text:
She loved to sing and dance and rhyme.
But her happiness was running out of time.
She screamed and clawed to anyone at all,
Because blood and skin couldn't break her fall.
Tears and sobs and screams ran out,
And still nobody heard her shout.
Humans, monsters, but nobody came.
And to everyone else they did the same.
She was lucky he was being kind that day,
So he didn't take her life today.
Smiling and happy, her journey began,
To free all monsters was her plan.
She wasn't perfect,
But it was worth it.
She didn't want to be best.
But despite everything, she never reset.
(Horrortale!Sans X Reader)
- fanfiction
- horror
- psychogen
- sans
- undertale
high-jinx Jun 20, 2016
roses are red violets are blue a bowl f sugar is as sweet as you... but the roses have wilted and the violets are dead sugar bowl is empty just like your head
3y3Ballz Jun 27, 2016
Horror tale is just like underfell just with less color and its creepier
Apollosmoon Jun 10, 2016
Here is a ryme to say to your worst enemy: Roses are red, Violets are blue, I'll punch your face, I hate you. Or Roses are red, Violets are blue, I have 5 fingers, The middle one is for you.
lunamiraxus Aug 08, 2016
Determination is something that keeps you alive its lyk never giving up till you have something everyone needs/you want
dacatnextdoor14 Aug 30, 2016
Imma just change that to curiosity cuz that's my trait that I made so yeah
-Writer_Person- May 22, 2016
One day your insanity will be lost... Will you be happy? Or will you be sad? Will horrortale make you even more mad? Poems are fun


text:
Kamibashi is just about the cutest shop ever, and eco-friendly to boot. I especially love their String Doll Gang. The String Doll Gang is a band of awesome fun character keyrings, handmade with Fair Trade practices in Thailand. Each String Doll has his or her own special flavor and a power that … [Read more...]
Cate & Levi eco-friendly journals
Cate & Levi is a cool company with the ability to make reuse fun. Their new eco-friendly upscaled journals are no exception. Each of these adorable, fuzzy journals is one-of-a-kind, made especially for your child with soft reclaimed wool and a velcro closure for privacy. Inside each … [Read more...]
Where to order green & last minute Christmas gifts
So, Christmas is almost here, and hopefully you've already got your gifts in order. However, if you haven't, then as of today (Sunday, December 19, 2010) you'd better get cracking. Your options are whittling down and trust me most stores are madhouses. Hitting a smaller store is a good bet, or at … [Read more...]
DIY inexpensive & eco-friendly last minute gift baskets
Green gift baskets make excellent holiday gifts. I think it's better to shop early (if you do give gifts) because early shoppers tend to be more savvy about green criteria and price. Anytime people are crunched for time and hit the stores, it seems like they buy more than they mean to. However, … [Read more...]
The best green gift for the holiday season…
If you're going to spend more $ on a holiday gift, then an eco-friendly skateboard is your best bet for fun and value. It'll cost you about $80 - $200 for a decent eco-friendly skateboard set-up, however, a good board will last you years. Everyone at my house has a skateboard and we get hours of fun … [Read more...]
Adorable felt sweets for the holidays
I just saw the cutest little felt play sets at Baby Gardner. These would go great with an eco-friendly play kitchen set. My favorite set is the Animal Crackers Felt Play Set... This adorable treat is a Baby Gardner exclusive and comes with five pretty little stitched felt animal crackers … [Read more...]
Eight amazing eco-friendly Etsy shops for the holidays
Etsy has some of the most amazing holiday goodies in town. However, there are some downsides to be aware of... ORDER NOW!: Many Etsy shops need orders sooner, rather than later for the holiday season. Snooze and maybe lose: If you see something amazing at Etsy, it's a good bet someone … [Read more...]

subset: commoncrawl


text:
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Fesoterodine, a new once daily antimuscarinic, has proven to be an effective, safe, and well-tolerated treatment in patients with overactive bladder (OAB). To date, no analysis has evaluated the economic costs and benefits associated with fesoterodine, compared to antimuscarinics in Spain. The purpose of this analysis was to assess the economic value of OAB treatment with fesoterodine relative to extended release tolterodine and solifenacin, from the societal perspective.
The economic model was based on data from two 12-week, randomized, double-blind, and multicenter trials comparing fesoterodine and tolterodine extended released (ER). Treatment response rates for solifenacin were extracted from the published literature. Discontinuation and efficacy were based on the results of a 12-week multinational randomized clinical trial extrapolated to 52 weeks. Changes in health related quality of life were assessed with the King's Health Questionnaire, which was transformed into preference-based utility values. Medical costs included (expressed in € 2010) were antimuscarinics, physician visits, laboratory tests, incontinence pads and the costs of OAB-related comorbidities, fractures, skin infections, urinary tract infections, depression, and nursing home admissions associated with incontinence. Time lost from work was also considered. Univariate sensitivity analyses were also performed.
At week 12, continents accounted for 50.6%, 40.6% and 47.2% of patients in the fesoterodine, tolterodine, and solifenacin groups, respectively. By week 52, the projected proportions of patients remaining on therapy were 33.1%, 26.5% and 30.8%, respectively. The projected quality- adjusted life years (QALY) gain (compared to baseline) over the 52-week simulation period were 0.01014, 0.00846 and 0.00957, respectively. The overall treatment cost was estimated at €1,937, €2,089 and €1,960 for fesoterodine, tolterodine and solifenacin, respectively. Therefore, treatment with fesoterodine resulted in similar overall costs and greater QALY gain than treatment with either tolterodine or solifenacin. Sensitivity analysis showed that these results were robust to all changes performed.
The results of this economic analysis suggest that fesoterodine is a cost-effective alternative to tolterodine and solifenacin for the treatment of patients with OAB in Spain. Fesoterodine provides additional health benefits while maintain a similar level of costs being a cost-effective treatment strategy from a societal perspective.
Overactive bladder (OAB) is a symptom-driven condition defined as urinary urgency, with or without urgency urinary incontinence, usually with increased daytime frequency and nocturnal voiding [1,2]. It is a highly prevalent condition, related to an overall OAB prevalence of 11.8% in adults above 18 years of age in Western countries [3]; affecting men (10.8%) and women (12.8%) comparably and increased with age [4]. This corresponds to approximately 1 in 8 adults. These numbers are similar to a 17% prevalence previously reported in 6 European countries (France, Germany, Italy, Spain, Sweden, and the United Kingdom) [4] as well as in the United States in adults above 40 years of age [5]. In Spain, the latest prevalence data showed an OAB and/or urinary incontinence prevalence around 10% in women (between 25 and 64 years), and 5% in men (ages between 50 and 65) [6]. In people over 40, prevalence is set between 20-22%, and higher than 50% over 65 years old [6]. Therefore there should be about 3 million people over 40 suffering this condition in Spain [7].
OAB has devastating consequences for sufferers both genders which impact upon their health related quality of life (HRQoL), self-esteem and relationships [8]. The constellation of OAB symptoms has a profound negative effect on patients' quality of life and general well-being and can affect social, psychological, occupational, domestic, physical and sexual aspects of living [9,10]. Despite the high prevalence of OAB and the significant impact OAB has on patients' daily lives, up to 75% of patients remain untreated [4]. The reasons for this lack of treatment-seeking behaviour include patient embarrassment, the misconception that OAB and urinary incontinence (UI) are natural consequences of ageing, lack of knowledge regarding available treatments and unrealistic expectations [11,12]. OAB often precipitates other medical conditions, such as skin infections, urinary tract infections (UTIs), falls and fractures, and depression [5,13,14]. All these symptoms and facts results in a staggering €4,2 billion in the year 2000 OAB-related healthcare cost in 5 European countries (Germany, Italy, Spain, Sweden, and the United Kingdom); and is predicted to reach € 5,2 billion by 2020, a 25% increase. Incontinence pads were the source of the largest cost, accounting for approximately 63% of the annual per-patient OAB management [15].
A probing article recently stated that successful treatment of OAB depends on persistence with the prescribed medication, and efficacy and tolerability are key influencers of persistence. New antimuscarinic agents are now available for treating OAB that significantly improves symptoms of incontinence, urgency and frequency with few adverse effects. An improved efficacy and tolerability profile should result in greater patient satisfaction and persistence with treatment during long-term therapy [16]. Fesoterodine, a new once daily antimuscarinic, which has been recently marketed in Spain, has proven to be an effective, safe, and well-tolerated treatment in patients with OAB in two large pivotal phase III studies [17,18]. Fesoterodine has also demonstrated clinically and statistically significant improvements health-related quality of life (HRQoL) compared to placebo in subjects with OAB [19].
Health economic analyses assess the implications of projected outcomes and cost of medical interventions. Economic assessments of new therapies are often required by many health decision-making authorities. These are evaluated in order to properly allocate scarce healthcare resources. To date, no analysis has been performed to evaluate the economic costs and benefits associated with fesoterodine related to other existing antimuscarinics in Spain. Thus, the objective of this analysis was to assess the 1-year economic value of OAB treatment with fesoterodine relative to extended release (ER) tolterodine and solifenacin, from the societal perspective.
A cost-effectiveness analysis (CEA) was performed in this study through a decision-tree model developed in an Excel spreadsheet. Cost-effectiveness is typically expressed as an incremental cost-effectiveness ratio (ICER): the ratio between the difference in costs and the difference in benefits of two interventions. A threshold value is often set by policy makers, who may decide that only interventions with an ICER below a specific threshold are cost effective, although decision on funding may be more complex and subject to additional factors. In Spain, there is no a generally accepted cost-effectiveness threshold value. However, ICER below €30,000 per Quality-adjusted-life-year (QALY) gained use to be considered cost-effective [20]. The decision-tree model was developed to simulate the typical clinical treatment pathway of an individual initiating OAB therapy with fesoterodine 4 mg/day, ER tolterodine 4 mg/day, or solifenacin 5 mg/day (see Figure Figure1).1). This economic model assessed the economic benefits of treating OAB with incontinence with fesoterodine relative to extended release tolterodine or solifenacin, based on data from two 12-week, randomized clinical trials and the published literature (see ahead). At weeks 4, 12, 24 and 52 patients were classified as responders (those who are restored continence or <1 urge urinary incontinence episode/24 hrs) or non-responders. At four weeks after treatment initiation, treatment responders are assumed to continue their initial therapy. Non-responders are assumed to titrate to the higher dose of fesoterodine or solifenacin. As an assumption, 50% of responders to fesoterodine 4 mg and solifenacin 5 mg were assume to titrate to the higher dose at week 4, and the same proportion of non-responders in both treatments were elect not to titrate. Because only one dose of tolterodine is modelled, all non-responding patients are assumed to continue with the same treatment. This allows for patients in the tolterodine arm to have two chances at treatment response, as there are for fesoterodine and solifenacin. Responder status is assessed again at week 12. At this point, responders are assumed to continue treatment and all non-responders are assumed to discontinue (i.e., no further titration is allowed and patients are not assumed to lower previously-titrated doses). Responders to treatment at week 12 are assumed to remain responders for the duration of the model unless they discontinue for non-efficacy reasons. This assumption is supported by studies of tolterodine that suggest very little change in treatment efficacy takes place over the longer term in patients who are compliant with therapy [21,22]. Therefore, no further changes in drug efficacy were assumed to occur after week 12 although some patients were assumed to discontinue for non-efficacy reasons between weeks 12 and 52 [23,24]. Discontinuation, efficacy, and changes in HRQoL results of the trials were extrapolated from 12 to 52 weeks using the method of last observation carried forward for all the comparators.
Following Spanish CEA guidelines, the comparators considered in the analysis should be the relevant ones in current clinical practice; i.e. the most commonly used in the higher number of patients [25]. The 96% of the I.M.S. reported Spanish antimuscarinic sales [26] are attributed to fesoterodine, tolterodine and solifenacin; the three most consumed drugs in Spain; with the rest of antimuscarinics commercialized in Spain included in the remaining 4% of the OAB treatment market, and are not considered in this study due to its low economic impact on health budgets. As the time horizon for this analysis is 1 year, no discount rate was included in the analysis [25]. As this analysis was not carried out on humans, it represents a hypothetical patient ant the treatment pathway simulation, it was not needed to get the approval of any ethics committee.
Model is populated with data from more than 1.000 patients with OAB and incontinence enrolled in two 12-week, randomized, placebo controlled, double blind, international clinical trials [17,18]. These phase III trials were designed to investigate the efficacy, tolerability, and safety of fesoterodine 4 mg/day, fesoterodine 8 mg/day, tolterodine 4 mg/day extended released, and placebo in patients with OAB and incontinence. Male and female subjects ≥18 years of age with ≥8 micturitions/24 h, OAB symptoms with urinary urgency and ≥1 urge urinary incontinence episode/24 h were included in these analyses. Trial evaluation endpoints were at weeks 2, 8, and 12 post-treatment starts-up. To estimate the treatment response rates at week 4, the efficacy and discontinuation data at week 8 were chosen as a proxy. As solifenacin was not a comparator in either clinical trial, efficacy data (5 mg and 10 mg data combined) were abstracted from clinical trial published in the literature [27-30] and enrolling patients with a similar profile than the ones enrolled in tolterodine and fesoterodine trials. HRQoL data was extrapolated from the interventions in the clinical trial. Four studies published the endpoint of solifenacin restoration of continence. Haab et al. [27] reported that 52% of patients on either solifenacin 5 mg or 10 mg were restored to continence at week 12. However, this group did not report the corresponding value for the placebo group. Millard and Halaska [28] reported restoration of continence for those with severe incontinence at baseline (15.3%, 28.4%, and 30.5% for placebo, solifenacin 5 mg, and 10 mg, respectively). Wagg et al. [31] reported 49.1% and 47.3% of elderly patients on solifenacin 5 mg and 10 mg, respectively, and 28.9% of patients on placebo had restoration of continence. Because fesoterodine trial populations include non-elderly subjects, the analysis of phase III clinical trials by Cardozo and colleagues was chosen to make assumptions on such segment of population [29]. This study examined data from 2,030 incontinent subjects. Of patients incontinent at baseline, 34% were restored to continence at week 12, and 51% and 52% were restored to continence in the solifenacin 5 mg and 10 mg groups, respectively. These data correspond to a relative risk (RR) of 1.50 and 1.53, respectively, compared to placebo. We applied these RRs to the placebo values at weeks 12 to obtain an estimate of the solifenacin efficacy. Efficacy at week 2 or week 8 is also assumed to be the RR multiplied by the corresponding placebo value. Efficacy values, measured as percentage of patients with resolution of incontinence, are shown in Table Table11.
Some published data have not shown 12-week discontinuation rates for antimuscarinics to be significantly different than placebo [30]. Therefore, the values considered in this analysis are equal to placebo discontinuation (Table (Table1).1). Fesoterodine phase III clinical trials were also the source for the percentage of patients with nocturia at baseline (48.58%) and for the percentage of patients with nocturia at baseline without nocturia at W12 is shown in Table Table11.
The cost, measured in Euros, of each treatment arm is the sum of purchased medical and non-medical resources used and non purchased resources (lost productivity of the patient or unpaid family member/caregiver support). Both direct and indirect costs related to OAB were considered in the basecase analysis following a societal perspective that is recommended in Spanish CEA guidelines [25]. Additionally, the payer perspective (Spanish National Healthcare system, which considered only direct costs) was obtained and presented separately as a sensitivity analysis [25]. Costs inputs were taken from the published literature and expressed in €2010. Direct medical costs included were antimuscarinic drugs, physician visits, laboratory tests, incontinence pads, and costs of OAB- or incontinence-related co morbidities (fractures, skin infections, urinary tract infections, depression, and nursing home admissions all of them associated with incontinence), and the cost of treating constipation adverse events (Table (Table2).2). Health care resource utilization included is showed in Table Table33.
The probability of OAB-related co morbidities depended on the patients' responder and treatment status. Studies have shown the risk of falls and fractures, skin infections, urinary tract infections, to be positively associated with OAB and the risk of depression and nursing home admissions to be associated with OAB with incontinence. Patients with controlled OAB have lower risk of co morbidities than non-responders or untreated patients (Table (Table3).3). Skin infections and UTIs have the possibility of occurring more than once per year, and the expected number of events per person is included. The mean numbers of UTI per patient for these two populations are 0.3 and 0.7, respectively. To calculate the average number of UTIs per patient experiencing one, the following formula was used (a representative calculation for successfully-treated patients is shown):
Analogously, we calculate the expected number of UTIs per unsuccessfully-treated patient as well as the expected number of skin infections for both treatment categories. The utility decrements for fracture, depression, and nursing home are also considered in the analysis (Table (Table3),3), with its corresponding literature sources.
An assessment of the indirect productivity costs associated with OAB and incontinence was also included. Lost productivity at work due to OAB can come from many sources. For one, frequent voiding during sleep time (nocturia) can deprive one of needed sleep, mimicking the symptoms of insomnia. We assume the decreased productivity during work hours for those with nocturia relative to those without nocturia to be 9.2% [32], representing the difference between the percent work impairment for patients with nocturia (13.8%) and control patients (4.61%), Table Table2.2. Another cause for lost work is the presence of incontinence, where patients may choose to work fewer hours because of their condition. Data show women who work for pay report working fewer hours per week (38 vs. 30) [33]. Incontinent men with OAB factor their symptoms into decisions about location and hours worked more than continent men or women with OAB and more than twice as much as women with incontinence (21% vs. 8%). A conservative assumption to capture the monetary value of this productivity loss would be to assume those incontinent patients who are employed work 21% fewer hours than those without incontinence (the percent difference between the number of hours worked per week for women without incontinence versus women with incontinence [38 hours-30 hours]/38 hours). Spanish employment and wage data were entered into the model to estimate the decreased productivity while at work due to interrupted sleep by nocturia episodes and lost time from work due to incontinence (Table (Table2).2). The model inputs the productivity costs of each treatment arm compared to no-treatment, as relative productivity gains. As explained, incontinence and nocturia episodes were related, respectively, with reduced work hours and lost productivity while at work and their associated costs. If no treatment is considered, higher productivity costs are observed compared to receiving an adequate treatment. For this reason, negative values (or productivity gains) would be obtained for each treatment arm compared in this study.
In this analysis, effectiveness of medical interventions was expressed in term of Quality-Adjusted-Life-Years (QALY) gain. Changes in HRQL were assessed from a disease specific HRQL tool during the trial: the King's Health Questionnaire [34], which was transformed into preference-based utility values for responders and non-responders [35]. KHQ is an instrument specifically designed to assess the impact of bladder problems on HRQL in women and has been shown to be reliable, internally consistent and valid in men and women [34]. The items of the KHQ cover 5 domains: role limitations; physical functioning; social functioning; emotional problems; sleep disturbance and general health. Each patient's 5 domain scores from the KHQ were incorporated into a regression algorithm developed by Brazier et al. to generate preference-based utilities [35]. The authors have previously used this approach to estimate preference-based utilities from the SF-36 [36]. KHQ responses were collected from trial participants at baseline and again at week 12 (Table (Table3).3). Utility for patients not on therapy was assumed equal to the baseline value. The QALY gains from baseline to week 12, from week 12 to week 24, and from week 24 to week 52 were calculated based on patient's treatment status (continent, incontinent, or no treatment). The difference between week 52 utilities and baseline utilities for responders and non-responders were the effect measure in the cost-effectiveness ratio. As described in Table Table3,3, fracture, depression, and nursing home admissions are assumed to be associated with a decrement in utility relative to not having these conditions. The percent decrease is included as a model condition.
For each of the treatment interventions, the model calculates the expected total one-year costs (including both direct and indirect costs). The model also determines the expected proportion of patients on each treatment having restoration of continence at the end of 1 year and the QALYs gained for each intervention. These outputs are combined to create the incremental cost effectiveness ratio (ICER), representing the additional cost associated with fesoterodine treatment divided by the additional QALYs gained with fesoterodine treatment relative to tolterodine and solifenacin, respectively.
Several univariate sensitivity analyses of fesoterodine versus tolterodine ER or solifenacin were performed in order to find if the results were robust to changes in main assumptions or inputs of the analysis: trial time horizon, co morbidities costs and rate per year, utility estimates, direct medical services costs, utilization and productivity data, proportion of continent patients at 12 and 52 weeks, and proportion of responders to fesoterodine 4 mg and solifenacin 5 mg who elect to titrate to the higher dose at week 4, as well as the proportion of non-responders who elect not to titrate. All the variables were changed in a range of ±25%, a plausible range of variation of both costs and health effects. Following Spanish CEA guidelines [25], the payer perspective results (Spanish National Healthcare system, which considered only direct costs) were obtained and presented separately as a sensitivity analysis.
Clinical and cost-effectiveness results are shown in Table Table44 and Figure Figure2.2. At week 12, the proportion of continent patients on each treatment at the end of the model period (responders) was higher for fesoterodine and solifenacin than for tolterodine. By week 52, the projected proportions of patients remaining on therapy was again higher in the fesoterodine arm of the study. The projected quality- adjusted life years (QALY) gain (compared to baseline) over the 52-week simulation period showed greater gain for fesoterodine in comparison with the other two drugs evaluated, while the overall treatment costs were similar among the three drugs (Figure (Figure2).2). However, as the analysis was deterministic, did not allow for a statistical comparison between drugs. These results are related to the lower total treatment costs of fesoterodine in 52 weeks due to the proportion of responder's patients continuing therapy throughout the 52-week period. Therefore, treatment with fesoterodine resulted in lower overall costs and greater QALY gain than treatment with either tolterodine or solifenacin.
Sensitivity analysis showed that, for the majority of plausible scenarios, the results obtained were robust to all changes performed in the inputs data considered, consistently showing similar cost but higher effectiveness for fesoterodine over the other compared antimuscarinics (cost-saving ICERs), except when the time horizon was changed to 12 weeks. Nevertheless, if the total duration of treatment were reduced to approximately 3 months only, fesoterodine would still continue being a cost-effective option, with an incremental cost-effectiveness ratio of 574€ and 14,568€ compared to tolterodine and solifenacin, respectively when the NHS perspective is analyzed only (Table (Table5).5). If the societal perspective is considered, then, fesoterodine would not be cost-effective relative to solifenacin for treatment duration of 12 weeks or less only. On the other hand, changing proportions of continent subjects modified the ICERs of fesoterodine relative to the other comparators only when the percentages were reduced by a 25% (table (table5).5). However, ICERs of fesoterodine over tolterodine and solifenacin were, respectively, of €39,447 and €17,814 per QALY gained, which are still in the range of acceptable cost-effectiveness in Spain.
This decision-tree model cost-effectiveness analysis, the first one that compares fesoterodine and other salient antimuscarinics in Spain, showed that the treatment with fesoterodine resulted in similar overall costs but greater QALY gain than treatment with either tolterodine or solifenacin. In other words, fesoterodine acquisition cost is outweighed by the lower costs related to both direct and indirect resources used considered in this study. This analysis tried to be as much robust as possible, including the relevant comparators (the ones that represent 96% of the Spanish year 2010 OAB treatment market), the adequate efficacy data and the adequate costs. Additionally, several univariate sensitivity analyses were done, to demonstrate the strength of the assumptions. As explained in the results section, fesoterodine continued being the dominant option in most sensitivity analyses done, particularly when the time horizon of analysis is set at 52 weeks. When the time horizon is changed to 12 weeks only (this happening in some particular patients who abandon the OAB treatment rapidly), fesoterodine would still be a cost-effective option when the NHS perspective is considered only: incremental cost-effectiveness ratios per QALY gained of 574€ and 14,568€ compared to tolterodine and solifenacin, respectively. However, if it is considered the societal perspective in the 12-weeks scenario, fesoterodine would be cost-effective relative to tolterodine only. Nevertheless, the plausibility of this scenario is really low even considering than persistence rate with antimuscarinics has been showed to be lower than with other treatments for chronic conditions [16]. At least, in the case of solifenacin persistence, it has been communicated to be above 90% after 12 weeks of starting the therapy [27].
The model is considered to be comprehensive by including several aspects of OAB affecting the overall economic burden of disease. These include the cost of incontinence pads and the cost of lost productivity due to impairment at work or lost time at work due to OAB symptoms. Also, it includes the cost of associated co morbidities arising with uncontrolled OAB. The main reason of incorporating indirect costs is due to their relevance for OAB. Kobelt et al (2003) [32] conclude that in an otherwise healthy and professionally active group of individuals, waking at night to void, significantly diminishes their overall well-being, vitality and productivity, leading to a significant level of indirect and intangible costs. Additionally, over 21% of the OAB population worried about interrupting meetings with frequent trips to the toilet and 3% of the population changed jobs or were fired because of their bladder control problems [37]. Considering these figures, lost productivity and lost wages were included in this analysis. Nevertheless, results are consistent with base case scenario even if indirect costs are not included in the analysis and the perspective of National health System is analyzed solely.
As in all scientific works, this analysis includes limitations and strengths. One of the strengths of the model is the use of the clinical trial data for the comparison of all alternatives, which ensures comparable patient populations among the treatments. However, unlike in the actual trial, the model assumes patients whose OAB is not controlled by treatment at each assessment point will discontinue therapy at that point, replicating a treatment pattern more reflective of real clinical practice. On the other hand, solifenacin was not included in the clinical trial and was modelled using published data. In order to diminish the possible impact in the results of solifenacin data, the meta-analysis of phase III clinical trials by Cardozo and colleagues was chosen [29], which examined data from 2,030 incontinent subjects. Inclusion criteria for these studies were rather similar to the fesoterodine trials. Another possible limitation is that our analysis was not able to incorporate the so-called out-of-pocket expenses, i.e.: incontinence pads not funded by the NHS, particularly because studies used as a sourcing data for the analysis were unable to differentiate it. Finally, this economic model was designed as deterministic, then; only point estimates are showed not allowing for statistical comparison between drugs in both costs and effectiveness. However, these results encourages for development of more sophisticated economic modelling of such drugs using, i.e., probabilistic approach.
As previously mentioned, this is the first cost-effectiveness analysis performed with Spanish data that compares fesoterodine with another antimuscarinics highly used in our health context. However, several economic analyses have been previously published with different antimuscarinic drugs in other settings. Considering the comparators included in this analysis, four economic evaluations have compared solifenacin to ER tolterodine in three different settings [38-41]. These analyses showed that treatment with solifenacin was less costly and more effective than tolterodine. Only one of the four economic evaluations includes fesoterodine as a comparator [41], with controversial findings in comparison with the results include in our work. The article included some information based in the experience in clinical practice use of all antimuscarinics except for fesoterodine since it was not marketed yet at the time of the analysis included in the paper (year 2008). Due to the lack of available data, fesoterodine inputs were based on extrapolated assumptions from the use of other antimuscarinics instead of data from clinical trials. Another difference is the type of resources and corresponding cost considered in the analysis, since only were considered some direct medical costs, while in the present economic analysis, following Spanish guidelines, indirect costs were also included [25]. Drug-specific treatment persistence data were obtained from the Information Management System database and covered the 12-month period ending in April 2008. As fesoterodine was only on the market since July 2008, treatment persistence data from longitudinal databases were not yet available. To approximate the percentage of patients stopping and switching treatment with fesoterodine in the base-case analysis, Cardozo et al. [41] used the persistence rates for tolterodine ER, which could potentially represent a bias against fesoterodine. Finally, the percentage of patients who stop or switch treatment due to poor compliance was based on expert opinion.
In conclusion, the results of this economic analysis, supported by sensitivity analyses and despite the limitations mentioned, suggest that fesoterodine is a cost-effective alternative to tolterodine and solifenacin for the treatment of patients with OAB in Spain. Fesoterodine provides additional health benefits while maintain a similar level of costs being a cost-effective treatment strategy from a societal perspective and from the National Health System as well.
This study was funded by Pfizer, Inc. DA and JR are employees of Pfizer Inc Spain and JT is employee of Pfizer Inc, New York. SA and CES have not received any financial support from Pfizer Inc for writing or interpreting the present research. SA and CES declare that they do not have financial and non-financial competing interests. A funding was received by MEISYS, an independent consultancy agency, for drafting the manuscript and also for final adaptation of the model to the Spanish context.
SA, CES and JR participated in the design of the study, coordination, carried out the acquisition of data and revised it critically for important intellectual content. JT developed the decision-tree model for local adaptations, which was used to obtain the results of this study. All authors have made a significant contribution to the findings and methods in the paper, and interpretation of data. All authors helped to draft the manuscript, read, modified and approved the final manuscript.
The pre-publication history for this paper can be accessed here:
The authors thank Mercedes García-Vargas and Belen Martí that contributed towards the preliminary phases of the study by making substantial contributions to, respectively, acquisition and analysis of data. The authors also wish to acknowledge MEISYS for editorial support in preparation of the manuscript, on behalf of Pfizer Inc Spain, and also for final adaptation of the model to the Spanish context.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Reviewed By William H (McHenry, IL) Reviewed for a 2004 GMC Yukon XL —9/21/2007 7:01 AM
I installed my new K&N cold air intake about 2 weeks ago and am very happy with the results. The installation took about half an hour and went very smooth. The instructions were clear. I noticed an improvement with the horsepower right away.


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Daily briefs of the top news stories impacting Christians around the world. In today's edition:
Ministry Relief Efforts Reach Out to Tsunami Victims in South Asia
Sports World And Christian Community Loses A Great Athlete And Man Of God
Prostitutes in Florida Community Find a New Start at 'Heaven's Garden'
Ministry Gives Ecuadorian Evangelists Smooth Landing Among Villagers
Ministry Relief Efforts Reach Out to Tsunami Victims in South Asia
Jody Brown, AgapePress
Relief agencies around the world are sending supplies and volunteers to South Asia in the aftermath of one of the world's greatest catastrophes. According to various news reports, the death toll from the tsunami that rolled across the region on Sunday has now risen to nearly 40,000. The earthquake-driven waves struck 10 different countries, leaving behind death, destruction, and discouragement. Sri Lanka and Indonesia were among the hardest hit, with reports of more than 18,000 and 15,000 deaths respectively. Deaths in India are estimated to be as high as 7,000. Other countries hard hit include Thailand, Malaysia, Burma, and Somalia. The number of deaths is expected to climb in areas where both access and communication are limited. Among the groups offering emergency food and shelter to victims in South Asia are the International Mission Board (IMB) of the Southern Baptist Convention and the organization Food for the Hungry. And United Methodist News Service reports the United Methodist Committee on Relief is joining with other faith-based disaster relief agencies to aid the victims in the area. Millions of people are without food, water, and shelter. Food for the Hungry is coordinating with local-church partners to distribute basic health supplies and care, along with food and clothing to meet the needs as quickly as possible.
Sports World And Christian Community Loses A Great Athlete And Man Of God
Jim Uttley, Assist News Service
The sports world and the Christian community has lost a great athlete and a man of God. Reggie White, 43, died the day after Christmas of what's believed to be respiratory failure as a result of sleep apnea. One week after his 43rd birthday, the man many called "the Minister of Defense," was gone. Reggie was a starring player for the Philadelphia Eagles, the Green Bay Packers and in his last season with the Carolina Panthers, ending his career in 2000. Standing at six feet five inches and weighing 300 pounds, White was famous for attacking opposing quarterbacks. When he retired after 15 seasons, White held the career record for sacks (198). White was a great football player but he was also a Christian who loved the Lord. White also defended the gospel whenever he had opportunity. He wasn't afraid of controversy. While playing for the Eagles, White used to share the gospel with teens on Philadephia inner city streets. He challenged them to stay in school and keep away from drugs. During his career, White was an associate pastor of the Inner City Community Church in Knoxville. He set up a fund to help people who couldn't get funding from other sources.
Prostitutes in Florida Community Find a New Start at 'Heaven's Garden'
Charisma News Service
The compassion of a Florida woman is helping former prostitutes find the gospel -- and a way off the streets. Aida Bowers is on a mission to rid Daytona Beach of prostitutes -- not by sending them to jail, but by rescuing and rehabilitating them. In November 2003, she launched Heaven's Garden -- a nonprofit, community residential home in the heart of Daytona's red-light district -- to provide a sanctuary and training ground for the women she snatches from the street. Hundreds of women are arrested annually for engaging in commercial sex in Daytona. Although never a prostitute herself, the mother of three claims she has a heart for these women. Bowers takes them into the house, feeds them and gives them clothes. She nurses them if they are sick or wounded. Then she offers them the opportunity to stay and participate, at no charge, in the voluntary yearlong program she provides. Throughout the program they receive in-house teaching and counseling from Bowers and representatives of various agencies. In addition, they attend church regularly as well as Bible studies and local home meetings. Bowers hopes to increase her capacity to 100 rooms and expand her facilities to include a crisis unit, a detoxification unit and a learning center for continuing education. (http://www.charismanow.com)
Ministry Gives Ecuadorian Evangelists Smooth Landing Among Villagers
Allie Martin and Jenni Parker, AgapePress
Leaders of Ecuador's national church have reversed an earlier decision and have opted to allow Mission Aviation Fellowship to assist their evangelists in carrying the gospel to unreached areas of the South American country. Southern California-based Mission Aviation Fellowship (MAF) is a ministry that serves to multiply the effectiveness of the Church worldwide, using aviation and other strategic technologies to overcome barriers in reaching people all over the world for Christ. Serving the needs of the isolated and the poor in some of the world's most inaccessible regions, MAF operates a fleet of 62 aircraft throughout 16 countries of Africa, Asia, Latin America, and Eurasia. Earlier this year, leaders of the national Schuar Church in Ecuador decided against using MAF services to get evangelists to remote areas. Church officials said the initial decision was based on financial concerns. The Schuar Church leadership ended up realizing that MAF's services were worth the expense after all. Each year MAF flies some 3.2 million miles to remote regions of the world in support of nearly 600 missions, Christian ministries, and non-government organizations. In addition to providing flight services to isolated areas worldwide, MAF offers these areas communications technology and other resources , including distance education, HF/VHF radios, e-mail, Internet access, and networking solutions.


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Because of the discrepancy between the broadcast TV season (September-May) and the eligibility period for the SAG Awards (calendar year), broadcast series get an extra shot at SAG Awards for the January-May portion of their final seasons. NBC's 30 Rock did one better today, landing three SAG nominations despite airing only five episodes during the 2013 calendar year — the series' final five installments.
Related: Edie Falco & Alec Baldwin Set SAG Awards Nomination Record
According to the SAG Awards rule book, eligible on the comedy side are "30 minute comedy series (with a minimum 21-23 minutes of actual programming content) with an ongoing theme and storyline in a minimum of six continuous episodes (reducible to a storyline of four continuous episodes in the cases in which the series is subject to a "short order.") 30 Rock was not a subject of a short order; its final season included 13 episodes. But it qualified as SAG Awards' eligibility rules are different for final seasons, said SAG Awards executive producer Kathy Connell. "In a final season, we allow a show to wrap as long it is in the calendar year," and the six-episode minimum does not apply, she said.
This marks the eighth time 30 Rock, which ran for seven seasons, has competed at the SAG Awards. It is nominated for best comedy ensemble; best comedy actor, Alec Baldwin; and best comedy actress, Tina Fey. Baldwin has been the most dominant winner in SAG Awards history with seven consecutive trophies for his role as Jack Donaghy. He has a good chance to extend that streak to eight, one more than his seasons on the show. His co-star, 30 Rock creator Fey, has nabbed four SAG Awards to date, including one this past January, and the series' ensemble has won once.
Related stories
SAG Awards TV: Little New Blood As Actors Stick With Old Favorites, Reward Overlooked Performers
SAG Awards Film: Robert Redford Shocker Shakes Up Race As Actors Boost Chances For 'Butler', 'August' And 'Dallas'
SAG Awards Winners List: 'The Help', Viola Davis, Jean Dujardin, 'Boardwalk Empire', 'Modern Family', Steve Buscemi, Jessica Lange
Get more from Deadline.com: Follow us on Twitter, Facebook, Newsletter


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Hyderabad: Minister for Municipal Administration and Urban Development K T Rama Rao on Thursday urged youngsters in the State not to get bogged down by negativity and despair.
On the 155th birthday celebrations of Swami Vivekananda at the Ramakrishna Math, celebrated across India as National Youth Day, the Minister felt that Vivekananda's teachings are ideal to guide today's youth to take the right path for the country.
"I urge you not to be afraid of death, which is inevitable but be afraid of an unlived life. Set a goal for yourself and work towards it. There is a constant battle between hope and despair within us and young people should never get bogged down by despair," Mr. Rama Rao said, while addressing youngsters in the packed auditorium of the Math.
The Minister said that the country as a whole was on the cusp of breaking into the big league in the world.
"Youth in India today are daring to dream big. They are not satisfied with the tag of mediocrity and want to achieve more. Close to 50 per cent of our population is just below 29 years and the huge population that India is not more seen as a hindrance to economy. We are a nation that is getting younger and we should make full use of it," said Mr. Rama Rao.
Ramakrishna Math president Swami Jnanadananda said that the values of Vivekananda were vital in this day and age.
"Vivekananda was a personification of values like truthfulness, compassion, self-confidence and fearlessness. These values are very important for today's youth, who are the backbone of our country and have to play a crucial role in the country's development," he said.
Director of Vivekananda Institute of Human Excellence (VIHE), Swami Bodhamayananda said Swami Vivekananda was the first thinker who introduced 'Indian culture' to the West.
"He was the first to talk about India and its culture when everybody knew our country as a colony of the British," he said.
Several personalities from various walks of life attended the event.


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"Killer from the Pecos": Texas Ranger Chick Bowdrie rides into the wild town of Almagre trailing a Pecos bank robber who has left two men dead. All Bowdrie has to go on is an unconvincing eyewitness description, a name scrawled on a tattered postcard, and his own skills as a master tracker. But Bowdrie will need luck as much as skill when looking for answers in Almagre, for the town is gripped in a stranglehold by a ruthless cattle baron named Bonelli, and to bring his quarry back, Bowdrie will pin on a marshal's star to face down Bonelli and his gunmen.
"Lit a Shuck for Texas": Johnny Buck is a young Texas cowboy working for the Bar W. In the process of roping an old stob-horned steer, Buck is thrown from his horse into a cleft where he encounters the mystery of a murdered man and a bag of ore that just might be gold. The taciturn owner of the Bar W discounts Buck's story of the "gold", but Buck soon finds that some of the shadier ranch hands are gunning for him. With a widow's daughter, a lost mine, and a missing prospector in the balance, Buck has no choice but to solve the mystery...or die trying.
"Turkeyfeather Riders": Jim Sandifer had run Grey Bowen's ranch for years in his absence. When Bowen reappears with his newly betrothed, Rose Martin, and her grown son, Lee, Sandifer is glad to see his boss. But scheming Lee Martin has turned Bowen against his foreman and his neighbors. Can Jim stop the range war that's brewing without losing his job? And what are the Martins really after?
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Monday, June 5, 2017
Musing Over the Lord's Prayer
2 comments:
- AnonymousJune 23, 2017 at 10:32 AM
When we pray we enter the spiritual realm which many refuse to admit is real. The Lord's prayer in Matthew opens the door for us and reminds us that " Our Father" is in heaven and not part of this earthly realm. Heaven is the dwelling place of God and cannot be reached by earthly means but rather by spiritual communication called prayer. It is very real and often called "the breath of the soul'. Gramps.ReplyDeleteReplies
Thanks for sharing. That's a truth I hadn't really considered before yesterday, so I'm glad you mentioned it - in a way, too, the notion of God the Father being in Heaven seems to support the importance of not being of this world. I hadn't heard of prayer as being described as "the breath of the soul", but that's a beautiful way of describing it.Delete


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The US House of Representatives is expected to pass what'll be known as the Dodd-Frank Law tomorrow, following what's expected to be a last-minute doomed effort to introduce a half-hearted effort to do something about Fannie Mae and Freddie Mac, writes Edward Mills of FBR Capital Markets in a repor to clients. It's also possible that Wall Street's friends among New York Congressmen, and other "moderate Democrats", will vote No in an effort to keep bankers' campaign funds coming in, "but passage in the House should not be a problem."
The Senate could prove a tighter squeeze. Sen. Robert Byrd (D-WV)'s death means one less Democrat. The Ds will have to hold Republican Sens. Snowe and Collins of Maine and Scott Brown of Massachusetts, who's balking at the $20 billion bank and hedge fund tax tacked into the bill ast the last minute. Maybe past opponents Sens. Grassley (R-Iowa), Cantwell (D-Wash) or Feingold (D-Wis.) will end up backing the bill, Mills suggests.
Last-minute changes: Blank Rome's Financial Reform Watch notes that House Agriculture Committee Chairman Collin C. Peterson (D-Minn.) got interest-rate, currency, gold and high-rated credit-default swaps exempted from the No-Bank-Derivatives rule; while the Volcker Rule ban on proprietary trading is still controversial. Senate vote had been slated for Wednesday.
Still opposed: "The financial crisis was not caused by crooks on 'Wall Street'... even though there was a great deal of fraud," thunders veteran bank analyst Richard X. Bove of Connecticut-based Rochdale Securities LLC in a note to clients. "The financial crisis was caused by the creation of too much money, and too few solid investment opportunities."
Bove says the fragmented G-20 meeting in Toronto confirms his view: "Countries with healthy banks" (Germany, China) "rejected, in total, the suggestions being made by the United States" and its allies, who wanted more sweeping changes to bank rules.
"The crisis is a classic," Bove adds. ""So-called wealthy industrialized nations" like the U.S. have lost most of their productive manufacturing base. But "they have not lost the desire to acquire" stuff they can't really afford anymore. So rich countries "create money" so their cosnumers can borrow it to buy stuff from "the so-called poorer emerging nations... until such time as it becomes evidence that the debtors cannot pay, and failures and crises develop." Fraud is a symptom of bloated Western economies, and not the cause, Bove concludes.


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United States Court of Appeals for Veterans Claims
Revenue Sharing II
I suggest you provide Federal workers a real incentive for saving by allowing them to keep as bonuses a fair share of annual appropriations not obligated at the end of the fiscal year.
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NEARLY 20,000 pensioners in Doncaster are living in fuel poverty, according to shocking new figures.
An appeal to help elderly people survive the winter has now been launched after it was revealed an estimated 17,000 over 65s in the borough cannot afford to heat their homes.
The figures also revealed around 88 more people aged over 65 died in Doncaster last winter than in any other season last year.
The findings show that around 80 per cent of these excess winter deaths were a result of circulatory or respiratory diseases, which are exacerbated by cold weather conditions.
The South Yorkshire Community Foundation (SYCF) has launched the Surviving Winter Appeal, to encourage people to make donations to help older and vulnerable people affected by fuel poverty this winter.
The campaign was originally inspired by individuals who wanted to donate their Winter Fuel Payment from the Government to support older and vulnerable people who are less fortunate than themselves.
Now everyone is being encouraged to donate.
Pauline Grice, chief executive of SYCF, said: "Surviving Winter aims to encourage those who can afford to, to support those in need for whom the Winter Fuel Payment is not nearly enough.
"The Winter Fuel Payment is an absolute lifeline to the 17,000 older people who are living in fuel poverty in Doncaster and it is clear to see just how much local people truly rely on it."
The Winter Fuel Payment is a tax free payment made by the Government during November and December to people over the age of 60. The amount people ranges from around £150 to £300 depending on people's circumstances.
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Households are considered to be in fuel poverty if they have to spend more than 10 per cent of their income on fuel to keep their home in a satisfactory condition.
Nationally 33 per cent of pensioners are believed to be living in fuel poverty.
One of those backing the scheme is Sylvia Allsop from Balby who says rising fuel bills make it difficult to heat her home.
Mrs Allsop said: "It doesn't feel very comfortable at all. You can get yourself warm in one room but then you go into another room and its absolutely freezing. Then you have to start all over again trying to get warm.
"I try to make sure I have enough gas in my token meter, but sometimes I just pull the blanket over me to save a bit of money.
"I get about £250 and it goes straight on to my gas. I'm sure that some people don't use it for gas, but some elderly really do need it."
Donate via the internet www.sycf.org.uk/survivingwinter or via post to Surviving Winter Appeal, South Yorkshire Community Foundation, 6 Leeds Road, Sheffield, S9 3TY making cheques payable to South Yorkshire Community Foundation.


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The cable drama renewals just keep on coming. A few hours after AMC announced a second season of "Halt and Catch Fire," and a day after "Rectify" and "The Strain" got renewed, Showtime has ordered third seasons of both "Masters of Sex" and "Ray Donovan." Both shows will be back next year with 12-episode seasons, and are each halfway through their second seasons.
"Masters" scored five Emmy nominations for its first season, and has already won one (for Allison Janney's brilliant guest work). Lizzy Caplan from "Masters" and Jon Voight from "Ray Donovan" are up for awards on Monday.
Though I had issues with the latest episode of "Masters," the season overall has had a lot of brilliant moments – including one of the single best hours of TV drama of the year – and I'm glad Showtime is sticking with it even though it's not a super-commercial property. (Ratings have gone up over the course of the season – episode five was up 18 percent over the premiere – which is good to hear.)
I haven't watched "Ray Donovan" season 2 at all, after sticking through all of season 1 in the hopes that all the talent on hand would coalesce into something more than formulaic cable anti-hero schtick. But if there are people who are enjoying season 2 – and/or feel it's notably better (or worse) than season 1 – feel free to discuss in the comments.


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As the sun sets on 2013, wishing everyone a safe and #powder filled new year. Skier: #dpsskis founder Stephan Drake, Photo by @oskar_enander.


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Posted on February 22, 2008
Boca Juniors midfield ace Juan Roman Riquelme says it is imperative that the team fly out of the gate if they hope to reclaim the league crown this season.
After two games, the Bombonera gang stand fourth on four points, and the play maker has warned his teammates about the bullseye they carry every match.
"It will be very difficult for us, all the teams want to beat us and we want to beat all of them," Riquelme told the club website.
"Each game will be very difficult, every team we face will make life hard for us and we have to accumulate as many points as possible in the first few rounds."


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Humans have always dreamed of exploring the unknown, whether it was what lay beyond the horizon or what lay beyond the stars. While humans have achieved incredible feats in exploration—mapping the world and sending people to the moon—there is still unexplored terrain tugging on the human imagination, but potentially still out of our reach. This is where robot explorers come into play. Read More
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Video games today are a far cry from where they began, but from Pong to the latest motion capture and 3-D graphics technology, engineers have been the backbone of this exciting and entertaining industry. Read More


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A. I recommend you get this investigated as soon as possible. I would be cautious there could be something blocking the nose/sinus/middle ear such as a polyp, mass or infection which is aggravating this area and causing the signs you describe. Bleeding is most definitely not normal from sneezing.
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Select your stay dates to check availability at G guesthouse Itaewon - Hostel
G guesthouse Itaewon - Hostel
About the Hotel
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A stay at G guesthouse Itaewon - Hostel places you in the heart of Seoul, minutes from Seoul Central Mosque and close to National Museum of Korea. This hostel is within close proximity of Leeum Samsung Museum of Art and Itaewon Antique Furniture Street.
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Rec, Spa, Premium Amenities
Take in the views from a rooftop terrace and make use of amenities such as complimentary wireless Internet access and a television in the lobby. This hostel also features tour/ticket assistance and barbecue grills.
A complimentary continental breakfast is served daily.
Business, Other Amenities
Featured amenities include complimentary high-speed (wired) Internet access, multilingual staff, and luggage storage.
Hotel Facilities
- Rooftop terrace
- Free wired high-speed Internet
- Front desk (limited hours)
- Designated smoking areas
- Safe-deposit box at front desk
- Number of buildings/towers - 1
- Designated smoking areas (fines apply)
- Free breakfast
- Free WiFi
- Television in lobby
- Multilingual staff
- Tours/ticket assistance
- Year Built 2014
- Laundry facilities
- Number of floors - 3
- Barbecue grill(s)
- Luggage storage
Room Facilities
- Premium bedding
- Spring water bathtub
- Free local calls
- Hair dryer (on request)
- Desk
- Free toiletries
- Daily housekeeping
- Shared/communal kitchen
- Shared accommodations
- Cribs/infant beds (surcharge)
- Bathtub or shower
- Free wired high-speed Internet
- Espresso maker
- Hypo-allergenic bedding available
- Television
- Pillowtop mattress
- Refrigerator (on request)
- Slippers
- Private bathroom
- Cookware, dishware, and utensils
- Free WiFi
- Microwave (on request)
- Climate control
Hotel Policy
Know Before You Go
- Only registered guests are allowed in the guestrooms.
- No pets and no service animals are allowed at this property.
The following fees and deposits are charged by the property at time of service, check-in, or check-out.
- Crib (infant bed) fee: KRW 15000 per night
The above list may not be comprehensive. Fees and deposits may not include tax and are subject to change.Show all hotel policy Show less hotel policy


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What is a participative leadership style? It is one that adds a bit of democracy into the chain-of-command. Instead of having a leader simply dictate the jobs that need to be done or the course of action that must be taken, the participative leadership style allows for a feasible amount of participation by those who are going to be affected by any decision that is made.
There are two basic methods of participative leadership that happen right now: representative participation and participatory management. In the representative form, a group of employees is directly involved in the decisions that an organization makes. In participatory management, a supervisor and their direct reports will work together to be responsible for certain decisions, but not necessarily the overall management of the company.
Why Choose To Use Participative Leadership?
Participative leadership styles focus on the concepts of sharing power. Because employees have more involvement in the decisions that are made, they are also more likely to take ownership of the work that needs to be done and complete it with a higher quality. It's a motivation of growth through development because instead of having an employee try to eliminate errors, the employee is instead trying to produce positive ideas for change.
That's where employees often grow stagnant. They become satisfied with their position and only do just enough to earn their paycheck every week. By investing in their creativity now, however, the participative leadership style is able to keep challenging employees in a positive way and this tends to create more cohesiveness in the working relationship.
Essentially the employee becomes a stakeholder in the participative leadership style. The power is redistributed from the bottom up, which means the most power is held by the entry-level employees. This allows them to protect their interests, but still receive guidance from leaders who have the experience and knowledge necessary to direct the group toward overall goals that reflect the mission of the organization.
What Holds the Participative Leadership Style Back?
The issue that comes up when using participative leadership styles is that decisions tend to come slowly. When there is a group of employees tasked with making a singular decision, it becomes nearly impossible sometimes to get controversial things done because there will be gridlock. Some will want to take a risk and others will not. This means the choice that is made is to not make a choice.
That's why the participative leadership style is often introduced in specific areas of an organization where fast, emergency decisions don't need to be made. In doing so, the front line employees end up getting some extra skin in the game. This helps everyone succeed a little more, develop individualized leadership skills, and ultimately do more good things every day.
When implemented correctly, participative leadership can change an entire organization for the better. It can lower employee turnover, inspire creativity, and create the investment that is needed for true change to occur. Used in conjunction with other leadership styles, it is one of the most powerful tools that you'll ever have in your toolbox.


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Optional three-point lift only for AF-10 and AF-5 harrows.
Free shipping to business address
CMI products toll free order and help line 1-800-335-1880. OHIO RESIDENTS will be charged Ohio Sales Tax unless we have a OHIO SALES TAX EXEMPTION FORM on file. The form is available at the link on the left side of this page.


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9 Manning Circuit Tarneit 3029 VIC
This newly built, corner property, which is only two years old, offers loads of potential with a spacious floor plan to suit any loving family. Located in the central pocket of Tarneit, Close by to Primary & Secondary schools, within walking distance to Baden Powell College, Local Shopping and Childcare Centers, public transport (only 800m to Bus stop from the property) and less than a 5 minute drive to Tarneit Train Station, as well as easy access to M1 Freeway. This immaculate family home, offers;
• Large Master Bedroom including walk in robe and ensuite
• Two remaining bedrooms including built in robes
• Two bathrooms
• Kitchen overlooking the formal dining and family living arrangement
• Double Remote Lock up Garage
• Quality fittings include- ducted heating, evaporative cooling, floorboards, stone benchtops, splash back, landscaped gardens
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YPA Estate Agents Wyndham City
Werribee VIC, 3030
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Real Estate For Sale in Tarneit, VIC 3029 priced between $290,000 and $530,000


text: What are some options for making an octopus tank look attractive? I've had my tank properly setup, cycled and running excellently for a while now, but haven't figured out a way to make it loo more eye-popping. There are not too many creatures I can add to add color (and those that I can, I have), and I can't have corals because the octopus isn't reef safe/doesn't like high intensity light. What kinds of things do people add to their tanks to make them look visually appealing?


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The Ten Worst
Wild West Outlaws
Alton Pryor
Copyright 2012 by Alton Pryor
Smashwords Edition
This eBook is licensed for your personal enjoyment only. This eBook may not be resold or given away to other people.
Table of Contents
Chapter 1: The Rufus Buck Gang
Chapter 3: Robert Clay Allison
Chapter 4: Cullen Montgomery Baker
Chapter 6: Henry "Dutch Henry" Born


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Discussion in 'Android Devices' started by ArtGuy, Jun 16, 2010.
TiKL - Touch To Talk (PTT) v1.6 Application for Android | Communication
I dig it..... I use it daily.......works pretty well...
I use it too. I bug my wife all the time while she is at work. Muwhahaah!
Ugh, how annoying.
Is it a battery hog?
Do both phones have to be an EVO or an android variation?
As far as I know, to use the app, they have to be Android.
The app does use a server to route the information from your phone, to recipients phone. So it's possible they may have other apps on other OS devices.
EDIT: Looked them up. They currently only have apps on the Android OS. So yeah, only android devices.
Both Android. Tested with my EVO and others with Droid and Droid INC.
Is there a delay??
not at all. i did notice with low signal it gets choppy.
There is some delay (test with my Wife's phone and mine in the same room.) Maybe 1 or 2 seconds. Not much. Nearly the same as talking on the phone.
Love this app
Sent from my PC36100 using Tapatalk
So both people have to have the App open right? And is it speakerphone only?
It'd be funny if you could force your voice to come out of the other person's Evo at anytime you want.
Yes it is speaker phone.
And YES, you can yell at the person ANY time you want! ^_^
You can even Conference with multiple contacts. SWEET!
I THINK it automatially opens the app when you speak to the person.
I use it daily to keep in touch with my peeps. Great app.
ghetto Nextel
I'm using it, works great.
Sent from my PC36100 using Tapatalk
I just started using it today and it works just like my work phone (Blackberry 8350i) that uses Nextel direct connect.
LOL! I couldn't agree more, but I love it!
Sent an email to the developer and asked for continued support! No ads, more options via a paid version!
Been using all day, love it!!
Hahah..I already posted this with a link to the actual program.....
too funny
Thanks I bug my sister now on her Hero. Can't believe how easy it is to use and good quality for free ... thanks again .... over
My wife and I love it. Thanks for yjr heads up. Makes wading through the whining *almost* worth it.


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Published at Sunday, May 14th 2017, 05:41:17 AM by Came. Sofa.
Tags: rv sofa sleepers for sale. rv jackknife sofa cover. rv jack knife sofa craigslist. rv jackknife sofa slipcovers. rv jackknife sofas. used rv sofa.
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Laserfest photon
The Particle Zoo
Special Edition LASERFEST PHOTONS in your choice of red, green or blue! (Each color is a different wavelength of light.) Features custom Laserfest tag. Made for the 2010 Laserfest celebrations honoring laser pioneers.
Approximately 2 oz (57 gm); 4.5 inches (11 cm) across.
For ages 5 and up as it contains glued-on/small parts.


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--RHP Aaron Harang allowed two runs (one earned) on eight hits over seven innings Tuesday night. That is the only run he has allowed over 15 innings in his last two starts. And he has two no-decisions to show for it.
--1B Brad Hawpe hit a two-run homer. He has hit in 18 of his last 24 games and is batting .314 since April 25.
--RHP Heath Bell hasn't talked with the Padres about a contract extension since spring training, fueling speculation that the closer's days with the Padres are numbered. The Texas Rangers are said to be interested. Other teams said to have interest in Bell include the Cardinals, Angels and Phillies. A source with the Padres said things could heat up around the All-Star break.
--C Nick Hundley suffered a slight setback this week in his rehab from a right oblique strain. Hundley had hoped to start hitting at the end of last week, but that plan was put on hold. Hundley hopes to start swinging Friday, which means the start of his rehab assignment is at least a week away pending further tests.
--Padres majority owner John Moores and the owners of the Atlanta Hawks have agreed to terminate Moores' exclusive negotiating period to purchase the NBA team.
--The "player to be named" due the Padres from Tampa Bay in the SS Jason Bartlett deal has turned out to be "cash considerations."
5 -- Consecutive losses by the Padres. That is the longest losing streak of the season for the Padres, who are 1-6 on this homestand and 8-20 on the season at Petco Park.
"Aaron pitched well. His fastball velocity was up again. He pitched well. He handled a lineup that leads the National League in hitting and runs scored." -- Padres manager Bud Black on Aaron Harang's Tuesday outing.
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