibility to his writing). The basic plot is that billionaire oil man Red Stevens (Garner) dies and, rather than give all his wealth to the greedy Texan relatives seated around the table at his will reading, he assigns his spoiled grandson Jason (Drew Fuller, who I have never heard of) 12 tasks (or "gifts"…see the Christmas connection?) to complete. The prize? "The Ultimate Gift". What is "The Ultimate Gift"? No one knows, including Red's lawyer, Theophilus (or "Ted" to anyone who doesn't want to try and pronounce "Theophilus") and his assistant Miss Hastings, who does not have any first name, much less one as cool as "Theophilus".
Thus sets up a series of challenges for poor Jason, the first of which involves being put to work by a ranch hand named Gus (Dennehy; in a movie with a character named Theophilus, Gus got kind of hosed on the character naming thing). Once he finishes putting about a million fence posts in the ground (seriously), Jason returns and finds that all of his stuff is gone, including his car, his apartment and his credit cards, so he ends up homeless for a night to teach him the value of money. Because this is a feel-good movie, and nothing makes people feel better than sick children, he naturally meets a young girl with leukemia (Breslin) and her mother. Strangely, the young girl is also a goth with a penchant for wearing stuff with skulls on them, adding a macabre touch not normally associated with sick kids in movies.
From there the movie goes on and off the rails about a dozen times. There's a Thanksgiving dinner party with the awful Texas relatives (seriously, they're such stereotypical Texans that I'm shocked no one was shooting a six-shooter in the air). There's a budding romance with the mother of the girl. There's conflict with the girl and her mother. And of course there's the heartwarming kidnapping by militants in Ecuador.
Oh, you weren't expecting that? Yes, while on a trip to Ecuador to visit the library his father built, Jason decides to go into the jungle to see where his father's plane crashed, at which point he's taken hostage for "several weeks" by the local rebels. The rebels clearly don't know what to do with him, as they never demand a ransom or anything. Given that he's the potential heir to a billionaire's fortune, that feels like a missed opportunity. This is both the best and worst "kidnapped by guerillas" plot in Christmas movie history. It's also the only "kidnapped by guerillas" plot in Christmas movie history (Die Hard was terrorists, which is totally different!).
Anyway, Jason eventually is freed by the military, comes back, gives the sick girl and her mom one last Christmas with Gus and his heart of gold, completes all 12 tasks and receives "The Ultimate Gift" (spoiler alert!): $100 MILLION DOLLARS (yes I know putting "DOLLARS" is redundant, but it looks better!). Naturally, Jason has learned a lot about himself and helping others, so he uses the money to open a hospital for sick kids. The movie ends with Jason and the girl's mom in love (though the girl is in a better place…namely Little Miss Sunshine)
As I mentioned, this was actually in theaters for all of about a week, as it bombed. However, due to popularity with both "values voters" types and sappy Christmas movie fans everywhere, a sequel, The Ultimate Life, was produced in 2013. They replaced the guy who played Jason, and somehow Peter Fonda shows up, though not on the motorcycle from Easy Rider.
Sappiness Rating (1-5 Tears): 3. Sick kids are always sad, but there's not a lot else to cry over in this movie, unless the lawyer falling in love with his assistant at the end makes you tear up (though perhaps because it's a major breach of ethics).
WTF Rating (1-5 Eyerolls): About a 7. First, you have a dead guy basically take away his grandson's stuff while he's off doing hard (and free!) labor for his crazy ranch hand friend. Then he just happens to meet and fall in love with a woman and her daughter while sleeping on a park bench. Oh, and have I mentioned THE KIDNAPPING BY GUERILLAS?
Sappy Christmas Movie Tropes: Sick kids, finding the true meaning of Christmas, finding love, helping your fellow man
December 4, 2017 December 22, 2018 EasterosChristmas, Movie Reviews
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text:
Tipping point in the Antarctic – 0.1degrees Centigrade?
WATCH / April 16, 2013
A report published this week in Nature Geoscience, reveals a steadily increasing temperature over the last few decades in the Antarctic Peninsula. This has been discovered by looking at the pattern of summer snow melt revealed in an ice-core, which represents conditions over the last 1000 years.
Although results from similar recent research on the West Antarctic Ice sheet give a more ambiguous result, of periods of warmer and cooler conditions over the last 2000 years, it appears beyond doubt that in the peninsula – which is much further north, conditions have become significantly warmer, as well as spending a significant time above the critical temperature – freezing point.
One of the researchers, Dr Nerilie Abram from ANU, was interviewed by Fran Kelly on Radio National about the research.
http://www.abc.net.au/radionational/programs/breakfast/new-evidence-shows-increase-in-summer-ice-melt/4628490
Sadly she gave the normal scientist's response to Fran Kelly's inavoidable question: "But it is possible that these changes could be due to 'natural causes'?" Instead of emphasising that while natural variation might have played a part in the last thousand years, but that the changes in the last 50 were categorically not 'natural', Dr Abram got diverted into a discussion about natural variation, and the fact that changes in other areas of Antarctica didn't show the same result. ( the ABC had already emphasised this by talking about another research project on the West Antarctic ice sheet which indicated that warmer periods similar to the current one had occurred repeatedly in the last 2000 years – music to the ears of the denialists)
It wasn't until right at the end of the interview that in the process of explaining in detail about the conditions on the Antarctic peninsula, Dr Abram showed that the warming was directly linked to changes in the Ozone hole! Apparently this had resulted in an increase in wind speeds, and consequent changes in the local climate. Now if there is one thing that those wretched deniers can't challenge, it's the human cause of the Ozone hole.
The whole slant of the ABC's presentation of this research ( the need to provide 'balance' by reporting the views of a small group of cranks alongside the science)was echoed in a short report on the news, while a spot on AM somehow avoided the use of the word 'HUMAN'; even when asked an open question:
"SARAH CLARKE: And looking at the fact that the most rapid melt has been in the last 50 years – why do you think that is?
Dr Abram gave a circuitous answer; one which was actually about this being evidence of a significant tipping point, but without saying so noone would really have got that idea:
NERILIE ABRAM: So what the ice core shows, which is quite interesting, is the changes in environment that happen when the climate warms don't necessarily have to happen gradually or in a nice linear way.
http://www.abc.net.au/am/content/2013/s3736742.htm
It was however mentioned several times that 'the coldest period' was 600 years ago, without any apparent recognition that the key claim of the climate change deniers is that it was hotter 800-1000 years ago than it is now, and this report did nothing to counteract that stupid claim, particularly when combined with the mention of the 'other research'.
I look forward to the time when the ABC and other official presenters of such reports put the emphasis where it is necessary – on the implications of this extra evidence of rapid change for the climate system, in this case the one that may affect Australia's climate significantly.
It is long past time when we need to give space to the climate science bullshitters; it's as silly as interviewing a fundamentalist Christian to comment every time we have a report on something that happened more than 5760 years ago.
April 16, 2013 in Scientific reports on climate issues.
Senate enquiry on Extreme Weather
MEDIA RELEASE – IMPACTS OF HEATWAVES ON BORDER REGION [24.3.14]
Media release – World's hottest year on record
← The critical decade report
Flagrant double standards →


text:
What to Do When a Bad Employee Asks for a Reference
When you don't have much good to say about a former employee, what should you tell reference checkers?
By Alison Green@askamanager
Most managers love being able to give references for good employees. It feels good to help someone land a job, and to help an employer land a good worker. But what do you do if you're asked for a reference for an employee you can't honestly recommend?
Here are five ways to handle reference requests when you don't have anything nice to say.
1. First and foremost, whenever possible, warn the employee in advance that you won't be able to provide a positive reference. You may still receive calls from reference checkers who go outside the list of references provided by the candidate, but this should minimize it.
Sometimes managers agree to be a reference in a moment of weakness--they're caught off-guard by the request and agree because they don't know how to politely decline. If you've done this, you can go back to the employee once you've had a chance to think the request through and say something like, "This is a little awkward, but after you asked me about a reference, I thought about it more and realized that I wouldn't be able to be a great reference for you. I'd rather tell you now than not have you realize that you shouldn't send reference checkers to me."
2. There's an easy out if the employee worked for you more than a couple of years ago: You can explain to the reference checker (or to the employee herself) that you don't feel equipped to be a reference since her work for you was so long ago that you can't remember the types of nuances that reference checkers are looking for.
3. If the employment was more recent and No. 2 isn't feasible, you can fall back on saying you can only confirm title and dates of employment. However, be prepared for savvy reference checkers to ask if this is your policy across the board or just for this candidate, or to offer you a release from the candidate allowing you to discuss her work.
4. Consider honesty. As a manager yourself, you probably rely on references to give you the inside scoop on candidates, and if you've been hiring for long, you've probably received information from references that helped you make better hiring decisions. Consider returning the favor. After all, reference checking (and the whole hiring process, for that matter) is all about finding out whether a candidate and the job are a good match. If they're not a good match and that's not discovered until after the person is hired, the company will be stuck with a poor performer and the employee will be stuck struggling in a job and maybe even losing it down the road.
Of course, if you do choose to provide a reference for a poor performer, stick to objective facts. (Despite some managers' concerns about defamation cases, it is legal in the U.S. to give negative references as long as they're truthful--but that means you should stick to being objective and factual.)
5. Last, while you're still managing people--long before they ask you for references--do your best to make sure they know where you stand on their work. If you're doing your job as a manager and giving clear and regular feedback, most employees will leave your team with a good understanding of what kind of reference you'd be likely to give them, and it shouldn't come as a surprise when you explain you can't provide a good one.
Published on: Jun 18, 2015


The Lock-Jaw Pro collar is specially designed for Bumper Plate use, Olympic lifting, and Crossfit-style workouts. Like the original Lock-Jaw, The Lock-Jaw Pro barbell collar features a solid nylon resin frame and injection molded pressure pads, making it nearly unbreakable. The single-action cam lock securely clamps the collar once positioned on the bar. A permanent spring snap-latch keeps the collar secured on the bar through the most brutal workouts. The latch is easily released with one hand when changing weights.


text:
911 Operator 12+
Emergency Units Dispatching
#27 in Strategy
In 911 OPERATOR, you take on the role of an emergency dispatcher, who has to rapidly deal with the incoming reports. Your task is not just to pick up the calls, but also to react appropriately to the situation – sometimes giving first aid instructions is enough, at other times a police, fire department or paramedics' intervention is a necessity. Keep in mind, that the person on the other side of the line might turn out to be a dying daughter's father, an unpredictable terrorist, or just a prankster. Can you handle all of this?
PLAY ON ANY CITY IN THE WORLD*
Check out thousands of cities from all around the world. The Free Play mode lets you choose a city to play on - the game will download its map, along with real streets, addresses and the emergency infrastructure. You can also try the Career mode, which contains 6 cities with unique events – survive an earthquake in San Francisco and save Washington, D.C. from bomb attacks.
A number of police, fire department and paramedic units are at your disposal. The forces may use a variety of vehicles (from common ambulances to police helicopters), essential equipment (e.g., bulletproof vests, first aid kits and technical tools) and consist of team members with different abilities.
PEOPLE'S LIVES ARE IN YOUR HANDS!
- Over 50 recorded dialogues inspired by real calls: serious and dramatic, but sometimes also funny or annoying.
- Real First Aid instructions.
- Opportunity to play on any city in the world!
- 6 selected cities in Career mode, featuring unique calls and events.
- More than 140 types of reports to encounter.
- 12 types of emergency vehicles (including helicopters, police cars and motorcycles).
(!) The game requires Internet connection to download free maps. The offline game is available after downloading the maps.
(!) The game does check the user's location once to propose a city for download. User's location is anonymous and not stored.
All map data © OpenStreetMap authors
* The term "city" is used within the meaning of OpenStreetMap service and relates to urban areas described as "city" or "town" therein.
New expansion is now available!
SEARCH AND RESCUE DLC
Veggieleezy , 06/20/2018
Enjoyable game, one big problem and one smaller problem.
I've been hoping this game would come out on iOS, and I quite like it so far. But I really wish the sound options were more clear. Mute Operator? Does that mean mute the player's voice? Muffle Normal Calls? Does that mean you'll hear "mwamp mwamp mwamp" rather than voices when you receive calls? And why is there no option to mute the radio chatter, which gets repetitive within the first three minutes of a round and never ends, without also muting your units? These aren't explained and I feel like they ought to be.
That's really my only big problem so far. There is a learning curve and you've got to put yourself in the mindset of someone on that end of those phone calls, which is really interesting. Also, it's really cool to see so many towns and cities across the world. However I would personally prefer there was a loading bar rather than the spinner when downloading maps. I feel like it'd make it a bit clearer if the game was still downloading the map or if it were just stuck.
PackPride22 , 12/08/2017
Good game, could use some improvements
Overall I really like this game, it's challenging and make you think about each individual call and what units you should send. The ability to download any city and play on that map is another really cool feature, I like playing in my own town.
I would suggest a few things that could use improving:
Some levels are so challenging, even on easy, that it's almost impossible to not get fired. While I can appreciate a challenge, if you get fired and have to repeat the level, you do not get to keep any of the money from that level that could toward buying more emergency assets, so you revert back to the money you had before. It would be nice if you could keep that money so as to help defeat that level next time.
I can't believe I'm saying this: but I would like to see an option in the DLC for more money. Maybe $50,000 for $.99? $100,000 for $1.99?
Also, be aware that this game, at least on my iOS 11.2 on a iPhone 6S plus, is a complete battery killer over a short amount of time. I've also found the phone heats up to a noticeable level that makes me a little nervous. Again, could just be my phone, but I'm sure this is a major GPU and processor hog that is accounting for that.
Other than that I really enjoy the game, it is a lot of fun and I look forward to future updates.
thebesttjj09 , 06/01/2018
Fun but...
This game can be really fun but it is a ton of information for one little screen. I'm currently working in Boston and having to handle the Boston riots. Around a riot is a ton of different crimes/emergencies happening so you can't even tell where each unit is and what is happening there. Therefore, it is extremely frustrating when getting a call from the national guard to return all units to their stations and you can't because of all the on screen information. Failed this part of the game probably four times now (that's about an hour or so of gameplay!!!) and it's not because I can't handle everything or I'm not good enough to pass it. It's simply because of all the info in one area of the map that even when you do command someone to leave their area you get a "we can't do that now." You'd think they have just a button next to each unit on the incident screen (incident screen tells the state of each unit... whether they are fighting, off duty, injured) to tell them to report to their station.
Games Operators sp. z o.o.
Requires iOS 10.3 or later. Compatible with iPhone, iPad, and iPod touch.
English, French, German, Japanese, Korean, Polish, Portuguese, Russian, Simplified Chinese, Spanish
Infrequent/Mild Medical/Treatment Information
© 2017 Games Operators Sp. z o. o.
First Response $0.99
Special Resources $2.99
Every Life Matters $3.99
911 Operator Lite
First Strike: Nuclear War RTS
Ultimate General™: Gettysburg
Door Kickers
Game Dev Tycoon
Ship Tycoon


text:
package com.ait.toolkit.sencha.touch.client.events.dataview;

import com.google.gwt.event.shared.EventHandler;

public interface DiscloseHandler extends EventHandler {
	public void onDisclosure(DiscloseEvent event);
}

redpajama_set_name: RedPajamaGithub


Happy September! Wow, August just flew by, didn't it? Pretty soon, we'll be coming across the first day of autumn (September 23) and then the holidays attack. Hope you've all been saving up for Christmas - it's right around the corner. Eek!
Did you know that September is National Sewing Month? A proclamation in 1982 from President Ronald Reagan declared this "In recognition of the importance of home sewing to our Nation." What a great time to announce the newest item available in the Cozy Reverie Etsy shop: Handmade Scarves!
As a shop owner, I have to remind myself to be a few steps ahead of the seasons. This year, I've actually done it! Halloween greeting cards and now scarves! I'm so excited to announce that Cozy Reverie is now offering handmade fleece infinity scarves. They can be worn as one long loop, or looped around twice as a cowl scarf. These make it so easy to add color and style to your outfit of the day!
Not only are there fleece scarves in the shop, there are also performance knit scarves with fabric designed by yours truly! With my original designs, they do cost a bit more, mainly because it is my artwork being professionally printed onto performance knit fabric. Fancy, huh? Due to the current process, these are available as made-to-order only. Hopefully, they will become ready-to-ship in the near future!
This opens up the possibilities for customized scarves! How incredible would it be to give your best bud a scarf with their favorite quote printed on it? Or maybe even an illustration of them? This would be perfect for the holiday season! Plus, performance knit scarves work as an all-year-round accessory. I'm already sketching out ideas of the gifts I'm going to make.
So many ways to make a scarf special and unique!
How would you customize your scarf?


Dandelion Energy Inc., a company that emerged from Alphabet Inc's X Incubator last year, says its custom built rig will make homeowner geothermal heating systems more affordable.
Brooklyn-based company expects to begin drilling in June for heating and cooling systems that cost less than $ 20,000. According to Chief Technology Officer James Quazi, this is about half the price of typical geothermal plants available today.
Geothermal dormitories are uncommon, partly because of the cost and effort of digging the wells. Dandelion's drill has been designed to address this problem. The systems use pumps from Aaon Inc. to extract underground heat that keeps the houses warm in winter and provides air conditioning in summer. The company already markets the technology in parts of the state of New York.
"We have an order backlog of about 50 customers who have signed up since last fall," Quazi said in an interview. "We will start our first installations in June."
35 a month for over 20 years. New York offers a one-time government incentive for geothermal homes that will offset the costs by at least $ 3,000, depending on their size.


This picture shows how often and how strongly the wind blows from different directions through a typical October. The longest spokes point in the directions the wind most commonly blows from and the shade of blue suggests the strength, with the strongest winds shown by the darkest shade of blue. It is based on 2976 NWW3 forecasts of wind since since 2006, at 3hr intervals, for the closest NWW3 model node to Indian River (Southside), located 12 km away (7 miles). There are insufficient recording stations world wide to use actual wind data. No doubt some coastal places have very localized wind effects that would not be predicted by NWW3.


text:
sum total
EnglishEdit
Alternative formsEdit
sum-total
sumtotal
sum total (plural sum totals)
Total; the result of adding a set of figures or counting a number of items.
1890, The British Chess Magazine - Volume 10 , page 494:
It may be noted that the maximum number and sum total in points of the table may be changed to the second mode simply by multiplying them by two.
1896, New York (N.Y.) Board of Aldermen, Proceedings of the Board of Aldermen - Volume 220 , page 148:
This column should contain the remainder after deducting the amounts for each town or ward in column 5 from those in column 4, observed that the sum total of column 5, when deducted from the sum total of column 4, is equal to the sum total of column 6.
2000, Monthly Energy Review: March 2000 , →ISBN, page 160:
The average Btu value of coal by coal-producing area was applied to the volume of deliveries to other industrial users from each coal-producing area, and the sum total of the heat content was divided by the total volume of deliveries.
2013, Renee Vellve, Saving the Seed: Genetic diversity and European agriculture , →ISBN:
The sum total does not match current genebank holdings (1,238,000) as this table only covers those accessions properly described and reported to IBPGR as of 1991.
Entirety; the aggregate of everything.
2014, DC Doyle, Greater Than The Sum Total: A Novel , →ISBN:
A very wise person once told me that I was "greater than the sum total of everything that has happened, is happening, or will ever happen" in my life.
2002, Paul Benedetti & Wayne MacPhail, Spin Doctors: The Chiropractic Industry Under Examination , →ISBN, page 36:
For six days I witnessed the giving of a number of treatments. That was the sum total of information that was transferred in exchange for tuition paid.
2004, Eric J. Cassell, The Nature of Suffering and the Goals of Medicine , →ISBN, page 98:
Consider this definition of disease (to go back a step) from a medical dictionary: "A specific entity which is the sum total of the numerous expressions of one or more pathological processes.
Epitome.
1998, William Hendriksen, More Than Conquerors: An Interpretation of the Book of Revelation , →ISBN:
Moreover, by and by the Church will come "out of the tribulation, the great one," the sum total of all tribulations.
2006, Phyllis Granoff, The Forest of Thieves and the Magic Garden , →ISBN:
He is the sum total of all vice and that woman is the abode of all virtue; that wicked man is fire incarnate; she is cool like snow.
2008, Charles Haddon Spurgeon, Devotional Classics of C. H. Spurgeon , →ISBN, page 8:
If there be one name more charming, more precious than another, it is this name. It is woven into the very warp and woof of our psalmody. Many of our hymns begin with it, and scarcely any, that are good for anything, end without it. It is the sum total of all delights.
TranslationsEdit
result of adding a set of figures
Spanish: sumatorio (es) m
mulattos
Retrieved from "https://en.wiktionary.org/w/index.php?title=sum_total&oldid=51568765"
Last edited on 20 February 2019, at 10:40


CARPE DIEM HAIKU KAI: Carpe Diem Special (3rd guest) Herman van Rompuy's 2nd "inaugurate spring"
Carpe Diem Special (3rd guest) Herman van Rompuy's 2nd "inaugurate spring"
Welcome at a new episode of Carpe Diem Haiku Kai. I first have to mention something before I introduce the second haiku by Herman van Rompuy. I recently got a comment by Kala Ramesh according her second special "tangled thoughts" which I published several days ago. It turns out that two of the used tanka were not written by her, however they were listed under her name, so I decided to remove the both tanka which were not of her. It's a sloppy mistake, but I thought they were written by her, because they were listed under her name. My excuses for this mistake and maybe infringement of rights of the real poets of the tanka.
Okay ... back to today's CD Special by Herman van Rompuy, former president of Belgium and former president of the EU. As I told you all in the first CD Special by him I haven't got permission yet to use his haiku, however I think he is okay with it, because he didn't respond. If there is a problem please let me know.
In his haiku he talks about a ditch in which toads are mating in spring. So the images in his haiku brought me the haiku as above shown.
Well ... did I say to much? A beautiful haiku and I think you can follow my associations with this haiku.
I think this haiku (or do I have to call it senryu) is created with the same images as in the haiku by Herman van Rompuy, but I only changed it to the "spring of youngsters who fall in love for the very first time and are discovering the beauty of love".
This episode is NOW OPEN for your submissions and will remain open until October 17th at noon (CET). I will (try to) post our next episode, beads (in honor of Jane), later on. For now ... have fun!


text:
Собор Тамацукури, другой вариант –  Собор Пресвятой Девы Марии ( カトリック玉造教会 каторикку тамацукури кё:кай; 大阪カテドラル聖マリア大聖堂 о:сака катэдорару сэй мариа дайсэйдо:; 大阪カテドラル о:сака катэдорару) — католическая церковь, находящаяся в Осаке, Япония.  Храм является кафедральным собором архиепархии Осаки. Наименование храма происходит от названия одноимённого городского района Тамацукури, на территории которого он находится.

Первый католический собор под наименованием Собор Святой Агнии был построен в 1894 году. Этот храм был разрушен во время бомбардировки в 1945 году. Современный храм во имя Пресвятой Девы Марии был построен в 1963 году. Церковь располагается на территории древней резиденции даймё из рода Хосокава.

Перед храмом на площади располагаются каменные статуи японских католиков Укона Такаямы и Грации Хосокавы, третьей дочери даймё Акэти Мицухидэ, которая вышла замуж за даймё Тадаоки Хосокаву. Во внутреннем пространстве храма находится икона «Госпожа Грация во время последних дней», написанная японским художником Домэто Инсо, и около ста витражей, изображающих жизнь Иисуса Христа и Девы Марии.

Примечания

Ссылки
  Grand Cathedral of the Virgin Mary of Osaka
 Официальный сайт храма

Соборы Японии
Католические храмы Японии

redpajama_set_name: RedPajamaWikipedia


The Columbia Gorge Health Council works in partnership with PacificSource Community Solutions Coordinated Care Organization – Columbia Gorge Region. The Columbia Gorge Health Council consists of local leaders in health care along with county and community representatives. Thru local engagement and leadership, our goal is better health for all.
The Community Advisory Council (CAC) ensures a community voice in programs while the Clinical Advisory Panel (CAP) provides stewardship of best clinical practices. The Board, CAC and CAP each meet monthly as noted in the Upcoming Events calendar.
The Columbia Gorge region turned an ordinary requirement from Oregon lawmakers into an extraordinary opportunity to improve the health and wellness of all residents.