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Idea Contagion
For good or ill, behaviors among humans pass not only by genes, but by language. A judgmental way to put this is that behaviors and ideas are "contagious." Pathological homesickness, apotemnophilia,[4] multiple personality disorder, and even Ursuline convents in seventeenth-century France[6] have been posited to arise from contagion.
In particular, suicide is widely accepted as a contagious behavior. The posited contagion even has a name - the "Werther effect." Belief in the media contagion of suicide is so strong and pervasive that "media guidelines" - a form of voluntary censorship - are widely observed in reporting on suicide.
There is evidence that many behaviors other than suicide are similarly "contagious," however. Violence against others, in particular, is well-studied in its relation to media contagion. The harm of violence, especially homicidal violence like murder and murder-suicide, is much greater than that of suicide. And the evidence in favor of "violence contagion" is stronger than that of suicide contagion. Why, then, are reports of suicide voluntarily censored, while reports of violence are not?
Suicide Contagion: The Evidence
The evidence for suicide contagion through the media is almost entirely ecological. The studies that provide the basis for the phenomenon of suicide contagion are somewhat questionable.[7] Many suffer from lack of control for important variables; those that are controlled suffer from problems with the control groups or small sample size. Some ecological studies have indicated that the suicide contagion phenomenon is real;[2] others have contradicted those findings. Even among studies that find a correlation between suicide rate and media reports of suicides, the correlation is often much weaker than the correlation of the suicide rate with other factors, such as the unemployment rate.[9]
Of course, there is a more abstract critique of ecological-level data in general. A criticism[1] of David Phillips' ecological data on suicide contagion and fatal aircraft incidents goes as follows:
Phillips asserts that the statistically significant increase in aircraft fatalities can be explained due to suicide, as well as a "consciously or unconsciously" induced motive on the part of the pilot to also murder some person or persons. What Phillips does, in effect, is impute suicidal motives to some deceased persons on the basis of the statistically significant increases in accidents. Such a jump is conceptually unwise because it is based on a tautology: the statistical increase is the basis for defining some cases as suicide, but these cases are also used to explain the increase. [Citations removed.]
At any rate, a major problem with suicide contagion research is a lack of empirical evidence at an individual level. The one case-controlled study that I am aware of[7] fails to demonstrate any link between hearing media reports of suicide and making a suicide attempt - and, in fact, demonstrates that hearing a media report of suicide has a significant protective effect against suicide attempts.
The study authors interviewed 153 people, ages 13-34, who were "victims" of nearly lethal suicide attempts and who had been treated at local emergency rooms in the Houston, Texas, area. A control group of 513 subjects was similarly interviewed. The conclusion? Not only did the study fail to demonstrate any sort of "suicide contagion," but, as mentioned above, the authors note a statistically significant protective effect when a subject heard a news report of suicide within 30 days prior to the suicide attempt or had a friend or acquaintance make a suicide attempt. That is, the ER suicide-attempt group was actually less likely than the control group to be aware of a recent media report of a suicide, or to have experienced the suicidal behavior of an acquaintance! The suicide attempt of a parent or relative had no statistically significant effect on suicidal behavior, whereas the usual "suicide contagion" sources had a statistically significant protective effect - the opposite of what the suicide contagion model predicts.
Violence Contagion?
The evidence for violence contagion is much stronger than that for suicide contagion. But whereas suicide censorship is widely accepted, censorship of other-directed violence in media stories is rare.
Violence contagion is demonstrated by the same type of ecological study as suicide contagion.[8] In addition, unlike the suicide case, there is a body of laboratory evidence suggesting that exposure to violent stimuli increases aggressive behavior. However, despite both sources of evidence, the theory that media reports of violence "cause" real-life violence is not at all universally accepted.[5] And the idea that the media should voluntarily self-censor with regard to reports of violence is much less widely accepted than self-censorship of reports of suicide, despite greater evidence for a causal link in the former case.
Contagion and Moral Responsibility
I believe that the insistence that suicide is media-contagious, but violence is not, is not rational, but is a consequence of the differential attributions of moral responsibility in cases of suicide versus other-directed violence. Suicide is seen as an irrational act; the actor, as the story goes, is not in control of himself, certainly not sane, and is therefore vulnerable to external effects.
On the other hand, the idea that violent acts like homicides are attributable to media suggestion is generally seen as a pathetic excuse. Perpetrators of violence are perceived as much more morally responsible for their acts than suicides; despite evidence to the contrary, idea contagion is psychologically ruled out as a cause of violence, but not of suicides (though there are exceptions to this line of thinking[3]).
Is political corruption contagious? Adultery? Prostitution? Drug abuse? Such questions are rarely even studied. Obesity certainly appears to be contagious. If so, should we censor reports of these topics to avoid a contagion effect? To do so would seem ludicrous and counter-productive, not to mention contrary to our political ideals. But the censorship of suicide goes unchallenged.
Moral Responsibility and Willingness to Censor
The more an actor is seen as the agent of his actions, the less outside influences are seen as affecting his actions. Therefore, in cases where moral responsibility is strongly attributed to an actor, outside influences are unlikely to be taken seriously as a cause of his actions - and, therefore, it is not necessary to censor these "outside influences" (such as media reports).
It is my belief that the widespread voluntary censorship of reports of suicide - from use of politically correct language to pervasive norms of message content - are the result of the modern trend to exculpate suicides from moral responsibility and redefine suicide as an act of insanity. There is, however, little evidence that suicides are any less morally responsible for their actions than murderers. Certainly, many other behaviors are media-contagious - but they are not censored, nor are many of them even studied.
I think that one possible explanation is that, at a deep level, people understand that suicide is just not that bad compared to actual acts of violence - despite hysterical language describing suicide as "self-murder." We want to exculpate people from acts to which we are sympathetic. While we often refuse to define acts outside of societal norms as "not wrong," we may nonetheless refuse to attribute full moral responsibility to these acts. However, this sort of sympathy backfires in our society. People who are "not responsible for their actions" must be "protected," often in painful and dehumanizing ways; and society is responsible for their "protection," often to the detriment of freedom.
Think of the children.
On a largely unrelated note, could this be the stupidest news story about suicide of all time?
Works Cited
1. Altheide, David. "Airplane Accidents, Murder, and the Mass Media: Comment on Phillips." Social Forces 2:593-596 (Special Issue, 1981).
2. Bollen, Kenneth, and David Phillips. "Imitative Suicides: A National Study of the Effects of Television News Stories." American Sociological Review 47:802-09 (1982).
3. Coalition of Law Abiding Sporting Shooters. "Ideas Kill: Science Shines a Light on Port Arthur Deaths." Retrieved from http://www.class.org.au/ideas-kill.htm on 04/06/2009.
4. Elliot, Carl. "A new way to be mad." The Atlantic, December 2000.
5. Gunter, Barrie. "Media Violence: Is There a Case for Causality?" American Behavioral Scientist 51:1061 (2008).
6. Jones, Marshall, and Elizabeth Rapley. "Behavioral Contagion and the Rise of Convent Education in France." Journal of Interdisciplinary History 31.4:489-521 (2001).
7. Mercy, James, Marcie-jo Kresnow, Patrick W. O'Carroll, Roberta K. Lee, Kenneth E. Powell, Lloyd B. Potter, Alan C. Swann, Ralph F. Frankowski, and Timothy L. Bayer. "Is Suicide Contagious? A Study of the Relation between Exposure to the Suicidal Behavior of Others and Nearly Lethal Suicide Attempts." (American Journal of Epidemiology 154:2 (2001).
8. Phillips, David. "The Impact of Mass Media Violence on U.S. Homicides." American Sociological Review 48:4:560-568 (1983).
9. Stack, Steven. "Divorce, Suicide, and the Mass Media: An Analysis of Differential Identification, 1948-1980." Journal of Marriage and the Family 2:553-560 (1990).


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Hello. Good new for those of us who love large spoons… The UK's favourite (and only) ladle superstore is celebrating two years of trading in Beckworth this week with a massive stock clearance sale. That's right, Len's Ladle Superstore is clearing the shelves of some of it's underperforming ladle lines. Recently retired dance teacher and store owner/manager Len Goodman has instructed his young assistant Bruno Tonioli to sell off the many badly bent and rusting items, so grab yourselves a large-spoon like bargain (whilst stocks last)… As Len often regales regulars down the pub "A house isn't a home without a ladle. Or two." Yours sincerely Valerie Saddleworth CBE. Chairlady. The Beckworth Guild of Trade & Commerce.
(Above) Just one of the lovely ladles available (at full price) in store today

subset: commoncrawl


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VideoHive TV Show Promo or Opener 73740
After Effects Project Files \ Openers \ Other
TV Show Promo or Opener 73740 by BBB @ VideoHive
After Effects Project Files \ Openers \ Other
After Effects Version: CS4 File Size: 2.2mb Requires Plugins: No Resolution: 1280x720
Stylish promo or opener with keywords about the subject of the show.
1) Whats the theme of the tv-show? Collect keywords about it.
2) Replace all the words with your own words (double click the layer)
3) Replace the title of the show and the name of the TV station (or add a logo instead of the text)
4) Change background color (if you want)
5) Replace the eye in the with something else (or just delete it)
6) Change to position of the camera if you want.
7) Thats it! Easy as 1,2,3.
Great as a promo, show opener or trailer.
Also very nice on a white background with colored text.
The music was made by me and you can use it for free in your (commercial) project!


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What could be a cuter way to help homeless dogs and cats find forever homes than at a Puppy Sweater Party?
The Richmond Welfare Foundation and hardwood Brewery teamed up to help homeless dogs and cats find homes.
Pet Parents, Meet Your Cute New Fur Friends
Dogs and cats form Richmond animal care were brought to the brewery, dressed in adorable sweaters. Prospective parents got to meet and spend time with the dogs and cats.
Many Found Homes
Luckily, many of the dogs and cats were adopted and went home with their new, loving families just in time for the holidays.
Tips For Helping Homeless Pets This Holiday Season
First, know that there are thousands of dogs in shelters (some of these are kill-shelters), rescues, and at the county pound right in your area. These pets are just waiting for someone to bail them out and give them a loving home.
Before you buy, considering adopting.
Because these dogs and cats deserve a home.
Don't Forget The Big Boys And Girls
Don't have a lot of extra energy to chase a puppy or kitten around? Consider adopting an adult or senior dog or cat. Many times these beautiful animals have been dumped after years of faithful friendship. Giving them a home will be one of the most rewarding gifts you'll ever give.
Consult Your Local Shelter Or Petfinder
Pet finder is a great website for finding homeless dogs and cats. Search by city, breed, even size.
You can also do a simple web search to find the type of dog you're looking for that is waiting for you at the rescue or shelter.
Not Ready To Adopt?
Not ready to bring in a homeless dog or cat? Can't handle the expense or just don't have the time or space for them?
No problem. If you can't adopt, donate.
Shelters and rescues always need:
- Food and treats
- Blankets and beds
- Toys, leashes, and collars
- Paper, office supplies
- Crates
- Money
If you can't afford to donate money, remember that they'd gladly accept your time. Helping walk or wash dogs and cats is a huge help to shelters. Assisting in adoption drives, or simply getting the word out helps tremendously. Cross-sharing on social media is an easy, no-cost way to help homeless pets find homes this holiday season.


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I decided to take an extra week off after New Years, although then i panicked about something and went to work on Tuesday anyway. But I'm off today, and for the next four days. Leon is back at work, so I'm going to spend the days knitting and reading and watching trashy television.
I'm reading Elizabeth Gilbert's The Signature of all Things. It's been in my queue for ages and I was undecided about whether to read it, but then Racheal Herron raved about it, so I decided to read it. (Stalker much?) I'm enjoying it, although it is written in an odd manner, more like someone telling a story than an actual novel. I've got a long time to decide if i like it, it's a chunky book.
I'm knitting Double Heelix sock from Knitty, as a sports sock. I'll do a full post about how I feel about these next - so many feels about one sock! But it's coming along nicely and will certainly make a usable pair of sneaker liners.
And that's me for another week. Pop over to Ginny's blog, to see what she, and the rest of the Yarnalong, are up to with their knitting and reading this week.
My adventures in knitting, spinning, dyeing, reading and living life the best way I know how.
Wednesday, January 6, 2016
Yarnalong -the one with more holidays
Posted by Sharondoubleknit at 4:07 AM
Labels: yarnalong
2 comments:
I'm reading Elizabeth Gilbert too, her new book though "Big Magic." I hope you enjoy her novel, it's on my list too. I still have never knit a pair of socks, but this could be the year:-) Happy knitting & Happy New Year!ReplyDelete
I did enjoy that book, but agree it took awhile to get into the style. Nice yarn that you're turning into a sock - aren't we clever to be able to do that? :-)ReplyDelete
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Our Story… a Little History
Our story? It's not fascinating but it is honest.
In our small country with dikes and bikes we've started our company Snel.com. Our aim was to build an automated platform that would make hosting and server management fast and simple. And we did. This turned our company into a well-recognized Dutch hosting provider.
The exciting thing is that we still have the same fire, the same passion and we are still surrounded with the people we love working with.
Our Core Values
Our lifeblood; we make the complex simple.
Our heart passionately beats for internet hosting.
We provide all the tools you need.
We do things well, even when no one is looking.
We are real, honest and friendly.
We take responsibility; you can count on us.


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|Home | About | Journals | Submit | Contact Us | Français
To evaluate the impact of a locally adapted evidence-based quality improvement (EBQI) approach to implementation of smoking cessation guidelines into routine practice.
We used patient questionnaires, practice surveys, and administrative data in Veterans Health Administration (VA) primary care practices across five southwestern states.
In a group-randomized trial of 18 VA facilities, matched on size and academic affiliation, we evaluated intervention practices' abilities to implement evidence-based smoking cessation care following structured evidence review, local priority setting, quality improvement plan development, practice facilitation, expert feedback, and monitoring. Control practices received mailed guidelines and VA audit-feedback reports as usual care.
To represent the population of primary care-based smokers, we randomly sampled and screened 36,445 patients to identify and enroll eligible smokers at baseline (n = 1,941) and follow-up at 12 months (n = 1,080). We used computer-assisted telephone interviewing to collect smoking behavior, nicotine dependence, readiness to change, health status, and patient sociodemographics. We used practice surveys to measure structure and process changes, and administrative data to assess population utilization patterns.
Intervention practices adopted multifaceted EBQI plans, but had difficulty implementing them, ultimately focusing on smoking cessation clinic referral strategies. While attendance rates increased (p<.0001), we found no intervention effect on smoking cessation.
EBQI stimulated practices to increase smoking cessation clinic referrals and try other less evidence-based interventions that did not translate into improved quit rates at a population level.
Tobacco use is the leading preventable cause of mortality, accounting for 435,000 deaths in the United States (Mokdad et al. 2004) and 4.8 million deaths due to tobacco worldwide (Ezzati and Lopez 2003). In the United States alone, smoking is responsible for $157 billion in annual health-related economic losses, which translates into each pack of cigarettes sold in the United States leading to $3.45 in medical expenditures and $3.73 in lost productivity (MMWR 2002).
While the prevalence of tobacco use has decreased dramatically over the last 40 years chiefly through public health interventions (MMWR 2003), we have not seen further declines in the past decade despite the availability of an increasing array of efficacious treatments (Ranney et al. 2006). Routine treatment of smokers by physicians has been a national health objective, but physician detection of smokers, counseling of smokers to quit, and prescription of pharmacotherapy to aid them in quitting have been well below quality standards (Thorndike et al. 1998). Dissemination of smoking cessation clinical practice guidelines during the mid-1990s offered substantial promise for making greater inroads by promoting evidence-based recommendations targeting changes in physician behavior and adaptive changes in health care settings. In particular, the guidelines reflect strong empirical evidence of the value of systematic screening for tobacco use, advising smokers to quit, and providing smoking cessation treatment (both counseling and medications) (Cromwell et al. 1997; Fiore 2000). The guidelines offer an explicit roadmap for integrating interventions with demonstrated effectiveness into routine clinical care (Fiore, Jorenby, and Baker 1997; Raw, McNeil, and West 1999).
However, most guideline dissemination efforts have met with only limited success. While early dissemination encouraged primary care physicians to ask about smoking and advise their patients to quit, few practicing physicians met criteria for adequate counseling to help smokers quit and fewer still provided smokers with necessary assistance or arranged follow-up services (Goldstein et al. 1998; DePue et al. 2002). System-level interventions have generally been recommended to help individual clinicians adopt guideline-adherent practices (Bero et al. 1998; Solberg 2000). These include improved forms of documentation to record smoking status (e.g., intake forms, "vital sign" stamps, stickers), clinician prompts or reminder systems for fostering guideline-adherent actions, provision of on-site educational materials, designation of a coordinator or clinical "champion," training of nurses/support staff in person or by phone to replace physician counseling, audit-and-feedback of clinician guideline adherence, computerized decision support, and incentives (Lichtenstein et al. 1996; Katz et al. 2004; An et al. 2006). Adoption of these approaches into practice settings, however, involves organizational change (Wensing and Grol 1994; Oxman et al. 1995). There is growing consensus that implementing research into practice through organizational change (Stone et al. 2002) depends in large part on the degree to which they account for or are adapted to the context of individual practices (Grol 1992, 1997) to facilitate diffusion (Rogers 1995).
Quality improvement (QI) methods assist practices in implementing improvements that are synchronous with local needs, priorities, and resources. Evidence-based quality improvement (EBQI) methods are based on the premise that practices will have greater success in achieving true improvements through organizational change using prior evidence from the literature as a guide for their activities. The objective of this study was to evaluate the effectiveness of an EBQI method for enabling health care managers, rather than researchers, to implement evidence-based smoking cessation interventions in the context of local practice needs and under routine conditions and to determine its impact on practice-level smoking cessation.
We approached for participation all facilities with three or more primary care providers and 3,000 or more primary care patients in the three contiguous and geographically proximal Veterans Health Administration (VA) health care networks in the southwestern United States. Three facilities declined to participate due to competing demands and time constraints. The research team's home institution was excluded from trial participation. We paired the remaining 20 eligible VA facilities on size and academic affiliation blocked on VA network to control for the influence of network-level policies, resource allocation, and leadership differences. One site's Institutional Review Board (IRB) was closed, eliminating the site and its matching facility, leaving 18 sites.
We used a group-randomized trial design to evaluate the impact of this EBQI approach to smoking cessation guideline implementation (Campbell et al. 2000). We randomly allocated one site from each pair to the intervention (n = 9) or control group (n = 9). IRB approval was maintained at all final participating sites.
Using the U.S. Public Health Service smoking cessation guidelines as our foundation for evidence-based practice recommendations, we designed and used an organizational QI intervention comprised of physician and patient educational materials, structured evidence review, local priority setting, QI plan development and adaptation, and site-specific audit-and-feedback, supplemented with ongoing expert review. At each intervention practice, 30-minute didactic sessions on population-based approaches to smoking cessation were delivered, followed by implementation planning using an expert panel process to help local opinion leaders set institutional priorities. Participating sites and their QI teams, rather than researchers, were the decision makers, ensuring local control of the adaptation of intervention features (Rubenstein et al. 1995). In addition to promoting detection of smokers through screening, smoking cessation experts from the research team provided evidence summaries for the main approaches advocated by the Department of Defense (DoD)/VA clinical practice guidelines for smoking cessation—namely, referral to a smoking cessation program, treatment within primary care, or telephone counseling (DoD/VA, 2004)—and offered recommendations for minimum protocols and implementation strategies that could be used to achieve organizational benefit (Sherman et al. 2005).
Following the panel, each intervention practice received a compendium of smoking cessation resource materials and tools for patients and providers shown to be effective in practice, as well as a QI manual outlining intervention processes and linking sites with research team assistance in obtaining and implementing any of the best practices included in the compendium. Academic experts participated in monthly audio or video conferences with site leadership to facilitate ongoing local adaptation of the prioritized interventions into explicit QI plans that laid out specific steps and resources necessary to act upon their chosen strategies (e.g., telephone outreach, provider profiling). Site leaders were encouraged but not required to revise their QI plans based on expert review and input. Bimonthly newsletters highlighted practice successes and challenges among participating sites. Each practice also received quarterly audit-and-feedback progress reports, including comparisons with other sites. Table 1 describes implementation characteristics.
Control sites received guideline copies. Because smoking cessation was among VA's performance measures, all sites also received audit-and-feedback reports from externally audited random patient records, which rank ordered site- and network-level performance (Kizer 1999).
We enrolled a representative cross section of smokers by screening random samples of all practice patients with three or more visits in the previous 12 months. Patients were contacted by trained interviewers using computer-assisted telephone interviewing, who described the study, administered informed consent using standardized protocols, and screened for smoking status (California Tobacco Surveys 2002). Current smokers were enrolled and further surveyed in the same call between March 22, 2000 and February 23, 2001; 12-month follow-up interviews were conducted on approximate anniversary dates between April 9, 2001 and January 2, 2002.
Following enrollment, trained telephone interviewers administered a 20–30-minute survey instrument including measures of smokers' sociodemographics (e.g., age, gender, race–ethnicity, insurance), health status (including the Veterans' SF-36 [Jones et al. 2001], Mental Health Index [Veit and Ware 1983], depression [Andresen et al. 1994], physical activity [Ainsworth, Jacobs, and Leon 1993], alcohol use [Saunders et al. 1993]), smoking behavior, nicotine dependence (Heatherton et al. 1991), readiness to change (DiClemente et al. 1991), and prebaseline treatment experience. Random interviews were selected for supervisor "observation" (i.e., silent listening-in to a live interview) in accordance with California law. At follow-up, smokers were resurveyed regarding their smoking behavior and treatment experience. Site surveys and intervention logs were used to track the implementation decisions of each primary care practice (Sherman et al. 2006). The number of unique patients, visits and mean visits per patient for primary care and smoking cessation clinics for intervention and control practices were obtained using designated clinic stop codes (301 and 323 for primary care; 707 for smoking cessation) from the VA Outpatient Clinic file.
Baseline characteristics of enrolled patients were compared by intervention group using t-tests for continuous variables and χ2 tests for categorical variables. Variables hypothesized to be predictive of smoking cessation were tested; predictor variables significantly correlated with smoking cessation were evaluated for collinearity and subsequently included in the logistic regression model in an intent-to-treat analysis (Mickey and Greenland 1989).
We used random hot deck imputation (Little 1988) to handle missing covariate values (fewer than 1–2 percent). We weighted patient data for the probability of enrollment (i.e., to better represent the target population of all primary care users) and attrition (i.e., to adjust for nonresponse between baseline and follow-up) using recursive logistic regression models (Rubin 1987). Predictor variables for enrollment weights included study randomization blocks and patient demographics (age and gender). Predictors for attrition weights included patient age, readiness to change, access to other public or private insurance, disability status (i.e., recipient of worker's compensation or Social Security Income), and reliance on VA care (i.e., exclusive VA use versus non-VA and low-VA use). Final weights were the reciprocal of the product of the model-predicted probabilities for the stages of enrollment and follow-up.
We used weighted logistic regression (SPSS version 11.5) to evaluate intervention effects, adjusting for patient-level predictors of smoking cessation (30+ days without smoking) at 12-months follow-up. We assessed the intraclass correlation coefficient (ICC) to determine the need for cluster adjustment; because the ICC was not statistically significant from zero, an unadjusted analytic approach was used. We assessed goodness of fit with the Hosmer–Lemeshow statistic (Hosmer and Lemeshow 2000).
We analyzed smoking cessation clinic attendance rates by identifying all unique patients with evidence of a visit to a smoking cessation clinic stop using codes in VA administrative data files for 12 months before (fiscal year or FY1999), during (FY2000) (concurrent with patient enrollment of the smokers' cohort), and after EBQI implementation (FY2001). We divided these by the estimated number of smokers in each practice (estimated prevalence of smoking) multiplied by the number of primary care patients seen in the same time periods as rates per 1,000.
Randomized practices were equivalent at baseline, with exceptions of higher use of provider incentives and tracking of screening performance in intervention practices and more provider counseling feedback and pharmacotherapy prescription authority in control practices (Table 1). Ranging from five to 13 participants, kickoff intervention meetings all included the heads of Medicine and/or Primary Care, while senior leadership (i.e., director) was present in six of nine practices. Practice-level site champion qualifications varied (four Ph.D.s, three R.N.s, one M.D., and one other). All intervention practices (100 percent) chose and endorsed their top 5 priorities for smoking cessation, received tailored expert advice to help develop locally customized QI plans and then received expert feedback on them. All QI plans focused on smoking cessation clinic referrals as the main guideline implementation strategy. Local QI plans for accomplishing this goal varied, with emphasis on smoking-related provider education, feedback, and patient education (Table 1).
Intervention practices' actual levels of implementation varied (Table 1). Provider and patient education activities were most commonly implemented (both rated as "not too difficult" to implement). While more broadly proposed, provider feedback (e.g., # of referrals, # on nicotine replacement therapy) was only partially implemented in a single site (rated "very difficult" in sites unable to implement). Changes to primary care (e.g., brief counseling, computerized reminders) and to smoking cessation clinics (e.g., counselors or "health techs" hired) were each planned and implemented in only two sites (and rated as "very difficult"). Provider incentives linked to referral behavior were only partially implemented in one site (rated "difficult"). Five practices (three of which were unable to implement the majority of the activities in their QI plans) added new activities not part of their original plans. These new activities were generally not part of the evidence-based toolkit that they were provided and thus varied in the degree to which they were evidence based (e.g., addition of 10 hours of psych tech time, increased availability of a variety of behavioral programs, establishment of a separate smoking cessation pharmacy clinic, addition of clinical pharmacists to provide individual counseling, and tobacco cessation clinical reminder).
Intervention practices saw a large absolute increase in smoking cessation clinic referrals (from 1,137 to 1,926 smokers seen) compared with control practices (from 1,979 to 1,993) (p<.0001) between baseline and 12-month post-EBQI implementation (Table 2). Intervention practices also demonstrated increased attendance rates (from 56.0 to 72.6 per 1,000) versus control practices whose attendance rates actually declined in the face of influxes of more primary care patients to the system (from 77.0 to 68.3 per 1,000) (p<.0001). Among those who attended, smokers in intervention practices had more visits post-EBQI (3.9 versus 3.5, p<.001).
We screened over 36,000 randomly sampled primary care patients to identify and enroll about 1,000 smokers in intervention and control practices, with a 56 percent response rate at 12-month follow-up (Figure 1). Overall, 77 percent of primary care patients had smoked in their lifetimes, while 20 percent were current smokers. Enrolled patients tended to be men (94 percent), with a high school diploma or better (86 percent), married (52 percent), and average age of 63.7 years.
We found no baseline differences in sociodemographics, health habits, readiness to change, or primary care visits (Table 3). Control site patients were more likely to smoke everyday, wake up to smoke, and to have tried nicotine patches, attended a smoking cessation program, and tried other ways to quit preintervention. They reported lower general health status and greater receipt of disability or Social Security Income, and were less likely to live alone. They were also more likely to use primary care providers for their health care compared with specialists.
At 12-month follow-up, 8.7 and 9.0 percent of enrolled smokers quit in intervention and control sites, respectively (Table 4). Control practice smokers reported more nicotine patch prescriptions and more referrals to smoking cessation programs, consistent with their self-reported histories pre-EBQI implementation; attendees, in turn, were more likely to be prescribed Zyban or Wellbutrin. Adjusting for baseline differences (noted in Table 3), we found no intervention effect on quit rates (Table 4). We had a 71 percent chance of detecting a statistically significant difference at the p<.05 level between intervention and control smokers in post hoc power analyses (assuming a two-sided test). Across all practices, patients who quit were more likely to see primary care providers for their usual care (OR=2.68, 95 percent CI 1.41–5.68) and less likely to be everyday smokers (OR=0.47, 95 percent CI 0.28–0.79) (Table 4).
We found that EBQI approaches to helping practices implement guideline-adherent smoking cessation care into routine practice achieved a limited set of evidence-based process changes but failed to improve patient quit rates. We explore a number of possible explanations for our results and their implications for implementing evidence-based practices.
First, we found that practices, as they had intended, succeeded in implementing increased smoking cessation clinic referrals. Practices rated such referrals as their top-ranked QI strategy (as opposed to primary care or telephone-based guideline alternatives), despite advice from the study's expert panel to the contrary. While the published literature on the efficacy of smoking cessation supports smoking cessation clinic referral as a virtual gold standard (Fiore, Jorenby, and Baker 1997), using this approach to improve outcomes across large and heterogeneous primary care populations may not be effective. For example, QI teams may not have adequately considered the impact of attempting to direct a larger flow of patients to a scarce resource, such as the potential for "bottlenecks" due to limited capacity. Experts also cautioned teams about the substantial evidence that many patients do not agree to referral, and that many who agree do not actually attend (Thompson et al. 1988; Van Sluijs, Van Poppel, and Van Mechelen 2004), making referrals unrealistic for large segments of the primary care population. In addition, referral delays may reduce the immediacy of PC physician responsiveness to patient readiness to change. Recent evidence regarding the effectiveness of smoking cessation helplines (i.e., Quitlines) and e-mail messaging suggest that immediate intervention may be especially beneficial (Fiore et al. 2004; Lenert et al. 2004).
On one level, the choice of the referral strategy by QI teams is understandable. Busy PC physicians may have found the referral option, accompanied by rigorous evidence of smoking cessation clinic effectiveness, especially attractive. Study practices also experienced substantial increases in patient volume over the course of the study, making referral, with its low burden on clinician time, potentially easier to implement than alternatives that require more PC-based participation. Increasing patient volume may also have contributed to generally reduced levels of organizational slack (Rogers 1995) for undertaking more complex or difficult strategies. The referral strategy, however, may not have had a large enough reach across primary care patients to impact population smoking cessation outcomes.
We expected our EBQI approach to enable participating sites to implement packages of recommended evidence-based strategies geared to accommodating the full range of needs of primary care smokers. Instead, the EBQI process resulted in QI plans with a mix of evidence-based and nonevidence-based interventions, many of the most promising of which did not get implemented as intended. The practices tried to add several PC-based activities into their QI plans (e.g., provider feedback reports) on top of the focus on smoking cessation program referrals in response to expert feedback. Ultimately, however, few practices succeeded in implementing these additional strategies, with the exception of provider and patient education, neither of which are considered sufficient in and of themselves. Most practices ended up trying to incorporate additional unplanned strategies that were not really evidence based (i.e., good ideas but lacked prior empirical evidence of their effectiveness).
So why did the intervention practices listen selectively to the evidence and the advice of smoking cessation "experts"? One possibility is that our intervention practices' more ambitious QI plans were not accompanied by adequate resources. In applying EBQI to depression care improvement, for example, study practices applied to their organizations for specific resources to implement their proposed QI strategies (Rubenstein et al. 2006). The study also provided QI team members with paid release time and on-site QI facilitation. In contrast, our study provided only education and facilitation from a distance. Without more support, stakeholder teams may accomplish the "plan-do" (PD) phase of PDSA cycles, without investing in the remaining processes necessary to accomplish true change (Walley and Gowland 2004). While we provided considerable data on local smoking cessation-related performance to the QI teams (e.g., smoking cessation visit rates), we did not provide information technology (IT) tools for them (e.g., no reminders or templates). IT capabilities might have boosted practice success (Hawe et al. 2004). Overall, more attention should be paid in future smoking cessation QI efforts to the level and types of resources needed to accomplish major change (Flottorp, Havelsrud, Oxman 2003).
Another possibility is that, while we tried to stack the QI processes in favor of the evidence, it was easier for participants to expand on something that was already in place (the smoking cessation clinic) than take on new initiatives focused on counseling and treatment in primary care. Many participants in the initial priority-setting meetings voiced comfort with having a smoking cessation clinic to solve their performance problems. Consistent with findings from depression care improvement, practices tended to choose passive strategies such as education rather than active change strategies (Sherman et al. 2007a), whereas the active strategies that encompass organizational change may be most effective (Stone et al. 2002).
In addition, tension exists between wanting to learn from an expert and the realities of not wanting to be told what to do and the notion that the expert does not know "our patients" or "our place." The EBQI process also relies on local authority to make organizational changes, and is thus dependent on the strength of local leadership (Rubenstein et al. 2002). Also, these practices were not selected based on perceived need to improve smoking cessation, and there is some evidence that practices choosing to buy help, rather than partake of offered help, fare better (Parker et al. 2007). The high level of practice choice may have helped stakeholders to "own" the process and outcomes of their EBQI experience, and might be expected to increase the likelihood of their sustaining adopted changes, but also supported the observed variability between sites.
After this intervention, our next studies focused instead on premade intervention options (i.e., pick A or B) (Sherman et al. 2007b). What is not clear is where the handoffs in this strategy occur. In other words, when does the researcher walk away and the practice stand alone? Unlike QI models promulgated by the Institute for Healthcare Improvement that require substantial meeting time within the context of "collaboratives" (Pearson et al. 2005), EBQI is designed to leverage initial planning meetings into local innovation and ownership. The literature is not clear on how these alternate QI models differ (Mittman 2004), but one issue remains central to all of them and that is the need for better insights on how one gets the QI process to reflect real life.
By the luck of the draw, intervention practices also appeared to be at an early disadvantage compared with control practices. Control practices appeared more likely to be early adopters of smoking cessation interventions at baseline. Specifically, a greater proportion of them used tools to encourage PC counseling and gave PC clinicians authority to prescribe smoking cessation medications (e.g., nicotine patches), and their baseline rates of smoking cessation clinic attendance were higher than those in intervention practices based on administrative data and patient self-report. By 12-month follow-up, intervention practices had significantly increased their attendance rates, while control practices had lost some ground at the practice level. The EBQI process may have helped convince managers and providers of the value of smoking cessation improvement (Michie et al. 2004) and in turn given them a structured process for successfully implementing at least one facet of evidence-based care they had targeted (i.e., increased referrals to smoking cessation programs). However, because the groups were not balanced at baseline despite randomization, it is difficult to interpret with certainty the cause for equivalence at follow-up. If intervention practices were in fact later adopters, then we may be observing a natural catch-up process independent of EBQI.
While intervention practices accomplished higher attendance rates practice-wide, EBQI-fostered changes failed to have an impact on patient outcomes in the form of smoking cessation. Control practices' efforts, without support from EBQI implementation, accomplished equivalent quit rates. There are several possible explanations for this result. First, our central outcome was smoking cessation rates in the population of smokers in intervention practices. If the best possible "evidence-based treatment" achieved a 10 percent increase in cessation rates (i.e., a very reasonable intervention) and the implementation method (here, EBQI) improved delivery of this intervention by 30 percent (i.e., a very successful QI implementation strategy), at best we can achieve a 3 percent increase in population cessation rates. While effects of this size can be difficult to measure in the context of a scientific study, an effect of this order would be important from a public health standpoint. Second, both intervention and control practices were operating under national VA performance measures incentivized at network and facility levels. Thus, control practices may have moved forward on a host of QI activities in the absence of an EBQI process to foster priority-setting, external expert review, and practice feedback. Instead, their practice feedback came in the form of nationally provided measures of local smoker identification and tobacco counseling rates that may have resulted in their higher levels of PC-based smoking cessation interventions at baseline. The value of PC-based changes is further supported by our patient-level trial results demonstrating that the strongest independent predictor of smoking cessation was usually being seen by a primary care provider for their health care.
Our study lends itself to several teaching points for research–clinical partnerships. First, researchers must be cautious in overselling the potential absolute impacts (e.g., percent change) of evidence-based practice when applied to the practice or population of patients served. In essence, pushing a large volume of patients into a small "box" (i.e., smoking cessation clinics)—even if it is a great "box"—is not going to work and only a fraction of smokers will be affected. Second, practicing clinicians and managers must be mindful that even small but consistently positive impacts at the population level may still yield important benefits (i.e., 3 percent of 46,000 smokers translates into almost 1,400 fewer smokers, with the concomitant improvements in health status and potential cost savings over time). Viewing these efforts as learning partnerships and using them to confront barriers, address local resources (human and financial) and refine processes in the spirit of continuous improvement in the context of the evidence will shorten the learning curve and improve the yield of future initiatives.
This study has a number of notable limitations. First, in the absence of a practice registry of smokers, we had to screen thousands of patients to identify a systematic sample of smokers. We used enrollment weights to address patterns of refusal and noncontact. We also incurred significant sample losses at follow-up; we used attrition weights to address potential response biases that might have resulted in retaining smokers at advanced stages of change (Emery et al. 2000). We empirically found that patients' readiness to change was not predictive of participation at follow-up. Consistent with the veteran population of VA users, our sample of smokers also over-represented older men, limiting the generalizability of patient-level results to similar groups. We measured smoking cessation attendance rates using national VA administrative data files, and may not have captured all visits due to local coding differences.
We also found discrepancies in rates of smoking cessation clinic attendance between administrative and survey data at follow-up. Administrative data demonstrated comparable attendance rates between intervention and control practices (i.e., intervention sites had "caught up"), while patient-reported attendance was higher in control practices. While we randomly sampled clinic visitors, it is possible that enrolled smokers represented more frequent users (Lee et al. 2002). We also had access only to age and gender of nonparticipants, limiting the precision of our ability to weight to the population of smokers. Patient-reported histories of referral and attendance were also higher in control practices at baseline, so it should not be surprising that they remained higher at follow-up. Time windows also differed somewhat (Rubenstein 2006).
The VA has been a leader in nationally implementing smoking cessation guidelines, made possible by computerized reminders, routine feedback of chart-based audits and performance incentives since the mid-1990s (Ward et al. 2003). While the focus on Ask and Advise has helped the VA achieve remarkable results on screening for tobacco use and physician counseling, we believe our findings point to the fact that attention to Assess, Assist, or Arrange in the "5 A's" is now warranted as smoking cessation treatment remains low (Anderson et al. 2002; Jonk et al. 2005). VA's common purpose and priorities are also important vehicles for knowledge creation when QI is armed with research evidence (Francis & Perlin 2006). EBQI holds promise for overcoming barriers to translating evidence into practice (Shojania and Grimshaw 2005), by making relevant research knowledge, data and tools accessible to managers and QI teams (Solberg et al. 2004). However, EBQI poses pitfalls for practices not prepared to support their priorities with organizational resources for training, IT support, and protected time to design and implement planned QI activities (Solberg et al. 2000; Feifer et al. 2004).
Joint Acknowledgment/Disclosure Statement: This study was funded by the VA HSR&D Service (Project #CPG 97-012). The trial was registered through ClinicalTrials.gov (Registry No. NCT00012987). Dr. Farmer was supported by a VA HSR&D career development award (Project #MRP 04-221). Dr. Yano was supported by the original grant, and subsequently by the VA Greater Los Angeles HSR&D Center of Excellence (Project #HFP 94-028) and a VA HSR&D Research Career Scientist Award (Project #RCS 05-195). We acknowledge the support of our site principal investigators: Timothy Carmody, Ph.D., Carol Chavez, N.P., Linda Ferry, M.D., Michael Gould, M.D., Betty Hedrick, N.P., Linda Hill, R.N., James Howard, M.D., Susan Blair Knepper, F.N.P., Charles McCreary, M.D., Matthew Meyer, Ph.D., Celia Michael, Ph.D., Nicole Miller, Ph.D., Sharon Rapp, Ph.D., Mitch Rice, R.N., M.N., Robert Smyer, M.D., David Webb, M.D., Brian Yee, M.D., and Sheila Young, Ph.D. We also acknowledge MingMing Wang, M.P.H., for administrative data acquisition and analysis, Ismelda Canelo, M.P.A., for administrative support, and the many interviewers and staff at California Survey Research Services Inc. (CSRS) in Van Nuys, CA. We would also like to thank the editors and reviewers for their extremely helpful, substantive input leading to improved reporting of these trial results.
Disclosures: The authors have no relevant financial interests or advocacy positions pertaining to this manuscript. VA policy requires submission of a copy of manuscripts on acceptance for internal preparation of briefings and/or press releases as needed in anticipation of publication, but they do not undergo or require internal peer review or comment periods. Preliminary versions of this work were presented at the VA HSR&D Annual Meeting (2004, 2006) and the Society for General Internal Medicine (2003).
Disclaimers: Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
The following supplementary material for this article is available online:
Appendix SA1. Author matrix.
This material is available as part of the online article from http://www.blackwell-synergy.com/doi/abs/10.1111/j.1475-6773.2008.00865.x (this link will take you to the article abstract).
Please note: Blackwell Publishing is not responsible for the content or functionality of any supplementary materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article.
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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All Terrain Cycles is the UK's Largest & Oldest Independent Bike Store. Buy mountain bikes, road bikes and cycle clothing. 3 years 0% Finance available on all bikes.
Product Code: 112441
Additional mounting kit suitable for 2011 Adventure Trailer bikes
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Shoulder Separation (cont.)
Is It Possible to Prevent a Shoulder Separation?
Prevention of shoulder separation involves wearing proper protective equipment when participating in sports, making sure shoulder muscles are well-conditioned and strong, and preventing falls. If any activity causes shoulder pain, stop and see a doctor before the condition gets worse. If there is a pre-existing shoulder injury, do rehabilitation exercises and allow the injury to heal completely.
Shoulder Separation Pictures
The patient's right shoulder (viewer's left) is separated. Photo courtesy of Lisa Chan, MD, Department of Emergency Medicine, University of Arizona College of Medicine.
Acromioclavicular joint separation. X-ray courtesy of Lisa Chan, MD, Department of Emergency Medicine, University of Arizona College of Medicine.
Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery
Medically Reviewed by a Doctor on 11/14/2016
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The acromioclavicular (AC) joint is a diarthrodial articulation with an interposed fibrocartilaginous meniscal disk that links the hyaline cartilage articular surfaces of the acromial process and the clavicle.


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Evidence of hormone disruption in humans "weak", says WHO
Evidence of impacts from endocrine disrupting compounds on humans is weak though highly plausible, an expert panel for the World Health Organisation and the UN Environment Programme has concluded.1 A draft report released in May recommends continuing research on basic science coupled with testing to identify potentially active substances and exposure monitoring.
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A Healthy Slice, for Runfessions.
While not strictly a running related confession, it would probably help my runs significantly if I hadn't fallen off the healthy eating wagon. Recently my diet hasn't been the greatest. Between my Jelly Belly binges and lots of prepackaged food I'm not very proud of my eating habits lately.


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Bathurst's Premier LAN Events
ZebbieLAN's are a local LAN community from Bathurst, Australia who gather to participate in LAN's featuring Tourneys, Prizes, Big Games & More.
Named after our late Founder Zebbie. [ZebbieLAN] aims to continue his memory by giving attendees the best day possible.


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Bees offer Adomah bumper deal
Barnet have offered highly-rated winger Albert Adomah a record-breaking new three-year contract.
Last Updated: 30/10/09 8:35pm
Albert Adomah has been offered a new contract by Barnet which would make the winger the best-paid player in the club's history.
The 21-year-old has created a huge impression since joining Barnet in January 2008 and is one of the brightest prospects in the Football League.
He was the subject of a failed by Blackpool on transfer deadline day in September, and has also attracted interest from Norwich City and Watford.
Adomah is out of contract at the end of the season and Bees chairman Tony Kleanthous confirmed the lucrative nature of the three-year deal offered to the exciting wide man.
"Our offer shows what we think of Albert - he has done a great job for the club and is a key part of the side that has started this season so well under manager Ian Hendon and his staff and is, hopefully, underlining our promotion intentions," Kleanthous told the club's official website.
"We accept that there is a lot of interest from clubs in higher leagues and, as we have always said in relation to any player at Barnet FC, if the right offer came in that was acceptable to both the club and the player we would not stand in his way and would wish him well for the future.
"Whatever Albert decides about our offer we will accept his decision, happily or regretfully."


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Clearaudio TT2 tonearm
So as to never ever compromise the beginning of the signal path we at Clearaudio favour tangential tonearm design. The application of our experience, machining, design and engineering has turned this choice into a Master Class of tonearm design.
The by now legendary Statement tangential tonearm TT 1was an iconoclastic instrument of this principle.
We are very proud to introduce the new TT line as State-of-the art tonearms and as the ultimate for the music lover who wants perfection. Whatever was possible to improve, we did.
The TT2 tonearm is massive, extreme solid and almost free of resonances.
By using this tonearm in connection with an adequate cartridge system, you will have the possibility to tap the full potential of your hi-fi system.
As a special feature the TT 2 tonearm comes with an integrated and comfortable height adjustment.
Technical specifications
Tracking principle:
Patented two-point - tangential tracking, resonance-optimized chassis
Version: silver aluminium
Construction design:
- Strictly mechanical
- Selected high precision ball bearings running in a
polished glass tube
Ca. 1990 g
(without tonearm base; base: appr.: 235 g)
Dimensions (W/D/H in inches):
Approx.: 12 x 4 x 3
Dimensions (W/D/H in mm):
Approx.: 300 x 100 x 70
Manufacturers guarantee*:
5 Years
*Only if the warranty registration card is correctly filled out by the owner and sent back to Clearaudio within the stated time.
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UK ORDERS: We despatch the bulk of our UK mainland items on a 24 hour service – Free of Charge. Free delivery also applies to the Isle of Man, Isle of Wight, the Scilly Isles, the Scottish highlands and Islands, the Channel Islands and Northern Ireland but may take a day or so longer. Smaller items are delivered using Royal Mail recorded delivery or special delivery. Larger items are delivered using a courier service such as Interlink Express, DPD, UPS or DHL.
INTERNATIONAL ORDERS: We offer competitive rates which can be confirmed by email. Please just ask – we will need a full delivery address and telephone number. Smaller items are delivered using Royal Mail Small Packets Airmail with International Tracked and/or Signed depending on value of item and availability of the service. Larger International shipments are sent by insured and tracked services using DPD, DHL or UPS. If there are any delays due to specific customs regulations, etc, you will be contacted by Turntableworld or by the courier with a request for any further information required. Customs duties do not apply for shipments into any EU country (for a full list please refer to the EU Country List). Customs duties can apply for countries outside of the EU. Customers in these countries are responsible for all taxes and duties incurred when the items enter their country.


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Polished, commanding, humble and armed with a ready supply of emotive quotes to stir the soul of the most cynical Kop veterans, each utterance seemed to cleanse the Anfield air which has often seemed contaminated by recent traumas.
The new Liverpool manager's flawless first impression on Friday may be limited to words rather than deeds, but there were moments when it seemed Fenway Sports Group had indeed appointed a man of gravitas and vision.
This was never more apparent when, sensing the muddled perceptions of the 'sporting director' model Liverpool continued to champion, Rodgers intervened to create absolute clarity. For those still obsessing about multi-tiered management structures, here is the reality in plain English: Rodgers is Liverpool's new boss.
Technical, medical and scouting expertise will 'underpin' him. If that is not quite what FSG had in mind on starting their recruitment process a fortnight ago, that is what they have now signed up to.
"If you want to have a sporting director, get him in and then you can pick your manager from there but if you do I won't be the manager," said Rodgers, with striking authority. "It's very simple - you've got a manager and in and around that you've got different departments.
"I can't do everything, that's nigh on impossible, and that's no different to any other top manager. They'll manage their club and then they'll have a chief scout and heads of recruitment and heads of medical and he will manage that. Then obviously these people will go out and identify targets that fit the identity of the club and bring a list of three or four names, we'll look at the value and worth and then you'll make the decision as the manager because it's absolute madness if you are the manager of the club and someone else tells you to have that player.
"I've had total clarity with that. It was for this reason that I didn't want to say what I've said and then in three weeks' time Louis van Gaal walks in the door. It does not work.
"I am better when I have control. I am not a power freak. But I need to feel that I can manage it in terms of the team and I have a direct clear line through to the owners. Once that becomes hazed and grey, for me there is a problem."
Liverpool's recruitment process was thorough enough to recognise compromises were required to get the right man. Rodgers' background checks were exemplary, and his mentoring by Jose Mourinho undoubtedly assisted his cause. Rodgers received a text from Mourinho urging him to take the job.
Since accepting, the 39 year-old has called Steven Gerrard and Jamie Carragher, both of whom are excited by the prospect of working with him. Liverpool's senior players always unconditionally support new managers rather than undermine them.
Gerrard, on England duty, registered his approval. "I've been kept in the loop all along by the board and the owners, and he was first-choice so take no notice of Dave Whelan," said Gerrard. "I'm very excited. I've kept my eye on the television and am aware of what's happened. I spoke to Brendan [on Thursday] night for quite some time. I'm very excited and looking forward to working with him. Before I spoke to him I'd heard great things, from the Chelsea boys and a few others who have worked with him. I've done a bit of homework and everyone speaks really well of him. I'm really excited.
"He never went into detail about his visions for the club. I'm sure he will in the future. It was basically just a meet and greet kind of phonecall. He's excited and looking forward to working with all the players. I feel exactly the same. As a player you don't like to see changes in managers. You want continuity. Hopefully he can progress the team and move us forward and stay for a long time. It's good to work with a manager for a long time. You get used to him and into a rhythm."
There have been times when heading to and from Anfield has felt like a chore, the club appearing to be either debilitated by civil unrest or imprisoned by its past. This felt like a belated welcome to the 21st century.
History is never far away, though. At a club where the sound bites of Bill Shankly decorate the walls as philosophical truths, Rodgers revealed himself to be a man with a poetic grasp of Anfield romanticism.
"When you come to a club like this one the shirt weighs much heavier than any other shirt. The weight of expectation is phenomenal," he said.
"My job next year is to try and lift some of that weight off the shirt. I'll take the pressure. The players can just go and concentrate on performing and if you do that you'll get the result eight or nine times out of 10 because of your talent. I want to use the incredible support to make coming to Anfield the longest 90 minutes of an opponent's life.
"That's the idea. I want to see this great attacking football with creativity and imagination, with relentless pressing of the ball.
"This is a club that is historic for the identity, style and DNA of its football. They are an educated group of supporters at this club and, OK there might be watered down versions of the style of play, but you can't come to Liverpool and play a direct game of football, lumping-it-style.
"The reality is that this is a club where I need to align the playing group with the supporters. There is an imbalance at the minute. You've got some of the world's best supporters here and the playing group is not quite at that level yet.
"You've got some wonderful players here, some wonderful talent, but the work over the next number of years is to see if we can get that aligned. The reality is that, right now, it's not. I'm not going to sit here and bluff. It is going to take a bit of time. There are some big, talented players here but there is no doubt that to get the team to play how I want to play I'll need to bring in other players. To play the offensive, attacking football we did at Swansea we had to make changes in terms of recruitment.
"What excites me is the motivation to get that level back up again and that is why I came here."
Rodgers' first day was blessed with charm, charisma and goodwill. If his teams perform as expertly as he did here, the latest ushering of a new Anfield era will finally yield its desired effect.


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Matthew McConaughey, Jennifer Garner, and Jared Leto Had to Make Fast Choices for 'Dallas Buyers Club'
Matthew McConaughey, Jared Leto, and Jennifer Garner talk about working on the film "Dallas Buyers Club."
Matthew McConaughey, Jennifer Garner, and Jared Leto Had to Make Fast Choices for 'Dallas Buyers Club'
Matthew McConaughey, Jared Leto, and Jennifer Garner talk about working on the film "Dallas Buyers Club."
Actor-Writer-Filmmaker Guinevere Turner Raises Funds for 'Creeps' with Indiegogo
Backstage talked to Guinevere Turner about her indie past, her creative present, and what she hopes to accomplish with "Creeps" in the near future.
'12 Years a Slave' and 'Fruitvale Station' Among Gotham Nominees
The Independent Filmmaker Project announced the Gotham Awards nominees Wednesday, with Chiwetel Ejiofor and Cate Blanchett earning nods for "12 Years a Slave" and "Blue Jasmine."
29th Annual Boston Film Festival Kicks Off With Andy Garcia
The Boston Film Festival, which opens Friday, will feature the premiere of "At Middleton," a romantic comedy starring Andy Garcia and Vera Farmiga as parents who fall in love during a college tour with their respective kids.
Abigail Breslin's 4 Tips for Success
Starring in her first horror film, "Haunter" Abigail Breslin says she never stops learning and shares some of what she's learned about creating connections.
Why Chiwetel Ejiofor Almost Turned Down '12 Years a Slave'
The British actor was so daunted by the responsibility of playing a real-life escaped slave he came close to not taking the part. Then he reconsidered.
James Badge Dale's 4 Keys to Creating Memorable Characters
James Badge Dale talk about taking on the role of Lee Harvey Oswald's brother in "Parkland" and offers some tips on creating memorable characters.
Sarah Paulson Likes To Earn Her Roles
The Emmy-nominated actor has a busy October, with "12 Years a Slave" opening in theaters Oct. 18 and "American Horror Story: Coven," premiering Oct. 9 on FX.
Where to Go to Find Work as an Actor
Could incentive fatigue keep work in L.A. and NYC? From North Carolina to Missouri, where "Winter's Bone" was filmed, lawmakers are debating or have settled on sunsetting their incentives, while states such as Michigan have added tighter controls—and fewer dollars—to their programs.
Movie Star Chris Hemsworth Still Insists on Auditioning
When it came to Ron Howard's film "Rush," Hemsworth wasn't taking any chances or wasting any time—so he put himself on tape.


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'On his way to school, a young boy finds a red balloon tangled around a lamp post. Soon after rescuing it, the boy discovers the balloon has a mind of its own! Together, the boy and his balloon wander the streets, exploring the neighbourhood and searching for adventure.'
Source: Publisher's blurb.


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I travel a lot for work, and stay in plenty of very blah hotels, so any cool hotel concept catches my eye.
Obviously concept isn't everything. The hotel has to be good at the basics. A great mattress and bedding. A soft fluffy towel. A good desk with enough power points. Good food. Quick service etc. But after that, you can layer on a concept to make the hotel unique.
India is years behind developed countries when it comes to hotels. Until a few years ago, the only choice was between great (lovely 5 star hotels) and crappy (old, run-down, usually overpriced).
A new generation of hotels is popping up. The 3 trends are:
- Cheap 'business' hotels. The leading chain in this is the Ginger group. Rs.1000-3000 per night for a basic, but new/clean room with a proper mattress, 24hr hot water, self service pretty much everything, small gym, Wi-Fi etc. It's a great vision for how to run a hotel – strip out all the non-essentials, make whatever is left work really well. These hotels are aimed at domestic business travellers.
- Cheaper luxury brand hotels. This are things like Marriott 'Courtyard' hotels. They just leave off some of the higher end luxury features, and drop the room rates by about 20-40%
- Boutique hotels. These are small, luxury, stand-alone hotels, usually opened by someone who has always wanted to run a hotel (or has a great building and doesn't know what else to do with it 🙂 these might have 4-12 rooms and offer personalised service. Often the owner lives on-site.
- This first category is the one with the most potential. Ginger is building some pretty big hotels, but some of them are getting 100% occupancy, booked over a week in advance. To be clear, 100% occupancy is not the best thing for a hotel. It means the rooms have no natural down-time for maintenance, so the management has to refuse revenue in order to work on the rooms. That's turning down short-term profit for long-term value, a trait for which Indian businesses are not famous.
It also means that demand outweighs supply. More people can build similar hotels, and there are enough guests for everyone.
The one thing that I don't like about these hotels, is that they are bland. There is nothing distinctive or memorable. In these cases that is what they are aiming for, but once the basics are in place, there is plenty of scope for concept to be layered on top.
A great example of a concept hotel is the new Nhow Hotel, in Berlin, Germany.
The theme is music, here's how they have created it:
- All rooms with IPod connections and vast entertainment options
- Guitar hire through room service
- Top DJs playing in the bar
- Live music in the hotel's open spaces
- 2 professional music studios,
- Hotel staff include a full-time music manager, and many ex-students of local music colleges
- Filling out the 'Lifestyle" offerings are clothing sales from local designers, a headphone and streetwear store, and an art space.
- The architecture and interior design are both striking and were created by star designers.
This is the sort of place that you could stay in, and would still be telling people about a decade later!
Other than the recording studios, guitar hire, and musical staff, most of this stuff is not uncommon at good hotels around the world. What these guys have done differently is grouped everything together into a THEME. Creating a narrative that weaves around their offerings helps to market the property and help to guide future business decisions regarding services and expansions.


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Palm Beach Gardens, FL (PressExposure) February 25, 2012 -- On Sunday, at the lavish Lincoln Center, in Manhattan's Lincoln Square neighborhood of the Upper West Side, Rox and the entertainment world got together to heat up the night on the Red Carpet for one of Steven Spielberg's latest movies World Premiere of War Horse. Standing on this Red Carpet with the International Press Elite, was Roxanna Cella. Roxanna "Rox" Cella and Crew [Dan Cella] were invited to an all expenses paid trip to cover the exciting premiere of one of the world's most cherished filmmakers. Showing that Rox is not just a local South Florida based television show host, but also and esteemed Entertainment Journalist, with enough prowess to be invited to work along side the giants of the industry.
In four short months, Rox has developed, worked on and established credible working relationships with some of the entertainment, publishing, and business world's biggest gatekeepers. This has given her access to some of their top-tier celebrity clients. The hard work has paid off. Not only has Rox harnessed the ability to generate exciting, current and traffic-gathering content, but she also has put herself in the position to be recognized by some of the largest film companies in the world. This being an achievement in itself, Rox remains humble, understanding that the path to the top is a long one.
Dream Works and Disney provided Rox with a film crew at the event. They filmed her as she interviewed celebrities like Jeremy Irvine (War Horse), Emily Watson (War Horse/Breaking Waves), Stephen Lang (Avatar/Terra Nova), Tom Hiddleston (War Horse), Kathie Lee Gifford (Today Show/Live With Regis And Kathie Lee) and many other fabulous celebrities. But none of them could out shine the real star of the night, and that was Steven Spielberg.
Steven Spielberg arrived last, but certainly not least, to the Red Carpet where the fans, the media and Rox patiently awaited. Upon arrival a mob swarmed around Steven Spielberg. Amongst the reporters at the front of the group was Rox. Within seconds of the group interview, Rox had gotten in her first question, asking the director what he wanted his fans to walk away with after seeing the film. He replied, "I want them to leave the movie with their own personal responses. I'd rather have the audience work for their own emotional experience, then to hear how I feel and base their opinions off of me." Rox then was invited by Steven Spielberg to join him down the Red Carpet for another session of questions with the Foreign News Networks. After some more photos and videos, Steven Spielberg was lead off the Red Carpet and into his premier. Later that night, Steven Spielberg apologized at the after party to Rox for the shortness of the interview, and thanked her for coming to the event. The after party was full of celebrities where Rox partied with Ed Westwick (Gossip Girl) and the legendary Tony Danza.


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Showing social share count is essential as it helps to add social proof to your web page. Of course, there are exceptional when you have relatively no share & you don't want to show your share count as zero. I assume you are already following few if not all the tricks mentioned here to get more social media share for your content & you are no more into the Zero count zone. If you are using any social media sharing plugin or even the original twitter share button code, you must have been noticing that it doesn't show share count. It's sad that (30 comments)
The 30-Minute Social Media Workout for Every Marketer
Any sportsman will tell you that short but regular training is much more effective than one huge effort every two weeks. The same applies to social media – devoting half an hour to it every day will benefit you more than three hours once a week. We've come up with a fast, 30-minute social media workout that would help any marketer grow and engage their audience, and gain influence in their relevant niche. But don't worry, we've prepared some gear for you—we've made sure you are fully equipped with the best (and preferably free) tools! (54 comments)
5 Twitter Hashtag Tracking and Analytics tools
#Hashtags, #Hashtags everywhere! The world went berserk since Twitter's Hashtags were introduced back in 2009. The world was so serious about it to the extent that Hashtag was the 'Word of the year', even Facebook announced Hashtags recently in June 2013 and also there was a baby named 'Hashtag'! You can go on and say a lot against Hashtags and their importance, but their value is unquestionable in this world that is insanely connected. The internet is made up of long and short messages delivered online and Hashtags provide with a way of grouping (11 comments)


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This topic lists interesting community resources. Feel free to discuss about existing and point out new ones, but if the resource has it's own topic in the forum, then please use it for the discussion.
Jekyll.tips is an excellent starting point for the newcomer in Jekyll universe. It includes well written guides from set-up to hosting and even covers advanced topics like collections, pagination, and data files. The example templates make it also easier to dig deeper into Jekyll's templating world.
A fine collection of various Jekyll themes.
Another rich collection of Jekyll themes. You can also sort themes by conditions like popularity or alphabetically.
Planet Jekyll is an aggregator which contains various cheatsheets, link collections, and snippets.
Actively maintained collections of Jekyll themes.
{static is} The New Dynamic is a collection of links, articles, tools, events about the static web world, it's technologies, and solutions.
I tried to restore this post as much as possible. Removed some part of old discussion and links to specific resources' topics since those don't exist anymore.


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Great track from Sequel and all they want is the good times. If you feeling him and agree make sure you share this joint so he can make it to MsCosmo's show.
If you feeling this track stream it below and share the link by pressing on twitter and Facebook buttons below. Winner will be announced this Saturday at 6pm


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Tipp-Ex Correction Roller Micro Tape Twist Blue
One twist and it's safe
You can leave this one lying on the desk without worry. Its clever twist mechanism will make sure the tip is always safe.
€3,11 incl. VAT
|excl. VAT
|incl. VAT
No Waiting, No Mess, just instant correction with Tipp-Ex dry correction tapes, 8m Correction Tape, Immediate, clean, precise correction. Can be written on immediately after application. Patented rotating cap to protect tip.
With patented cap to protect the tape. Handy and easy.
Band Dimensions (W x L): 5 mm x 8 m.
Viking No. 2135975 EAN/UPC 3086123120044 Brand Tipp-Ex Product Type Correction Roller Refillable No Unit Each
Free delivery
Delivery costs
An order of €49,00* (excl. VAT) or higher is delivered free. Orders below this value will have a delivery charge added of €2,95 (excl. VAT). The insurance charge of €1,95 (excl. VAT) is added to each order independently from the order amount.
For partial deliveries the delivery charge is also calculated based on the total amount (excl. VAT) of your order.
*Postage stamps are exempt from free delivery limit.
Delivery times
Saturday – Sunday: Tuesday**
*Orders that are received by 3:00 pm on Friday are delivered with reservation on Mondays.
**Orders that are received by 3:00 pm on workdays are delivered with reservation on the next day.
For some products, such as furniture, a deviating delivery date of a few days may apply. This information is listed for the relevant products in our online catalogue or on this website.
The next possible delivery date is displayed during the online order and the order confirmation.
All articles marked with "delayed delivery" are delivered directly from the suppliers with different logistics partners, so the delivery time varies.
Payment options
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We accept payments with Visa and Eurocard / Mastercard / American Express. Your transactions are executed safely. Your personal data is transmitted securely by the SSL system.
Pay with PayPal easily and securely. Benefit from buying protection.
Delivery note / invoice
The invoice / delivery note will be added to the delivery address. After accepting the order, you have a payment term of 30 days.


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Discussion in 'Interiors' started by Girish, Jun 1, 2010.
Me keen on this... post pics ASAP mate
*subscribed* Orange light would match the dash indicators as well!!!
we are waiting! its the weekend!
We all are - If it's a DIY thing, I am sure to try & do it
Do post the instructions when you can - Waiting for them...
We are waiting to have a looks at the improved Cabin light by DIY,
Guys check out DIY-Automated Cabin FootLight
Guys need help, my front cabin light is blown off, where can get spares in pune. Spares guy in showroom told me i can find it in accessories shop. Any suggestions where i can get original spares?
Did it blow off by any of your experiments ?? I think you can take out the bulb alone from the light and get it from local automobile spare shop .
no experiment, it just fused, i removed the bulb, it has turned black, looking for any good shop in pune where i can find new one.
been once to CARAX in pune for seat covers and sun films, but dont know if they keep these.
Just go to any of the shops sells LED/Flash lights. they should have one.
If not OEM bulb go for this....
Separate names with a comma.


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Shrinking Magazines
Yachting Monthly's June issue had an interesting letter from a reader expressing disappointment at its 'diminished value' having shrunk from 200 pages in 2006 to 100 pages today.
YM responded by saying the number of editorial pages had only dropped from 80 to 76.
They didn't address the more interesting question of how the title is still viable with 24 pages of Ads rather than the 120 it had 10 years ago.
Part of the answer must be that, while magazine production costs have fallen significantly thanks to digital reproduction technology, IPC's (now Time Inc's) advertising rates have not followed suit.
With advertisers now also having to spread their budgets across a growing array of digital media, the net result is less advertising in print.
Smaller businesses in particular can't afford it, and that's not good for the marine industry as a whole.
Thinner mags have left readers aggrieved that they're getting a poor deal – some clearly welcome more Ads.
None of this need have happened. If magazines were to pass on those production cost savings, by lowering their rates, they might well achieve similar earnings as more businesses could afford to advertise.
The magazines would be bigger, readers wouldn't feel they're getting less value, and MY and others might even have kept more of their 2006 readership.


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With this Loyalty Merchant, your Shopping Benefits will be calculated based on the net value of your purchase because this Loyalty Merchant offers standard form of earnings.
Extraordinary Ordinary Day (EOD) specialises in premium quality shoes handcrafted by artisan cobblers. Everything it designs leads to your ultimate self-expression: style that make you feel sexy and confident with a high level of comfort.


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Etouffee it is!
Etouffee is another dish that is new to me. I did quite a bit of reading and asking around as research and found that the word "etouffee" means to smother in French. Usually a rich, spicy gravy, this dish consists of crayfish or shrimp smothered in a thick sauce over rice. I looked all over for crayfish but was told this is the wrong season. So on to shrimp. Shrimp covered in a thick, spicy sauce...I couldn't wait.
First, I needed a good shrimp stock as a base for the sauce. I shelled two pounds of shrimp, added lemon, onion, celery, a bay leaf, peppercorns, salt, and a few sprigs of thyme and water to cover. I strained the stock and found I had more than enough for the sauce.
Into the freezer went 4 cups of golden liquid that will serve me well in future gumbo or jambalaya. I was a bit surprised at the deep color after such a short period of simmering. Guess I'm used to making chicken and beef stock. The whole house smelled like a shrimp boil at this point and my husband kept wandering over to check the stove approvingly.
Next, out came the butter. Lots of butter. A bit of flour whisked in and cooked just until the color turned a bit. Then came piles of onion, celery, bell pepper and garlic. Everything was cooked until the vegetables were just wilted. Then came two cups of the stock, salt and cayenne.
Stirred and simmered everything for a few minutes and ended up filling the house with the most amazing smells. The sauce thickened up nicely and seemed just spiced enough to set of the tender shrimp once they joined the pan. I added the shrimp and kept simmering until they were just cooked through but still tender. Meanwhile, I made up some rice to go underneath and chopped some parsley to top it all off.
Here is my shrimp etouffee in all its glory. How to describe this dish? If I were a food writer I could come up with all kinds of clever ways to capture how this felt in my mouth, how it all tasted. Istead, I'll just say this: it was incredibly, unbelievably delicious.
Thank you, Adam, for putting together Gourmet Survivor II. You raised a lot of money for a very worthy cause, and because of you I have cooked and eaten more wonderful New Orleans food in the past food than I have in my whole lifetime.
Shrimp Etouffee
for the shrimp stock:
1/2 onion, sliced
one stalk celery, sliced
1/2 lemon
bay leaf
1/4 tsp. peppercorns
1/2 tsp. salt
4 srpigs thyme
water to cover
For the sauce:
2 lbs. shrimp with shells
8 ounces butter
1/2 cup flour
4 cups yellow onion, diced
3 stalks celery, diced
1 medium green bell pepper, diced
2 Tbs. garlic, minced
2 cups shrimp stock
1 1/2 tsp. salt
1 1/2 tsp. cayenne
1/4 cup parsley, chopped fine
For stock, combine shrimp shells with the remaining stock ingredients in a medium pot. Bring to a boil then turn to a simmer and cook for 30 minutes. Strain, set 2 cups of stock aside for this dish, and save remaining 4 cups stock for future use.
Melt butter in a large pan over medium heat. Add flour and cook until just turning color. Add onion, celery, bell pepper and garlic and cook until vegetables are just tender. Add shrimp stock, salt, and cayenne and stir to combine well. Turn down heat to a simmer and cook for 10 minutes. Add in the shrimp, stir, and simmer until shrimp is just cooked. Serve over rice and sprinkle parsley over the top.


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In addition to the artwork on display in the museum, Quinnipiac University houses a significant collection of printed materials relating to the starvation that occurred throughout Ireland from 1845–52 and the forced emigration during these years and beyond. This collection is available in the Lender Family Special Collection Room at the University's Arnold Bernhard Library on the Mount Carmel Campus.
Some of the volumes housed in the Lender Room are extremely rare and were written at or close to the time of the Great Hunger. Others include tragic and moving accounts and personal recollections taken from letters and diaries of the period. Present-day authorities and scholars, historical novels, essays and personal reflections contribute to the record. Quinnipiac University continues to build on this valuable resource for scholarly research and for educating people on the reality and implications of this tragic period in human history.
The British Parliamentary Papers relating to Ireland from 1801–93 is a highlight of this collection. Consisting of some 4,500 individual items, including bound volumes, individual reports and administrative files, these official papers document various aspects of life in Ireland during the 19th century: the people, their land (or lack of it), education, rebellions, famines and religion. The collection also features the rare four-volume, The Bogs of Ireland, 1812-19, which include 68 magnificent maps of Irish bogs, a copy of the six-volume set on the Disturbances in Ireland published in 1825, and a complete set in 12 volumes of The Parnell Commission.
The room was dedicated on September 21, 2000, in honor of Murray Lender, Marvin Lender and members of the Lender Family, whose generosity and dedication to promoting education and public awareness about The Great Hunger made the collection possible.
To make an appointment to view the collection in the Lender Family Special Collection Room, please visit: http://www.thegreathunger.org/MoreInformation/ContactUs.asp.
For information related to Ireland's Great Hunger Institute, scholarly resource for the study of The Great Hunger, and programs please visit: https://www.qu.edu/on-campus/institutes-centers/irelands-great-hunger-institute.html


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The following video is a review of the Trigger Point Therapy Workbook by Claire Davies.
This is an excellent book and one of the best on the subject of trigger points. Comprehensive with great illustrations and we consider it a MUST have resource. You can order it from amazon or other online book sellers and you can also often times find it in your local book store.
Be sure to take advantage of our additional videos and articles about trigger points and trigger point therapy.
Written By: Updated: December 8,2009


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Ethiopian Chicken Stew (Doro Wett)
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Chiusa is an alpine village with pastel-coloured houses and birrerie. It has a special eatery with typical hearty fare of the Sud Tirol region where, if you're lucky enough, you can eat in a booth... Read more
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What: A city surrounded by water, San Francisco has a plethora of fresh seafood at its disposal. Sure, you'll find it finely cut into impeccable sushi and sashimi and expertly sautéed by a myriad of chefs here, but cioppino is the most quintessentially San Francisco seafood dish. A tomato-based seafood stew that originated here in the 1800s among the Italian fishing community, cioppino is traditionally filled with whatever was left over from the day's catch, often including mussels, clams, shrimp, white fish, and even a whole Dungeness crab, all of it cooked with ample amounts of garlic and wine. The origin of the name is three-fold: Ciuppin means "to chop" in Ligurian Italian, and cioppino features all manner of leftover, "chopped" seafood. Ciuppin is the actual name of a Genoese seafood stew (though that version features fewer tomatoes). And, according to some sources, the name cioppino comes from the request, "Hey, you—chip in!" made to fellow fishermen in beginners' English. In any case, cioppino quickly became a fixture at San Francisco's Italian restaurants, and remains a staple at the city's seafood-centric spots.
Where: When it comes to classic San Francisco seafood, it's hard to beat Sotto Mare (552 Green St., betw. Grant & Columbus Aves., map) in North Beach, San Francisco's traditionally Italian neighborhood. The restaurant serves up delicious, fresh seafood, simply prepared—petrale sole gently cooked in butter, pan-fried sand dabs, just-shucked West Coast oysters, and, of course, cioppino. The space is warm, bustling, and always crowded—the walls are covered with framed photos of owner Gigi Fiorucci with San Francisco luminaries, evoking Sotto's storied San Francisco past.
When: Mon-Sat, 11am-9:30pm
Order: The "Best Damn Crab Cioppino" ($41). Sotto Mare stakes a bold claim with its menu description, but the textbook-perfect take on cioppino lives up to the hype. Served in a grand silver tureen, the restaurant claims it is "enough for two", yet we've fed up to six people with this brimming bowl of seafood (particularly when paired with a couple of generous plates of fish). Massive hunks of cracked crab are best attacked with your hands; plump, briny mussels and clams, sweet shrimp, and falling-apart whitefish round out the mix. But what makes this cioppino so good is the broth. It's rich with bright, sweet tomato flavor, given depth with a hearty pour of wine, and laced with enough garlic for a good bite. Make use of the bibs provided—it won't be long before you're hit with a delicious shellfish splatter.
Alternatively: We also love the cioppino at Anchor Oyster Bar (579 Castro St., betw. 18th & 19th Sts., map) in the Castro—the flavor profile is similar to Sotto's, but with even more garlic. You'll find winning versions at Tadich Grill (240 California St., betw. Battery & Front Sts., map) and Woodhouse Fish Co. (multiple locations, including 2073 Market St., at Church St., map), as well.
©2017 Eat Your World, LLC - All Rights Reserved


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A SCHOOLBOY who became an internet sensation for his amazing impressions of Alex Salmond has turned his hand to mimicking US President Donald Trump to help children in Malawi.
Ryan McGuigan, 15, has battled back from bowel disease, his parents' divorce and the loss of his beloved grandfather to become one of the youngest, if not the youngest, stand-up comedians in Scotland.
His confident yet hilarious, impressions of the former First Minister, as well as Ed Miliband, David Cameron and Nigel Farage, attracted huge praise from comedians like Kevin Bridges and Rory Bremner.
Ryan is also heavily involved in fundraising and committees for Malawi projects at his school, St Margaret's High in Airdrie, Lanarkshire, who have published moving diaries of their trips highlighting the work they do, and how it has helped the children in Malawi and affected them personally.
Staff, pupils and former pupils are now on tour with their 2016 diaries as they prepare for this year's return trip on June 22 and they recently visited Galashiels Academy to speak to pupils at their assembly.
Their next stop is the tiny Hebridean island of Eigg on Monday, May 22, after locals invited them along to speak to the four pupils at the small school, and they are very excited to give a talk about their adventures in Malawi.
Third-year pupil Ryan said: "I started studying Donald Trump very closely, what he was saying and what he was doing, on TV in the run-up to the US election. Doing impressions of Donald Trump gets a lot of laughs and people really enjoy it as he is a larger-than-life character and there is plenty to go on.
"I will be taking my impressions to Eigg Primary and we will be telling the pupils over there about our last trip to Malawi and our diaries. I can't wait to go to the island.
"When I did my impressions at Galashiels Academy, everyone absolutely loved it. I didn't expect to get such a great response."
Despite spending much of his early years in Glasgow's Yorkhill children's hospital receiving treatment for ulcerative colitis, a form of inflammatory bowel disease, and helping to look after his younger brother Martin, 10, who is autistic, Ryan still finds time to rehearse his lines and keep up to date with politics.
His uncanny impression of Salmond earned him a trip to meet him at the Scottish National Portrait Gallery to witness the unveiling of his portrait in 2015, and since then he's been gigging at comedy shows to raise money for the Aiming Higher in Malawi charity project which transforms the lives of disabled children.
Ryan has had the support of fellow pupils at St Margaret's and his English teacher Andy McKay, who is also involved in the Malawi projects, with his impressions.
McKay said: "We are really excited about going to Eigg, there are only four weans in the school but we feel like rock stars because I've been getting text messages from people about us coming up.
"There will be over 20 of us going including Ryan and, for the warm-up, we'll be getting him to do his Trump impression which is the best in the world, even better than he is himself, and he's so funny. You really have to see him to believe him. Down in Galashiels he had everyone killing themselves with laughter. It went down a storm. He really is a very talented young man."
As part of the North Lanarkshire Council Aiming Higher project, Ryan's family sponsors four-year-old Yamikani Austin, who has a haematoma, and the money will help pay for treatment.
For the past few years, pupils at St Margaret's have been producing diaries written from the heart while they were out in Malawi. The diaries, titled "Friendship, Family and Faith" are the accounts of the 2016 visit and pupils are now on tour with the book.


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Tuesday, July 12
Enjoy the July 12 "Danny Bonaduce & Sarah Morning Show" —
- The Doochman is teaching his son how to ride a bike.
- Gibbons put condiments on the car of a girl who didn't like him.
- Sarah used to be addicted to Tetris.
WATCH today's episode on DANNY TV here.
DOWNLOAD today's episode on iTunes.
STREAM today's episode below:
Want more Bonaduce? SUBSCRIBE to the KZOK YouTube Page


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Definition of "Al-'amir"
Lit: Inhabited or cultivated land. Tech: Land belonging to people collectively, such as a path, a canal or a river. Nobody can claim ownership of these lands except with the express permission of the people. See also al-mawat.
Create Your FREE Account…
IslamicBanker helps professionals navigate Islamic markets by providing powerful insights, analytics and collaboration tools.


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New poker experience at 888pokerJoin now
Join now to get $88 FREE (no deposit needed)
APPT9 Macau: Winfred Yu on Moving the PKC to The Venetian
We talk to Winfred Yu, President of the Poker King Club, about the move from his poker room to The Venetian, and its big opening where Phil Ivey, Tom Dwan and Johnny Chan were in attendance. Oh yeah, and we find out why Dwan didn't play the charity event they hosted.
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Jonathan Ward – MIT – Machines That Make
I've been interested in all kinds of machine tools for a long time, and in the various projects like Rep Rap and the like that use either additive or subtractive technologies. Now that I am involved more in radio stuff, the prospect of milling small pc boards seams very cool, and this little CNC mill seems to fit the bill. Preserved for later.
Comment from Elwood Downey
Time 1/12/2010 at 4:47 pm
That does indeed look ideal, thanks for posting. But how to make those nice plywood parts? Anyone up for offering this as a kit (oops – that might be a commercial application according to MIT)?


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Operation Blue Santa
Back in 1972, Operation Blue Santa started out helping two families. Now, the operation serves more than six-thousand families and has given out over twenty-thousand gifts. Here to tell us how we can help spread some holiday cheer through the operation is Mike Sheffield with the Austin Police Department and Kristi Carter of Supershuttle Local Business.