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Advanced practice registered nurses could be valuable asset to Michigan health system
Some aspects of U.S. Affordable Care Act may be challenging for states to implement, but there is one very easy step Michigan legislators can take right now to improve health care access and delivery in our state. This action will minimize the impact of a growing physician shortage, especially with primary care and in underserved areas. It will catch Michigan up to 18 other states and the District of Columbia that already have enabled an important group of health professionals to practice to the full extent of their training.
What Michigan needs to do is pass Senate Bill 481, now pending, which will authorize advanced practice registered nurses (APRNs), such as nurse practitioners, to continue doing the work they now do — but to do it under their own licenses and accountability.
AnnArbor.com file photo
Currently, APRNs in Michigan are required to have a signed agreement with a physician who oversees their practice. While on the surface this may appear innocuous, this policy geographically ties physicians and APRNs together, contributing to geographic mal-distribution of providers - leaving rural and other areas of the state without the primary care providers they need.
The current policy also essentially ties APRNs to a consulting relationship with a physician who may not know the patients as well as the APRNs do themselves. Moreover, many studies have demonstrated that APRNs' practice is safe and high quality, and that this type of oversight is not necessary; instead, it produces costly redundancy.
APRN education at the University of Michigan and elsewhere is extensive and carefully regulated through national standards for curriculum and certification examinations. In practice, APRNs must prove their proficiency through national boards, similar to how most medical specialties are regulated.
When the Affordable Care Act becomes fully enacted in 2014, nearly 900,000 more Michigan citizens will be eligible for insurance exchanges or Medicaid expansion. In order to extend good care to them, health services will need to expand. But recent reports indicate Michigan already is facing a physician shortage much larger than the national average, even before the nearly a million more citizens become newly qualified for insurance.
Our state's health professional crisis likely will worsen in another way if legislators don't act quickly. Highly employable APRNs tiring of Michigan's stalling out on making good regulatory sense already are leaving and going to states where regulation is in alignment with national standards.
All providers, MDs and APRNs alike, must be able to deliver care to the full capacity of their education, training, and national certifications in order to support the needs of the public. A 2010 Institute of Medicine report describes laws limiting the practice of APRNs as barriers to providing the optimal health care, and it finds nurse practitioners and other APRNs highly competent in providing primary care.
So why does Michigan law prevent the professionals who could best mitigate the state's health care shortage from doing so? Why does it continue to prohibit APRNs from using the full extent of their education to treat patients?
I encourage you to join me and many medical professionals in calling for a stop to politicking and pressure tactics from powerful interest groups. It's time to do what's right for the citizens of Michigan.
Kathleen Potempa is the dean of the University of Michigan School of Nursing.
UM Doc
Tue, Dec 4, 2012 : 12:19 a.m.
First, I think at this point, we can all agree that the training between physicians and NPs are simply not comparable. Beyond the differences in the sheer quantity of training, more important is the fact that NPs spend this time learning nursing, not medicine. Second, the question of whether all of this extra training that physicians receive is necessary for a primary care provider is critical. The answer that the nursing lobby proposes is "no": that an NP education is sufficient for most primary care visits. They claim that studies show equivalent outcomes between care rendered by physicians versus that rendered by NPs. This is simply false. All of the care delivered by NPs in these studies have been provided under the supervision of a physician. No trials have compared the health outcomes of patients treated solely by an NP versus patients treated only by physicians. To use a mathematical argument, where (a) = physician and (b) = NP, most studies would support this: a + b > a The biggest falsehood that the nursing lobby promotes is that based on the above finding, that a = b.
E Claire
Tue, Dec 4, 2012 : 4:38 p.m.
You note "supervision of a physician". You do understand that this means a physician's name is attached to the office, not that the physician is actually sitting in that office reviewing everything the NP does before its done, right? I think the biggest issue is that most drs get such a big head, they can't believe anyone can do even the simplest of tasks that they, the drs, would normally preform. You are not God.
E Claire
Mon, Dec 3, 2012 : 9:48 p.m.
I haven't read the bill or read through all posts but... I went to the same doctor for years. I was happy but he didn't always listen to what I was saying and I always felt rushed and a bit looked down upon). I moved here to AA and started seeing a NP (I have a not serious condition that requires twice yearly checkups). The NP actually takes the time to listen to me and really looks into what's going on. The normal arrogance of drs was not there...I no longer have to go more than once to get the person to understand that, although they have the education, its my body and I know when something is wrong. I'll never go back to using a dr and will stick with NPs.
patient advocate
Mon, Feb 4, 2013 : 2:07 a.m.
It is interesting you mention this E Claire. Many people share your feelings regarding superior outcomes with nurse practitioners as opposed to physicians. This may be in part, due to the patient centered nature of the interaction. Patients are often more involved with treatment plans when they are designed in conjunction with the patient, not dictated to the patient. This may be one reason nurse practitioner interventions are often well perceived and also very successful. As more studies, evidence, and analyses regarding the comparison of practitioners come to the forefront, more and more knowledge will become available to help people make choices regarding their medical care. The Cochrane Database of Systematic Reviews provides evidence based recommendations, based on the highest level of evidence available. In 2004 an analysis was performed comparing patient outcomes in situations where advanced practice nurses were substituted for primary care physicians. The conclusion was that there were no differences were found between doctors and nurses in health outcomes for patients, process of care, resource utilisation or cost. Nurse practitioners provide safe, high quality care. They have excellent outcomes and extremely high patient satisfaction ratings.
E Claire
Tue, Dec 4, 2012 : 4:32 p.m.
UM Doc, you prove my point. You assume to know what my condition must be by the little I wrote and you assume that "listening" means we chat about holiday plans. Total arrogance. Is your opinion based on the fact that most NPs are women? My condition requires a simple pill every day. The dosage may be adjusted according to the results of blood tests and how I feel. The dr only looked at blood tests and assumed that, if he couldn't see them, other things going on in my body were not due to incorrect dosage. Now that I go to a NP, SHE, yes SHE, looks at everything and my condition has never been managed better. And please, don't be ignorant; if I have chest pains or something similar, I know to go to the emergency room, not to my NP (or a primary care dr for that matter).
Tue, Dec 4, 2012 : 3:32 a.m.
Ann Arbor Nurse - that's absolutely not true about primary care doctors. Primary care doctors DO know how to take care of sick patients. That's a huge part of residency training and one of the big differences between an MD and an NP. Even family practitioner residencies are mostly inpatient training for their intern year, internal medicine is virtually entirely inpatient training. Specialists aren't better equipped to take care of sick patients, they just have the luxury of being able to focus all of their time on one problem and have the additional training to do so. As I said above, NPs are a fundamental part of our health care system and a great resource for many patients but the role of the MD is critical for making sure that rare or difficult to diagnose conditions that are outside of the scope of the NP training don't get missed.
Ann Arbor Nurse
Tue, Dec 4, 2012 : 2:21 a.m.
Primary care doctors also don't have to the training to handle very sick patients, so you don't have much of a point. NP's are capable of handing diabetes or hypertension as well as another primary care Dr. If the case becomes too complicated they would refer to endocrinologist for a diabetic or a cardiologist for hypertension. For basic management they are qualified. I'm not sure if any of you realize this, but medicine is constantly changing and the latest research on disease management is as easily accessed by a NP as an MD. Additionally, there are studies showing equal patient outcomes even when NPs practice independently. I really think you all are missing the point. NPs are NOT trying to be MDs, but they truly are qualified to provide excellent and safe patient care.
UM Doc
Tue, Dec 4, 2012 : 12:28 a.m.
That's unfortunate that you have had a negative experience with your physician. However, your fundamental reasons for preferring your NP over your physician, while important, have little to do with how well you are being managed medically. When you walk out the door, it may feel nicer that your NP spends more time talking to you about your holiday plans. Unfortunately, the consequences of not optimally managing your hypertension or diabetes (or any number of chronic conditions) will not be realized for years into the future.
citizen kane
Mon, Dec 3, 2012 : 10:21 p.m.
we'll see when you really are sick with something. there won't be a nurse practioner for miles that will care for you. Why? because THEY DON'T HAVE THE TRAINING!
Mon, Dec 3, 2012 : 1:53 p.m.
These nurses have no where near the training a medical doctor does, nor even a physician's assistant. This bill is scary. It opens up being denied access to a physician in busy clinics.
patient advocate
Mon, Feb 4, 2013 : 1:45 a.m.
JK, You may find this helpful: http://www.practicingclinicians.com/cms/wb/pages/nursepractitioner_and_physicianassistant.php
Sonja Greenfield
Tue, Dec 4, 2012 : 2:49 p.m.
As an NP student, I've been trained both physicians and other NPs. In my current site we have a great collaborative relationship with the physician, and we actively seek them out for consultation if need be.
Ann Arbor Nurse
Tue, Dec 4, 2012 : 12:38 a.m.
They don't feel that they practice medicine in the same fashion as an MD. They practice nursing, which is a different profession, not less competent profession. APRNs should be able to practice to the full extent of their training which includes health assessment, diagnosis and treatment of certain, but not ALL illnesses. They are not wishing to practice outside of their scope, which is where the confusion lies. APRNs are a great provider for basic primary care, which one an area they are needed most. A primary care physician refers to a specialist when a complex case comes in, which is exactly what an APRN would do.
citizen kane
Mon, Dec 3, 2012 : 10:28 p.m.
Miss Ann Arbor Nurse you definitely said correct. an NP is trained by other nurses. there isn't an MD in site. PA's are trained by MD's. Since when did nurses who go to nursing school taught by other nurses suddenly wind up with the notion that they can practice medicine in the same fashion as an MD? I just don't get it.
citizen kane
Mon, Dec 3, 2012 : 10:24 p.m.
true but a physician assistant ALWAYS has a physician he/she is connected to. period. any questions or difficulties and its now a team effort to care for you. Thats a huge difference.
Ann Arbor Nurse
Mon, Dec 3, 2012 : 2:19 p.m.
I am curious as to type what of training you think physicians assistants have? As far as I know, they hold a bachelors degree in anything (similar to an MD) and graduate with tho medical knowledge or patient care experience. They then enter a 2 year program and become a PA. An advanced practice nurse has a 4 year bachelors degree in NURSING, then at LEAST 2 more years getting an advanced practice degree. That is the shortest route to becoming an APRN, which equals 6 years. Could you explain to me how a PA has more "training". Also, FYI they are trained under the medical model, which is different than nursing. I will not comment as to which type of education is better for a mid-level provider because that is a matter of opinion, but they are definitely different.
Mon, Dec 3, 2012 : 5:05 a.m.
I'm a registered nurse with a bachelor's in nursing, I've worked as a critical care and emergency nurse since 1995. And quite frankly, when I go for healthcare, I want to go to my doctor, not a nurse practitioner. I think both AnnArborite and UM Doc have made some very good points. An advanced practice nursing degree is a masters degree, two years after undergrad, and is not nearly as in depth as the 4 years of medical school plus years of residency training that doctors receive. 2 years vs 6-8 years, how can you say that the two are equal? Now don't get me wrong, some APRN's are absolutely brilliant, while some of the dumbest people I've ever met were doctors - there will always be people on the outer ends of the curve in any profession. But APRN's have only a portion of the knowledge base that MD's do. The APRN's that I've felt the most respect for and been happy to work with are those that work in partnership with their MD colleagues, while those that have made me nervous are the ones that think they're as good as a doctor and can work alone. APRN's can very well fill a void in healthcare if utilized effectively, they can be extremely useful and effective in certain roles, but they don't have the capabilities that a full doctor does. I feel that the work and role of APRN's complements that of MD's, it does not replace it. Quite frankly, and I'm comfortable saying this as a registered nurse, the nursing profession, and especially the schools of nursing, need to be careful of their own arrogance. Nursing is not the same as medicine, they're two important but completely different roles in health care. I'm going to quote UM Doc here, I think he put it very well. "NPs are not dangerous because they are not equal to physicians, they become most dangerous when they convince themselves of their equivalence to physicians."
Mon, Dec 3, 2012 : 3:31 a.m.
In agreement with citizen kane, it is ironic that the Dean feels the nursing profession is feeling 'pressure tactics from powerful interest groups.' There is no doubt that nurse lobbying groups are extremely powerful and have been quite successful in pushing forward a political agenda. The issue regarding nurse anesthetists and medicare reimbursement serve as one example. Largely, this is less about anesthesiology and more about increasing scope of practice for nursing as a whole. The issue of rural medicine is simply a tactic to further the agenda; as any policy will not be limited to rural medicine but be applied globally across all demographics and regions. Dean Potempa was recently interviewed by the NYT this fall regarding nurse programs providing PhD credentials and hence the title 'Doctor' to the individual graduating from the program-University of Michigan has a such a program. This only makes the environment more confusing. Who is a doctor? Is it important to have a "doctor" provide clinical services? Obviously Dr. Potempa believes so as she supports the program under her leadership as Dean of Nursing. But, only to make it more confusing, she argues here that a masters of nursing is what entails the 'full extent of training,' and to be quoted in the NYT article further supporting this noting "Dr. Potempa said that nurses with master's degrees were every bit as capable of treating patients as those with doctorates." So what gives? What is the "full extent of training?" This appears to be the most significant question of all. Who is best suited to deliver medical care? Even further, will nursing develop surgical programs eventually? This seems an appropriate extension of the scope of practice argument, especially as General Surgeons are becoming more sparse. Shouldn't we determine the appropriate credentials and then work to fill our ranks accordingly, rather than simply 'filling a need' because we don't number eno
citizen kane
Mon, Dec 3, 2012 : 2:15 a.m.
Hmmm, let me see "pressure tactics from powerful interest groups" you are including the nursing lobbyists, right? I am sure they explaining all the reasons including lack of medical school training needed to treat a patient? maybe they are and the congress is listening.
citizen kane
Mon, Dec 3, 2012 : 2:10 a.m.
Kathy, Aren't you referring to Physician Assistants?
Sun, Dec 2, 2012 : 11:49 p.m.
There is definitely an element of turf war; however, we need to determine what is appropriate training. Kathleen states in the first paragraph that we should "[enable] an important group of health professionals to practice to the full extent of their training." Thus, the full extent of training is that of an APN. Why, then , are we wasting crucial dollars and time overtraining physicians to perform the same function? What is the appropriate level of training? This is not an silly question. Much time, energy, stress, and financial resources are devoted while enduring MD/DO training; often upon the back of the individual. It is not as much a turf war as a level of frustration at the rules of the game being changed mid-game. As a physician, based upon this new push, I would urge 'pre-med' students to not take on more debt, and go the nursing route. It is less stressful, the debt load is a great deal less, and the country is telling us that the MD level of training is not necessary to perform a large majority of medical care. That is the message that most concerns me most; disguised as a concern for paucity of care and lack of access.
Sun, Dec 2, 2012 : 4:54 p.m.
Maybe it's true that we need more and cheaper health care deliverers given the aging and growing population and the coming Medicare cuts. However, let's not kid ourselves that that replacing doctors with nurses is going to provide the same quality of care. Nursing schools are nowhere near as selective as medical schools and nurses get nowhere near the amount of training that doctors get. I know this, having doctors, nurses and advanced practice RNs in my family. No comparison at all.
UM Doc
Sun, Dec 2, 2012 : 4:31 p.m.
One of the biggest dangers with these studies that "demonstrate" equal patient outcomes is that all of the care delivered by NPs have been supervised by physicians, with more complex cases being handled almost exclusively by physicians. Therefore, the effective comparison is physician-only care versus physician + NP care. Therefore, it should not be surprising that there are small differences in outcomes since ultimately a physician was responsible for the care being delivered. Twisting these conclusions to say that NPs deliver equal care to physicians is simply irresponsible and dangerous. Simply look at the amount of training required to produce a family physician (relatively short training compared to specialists) versus that of an NP: Physician: 4 year Bachelor's degree + 4 years Medical School + 3 years Residency Training NP: 2-4 year Associate or Bachelor's degree + 2 years of NP training Of the 11+ years spent training for a physician, roughly 20,000 hours are spent in clinical training. In the 4-6 years of training for NPs, clinical training encompasses roughly 3,000-5,000 hours. There is not even a remote resemblance of equivalence here. As independent practitioners, NPs are not dangerous because they are not equal to physicians, they become most dangerous when they convince themselves of their equivalence to physicians. The recent trend of expanding the scope of NP responsibilities is a result of the well organized nursing PAC presence in Washington rather than being informed by evidenced-based outcomes research. That other states have passed similar laws is not a convincing reason for Michigan to make the same mistakes.
Mon, Dec 3, 2012 : 1:01 p.m.
Look at undergrad, all the MDs I know took zero patient care or other medical training in undergrad. Not so for my nursing friends, they had ~1yr max of standard undergrad. So take 4 years off of your 11 year total please... You also fail to mention the scope of services offered by each. For 90% of my DR office visits, I don't need a MD or DO... They have different skill sets. Someone who flies a twin seat plane needs less training than a 747...
Mon, Dec 3, 2012 : 6:19 a.m.
@UM Doc. In regards to the education requirements you stated I believe that the 4 year Bachelor's degree that Physicians have should not be counted as "training." Premed students spend little to no time "training" to become doctors in the course of the bachelor's degree coursework. Sure some may spend some time volunteering to boost their applications, but for the most part premed students have little to no hands on patient care and don't even step inside a patient's room until year 2 of med school. Also you can not enter NP school with an associates degree so nurses have at least 4 years of undergrad prior to entering NP school. I am not discrediting the education the Physician's have I just don't think that they learn anything significant in regards to practicing medicine in their undergrad.
Mon, Dec 3, 2012 : 4:10 a.m.
I'm a physician as well and work with many midlevel providers including NPs and PAs. Virtually all of the NPs I have worked with do excellent work. But as UM Doc pointed out, the length of training is significantly shorter than that of a physician. More importantly however, the training is different. The skills taught in nursing school and masters programs are not the same as those taught in medical school and residency. It goes beyond the total hours or number of years spent in training. As a physician, I could not even come close to doing a nurse's job because I don't have the training that a nurse does. Nursing requires every bit as much hard work and intellect as being a physician but focuses on different aspects of patient care. A two-year masters degree (some of which are done online) does not change that. Nurse practitioners are a vital part of the medical system and provide excellent care to their patients in the proper setting. I would happily let my family members be cared for by an NP, but only one who has proper oversight.
UM Doc
Sun, Dec 2, 2012 : 8:06 p.m.
The semantics of whether the path to become an NP is called "training" or "education" is a non-issue. Call it what you want, but you seem to miss the broader point: the path to become an NP is nowhere near extensive enough to warrant equal responsibilities to a physician.
Melissa M.
Sun, Dec 2, 2012 : 7:12 p.m.
I'm not going to engage your entire argument here, because I have a huge paper to write as part of my NP "training" that I have to get to, but I have to point this out: That NP "training" you describe is a masters' degree, and a fully packed one at that. Before you get a masters' you must have a bachelors; as such there are no APRNs practicing with an associates in nursing (there are still some with post-baccalaureate certificates). APRN education includes education in public health, health policy, research methodology, data analysis and statstics, pharmacology, anatomy and physiology, pathophysiology and health asssessment, as well as extensive clinical practicums. Most of us also have years of experience as registered nurses from which we derive an extensive knowledge base. To describe our education as "training" is incredibly dishonest and insulting.
UM Doc
Sun, Dec 2, 2012 : 5:31 p.m.
brian123: Several points here. 1) A projected physician shortage should be met with an expansion of physicians. There is already some headway on this in the area, with a new medical school at Oakland University with their clinical training to be completed at Beaumont. Furthermore, an argument for an expansion of current class sizes could be made. Also, the number of qualified physicians who graduate from foreign medical schools and pass the same licensing exams US physicians are required to take far exceed the demand. Bottom line, physicians should never be replaced with nurses. 2) With respect to rural and underserved areas, physicians need to be incentivized to practice in these areas. Even if you expand the scope of NPs, they will make the same decisions with respect to where they live, and you'll see more of an oversaturation of primary care providers in already oversaturated areas. There are some programs out there, such as loan forgiveness for those who practice in these areas, but more can be done. Efforts should be made at incentivizing physicians to expand their practices into geographic areas that are underserved.
Sun, Dec 2, 2012 : 4:45 p.m.
*particularly in rural or medically underserved areas where attracting doctors is especially difficult.
Sun, Dec 2, 2012 : 4:43 p.m.
UM Doc - - you definitely have a point about extent of education. And i'm sure most people would rather be seen by a physician with many more years of education than a NP. However, the issue here is the reality we live in. There is a severe shortage of docs in the primary care setting, practicing preventative medicine. Many of these minor issues or "well visits" can be seen sufficiently by a trained NP. With millions more people about to come on the grid (after ObamaCare comes into full effect), how else are we going to meet demand?
Sun, Dec 2, 2012 : 3:02 p.m.
DBH: http://www.ncbi.nlm.nih.gov/pubmed/22372080http://www.ncbi.nlm.nih.gov/pubmed/23148952 http://www.ncbi.nlm.nih.gov/pubmed/22875555 http://www.ncbi.nlm.nih.gov/pubmed/22551089 http://www.ncbi.nlm.nih.gov/pubmed/23010919 Would you like more? This is an excellent article about collaborative care in obstetrics, published in the Green Journal: http://www.ncbi.nlm.nih.gov/pubmed?term=darlington%20warwick Let me know when you need more reading! Happy to accommodate, since, luckily, there's a wide research base to choose from.
Sun, Dec 2, 2012 : 3:20 p.m.
Thank you, @Meg, I expect those will suffice.
Sun, Dec 2, 2012 : 2:50 p.m.
When writers (including the author of this opinion piece, as well as (as of now) @Meg below) cite research supporting their stances, I wish they would include links to such research so readers could evaluate the evidence themselves.
Sun, Dec 2, 2012 : 3:22 p.m.
Sorry, that should have been "...(as of now) @Meg **above**)..."
Sun, Dec 2, 2012 : 2:40 p.m.
As the comment about how nurses make mistakes is true, but does not mention how many mistakes the doctors make. After watching mistakes by doctors personally for thirty plus years, the idea that they are much better than nurses is pretty funny. That is a very large part of why malpractice insurance is so bloody high.
Sun, Dec 2, 2012 : 2:17 p.m.
Dean Potempa, thank you for this column. As a certified nurse-midwife who was educated and practiced in Washington State, where ARNPs have independently practiced since 1994, I have been mystified by Michigan's refusal to look at the evidence supporting ARNPs as safe and effective providers of care. Ann Arborite: I'm assuming that you've never seen an error by a physician. As a nurse for over a decade before I began practicing as a CNM, I've seen a lot. More than that, I've seen differences in practice opinions, which may be considered by those with less willingness to consider the research evidence to be "mistakes". Do ARNPs make mistakes? Absolutely. Do physicians? Absolutely. But two decades of outcomes research supports ARNPs as safe providers. Ann Arborite, this shouldn't be about turf wars, or how threatened one profession feels when their monopoly on care is challenged. This should be about the patients, and the research supports the use of ARNPs as well as physicians. You may want to consider the experiences of physicians and patients in states like Washington, where ARNPs in independent practice are considered colleagues and equals by the physicians. Our scope of care is different, our discipline is different, but "different" is not "lesser". Getting out of Michigan to see how things are done elsewhere is a refreshing -- and educational -- experience.
citizen kane
Mon, Dec 3, 2012 : 2:20 a.m.
Meg, if its so great out there why aren't you still practicing there? you aren't hiding from anything are you?
Sun, Dec 2, 2012 : 11:34 p.m.
Ann Arborite, I say again. Your argument of 'less training" is completely flawed. It is equal training in a different field. How is it you find that so hard to understand. Meg isn't saying she doesn't need doctors. She is saying that to continue to work in this archaic style of healthcare where physicians view NP's as subordinates with less training which in turn limits access to high quality care is unacceptable. She is saying, and I agree with her, that in order for things to move forward and to accomodate the inevitable 1 million new patients, you and your like-minded peers need to get over your 1980's nostalgia and accept that your philosophy is no longer relevant. Sorry.
Sun, Dec 2, 2012 : 4:21 p.m.
Nurses can, actually, practice nursing just fine without physicians. It's not a subspecialty of medicine; it's an independent discipline with its own research and theory. You aren't citing anything to support your claims of "lesser" care, so the assumption must be that you're using yourself as a research authority -- which is always questionable.
Ann Arborite
Sun, Dec 2, 2012 : 4:16 p.m.
Actually, Meg, I have practiced in two other states other than Michigan. And yes, I have seen physicians make mistakes. The whole goal here is to DECREASE the probability of error. And giving ARNPs, who have less training, more independent responsibility, is not going to accomplish that. You're right that the issue should not be about turf wars. It should be about working together to serve a population. However, that's not what you're advocating - you want to work completely independently. You will be hard pressed to prove to me that LESS training is as good as MORE training. When you have a breach baby that you cannot deliver vaginally, what do you do? I would hope you contact a physician & surgeon who is capable of performing a c-section if necessary. Advanced practice nurses provide a very useful and necessary part of our health care delivery system. Yes, they can provide very competent care. Doctors can't function without nurses. But, it would be folly for nurses to feel they can function without doctors. If a nurse wishes to practice independently, there is certainly a well-established path for her/him to take: it's called medical school. ARNPs already have a fairly independent practice system in this state. Maintaining at least a formal, if be it loose, coordination with a physician, can only help the public good.
Ann Arborite
Sun, Dec 2, 2012 : 1:48 p.m.
While I can understand the author's stance on this subject as the Dean of the Nursing School, I respectfully disagree with her. As a physician who has practiced for about 20 yrs, I have practiced with many "physician extenders" in several states. I think it is important for the public to realize how much shorter their education is compared to a formal medical training. Furthermore, there is a fundamental difference between the field of nursing and the field of medicine. Just tacking on a couple years at the end of a nursing education does not make them a doctor. Yet, this is exactly what they seek - they want to see patients independently without having any oversight. It's interesting that PAs, the other group of "physician extenders" haven't tried to do this - their education is much more similar to an MD/DO's, and I feel that they, as a profession, understand the key differential the 5+ years of training difference makes. Nurses who are advocating this bill don't seem to get this. I have seen many, many mistakes by NPs in my practice. These were honest mistakes made by good NPs. However, had it not been for the backup of well trained physicians, real harm could have come to patients. Yes, it's true that the ACA is going to worsen access to health care for all of us. More people are going to be insured (which is good), but there aren't enough doctors to go around. Furthermore, the ACA is essentially forcing physicians to sell out their practices to large hospital systems just to stay in business, due to provisions within the bill such as ACOs, which only very large institutions will be able to afford. Just look at what's happened here in town - St. Joe's has gone on a buying spree and bought up a huge chunk of the primary care doctors & specialists. An employed physician just is not going to work as hard as an independent one. We should fix the ACA, not settle for more quantity/less quality care.
Mon, Dec 3, 2012 : 12:51 p.m.
Monopoly anyone? I have seen many MD/DOs also make mistakes that were caught by Nurses... A Nurse or NP is YOUR last line of defense for a DOCTOR killing/harming you. Id rather have a NP from UM treat me than a DO from a Caribbean BS school... You forget to mention that NPs also do not do ALL of the same services MD/DOs do...
Mon, Dec 3, 2012 : 5:18 a.m.
Dr Annarborite is correct here. This is nothing new, expanding NPs has long been recommended as a method of resolving two important problems that add to the cost of health care, the lack of doctors, especially in the area of general practitioners and the high cost of paying Drs. However his points on education is on point. An NP degree is achieved by obtaining a Masters degree, not a Phd. They should work under the guidance of a physician. Terri this is why NPs are exactly physician extenders, as are physicians assistants. I do not like that term however but it is exactly what they do and it is a way to attack health care issues.
Sun, Dec 2, 2012 : 11:23 p.m.
If you are a physician, which I have no way of knowing if you actually are, you are exactly the type of physician that is the problem. I agree that med school is different than nursing school. But your comment about "just tacking on a couple years" shows how uninformed and out of touch you really are with contemporary education. Most nurse practitioners are becoming DOCTORS of nursing. And I have seen MANY mistakes and caught MANY mistaked made by good doctors. If you can't accept the fact that healthcare needs this change, then maybe it's time to pack your bags and allow yourself and your arrogance to retire.
Sun, Dec 2, 2012 : 4:20 p.m.
@Meg, I never said you were oatmeal. You understand the concept of analogies, do you not? As for the rest of your reply, see my previous postings. I wish you the best of luck.
Sun, Dec 2, 2012 : 4:02 p.m.
I'm not oatmeal. "Physician extender" is inherently disrespectful to non-physician providers, because we're not practicing the same discipline. By your rationale, physical therapists and speech-language pathologists are also physician extenders, but you'd be hard-pressed to find a physician who called them that. "Physician extender" is applied primarily to nurses -- particularly those uppity ones who don't know our place, apparently.
Sun, Dec 2, 2012 : 3:57 p.m.
All right, @Meg, I'll take one more stab at this. We appear to disagree about two different things. I am explaining what the definition of "physician extenders" IS, whereas you are writing about what the definition of "physician extenders" SHOULD be. The definition is the definition, like it or not, appropriate or not. I didn't make it up, it is not my opinion, and the definition is widely used. Personally, I have no opiniion on the appropriateness of the definition as it pertains to nurses with advanced degrees though clearly you do, and I respect that. Regarding the appropriateness of using the word "extender" attached to the word "physician" for someone who doesn't practice medicine (in a formal sense, at least), I don't see the problem. There is no conflict that I can see. The essence of an extender does not need to be identical to the thing extended. In cooking, for example, oatmeal can be used as an extender for meatloaf, even though oatmeal and meatloaf are quite two different things.
Sun, Dec 2, 2012 : 3:21 p.m.
Why should inappropriate and disrespectful language be used at all, regardless of whether it's used in the antiquated Michigan law? I don't practice medicine, so it's actually impossible for me to be a "physician extender".
Sun, Dec 2, 2012 : 3:19 p.m.
@Meg, I am not questioning your degrees, certifications, qualifications, or anything else. I am simply pointing out that the definition of "physician extenders" includes nurse practitioners and others with advanced nursing degrees. You may object to being included in the definition, but in those states that require physician supervision of nurse practitioners, it is a reality, like it or not.
Sun, Dec 2, 2012 : 3:07 p.m.
DBH: I'm not an extender. I'm a licensed professional, educated in both nursing and midwifery, and board-certified to practice my specialty. The lack of progress made by MI state law is the problem, not my qualifications to provide care to women throughout the reproductive lifespan. Independently, by the way, in 18 states.
Sun, Dec 2, 2012 : 2:54 p.m.
@Terri Eagen-Torkko, I think you are incorrect about this, at least in Michigan and other states that legally require physician supervision. "Definition: "Physician extenders" is a category name for nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists (CNSs). Also Known As: nurse practitioners, physician assistants or clinical nurse specialists" http://patients.about.com/od/glossary/g/physicianext.htm
Terri Eagen-Torkko
Sun, Dec 2, 2012 : 2:31 p.m.
You've got this wrong from the get-go: Nurse practitioners are not "physician extenders."
Sun, Dec 2, 2012 : 1:34 p.m.
I think freeing Advanced Practice nurses to do legally what they have been trained for is an excellent idea, but I fear that they will find it very difficult and prohibitively expensive to obtain the malpractice insurance that would be essential to opening a clinic or practice of their own. Possibly using APRNs as the primary-care provider in county or regional government-run clinics would be more successful in rapidly improving access to routine medical care for many more Michigan citizens, especially those in rural communities.
Sun, Dec 2, 2012 : 3:45 p.m.
AMOC, ARNPs in Washington have found their malpractice coverage quite affordable, unless they're practicing in a high-risk specialty like pregnancy/birth care.


text:
Stripe Arctic group of frontier troops. Shield on a black background. Overlock machine.
- Brands ООО "Нева-Прогресс"
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Stripe Arctic group of frontier troops. Shield on a black background. Overlock machine.
Background: black. olive, dark blue
file name in the design database: APGJ
Number of colors: 3
manufacturing Technology: embroidery, manufactured in accordance with order 300 from 22.06.2015 Ministry of defence of the Russian Federation
Threads: polyester or metallic thread
Treatment of the edge of the stripe overlock: Option
Base: gabardine, felt, CordS®
*the PREMIUM option means using Cordas the base of a moisture-resistant and wear-resistant material and the addition of a stripe with a rigid substrate made of special cardboard. This patch design provides high rigidity, no spools, abrasion resistance, water resistance. The total density of the materials that make up the patch with the PREMIUM option is 900 grams per square meter.

subset: commoncrawl


text:
Shovels & Rope
The best album credited to Shovels & Rope is O' Be Joyful which is ranked number 9,109 in the overall greatest album chart with a total rank score of 126.
Shovels & Rope is ranked number 4,422 in the overall artist rankings with a total rank score of 175.
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Shovels & Rope best albums
The following albums by Shovels & Rope are ranked highest in the greatest album charts:
This may not be a complete discography for Shovels & Rope.This listing only shows those albums by this artist that appear in at least one chart on this site. If an album is 'missing' that you think deserves to be here, you can include it in your own chart from the My Charts page!
Shovels & Rope best tracks
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Saw these guys on Austin City Limits. Excellent.
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|20. The Who


text:
Craig Finn of The Hold Steady has gone solo. His debut record, Clear Heart Full Eyes, is released on January 23 through Full-Time Hobby and now he's been announced as the tour support for The Felice Brothers. They'll be playing the following shows on the following dates throughout March.
13 - London, Macbeth
14 - Birmingham, HMV Institute
15 - Dublin, Academy
16 - Belfast, Spring & Airbrake
17 - Glasgow, ABC
18 - Manchester, Academy 2
20 - London, Koko
If you want to catch him before then, though, you can do so. Mr Finn will be playing a gig at London's Rough Trade East on January 25 at 7PM. Expect to hear some album tracks, of course.
Main photo by Amber on Flickr


text:
Irving H. Rothman
President and Chief Executive Officer, HPE Financial Services
Irv Rothman leads HPE Financial Services (HPEFS), the IT investment and financing subsidiary of Hewlett Packard Enterprise (HPE). Mr. Rothman is responsible for the worldwide delivery of solutions that enable business transformation.
HPEFS delivers IT investment strategies that maximize the full potential of technology to help drive business transformation and create better business outcomes. The company is headquartered in Berkeley Heights, New Jersey, with regional locations in Dublin, Ireland, and Singapore. HPEFS has over 1,600 employees worldwide and does business in more than 50 countries.
Prior to joining HPEFS, Mr. Rothman was President and CEO of Compaq Financial Services Corporation (CFS). He led CFS from its founding in 1997, growing the business to greater than $3.7 billion in assets generating over $1.0 billion in revenue prior to the HP-Compaq merger which was completed in 2002.
With over 44 years in the financial services industry, Mr. Rothman has held leadership positions with U.S. Leasing International and Thomson McKinnon Securities before joining AT&T in 1985. As a group president of AT&T Capital Corporation, he helped build an organization that ultimately grew to be the second largest leasing company in the US.
Mr. Rothman is the author of a book entitled "Out-Executing the Competition: Building and Growing a Financial Services Company in Any Economy," published by John Wiley & Sons, Inc. He attended Rutgers University and earned an MBA in Finance from Pepperdine University.


text:
Microsoft's chief software architect Ray Ozzie, who recently took over the post from Bill Gates, has had a long history in the software industry. He created the product later known as Lotus Notes, and later started his own company, Groove Networks, that developed a peer-to-peer information sharing program. As such, whenever he talks about Microsoft's future direction, as he did today at Microsoft's annual financial analysts meeting, people are going to pay attention.
Ozzie talked about the future of Microsoft's software initiatives, and how the company was going to try to develop applications that sat between client applications and web-based databases. "It's an architectural principle...and it's also a new online delivery model," he explained.
The software architect dismissed the hype over "Web 2.0," saying that it wasn't the "be-all," as well as stating that the full impact of the Web hasn't been felt yet. He believes that mobile devices, TVs and other hardware products (such as the Xbox 360) are probably more important in the long run. His vision statement described Microsoft's goal of making products "work together in simpler yet meaningful ways," and reducing the information burdens caused by owning multiple computers or other devices.
It's an interesting approach, but is Microsoft's new chief architect downplaying the Web merely to calm down the hype around Google and other successful Internet companies?


text:
Crime Prevention:
How to Help a Troubled Friend
Suicide is the third leading cause of death for 15- to 24-year-olds, according to the U.S. Centers for Disease Control and Prevention. Only accidents and homicides take more lives in this age group. In the past, suicide was viewed as a sin or a crime.
Today we understand that someone who thinks or talks about committing suicide is not bad or weird, but deeply troubled and temporarily may be unable to cope with his or her situation. Most seriously depressed people can be helped through counseling and/or medication. Many suicides can be prevented if the problems are brought to light.
You Can Help by Getting Help
If you have a friend who has threatened or attempted suicide or who hints that he or she might do so ("I'm no good to anybody" or "I won't be around to bother you much longer"), it is vital to get help as quickly as possible. Talk to your school guidance counselor or your parents. You can locate a suicide and crisis hotline in your state by going online to www.suicide.org/suicide-hotlines.html. Or you can call the National Runaway Switchboard (800-621-4000) or the National Hopeline Network [800-SUICIDE (800- 784-2433)] to get help for your friend. Both hotlines operate 24/7.
You Can Help by Listening
No matter how much you care about your friend, you probably won't be able to solve his or her problems, but listening may help. Here are some guidelines:
- Express your concern but don't be judgmental. Don't get involved in a debate about suicide.
- Let your friend talk out negative feelings or thoughts. Don't try to gloss over the problems by saying, "It's not that bad," or "Everything will work out okay." And don't feel you have to have the answers. Just listen attentively. Make sure the person knows that you care about him or her.
- Encourage your friend to talk to a trusted adult or to call a hotline. If you think your friend can't or won't do this, do it yourself. It's not a betrayal of a friend's trust to seek help that can save a life. Tell an adult or call a hotline. Most hotlines offer anonymity and confidentiality. If you're not sure how serious the problem is, you can tell the hotline counselor about the behavior you're worried about, and he or she can help you decide whether your friend needs help and where to find that help.
Signs That a Person May Need Help
Everybody feels depressed or sad from time to time. But sometimes these feelings last and become overwhelming. Here are some signs that may indicate that your friend needs help:
- marked personality change;
- withdrawal from family, friends, and usual activities;
- changes in eating or sleeping habits;
- unusual neglect of appearance;
- inability to concentrate, constant boredom, general feeling of sadness; and
- complaints about physical ailments that seem to be related to emotions. People who are particularly vulnerable to suicide may show one or more of the following signs:
- They've made previous attempts.
- They have a history of mental disorders sometimes combined with alcohol or substance abuse.
- There is a history of suicide in their family.
- They have recently suffered a stressful life event or loss.
- They have easy access to lethal methods (especially guns).
- They have been exposed to suicidal behavior of others.
- They have been incarcerated.
It's Not Your Fault!
If someone you care about becomes a victim of suicide, you may feel guilty. You may think that there was something you could have done to prevent it. You must keep in mind that nothing you said or did caused that person's suicide. You are not responsible for it. Talk with a counselor or trusted adult to help understand and deal with your feelings. Even if it's not your fault, you will still grieve for your friend.
American Association of Suicidology
4201 Connecticut Avenue,
NW Washington, DC 20008
American Foundation for Suicide Prevention
120 Wall Street, 22nd Floor
New York, NY 10005 888-333-AFSP
- 800-621-4000
- www.suicide.org/suicide-hotlines.html


text:
GeoLogics is a high-technology and technical services company with over 25 years of successful participation in development and experimental programs for aerospace and defense contractors, government agencies, and research laboratories. GeoLogics specializes in creating mission critical solutions and provides technical support in the areas of R&D, engineering, communications, software, and systems development.
We are constantly searching for exceptional talent to fill a variety of job opportunities nationwide. GeoLogics has received numerous awards for technical excellence and performance. Find out today how we can provide superior career opportunities to meet your highest expectations.
Join our Talent Network and stay up-to-date on our openings as they continue to become available!
What is a Talent Network?
Talent Networks enhance your job search and application process. Whether you choose to apply or just leave your information, we look forward to staying connected with you.
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Are you looking for a new job? Check out these current opportunities: Engineering Jobs
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text:
The future financial services
Simplifying customers' daily lives with future-proof financial technology
In the future, financial technology will dramatically change how financials operate, the services they deliver, and their interaction with customers and partners. Through an ecosystem and open banking approach, they will be enabled to remain relevant and will be able to ensure the provision of financial services to customers at any time, in any location, and on any device.
In the financial sector, we will see a dramatic change in the IT landscape – it will shift from a traditional landscape to an open transactional 'API driven' data service landscape.
Future proofing your financial services IT with Fujitsu
At Fujitsu, we have been developing and deploying financial IT solutions for banking and insurance customers for over 40 years. We are recognized as a global leader in delivery, support, and IT management, and work in close partnership with banks and insurers to co-create solutions that enable agile and flexible service delivery.
Find out how our financial IT solutions have solved our customers' business challenges
Software robot processes data faster, cheaper, and without errors.
For Mizuho Bank, we implemented a biometric security solution conforming to international FIDO standards.
Find out more
Improving the user experience and service delivery with a new digital banking platform.
For SEB, we deployed a user-friendly platform, that offers the flexibility to develop future online banking services.
Find out more
How will advanced digital technology enable future banking services?
FUJITSU Financial Solution Finplex
Developing and creating new banking services at speed.
Find out more
The case for quantum and quantum-inspired computing in financial services
What if it were possible to optimize short-term funds management or large portfolios of highly fluid assets in near real-time?
Find out more


text:
David David
Sold Out
Limited Edition Print
David David is has a bit of a thing for colour and pattern. And colourful patterns.
Limited Edition
This is a limited edition print of 50. Signed and numbered by the artist.
70 x 100cm Giclée print.
Signed by David Saunders, edition of 50.
310 g.s.m, 100% cotton fine museum grade art & photo paper.
Pure pigment inks.
About the Artist
Artist and designer David Saunders graduated from Chelsea College of Art and assisted Tracey Emin, Mat Collishaw and other Young British Artists before launching fashion and interiors label David David in 2008. His bold geometric prints have since become synonymous with the brand and featured in collaborations with the likes of Louis Quatorze, Fred Perry and Rimowa.
David David's 2012 collaboration with furniture designers Glass Hill featured in the V&A's British Design from 1948-2012: Innovation in the Modern Age. Jameel Prize nomination followed in 2013 (an award for contemporary art and design organised by the V&A), and the brand went on to collaborate with Studiomama on a range of chairs nominated for Designs of the Year 2013. A commission for the London Design Festival 2014 saw David David re-tile the walls of the V&A's tunnel entrance with more than 50 sq m of printed ceramics (Carousel Wall 2014, supported by Johnson Tiles).
"David David is the poster boy for the London crossover between art and fashion", Sarah Mower, American Vogue.
"David David typifies the interests of a younger generation in the authenticity of the process", Ghislaine Wood, Victoria and Albert Museum.
Delivered unframed in a reinforced cardboard tube.


text:
These are the Talking Points for the Fedora 13 release. For information on how these talking points were chosen, see Talking Points SOP. They are intended to help Ambassadors quickly present an overview of highlighted features when talking about the release.
- 1 For desktop users and everyone
- 2 For administrators
- 3 For developers
- 4 Spins
For desktop users and everyone
Things of general interest to most people using Fedora.
Automatic print driver installation
Automatic print driver installation feature
Leverages PackageKit capabilities so Live images don't need to ship all printer drivers. Equals or surpasses functionality of proprietary operating systems. Builds new, compelling functionality based on free desktop capabilities (PackageKit, D-Bus) combined with RPM hooks.
Summary sentence of talking point.
Automatic installation of language packs
Yum Language Package Plugin feature
Provides automatic installation of langpacks (eg for openoffice, KDE, etc).
Summary sentence of talking point.
Redesigned user management interface
The user account tool has been completely redesigned, and now makes it easy to configure personal information, make a personal profile picture or icon, generate a strong passphrase, and set up login options. Designed and implemented by several members of the Desktop SIG.
Summary sentence of talking point.
Color management
Color management helps artists, photographers, designers, and others display and print work more accurately using 100% free software. Written by Richard Hughes, Red Hat engineer and Fedora contributor.
Summary sentence of talking point.
NetworkManager improvements include CLI
NetworkManager bluetooth DUN feature, NetworkManager command line feature, NetworkManager mobile status feature
Adds dial-up modem support for older Bluetooth-equipped phones, to complement the personal-area networking already supported in Fedora. Addresses a long-standing missing link for command-line junkies who want NetworkManager to integrate with the CLI. Also useful for jetsetters who operate in lower-power text modes. Provides a better indicator for signal strength, and lets people know if they are roaming.
Summary sentence of talking point.
Experimental 3D extended to free Nouveau driver
link-to-feature, link-to-feature
3D support was added to the completely free and open source software (FOSS) radeon driver in F12 [adamw note: this is not entirely accurate. radeon supported 3D for r400 and earlier chips for years. what was added in F12 was experimental support for r500 and r600 chips], and now this support has been extended in F13 to the equally free nouveau driver. Fedora and its sponsor Red Hat are dedicated to improving the quality and coverage of completely free accelerated video drivers. While we support user choice and do not prevent use of closed, proprietary drivers, we also recognize that these drivers sometimes conflict with and cause problems in the software written by FOSS community members. We prefer to honor the commitment of the FOSS community with our own commitment to free drivers that complement their work.
Summary sentence of talking point.
For administrators
Improvements that make system administrators' lives better.
BFO is a unique feature in Fedora. We're the first to offer it. It allows users to download a single, tiny image and install current and future versions of Fedora without having to download additional images.
Summary sentence of talking point.
Authconfig UI redesign
Better integration of new SSSD technology in the configuration UI for authentication, and a full UI revamp making it much easier to configure your Fedora system to work in a number of different authentication environments.
Summary sentence of talking point.
Pioneering NFS features
NFSv4 by default feature, NFS Client IPv6 feature
Fedora 13 changes its default to NFSv4, resulting in improved performance with a seamless transition for users. Clients gracefully falling back to other versions if required by an NFS server. Continues Fedora's role as a front-runner for NFSv4 -- the first distribution to include it, the first to switch to it by default. The other major step forward in NFS is support for IPv6, so clients in mixed or IPv6 only environments can now make full use of NFS.
Summary sentence of talking point.
Fedora 13 now makes available a complete groupware suite that can be used as an Exchange replacement for Web-based mail, calendaring, and tasks. Features include IMAP/POP and iCal/CalDAV capabilities, native mobile phone support, the ability to integrate with existing Linux mail servers, a full set of programming interfaces, and a comfortable look and feel using modern Ajax technologies.
Summary sentence of talking point.
Experimenting with btrfs
System rollback with btrfs feature
Btrfs is capable of creating lightweight filesystem snapshots that can be mounted (and booted into) selectively. The created snapshots are copy-on-write snapshots, so there is no file duplication overhead involved for files that do not change between snapshots. It allows developers to feel comfortable experimenting with new software without fear of an unusable install, since automated snapshots allow them to easily revert to the previous day's filesystem.
Summary sentence of talking point.
For developers
Innovations that make Fedora a great platform for software developers.
SystemTap static probes
While Fedora used to have pretty decent introspection tools for the kernel, this release expands the visibility of monitoring on a higher level what is happening inside language runtimes like Java, Python and TCL. A start has been made with other user space applications like PostgreSQL, which will be extended to many more applications in Fedora 14 (this is a continuous process, making Fedora a better and tightly integrated developer platform). The feature page already has compelling examples for how this makes observing what your Python programs do very powerful. Additional examples should be added for the other language runtimes enabled by this feature.
Summary sentence of talking point.
Easier Python debugging
Easier Python debugging feature
Engineering team member David Malcolm has added new support that allows developers working with mixed libraries (Python and C/C++) to get more complete information when debugging. Backtraces will now show output from code written in both languages, including those generated by Fedora's Automatic Bug Reporting Tool (ABRT), and developers can more quickly improve software. --Dmalcolm 03:55, 20 February 2010 (UTC): I think it's also a good idea to combine this with the python part of Systemtap Static Probes - both give you more visibility into the internals of Python code on your system, albeit it in different ways.
Summary sentence of talking point.
Parallel-installable Python 3
Fedora 13 also blazes a trail with a parallel-installable Python 3 stack that will help programmers write and test code for use in both Python 2.6 and Python 3 environments. Beyond the core libraries, some additional libraries are already provided, with more expected to follow throughout this and future releases.
Summary sentence of talking point.
NetBeans 6.8 first IDE to support entire Java 6 EE spec
NetBeans IDE 6.8 is the first IDE to offer complete support for the entire Java EE 6 spec with improved support for JSF 2.0/Facelets, Java Persistence 2.0, EJB 3.1 including using EJBs in web applications, RESTful web services, and GlassFish v3. We also recommend it for developing with the latest JavaFX SDK 1.2.1, and for creating PHP web applications with the new PHP 5.3 release or with the Symfony Framework.
Summary sentence of talking point.
A few highlighted Fedora Spins coming out with this release.
Moblin Spin
Paragraph-long description of talking point.
Summary sentence of talking point.
Sugar on a Stick Spin
Paragraph-long description of talking point.
Summary sentence of talking point.
Design Studio Spin
Paragraph-long description of talking point.
Summary sentence of talking point.
Security Spin
Paragraph-long description of talking point.
Summary sentence of talking point.


text:
Low top black and gold sneaker
. 100% Leather : crafted from a black and gold suede leather. Premium laces with metallic nozzles. LE FLOW logo in white rubber at the back of each shoe. Unique white EVA ultra-light rubber sole with dark grey paint injection. Leather lining
Handcrafted in Portugal
Exists also for women
Fits true to size
ShippingWe offer Free Worldwide Shipping on all orders
Europe : 2 to working days 5 days
Rest of the world : 3 to 10 working days
If you place your order from outside the EU, you might have to pay import duties, depending on the local customs.
Returns If you are not satisfied with your purchase you can return it to us within 14 days after delivery for a refund.
The items must be returned non-used and in their original condition.
Email us at firstname.lastname@example.com


text: Paul McCartney sends 'message of peace' 4:43 PM PDT 9/24/2008 by Associated Press , AP FACEBOOK TWITTER EMAIL ME Former Beatle rejects criticism of Tel Aviv concert BETHLEHEM, West Bank -- Paul McCartney said Wednesday he's carrying a message of peace for Israel and the Palestinians, rejecting criticism of his planned concert in Tel Aviv. McCartney toured the West Bank town of Bethlehem, visiting the Church of the Nativity, built over the traditional birthplace of Jesus. The 66-year-old former Beatle ducked into the fourth-century church through its low, narrow entrance, taking pictures with a small camera. He lit two long, tapered white candles in different parts of the church, saying each time that they were "for peace." After posing for pictures with fans outside the fortress-like church, McCartney was asked to respond to criticism from some Palestinians that his visit to Israel supports its occupation of the West Bank. He said his visit Wednesday to the West Bank showed he was not playing favorites. "I'm here to highlight the situation and to say that what we need is peace in this region, a two-state solution," he said, referring to Israel and a Palestinian state. "I get criticized everywhere I go, but I don't listen to them," McCartney said. "I'm bringing a message of peace, and I think that's what the region needs." McCartney arrived Tuesday night ahead of his concert Thursday in Tel Aviv's largest park. Four decades ago the Israeli government banned a planned concert by the Beatles, ruling that the rock group's performance could corrupt the morals of Israel's youth. FACEBOOK TWITTER EMAIL ME Associated Press email@example.com @thr AP firstname.lastname@example.com @thr


text:
Create an Account - Increase your productivity, customize your experience, and engage in information you care about.
Where the Heart Is creates and sustains vibrant, thriving neighborhoods through physical, social and community enhancements including:
In partnership with you, your neighbors, the City of Garland and other allies, we are strengthening Garland one neighborhood at a time. The process includes:
|Date & Time
|Neighbors Helping Neighbors Day
|The Oaks Neighborhood
To learn how you can get involved, provide feedback, spruce up your home, meet your neighbors or volunteer with us, email the Office of Neighborhood Vitality or call 972-205-3864.
A big THANKS! to everyone who helped with the 2019 WHERE THE HEART IS: Neighbors Helping Neighbors Day on April 27. Over 50 volunteers lent a hand to work on five home repair projects and one community mural project. Check out the video below for a recap of the day.


text:
Closed end funds have created excitement this year among the yield-hungry—with yields in the range of 6%, 7% and even 8%—but before investors in search of income-oriented closed-end funds get too enthusiastic, they should check out whether the fund they're interested in uses leverage.
Leverage, says Alec Young, a global equity strategist with S&P Capital IQ, is often used to increase income in the closed-end fund world, especially in a yield-starved environment such as the one we're in right now. And while leverage isn't necessarily a bad thing, it does introduce a higher element of risk along with those high yields, which is why investors need to know what they're getting into.
"It's a very underappreciated concept," Young said in a recent interview. "Investors need to find out whether the fund managers will be using leverage. It doesn't mean if they are that it isn't a suitable investment, but it's something that you have to do due diligence around, because it does raise the risk profile of the fund. Leverage can magnify your upside, in that you'll get a bigger yield, but not all yields are created equal. Using leverage, you can get a 6%, 7% or 8% type of yield, but you have to understand that the price of these funds is more volatile, because when prices go down, they're more exposed."
For example, Young said, a closed-end fund might have $100 million in assets, and the manager will leverage that base and buy a total of $150 million worth of income-producing assets, such as stocks or bonds. The fund will earn yield on the larger amount that includes borrowed money, but the yield only applies to the fund's base amount.
The Upside and the Downside of Leverage
That's the upside. The downside, Young added, is if the assets decline in value.
"You can lose money at a faster rate," he said. "So if you have a $100 million fund and you're using leverage to buy $150 million in assets, it's important that the assets be stable to rising in value. Or, if they're falling, that the income they produce offsets what the capital loss is. The problem is, if you have $150 million in assets and you own that with leverage, and the assets start to decline, it magnifies the losses on your $100 million."
Conservative investors in the closed-end space would want a fund that has no leverage and would take a much lower yield, while a leveraged fund would be more appropriate for a more aggressive, income-oriented investor, Young concluded.
But Alan Goodson, product head for Aberdeen Asset Management, which specializes in international, Asia-Pacific and emerging-markets closed-end funds, asserts that a closed-end fund's ability to use leverage sets it apart from the pack.
"An advantage of a closed end fund compared with a mutual fund or exchange-traded fund (ETF) is its ability to use leverage," Goodson said in a recent interview. "From an investment management perspective, you have a fixed pool of capital, unlike an open-end fund, where shareholders obtain their liquidity from the fund itself, and the fund is continually growing or shrinking in size."
While acknowledging that leverage has both benefits and drawbacks, Goodson said the key benefit for income-producing funds that use leverage is their ability to borrow money on a short-term basis.
"The leverage is used to provide a supplement to the income-producing objective of the fund," Goodson said. "If you can borrow using short-term rates and invest effectively on long-term rates, then you can use that carry to boost the level of income that you can deliver to your shareholders. The downside to using leverage is naturally what comes with that: greater volatility of the net asset value (NAV) and therefore, indirectly, the share price of the fund."
RiverNorth/Manning & Napier's Proprietary Twist
S&P Capital IQ's Young said that because income-generating products have become such a "crowded theme," any new fund out there, closed-end or not, must garner investor assets by relying on a truly special proprietary twist.
For RiverNorth Capital Management and Manning & Napier Advisors, the proprietary twist in their new Dividend Income Fund (RNMNX) involves an open end fund that invests opportunistically in closed-end funds.
Launched on Aug. 7, RNMNX proposes to capitalize on the inefficiencies within the closed-end fund market and combine that with stock picking focused on publicly traded companies' free cash flow yield. The tactical closed-end fund equity strategy invests in equity closed-end funds while the dividend-focus strategy invests in dividend-paying common stocks of mid- to large-cap companies.
RiverNorth Chief Investment Officer Patrick Galley noted that about 70% of closed-end funds implement leverage, and this is why they have become known as yield securities. This creates RNMNX's opportunity, Galley said in a recent interview.
"A lot of that yield comes from leverage," Galley said. "That's the double-edged sword: risk. When times are bad, closed-end fund losses can be exacerbated. That's something we can take advantage of. We are a contrarian. When markets are doing well, that's an opportunity for us to sell into that positive sentiment."
'Leverage Can Help a Fund'
Unlike an open-end mutual fund or ETF, closed-end funds go through an initial public offering process where a fixed number of shares are issued, he explained. For people who bought the IPO, the only way to sell is to find a willing and able buyer. Therefore, the market price deviates from the NAV, meaning the liquidation value of the underlying assets.
"That's the opportunity that we're taking advantage of," Galley said. "When the closed-end funds start trading in the secondary market, inevitably that market price deviates from the NAV. Most of the time, they start to trade at a discount to the NAV, but sometimes they do trade at a premium."
Given that there are 630 closed-end funds—fixed income, equity-based and tax-free muni bond closed-end funds—"you can really get any type of asset class exposure you can think of with a closed-end fund," Galley said. "And a lot of times that discount or premium is dictated by sentiment because most closed-end funds are owned by retail investors."
So why should a retail investor (or an advisor, for that matter) invest in a closed-end fund?
"If you're investing for the long term and your true objective is just income, leverage can be beneficial," Goodson said. "Leverage can help a fund, but it can deliver greater volatility of the share price. It's important for shareholders to understand that."
Read more about RiverNorth at AdvisorOne.


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With Glee's third-season premiere less than three weeks away, Fox is revving up the McKinley High hype machine. The latest promotional gimmick: The release of the official and hilariously awkward 2011-12 class photos!
Glee Promo: Quinn's In the Pink, Finn Looks Blue, Brittany Is Planning [Spoiler]!
As you make your way through the slideshow, ask yourselves the following questions: Is there a hidden meaning to be gleaned from the varying backdrops? Which snapshot would you most likely want to carry around in your wallet? And, last but not least, where the hell is Ashley Fink?!
Flip through our slideshow, then tell us in comments who you think is looking good this school year….


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Annie Dookhan is not the first. She will not be the last.
Dookhan, who in 2013 pleaded guilty to 27 criminal counts involving obstruction of justice and tampering with evidence, was a chemist employed by Massachusetts to test evidence in drug cases. She was involved in thousands of them, and she routinely falsified evidence. For example, she declared samples positive for drugs without testing them and forged colleagues' signatures on reports. On Wednesday, Massachusetts announced that it was obliged to throw out 21,587 drug convictions secured with questionable evidence.
In September 2001, Oklahoma City fired forensic chemist Joyce Gilchrist. Gilchrist had been accused of falsifying evidence, though she never was charged with a crime. She had offered testimony in capital murder cases in which she claimed that DNA samples matched those of the accused — claims that later turned out to be false. Jeffrey Todd Pierce, who served 15 years in prison on a rape charge bolstered by DNA evidence that turned out to be false, sued Gilchrist and the district attorney for $75 million, claiming that they had conspired to falsify evidence. Oklahoma City settled. Curtis McCarthy spent 20 years on death row thanks in part to Gilchrist; his conviction was thrown out after the court found that Gilchrist had mishandled evidence and may have intentionally altered it. The Tenth Circuit Court of Appeals found that she had fabricated evidence in another capital case.
In the 1990s, Dr. Ralph Erdmann, a highly paid pathologist working for Lubbock County, Texas, ran into a spot of trouble: At one point he had misplaced a human head, and in one autopsy report he duly recorded the condition of the spleen of a man who did not have one. He kept blood samples in his home refrigerator, next to the mustard. He was eventually convicted of a raft of felonies involving evidence tampering and perjury. Local lawyers insisted that he was cooperating with the district attorney and providing whatever evidence was needed to produce a conviction. His tainted evidence helped produce convictions in at least 20 capital murder cases.
Dookhan received a sentence of three to five years and was shortly thereafter paroled. Gilchrist was never charged with a crime. Erdmann was sentenced to community service; he later was imprisoned on weapons charges and served two years. We go pretty easy on these kinds of crimes. We shouldn't.
It is strange — and wrong — that we permit this sort of thing to happen, and that our attitudes about police and prosecutorial misconduct remain so blasé. It is natural that we want to give the benefit of the doubt to the people involved in the difficult work of keeping society safe from criminals, but it is a fact of human existence that police and prosecutorial work is a magnet for corruption. Prosecutors have ambitions, and police officers have bills to pay. Prosecutorial abuse is a problem from Texas to Massachusetts to California, and practically every big-city police department in this country has at one time or another been penetrated by organized-crime syndicates or suffered other forms of systemic corruption.
This is a moral problem, but too often our moral insistence that this sort of thing simply should not happen blinds us to the fact that it does happen, consistently, and that we need to take prophylactic measures against it.
Consider, for a moment, the very popular idea of drug-testing welfare recipients. There is very little evidence that this produces lower rates of drug use on the part of welfare recipients, and no evidence at all that it lowers welfare caseloads — much less that it does so in a way that offsets or more than offsets the cost of the drug testing. It might conceivably have some effect on casual recreational drug users, but as anybody who ever has worked with full-blown addicts knows, they will give up a great deal (jobs, custody of their children, marriages, self-respect) in the service of their addictions. We would be far more likely to reduce welfare dependency by treating addiction than to reduce addiction by restricting welfare dependency. But the desire to punish is a permanent part of the human outlook, and it has its own demands.
Why not test police and prosecutors instead?
Trust in institutions is the lubricant that permits the machinery of an open society to run.
Not for drug use. We would be far better off applying a similar idea in the matter of criminal cases by having independent third parties randomly retest DNA samples, drugs, and other physical evidence in felony cases. Erdmann's autopsy reports were not only falsified — in many cases, he apparently did not perform the autopsy at all. Dookhan's work similarly would have been exposed by ordinary oversight measures that are routine in other settings. We do not need Sherlock Holmes to root out this sort of wrongdoing. We only need basic responsible action.
Expensive? Surely. But not nearly so expensive as retrying 21,587 felony cases linked to a single chemist or making restitution for wrongful convictions. Difficult and problematic? No doubt, but not nearly so troubling as the possibility of wrongly convicting innocent people — or, as the wiser among us will appreciate, of convicting guilty people on bad evidence. It may very well have been the case that every man and woman Erdmann sent to death row was 100 percent guilty as charged; properly understood, that question is irrelevant to the issue of falsifying evidence and other forms of misconduct on the part of prosecutors and their colleagues. A bogus trial that produces the right result is still a bogus trial.
And it is expensive to have bogus trials.
Not only because of the obvious costs involved in reopening cases or making multimillion-dollar payments to those wrongly convicted, but because a liberal society runs on trust. Trust in institutions is the lubricant that permits the machinery of an open society to run. We ought to be routinely reexamining the work of prosecutors and police officers in a systematic and regular way not because we expect to find widespread abuse and misconduct but because we do not expect to find them.
Trust has to be earned.
In the 1950s, outlaw motorcycle gangs briefly became a subject of national fascination, owing in part to Marlon Brando's performance in The Wild One. (Hunter S. Thompson's later exploration of the subject in Hells Angels was his best work.) A representative of the American Motorcycle Association is supposed to have remarked that 99 percent of all motorcyclists were decent, law-abiding citizens. Since that time, outlaw motorcyclists have proudly worn a patch reading: "1%."
Outlaw prosecutors, outlaw coroners, and outlaw chemists do not wear any such patch. And they probably don't even amount to 1 percent of the people with whom we entrust the enforcement of our laws and the administration of justice. But they are there.
What are we going to do about that?
— Kevin D. Williamson is the roving correspondent for National Review.


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Nation's educators applaud president's plans to invest in education
Making education a national priority is a way out of economic crisis
WASHINGTON - January 27, 2010 -
National Education Association President Dennis Van Roekel tonight expressed support for concepts outlined in President Barack Obama's first State of the Union address to improve elementary and secondary education in America and make it possible for more Americans to attend college.
The following statement can be attributed to NEA President Dennis Van Roekel:
"The President made it very clear tonight that he refuses to sacrifice the education opportunities available to Americans as a way of digging out of our economic crisis. A country that makes education a priority is a country bound for economic success.
"We applaud the President's promise to improve our schools by investing in what works. NEA members have worked years under the flawed No Child Left Behind law, so we are anxious to work with the administration to reauthorize the Elementary and Secondary Education Act in a way that celebrates successful students, educators, and schools. We know that reauthorizing this law won't be easy, but like the President, we believe the success of our children should not depend more on where they live than their potential. We don't know all the details of the proposals suggested by President Obama in his State of the Union address, but we agree with him that one of the best anti-poverty programs is a world-class education.
"We know that education helps to improve the standard of living for individuals and American families. We support the President's plan to transform the federal student loan program and make college more accessible for a greater number of Americans. It just makes sense to invest in our students, not banks and private companies. We especially like his proposal to forgive some student loan debt for students who choose careers in public service. And, we join him in urging the Senate to pass legislation to help revitalize community colleges.
"The need for a dramatic plan to create more jobs and put more Americans back to work has never been more urgent. We hope that the jobs bill will include additional funding to help rebuild and restore the nation's crumbling public school buildings. We know that safe and modern environments are essential for student learning and success. Our experience tells us that students learn better in classes with fewer students and that laying off educators is a sure path to stunting innovation and impeding America's prosperity. We thank President Obama for acknowledging all of this in the American Recovery and Reinvestment Act and we applaud his plans to build on that effort.
"Finally, we've faced some very tough challenges, individually and collectively as a nation. The President rightfully acknowledged the pain and sacrifices of working families over the past year. President Obama has demonstrated courage and leadership in tackling some very tough issues, but we know that the battle between policy and politics will continue. We move forward with confidence that with a shared vision for America, collaboration and hard work – the best is yet to come."
The National Education Association is the nation's largest professional organization, representing 3.2 million elementary and secondary teachers, higher education faculty, education support professionals, school administrators, retired educators and students preparing to become teachers.
CONTACT: Rene Carter (202) 822-7823, firstname.lastname@example.com


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Broncos coach Josh McDaniels has formally asked permission from the Buffalo Bills to interview their running game coordinator/running backs coach Eric Studesville.
Even though the Bills recently released their entire coaching staff, many assistants like Studesville are still under contract with the Bills and permission is still needed to interview.
Studesville would become only the Broncos' second running backs coach in 16 years. Bobby Turner, the Broncos' running backs coach for the previous 15 seasons, recently left to become associate head coach for the Washington Redskins and head coach Mike Shanahan.
Prior to his six seasons with the Bills, Studesville was the New York Giants' running backs' coach from 2001-03. His 1,000-yard runners include Tiki Barber, Willis McGahee, Marshawn Lynch and Fred Jackson, who has developed from an undrafted rookie from Division III Coe in 2003. Jackson spent two years playing in indoor football leagues, and a third year in NFL Europa before getting his chance with the Bills in 2007.
Mike Klis: 303-954-1055 or firstname.lastname@example.com


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Counselling - Listooder
Find a Counsellor or Psychotherapist within the area of Listooder
Found 13 listings
Mindhealth Counselling
Hillsborough, County Down, Bt266DQ
Mindhealth Counselling offers a private, confidential and non-judgemental environment where clients can discuss their concerns and difficulties with a professional and fully qualified therapist. [...]Distance: 9.45 miles.
Caroline Hazzard Psychotherapy
Belfast, County Antrim, BT7
Face to face psychotherapy and counselling. Completely confidential. Specialist in CBT for adults and teenagers. Children's emotional resilience workshops held monthly.Distance: 12.12 miles.
Marcus Campbell (Compass Consulting)
Belfast, County Antrim, BT9 6AZ
If you're thinking about counselling, maybe you're feeling confused, or overwhelmed, or stuck, or just tired of things never changing. Maybe you feel alone. I've had [...]Distance: 12.26 miles.
Darren Magee
Belfast, County Antrim, BT9 5LH
07771 797652
I am an accredited member of the National Counselling Society (NCS) and a registered therapist with the British Association of Counselling and Psychotherapy (BACP). [...]Distance: 12.26 miles.
Siobhan Magill Counselling
Belfast, County Antrim, BT5 5DY
Is life getting the better of you? Do your burdens seem too heavy to bear? Can you see no light at the end of the tunnel? Well [...]Distance: 13.19 miles.
Room Psychotherapy
Holywood, County Down, BT18 9HW
Room Psychotherapy offers CBT Counselling treatments for anxiety, low mood, anger, self-esteem and relationship difficulties. We are a small team of therapists and mental [...]Distance: 16.11 miles.
Newtownabbey Talk Therapy
Belfast, County Antrim, BT370TR
I provide affordable counselling in Belfast, Newtownabbey and further afield with the use of skype/phone counselling. I ensure a warm, safe and trusting environment, [...]Distance: 18.85 miles.
Lindsay Smyth – Hart Hypnotherapy Belfast
Belfast, County Antrim, BT37 0ZW
07833 353537
Making a positive change can be much easier than you think – and I can help you do it - using practical, evidence based [...]Distance: 19.83 miles.
AD Counselling Newtownabbey
Newtownabbey, County Antrim, BT36
Offering bespoke private therapy and healing, Newtownabbey and surrounding areas. Sessions are delivered in a safe, comfortable, confidential environment, imploring a warm professional approach [...]Distance: 19.93 miles.
Karen McCleary
Belfast, County Antrim, BT29 4FT
I am an Integrative Counsellor specialising in Cognitive Behavioural Therapy (CBT) proven to be affective therapy for Depression and Anxiety. Providing reflective space in [...]Distance: 20.01 miles.
SR Hypnotherapy and Counselling
Bangor, County Down, BT19 6LP
We offer a unique combination of Psychotherapeutic Counsellor and Clinical Hypnotherapy to treat all mental health issues. Starting with a free Initial Consultation, I offer [...]Distance: 20.65 miles.
Loretta Kelly Counsellor
Crumlin, County Antrim, BT29
We all want to lead happy, fulfilled lives but at times the problems we face leave us sad, stuck or confused. I believe that [...]Distance: 21.77 miles.
Joanne Watt Counselling
Antrim, County Antrim, Bt39 0jg
I offer a very private, comfortable and relaxed space, where you can have a regular time and safe place to talk through your challenges [...]Distance: 22.58 miles.


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Latest Trading Alerts
Here are our latest buy and sell signals. They are also sent by email to all our members.
A new signal is usually added after the market closes and is valid for the next day. The posted date represents the day when the signal is valid, not the day it was posted.
[Content protected for members only. Please login or become a member]


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Next: ax_try_awk_expout, Previous: ax_trilinos_thyra_epetraext, Up: The Macros
Run a test using the awk program found on AWK variable. The test being run has TEST-BODY as body and is feeded with TEST-INPUT. If successful execute ACTION-IF-SUCCESS otherwise ACTION-IF-FAILURE
This work is heavily based upon testawk.sh script by Heiner Steven. You should find his script (and related works) at <http://www.shelldorado.com/articles/awkcompat.html>. Thanks to Alessandro Massignan for his suggestions and extensive nawk tests on FreeBSD.
Download the latest version of ax_try_awk_anyout.m4 or browse the macro's revision history.
Copyright © 2009 Francesco Salvestrini email@example.com
Copying and distribution of this file, with or without modification, are permitted in any medium without royalty provided the copyright notice and this notice are preserved. This file is offered as-is, without any warranty.


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24mm Royal Blue Polyspun Barrier Rope With Gun Metal Black Cup Ends
24mm Royal Blue Polyspun Barrier Rope With Gun Metal Black Cup Ends
As standard, our Barrier Ropes are available in 1,2 and 3 metre lengths. but can be manufactuRoyal Blue to your requiRoyal Blue length.
Barrier ropes are ideally used for queuing systems and display protection.
These Barrier ropes are made with a polyspun rope. Polyspun is made from a soft acrylic fibre.
Barrier Ropes can be supplied with a fixed cup end, hook & eyeplates, or mixed to your requirements.
What You Get
- Rope in selected length
- Two Cup End fittings attached to the rope
- 6 x Matching screws to attach your barrier rope to your desiRoyal Blue location
- Brand: RopeServices UK
- Product Code: 4130
- Availability: Out Of Stock
- £25.00
Available Options
Tags: barrier rope, barrier, queuing system, crowd control, natural rope, rope fittings 24mm, royal, blue, polyspun, with, gun, metal, black, cup, ends, ropes


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Select a topic or year
More viewers enjoying High-Definition (HD) television programming means there are more bits being transported and consequently significantly more data than ever before for television broadcasters to capture, distribute, edit and store. The award-winning, seven-year initiative led by IBM and Fox focused on two areas: the integration of traditional broadcast transport and encoding standards with information technology (IT) industry open standards such as the LTO (Linear Tape Open) tape format; and the development and application of the LTFS (Linear Tape File System) in a broadcast environment.
"This combined effort of IBM and Fox Networks Group has led to major industry-wide improvements across digital workflows," said John Leverence, Senior Vice President, Awards for the Television Academy. "It's also provided vast reductions in the costs associated with capturing, storing and repurposing media content, while providing dramatic enhancements in transfer rates, storage density, automated workflow, and content availability."
By standardizing technologies in this way, Fox can now use open-standard, file-based tape in all aspects of production, post-production and distribution functions – displacing costly proprietary tape formats and/or disk subsystems. This provides media companies with the consumer equivalent of having their entire library of DVDs online and available at any time, and the ability to go to a specific scene, in any one of the movies, in an instant.
In the early stage of the technology initiative, the IBM/Fox team applied IBM-patented technologies invented by IBM Research for high-speed data movement. They also integrated traditional broadcast transport and encoding standards with IT industry open standards. This allowed either Standard Definition (SD) or HD programming to be available in real time for digital recording and repurposing -- with improved economics.
Initially used for the "NFL on Fox" HD broadcasts, this approach has since been expanded by Fox in terms of program content (MLB games, NASCAR events, and popular live shows in HD such as "American Idol" and "So You Think You Can Dance?"). As a result, Fox has achieved a dramatic reduction in costs to record, store and retrieve increasing volumes of digital video and audio content, regardless of whether it was SD or HD TV. For example, Fox achieved a 19-1 improvement in recording costs, and eliminated the use of manual tape handling as it migrated to this open standard environment.
"With the IBM project, Fox is lowering costs by using LTO and LTFS technology to improve our efficiency meeting current and future demands – while using broadcast standards already deployed in our operations centers and well understood by our technical staff," said Richard Friedel, Executive Vice President and General Manager, Fox Networks Engineering and Operations.
"The media and entertainment industry is experiencing a fundamental transformation which requires innovative new approaches," said Steve Canepa, General Manager, IBM Global Media & Entertainment Industry. "We're proud to be working closely with the industry to capture both the cost-advantages and workflow benefits enabled by standards-based IT technologies across all aspects of production, post-production and distribution."
About Fox Networks Group
Fox Networks Group consists of Fox Broadcasting Company (FOX), FOX Sports Media Group, the company's national and regional cable programming services, FOX International Channels and Fox Networks Engineering & Operations. These units produce, program and transmit much of America's most popular entertainment via 43 owned-and-operated TV networks, video on demand and other media platforms.
About IBM
For more information on IBM visit www.ibm.com/media
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News about IBM solutions for media and entertainment companies


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The International Food Blogger Conference is just a week away, and I wanted to share a few of my favorite places to eat in Seattle with everyone coming from out of town. I am a proud Seattleite, and I love showing off my city to visitors!
Monthly Archives: September 2013
My Seattle Food Picks for IFBC Attendees
Filed under Events, Filipino food, Reviews, Savory, So right, Sweet
Tagged as Asian, bacon jam burger, Bakeman's Delicatus, Bar del Corso, Bar Sajor, Beacon Hill, Belle Epicurean, brisket, Chinatown, Delite Bakery, Ellenos Greek Yogurt, falafel, Filipino food, Food trucks, frybread tacos, Green Leaf, grocery store, Hallava Falafel, historic menu collection, Hole in the Wall BBQ, Huong Bin, IFBC, Il Corvo, Inay's, Indian food, International District, International Food Blogger Conference, Japanese, Kau Kau, London Plane, Matt Dillon, Maximus Minimus, Monster Dogs, Off the Rez, pasta, Pike Place Market, Pioneer Square, pork, pulled pork, Rachel's Ginger Beer, Rain Shadow Meats, restaurant recommendations, roast duck, sandwiches, Seattle, Seattle hot dog, Seattle Public Library, silog, Skillet, Storyville Coffee, Sweet Iron Waffles, Tamarind Tree, Travelers Thali House, Uwajimaya, vegetarian pizza, Vietnamese, W Hotel, World Pizza