text:
"1) What is width of granite top (without spice or towel rack) 2) Is this available in antique white?"
Love this cart. We're using it in an office breakroom. Perfect....
Create-a-Cart White Granite Top by Home Stylesby Home Styles
ITEM#: 14182317Create-a-Cart is constructed of solid woods in a white finish with a salt and pepper solid granite top. This cabinet include four cabinet doors with 3 adjustable shelves, spice rack, towel bar, paper towel holder, and locking rubber casters.
- Materials: Asian hardwood, solid granite
- Finish: White finish, Salt and pepper solid granite top
- 4 cabinet doors open to storage with 3 adjustable shelves inside
- Handy spice rack and towel bar
- Paper towel holder
- Heavy duty locking rubber casters
- Dimensions: 34.75 inches high x 48.75 inches wide x 17.75 inches deep
Assembly required. This product ships in two (2) boxes.
Note: This product will be shipped using Inside Home delivery. The product will be delivered to the nearest dry area (front door, garage, etc.) of your residence. Signature required upon delivery.
|Casual, Contemporary, Traditional, Transitional
|Assembly Required
|Cart Type
|Kitchen Cart
|Counter Type
|Product Features
|See Details
|30 day Limited Manufacturer
|Model Number
|Country of Origin
Customer Reviews
Most Recent
Great quality - love the look & details
Love this cart. We're using it in an office breakroom. Perfect.Read More
Perfect piece for my kitchen
Did a kitchen reno on a vintage craftsman house. The cabinets were white black bases, white uppers, with salt and pepper granite. This island matched so perfectly it was as though it was custom designed for the house. Arrived in perfect condition and assembled easily. Great purchase.Read More
Couldn't be happier!! Took 2 hours to put together. Gives us so much extra room for storage.Read More
Honestly, masonite construction?Read More
Beautiful addition to my kitchen. Giving 4 stars only because the granite counter top was cracked. Overstock though is replacing it and it will be even better when we install the new top. Absolutely beautiful cabinet. On wheels, moves easily, love the side rack and towel bars.Read More
Most Helpful
Kitchen Cart, self assembly
Cart came totally dissembled, putting it together was fun. Most everything went together as the directions showed. The marble top arrived broken. I reported it the same day, with in 7 days a new top arrived. Fortunately, the company sent two replacement tops and one of them was broken so I ended up with one good top and sent the broken top back. When fully assembled and with the replaced top, we are very satisfied for the price.Read More
Not what I expected for the price
The granite top had a broken corner, the bottom piece of the cart also had a broken piece. Now I have to deal with returning it and waiting for a replacement.Read More
A slight miss
I was so excited to order this island for my kitchen, but was disappointed when it arrived. The design is great, the added storage is key, but the quality of the wood is not as good as I was expecting, especially at this price point. The granite stone was just as it shown on the website, overall i would say it's just meh. The 2 top drawers do not slide smoothly, they scrape against the stone top when they open and close which will have to be fixed somehow... The center shelf came completely damaged, however Overstock customer service was amazing! they really took care of this and I had a replacement shelf within a few days. I did keep the island because it would be a major pain to disassemble and repackage and send back. I don't hate it, but I don't love it either.Read More
Great deal, great cart!
Best price on the net, fast shipping, and a beautiful cart in the kitchen. This baby DOUBLED our counter space and gave us much needed extra storage. Add in the fact that it was easy to assemble and looks GREAT and you've got a winner. Thanks, Overstock!Read More
Ok for the price
Delivery was fast, but unfortunately the granite counter top has a resealed crack that can be seen and felt; disappointed because this item was supposed to be new and without defect.Read More
Questions & Answers
This counter top is approximately 44.5 inches wide x 35.5 inches high x 17.5 inches deep without the spice or towel rack. Unfortunately the antique white is currently unavailable. However, the white is available.
"Is the height 34.75 inches with or with out the wheels? Are they optional, is there an alternative included for the legs? Thanks!"
Hello natI3113, this item is approximately 34.75 inches high with the wheels attached. We do apologize, we do not offer this item with optional legs. Thank you for shopping with us.
"Why did you choose this product?"
What I was looking for--Price fit my budget Allen
"I want to put this cart in the middle of my kitchen, like an island. What does the back look like?"
Thank you for shopping with us sarahlilibit. It will have a finished back, the panels will slide between posts. Have a great day.
"Are all 4 cabinets separate storage areas or are any connected for a larger space."
Thank you for your question jrpopowich. There are three storage areas. The two doors in the middle open to a larger area that measure: 18 inches w x 23½ inches h x 14 ½ inches. The two side doors have their own storage each measuring: 8½ inches w x 23½ inches h x 14½ inches d. The small shelf is: 93/8 inches w x 145/8 inches d The large shelf is: 187/8 inches w x 145/8 inches d. Have a great day.
"This island would fit perfectly, if I didn't have to install the spice rack and towel rack. Do you need to put on the spice rack and towel rack or is it optional?"
Thank you for contacting us akrop62. You can leave both of them off during assembly. Please let us know if you have any further questions.
"Are there 2 working drawers on the top? The product information only lists 3 adjustable shelves. Thanks."
Yes, there are two functional drawers on this product.
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Urban Farmhouse Kitchen
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text:
Valentine gift/cardSubmitted by DorsetMartin on Tue, 2006-02-14 21:47
I made this potholder as a card for my guy.
I made this potholder as a card for my guy.
Here is the first pair of fingerless gloves. My friend Ken dyed the yarn and I love the way the colors play through. Keep my hands warm while reading the NYTimes. Hopefully this will get the picture up to the site. Still a bit of a dunce when doing this.
Here's a pig I made last summer. Ollie will always be the most handsome pig on MWK, but this guy (named "Pig") is royalty in our home. He's made from an 80-20 cotton-merino blend, which is very soft. This was a gift for my partner, who fell in love with it in a book we saw at a shop.
I learned a lot on this, my first "big" project. Foremost: learn to finish and seam for real before attepting something I intend to wear!
Japanese NORO Kureyon, brushed wool, numbers 88 and 138 (I think):View them here
Soak in cold water with Woolite or other fiber-friendly mild liquid soap. Nothing antibacterial or with anything that could be counted as bleach. Rinse in cold water
Just finishing the back of my latest sweater. I've completed one arm as well. Should be wearing a nice thick sweater just in time for a warm spring day...
My latest work done - nice warm sweater with hood also a drops - design 85-1
click here for english drops site
click here for the NORDIC drops - design site
Love and care Palle
Happy Birthday!!! Congratulations Charles Burbridge!!
I love your show in TV!!
I didn't get a scarf last Christmas, any left for me?
This is the Fluffy Collar as modeled by Sadie, our 9 year old Italian Greyhound foster. Doesn't she look fabulous? This is my first attempt at knitting with two strands of yarn, and my first attempt at knitting with a novelty yarn. I used Lion Brand Micro-spun sport in black, and Lion Brand Fun Fur in Purple on size 10.5 bamboo DPN's. I've got two other female dogs in the house who are also getting this collar, and two males who will get the Supersoft Collar from the same issue, done up in the sage Lion Suede.
Casting on with two colors separately
Recently I wanted to knit something using two colors of yarn from the cast-on row, but I didn't want to "wrap" the yarns. That is, I wanted to cast on 1 "stitch" of color A and then one stitch of color B.
So I did. I cast on 1 st of A, then 1 st of B, then 1 of A, then 1 of B and kept repeating that A/B/A/B cast-oning. (Might one call the Abba Cast-on?)
Then I PURLED the first row using ONLY color A. Then, turning, I purled right back in A on row 2.
Then for row 3, I purled using only B -- and purled back in B for row 4.

subset: commoncrawl


text:
Christine Sinsky, MD; Lacey Colligan, MD; Ling Li, PhD; Mirela Prgomet, PhD; Sam Reynolds, MBA; Lindsey Goeders, MBA; Johanna Westbrook, PhD; Michael Tutty, PhD; George Blike, MD
Acknowledgment: The authors thank each of the medical students who assisted in this work: Komal Dhir, Eyitemi Fregene, Michelle Kim, Timothy Nobbee, Timothy O'Dowd, Nirali Patel, Max Schmidt-Bowman, Fernando Vasquez, Kathryn Whittington, and Sylven Yaccas. They also thank Louis Shelzi (Dartmouth-Hitchcock), who supported training and fieldwork, and Sheree Crick (Australian Institute of Health Innovation, Macquarie University), who provided essential support for all WOMBAT work.
Financial Support: By the American Medical Association.
Disclosures: Dr. Sinsky serves on the advisory committee for healthfinch, a start-up that works on practice automation. Dr. Li reports grants from Mary Hitchcock Hospital and Dartmouth-Hitchcock Clinic during the conduct of the study. Ms. Goeders reports that the study was paid for by her employer, the American Medical Association. Dr. Westbrook reports funding from Dartmouth-Hitchcock Clinic during the conduct of the study. Dr. Tutty reports that the study was paid for by his employer, the American Medical Association. Dr. Blike reports a grant from the American Medical Association during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0961.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available to approved persons through written agreement with the authors from Dr. Li (e-mail, email@example.com). Data set: See Tables 1, 2, 3 and 4.
Requests for Single Reprints: Christine A. Sinsky, MD, American Medical Association, 330 North Wabash Avenue, Suite 39300, Chicago, IL 60611.
Current Author Addresses: Drs. Sinsky and Tutty and Ms. Goeders: American Medical Association, 330 North Wabash Avenue, Suite 39300, Chicago, IL 60611.
Dr. Colligan: Sharp End Advisory, LLC, PO Box 222, Hanover, NH 03755.
Drs. Li, Prgomet, and Westbrook: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia.
Mr. Reynolds: American Medical Association, 4622 North Damen Avenue, Chicago, IL 60625.
Dr. Blike: Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Building 50, Lebanon, NH 03756.
Author Contributions: Conception and design: C. Sinsky, L. Colligan, L. Li, M. Prgomet, S. Reynolds, J. Westbrook, M. Tutty, G. Blike.
Analysis and interpretation of the data: C. Sinsky, L. Colligan, L. Li, M. Prgomet, S. Reynolds, J. Westbrook, G. Blike.
Drafting of the article: C. Sinsky, L. Colligan, M. Prgomet, S. Reynolds, L. Goeders, M. Tutty, G. Blike.
Critical revision of the article for important intellectual content: C. Sinsky, L. Colligan, L. Li, M. Prgomet, S. Reynolds, L. Goeders, J. Westbrook, M. Tutty, G. Blike.
Final approval of the article: C. Sinsky, L. Colligan, L. Li, M. Prgomet, S. Reynolds, L. Goeders, J. Westbrook, M. Tutty, G. Blike.
Provision of study materials or patients: L. Colligan, S. Reynolds.
Statistical expertise: L. Li.
Obtaining of funding: C. Sinsky, L. Colligan, M. Tutty, G. Blike.
Administrative, technical, or logistic support: L. Colligan, S. Reynolds, L. Goeders, M. Tutty, G. Blike.
Collection and assembly of data: L. Colligan, M. Prgomet, S. Reynolds, L. Goeders.
Little is known about how physician time is allocated in ambulatory care.
To describe how physician time is spent in ambulatory practice.
Quantitative direct observational time and motion study (during office hours) and self-reported diary (after hours).
U.S. ambulatory care in 4 specialties in 4 states (Illinois, New Hampshire, Virginia, and Washington).
57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for 430 hours, 21 of whom also completed after-hours diaries.
Proportions of time spent on 4 activities (direct clinical face time, electronic health record [EHR] and desk work, administrative tasks, and other tasks) and self-reported after-hours work.
During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.
Data were gathered in self-selected, high-performing practices and may not be generalizable to other settings. The descriptive study design did not support formal statistical comparisons by physician and practice characteristics.
For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work.
American Medical Association.
Table 1. Definitions of Physician Work Activities and Tasks
Table 2. Interrater Reliability for Reference Testing Video
Table 3. Participant Characteristics
Table 4. Physician Time Distribution During Office Hours, by Task Category
Terms of Use
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Armand Rodriguez
September 11, 2016
An objective study that confirms what many of us have been saying for quite some time. And even these shocking results are probably an underestimation of the amount of time physicians spend "treating" the EHR instead of the actual patient. Physician efficiency, productivity and income decrease while frustration, helplessness and burnout increase. And yet our leaders in organized medicine and policy makers in government decry the shortage of primary care physicians and the growing popularity of the direct primary care model of medical practice.
Richard C Galgano, DO
Atrius Health
September 7, 2016
Describes my practice
To the editors, the study by Dr Sinsky et al, accurately reflects the distribution of time in my practice as well as those of my colleagues. While EHRs and new ways of communicating with patients may offer significant benefits, especially with respect to managing populations and improving communication, they also increase the workload and documentation requirements for clinicians. Before EHRs became widespread, I recall learning that the average appointment for an adult (primary care) patient, required 25 minutes to address 3 problems and complete documentation. Given the difficulty in retaining/attracting primary care physicians, addressing this issue is important.
Jeffrey Chi, John Kugler, Lisa Shieh, Junaid Zaman
Stanford University School of Medicine, Program for Bedside Medicine
October 2, 2016
It's not just the time spent, but how it's spent.
To the Editor:In their recent study, Sinsky et al address the growing concern that the electronic health record (EHR) is having on the physician-patient relationship, showing that only a fraction of a physician's workday is spent in with patients (1). While it is often lamented that we must do more to bring physicians back to the bedside, they were likely never there to begin with. Time-motion studies over time have consistently shown that physicians have always been burdened with indirect patient care (2). Rather than helping, EHRs appear to have only added to an existing problem. Nevertheless it is worth wondering why the problem of physician burnout is blamed on EHR, if it is not substantially changing the time we spend with patients. Perhaps it is the nature of indirect patient care that has changed. As Dr. Wachter illustrates in his recent book, "time used to be spent going to radiology and discussing cases and images in collaboration with other physicians, whereas now radiology images can be viewed virtually anywhere, saving a trip to the radiology department" (4). This can lead to today's physicians feeling challenged by information overload, responsible for sifting through data with increasing orders of magnitude. Information is not necessarily organized or optimized for physicians, because, unlike the paper chart of old, the industry leading EMRs are built for documentation and billing and not primarily for ease of use by physicians for patient care (3). Given the many automated time-saving features, EHRs have the potential to solve much inefficiency in healthcare, allowing for more time with patients. However, even the current generation of trainees who were raised on keyboards and screens will face significant challenges unless they are able to interact with EHRs that are intuitive, user-friendly and serve patients and the clinical team caring for them. If we can partner with EHR software developers to envision an ideal workflow, one that is time saving that optimizes use of clinical decision support to help providers do the right thing faster - we can then move towards a future where the EHR can synergize with our work rather than add to it. This study by Sinsky et al should serve as our reference point that we measure future success against. Any new system or work flow should look to see how much additional time at the bedside the "solution" provides. 1) Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, Westbrook J, Tutty M, Blike G. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016 Sep 6. doi: 10.7326/M16-0961. 2) Czernik Z, Lin CT. A PIECE OF MY MIND. Time at the Bedside (Computing). JAMA. 2016 Jun 14;315(22):2399-400.3) Zulman DM, Shah NH, Verghese A. Evolutionary Pressures on the Electronic Health Record: Caring for Complexity. JAMA. 2016 Sep 6;316(9):923-4. doi: 10.1001/jama.2016.9538.4) Wachter, R (2016) The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age. New York City, NY McGraw-Hill Education
Steven Bishop, MD; Jeffrey Kushinka, MD; Shin-Ping Tu, MD MPH
VCU School of Medicine
October 6, 2016
Time as Taxation
To the editors: This study by Dr. Sinsky and colleagues draws some unfortunate, but not surprising, conclusions. Their study gives weight to the concerns we and our colleagues have had about the practice of medicine for some time (1).Looking beyond this study, if you could add up all of the additional time (i.e. costs) layered onto the practice of medicine, you would find an extraordinary tax on the provision of medical care. "Physician burnout," "workload compression," and other issues related to this taxation on physician time are the subjects of much study and scholarship currently. However, we are concerned that not enough is being done to eliminate or reduce the actual taxation as opposed to just studying it. Physicians choose medicine to care for the sick, not to tend to endless documents and forms. We are trapped in something economists call "Harberger's Triangle (2)." Harberger's Triangle is a method of describing the "deadweight" created by taxation. A certain amount of physician time is available each day, and the time (and therefore cost) to complete each task must come from somewhere. As the costs of complying with tasks that don't improve patient outcomes accelerated, we now find ourselves in a situation where the utility of each physician is severely diminished. This destructive tariff creates a gap between the clinical care we could provide and what we are able to provide. "Rent-seeking" is another term for this accelerating tendency to create ever more complex regulations on physician time and resources." Rent-seekers create rules, fees, and regulations where none are needed in order to redistribute wealth to themselves without creating new value in the process (3). Physicians and patients need to recognize this valueless taxation on our time, mental energy, and finances. If we want something better, we encourage everyone to begin by calling these behaviors what they are: taxation--and on a massive scale. This taxation and "rent-seeking" steals time between doctor and patient, depletes the wealth of our society, and drains the joy from practicing medicine, all to tend to tasks of no value to patients or the profession. We need to start demanding evidence-based practice from our administrators and non-clinical colleagues. Start with this at your next departmental meeting: "why are you taxing my time with the patient and what is the evidence that this [insert new requirement here] will help them?"References:1. Sinsky C, Colligan L, Li Ling, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. Published online 6 September 2016 doi:10.7326/M16-0961 2. Hines, J. Three Sides of Harberger Trinagles. Journal of Economic Perspectives, Vol. 13, no. 2 (Spring 1999): 167-1883. Rent-seeking. Wikipedia. Accessed online 9/7/16: https://en.wikipedia.org/wiki/Rent-seeking
Jessica L. Colburn, MD, John R. Burton, MD
Johns Hopkins School of Medicine
December 12, 2016
Proposed Physician Retreat to Brainstorm Solutions
Sinsky and colleagues (1) in their excellent and provocative study of the allocation of physician time in ambulatory practice point out problems related to electronic health records (EHRs). In an accompanying editorial Hingle (2) encourages strategies to improve physician's use of EHRs. Clearly there are many benefits to the EHR. However, in at least general internal medicine and geriatrics many perceive the EHR to be too complex, not intuitive and user unfriendly. One suggestion to improve physician efficiency by improved EHRs follows: A major EHR company might sponsor in collaboration with the ACP a two day retreat for active physician users who have only average EHR expertise. About twenty physicians would gather to use the EHR to evaluate standardized patients scheduled in 20-60 minute time slots. A scribe would record the EHR problems that arise both from the perspective of the physician and patient. EHR experts would observe but not speak. The second day would be devoted to reviewing, prioritizing and designing strategies to fix problems. References1. Sinsky C, Colligan L, Ling L, Prgomet M, Reynolds S, Goeders L, et al; Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016; 165: 753-760.2. Hingle, S; Electronic Health Records: An Unfulfilled Promise and a Call to Action. Ann Intern Med; 165: 818-818.
David Serota
Emory University
December 13, 2016
To The Editor:
Sinsky and colleagues (1) have produced important quantification of the amount of hours spent with direct patient care versus electronic health record (EHR) work in modern ambulatory practice. Much of the lay press response to this study (2) has characterized the modern doctor's work as clerical paper-pushing. A pessimistic interpretation of these data portrays the downfall of "The Good Doctor" at the hands of their own technological advances. The amount of EHR interaction required of all physicians is increasing and will likely continue to increase. This study brings up important questions with regard to physician satisfaction and compensation for EHR work done outside of clinic visits; however, more EHR time does not necessarily equate to worse patient outcomes. While some time on EHRs is spent performing undeniably menial tasks, a larger portion of the time spent in the EHR is on tasks that improve patient care. I feel lucky to have come of age in a completely post-paper chart era. As I see patients at a Veterans Affairs medical center I am endlessly grateful to have access to more than 10 years of organized data on my patients. The difficult truth for some is that there are a new set of skills necessary to be a successful physician. Aside from the eternally important humanistic aspects of patient interaction, foremost among these skills is data collection, management, and interpretation. Much of the information previously obtained through face-to-face patient contact is now found in the EHR; often in a more organized and accurate manner than can be relayed by a patient or a disparate smattering of illegible hand-written notes. Much of the work we do on EHRs is useful, improves patient care, and is extremely worthwhile. Physicians and those in training should expect more EHR time but not assume that it is frivolous. The piece by Weinberg (3) in the same issue of Annals tells the story of an older classical "good doctor" overwhelmed by an EHR. He is juxtaposed against a cold and distant (but efficient) resident who is exceedingly nimble and proficient with technology. The moral of the story is to focus on human interaction with our patients rather than on getting work done expediently in the EHR. I argue that these two virtues are not mutually exclusive, and that physicians should be expected to achieve both. There is no virtue in running an hour behind schedule, as is the protagonist in that story. Just as I was reprimanded as a medical student for not knowing how to check a pulsus paradoxus, physicians should be expected to know how to chart quickly, extract data accurately, and enter electronic orders precisely as part of the core skills of being a physician. 1) http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties 2) http://www.forbes.com/sites/brucelee/2016/09/07/doctors-wasting-over-two-thirds-of-their-time-doing-paperwork/#68b1611f6e5d 3) http://annals.org/aim/article/2590891/coeur-d-alene
Brian Woods
St Francis Hospital, Roslyn, NY
December 14, 2016
Other clinical settings might have it worse (or better)
As an internist, intensivist, and anesthesiologist, I would like to see this study modality applied to the intensive care unit and the operating room. I venture that in the ICU, the ratio of EHR:patient use is much more, and in the OR, it is much less. Presumably these different ratios result from differing amounts of textual, imaging, or conversational information that require processing and documented responses in the three settings of ICU, OR, and clinic (high in the ICU, middle in the clinic, low in the OR), versus the actual hands-on patient interaction and intervention required (high in the OR, low in the clinic).
Join Y. Luh, MD, FACP
Providence St. Joseph Health
January 4, 2017
Clerical Burdens, Burnout, and Access to Health Care
This simple yet novel study by Sinsky and colleagues studying physician time allocation provides additional objective data underscoring the unreasonable clerical burdens placed upon physicians.(1) Tasks that were formerly handled by phone or via medical office staff are now electronic tasks that can only be entered or handled by physicians (ie, computer order entry), relegating physicians to the role of data entry clerks. The clerical burden on physicians from suboptimal design of EHR's has been exacerbated by additional regulatory burdens from CMS, such as the Meaningful Use program, which did not deliver on its intent to make EHR's better coordinated via interoperability.(1) Medical office staff spent significant time faxing and scanning documents between different EHR systems. Viewing scanned documents proved cumbersome, as it sometimes took several minutes to load each scanned document--flipping through a paper chart would have been faster. Taking this study together with a recent study by Shanafelt and colleagues that linked clerical burden and physician burnout (2), physician burnout is now a reality, especially when time spent on administrative tasks is double that of patient face to face time.(1) Sinsky's study focused on the administrative time spent on just day to day practice with current EHR technology, and does not include time spent on CMS regulatory mandates. With the increased reporting and regulatory requirements of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA),(3) there is a crisis that threatens the longevity of practicing physicians. Shanafelt and colleagues also showed how burnout between 2011 and 2014 translated to a reduction in the US physician workforce equivalent to about 7 graduating medical school classes.(4)The perfect storm of poorly designed EHR's, increased physician administrative workload, increased regulatory requirements that directly affect reimbursement, educational debt, and evolving maintenance of certification (MOC) requirements will undo the foundation of health care reform--making health care more accessible and appropriate. Physicians dealing with burnout by cutting their professional work effort via early retirement, pursuing non medical careers, or going part-time will exacerbate the present physician workforce shortage.(4) 1. Sinsky C, Colligan L, Ling L, Prgomet M, Reynolds S, Goeders L, et al; Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016; 165: 753-760.2. Finding Meaning in a Flawed Meaningful Use Program: Pathways Toward Physician Compliance. ReachMD website. https://reachmd.com/programs/everyday-family-medicine/finding-meaning-flawed-meaningful-use-program-pathways-toward-physician-compliance/7740/#sthash.8QdlBzeo.dpuf. Published July 29, 2016. Accessed January 4, 2017.3. Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models; Proposed Rule (CMS-5517-P). Letter to Andrew Slavitt, June 24, 2016. American Medical Association website. https://download.ama-assn.org/resources/doc/washington/macra-state-speciality-sign-on-letter.pdf. Published July 29, 2016. Accessed January 4, 2017.4. Shanafelt, T.D., Sinsky, C.A., Dyrbye, L.N., and West, C.P. Potential impact of burnout in the US physician workforce. Mayo Clin Proc. 2016; 91: 1667–1668.
Christine A. Sinsky, MD Michael Tutty, PhD Lacey Colligan, MD
February 6, 2017
Response to Letters to the Editor
We agree with Dr. Luh--many physicians feel they have become data entry clerks. This cannot be good for patients. The rise in burnout between 2011 and 2014[1], driven in part by the implementation of EHRs and associated regulation, translates into a reduction in the US physician workforce equivalent to the loss of 7 graduating medical school classes. If we included the decline in the effective physician workforce, as physicians spend less of their professional effort on work for which they are uniquely trained, the real loss is far greater.Dr Bishop and colleagues liken the time physicians spend on clerical work to a type of taxation, stealing time away from patients and draining joy from the practice of medicine. We would add that because many physicians try to accommodate the several hours per day of extra clerical work while preserving their time with patients, this "taxation" is often borne by physicians' families and their personal lives. Dr. Serota proposes physicians accept that a significant portion of their worklife will be spent on the EHR and suggests learning to get EHR work done faster. We agree that not all time spent on the EHR is frivolous, but we do believe that the 2-3 hours physicians of multiple specialties, ages and settings are required to spend on computer and deskwork for every hour of direct clinical face time [2, 3] is out of balance. Rather than ask physicians to do the wrong work more efficiently, we suggest first asking whether the work adds value to patients and if so, is it being done by the most appropriate person?Dr Serota suggests data management is a new skill for physicians, when in fact synthesizing, interpreting and contextualizing information has been a part of physician work both before and after the advent of EHRs. What is new is the role of the physician as first responder for incoming information and the responsibility for converting the clinical encounter into discreet digital data for multiple stakeholders and for subsequent audit. A physician of any generation who strategically delegates tasks according to ability is poised to maximally leverage the investment society has made in their training. And the organized physician community, working with vendors, payers and regulators to lessen the time costs of EHR-enabled healthcare, will support the Quadruple Aim [4]of better care for individuals, better health for the population, at lower costs, with improved well-being of the health professional workforce.1. Shanafelt, T.D., et al., Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings. 90(12): p. 1600-1613.2. Sinsky, C., et al., Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, 2016.3. Wenger, N., et al., Allocation of internal medicine resident time in a swiss hospital: A time and motion study of day and evening shifts. Annals of Internal Medicine, 2017.4. Bodenheimer, T. and C. Sinsky, From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med, 2014. 12(6): p. 573-6.
Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016;165:753-760. doi: 10.7326/M16-0961
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About 10 years ago, I put a few of my handmade folded fabric ornaments up on eBay to see if I could make a little extra Christmas money.
I had no idea that this one simple thing would one day turn into this website.
My adoration for making these fabric ornaments goes way back to when I was about 15 years old. One day my mom came home from the Ben Franklin craft store (remember those?), where she'd just seen a demonstration for making "quilted" ornaments. She'd brought home bags of supplies, and she, my sister, and I sat around for the rest of the afternoon, folding and pinning our hearts out.
I kept making them through the years. When I got married to my Marine love, we were pretty broke (we were young, and he was a Private) ….. so I started making my ornaments with any material I could get my hands on, even cheap dollar store ribbon. I loved making them so much that sometimes I would even take my old ornaments apart, just so I'd have pins and another styrofoam ball to use for the next one.
(This is how I learned lots of little ways to save on pins and materials. I made everything stretch!)
Right after I started my tiny business (okay….hobby) selling my ornaments online, tragedy struck our family. I became a widow and single mom of 2 very young kids. Not wanting to immediately put my kiddos in daycare so that I could go back to work, I decided to see if I could find a way to make my little ornament business support us.
That's when the beginnings of this site that you're on now took shape. Now you'll find not just ornaments for sale, but also tons of free ornament craft ideas and DIYs, along with several different folded fabric ornament e-Books that I've written.
I hope you will enjoy all of these ornament ideas and projects as much as I do! Just, be careful….they are addictive. Just wait until you find yourself folding every single material you come across into little triangles to see how it will look on an ornament. :)
I really appreciate you being here.
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This Alix East Cutout Bikini Top features a halter neckline, open front, and a racerback.
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The 71-room hotel is built around an old flour mill with a panoramic view of River Bulbourne threading through the property. This is an Old World retreat from bustling city life in picturesque surroundings, as well as a convenient getaway venue with plenty of spacious free car parking. It also offers wonderful amenities and hospitality for a relaxing stay, with convenient access to the area's tourist, industrial and commercial centres. The air-conditioned hotel has a lobby with 24-hour reception and check-out service, hotel safe and cloakroom. Guests may relax in the caf� or bar and dine in the restaurant. Conferences facilities, room and laundry services and WLAN Internet access are also offered to guests.The traditional rooms offer satellite TV, en suite bathrooms with shower and bathtub, tea and coffee making facilities, free wifi Internet access and a double or king-size bed. Other in-room amenities include a direct dial telephone, radio, ironing set and central heating.
By car: from the M 25 (junction 20), take the A 41 and leave at the junction signposted Bourne End, Boxmoor, Berkhamstead. From the M 1 (Junction 8), drive toward Hemel Hempstead and follow signs to Apsley, Bourne End and Berkhamstead. The nearest train stations are Hemel Hempstead and Boxmoor, 20 minutes from London Euston.


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Wednesday, December 17, 2008
Analysis of Recent SAT Rulings on Insider Trading and FUTP Against Dilip Pendse
The Securities Appellate Tribunal ('SAT' or 'Tribunal' ) recently set aside two orders (collectively referred as 'Impugned Orders' ) passed by market regulator i.e. Securities Exchange Board of India ('SEBI') against the former high profile managing director of Tata Finance Limited's ('TFL') Mr. Dilip Pendse. The Impugned Orders were passed on December 29, 2006 and December 28, 2007.
In Appeal No. 90 of 2007, SAT turned down the charges of insider trading stating that SEBI has failed to apply the fundamental principles of law. In Appeal No. 22 of 2008, SAT set aside SEBI's order of banning Pendse from trading in the securities market for his alleged illegal transactions in the shares of Global Telesystems Limited ('GTL') on the ground of lack of evidence.
Let us analyze each of the judgments separately.
1. Pendse and one Mr. Jaivant Talaulicar ('Talaulicar') were the managing director and director respectively of TFL and also directors of Niskalp Investment ('Niskalp'), an investment company and wholly owned subsidiary of TFL.
2. SEBI's investigation revealed that Pendse aided Talaulicar through counseling and organizing deals on his behalf in the shares of TFL and thereby violating insider trading regulations.
3. SEBI alleged that Talaulicar and his family sold one lac shares of TFL on March 30, 2001 through an off market transaction at negotiated price of Rs 69 per share to one JIP Investments ('JIP') which is a sub broker of JHP Securities Private Limited ('JHP') member of BSE. SEBI also found out that on the same day JIP received Rs. 70 lacs from JHP who received it from Niskalp. In other words, the purchase of the shares was funded by Niskalp. Later in May 2001 JIP sold these shares to a broker at prevailing market price of an average of Rs. 35 per share for which JIP received a consideration of Rs. 34.21 lacs. The total amount was far less than JIP paid to Talaulicar in March 2001. Talaulicar then paid a sum of Rs. 34.79 lac (the difference between the two sale prices). JIP paid this amount to JHP which in turn paid to Niskalp.
4. When Talaulicar was examined by the Adjudication Officer of SEBI ('AO'), he stated that he wanted a loan of Rs 75 lacs from TFL to purchase a house in Goa. Pendse being the managing director of TFL at that time denied the application as Talaulicar was a director and this would raise an issue under Section 295 of the Companies Act, 1956. In the circumstances, Talaulicar requested Pendse to sell off his (Talaulicar's) personal and family's one lac TFL shares. In consideration of TFL shares Pendse handed over cheques of Rs 69 lacs.
5. On the basis of the statement given by Talaulicar, SEBI was of the view that Pendse had aided Mr. Talaulicar by a way of counseling and organizing the transfer of shares on his behalf in a circular manner and thereby was guilty of insider trading and violated Regulation 3 of the Insider Trading Regulations. However, Pendse denied having committed any offence and specifically pleaded that he was not involved in any transaction with Talaulicar for sale of his one lac TFL shares. Pendse further requested for cross examination of Talaulicar.
6. The AO on a consideration of the material collected during the investigation came to the conclusion that Pendse had aided in organizing the trades on behalf of the Talaulicar. Therefore, under Section 15J of the SEBI Act, the AO imposed a monetary penalty of Rs. 150,000/- on Pendse.
SAT's Decision
7. SAT held that there was no evidence that Pendse handed over cheques for Rs. 69 lacs to Talaulicar as consideration for the sale of one lac TFL shares. The broker through whom the sale was arranged categorically denied the claim that anyone had approached him for funding Talaulicar or his family. Further, the Tribunal established that Talaulicar himself is an insider and did not require any counseling or assistance for trading of the above mentioned one lac TFL shares.
8. The core issue, whether Pendse was guilty of insider trading or counseling and aiding Talaulicar was decided by solely relying on the statement of the latter and without being validated through any other evidence. The AO has solely relied on the statement of Talaulicar for holding Pendse guilty. Failing to offer witness for the cross examination violates the principles of Natural Justice. Talaulicar ought to have been cross examined before holding Pendse guilty.
9. Further the SAT refused to accept the evidence gathered by the private body (i.e. investigation report prepared by the committee of Tata Group) on which the AO had relied, as the order of any adjudication authority ought to be based on an independent investigation and not be influenced by extraneous factors.
10. The Tribunal concluded that assuming the funds really flowed from Niskalp to broker and then to Talaulicar, there has been no evidence that Pendse was responsible for such alleged losses. Therefore, the SAT turned down the charges of insider trading charges as against Pendse on account of failure to adhere to the fundamental principle of permitting cross examination of a person on whose statement such charges were established.
1. SEBI received a complaint from TFL regarding the illegal carry forward transactions in the shares of GTL by Pendse. As per the investigation of SEBI, Nalini Properties Private Limited ('Nalini'), a company controlled by Pendse, had executed certain transaction in shares of GTL in year 2000.
2. The Show Cause Notice ('SCN') alleged that the transaction had actually not been executed and by only passing the book entries relating to this transaction, Nalini and others indulged in falsification of accounts and records.
3. On the basis of the allegation, SEBI debarred Pendse from dealing in securities market for two years for violating the Securities Contract Regulation Act, 1956 ('SCRA') and SEBI (Fraudulent and Unfair Trade Practice relating to the Securities Market) Regulation, 1995 ('FUTP Regulation').
SAT's Decision
4. The first allegation of SEBI was that Pendse breached Section 13 of SCRA. SEBI alleged that Pendse through Nalini executed "off-market transaction" (not being covered by spot transaction under Section 18 of SCRA), which is deemed to be invalid and illegal. However, Pendse argued that these transactions were clearly through a broker of the stock exchange and therefore they were in accordance with the requirement of the Section 13 of SCRA. The SAT accepted the argument of Pendse and ruled that Pendse did not violate Section 13 of SCRA. The SAT further rejected the argument of SEBI that transaction was in breach of notification under Section 16 of SCRA since the same was not alleged in the SCN or the SEBI Order.
5. The second allegation of SEBI was that the charge of violation of Regulation 6 of the FUTP Regulation i.e. Pendse sold 25000 shares off market to a broker at Rs. 1400 and when the shares were finally sold on stock exchange by Niskalp, the latter got a price of only Rs 125 per share. Thus there were substantial losses incurred by Niskalp through chain of fictitious transaction which was created by Nalini. TFL also complained to SEBI regarding the transactions which were created by Pendse. SAT rejected the allegation on the grounds that there was no evidence to show that the accounts and records were falsified to perpetrate the alleged fraud. Further it was pointed out that SEBI and SAT are not concerned with the dispute between TFL and Pendse .
6. Therefore, on the above grounds stated, SAT struck down the Impugned Order pending against Pendse.
After reading the judgments carefully one can observe that Pendse through his controlled companies and associates may be involved in some kind of circular trading. However SEBI officer while drafting of SCN and the Impugned Orders failed to gather proper evidence in support of the charges levied against Pendse and failed to incorporate all the grounds for providing their case as required under the laws of India.
Therefore the orders had to be set aside on the grounds of failure to adhere to the principles of Natural Justice. To avoid these kinds of situations in future, SEBI ought to streamline its investigation and adjudication processes so that its actions are not struck down on procedural grounds such as lack of evidence or failure to comply with natural justice, let alone on substantive legal issues. This will help the market regulator to work more efficiently and hold manipulators liable for their actions.
3 comments:
- Renu Gupta said...
A very basic question. How did the wholly owned subsidiary come to acquire shares of its holding company? This is clearly not allowed under the Companies Act, 1956.
- December 17, 2008 at 11:41 AM
- Renu Gupta said...
I would like to contribute a post. Since your email id is not available on this website, i am pasting the post below in this comments column, for your review.
"DDA flat allotment scheme 2008
Here are some news reports on the recently declared results of the housing scheme floated by DDA.
Some interesting facts and figures of this scheme:
1. Application forms sold = 12.64 lacs @ Rs.100 each
2. Total money amassed by DDA by sale of forms (non-refundable) = Rs.12.64 Crores
3. Number of flats available = 5,238 (another figure of 5,020 was given in the newspaper reports. For calculations in this post, I am using 5,238 as the correct figure)
4. Application fee per applicant = Rs.1.5 Lac
5. Eligible applicants = 5,66,906
6. Money received by DDA from eligible applicants = Rs.8,503,59,00,000/- (Eight Thousand Five Hundred Three Crores Fifty Nine Lacs Only)
7. Money to be withheld by DDA for 5,238 applicants = Rs.78,57,00,000/-
8. Money to be refunded by DDA for the unsuccessful applicants = Rs.8,425,02,00,000/- (Eight Thousand Four Hundred Twenty Five Crores Two Lacs Only)
9. Interest earned by DDA during September 16, 2008 and December 16, 2008 (last date of applications and date of draw) = Rs.120 Crores (as per http://timesofindia.indiatimes.com/Delhi/DDA_amasses_over_Rs_120_cr_in_interest/articleshow/3847761.cms)
Now when DDA sells only 5,238 flats. It has made some quick bucks here, see point 2 and 9 above.
DDA spokesperson Neemo Dhar said "we will give demand letter to all successful allottees by December 30. Also, we will try to refund all applicants who did not get lucky by December 30."
The application brochure revealed some interesting terms and conditions:
1. Eligibility - Only one person in a family can submit application. Family means spouse, dependent/minor children, if any. (This condition has been easily flouted by applying in the name of children (above 18) in the family)
2. Eligibility - There is no income limit. The applicant can apply according to his/her requirement and affordability. (Since this scheme aims at providing affordable housing to the masses, there surely needs to be an income level to exclude those already owing a residential premise, in their name or someone else's)
3. Other General Conditions – DDA reserves the right to alter any term and condition/clause of the scheme at its discretion as and when considered necessary. (This is too broad a discretionary clause, which is prone to abuse).
Thoughts: Interest earned by DDA from this entire scheme appears to be an unfair gain. As SEBI has recently introduced the ASBA (Application Supported by Blocked Amount) process for share application money, something on the same lines could be suggested in such housing allotment schemes. "
- December 17, 2008 at 1:25 PM
- bhushan said...
Dear Renu,
Thanks for your pertinent observation. In fact, I would like to clarify that Niskalp (the subsidiary of TFL) had funded the whole transaction. They did not purchase any shares of TFL (as that would have violated the Companies Act). I have made appropriate changes to the post.Thank you once again for drawing this to my attention and apologies for the inconvenience caused.
- December 23, 2008 at 6:59 AM


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This is a nice vacation from writing about Barack Obama and the Muslims. It's about Bud. You know …
You can't make this stuff up, really. Real life is so much stranger than fiction. I mean there was Obama's speech on terrorism last night. You know, the terrorism caused by Americans who exercise their right under the 2nd Amendment. That terrorism. Who could make that up? And I couldn't make this up either.
Bud Weisser, 19, was placed under arrest for trespassing at the Budweiser Brewery located at 9th and Arsenal in St. Louis.
Police say Weisser entered a secured area at the brewery after 6pm on Thursday. Security officers told him to leave and called police after an altercation.
Weisser was taken into police custody. He was issued summonses for trespassing and resisting arrest.
This is not Bud Weisser's first run in with the law. He snuck into a gas station in August 2014.
At the time of the gas station break in Bud was known as "Tex Aco." It's not known why he changed his name. But you can guess.
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|Patriots Look Poised For Another Super Bowl Run
|Bruins Trade For Drew Stafford
|Black and Gold Bruins Turn Yellow On Parade Day
|Inconsistency Will Continue For Bruins Unless A Change Is Made
Despite what the standings may show before the Thanksgiving break, this years Bruins team is on the right track. As of Nov. 23 the B's currently hold the second Wild Card spot with 22 points and have been playing inspired hockey as of late. Let me speak for the majority of Bruins fans here when I say that I've been pleasantly surprised thus far since I wasn't expecting this team to be as competitive as they are at this point.
My biggest concern entering this season, along with almost everyone who's followed the B's the past couple years, was their dull defensive group. On paper, they are one of the worst units in the entire NHL but so far, they've managed to not completely sink the teams and fans postseason aspirations. Granted they have had their moments where they look like they're fishing for swordfish in their own end, however it hasn't been as bad as it could be. Obviously, the white knight in this case has been the expected-unexpected emergence of Brandon Carlo.
The 19 year-old from Colorado Springs has stepped right into the top pairing alongside Zdeno Chara and has done just about everything that has been asked of him at this point. His big 6'5″ frame knows how to maneuver around the ice and his impressive poise combined with his simple, no-nonsense style of play has absolutely been a welcome addition to the Bruins backend. I will say that he certainly does look his age on the ice at times as he gets thrown around quite a bit and sometimes looks overwhelmed in the D-zone but all that comes down to inexperience and that will improve the more he plays. Basically, I don't think it's too much of a stretch to say Carlo has been a huge reason this team has been as successful as they are in the early-goings of the year.
Behind Carlo and the other five defensemen on the ice stands a man that was on the verge of being run out of Boston this fall in Tuukka Rask. However, after amassing one of the best starts of his career this season recording an 11-3-0 record in 14 appearances, it would be foolish to overlook the contributions Rask has made to the B's 11-8-0 overall record. To keep it simple, every game Rask hasn't started the Bruins have lost, and those games were missing the same feel to it with Rask on the bench. Not only that, but for the most part, Rask has been an imposing presence in the crease making the majority of his saves look very easy. If Tuukka can keep this up he's going to be in contention for the Vezina Trophy at the end of the season, alongside my favorite goalie in the league in Carey Price (sarcasm, of course) and could single-handily lead the B's to the playoffs for the first time in three seasons.
The last player I've noticed more than any other through 19 games has been David Pastrnak. I'm glad to be saying this because I really enjoy what Pastrnak has brought to the table since he's been on the roster and I think he's the true goal scorer the Bruins have missed since trading Tyler Seguin. Leading the team with 10 goals, Pastrnak has looked much more confident in the offensive zone stringing together some nice plays with Patrice Bergeron and Brad Marchand. The one concern I have surrounding his game though is his health. Similar to Carlo, Pastrnak is a young kid still developing muscle and is more at risk to injury because he's on the weaker side. It's been an issue in the past and it has popped up already this season, so if anything will hold him back this year, it'll be the injury bug. Other than that, it's clear that his overall game is starting to show improvement as his back-checking alone has improved ten-fold, as well as his defensive game in general, and it'll be critical once the big games roll around in February and March.
Like I said, while the B's haven't been tremendous so far, they also haven't looked dreadful. This team really didn't have much roster turnover and the new guys on the roster, with the exception of David Backes, are all young players still trying to fill a role so at least to me, it's hard to be upset with the results we've gotten so far. As a team, they seem to be a lot more likeable than in years past and I feel like that comes from their tendency, at least until now, to not give up in games. Other than an embarrassing 5-0 loss to the Minnesota Wild on Oct. 25 and two 5-2 losses to the New York Rangers, every game they lost was a back-and-forth game that I felt they had a good chance to win.
Look at their most recent game against the St. Louis Blues, a couple bounces go their way and they more-likely-than-not walk away with a win against a predominantly top Western Conference team. A 3-2 loss at Montreal also comes to mind in this example as the B's were the better team in this game, but just couldn't muster a goal past Price. This could be the most important aspect to this years team because as we all know, part of the reason they've failed to make the playoffs was their inability to win big games down the stretch. If they are showing some heart now, I can't imagine that'll disappear once the games become even more important down the line.
When it all boils down to it in April, we'll look back on this start and the towering play of Carlo, Rask's extraordinary start, the superb play of Pastrnak, and the overall pride this year's team possesses and be shocked. Hopefully it'll be a positive shock because they didn't get a higher seeding in the playoffs, and not a negative shock if they fail to make the postseason, again. Now that would be something I would not be thankful for.
Tags: Boston Bruins, Brad Marchand, Brandon Carlo, david backes, david pastrnak, NHL, Patrice Bergeron, Tuukka Rask, Zdeno Chara


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Our mission: To protect and enhance the quality of life for domestic, farm and wild animals in B.C.
Your gift can help save lives. The BC SPCA is a not-for-profit organization that relies on public donations to protect and enhance the quality of life for domestic, farm and wild animals in British Columbia. Funds donated to the Cowichan & District SPCA will be used to help animals in your community.
Celebrate a birthday, wedding, the memory of a loved one or create a fundraising challenge by requesting donations in your honour or in memory of a special animal lover or pet. It's quick and easy to create your own unique champion page. You'll be guided through steps to invite friends and family to support the Williams Lake & District Branch BC SPCA and help you personally thank each one!
Our branch relies on donated items for the day to day care of animals in need.
Our branch can benefit from the points accumlated through affliated corporate reward points programs. The following are the reward programs with which we are currently involved. Click on the link for more information, and to find our specific branch information that you'll need to participate.
Your legacy is important because it represents the values that you stood for in your lifetime. It is a statement to the world about who you were and your belief in a better world for all living things.
If you choose the BC SPCA as one of your beneficiaries, you will be helping to provide love, care, and compassion to future generations of animals in British Columbia. Visit our main support information section to learn more.
We salute and honour our friends in the community.
Our signature event of the year is always a great success raising much needed funds for animals in need. But we couldn't do it without your help. Learn more about registering to participate or volunteer.
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Vision in leadership is important. So is focus.
Ford has installed a "visionary" as its CEO. But without enough focus to go with that vision, Ford may end up just spinning its wheels.
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When Bill Ford handed over his job to Mulally, he had his back. It worked. He needs to make that a priority again.
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Wall Street still harbors its doubts about General Motors, but CEO Mary Barra's leadership team deserves credit for making considerable progress on one of the business world's most daunting challenges: fixing GM's deep-seated, dysfunctional culture.
Volkswagen's concept of responsibility for its misdeeds seems to tail off the further up the corporate ladder investigators go.
Today's GM can act more decisively because its finances are not only more stable, but also more transparent. Thanks to an accounting system overhaul that Dan Ammann spearheaded as CFO, GM has much clearer intelligence on the performance of its various markets, subsidiaries and product lines.
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Volkswagen hasn't yet publicly released the findings of an internal investigation. So much remains to be disclosed about who at the company enabled the conspiracy to cheat on diesel emissions tests.


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New Volkswagen Systems Aim for Accident-Free Driving
Volkswagen has reaffirmed its dedication to developing driver assistance systems to significantly reduce traffic fatalities under the automaker's "Vision Zero" concept.
Currently, the German automaker is focusing on improving the perception of the vehicle's surroundings and events in traffic, finding ways to assist the driver in challenging traffic situations, helping improve the safety of vehicle passengers and others in traffic, and new ways to help drivers avoid accidents and serious injuries.
One of the technologies that Volkswagen is introducing are parking assistants, a system that enables automatic parking and exiting from narrow spaces through the use of a smartphone or remote control. The system would be useful in scenarios where the car can fit, but not with enough space to open the doors.
In addition, the automaker is also looking into developing a technology that could help vehicles navigate automatically through road construction zones, along with systems that take control of steering in a medical emergency and help safely brake the vehicle to a stop.
Discuss this story at VWForum.com


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Ernie Hecks has been playing some lilting dance music at San Francisco's Fairmont Hotel but it's only been within the past years that the disk-buyinq crowd has caught up with him. Here again art the smooth Heckscher sounds on pops and show tunes for more dancing and listening pleasure.
As samplers go, this is one of the best. An excellent cross section of artists from the Stockfish catalog. I am especially taken by the cuts from Alan Taylor ("The Beat Hotel" in particualr) and Chris Jones. Sonics are clean, clear and crisp, with an exceptional sense of timbre. I've purchased a few of the CD's of the artists I've heard on this sampler, and I'm here to tell you, they sound great to - though they can't beat these SACD tracks.
Since the release of Stockfisch's first SACD sampler, the audiophile label has recorded and published many new Stockfisch productions including well known artists of the singer/songwriter scene as well as so called 'insider tips'. Listen to 15 new tracks, 70 minutes on this Hybrid-SACD! Just like Vol. 1, this second Stockfisch collection Closer To The Music Vol. 2 offers on its 15 individual tracks a wide musical variety. These recordings, as any listener will experience, exemplify once again the Stockfisch philosophy: closer to the music!
This is the third compilation from the critically acclaimed 'Closer to the Music' sampler series. You will listen to recent recordings of known artists like Sara K. , Allan Taylor, Eugene Ruffolo and David Munyon , but also to new Stockfisch-discoveries like Dennis Kolen (NL), Paul O'Brien (CDN), BEOGA (IRL), Carl & Parissa (AUS), Beo Brockhausen (D) and more. These recordings, as any listener will experience, exemplify once again the Stockfisch philosophy: closer to the music!
And again this 4th compilation offers both a selection from current releases and presentations of artists and albums that will be released by Stockfisch Records in the next months. Belonging to these forecasts you can hear two tracks from the new Paul Stephenson album, who already had recorded two CDs for Stockfisch. Furthermore one song by Zebra Sommerwind, the trio around Fiedelmichel-doyen Thomas Kagermann, featuring German (folk-)songs in contemporary arrangements.
Just as it's four predecessors did, the compilation "closer to the music Vol.5 " provides an aural overview of the latest and the forthcoming Stockfisch productions - this time for 2015. More than 79 minutes of unusual recordings and fascinating music.


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4:00, Tea
5:00, Walk/reflection/journaling/personal time
5:30, Yoga class
7:00, Supper
8:00, Review of the day followed by guided meditation


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Job satisfaction, making enough money, and being close to familyKacie
Can we possibly have it all? Can Shane have a job that fulfills him, pays enough money, and lets us live close to family? I don't know if we can have all three things at once, but we're going to try.
Shane and I have been living in Pittsburgh for almost one year. It just isn't the right city for us. We're way too homesick. We belong in Bloomington, Ind., and that's all there is to it.
With a year of being pretty miserable here under our belts, and now with a baby on the way, it's becoming more clear that we really do want to move back to Bloomington. But, is that the absolute best decision for our family?
Bloomington doesn't have a huge job market, and it could be quite difficult to find a relevant job there. It's not a big city (less than 100,000 people) and I don't know if he'll be able to find something that fits his skillset, fulfills him, and also pays enough.
It's almost guaranteed that if we move back, Shane will take a pay cut. The cost of living in Bloomington is supposedly slightly higher than it is here, but I think we can find a cheaper apartment there. And, the city has an Aldi (and CVS and Rite Aid) so we'll be able to get our groceries and toiletries for a low price.
If we live in Bloomington, we'll be near his parents and most of his extended family, who live in the city or the nearby towns. My family lives one to two hours from there. It will be amazing to be able to see them more often!
Plus, I really love Bloomington. I lived there for four years, from the time I was a freshman at Indiana University until graduation. The summers are incredible, but even during the school year, the city is a great place to be. The restaurants, festivals, general atmosphere, the people, and even the scenery. I love it all.
With Shane's current job, we're expecting to move to a new city within the next few months anyway. When he took his position within his company, it was a year-long program, and then he would be transferred to a new position. None of the possible places (too many to mention) are all that close to home.
Don't forget that we're expecting our first baby in December. Our current insurance will pay most of our baby-related expenses, and our out of pocket totals will be about $280, which we should be able to pay with our flexible spending account.
It's hard to say what our health insurance situation would be if Shane took a new job somewhere. If we needed to, though, I think our emergency fund could cover our expenses, if we found ourselves under or uninsured.
In my mind there are a few possible scenarios:
1. Shane takes a new position with his current company. The new position is also in Pittsburgh. If that happens, we would want to stay in our apartment for another year, renewing our lease for $770/month.
2. Shane takes a new position with his current company, but in a different city. If that happens, we'd break the lease (with 60 days notice), and his company would pay the $770 for us to get out of it.
3. Shane takes a new job with a new company in or near Bloomington. If we break our lease, that $770 comes out of our own pocket. But, if we change to a month-to-month lease, we'd pay $820/month, or an increase of $50 per month.And, if we knew that we'd be staying in Pittsburgh after all, we could change it back to a year-long lease and bump our rent back down, with a possible credit on that extra $50/month paid.
So, what in the world do we do? Do we try to maintain or increase our income, even if that means Shane possibly won't enjoy his job, with us living a day's drive or more from family? Do we stick it out for a little while longer in Pittsburgh so that our baby's birth is paid for? Or do we move home, possibly paying thousands of dollars in moving expenses and more, but have an entire support system of family near us?
Here's what I think we're going to try. We're going to renew our lease on a month-to-month basis. We'll spend the next month or so trying to find a great job for Shane in Bloomington. It should be in a healthy work environment that values its employees. It should pay at least $35k with some form of health insurance.
Is that really too much to ask? I don't know. Please keep us in your prayers.
Have you ever faced similar decisions? What did you do?
23 Responses
to "Job satisfaction, making enough money, and being close to family"
By Joanna on May 23, 2008 | Reply
You've demonstrated you guys can live on less than what Shane currently makes- significantly less- so the pay cut would impact really long term goals (like maxing out the 401k) but would not impact your current standard of living. Bloomington's a great town, and, as you said, I think you can find cheaper housing than what you're paying now.
You could also consider moving to Indianapolis, right between both your families, and with better job prospects. I hear there are some pretty cool fellow bloggers that live there, too ;-)
Joanna's last blog post..Connor is two!
By Marie on May 23, 2008 | Reply
I think that your happiness is most important. You seem to be incredible at stretching a buck and I think you will be able to be sucessfull in either situation. I would pick the one that brings your family the most happiness.
Marie's last blog post..Its O fficial
By Tenille on May 23, 2008 | Reply
It sounds like you have a good plan so far, how exciting!
And remember, whatever new job he takes in Bloomington doesn't have to be forever, he can always keep looking, but I think being around family is a way bigger factor to happiness than job satisfaction, personally!
I'd just build up as big of an emergency fund as you can between now and when baby arrives, just in case.
Tenille's last blog post..Call Me Ishmael
By Manch on May 23, 2008 | Reply
Kace, I'm going through the same thing, but with fewer complications. I love reporting in Richmond and being so close to family, but living here is neither inspiring nor fun. Every day I think about moving, and when I visit friends in larger cities (YOU, even those in Indianapolis) I think about how wonderful it would be live there, among other young adults. Seems to me it's the sort of thing where you just have to do what feels right and not look back. What is the thing you think about doing every day? Do it. And make it work. I'm currently working on taking my own advice …
By Heather on May 23, 2008 | Reply
I think happiness with work is a big deal. I stopped teaching when my 1st son was born. For the first 6 months my husband came home almost every day telling me tomorrow he may just quit. It was awful. It got to the point where I would have been happy for him to do that. Luckily he found a job that he loved and was still in the same city (where my family is.) Overnight everything changed because he was happy at work again. So my advice & prayer for you is that your husband finds a job where he is happy. Once that happens everything else will fall into place easier.
Heather's last blog post..Don't plan to loose weight right before a birthday
By Marianne on May 23, 2008 | Reply
Kacie, I read your blog daily and occasionally comment, too.
I've lived this exact situation. Exact.
Two things:
1) Family is everthing; and
2) You only have one chance to live life – don't settle for your second choices if hard work and sacrifice will get you where you want and need to be.
I'm going to email you offline and share my thoughts so I don't leave a book here!
By Lisa on May 23, 2008 | Reply
As an old person here (46) I'd say birth is pretty unpredictable and a c-section without insurance can ruin you financially. I'd go for the paid-for birth and THEN find the job in Bloomington / Indy. Two years experience on a job can be a big help too. That said, I also know an EXCELLENT head-hunter who might be a help. The employer always pays the fees–not your husband. You can contact me at my email if you'd like that name.
But, I agree that FAMILY is a very big deal–esp if you'll be a stay-at-home Mom so you won't get too isolated.
And, finally, no one who graduates from IU ever wants to leave Bloomington!! I know–I've tried for years to get a job there! My Mom's family is from there and built many of the homes surrounding the campus!
By Kristy on May 23, 2008 | Reply
I agree with most of the other commenters, Kacie. Family is everything…and will become even more so once the baby arrives. I can't begin to tell you how much you'll appreciate their help and advice after the baby.
You guys are great managers of money. If I were in your shoes, I'd begin job hunting in Bloomington or anywhere much closer to home. Shane has the next 35+ years to work. But, you've only got one chance to raise this little one near family.
Good luck with whatever decision you make. I know you will weigh all of your options carefully!
By Kacie on May 23, 2008 | Reply
Thanks for your perspective, everyone. It's nice to know that we're not totally alone!
It's a stressful time, for sure. We're going to do our best to do this as rationally as possible, so we don't end up having regrets later.
Even if we can't move to Indiana right away, it's our eventual goal, and perhaps we can get there within a few years at the absolute latest.
Thanks so much for sharing your stories and offering encouragement!
By Kristy on May 23, 2008 | Reply
I become more and more convinced as I get older that following hard after the life you want is really the only way to live. Look hard for jobs – you would be surprised how quickly things can fall into place.
Kristy's last blog post..challenge (day three).
By Lori on May 23, 2008 | Reply
Kacie, I was in a very similar situation with the birth our son Goose. The only difference is we were only two hours away from our possible new home, not a day. Let me tell you – happiness is the most important thing. The money situation will fall into place with prayer and trust in God. When we found out I was pregnant, we had to make some decisions about work – we could have stayed where we were with hubby completely miserable in his job, or we could take the plunge and move and pray for the best outcome. We moved two weeks before my due date, and I had to drive two hours each way to my doctors appointments for two months because they wouldn't let me switch docs so close to the due date. Hubby started work one week before we moved. I was SO SCARED the baby would come before we moved and I'd have to drive two hours away to the hospital where my doctor was. But it all worked out thanks to a lot of prayer. We took the happiness route and let God take care of the rest. And he did. Keep in mind – most group health insurances cover pre-existing conditions. So if you're husband does get a new job with insurance, you will most likely be covered, so the money for labor and delivery or c-section shouldn't be much of a problem. And if it is, consider a birthing center, they are much cheaper than hospital births and WAY less likely to result in a c-section. A great video to watch about this is "The Business of Being Born". It's excellent. Good luck to you!!! :)
By Bethany B-A on May 23, 2008 | Reply
Well, I'm biased, because when I visit home, I'll have a 99% better chance at seeing you.
But other than that, really, being happy is the most important, whatever that means to you and Shane. You could consider finances, but you'll be doing less traveling and I bet things in Indiana (outside of Hamilton County) are just as cheap, if not more so, than Pittsburgh. Maybe Shane will have a shorter (and cheaper) commute and your in-laws can help with babysitting.
I also agree about the birthing center/doctor thing. I don't know if Btown has a birthing center, but since you know more people there, you can get a better recommendation for a doctor or midwife that will give you the care you need that will avoid a C-section or other costly, and many times unnecessary, stuff in that department.
Money isn't everything, even though you need it, especially with a baby on the way. I somehow don't see you regretting a move there, as long as it's what Shane wants for his career, because being happy in your job is SO important.
Bethany B-A's last blog post..Weekend in San Fran
By ashley @ twentysixcats on May 24, 2008 | Reply
I understand your longing to be somewhere and be so far away from family. I grew up in South America, and I missed the States and my grandparents soooo much. But, that's where God wanted us and now I'm back here. :-) (Of course, I'm not saying that God doesn't want you in Indiana – that was just our situation.)
I think there are two ways to look at it: 1) Family is soo important, and I think there is a lot to be said for intentionally staying nearby. 2) In ten years, two years in one place may seem like a blip in the radar. It seems interminable now, but you might find this a really growing time for you. Also, just keep in mind that for Shane's career it might look better on a resume if he had a few years under his belt. My husband did the same thing – worked for a year and then moved to Atlanta to be with me and started a new job. Everyone told us that he should stay at his current job for several years because otherwise potential employers may consider him a "flight risk". That doesn't mean Shane SHOULDN'T get another job now, but it's just something to keep in the back of your minds!
ashley @ twentysixcats's last blog post..time of my life
By Homemaker Barbi (Danelle Ice-Simmons) on May 24, 2008 | Reply
Your dilemma does sound very difficult. It can be so hard to weigh choices when you have to add in the element of the unknown (job market, housing availability, etc.). I wish you and your husband luck in whichever decision you make. No matter how it turns out, take comfort in the fact that you are making the best choice with the information you have, and you can't do any better than that!
Homemaker Barbi
By T on May 24, 2008 | Reply
I think I'd pray long and hard for a clear answer before jumping into something. Have you ever done Experieincing God? Might be worth your time before making a huge change in your lives. We're military and family has never been close- #3 is due any minute- and one assignment was a post-Soviet country for 2 years. Miss them? Sure, but wow, has God filled in the gaps and richly blessed us. I have confidence that God wants nothing more than to give you more than you could even imagine…
By S.B. on May 25, 2008 | Reply
Hi Kacie,
I will keep you in our thoughts and hope Shane gets a job close to home. I think you have to do what will make you guys happy and be near your family.
I live close to mine and M.B.'s parents and they've helped so much with the baby and its a real source of joy for them.
You two are so financially savvy – you can live on less. Good luck.
S.B.'s last blog post..Rite Aid Free After Rebate Item – Week of 5/25
By Jennifer Gaffron on May 25, 2008 | Reply
I have been checking in to your blog every so often and I have found some helpful tips. I work in downtown PIttsburgh, just like your husband. Honestly, I don't understand why you can't get a job outside of the house so that you can help your husband save money for a potential career change. I have been married for two years, and my husband has a good job, and I still work full-time so that I can work with my husband to meet our financial goals. I understand that you're pregnant. However, I intend to start trying to start a family soon, and I fully intend to keep working after I become pregnant.
By Marcy on May 25, 2008 | Reply
I'll say a little prayer for you. In the end you'll know what the best decision is for you and your growing family. It just might take a little bit of time to figure it all out.
Marcy's last blog post..Our Decision about Sam's Club
By Mommy Cracked on May 25, 2008 | Reply
No advice…just lots of prayers and good wishes.
By Kacie on May 25, 2008 | Reply
Hey Jennifer,
Thanks for your concern about our money situation. It's true that I'm not working outside the home. However, I am working as a freelance writer, and I'm bringing in quite a bit of income from those ventures.
My husband and I definitely want me to stay at home with our baby, and working from home now will help me get ready for that.
To each her own. Thanks for reading.
By John Hunter on May 25, 2008 | Reply
Prioritize happiness over wealth. Certain economic realities cannot be easily ignored but far too many people focus too much on their annual salary. It is one factor but should really be much less important than many make it.
John Hunter's last blog post..Economist Challenges Government Data
By Crazykinux on May 26, 2008 | Reply
Hi Kacie,
I've only been reading your blog for a short time now, but having gone through a similar situation 6 years ago, I'd say start working on a plan to move back to Bloomington. as soon as possible. I'm sure you're husband can find the appropriate job – one he enjoys, pays well and is in or around Bloomington.
Way back in 2002, my wife and I we're both working in Toronto (Canada) and really missed our friends and family back in Montreal (about 6 hours away). So we made a plan that whom ever found a job in Montreal first, the other would follow. I was the one who found a position, and though the pay wasn't as good as in Toronto, I can tell you that it was the best decision we ever took.
I wish you the best and will look forward to reading that future post of yours on how you're now living near Bloomington!
Cheers, from a Canadian fan!
By Becky@FamilyandFinances on May 27, 2008 | Reply
I'm with everyone else – family is so important!
My husband and I would both enjoy living further south than our cold home in Wisconsin. ALL of our family is here, though, and no amount of warm weather could ever replace them. So, Wisconsinites we will remain :)
I'll definitely pray that God will open the doors He wants you to go through and that He will lead you to where you need to be!
Sorry, comments for this entry are closed at this time.


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The Smartphone has become the digital Swiss Army Knife of modern life. Beyond making phone calls, it takes pictures and videos, facilitates purchases, connects us to our social networks, helps us navigate around town and runs applications for almost any imaginable purpose — including one you couldn't imagine.
Today's Smartphone is a high-powered microcomputer; incredibly, now all that computing power is being harnessed collectively for the greater good, in the search of a cure for the Zika virus.
Most of us walking around with these mini-miracles in our pockets and purses cannot imagine life without them — so much so that it prompted President Obama recently to suggest that we might even be "fetishizing" them. But he might want to rethink that with news of the #OpenZika project.
The research project, spearheaded by IBM's World Community Grid, is a tech platform that turns a network of volunteers' personal computers, as well as Android smartphones and tablets, into a virtual supercomputer.
Volunteers who download the World Community Grid app authorize researchers to run calculations on their devices, running virtual experiments on compounds that could become components in creating an antiviral drug to combat the mosquito-borne virus.
There are roughly 2.6 billion smartphones in use around the world, and an additional 1.4 billion smartphones are sold every year, according to Consumer Technology Association research. In many developed economies, there are more smartphones than people, and ownership rates are growing even in the most remote corners of the world.
Smartphones are so popular they continue to erode landline ownership, which has dropped to roughly 50 percent of American households. They have also sidelined millions of digital cameras, a device owned by 80 percent of Americans as recently as 2011. Today, only 61 percent of us own digital cameras. We are quickly and enthusiastically migrating our offline and online activities to our smartphones.
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About a_placebo
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a_placebo posted a topic in Application Installsi have been trying to silenly install and register steganos security suite 2006 v8.0.2 and internet anonym 2006 v8.0.1. I can install them silently by extracting the msi for them exe and using the /qb switch but then i try to enter the serial number by regedit but it doesnt work heres the reg file after silent install/reg when i run program for first time it still asks me for the serial number, anyone out there done it yet?
a_placebo replied to a_placebo's topic in Unattended Windows 2000/XP/2003i still cant get an 7GB iso to boot in my vitual machine it just hangs on the detecting hardware stage. has anyone got any other ideas or suggestions. I tried making the ISO in UltraISO but still didnt work, maybe i got some of the settings wrong. Is there a limit to the size of file names or CaSe or any other restrictions in the ISO format that i should know about? Please help
a_placebo replied to a_placebo's topic in Unattended Windows 2000/XP/2003I shall certainly give it a try tonight, but what settings would you suggest?
a_placebo posted a topic in Unattended Windows 2000/XP/2003I have created an unattended windows xp image with alot of software that i want to install using RunOnce method. The RunOnce works great and silently going through all the software when i tryed running it on an already installed VM. The unattended win xp works great to when apps are not added but for some reason when i create the final image which is 5.5GB then i get the error "Virtual machine kernel stack fault (hardware reset)" on VMWare when its at the "setup is inspecting your hardware config" stage of setup, right after boot. i beleave it has something to do with in image being to big, but surely you can make a DL DVD unattended Win XP CD? I have been using nLite RC3 to make the image but have also tried to do it manually with no success. Can anyone help please


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Zigic scored the winning goal in the Carling quarter-final clash with rivals Aston Villa earlier this week.
But the Serbian striker has had a poor start for Birmingham since joining the club in a £6million deal from Valencia over the summer.
"Listen, Ziggy is 29, he is an experienced player, he is a Serbian so he is a proud man," said McLeish.
"He has come over to the Premier League and he wants to make an impression.
"He has tried to adjust to the English game.
"He is used to playing the European game where there is a build-up and there are probably only four or five headers in an entire game.
"In England it's crash, bang, wallop and he has got to compete for everything.
"It's been a bit of a culture shock to him. I was ready to take him off when he scored.
"It was great that he scored and hopefully he wins a few friends with that goal."
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Being an amiable guy is good for you and Jurgen Klopp is living proof.
Summer 2016 is set to be a very exciting time for football fans, as this is when the long awaited Euro 2016 tournament kicks off.


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