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Kieran Messer - Google+Search Images Maps Play YouTube News Gmail Drive More »Send Feedback | Web History | Help | Sign inProfileHomeProfilePeopleCollectionsWhat's hotCommunitiesEventsHangoutsPagesSettingsFeedbackHelp · RegionPrivacy · Terms · Maps TermsStart a hangout Kieran Messer95,376 viewsProfileKieran Messer95,376 viewsAboutPostsPhotosVideosReviewsStreamKieran MesserShared publicly - 2014-06-23 Blimey. Long time since I've been here...Read moreShow less1Add a comment...Kieran MesserShared publicly - 2013-03-02 Me like!Read moreShow lessRoyal Caribbean UKfacebook.com1Add a comment...Kieran MesserShared publicly - 2013-01-27 So bored...Read moreShow less11 commentBrian Nicholson+010 Reply PooRead moreShow lessAdd a comment...Kieran MesserShared publicly - 2013-01-08 Bungee Bungalow - Pyramids11 commentBrian Nicholson+010 Reply I like this, I would like to hear more fromthis wizard : )xRead moreShow lessAdd a comment...Kieran MesserShared publicly - 2012-12-31 Looking forward to dinner!Read moreShow lessMediterranea Restaurant & Pizzeria21 Westow Street, London, Greater London SE19 3RY, United Kingdom1Add a comment...House MusicKieran Messer♫ Question - 2012-12-09 I am kinda like a producer myself. Check out my website!Read moreShow lessBungee Bungalowbungee-bungalow.weebly.comI'm Bungee Bungalow, a normal young person who has a thing for dance and house music. So much so, that I downloaded Virtual DJ, and made a few remixes. You should check them out; they're under...2Add a comment...Kieran MesserShared publicly - 2013-03-02 Volume 2fororchestra.bandcamp.com1Add a comment...Kieran MesserShared publicly - 2013-03-01 Posting something because I hadn't for ages...Read moreShow less1Add a comment...Dance & Electronic MusicKieran MesserDiscussion - 2013-01-26 Hello!Read moreShow less1Add a comment...Electronic MusicKieran Messer - 2013-01-26 Hello there everyone!This is my first post in this community, and I am pretty happy to have joined.Why not take a look at this song I made, which had been broadcast on BBC Introducing in my local area?Read moreShow lessBungee Bungalow - Pyramids3Add a comment...Kieran MesserShared publicly - 2013-01-04 Break BarThe Mall, Grays RM17 6QE, United Kingdom1Add a comment...The BungeehoodKieran MesserownerDiscussion - 2012-12-26 How's it doing guys? Enjoying the Epmix? Song of Xmas 2012?Read moreShow lessBungee Bungalow's December 2012 Epmix11 commentRobert Goodall+010 it is christmas not xmasRead moreShow lessAdd a comment...MoreLoading...StoryTaglineOMG Why am I living?IntroductionI am Kieran Messer, a producer from the UK.LinksYouTubeKieran MesserBasic InformationGenderMaleWe were unable to fetch any YouTube videos at this time. Please try again.Videos are visible only to people they've been shared with.We were unable to fetch any videos at this time. Please try again.Grange Bracknell Hotel Charles Square, Bracknell RG12 1DF, United KingdomThe restaurant and bar had a nice feel to it of poshness and the room was good. Maybe a bit of wallpaper off but otherwise OK.Public - 3 years agoreviewed 3 years agoFlamingo Park E Beach St, Hastings TN34 3AR, United KingdomWe had a look on the Flamingo Park website and it didn't have as many rides as it had claimed to have. Compare the number of rides from there to as many as you can see from the cliffs, access via those tram things.Appeal: Very GoodFacilities: Poor - FairService: GoodPublic - 3 years agoreviewed 3 years agoCarphone Warehouse Intu Lakeside, Unit, 244 Lakeside Shopping Centre, West Thurrock RM20 2ZQ, United KingdomQuality: Poor - FairAppeal: GoodService: GoodPublic - 3 years agoreviewed 3 years agoCopper Box Arena Queen Elizabeth Olympic Park, London E20 3HB, United KingdomI went for Handball for the day after the opening and LOVED it!Public - 3 years agoreviewed 3 years ago16 reviewsHobbledown Horton Ln, Epsom KT19 8PT, United KingdomThe playground was alright. I thought the tunnels were too small for me, but I managed to fit in.
Other than that, there is nothing else. There were very few animals. I did manage to spot a pig, but it was surrounded in its own poo. Surely this is neglect in a case.
The staff were friendly when we were buying ice cream and the toilets were clean enough, however, we probably won't be going again, since like another reviewer said, you're basically paying for access to a playground. • • •The playground was alright. I thought the tunnels were too small for me, but I managed to fit in.
The staff were friendly when we were buying ice cream and the toilets were clean enough, however, we probably won't be going again, since like another reviewer said, you're basically paying for access to a playground. • • •Appeal: GoodFacilities: GoodService: Poor - FairPublic - 3 years agoreviewed 3 years agoCheyenne Spur Unit 3.02, The O2, The Entertainment Distric, The O2 Dome, London SE10 0BB, United KingdomYup, it's Spur, another one of the chain restaurants we see all over the place. The food is pretty nice in here and the staff seem friendly, but the atmospere gets ruined by pop music. This is why I rated decor lower.Food: ExcellentDecor: GoodService: Very GoodPublic - 3 years agoreviewed 3 years agoHendra Holiday Park Newquay Cornwall Newquay TR8 4NY, United KingdomMe and a few family members last year enjoyed our visit to Hendra. LidL and Morrisons just down the road. Two arcades. Probably the 2nd best comedian I ever watched. Although security had a bit of a moan at me, it was for good reason, because me and a few newfound friends caused a bit of a nuisence. Definetly reccomend. Newquay Airport nearby for those travelling from afar.Appeal: ExcellentFacilities: ExcellentService: ExcellentPublic - 3 years agoreviewed 3 years agoMoreLoading...

value: This website .


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3 bedroom detached house for sale in Ullswater Avenue, Darlington, DL1
www.rightmove.co.uk/property/63820882
Situated in the Eastbourne area, close to excellent local amenities and Darlington Railway Station, we are delighted to offer for sale this modern, well presented Three Bedroomed Detached Residence, located in a cul-de-sac.
Warmed by Gas Central Heating, with the benefit of Double Glazing and a Security System, the family accommodation briefly comprises: Entrance Vestibule, Inner Hallway with staircase leading to the first floor, useful ground floor Cloaks/wc, Lounge with double glazed window to the front aspect, and Kitchen/Diner, which is fitted with a range of units, integrated appliances and french doors opening to the rear gardens.
To the first floor there is a Landing area, Three Bedrooms, bedroom one boasting its own En-Suite, and the family Bathroom/wc is partially tiled and fitted with a white suite with overhead shower and screen.
Externally, the gardens to the front are open plan and laid to lawn with pathway to the entrance, and the driveway leads to the garage with up and over door, light and power. The rear garden is enclosed by timber fencing, mainly laid to lawn with patio area and outside tap.
Entrance Vestibule - Double glazed entrance door and laminate flooring.
Inner Hallway - Staircase leading to the first floor.
Lounge - 4.80m x 3.35m (15'9" x 11') - Double glazed window to the front aspect and laminate flooring.
Kitchen/Diner - 4.22m x 3.35m (13'10" x 11') - Partially tiled and fitted with a range of wall, floor and drawer units, work preparation surfaces, sink unit, plumbing for an automatic washing machine, integrated gas hob, electric oven and extractor hood, ceramic tiled flooring, double glazed window and french doors opening to the rear aspect.
Landing - Double glazed windows to the side and front aspect, and access to the attic.
Bedroom 1 - 4.98m x 3.33m (16'4" x 10'11") - Double glazed window to the front aspect and storage cupboard.
En-Suite - Partially tiled with shower cubicle having Creda electric shower, white w/c and handbasin, spotlights, extractor fan and double glazed window to the side aspect.
Bedroom 2 - 2.77m x 4.06m (9'1" x 13'4") - Double glazed window to the front aspect.
Bedroom 3 - 3.48m x 2.31m (11'5" x 7'7") - Double glazed window to the rear aspect.
Bathroom/Wc - Partially tiled and fitted with a white suite, comprising safety panel bath with overhead electric shower and glass shower screen, handbasin, w/c, extractor fan and double glazed window to the rear aspect.
Externally - The gardens to the front are open plan and laid to lawn with pathway to the entrance, and the driveway leads to the garage with up and over door, light and power. The rear garden is enclosed by timber fencing, mainly laid to lawn with patio area and outside tap.
To view this media, please visit the on-line version of this page at www.rightmove.co.uk/property-for-sale/property-63820882.html
Disclaimer - Property reference 27584345. The information displayed about this property comprises a property advertisement. Rightmove.co.uk makes no warranty as to the accuracy or completeness of the advertisement or any linked or associated information, and Rightmove has no control over the content. This property advertisement does not constitute property particulars. The information is provided and maintained by Ann Cordey Estate Agents , Darlington. Please contact the selling agent or developer directly to obtain any information which may be available under the terms of The Energy Performance of Buildings (Certificates and Inspections) (England and Wales) Regulations 2007 or the Home Report if in relation to a residential property in Scotland.
12 Jun 2017 12 Ullswater Avenue, DL1 £100,000

type: global

value: This website is a UK-based company that runs rightmove.co.uk, the UK's largest online real estate portal and property website. It is listed on the London Stock Exchange and is a constituent of the FTSE 100 Index.


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Lovely, fluffy tassle. Matches perfectly with my hat! Thanks!
White and Silver Sparkle Faux Fur, Fur Ball Fur Pom Pom Removable Interchangeable, 4" or 3" Diameter

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Iran wants to greatly expand uranium enrichment | Daily Mail Online
Published: 17:05 EDT, 9 July 2014 | Updated: 17:05 EDT, 9 July 2014

value: This website is the website of the Daily Mail, a newspaper in the United Kingdom, and of its sister paper The Mail on Sunday. MailOnline is a division of dmg media, which is owned by Daily Mail and General Trust plc.


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Mars Mission Set to Launch to Study Gases and Storms
An artist’s illustration of the European Space Agency’s Trace Gas Orbiter at Mars.CreditCreditEuropean Space Agency
The ExoMars 2016 mission — a collaboration between the European and Russian space agencies — is scheduled to blast off from Kazakhstan on Monday.
After a journey of seven months, the ExoMars spacecraft will arrive at Mars in October. Three days before arriving, the lander, named Schiaparelli after the 19th-century Italian astronomer Giovanni Schiaparelli, will separate from the orbiter. It is to enter the atmosphere at 13,000 miles per hour and quickly decelerate on its way to settling down on the surface.
A Russian Proton rocket will carry the ExoMars 2016 spacecraft. Liftoff is scheduled for Monday in Kazakhstan.CreditEsa/Getty Images
Schiaparelli carries instruments to measure Mars’s atmosphere during the height of the dust storm season. Its batteries are expected to last only two to four days. The Trace Gas Orbiter is to operate much longer, until at least 2022, circling Mars at an altitude of 250 miles. Its instruments will measure gases, like methane, water vapor and nitrogen, that exist in minute quantities but that could hold important clues about the possibility of life on Mars.
The ExoMars spacecraft was originally to be launched by NASA, but tight budgets led NASA to back out in 2012, and the Russians stepped in. The second half of the European-Russian ExoMars collaboration — a rover — is scheduled to launch in 2018, but that mission is expected to slip to 2020.
A version of this article appears in print on , on Page A4 of the New York edition with the headline: Mars Mission Set to Launch to Study Gases and Storms. Order Reprints | Today’s Paper | Subscribe

value: This website is an American daily newspaper based in New York City with a worldwide readership. Founded in 1851, the Times has since won 132 Pulitzer Prizes, the most of any newspaper, and has long been regarded within the industry as a national "newspaper of record".


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A metropolis or metropolitan archdiocese is a see or city whose bishop is the metropolitan of a province. Metropolises, historically, have been important cities in their provinces.
In the Eastern Orthodox Churches, a metropolis (also called metropolia or metropolitanate) is a type of diocese, along with eparchies, exarchates, and archdioceses. In the Churches of Greek Orthodoxy (Church of Greece, Greek Orthodox Archdiocese of America, etc.), every diocese is a metropolis, headed by a metropolitan: auxiliary bishops are the only non-metropolitan bishops. In non-Greek Orthodox Churches, mainly Slavic, the title of metropolitan is given to the heads of autocephalous Churches or of a few important episcopal sees.[1]
Retrieved from "https://en.wikipedia.org/w/index.php?title=Metropolis_(religious_jurisdiction)&oldid=849209328"

value: This website is the English-language edition of the free online encyclopedia Wikipedia. It was founded on 15 January 2001 as Wikipedia's first edition and, as of October 2021, has the most articles of any edition, at 6,412,521.


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Portman wanted rehab after Black Swan | entertainment | Hindustan Times
Portman wanted rehab after Black Swan
Updated: Mar 21, 2011 12:10 IST
Playing a mentally derailed ballerina in Black Swan was so taxing for Natalie Portman that the actress felt she should have checked into a rehab to overcome the effects.
Portman, who won the Best Actress Oscar for her brilliant portrayal of repressed Nina in Darren Aronofsky's movie on the balle world, has often talked about the intensity of the role, which left her exhausted.
Portman feels that instead of starting work on her next movie Thor she should have taken a break.
"I loved Darren Aronofsky and working with him was a deeply fulfilling experience but I just showed up for Thor spent. I probably should have gone into rehab."
However, the 29-year-old star, who is currently expecting her first child with fiance Benjamin Millepied, was thrilled to work with director Kenneth Branagh on 'Thor' because she has always been of his work.
"I must have watched Much Ado About Nothing about 500 times, I love that film so much. He was one of the first people I've met that I was excited about when I met them. When I worked with him, it exceeded my expectations."	tags

value: This website is an Indian English-language daily newspaper introduced and founded in 1924 by Sunder Singh Lyallpuri, founder-father of the Akali movement and the Shiromani Akali Dal in the Punjab Province. It played integral roles in the Indian independence movement as a nationalist daily.


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3 Tier Weave Cart add a fashion touch to this multi-purpose storage unit. Styling and design enhance visible storage areas while controlling clutter and providing access to frequently used items. Comp...
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Shoe Organizer. Storage Wardrobe. 1x Drawer Storage Cabinet. Storage Shelf. Size of the top board:25"Wx13"Dx1.18"H (63.5Wx33Dx3.0H cm). Item weight:9.79lbs/4.44kg.Quick and Easy assembly without any t...
6pcs Folding Storage Box Household Organizer Fabric Cube Bin Drawers Container
Description: 3-size storage boxes for different needs. Easy to use and save space. Ideal to put cards, keys, paper, makeup, cellphone and so on.

value: This website is an American multinational e-commerce corporation based in San Jose, California, that facilitates consumer-to-consumer and business-to-consumer sales through its website.


text: *'''[Brown]''' Eagleson, Pamela Stone. ''In Search of an Ancestry, the Stone-Shearmire Family History''. Kennebunk, Me.: P.S. Eagleson, 1984. {{FHL|279416|item|disp=FHL Book 929.273 St72e}}. *'''[Brown]''' Eagleson, Pamela Stone. ''In Search of an Ancestry, the Stone-Shearmire Family History''. Kennebunk, Me.: P.S. Eagleson, 1984. {{FHL|279416|item|disp=FHL Book 929.273 St72e}}. *'''[Brown]''' Jones, Gerald Edward. "The Benjamin Brown Family of Laurens, South Carolina, and Colonial Virginia," ''Magazine of Virginia Genealogy'', Vol. 47, No. 3 (Aug. 2009):193-212. *'''[Brown]''' Jones, Gerald Edward. "The Benjamin Brown Family of Laurens, South Carolina, and Colonial Virginia," ''Magazine of Virginia Genealogy'', Vol. 47, No. 3 (Aug. 2009):193-212. +*'''[Brownlee]''' "Virginia Valley Brownlees 1718-1985," Family File, [http://www.augustacountyhs.org/archives.html Augusta County Historical Society]. *'''[Broyles]''' Zimmerman, Gary J. and Johni Cerny. ''The Ancestry of the Broyles, Paulitz, Moyer and Motz Families.'' Bountiful, Utah: American Geneal. Lending Library Publishers, 1990. {{FHL|370243|title-id|disp=FHL INTL Book 975.5365 D25b no. 6}}. *'''[Broyles]''' Zimmerman, Gary J. and Johni Cerny. ''The Ancestry of the Broyles, Paulitz, Moyer and Motz Families.'' Bountiful, Utah: American Geneal. Lending Library Publishers, 1990. {{FHL|370243|title-id|disp=FHL INTL Book 975.5365 D25b no. 6}}. *'''[Buchanan]''' Trimble, David B. ''Buchanan and Gillespie of Southwest Virginia''. Austin, Texas: D.B. Trimble, 1992. {{FHL|572936|title-id|disp=FHL US/CAN Book 975.5 D2tda}}. *'''[Buchanan]''' Trimble, David B. ''Buchanan and Gillespie of Southwest Virginia''. Austin, Texas: D.B. Trimble, 1992. {{FHL|572936|title-id|disp=FHL US/CAN Book 975.5 D2tda}}. *'''[Buck]''' Buck, Walter H. and S.A. McCarthy. ''The Buck Family of Virginia''. Baltimore: Schneidereith and Sons, 1936. {{FHL|335346|title-id|disp=FHL US/CAN Film 1463955 Item 4}}. *'''[Buck]''' Buck, Walter H. and S.A. McCarthy. ''The Buck Family of Virginia''. Baltimore: Schneidereith and Sons, 1936. {{FHL|335346|title-id|disp=FHL US/CAN Film 1463955 Item 4}}. −*'''[Burgess]''' Reginald, R. ''The House of the Burgesses: Being a Genealogical History of Edward Burgess of King George and Stafford Counties, Virginia, with His Sons - Garner Burgess of Fauquier Co., Virginia; William Burgess of Stafford Co., Virginia; Moses Burgess of Orange County, Virginia; Reuben Burgess of Rowan Co., North Carolina - and His Grandsons - Edward Burgess of Culpeper Co., Virginia; John Burgess of Harrison Co., Kentucky; Henry Burgess of Fleming Co., Kentucky; Edward Burgess of Scott Co., Kentucky; John P.B. Burgess of Halifax Co., Virginia; Edward Burgess of Kanawha Co., West Virginia; William Burgess of Davie Co., North Carolina; Reuben Burgess of Davie Co., North Carolina; and Thomas Burgess of White Co., Tennessee - Together with Their Known Descendants Named Burgess''. San Bernardino, California: Borgo Press, 1983. {{FHL|397340|title-id|disp=FHL FAM HIST Book 929.273 B912r}}. +*'''[Burgess]''' Reginald, R. ''The House of the Burgesses: Being a Genealogical History of Edward Burgess of King George and Stafford Counties, Virginia, with His Sons - Garner Burgess of Fauquier Co., Virginia; William Burgess of Stafford Co., Virginia; Moses Burgess of Orange County, Virginia;

value: This website is a nonprofit organization and website offering genealogical records, education, and software. It is operated by The Church of Jesus Christ of Latter-day Saints , and is closely connected with the church's Family History Department.


text: Search results from Notated Music, Sheet Music, Performing Arts Encyclopedia, Maryland | Library of Congress

value: This website is the research library that officially serves the United States Congress and is the de facto national library of the United States. It is the oldest federal cultural institution in the United States.


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BBB Business Profile | USA Contractors Group
> USA Contractors Group
(916) 798-2900
5050 Laguna Blvd 211 #611 Elk Grove, CA 95758
Business Started: 9/10/2010
Business Started Locally: 9/10/2010
USA Contractors Group builds patio covers; remodels kitchens and bathrooms; installs roofs, siding and windows; and paints interior and exterior surfaces for residential clients throughout Northern California. Alternate Business Names

value: This website is a private, nonprofit organization whose self-described mission is to focus on advancing marketplace trust, consisting of 106 independently incorporated local BBB organizations in the United States and Canada, coordinated under the International Association of Better Business Bureaus  in Arlington, Virginia.The Better Business Bureau is not affiliated with any governmental agency. Businesses that affiliate with the BBB and adhere to its standards do so through industry self-regulation.


text: Patent US4389450 - Multiple layer packaging film - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsThis invention is a multiple layer packaging film in which the outer polymeric layers cooperate to achieve, between themselves, a relatively constant coefficient of friction differential, a fin seal capability, and a lap seal capability; even after the film is stored in wound-up roll form....http://www.google.com/patents/US4389450?utm_source=gb-gplus-sharePatent US4389450 - Multiple layer packaging filmAdvanced Patent SearchPublication numberUS4389450 APublication typeGrantApplication numberUS 06/238,210Publication dateJun 21, 1983Filing dateFeb 26, 1981Priority dateFeb 26, 1981Fee statusPaidPublication number06238210, 238210, US 4389450 A, US 4389450A, US-A-4389450, US4389450 A, US4389450AInventorsSuzanne E. Schaefer, E. Knott II JackOriginal AssigneeAmerican Can CompanyExport CitationBiBTeX, EndNote, RefManPatent Citations (5), Referenced by (60), Classifications (28), Legal Events (8) External Links: USPTO, USPTO Assignment, EspacenetMultiple layer packaging film

value: This website is a search engine provided by Google. Handling over 3.5 billion searches per day, it has a 92% share of the global search engine market.


text:
Me Vs. The World: Madina Lake: Amazon.co.uk: MP3 Downloads
See larger image Me Vs. The World
From the Album From Them, Through Us, To You
Attics To Eden › Madina Lake
World War III › Madina Lake
B0027P520E,B005O0W44G,B001EZ86X8,B002VH10R2,B007KTAW2K,B001F6BEWQ,B007Y1W02Y,B0041SRSSO,B004WX2AGS,B005SACS3E,B001KWIT64,B007OWF16A
Duration: 3:08 minutesGenres: Indie & Alternative ASIN: B001F3WF0E
Amazon Bestsellers Rank: 2,069,386 in MP3 Songs (See Top 100 in MP3 Songs)
ARRAY(0xad080b0c)

value: This website is an American multinational technology company which focuses on e-commerce, cloud computing, digital streaming, and artificial intelligence.


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Sales Service Associate Jobs, Employment in Williamsville, NY | Indeed.com
The search Sales and Service Associate jobs in Williamsville, NY did not match any jobs
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text:
Nonlinear Control, Global Edition book by Hassan K. Khalil | 1 available editions | Alibris Books
For a first course on nonlinear control that can be taught in one semester This book emerges from the award-winning book, Nonlinear Systems, but has a distinctly different mission and organization. While Nonlinear Systems was intended as a reference and a text on nonlinear system analysis and its application to control, this streamlined book is intended as a text for a first course on nonlinear control. In Nonlinear Control, author Hassan K. Khalil employs a writing style that is intended to make the book accessible to a ... Read More
For a first course on nonlinear control that can be taught in one semester This book emerges from the award-winning book, Nonlinear Systems, but has a distinctly different mission and organization. While Nonlinear Systems was intended as a reference and a text on nonlinear system analysis and its application to control, this streamlined book is intended as a text for a first course on nonlinear control. In Nonlinear Control, author Hassan K. Khalil employs a writing style that is intended to make the book accessible to a wider audience without compromising the rigor of the presentation. Teaching and Learning Experience This program will provide a better teaching and learning experience-for you and your students. It will help: Provide an Accessible Approach to Nonlinear Control: This streamlined book is intended as a text for a first course on nonlinear control that can be taught in one semester. Support Learning: Over 250 end-of-chapter exercises give students plenty of opportunities to put theory into action. Read Less
ISBN-13: 9781292060507
ISBN: 1292060506
Alibris ID: 14881775387
Alibris ID: 14232167177
Alibris ID: 14813741524
Alibris ID: 14225842075
Alibris ID: 14994406487
Alibris ID: 14994396240
Alibris ID: 14844334066
Alibris ID: 14858306759
Alibris ID: 14864466863
Alibris ID: 15027781299
Books by Hassan K. Khalil

value: This website is is an online store that sells new books, used books, out-of-print books, rare books, and other media through an online network of independent booksellers.


text:
9781586632267: Handwriting of the Famous and Infamous - AbeBooks - Sheila R. Lowe: 1586632264
Social History Sheila R. Lowe Handwriting of the Famous and Infamous
ISBN 13: 9781586632267
ISBN 10: 1586632264 ISBN 13: 9781586632267
Publisher: MetroBooks (NY), 2001
Handwriting communicates much more than what is committed to paper. A quick note, a carefully composed letter, an autograph or a scribble also reveals a great deal about the personality of the writer. What are the clues to look for in a person’s writing and what do they reveal? What do they tell experts that the writer might prefer to keep hidden? Join expert graphologist Sheila Lowe for an intriguing journey between the lines in Handwriting of the Famous and Infamous.
Discover what Elvis’ 1970s letter to Richard Nixon reveals about his state of mind (restless, extravagant, impulsive, and unrealistic) and what Hillary Clinton’s note to a supporter says about her (forthright, progressive, independent, and practical).
Each spread includes Between the Lines” features that focus on particular handwriting traits that you can use to analyze your own writing.
Like her fictional character Claudia Rose in the award-winning Forensic Handwriting Mysteries series, Sheila Lowe is a real-life forensic handwriting expert. She holds a Master of Science degree in psychology and has taught forensic handwriting examination at the University of California Riverside Campus in the CSI Certificate program and at the University of California Santa Barbara Campus in the Discovery program.
She's also the author of the internationally acclaimed The Complete Idiot's Guide to Handwriting Analysis and Handwriting of the Famous & Infamous, as well as the Handwriting Analyzer software. Sheila's analyses of celebrity handwritings are often seen in the media. visit facebook.com/graphogoddess claudiaroseseries.com or sheilalowe.com
ISBN 10: 1592239595 ISBN 13: 9781592239597
1. Handwriting of the Famous and Infamous
Published by MetroBooks, U.S.A. (2001)
Book Description MetroBooks, U.S.A., 2001. Hardcover. Book Condition: New. Dust Jacket Condition: New. NEW. Dj in protective mylar wrapper. Bookseller Inventory # 16SEPTUNKN1205
2. Handwriting of the Famous and Infamous
Book Description MetroBooks (NY). Hardcover. Book Condition: New. 1586632264 Ships promptly. Bookseller Inventory # HGT1632.2ABGG052617H0299
3. Handwriting of the Famous and Infamous
Book Description MetroBooks (NY), 2001. Hardcover. Book Condition: New. book. Bookseller Inventory # M1586632264
4. Handwriting of the Famous and Infamous
Book Description MetroBooks (NY), 2001. Hardcover. Book Condition: New. Never used!. Bookseller Inventory # P111586632264

value: This website is an e-commerce global online marketplace with seven websites that offer books, fine art, and collectables from sellers in over 50 countries. Launched in 1996, it specialises in used, rare and out-of-print books.


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Outsource google play create account projects!
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...we can create users that can only edit their own page on the site? This project is just for the maps plugin...want to create a site with multiple users that can edit their own page.
Give me an accurate estimate
Post your google play create account project FREE!

value: This website is an Australian freelance marketplace website, which allows potential employers to post jobs that freelancers can then bid to complete. Founded in 2009, its headquarters is located in Sydney, Australia, though it also has offices in Vancouver, London, Buenos Aires, Manila, and Jakarta.


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FeaturesVideo gear galore NAB 2014 show highlightsUnderwater surpriseSwimming with jellyfishIn-depth reviewBest of both worlds: Sony RX10ConversationsDPReview talks with industry executivesAccessory reviewOna Lima strap: Practical indulgence? Is the new version better? Manfrotto 190 tripod reviewFirst-Impressions ReviewSamsung NX30 Top of the World One World Trade Center 360-degree viewhow much detail can you squeeze out?Shooting Raw with the Nokia Lumia 1020Photographer profileEngineering a Dream: Benjamin Von Wong In-depth reviewOM sweet OM: Olympus OM-D E-M10Learn to shoot time-lapseBehind the shot: 'Louisville in Motion'In-depth review Olympus PEN E-P5: A step forwardGood clean funPhotographing bubbles, one bubble at a timeFirst impressions reviewNikon D4s: Hit ISO 409,600 Get up highOrion DVC210 DLSR crane reviewKodak rebornA look at JK Imaging's 2014 lineupElevate your movementCinetics Axis360 reviewWHAT TO BUY - AND WHYCamera and Lens Buying GuidesIn-depth ReviewPanasonic Lumix GX7: A different view

value: This website is a website about digital cameras and digital photography, established in November 1998. The website provides comprehensive reviews of digital cameras, lenses and accessories, buying guides, user reviews, and forums for individual cameras, as well as general photography forums.


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Supo Mungam - Arkane Song - BBC Music The BBC has updated its cookie policy. We use cookies to ensure that we give you the best experience on our website. This includes cookies from third party social media websites if you visit a page which contains embedded content from social media. Such third party cookies may track your use of the BBC website. We and our partners also use cookies to ensure we show you advertising that is relevant to you. If you continue without changing your settings, we'll assume that you are happy to receive all cookies on the BBC website. However, you can change your cookie settings at any time. Continue Change settings Find out more ]]> Accessibility links Skip to content Accessibility Help BBC iD Notifications
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The Find of a Lifetime by Harley R. West | NOOK Book (eBook) | Barnes & Noble® Books by Author Books by Series Collectible Editions Coming Soon by Date Coming Soon by Subject New Releases NY Times Bestsellers Signed Books Top Books of the Month
by Harley R. WestHarley R. West
The Find of a Lifetime by Harley R. West
This is a baffling murder mystery made very complicated by a series of bizarre events. Sheriff Red Evans has his work cut out for him in trying to solve this case. He discovers that he must change his approach repeatedly to attempt unraveling this strange situation.
2940015209709
Retirement provided the time that led the author into the field of writing. His first book was non-fiction; a chronicle of his time fighting in Korea. All of his later books have been fiction. The last several have been murder mysteries with twists and turns to keep the reader involved.

value: This website is an American bookseller. It is a Fortune 1000 company and the bookseller with the largest number of retail outlets in the United States.


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2. Barbarism and Civilization: A History of Europe in our Time (Paperback)
3. Barbarism And Civilization
Book Description OUP Oxford, 2009. PAP. Condition: New. New Book. Shipped from UK in 4 to 14 days. Established seller since 2000. Seller Inventory # FU-9780198730736
Book Description Oxford University Press. Paperback / softback. Condition: New. New copy - Usually dispatched within 2 working days. Seller Inventory # B9780198730736
Book Description Oxford University Press. PAPERBACK. Condition: New. 019873073X Brand New, printed in english , Ready to ship, fast delivery (6-8 busienss days ) worldwide. Seller Inventory # XOD#E16469
9. Barbarism and Civilization A History of Europe in our Time (Paperback)
BARBARISM AND CIVILIZATION A HISTORY OF EUROPE IN OUR TIME (PAPERBACK) -
Book Description Condition: NEW. 9780198730736 This listing is a new book, a title currently in-print which we order directly and immediately from the publisher. For all enquiries, please contact Herb Tandree Philosophy Books directly - customer service is our primary goal. Seller Inventory # HTANDREE01560364
10. Barbarism and Civilization: A History of Europe in Our Time
Book Description Oxford Univ Pr, 2009. Paperback. Condition: Brand New. 1st edition. 901 pages. 9.00x6.00x2.00 inches. In Stock. Seller Inventory # __019873073X


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motor bike tank bag | eBay
Skip to main contenteBayShop by categoryEnter your search keywordAll CategoriesAntiquesArtBabyBooks, Comics & MagazinesBusiness, Office & IndustrialCameras & PhotographyCars, Motorcycles & VehiclesClothes, Shoes & AccessoriesCoinsCollectablesComputers/Tablets & NetworkingCraftsDolls & BearsDVDs, Films & TVEvents TicketsGarden & PatioHealth & BeautyHolidays & TravelHome, Furniture & DIYJewellery & WatchesMobile Phones & CommunicationMusicMusical InstrumentsPet SuppliesPottery, Porcelain & GlassPropertySound & VisionSporting GoodsSports MemorabiliaStampsToys & GamesVehicle Parts & AccessoriesVideo Games & ConsolesWholesale & Job LotsEverything ElseAdvanced or register':' style="margin-right:3px">Hello -User-.'.replace(/-User-/,escape(a)))+"")}catch(b){document.write("")}})();Hello (Sign in to bid or buy) Daily Deals Sell Help & Contact My eBayExpand My eBay Summary Bids/Offers Watch List Wish List All Lists Purchase History Selling My Collections Followed Searches MessagesCollect & Spend Learn moreNotification Related: xbox 360 games xbox 360 steering wheel molle pouch citroen zx driveshaft baby highchair yamaha xt660z tenere td5 motor bike tank bag bagster
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Patent US7000008 - Method, system, and program for providing data updates to a page including ... - Google Patents
Disclosed is a method, system, and program for providing data updates to a page, wherein the page includes multiple regions of dynamic content that may be separately updated independently of each other. The regions of the page are displayed within a presentation program executing on a client. A server...http://www.google.com/patents/US7000008?utm_source=gb-gplus-sharePatent US7000008 - Method, system, and program for providing data updates to a page including multiple regions of dynamic content
Publication number US7000008 B2
Application number US 09/836,125
Also published as US20020152239, WO2002084534A2, WO2002084534A3
Publication number 09836125, 836125, US 7000008 B2, US 7000008B2, US-B2-7000008, US7000008 B2, US7000008B2
Inventors David Bautista-Lloyd, Arieh Markel
Patent Citations (20), Non-Patent Citations (5), Referenced by (80), Classifications (9), Legal Events (5)
US 7000008 B2
1 Betz, K., et al. "Developing Highly-Responsive User Interfaces with DHTML and Servlets." Performance, Computing, and Communications Conference 2000. IPCCC '00 Conference Proceeding of the IEEE International, Phoenix, AZ, USA Feb. 20-22, 2000, Piscataway, NJ, USA, IEEE, US, Feb. 20, 2000, pp. 437-443.
2 * http://www.webopedia.com/TERM/q/queue.html, visited Feb. 15, 2005.
3 International Application No. PCT/US02/11703, International Search Report, dated of mailing Aug. 8, 2003.
4 * Stevens, W. Richard, "TCP/IP Illustrated, vol. 1" New York, 1994, p. 2.
5 Sun Microsystems, Inc. "Sun StorEdge Component Manager 2.1 User's Guide", Jul. 2000, Revision A.
US7805523 * Feb 25, 2005 Sep 28, 2010 Mitchell David C Method and apparatus for partial updating of client interfaces
US8745163 * Aug 8, 2007 Jun 3, 2014 Wayport, Inc. Real-time, customized embedding of specific content into local webserver pages
US9066129 * Jun 13, 2012 Jun 23, 2015 Comcast Cable Communications, Llc Video presentation device and method
US20050197932 * May 10, 2004 Sep 8, 2005 George Gati Method for displaying accumulated interest
US20080027982 * Jul 27, 2006 Jan 31, 2008 Ebay Inc. Indefinite caching expiration techniques
US20130278706 * Jun 13, 2012 Oct 24, 2013 Comcast Cable Communications, Llc Video presentation device and method
U.S. Classification 709/219, 709/236, 709/228, 709/203, 707/E17.119


text:
2 DISC DVDs EDITION - HARRY POTTER & THE PRISONER of AZKABAN | eBay
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Details about 2 DISC DVDs EDITION - HARRY POTTER & THE PRISONER of AZKABAN
2 DISC DVDs EDITION - HARRY POTTER & THE PRISONER of AZKABAN
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We hope you will be happy with your purchase from pg-nostalgia. If in the rare event of an issue with either posting or anything else, we will always work with you to resolve them. Please note we always have proof of posting. If you wish to make a return please contact us via e-bay to arrange this. Returns can be arranged up to 14 working days after receipt. Auctioned lots may only be returned where there is an error or inaccuracy and the item is not as described or shown in the listing. Please read the description, and study all the pictures thoroughly so as to satisfy yourself as to the condition/suitability etc of the item. Postage for the item(s) returned to be paid for by the Buyer, unless the item is not as described. Items must be returned in the same packaging condition as when dispatched by myself.
Harry Potter Luxury Edition Antiquarian & Collectable Books,


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Selena Gomez Magazine | eBay Skip to main contenteBayShop bycategoryEnter your search keywordAll CategoriesAdvancedDaily DealsHi, (Sign in to bid or buy)My eBayExpand My eBaySellExpand SellCommunityExpand CommunityHelp & ContactExpand Customer SupportBasket
Promoted item:SEVENTEEN MAGAZINE MARCH 2014 - SELENA GOMEZ
SEVENTEEN MAGAZINE MARCH 2014 - SELENA GOMEZ
Selena gomez : there are 3 covers for this issue; cover dispatched will be at random. Seventeen magazine is the bestselling American teen girl mag, for teenage girls aged 12 – 19. Condition
magazineshack (1763
Selena gomez poster size approx a4 size.
Mizz Magazine Issue 720 Selena Gomez Front One Direction Janoskians Ross Lynch
Janoskians (1 full page about them inside) Selena Gomez on Front cover and 1 full page about her inside. Ross Lynch (1 full page on him inside) One Direction (1 full page on them inside) 23d 2h 16m left
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text:
15175610561087727684Chestac-8900
Act and Aqlq
Exercise-Induced Hypersensitivity Syndromes in Recreational and Competitive Athletes
AsmaAncianos
Asma Ex Acute
LIGHT Asthma Dr. Constantino
22356431 (1)
Kirsten M. Baker, Donald A. Brand and Jacob Hen, Jr
Chest 2003;124;2156-2163 DOI 10.1378/chest.124.6.2156
http://chestjournals.org/cgi/content/abstract/124/6/2156
Downloaded from chestjournals.org on March 7, 2007 Copyright © 2003 by American College of Chest Physicians
I n response to a rise in asthma mortality during the 1980s, 1 the National Institutes of Health con- vened an expert panel and published patient man- agement guidelines in 1991. 2 Updated in 1997 3 and again in 2002, 4 these guidelines offer a system for classifying asthma severity and a set of treatment recommendations based on that classification. The
*From Children’s Medical Group, Hamden, CT; Department of Pediatrics and Center for Primary Care Education and Research, New York Medical College Valhalla, NY; and Department of Pediatrics, Bridgeport Hospital-Yale New Haven Health, Bridge- port, CT. This work was performed at New York Medical College. This study was supported in part by Health Resources and Services Administration award #1D12HP00022. Manuscript received February 25, 2003; revision accepted June 24, 2003. Reproduction of this article is prohibited without written permis- sion from the American College of Chest Physicians (e-mail:
permissions@chestnet.org). Correspondence to: Kirsten M. Baker, MD, Children’s Medical Group, 299 Washington Ave, Hamden, CT 06518; e-mail:
kirsten@pol.net
system uses three variables—frequency of daytime symptoms, frequency of nighttime symptoms, and pulmonary function—to define four asthma catego- ries: mild intermittent asthma and three levels of persistent asthma (mild, moderate, and severe). For a classification system to be useful, different raters must be able to apply it in a consistent manner. A high level of interrater agreement could
For editorial comment see page 2054
bolster acceptance of the guidelines among primary care physicians, who have been slow to adopt them. 5–7 A low level of agreement would suggest the need for refining the classification system. Although researchers have documented poor agreement among specialists in the interpretation of pulmonary function tests, 8,9 we were unable to iden- tify previous observer variation studies concerning the classification of asthma. The goal of the present study was therefore to assess the interrater reliability
of the asthma classification system by measuring agreement among pediatric asthma specialists.
A survey was mailed to board-certified pediatric allergists and pulmonologists who had agreed to participate in the study. The survey included eight case summaries, and a multiple-choice questionnaire asking the physician to classify each case according to the 1997 guidelines, which were in effect at the time of the study. The classification portion of the guidelines was enclosed with the survey (Table 1). The case summaries were developed from the medical records of patients seen at The Pediatric Asthma Center at Bridgeport Hospital/Yale New Haven Health in Bridgeport, CT, between October 2000 and January 2001. The guidelines stipulate that the most severe of the three indicators— daytime symptoms, nighttime symptoms, and pul- monary function— determines the classification (Table 1). The classification system specifies clinical features prior to treatment. However, in specialty practice many patients present who are receiving controller medications, and the physician needs to classify them. This situation is reflected in four of the eight case summaries, including the case presented in the Appendix. The Institutional Review Board at New York Medical College ap- proved the study.
Each case summarized a patient’s first visit to the Pediatric Asthma Center, including medical, family, and environmental histories; physical examination; report of chest radiograph results; and pulmonary function test results if they were performed for
the initial evaluation (the Appendix presents case 2 in its entirety). Cases were chosen to represent a variety of age groups and the four classification categories. One patient was included who had respiratory symptoms but did not have asthma in the judgment of the patient’s physician. In addition to the asthma severity classification question, the questionnaire asked, for each case, whether symptoms vs pulmo- nary function determined the classification (Appendix). It also asked the physician to note any comorbid conditions and make treatment recommendations. Since the classification system is based in part on pulmonary function, the physician was asked to interpret pulmonary function test results included with five of the eight case summaries. Three case summaries did not include test results because children 5 years old are not usually able to perform the test. Respondents were therefore asked to interpret three additional pulmonary function tests to yield a total of eight tests, an adequate number for analyzing interobserver agreement. All of the pulmonary function tests were performed according to the American Tho- racic Society standards. 10,11 The questionnaire asked the physi- cian to indicate his or her specialty, years in practice, and practice characteristics.
Statistics were used to measure agreement among the respondents. 12 Measures the extent of agreement among different raters by calculating the observed agreement corrected for the agreement that would be expected by chance. Can range from – 1 to 1, with the following interpretation: 0.40 represents poor agreement, 0.40 to 0.75 represents fair to good agreement, and 0.75 represents excellent agreement. The Stata software package (Intercooled Stata 7.0 for Windows 98/95/NT; Stata Corporation; College Station, TX) was used to perform statistical analysis.
Table 1—Classification of Asthma Severity*
Step 4, severe persistent
Continual symptoms Limited physical activity Frequent exacerbations Daily symptoms Daily use of inhaled short-acting 2 -agonist Exacerbations affect activity Exacerbations 2 times a week; may last days Symptoms 2 times a week but 1 time a day Exacerbations may affect activity Symptoms 2 times a week Asymptomatic and normal PEF between exacerbations Exacerbations brief (from a few hours to a few days); intensity may vary
FEV 1 or PEF 60% predicted PEF variability 30%
FEV 1 or PEF 60% to 80% predicted PEF variability 30%
FEV 1 or PEF 80% predicted PEF variability 20 to 30%
FEV 1 or PEF 80% predicted PEF variability 20%
*Adapted from National Asthma Education and Prevention Program. 3 PEF peak expiratory flow. †The presence of one of the features of severity is sufficient to place a patient in that category. An individual should be assigned to the most severe grade in which any feature occurs. The characteristics noted in this figure are general and may overlap because asthma is highly variable. Furthermore, an individual’s classification may change over time. ‡Patients at any level of severity can have mild, moderate, or severe exacerbations. Some patients with intermittent asthma experience severe and life-threatening exacerbations separated by long periods of normal lung function and no symptoms.
CHEST / 124/6/ DECEMBER, 2003
Twenty-four of 26 physicians invited to participate accepted and were sent the survey. Of the 24 surveys sent, 15 were returned (5 of these were returned after reminders were sent), 14 of which were suffi- ciently complete to analyze. The response rate was therefore 58% (14 of 24 surveys). Respondents practiced in California, Connecticut, Delaware, Mas- sachusetts, Missouri, Ohio, and Washington. Five respondents were allergists, seven were pulmonolo- gists, and two practiced both specialties. Five re- spondents were community-based physicians, and nine respondents were hospital based. They aver- aged 13.3 years in specialty practice (range, 4 to 27 years), and 27.4 asthma patient visits per week (range, 3 to 80 visits). All participating physicians were board certified in pulmonology, allergy, or both. Table 2 shows how the 14 physicians classified each of the eight cases. For example, case 1 was classified no asthma by 11 physicians, mild intermit- tent by 1 physician, and moderate persistent by 2 physicians. Table 3 displays the statistics. The overall score of 0.29 for question 1 (95% confidence interval [CI], 0.25 to 0.33) indicates that the 14 asthma specialists exhibited poor agreement in classifying these cases. They demonstrated the greatest agree- ment for the mild intermittent category ( 0.44). Even when mild persistent, moderate persistent, and severe persistent were combined into a single “per- sistent” category (data not shown), the value for this combined category was 0.45 (95% CI, 0.41 to 0.49). While reducing the number of categories increased the overall value to 0.43 (95% CI, 0.38 to 0.48), this value still represents only fair agreement. Question 2 asked the physician to indicate the key factors used to classify each case: daytime symptoms, nighttime symptoms, pulmonary function, both day- time and nighttime symptoms, or a combination of these. The overall level of agreement for this ques- tion was poor ( 0.20), ranging from 0.03 to 0.31 for the different individual answers.
Since comorbid conditions can mimic or exacer- bate asthma symptoms, respondents were asked to identify additional diagnoses that would apply to each case (question 3). Allergic rhinitis, sinusitis, vocal cord dysfunction, and gastroesophageal reflux were listed explicitly, and space was provided for writing in other diagnoses. Scores ranged from 0.30 for vocal cord dysfunction to 0.80 for gastro- esophageal reflux. It was not possible to compute an overall score for question 3, 4, or 5 because the response categories were not mutually exclusive (ie, the physician was able to choose more than one category). The specialists exhibited a higher level of agree- ment in their interpretation of the pulmonary func- tion tests (question 4) than in their classification of asthma (question 1). Only one of the five responses to question 4 listed in Table 3—asthma revealed by bronchodilator—fell into the “poor agreement” range. One pulmonary function test came from a patient with a known fixed extrathoracic obstruction. Al- though the questionnaire did not include this abnor- mality as one of the choices, the physician was provided space to write in additional comments. If the physician noted obstruction of the upper airways or large airways, or described blunted inspiratory and expiratory loops in this space, that response was coded as positive for an extrathoracic obstruction. Otherwise, negative was assumed. The specialists were asked to choose one or more treatments from a list of options (question 5). To assess agreement level for use of any anti-inflamma- tory medication, responses for daily inhaled steroid and other anti-inflammatory were combined into a single anti-inflammatory category (data not shown). The value for the combined category was 0.41 (95% CI, 0.34 to 0.48). Table 4 reports the respondents’ treatment recom- mendations according to their asthma classifications. Altogether, there were 112 classifications (eight cases 14 respondents). Since the respondent could select more than one treatment option for a given
Table 2—Classification of Eight Cases by 14 Asthma Specialists*
*Data are presented as No. of physicians making classification.
Table 3—Agreement Among Asthma Specialists in Their Responses to Questions About the Diagnosis and Treatment of Eight Patients
1. How would you classify this patient’s asthma? No asthma Mild intermittent Mild persistent Moderate persistent Severe persistent Overall
2. This classification was made primarily on the basis of Daytime symptoms Nighttime symptoms Pulmonary function Day and nighttime symptoms All of the above Overall
3. What other diagnoses would apply to this patient? Allergic rhinitis Sinusitis Vocal cord dysfunction Gastroesophageal reflux
4. The pulmonary function tests show No asthma Asthma on baseline Exercise-induced asthma Asthma revealed by bronchodilator Extrathoracic obstruction†
5. What medication plan would you recommend for this patient’s asthma? No asthma medication As-needed bronchodilators Daily bronchodilators As-needed inhaled steroid Daily inhaled steroid Other anti-inflammatory
*The statistic may be interpreted as follows: 0.40 represents poor agreement; 0.40 to 0.75 represents fair-to-good agreement; and 0.75 represents excellent agreement. 12 †Write-in entry under “other findings.”
patient, there are 112 treatment recommenda- tions. No treatment options were selected for five of the classifications, which are indicated as “question left blank” in Table 4. Respondents recommended no asthma medica- tion for 18 of the 25 “no asthma” classifications (72%) and daily inhaled steroids for 9 of the 9 “severe persistent” asthma classifications (100%). When mild, moderate, and severe persistent asthma were combined into a single “persistent” category (data not shown), respondents recommended daily inhaled steroids for 50 of the 54 persistent classifi- cations (93%). They recommended some anti- inflammatory medication (daily inhaled steroid, other anti-inflammatory, or both) for 52 of these 54 classifications (96%).
When presented with the same clinical informa- tion about a series of pediatric asthma patients,
specialists varied in the conclusions they drew. The 14 pediatric pulmonologists and allergists in this study exhibited poor agreement in their application of the asthma classification guidelines and in their treatment recommendations. Their poor level of agreement in assigning no asthma implies a problem not only in classifying asthma, but also in making the diagnosis. The physicians exhibited better agreement in their interpretation of pulmonary function tests. Use of a simplified classification that combined mild, moderate, and severe persistent asthma into a single persistent asthma category still yielded only fair agreement among these physicians. This finding suggests that simplifying the existing classification in this manner would not, itself, result in a satisfactory level of agreement. While it was surprising to discover the extent of disagreement among pediatric asthma specialists in how they classified patients, perhaps the variability should have been expected. Studies have docu- mented observer variability within a number of
Table 4 —Summary of Responses to Question About Medication Plan, According to the Asthma Category Assigned by the Respondent*
Asthma Category†
No Asthma (n 25)
Mild Intermittent (n 33)
Mild Persistent (n 23)
Moderate Persistent (n 22)
Severe Persistent (n 9)
Total (n 112)
No asthma medication
As-needed bronchodilator
Daily bronchodilator
As-needed inhaled steroids
Any anti-inflammatory‡
Question left blank
*Data are presented as No. of times each treatment was recommended when a given category was assigned. †The number of times a given category was assigned is shown. For example, under “No Asthma,” 25 of the 112 assignments (eight cases 14 respondents) were classified as “no asthma.” ‡Indicates the no. of assignments for which either “daily inhaled steroids” and/or “other anti-inflammatory” was selected.
subspecialties: in radiologists’ readings of sonograms of breast masses, 13 in pathologists’ grading of dyspla- sia in ulcerative colitis, 14 and in orthopedic surgeons’ classification of scoliosis, 15,16 to name a few. Clearly, some disagreement is inevitable in the application of clinical judgment.
What might account for the variability in the application of the asthma classification system by this group of asthma specialists? There are at least three potential explanations: variability in interpretation of symptoms, variability in interpretation of pulmonary function test results, and variability in the impor- tance placed on symptoms vs pulmonary function. Overlap in the symptoms of asthma and other comorbid conditions can result in differences of interpretation that may affect physicians’ classifica- tions. A patient with frequent cough may be consid- ered to have more severe asthma by a physician who interprets that cough as a symptom of asthma. This same patient may be considered to have mild asthma by a physician who interprets that cough as a symp- tom of allergic rhinitis. Since respondents exhibited a higher level of agreement in their interpretations of pulmonary function tests than in their asthma clas- sifications, those interpretations probably do not account for a large portion of the variability in the classifications. In contrast, respondents exhibited very low agree- ment on which factors—symptoms or pulmonary function—most influenced a patient’s classification. The perceived importance of symptoms vs pulmo- nary function, not merely how physicians interpreted each of these, affected their classification choices. The handling of case 2 (Appendix) by different respondents illustrates how variation in the process-
ing of clinical information can lead to different classifications and treatment choices. One respon- dent interpreted the pulmonary function test as negative for asthma, classified the patient accord- ingly, and recommended no asthma medications. This respondent indicated that the classification was based primarily on pulmonary function. Another respondent also interpreted the pulmonary function test as negative for asthma, but classified the patient as moderate persistent asthma and recommended daily and as-needed bronchodilator, daily inhaled steroid, and other anti-inflammatory asthma medica- tions. This physician indicated that the classification was based primarily on daytime symptoms. While the treatments selected by these two physicians matched their classifications, their disagreement about the classification would have consequences for the patient: either the first physician recommended inadequate treatment or the second physician rec- ommended excessive treatment.
The asthma guidelines developed by the National Institutes of Health were intended to improve pa- tient outcomes by facilitating the diagnosis and treatment of this chronic condition. While asthma specialists in the present study recommended treat- ments that usually matched their severity classifica- tions, they disagreed among themselves about those classifications. Since proper therapy depends on proper classification, one is forced to question the effectiveness of the official guidelines in serving their intended purpose. In 2002, the National Institutes of Health released an update on selected topics of its national guide- lines. 4 Since the classification system in the updated guidelines remains essentially unchanged except for
the omission of pulmonary function testing in pa- tients 5 years old, the findings reported here continue to be pertinent. The clinical importance of the present findings rests on a chain of assumptions: (1) that our sample of specialists does not differ substantially from the general population of pediatric asthma specialists in ways that would markedly affect the findings, (2) that physicians would classify and treat actual patients in a manner similar to the way they handled the cases presented in the survey, (3) that disagreements could lead to nontrivial differences in treatment strategies, and (4) that those differences could potentially result in harm to some patients who would receive inade- quate or inappropriate therapies. The first two assumptions cannot be proven from our data, but they seem plausible and we have no reason to believe that they are not true. The remain- ing assumptions are supported by our findings. At minimum, therefore, our results suggest the need for confirmatory studies.
A survey cannot duplicate the experience of exam- ining a patient and gathering a medical history. While this is a real limitation, it is also an advantage:
physicians were all given the same information on which to base their decisions. It follows that dis- agreements must have occurred because physicians differed in their processing of the information rather than in their gathering of the information. While a response rate close to 100% would be desirable, it has been shown that response rates to mail surveys are lower for physicians (54%) com- pared with nonphysicians (68%). 17 Our 58% re- sponse rate is respectable for such a demanding survey given to busy physicians. Since our survey was administered to a limited sample of specialists, a larger study could be useful for confirming the results reported here. Neverthe- less, it should be noted that observer variation studies typically rely on a relatively small number of experts. For example, in the studies cited earlier 13–16 the num- ber of physicians ranged from 5 to 13. It is also important to note that data from the present sample yielded quite narrow CIs for most of the statistics reported in Table 3. It is therefore unlikely that a larger sample will produce markedly different results. Future studies should also examine intraobserver reliability, that is, the extent to which an individual physician classifies the same asthma patient the same way when presented with identical information on different occasions. Additional studies should also evaluate these issues using adult asthma patients.
Finally, studies should include a more detailed ex- amination of the reliability of pulmonary function test interpretations.
This study demonstrated substantial disagreement among pediatric asthma specialists in classifying a series of asthma patients. Since some disagreement is clearly inevitable in the application of clinical judgment, the findings of this study should not be viewed as a criticism of pediatric allergists and pulmo- nologists but as a challenge to develop methods for reducing the variability. As a first step, perhaps the expert panel of the National Institutes of Health, before releasing the next revision of its asthma guide- lines, should require a full-scale reliability study to ensure that the guidelines can be applied in a consistent manner by their intended users.
1. How would you classify this patient’s asthma? (Choose one
No asthma Mild intermittent Mild persistent Moderate persistent Severe persistent
2. The above classification was based primarily on the basis of
what? (Choose one answer only) Daytime symptoms Nighttime symptoms Pulmonary function Day and nighttime symptoms All of the above
3. What other diagnoses would apply to this patient? (Choose all
that apply) Allergic rhinitis Sinusitis Vocal cord dysfunction Gastroesophageal reflux Other
4. The pulmonary function tests show the following: (Choose all
that apply) Inadequate study No asthma Asthma on baseline Exercise-induced asthma Normal baseline, asthma revealed by bronchodilator Other findings
5. What medication would you recommend for this patient’s
asthma? (Choose all that apply) No asthma medications As-needed bronchodilator Daily bronchodilator As-needed inhaled steroid Daily inhaled steroid Other anti-inflammatory asthma medication
Appendix Table 1—Pulmonary Function Test Results for Case 2*
After Albuterol
FVC, L FEV 0.5 , L FEV 1 , L FEV 3 , L
FEF 25–75% , L/s MET, s FEFmax, L/s FEF 25% , L/s FEF 50% , L/s FEF 75% , L/s
FEV 1 /FVC, FEV 3 /FVC, FIVC, L FIV 1 , L TET, s
*FEV 0.5 forced expiratory flow at 0.5 s; FEV 3 forced expiratory flow at 3 s; FEF 25–75% forced expiratory flow, midexpiratory phase; MET maximum expiratory time; FEFmax maximum forced expiratory flow; FEF 25% forced expiratory flow at 25% of FVC; FEF 50% forced expiratory flow at 50% of FVC; FEF 75% forced expiratory flow at 75% of FVC; FEV 3 /FVC forced expiratory volume at 3 s/FVC; FIVC forced inspiratory vital capacity; FIV 1 forced inspiratory volume at 1 s; TET total expiratory time.
John is a 13-year-old boy presenting to the specialist for initial evaluation in October 2000 (certain clinically insignificant details have been altered to ensure patient anonymity). Pulmonary History: John’s breathing problems began when he was 2 years old, when he received a diagnosis of bronchitis, then pneumonia. Two years later, asthma was diagnosed. He did well until 2 years ago, when his symptoms increased. He did not do well until he was put on his present regimen 1 month ago. Now he has inspiratory wheezing when he is stressed, playing sports, or upset. Respiratory symptoms include shortness of breath, wheeze, dry cough, and tightness in the chest. Inspiratory wheeze can occur daily; nighttime symptoms occur once or twice a month. Hospitalizations and Emergency Department Visits: John had one emergency department visit 1 year ago for asthma. Warning Signs: Warning signs include cough, stuffed nose, runny nose, colds, behavior or personality changes, sneezing, dark circles under eyes, and raised shoulders. Triggers: Triggers include colds, runny nose, changes in weather, spring and fall seasons, cats, air pollutants, cold air, emotions (laughing/upset), smoke, strong smells, dust/dust mites, molds, or mildew. Other Medical Consultants: When John was 5 years old, he was seen by another pulmonologist, who recommended medications as needed. Sports/Activities: John plays baseball and basketball. Problems during these activities include respiratory wheeze in the throat. Allergies: Cat. Medical History: Birth weight was 8 lb, 7 oz. Pregnancy, labor, and delivery were normal. Growth and development were nor- mal. John as a history of GI reflux, and currently has food come up once a week. He has a history of hay fever. There is no history of sinusitis, eczema, nasal polyps, or ear infections. Family History: John’s mother is 36 years old and has gastro- esophageal reflux disease and allergies. John’s father is 44 years old and has hay fever. John’s brother is healthy, and his sister has seafood allergies. John’s grandmother has asthma, bronchitis, and gastroesophageal reflux disease. Irritants and Controls in the Home Environment: Irritants include oil heat, damp basement, dog (never in bedroom), smoker at father’s house (visits every other weekend), real Christmas tree, curtains seldom washed, no dust mite covers on pillows/mattress/box spring, dust. Controls include frequently used room air conditioner and no carpets. Vital Signs: John’s weight is 93 lb, heart rate is 69 beats/min, BP is 94/52 mm Hg, height is 63 inches, respiratory rate is 22 breaths/min, and oxygen saturation on room air is 98%. Physical Examination: John is well developed, well nourished, and has no respiratory distress. Head examination is within normal limits, except for allergic shiners and mild nasal conges- tion. Pupils were equal, round, and reactive to light. Tympanic membranes were normal. Nose was clear for rhinorrhea, with gray, pale, and swollen turbinates. Throat showed no erythema or exudates, positive for postnasal drip, and 2 tonsils. Neck was supple, with no masses; trachea was midline. Chest showed normal anteroposterior diameter, and no retractions. Cardiovas- cular was benign, and abdomen showed no hepatosplenomegaly. Extremities showed no clubbing. Neurologic evaluation was grossly intact. Skin showed no eczema, and lymph nodes showed no adenopathy. Chest Radiography: A chest radiograph revealed mild hyper- inflation at the time of evaluation.
Pulmonary Function: A pulmonary function test was per- formed on the day of evaluation (Appendix Table 1; Fig 1).
ACKNOWLEDGMENT: We thank the physicians who com- pleted the surveys and Patricia Patrick, MPH, and Paul Visin- tainer, PhD, for assistance with statistical analysis.
Centers for Disease Control and Prevention. CDC surveil- lance summaries: surveillance for asthma-United States, 1960 –1995. MMWR Morb Mortal Wkly Rep 1998; 47:SS-1
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National Asthma Education and Prevention Program. Expert panel report 2: guidelines for the diagnosis and management of asthma. Bethesda, MD: National Institutes of Health, 1997; publication No. 97-4051
National Asthma Education and Prevention Program. Expert panel report: guidelines for the diagnosis and management of asthma; update on selected topics 2002. J Allergy Clin Immunol 2002; 110(5 suppl):S141–S219
Cabana MD, Ebel BE, Cooper-Patrick L, et al. Barriers pediatricians face when using asthma practice guidelines. Arch Pediatr Adolesc Med 2000; 154:685– 693
Picken HA, Greenfield S, Teres D, et al. Effect of local standards on the implementation of national guidelines for asthma: primary care agreement with national asthma guide- lines. J Gen Intern Med 1998; 13:659 – 663
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Baker JA, Kornguth PJ, Soo MS, et al. Sonography of solid breast lesions: observer variability of lesion description and assessment. AJR Am J Roentgenol 1999; 172:1621–1625
Eaden J, Abrams K, McKay H, et al. Inter-observer variation between general and specialist gastrointestinal pathologists when grading dysplasia in ulcerative colitis. J Pathol 2001;
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Classifying Asthma: Disagreement Among Specialists Kirsten M. Baker, Donald A. Brand and Jacob Hen, Jr Chest 2003;124;2156-2163 DOI 10.1378/chest.124.6.2156
This information is current as of March 7, 2007
http://chestjournals.org/cgi/content/full/124/6/2156
This article cites 13 articles, 7 of which you can access for free at:
http://chestjournals.org/cgi/content/full/124/6/2156#BIBL
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James Bianco (#47745493)	member for 2 years, 11 months, 29 days
I am an avid genealogist from Western Massachusetts (Westfield/Montgomery area)I have (this past week March-2015) ceased creating new memorials and am now focusing on detailed bio development, which is what brought me to Find-A-Grave initially. Genealogical research has been a passion since my youth and while a day has not passed since joining the website that I did not work on the development of the memorials I have created, it was haphazard and somewhat random, often the result of an edit I received. So many memorials were created in long sessions from my photographs or from lengthy transcripts that it would have been impossible to fully develop each at the time of creation. I am now working cemetery by cemetery "filling in" full (when possible) dates from primary source materials and interlinking families. Many of my early New England roots are in the Hampden/Hampshire/Franklin Co., Massachusetts area, Stebbins & Alexander being the most important of the families I descend from. My children (through their mother) have colonial ancestry from all over New England, the primary surnames being Blake, Corliss, Libby, Bennett, Curtis, Aldrich, Frost, Thomas, Drown, Chase, Underwood, Pike, Boyden, Merrill & Heard.There are two "schools" of thought on Find-A-Grave, both have admirable and commendable goals. One is to create a basic memorial for an individual in order for others to know just where that elusive relative/friend/acquaintance is buried. Exposure is immense and in that respect there is no other website quite like this one.The other school of thought is to take this amazing resource and utilize all of the wonderful tools it offers to us as genealogists. Detailed bios, photographs, documents and the most beneficial of all, interlinking relations, both by the relationship edit option or by inserting html code linking to another memorial directly. _________________________________________I wholeheartedly subscribe to the latter, and as a result have worked very hard traveling extensively in my local area of New England photographing and memorializing those buried in cemeteries which do not have a readily available published transcript. In this past year I have taken close to 200,000 photos and to date uploaded over 100,000. 14 months ago I had to my credit just 12 photos, despite having been a member over a year at that point. I am very quick to respond to all edits and make valid biographical changes/links. Usually within an hour and always within 1 day. I will never go inactive, and I will never ignore an email or edit request. **If you need a local (Western Massachusetts) photo and you are not getting any response from a photo request, send me a message or email and I will get one for you provided the headstone exists. I am quite adept at deciphering even the most worn and aged headstones, and have access to various local genealogy libraries and state archives which may provide plot and location info. _________________________________________TransfersPlease do ask (via edit) for transfers of family members. I will certainly transfer more recent memorials (individuals who have passed away after roughly the year 1900).As far as memorials created for persons who died before roughly 1900 (and who do not fall within the FAG outlined family guidelines of 4 generations, in which case I will not hesitate) I will likely transfer those not related to my children or extended family after developing the memorial further and making the familial links. Too often early memorials are left vacant of detailed bios and merely "collected". We are given such an amazing tool here, the ability to develop and interlink, and enable a searcher to find a memorial easily. As you know the website exposure is immense. Keep in mind that there is no valid change/addition that cannot be made through an edit or suggestion, and unlike many here, I will respond quickly and I will never shirk my management responsibility by going inactive or ignoring your message. The only reason any memorial I have created is currently bare or lacking detail is that I have not yet begun to work on the particular family or cemetery._________________________________________*If you find that I have discovered the final resting place of an individual you have created a memorial for (burial unknown or incorrect cemetery) please contact me via email or edit/corrections. I always search the cemetery & town (and often county) before creating a memorial, and would never intentionally create a duplicate. I work very hard physically traveling to these often remote cemeteries in the hopes of discovering those previously lost. It is rather rude to dismiss my efforts and send me a "DUPLICATE" message after you have moved your memorial to where I have found the individual. This is Find-A-Grave and as such the first memorial created in the correct cemetery is the permanent memorial. Many people use this website like a genealogy program and add entire books or surnames as Burial Unknown memorials, moving them as graves are located. I also copy/paste into Excel a complete list of all memorials in cemeteries I have spent a great deal of time working with once I have completed uploading my photos. This way it is easy to determine if an identical memorial was "moved" into the cemetery from elsewhere, or an existing memorial in the cemetery altered to match another._________________________________________Thanks to all the FAG photo volunteers for your hard work! You are truly what makes this website such an incredible genealogical tool.James
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Search Contributor's Records First NameLast NameVirtual Cemeteries18th Century (499)Civil War (1258)Denio (46)Monson State Hospital (251)Struck by Lightening (10)Transfers (13)Find A Grave Friends10th Generation, Allison Ferris ..., Anonymous, CathyNaps, Cheshire, Chip5610, DaurRegt, Dave McCaffrey, David Allen Lam..., DeeB, Don Blauvelt, Fred Saar, George "Buddy" ..., GGreene, gleasonfamily, John P OCONNOR, karen jennings, Katrina, kdkb, Kevin Avery, [View all Find A Grave Friends...]Messages left for James Bianco (240)[Leave Message]
LMRRE: FalesThanks. Not related just run across a record then try to complete the connections when I can. Like the research. Love your photos. LindaAdded by LMR on Mar 05, 2015 10:39 AMCarli DrakeRE: Leon & Ruth DrakeIf you would like to transfer, I would appreciate it. Thanks!Added by Carli Drake on Mar 02, 2015 2:30 PMFrancis C. LaiglonRE: Richard H. HastingsAdditional information: Seaman first-class Richard H. Hastings was killed in action in the Pacific in 1943. His body was returned to the US for burial in 1948.Added by Francis C. Laiglon on Mar 02, 2015 8:18 AMKen SaccociaSmuel AldenHi Jim,I am not sure what you have asked me to correct on this memorial but.....in playing with the original photo believe the death date on the stone is 11 not the 14 I had published. This would agree with the information you sent me. In any event I have made this change and added his middle initial. Thanks for the info. KenAdded by Ken Saccocia on Mar 01, 2015 3:04 PMPeter McLaughlinRE: Thomas NixonJames,I noticed to contributed a photo to another of my old ancestors, Hepzibah Hapgood Goddard, if I remember right. I certainly do appreciate being able to find and view their graves. It really helps me to be able to link generations to document family lines. I am going to check the memorials out. It isn't necessary for you to transfer them, but its up to you. If they are your ancestors we are related. It doesn't really matter, you have done a great job of maintaining and updating them, and even researching them.Sincerely,PeterAdded by Peter McLaughlin on Mar 01, 2015 11:27 AMPeter McLaughlinThomas Nixon Family of MAThanks for updating my ancestors, the Nixon bunch in MA. I am trying to get a friend/cousin to connect Otis Nixon to his father and brothers, and that will only leave Warren Nixons line to be attached. Again, thanks for creating, updating and maintaining these memorials!PeterAdded by Peter McLaughlin on Feb 28, 2015 10:54 AMDon BlauveltElizabeth (Rollo) Lothrop-PittsfieldThanks James.Added by Don Blauvelt on Feb 26, 2015 1:47 PMJune CaresPliny ChurchThank You for the photo of his headstone.Added by June Cares on Feb 25, 2015 6:16 PMkaren jenningsGeorge Henry Brobstonthank you for the family transfer. I have added some information and photo. will continue to add as i have time. thank you again for the family transfer.Added by karen jennings on Feb 25, 2015 3:53 PMJanis Paulding SwansonAbbie SimmonsHi Jim, Great photo!! Thanks for taking another one and posting it and thanks for your photo offer. I may take you up on that...in the spring. :) Thanks again, JanisAdded by Janis Paulding Swanson on Feb 25, 2015 3:47 PM[View all messages...] Privacy Statement and Terms of Service Advertisement

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