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Shaw, William S. PhD; Reme, Silje Endresen PhD; Pransky, Glenn MD, MOccH; Woiszwillo, Mary Jane BS; Steenstra, Ivan A. PhD; Linton, Steven J. PhD
From the Liberty Mutual Research Institute for Safety (Drs Shaw, Reme, and Pransky and Ms Woiszwillo), Hopkinton, Mass; University of Massachusetts Medical School (Drs Shaw and Pransky), Worcester, Mass; Harvard School of Public Health (Dr Reme), Boston, Mass; Institute for Work and Health (Dr Steenstra), Toronto, Ontario, Canada; and Center for Health and Medical Psychology (Dr Linton), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
Address correspondence to: William S. Shaw, PhD, Liberty Mutual Center for Disability Research, 71 Frankland Rd, Hopkinton, MA 01748 (email@example.com).
This study was an intramural research project of the Liberty Mutual Research Institute for Safety, with travel support from a 2006 International Association for the Study of Pain research grant funded by the Scan/Design Foundation by Inger and Jens Bruun (Linton and Shaw).
Disclosure: The authors declare no conflict of interest.
Objective: To reduce a full psychosocial test battery to a brief screening questionnaire to triage return-to-work strategies among patients with low back pain (LBP).
Methods: Workers (N = 496) with acute, work-related LBP completed multiple psychosocial measures at intake, then a 3-month follow-up of pain, function, and work status. A sensitivity analysis was conducted to reduce the number of items while maintaining scale reliability, preserving associations with outcomes, and maintaining separation between patient subgroups.
Results: The pool of items was trimmed from 129 to 46 items, describing elements of emotional distress, pain beliefs, organizational support, and activity limitation. A confirmatory cluster analysis replicated previous findings of three risk subgroups: distressed, avoidant, and lacking employer support.
Conclusions: The reduced measure is a reliable and valid screening measure that can be used to identify early intervention needs among working adults with LBP.
There is a growing body of evidence supporting the importance of psychosocial and workplace concerns ("yellow flags") as prognostic factors in low back pain (LBP) recovery and return to work.1–11 Early assessment of psychosocial factors is recommended in many treatment guidelines,7,12–14 and this issue has been highlighted as an important component of quality care in "best practices" summaries.6,15–21 But, despite a widespread acceptance of the biopsychosocial framework for medical management of LBP,22 psychosocial issues are rarely raised by patients with LBP,23 and frontline providers often lack referral options for dealing with psychosocial issues.24 Thus, there is a continuing need to develop feasible psychosocial assessment and intervention methods in occupational medicine and other clinical settings to more effectively triage efforts to prevent chronic back disability.
An essential question is whether psychosocial factors can be reliably and feasibly assessed and incorporated into patient education and clinical decision making.25 A number of self-report screening measures have been developed,26–28 but scores typically indicate only whether a patient is at elevated risk, with no ability to discern specific problems that might be the target of intervention. When used to triage patients in clinical trials, at least one of these measures (the STarTBack screening tool) (Keele University, Keele, Staffordshire, UK)29 has shown modest improvements in patient outcomes and a significant reduction in treatment costs overall (primarily by reducing unnecessary treatments to low-risk patients).30 In that study, primary care patients at elevated risk received psychologically informed physiotherapy sessions. Although the STarTBack trial provides preliminary support for psychosocial triage of patients with LBP, more research is needed to refine psychosocial screening methods and evaluate them in a variety of clinical settings.
Cluster analysis of patient self-report data is one method that has shown preliminary support for delineating meaningful LBP subgroups, especially those with and without emotional distress.31–36 In a previous patient cohort, we identified four preliminary patient subgroups on the basis of disability risk factors that are as follows: those with few or no concerns ("low risk"), those lacking employer support, those with high emotional distress, and those with physical restriction without distress31; and these results were replicated in the current patient cohort by using a full psychosocial test battery.32 Three-month functional outcomes and return to work were poorest in the emotional distress group and intermediate in the other two risk groups, when compared with low-risk patients. In an occupational medicine setting, such classifications may provide a basis for triaging patients for additional intervention beyond conservative care and reassurance. The aim of this study was to build on our prior work by reducing the number of questionnaire items necessary to produce a feasible and reliable LBP screening tool (ie, the Pain Recovery Inventory of Concerns and Expectations [PRICE] measure) that could guide early interventions for high-risk patients.
For development of the screening measure, data were taken from a prospective cohort of 496 working adults (58% men) who completed a psychosocial test battery before an initial medical evaluation for work-related, acute LBP. The study was conducted in cooperation with a private network of occupational health clinics in the United States, with the eight participating clinics located in Massachusetts, Rhode Island, or Texas. Study eligibility requirements were (1) nonspecific sacral or lumbar back pain, (2) acute onset or exacerbation (fewer than 14 days), (3) pain self-reported as occupational in origin, (4) aged 18 years or older, and (5) fluency in English or Spanish. Of the 496 patients enrolled in this study, 359 (72%) could be reached for the 3-month follow-up assessment. Detailed demographic characteristics of the study sample have been published elsewhere,32 but the sample was generally representative of younger, blue-collar workers (mean age, 37 years) employed by medium to large companies. Comparisons of responders and nonresponders at 3-month follow-up showed that responders were older, more likely women, and of lower educational status (P < 0.05). The significant difference on psychosocial predictor variables was only for responders to report more organizational support (t[490] = 2.96; P = 0.003).
Patients were recruited from the consecutive caseload of patients reporting LBP, and volunteer patients completed a brief demographic questionnaire and a 10-page psychosocial test battery (approximately 10 to 15 minutes) after providing written consent. Patients then received a standard medical history and physical examination in adherence to current occupational medicine guidelines.13 Three months after the initial medical evaluation, participants were contacted to complete a brief follow-up questionnaire assessing pain, functional limitation, and work status. The 3-month time frame was chosen for its significance in distinguishing acute from subacute phases of LBP. All study procedures were approved by the institutional review board of the Liberty Mutual Research Institute for Safety.
Rationale for scale inclusion, existing psychometric data, and initial cluster analysis results for the full scales used in the patient cohort study have been presented in an earlier report.32 The findings from these original analyses were that eight of the psychosocial scales were reliable and valid predictors of disability outcomes and that a four-cluster solution provided the best fit in a K-means cluster analysis. The four patient clusters were given the labels of "minimal risk" (29%), "workplace concerns" (26%), "activity limitation" (27%), and "emotional distress" (19%). The eight scales that were included in the original cluster analysis were the Quebec Back Pain Disability Scale,37 a single-item rating of pain intensity,38 the Center for Epidemiologic Studies–Depression scale,39 the Pain Catastrophizing Scale,40 the Tampa Scale of Kinesiophobia,41 the Survey of Perceived Organizational Support,42 and two new measures developed or adapted by the authors: a nine-item Life Impact of Pain Scale and a three-item rating of recovery expectations.
The two new measures were developed for the study to expand on existing disability screening constructs. The Life Impact of Pain Scale was designed to assess the belief that a single episode of LBP has lifelong health and career implications, a negative viewpoint expressed in qualitative studies43–45 but not explicit in existing constructs such as pain catastrophizing. Respondents record level of agreement for nine statements (eg, "This pain episode will affect my future") on a four-point scale from "strongly disagree" to "strongly agree." In this initial cohort, the internal consistency (Cronbach α) was 0.82 and the 1-week test–retest correlation 0.88. Although many previous studies have included a single question pertaining to recovery expectation,46 we expanded this to three questions assessing different aspects of recovery (symptoms, function, and work status),47 with recovery time as the primary reference. Patients were asked to estimate the length of time (0 to 2, 3 to 7, 8 to 14, 15 to 30, 31 to 60, and more than 60 days) they expected for pain resolution, resumption of normal activities, and return to full-duty work. The internal consistency of the three-item scale in this cohort was 0.90, and the 1-week test–retest correlation was 0.65.
In addition to reassessing pain intensity (Visual Analog Scale) and functional limitation (Quebec Back Pain Disability Scale) at 3-month follow-up, participants provided details about current work status, any temporary modifications or physician restrictions, and the cumulative duration of work absences and work modifications. To provide an overall outcome measure that would distinguish the patients with a possible need for further monitoring, treatment, or referral, a composite clinical case rating was also used. Caseness was defined by problems in any of the three outcome domains: work status (unable to resume full duty work), pain rating (5 or greater), or physical dysfunction (greater than 50% items endorsed). Rationale for these cutoff scores can be found in an earlier cohort study.48
A sensitivity analysis was conducted separately for each of the eight psychosocial variables to reduce the overall length while still maintaining a sufficient level of reliability and validity. Although a conventional approach to psychometric testing of a new measure might suggest that the full sample be randomly partitioned into "training" and "validation" samples, our stepwise sensitivity analysis and clustering methods were not conducive to split-sample validation. Also, we hoped to minimize error by including a large sample size when making individual item discriminations. Thus, the full sample was included in all data analyses. With the exception of the single-item pain intensity rating, items were dropped one by one until any of the following criteria were reached: (1) the internal consistency (α) of the individual scale was diminished by more than 10% from the full-scale version; (2) the Pearson correlations of the measure with 3-month pain or disability scores were decreased by more than 10%; (3) the odds ratio of the measure with 3-month return to work was decreased by more than 10% in magnitude; or (4) only two items remained in the scale. Items were chosen for deletion in order of lowest to highest correlation with the total scale score (to maintain the highest level of internal consistency). Scale scores were coded as "missing" if more than two items on the scale were not completed.
After item reduction, the original K-means cluster analysis from the full set of items32 was repeated using scale scores computed only from the reduced items. The K-means cluster analysis is a statistical procedure for identifying relatively homogenous groups of cases based on selected characteristics.49–51 The computational algorithm starts with k random clusters, and then moves subjects iteratively between those clusters with the goal of minimizing variability within clusters while maximizing variability between clusters. The number of clusters, k, can be designated by the user to produce different cluster solutions. The relative locations of cluster centers were used to provide descriptive labels. Our criterion for the correct number of clusters was to determine the maximum number of patient clusters that still showed a noticeable improvement in the percentage of total variance explained (the "elbow" method)52 while also maintaining a Squared Euclidian distance between neighboring cluster centers of at least 2.0 standard deviation units (an "information criterion" method).51 We chose these combined criteria to consider both the explanatory strength and informativeness of cluster results. The analysis was repeated in sequential steps, each time increasing the number of clusters by one.
The reduced questionnaire was reevaluated in terms of total score reliability (internal consistency [α]) and validity (prospective correlation with 3-month pain and disability outcomes). A total severity index (a mean of the eight z scores) was computed to assess the new measure's overall correlation with 3-month outcomes. The area under the curve (AUC) was computed for the dichotomous outcome measures of return to work and clinical case rating.
Descriptive data for the eight psychosocial scales (both full scale and reduced scale) are shown in Table 1. The total pool of items was trimmed from 129 to 46 items without reducing the internal consistency or correlation of individual scales with outcome measures by more than 10%. The scales requiring that more items be preserved were the measures of depressive symptoms (Center for Epidemiologic Studies–Depression) and activity limitation (Quebec Back Pain Disability Scale). In contrast, only two items were retained for assessment of pain catastrophizing (Pain Catastrophizing Scale) and four items for fear of movement (Tampa Kinesiophobia Scale). The final 46 items were distributed as follows: depressive symptoms, 12 items; pain catastrophizing, 2 items; lack of organizational support, 7 items; activity limitation, 15 items; fear of movement, 4 items; perceiving grave life impacts, 3 items; poor expectations for recovery, 2 items; and pain intensity, 1 item.
The eight shortened-scale scores were standardized (z scores), then subjected to a K-means cluster analysis. When five clusters were specified, the Euclidean distance fell below 2.0; thus, the four-cluster solution was chosen, which converged after 18 iterations, with the Euclidian distances between cluster centers varying from 2.03 to 4.90 (Table 2). Analysis of variance results comparing group means for the four-cluster solution (Table 3) showed the relative contribution of each variable to the separation of groups overall. The omnibus test of group differences was statistically significant (P < 0.05) for all eight measures, but this would be expected on the basis of the aim of cluster analysis to maximize group differences. Depressive symptoms had the lowest F value for discriminating groups, and organizational support, the highest.
Interpreting and labeling of clusters were accomplished by noting the largest deviation of cluster means from the grand mean by using a radar graph (Fig. 1). On each of the spokes of the radar graph, the mean standardized scores are plotted by cluster (a score of "0" representing the grand mean). Cluster 1 consisted of 108 patients (22%) who reported few concerns on any of the predictor variables. Cluster 2 consisted of 115 patients (23%) who reported problems in nearly all areas, but the greatest elevations were related to emotional distress (catastrophizing, depression, poor recovery expectations, and life impact of pain). Cluster 3 consisted of 125 patients (25%) who reported lack of organizational support as a more pronounced problem relative to other groups. Cluster 4 consisted of 147 patients (30%) who had elevations with regard to pain intensity and functional limitation but were average in other respects. On the basis of these characteristics, we retained the four cluster labels from the prior analysis of the full-scale measures: "organizational concerns," "emotional distress," "activity limitation," and "minimal risk."
Individual cases were then "assigned" to the nearest cluster grouping and compared on demographic variables and outcomes of pain, functional limitation, return to work, and the composite clinical case rating at 3-month follow-up (Tables 4 and 5). Demographic comparisons (one-way analysis of variance or chi-square tests) showed no differences between clusters on sex or marital status (P > 0.05). Nevertheless, those in the "activity limitation" cluster were older (mean, 39.2 vs 35 to 37 years in the other groups), and those in the "emotional distress" cluster had lower education, income, and job tenure (P < 0.05).
There was a significant main effect for the four clusters on pain outcomes at 3 months (F[df = 3] = 21.64; P < 0.001). Post hoc comparisons using the Tukey honestly significant difference test indicated that the mean score of the emotional distress group (cluster 2) was significantly different from that of all the other groups (P < 0.001). There was also a significant main effect for the four clusters on functional limitations after 3 months (F[df = 3] = 28.1; P < 0.001), with the post hoc comparisons showing significant differences between all the clusters, except for no difference between the workplace concerns group and the physical limitation group. Controlling for age, education, income, and job tenure did not attenuate these group effects.
In terms of return to work (Table 5), the emotional distress group was more than seven times less likely to have resumed normal work responsibilities after 3 months (P < 0.001). The workplace concerns and activity limitation groups showed some increased risk of not returning to work (odds ratio = 2.09 and 1.82, respectively), but these effects did not reach statistical significance (P > 0.05). The composite clinical case rating, however, showed statistically significant differences (P < 0.05) between the minimal risk group and the other three groups. There was approximately a 2-fold risk of caseness in the workplace concerns and activity limitation groups and a 12-fold increase in the emotional distress group. The AUC for the overall PRICE severity index was 0.75 for predicting 3-month disability (Fig. 2) and 0.73 for predicting 3-month clinical case rating (Fig. 3).
This study provides initial psychometric evaluation of a new patient-screening tool that can be used for subgroup classification of patients with LBP, and this research direction has been ranked as a high priority among back pain specialists and researchers.53 Like several existing psychosocial screening measures,28 the PRICE provides a total score to estimate the overall prognosis for a quick recovery and resumption of normal daily activities. In addition, the PRICE screening questionnaire provides an indication of whether attention should be focused on workplace coordination, physical activation, or psychological coping, and this may improve the ability to provide more patient-centered strategies for early disability prevention. Further research is needed to determine whether the PRICE produces similar findings in other clinical settings and whether clinical application might improve disability outcomes; nevertheless, this study provides further support for the triage of patients with LBP, using a condensed psychosocial screening inventory.
One finding from the sensitivity analysis was that while only two to seven items were retained from most of the original scales, this was not the case for the Center for Epidemiologic Studies–Depression measure (where 12 of 20 items were retained) and the QPS physical function measure (15 of 20 items retained). Further deletion of items from either of these scales would have substantially diminished their associations with 3-month outcomes. Our interpretation is that the complexity of these constructs required more items to reliably quantify their effect on longitudinal outcomes. Although shorter psychosocial screening questionnaires are available to assess overall patient risk,29 a total of 46 items were necessary on the PRICE measure to reliably classify patients by problem area domains. At 46 items, the PRICE measure requires approximately 5 minutes to complete, and this seems feasible for waiting room administration.
Results of the study also provide evidence that a lengthy psychosocial test battery can be reduced to a feasible clinical screening instrument (46 items) without sacrificing reliability or validity of individual constructs necessary to draw meaningful contrasts between patients. Reduction of the total item pool from 129 to 46 items preserved the internal consistency of individual psychosocial constructs, while not confounding the four-group classification of patients found in an earlier cluster analysis using the full-length measures.31 This subgroup classification (derived from the 46-item scale) was further supported by significant group differences in outcome measures at 3 months. Although specific cutoff scores for choosing and assigning patients to early intervention may depend on other factors (cost of intervention, anticipated effect size, etc), the normative data from this initial cohort provide a preliminary basis for making such determinations for applying the PRICE questionnaire in clinical practice or in subsequent research trials. One possible strategy would be to establish a cutoff score on the total severity index, then assign early intervention strategies on the basis of the nearest cluster centroid.
One challenge of applying the PRICE in clinical decision making is that although specific patterns of psychosocial factors can be discerned, there remains a substantial correlation among these variables, and it may be difficult to judge which factors are the root cause to be targeted for early intervention. In particular, emotional distress seems to be an issue of at least moderate importance across all three risk groups. Interpreting a depression screening measure in the presence of acute pain is challenging, and clearly more theoretical work is necessary to understand whether such elevations represent a comorbid mental health condition, an affective component of pain experience, or an indication that pain has exceeded available coping resources. There is some evidence that emotional distress might have a different conceptualization for acute rather than chronic LBP.54,55 Although it might benefit all at-risk patients to receive multidisciplinary interventions addressing workplace, emotional, and physical function issues, this high level of clinical intervention is neither feasible nor cost-effective in most settings. When taking into account limited resources and referral options, measures such as the PRICE might provide an evidence-based strategy for using limited available resources for case management, workplace communication, and patient education and support.
Validity of the PRICE screening was supported by its prospective association with the 3-month disability outcome measures (return to work, functional limitation, and clinical case rating). The AUC for predicting 3-month outcome measures can be rated as "acceptable."56 This moderate level of predictive strength might be expected for a measure that was limited to modifiable factors within a circumscribed conceptual model and with no inclusion of demographic, medical history, or physical examination variables that also contribute incrementally to disability risk.5 Other self-report measures that have been developed solely for the purpose of maximizing prediction have reported similar or slightly better prediction,28 but these measures provide minimal guidance in selecting appropriate intervention strategies, and many questionnaire items represent nonmodifiable factors (eg, age, sex, education, job tenure).5 Given the complexity of psychosocial and workplace factors that contribute to LBP disability,5 it seems unlikely that future screening questionnaires will add substantially to the predictability of LBP outcomes from psychosocial measures in general patient cohorts. Combining the PRICE results with other patient information (eg, LBP history, physical examination findings, pain patterns, demographics, comorbid health conditions, job type) may further improve its accuracy of prediction.
One limitation of the PRICE measure is its focus on workplace and psychosocial factors to the exclusion of any biomedical data beyond a simple pain intensity rating. Obviously, such a measure should not be used in lieu of a standard medical history, and physical and psychosocial screening should not eliminate the need for careful screening of medical red flags, use of diagnostic triage and treatment guidelines, and biomechanical explanations for pain and prognosis. For most cases of uncomplicated LBP, however, a focus on workplace and psychosocial factors is clearly supported by epidemiologic evidence,5 and contemporary models of work disability have been clear to illustrate the breadth of individual, medical, and societal factors affecting work disability.18 Psychosocial screening of patients with LBP does not imply a psychogenic cause for LBP, but rather that the ability of an individual to adapt, intepret, and solve pain-related problems is influenced by pain beliefs, coping strengths, and social and environmental factors, and these factors influence musculoskeletal rehabilitation and healing.20 Although inclusion of physical examination results may have altered patient clusters, there is little evidentiary support that psychosocial factors in back disability are significantly confounded by symptom patterns or type of injury.10,57,58
Incorporating psychosocial and workplace factors into routine clinical decision making is consistent with providing quality, patient-centered health care, but health care providers need feasible and effective treatment or referral options to respond promptly and appropriately to patient needs. Providing more individualized treatment can be challenging in health care systems that are struggling to control costs and with treatment guidelines discouraging unnecessary diagnostics and referrals. Nevertheless, a number of (low- to moderate-intensity) intervention strategies for LBP have been helpful to address psychosocial and workplace concerns (Table 6), and their effectiveness may be improved if matched to patient subgroups. For patients lacking organizational support, interventions might include participatory ergonomic interventions, facilitated communication with supervisors, or problem solving to address workplace barriers.59,60 For patients with severe emotional distress, interventions might include group or individual sessions applying cognitive–behavioral strategies to address unhelpful pain beliefs, strengthen coping resources, and provide instruction in pain self-management.61–63 For patients with severe pain and activity restriction (but without emotional distress), intervention might focus on pain education, graded exercise, and gradual activity exposure.64–66 Combining patient screening with targeted early intervention may prove to be the best all-around strategy for reducing disability while also containing treatment costs, but more research is needed to support these claims.
Limitations of the study include the narrowly defined study population (mostly younger, blue-collar workers), an a priori theoretical model, and a focus on the acute phase of LBP, when a sizable number of patients will experience spontaneous improvement and many will be able to resume normal work activities with little or no support. Nevertheless, we found evidence of patients describing severe emotional distress, poor expectations for resuming work, pain catastrophizing, and beliefs that LBP had life-altering consequences within just hours or days after pain onset. These extreme views of patients are difficult to ignore, even during this very early stage of medical evaluation and monitoring. In contrast with chronic pain cohorts, we have found little effect of LBP history on psychosocial factors in this occupational medicine setting;67 so psychosocial factors do not seem to be the result of experience. Future studies might evaluate whether such disability risk factors vary with respect to physical job demands, job flexibility, or duration of pain. Although statistical techniques for determining the reliability and validity of cluster results are not well developed, stability of cluster membership over time would be another important psychometric property to evaluate when applying the PRICE in clinical decision making. Test–retest reliability for most of the underlying root measures is well established, but additional studies are needed to support reliability of the 46-item version of the PRICE measure in different clinical settings and disability contexts. Although we were unable to randomly subdivide the sample to assess reproducibility, the relatively narrow 95% confidence bands around the AUC estimates suggest these associations are not because of chance.
This study provides initial support for the reliability and validity of the PRICE, a new self-report questionnaire intended to provide a brief (46-item) screen of psychosocial and workplace factors that might be the target of return-to-work efforts for working adults with LBP. Although most questionnaire items in the PRICE were taken from existing psychosocial measures, the reduced scale is feasible for routine administration and designed to triage patients to the most appropriate forms of early intervention that might prevent long-term back disability. Such efforts to classify patients into meaningful subgroups for clinical decision making may improve the efficacy and cost-effectiveness of LBP treatment in occupational medicine and other clinical settings.
Copyright © 2013 by the American College of Occupational and Environmental Medicine
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A conservative group and several Republican lawmakers is filing a legal challenge to the newly adopted state budget, alleging that its assumption of $2 billion of yet-to-be-determined savings violates the Connecticut constitution.
"In 1992 the people of Connecticut overwhelmingly voted for [a] balanced budget amendment as a protection against the kind of shenanigans and abuse we saw this week at the state capitol,'' said Tom Scott, a former lawmaker who founded the Roger Sherman Liberty Center, the conservative think tank behind the lawsuit.
Dannel P. Malloy on Wednesday is "a dirty deal...a raw deal,'' Scott said.
Colleen Flanagan, spokeswoman for the Malloy administration, expressed confidence that the spending package would withstand the legal challenge.
"We researched the matter when the Republicans made this claim,'' she said in an email. "We've reviewed the matter and are confident that it is fully compliant with the Connecticut constitution and that the courts and won't interfere with the duly adopted budget of the State of Connecticut.''
It is not unusual for the legislature to pass budgets with millions of dollars in unspecified spending cuts, known lapses, which are left to the governor's discretion. But Scott and other critics say the size and scope of this year's lapses set it apart.
"Budgets that are passed here should not be out of balance,''Scott said at a press briefing this afternoon outlining the lawsuit. "While we've had gimmicks in the past, we've never had a budget that was $2 billion out of whack.''
The group asserts that leaving it up to the governor and his staff to make the $2 billion in assumed cuts built into the budget violates the state Constitution. "Legislators who took an oath to uphold the Constitution also have their rights being violated and, by extension the people they represent, because were deferring to unelected bureaucrats to make policy to the tune of $2 billion,'' Scott said.
State Sen. Len Suzio, a Republican from Meriden, noted that, as a freshman, this is the first time he's had the chance to take a stand. "I'm a brand new face up here...so I haven't yet been jaded by the process,'' he said.
Suzio notes that he has a background in accounting and finance--"I know a real budget when I see one and this is no real budget. It's a phony budget dressed up in gimmicks.''
The reliance on such gimmickry is all the more troubling because Malloy pledged to submit an honest budget, Suzio said. "This is a governor who promised to swear off gimmicks in the budget. He's employing the biggest gimmick ever used... in Connecticut."
Suzio and state Rep. Christopher Coutu, a Republican from Norwich, are both plaintiffs in the lawsuit, which is expected to be filed today in Hartford Superior Court.
Scott said more legislators, as well as state employees and small business owners, will join the lawsuit early next week. Suzio said he expects the entire Republican caucus in the state Senate to sign on as plaintiffs.


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Expedition Therapy instructors and clinicians are dedicated professionals with a passion for sharing their knowledge in the wilderness. Adept at facilitating group processes and supporting self awareness initiatives in the field, the experienced members of our field staff are excellent mentors with a wealth of practical experience. Many are active members of the Wilderness Medical Society, American Mountain Guides Association, American Avalanche Association, American Canoe Association, Leave No Trace® and American Alpine Club.
Beth J. Fogel, MSW, CSW, Primary Therapist Beth is a licensed therapist in the state of Utah and has worked with adolescents and young adults since 1994 in wilderness therapy, residential and inpatient hospital settings. Beth's eclectic, holistic, hands-on clinical style uses the open space of the wilderness to help students re-create their personal identities and gain confidence. She enjoys sharing her passion for the outdoors through poetry, photography, mountain biking, hiking and environmental advocacy.
"Beth Fogel is the consummate professional in the most down-to-earth and creative way. Her clinical expertise and treatment of both participants and families is top tier and she treats people from all walks of life with dignity, respect and compassion". -Consultant Referral Source, Northeast USA
Justin Gordon, AMFT, Primary Therapist Justin is an experienced therapist, with a Masters degree in Marriage and Family Therapy from Utah State University and a BA in Psychology from Southern Utah University. He has experience working with adolescents, young adults, families and couples and is a member of the American Association of Marriage and Family Therapy. Justin grew up in Southern Utah with a passion for outdoor recreation and adventure.
While Justin employs a very eclectic therapeutic repertoire, he is intentional when interacting with students and their families. Justin's therapeutic model is based upon Family Systems Theory, which is designed to initiate growth. Family Systems work encourages each individual to frame issues such as addiction, isolation, difficult relationships, anxiety, loneliness, avoidance, and conflict in a multigenerational family or system context. As a result, each person is much more likely to shift away from blaming others and move toward taking individual responsibility.
Justin focuses upon a humanistic, person-centered approach to guide interactions with students. This approach, created by psychologist Carl Rogers, places an emphasis upon the experience of being understood and valued, which creates a space for each student to experience the freedom to grow. Justin's genuine and authentic relationship building style is a non-judgmental, strengths-based, and empathic stance.
Justin also feels that modeling positive, collaborative relationships with peers is a natural catalyst in the personal growth process. He also believes that individuals and families can develop a deeper understanding of themselves and their relationships through a deep and meaningful connection with nature. In Justin's words, "Expedition Therapy is a unique opportunity for individuals to learn and practice communication skills, build upon their strengths, and derive meaning and values that will benefit the entire family system."
Justin has presented to professional groups on topics such as Bullying Awareness and Professional Ethics. He has acted as a Youth Advocate and is fluent in Spanish.
Bridger R. Ogden, LSUDC, Substance Use Disorder Counselor Bridger is a Utah State Licensed Substance Use Disorder Counselor who has enjoyed working in the field of addiction treatment since 2000. He is a graduate of the University of Utah College of Social Work's Alcohol & Drug Abuse Treatment Training Program. Bridger recently received his "Treating The Addictions" Certification through the Harvard Medical School. He has worked with adults in an intensive outpatient setting as well as adolescents in residential treatment.
Bridger believes that success in recovery grows from the motivation that is maximized when young adults are encouraged to define their own version of success and happiness. Then, through counseling, treatment planning, and family involvement, they can gain the tools necessary to recover and achieve their goals.
Aaron Wilson, Executive Director Growing up in the Pacific Northwest, Aaron developed an early passion for the outdoors. After backpacking on Mt. Rainier at age eleven, he was hooked. Aaron received a B.S. in Outdoor Recreation Management with an emphasis in Experiential Education from Brigham Young University. He is a certified Wilderness First Responder, a survival skills instructor and is certified in PCS. He has mentored young people for over twenty years, focusing on young adults in a therapeutic wilderness setting since 2007. As a wilderness guide, Aaron has led trips all over the United States, most extensively in the wildly varied topography of southern Utah and northern Arizona. He believes strongly in the mentoring relationship as a powerful force that underpins everything at Expedition Therapy. Aaron considers it an honor and a privilege to be part of the highly skilled, passionate team that has been created to help young adults improve their lives and relationships in a positive, supportive environment.1
Wes Light, Director of Adventure Education Wes has been guiding and instructing outdoor leadership, wilderness medicine, and outdoor technical skills courses for nearly a decade. He has worked in the backcountry areas of Alaska, Utah, Washington, Nevada and Mexico. Wes' current training and certifications include Wilderness EMT training, Wilderness First Responder certification, and Avalanche Level 2. He is a National Standards Program Instructor with the Wilderness Education Association. Wes is also a Wilderness First Aid, CPR and AED Instructor for the American Red Cross, Emergency Care and Safety Institute and Utah Wilderness Society.
David Lynch, Expedition Field Instructor David earned a B.A. in Adventure Education with a minor in Psychology from Fort Lewis College in Durango, Colorado. David first realized the humbling power and awe-inspiring beauty of nature during a backpacking trip in Wyoming nearly twenty years ago. He now enjoys backpacking, canyoneering, rafting, bicycle touring, snowboarding, building igloos, Ultimate Frisbee, and motorcycling. A former funeral home manager, David is pursuing a second career in therapeutic adventure with a focus on grief therapy. He is a Wilderness First Responder and Leave No Trace® trainer.
Jamie Berggren, Expedition Field Instructor Jamie has a B.A. in Environmental Science from Prescott College. He brings to Expedition Therapy nearly two decades of experience as a wilderness guide and outdoor educator in Utah, Colorado, California, Arizona and Alaska. His areas of expertise include whitewater rafting, canyoneering and rock climbing. Jamie is extremely knowledgeable about Natural History, Ecology and Astronomy, and loves to share his enthusiasm for these subjects with students and staff alike. He is a Wilderness First Responder.
Stacy Petersen, Expedition Field Instructor/Yoga Instructor Early in life, Stacy recognized a deep spiritual connection to nature. In the mountains of Utah, she discovered an inner peace when she was outside in the natural world. After receiving a BFA in Modern Dance from the University of Utah, Stacy came to know that her spirituality was deeply rooted in both movement and nature. She completed her Yoga teaching certification in 2007 with Dana Baptiste in Salt Lake City and began developing Earthflow Yoga, a culmination of her life experience. Stacy's classes offer a unique blend of physicality, flow and introspection, inspired by the systems and cycles of the Earth.
In Stacy's words, "Yoga has transformed my life, and I became a teacher to help others experience the benefits of this amazing practice. At the heart of every Yoga practice is self reflection and awareness. Yoga empowers us with the ability to bring greater awareness into the challenges and difficulties we face in our lives, so we can transmute self-destructive patterns and live in greater consciousness and peace."
In addition to teaching Yoga, Stacy is an avid Outdoor Enthusiast and Guide, as well as a certified Hypnotherapist, Oneness Trainer and Holistic Health Coach. She is also certified in Outdoor Emergency Care and CPR.
Bryan Teaters, Expedition Field Instructor Bryan holds a Bachelors Degree in Outdoor Education with a minor in Psychology from the University of Minnesota Duluth. He received his Wilderness First Responder Certification from the Wilderness Medical Institute. Bryan has a great love for rock climbing and learning about and from natural processes. He believes that the experiences that are encountered in the outdoors, no matter how big or small, can encourage deep and lasting change in anyone's life.
Joe Taylor, Expedition Field Instructor Joe has a B.A. in Anthropology and a Masters in City and Metropolitan Planning, both from the University of Utah. He has extensive experience in mountain and desert backpacking, canyoneering, river running, fly fishing, rock and ice climbing, and backcountry skiing. Joe has been an Eagle Scout, an elementary educator, an archaeologist, a rafting guide on the Colorado River, and a city planner. He is a Wilderness First Responder and is Leave No Trace® certified.


text:
Raya open house for Pekan parliamentary constituency on saturday
KUANTAN: Prime Minister Datuk Seri Najib Tun Razak will hold a Hari Raya Aidilfitri Open House for the Pekan Parliamentary constituency on Saturday.
Japan express symphaty for MH17 tragedy
KUALA LUMPUR: Japan today expressed its sympathies to Malaysia over the Malaysia Airlines (MAS) flight MH17 tragedy in east Ukraine on July 17.
Exco member Halimah denies Khalid makes unilateral decisions on state's administration
SHAH ALAM: Selangor state executive council (exco) member Dr Halimah Ali has refuted claims made by Parti Keadilan Rakyat (PKR) that Menteri Besar Tan Sri Abdul Khalid Ibrahim had been making his own decisions on the state's administration.
Boy dies after accidentally left in father's car for 8 hours
PADANG TERAP: A four-year-old boy died after his father accidentally left the victim sleeping in the car before going for teaching at a school in Kuala Nerang here.
Seven cars damaged awning collapsed after heavy rain
BUKIT MERTAJAM: The owners of seven cars had a rude shock upon discovering that an awning had smashed onto their vehicles today.
7-year-old Rabiatul Adawiyah to represent Malaysia at 10th Asian Schools Chess Championship in Taiwan
IPOH: Seven-year-old Rabiatul Adawiyah Mat Zaki will represent the country in the 10th Asian Schools Chess Championships 2014 in Taichung, Taiwan.
Six civil servants among 13 arrested by MACC for bribery
KUANTAN: Six civil servants were among 13 people arrested by the state Malaysian Anti-Corruption Commission (MACC) in the first half of this year for allegedly receiving bribes and attempting to offer bribe.
Mysterious charred remains found
NUSAJAYA: Police came across an unknown charred body that was believed to have been trapped in a home in Bandar Selesa Jaya here after a fire broke out today.
Couple claim trial for unauthorised withdrawals from accounts of four MH370 victims
KUALA LUMPUR: A bank officer and her husband were charged today with multiple charges involving unauthorised withdrawals of RM110,643 from bank accounts of three passengers and a steward of missing Malaysia Airlines flight MH370.
Tourism operators should monitor activities in Pahang
KUANTAN: The Pahang Tourism board has been reminded to keep an eye on tourist spots and their activities to ensure there will be no repeat of the "Penang Nude Sports Games 2014" like-activities.
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text:
DCS Copy Protection Limited
|DCS Copy Protection Limited Patent applications
|Patent application number
|AUDIO COPY PROTECTION SYSTEM - An apparatus for applying an anti-copy protection signal for use with switchable head recorders, such as Video Hi-Fi recorders, is described. A high frequency pulsed signal is added to an original signal. The pulses interfere with the compensator circuitry such that the switching of the record head cannot adequately be masked on recording of a signal. On playback, the switching of the recording heads can subsequently be heard. In Video Hi-Fi recorders, the effect of the high frequency signals also interferes with the compressor-expander circuits to worsen the sound of the head switching.
|Digital Processing Disruption Systems - A method and apparatus are described for modifying an analogue video signal to impair its conversion to a digital signal by an analogue to digital converter. The resulting modified signal may prevent the operation of the analogue to digital converter altogether, or, even if a digital signal can be output and recorded, may result in a signal which is difficult to view due to a reduction in quality on playback. The modifications made to the signal include altering the amplitude of the horizontal synchronization pulses in the original signal, and/or modifying the level of the back porch, or the region of the signal adjacent the back porch. Additionally, methods are contemplated for the use of specific response models for target analogue to digital converters, and display devices.
|Method and Apparatus for Providing a Copy-Protected Video Signal - A anti-copy programme signal is provided. Copies of the anti-copy video pulses made on a video recorder experience reduced quality and interference in playback making them unpleasant to watch. The uncopied signal can be viewed without any material effect on picture quality. The signal comprises a pulse added to each line of the signal throughout both the visible picture region and throughout the vertical blanking region, as well as a first modulated wave-form added to the vertical synchronization pulses of the signal and a second modulated wave-form added to several lines of the picture signal before the vertical blanking section. The presence of all three of these features together has been found to provide a surprising accumulative effectiveness in causing interference in the reproduction of the modified video signal during playback of the copied video signal, that is greater than the effectiveness provided by the different features taken separately.


text:
1. "Leonard Maltin's Movie Guide Ending After 45 Years." And Pete Hammond, for Deadline, says the Internet is to blame.
"Another print icon bites the dust. Leonard Maltin's 2015 Movie Guide will be the final edition of this film lovers' guide which started in 1969 under the title TV MOVIES. But in recent years the annual guide, which now numbers 1,611 pages and features nearly 16,000 capsule movie reviews, has become a victim of the changing times and the way information is consumed by a new generation. The new edition, which comes out on September 2nd is the last and that will be bad news for many industry-ites and film lovers who used it religiously. 'An entire generation has been raised to acquire all their information online from their mobile devices or computers. These are not the likely customers for a physical paperback reference book. Our sales have sharply declined in recent years,' Maltin told me this morning. The virtual death of bookstores likely didn't help the cause either. 'We still have a loyal readership. It's just smaller than it used to be. There are an awful lot of people who have been loyal to the book and are used to having it on their night stand or their coffee table for years and years and years. Some bought it sporadically and some bought it every year and god bless them,' he added."
Few video games so directly encapsulate the notion of "being a toy" as The Room, a popular iOS title now boasting a high-definition PC port, upscaled graphics, and touch controls substituted with a mouse. While the majority of games flooding the iOS marketplace feature little but simplistic gameplay and cartoonish 2D visuals, The Room made a mark with spectacular 3D graphics and moody ambience, establishing itself as a more mature and highbrow experience involving Hellraiser-style puzzle boxes tackled with Apple's intuitive touch controls. Solving each puzzle reveals more of the game's narrative involving the fates of past adventurers who would dare attempt the puzzle boxes, shades of Lovecraft permeating its storyline and complimenting the thick atmosphere that the visuals and sound design create.
1. "The Coming Race War Won't Be About Race." Ferguson is not just about systemic racism—it's about class warfare and how America's poor are held back, says Kareem Abdul-Jabbar.
"Dystopian books and movies like Snowpiercer, The Giver, Divergent, Hunger Games, and Elysium have been the rage for the past few years. Not just because they express teen frustration at authority figures. That would explain some of the popularity among younger audiences, but not among twentysomethings and even older adults. The real reason we flock to see Donald Sutherland's porcelain portrayal in Hunger Games of a cold, ruthless president of the U.S. dedicated to preserving the rich while grinding his heel into the necks of the poor is that it rings true in a society in which the One Percent gets richer while our middle class is collapsing."
There's a brief shot in Andrew Cividino's short film Sleeping Giant that's very similar to one in The Dirties, the self-aware comedy by Cividino's fellow Canadian Matt Johnson, which debuted at Locarno Film Festival last year. Premiering in the Pardi di domani competition at this year's edition, Sleeping Giant also shares with the other film themes of bullying and peer pressure. In the shot in question, two young boys fire flares into the air, and then at each other—and that it primes such a comparison reveals one coincidental link between last year's and this year's edition of the festival. Certainly, continuity is paramount at Locarno Film Festival, whose host town has a population of less than 16,000—small enough to feel like an intensely surreal bubble of stability, while the festival itself is paradoxically colossal, making for an atmosphere all its own.
Mind: Path to Thalamus isn't a subtle game. The title and in-game chapter labels reveal that you'll be traveling through a person's mind, specifically toward the thalamus, which essentially bridges and processes the brain's information, leveraging this between your sleeping and waking self. The narrative doubles down on this, too, needlessly explaining with a heavy hand (and heavy intonation) that ever since a tsunami claimed the life of your beloved Sophia, you've been in a coma. (Note: About a week after playing, the audio was patched to remove some of the more redundant/obvious parts, and there are plans to rework it entirely in a future update.) But life isn't subtle, and sometimes it blows you away—as does Mind, right from the very opening sequence in which a raging storm rips apart your quiet world. The following three hours (or longer, depending on your pace) are filled with similarly beautiful, trippy imagery—as well as some fiendish Portal-like puzzles that help the game rise above walking simulators like Dear Esther or Proteus. (The closest parallel is probably the similarly themed Trauma, though that's a more simplistic point-and-click adventure.)
For about as long as there have been video games, there have been video games about cars. It's a natural extension of the technology: We sit in front of a machine to be transported, virtually, behind the wheel of another one. Like fighting games and first-person shooters, driving games put us in command of experiences too dangerous to enjoy for real, liberating us from concerns of safety and responsibility and inviting us, all too gleefully, to push the limits of what can be done. Maybe you drive every day—a commute to work, an errand to the corner store. Driving games take that experience and amplify it, transforming the banality of the car into something extraordinary: an object to steal, to race, to destroy. Games do a lot with a four wheels and an engine. In life your car is bound to the rules of the road. In games it can go anywhere, do anything.
1. "Let's Be Real." Wesley Morris on Let's Be Cops, cop movies, and the shooting in Ferguson.
"This would just be more flushable summer waste (and, please, don't let me stop you from jiggling the handle), except Let's Be Cops somehow doubles as a fantasy that knows its social limits, limits that connect it to the turmoil in Ferguson, and those limits ease on down the road of race. The movie doesn't want to make a big deal about this, but Justin is black and Ryan white, which is newsworthy in that, despite one guy's annoyance with the other, they appear to have been friends long enough for racial osmosis to set it. Justin speaks the way black comedians—like Wayans's father, Damon Sr.—do when they're impersonating an uptight white guy. Ryan occasionally twists and spikes the cadences of his speech so it sounds comedically black. Justin says 'dude' a lot. Ryan likes 'bro.' Permeable racial identity becomes a kind of running gag, especially once Key and his impersonation of a loopy Mexican gangsta shows up."
"Cairo" begins with a song, climaxes with a poem, and concludes with a whisper, but it's what each of these leaves unspoken that captures the testy relationship between faith and doubt at the heart of The Leftovers. As the opening montage augurs the coming collision between Patti Levin (Ann Dowd) and Kevin Garvey (Justin Theroux), suturing her arrangements for the Guilty Remnant's next radical act to his preparations for dinner, the music we hear is excerpted from "I've Been 'Buked and I've Been Scorned," an African-American spiritual. Left out when Patti closes the church door, however, are the lyrics that traditionally come next: "Ain't goin' to lay my 'ligion down," the hymn resolves, "no, Lord." "Cairo" is a dark night of the soul, but the power of conviction is omnipresent at its margins.
After dipping into relative, perhaps unavoidable mediocrity in the aftermath of the sublime formalist treats offered by Lav Diaz and Matías Piñeiro, the Locarno competition got back on track and then some with the arrival of Pedro Costa's long-awaited Horse Money. This fourth feature-length installment of his ongoing Fontainhas series retains Colossal Youth's heavy stylisation and rangy protagonist, Ventura, only to turn further inward. Grown old and unable to control his ever-twitching fingers, Ventura has been committed to a psychiatric facility, whose shadowy, spectral corridors double up as passages through the mind. These halls can lead anywhere—a snaking labyrinth whose endless connections bridge past and present, Portugal and Cape Verde, Fontainhas and the forest, a dilapidated factory, and a harshly lit elevator where all things flow together.
The lurking anti-subtlety of The Knick's pilot picks right back up in "Mr. Paris Shoes," which leads by intercutting a day's first stirrings at two polar-opposite corners of New York City: the mansion of hospital proprietress Cornelia Robertson (Juliet Rylance) and her filthy-rich parents, and the just plain-filthy flophouse where Dr. Algernon Edwards (Andre Holland) is bunking. Waiting in line for the bathroom, he's teased by another African-American man for the fanciness of his leather shoes. In juxtaposing Algernon's basic struggle to get to a bathroom without being harassed with the pedantic musings of Robertson's father, August (Grainger Hines), director Steven Soderbergh is able to unleash a barrage of socioeconomic tensions, but it happens with such manic energy it almost feels like he's having too much fun with it. (Things are oversimplified, again, by the dialogue: The elder Robertson leads off by allowing, over the morning paper, that "They call our money 'new'—hmph—but it certainly does attract a crowd." As if wealthy people spend their leisure hours talking about nothing except how wealthy they are.)


text:
Casa Camilao
House | 3 bedrooms | sleeps 6
|Key Info
If you wish to have a pleasant and peaceful stay with your friends or
family in a rustic place, you have to choose Casa Camilao.
Surrounded by many trees, in a very quiet location, with a splendid
view over the Gulf of Naples and the entire bay of Sorrento, Ischia and Capri,
you will find Casa Camilao, rustic but very warm place, which can
accommodate easily 6 persons.
Three nice double bedrooms, two bathrooms with shower, lounge with fully
equipped kitchen overlooking the bay.
There is a magnificent large terrace on the sea with deck chairs and tables,
where you can have breakfast or, at dinner time, have a barbecue enjoying
the different sunsets.
The pretty private swimming pool, organized with umbella and sunbeds is
situated in a very looked after small garden.
The air conditioning will refresh the property, which has easy access to the
private parking for tw cars.
Come to Casa Camilao and we are sure your will not regret.
|Sleeps up to 6, 3 bedrooms
|Will consider
|Long term lets (over 1 month), Short breaks (1-4 days)
|Family friendly
|Suitable for children over 5
|Pets welcome, Yes, smoking allowed
Features and Facilities
|Sea view
|Central heating, Air conditioning, Satellite TV
|Cooker, Microwave, Fridge, Freezer, Washing machine
|3 bedrooms, 2 bathrooms of which 2 Family bathrooms, Solarium or roof terrace
|Single beds (2), Double beds (2), Cots (1), Dining seats for 8, Lounge seats for 8
|Linen provided, Towels provided
|Balcony or terrace, Private garden, BBQ
Availability Your dates are available
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Calendar last updated:20 Aug 2014
Based in Italy
- English
- Italian
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text:
Haina Hostel
No.14-8, Dongzhi Men Nei Da Jie, Dong Cheng District, Pechino, Cina, Distanza dal centro città: 4.6km
The Haina hostel is a cosy, modern hostel at the centre of Beijing, offering affordable accommodation in private, en-suite rooms. All rooms are clean, warm and comfortable and are equipped with key-card access systems, 24-hour hot water in western bathrooms, television, internet access and air conditioning/heating.
We are situated on Beijing's famous 'Ghost Street' (Gui Jie), a vibrant area famous for its nighttime eateries serving a wide variety of dishes, from traditional Chinese to contemporary international. We are also close to Sanlitun Street, HouHai Lake and Nan Luo Go Xiang, all areas famous for their nightlife. We are 5 minutes from the airport express service and 5 minutes from the subway, which can take you in 20 minutes to Tiananmen Square, the Forbidden City, the Silk Market, the Temple of Heaven and Wangfujing business and shopping district.
There are banks, post offices, hospitals, shops and convenience stores surrounding the hostel. Our reception is open 24 hours a day, and we offer a number of facilities including bicycle rental and a tours desk.
Disponibilità e tariffePer visualizzare la disponibilità e i prezzi, seleziona le date e fai clic su "Aggiorna date"
Ostello Servizi & Politiche
- Reception 24 ore su 24
- Sicurezza 24 ore su 24
- Aria condizionata
- Noleggio biciclette
- TV via cavo
- Telefoni a scheda
- Servizio fax
- Accesso a Internet gratuito
- Parcheggio gratuito
- Asciugacapelli a noleggio
- Accesso a Internet
- Biancheria inclusa
- Armadietti
- Deposito bagagli
- Servizio postale
- Luce per lettura
- Travel Desk per i tour
- Asciugamani a noleggio


text:
Problems around the house Guide for Virtual Families 2: Our Dream HouseHome / iPhone - iPod /
This page contains Virtual Families 2: Our Dream House Hints for iPhone - iPod called "Problems around the house Guide" and has been posted or updated on Mar 11, 2013 by Helpful corgi. Let us know what you think of this Hint by thumbs voting. Note: This apple iPhone game app may also be compatible with the game app for apple iPad.
- Developer: Last Day Of Work
- Publisher: Last Day Of Work
- Genre: Miscellaneous Edutainment
- Release Date: Dec 6, 2012
- ESRB: Not Set
Problems around the house Guide
There are 4 things that can go wrong. They are-
- Fires (oven and dryer)
- Leaks (sinks)
- Clogged stuff (toilet and shower)
- Ants (kitchen)
Here's how to fix them…
1) bring your person to the fire and make sure it says under action "() is burning!"
2) keep them like that for about 15 seconds
3) drag them to the upper left table in the workshop. There should be a fire extinguisher there.
4) place adult on it. If it doesn't say "putting out () fire" try again.
5) they will put out the fire!
Leaks/clogged stuff-
1) put them by the leak and wait for 15 seconds while their action is "the () sink is leaking!"
2) drag them over to the bottom workshop table and they should say "fixing (leaky/clogged) ()"
3) try again if they don't
4) they will fix the shower/toilet/sink!
1) when ants appear, put any person on them and they will say stomping ants.
2) praise them and you will get a goal and 25 coins.
3) place an adult on the brown pot on the counter in the kitchen.
4) they will "prepare cinnamon ingredient"
5) once they are done, drag that same adult onto the orange-yellow thing by the bins by the gate.
6) clear every person out of kitchen otherwise you will not get rid of ants
7) they will "finishing ant spray"
8) the ants will be gone and never come back!!!
9) plus you'll get a goal and 50 coins!
Hope this guide helped! Happy fixing!
Back to all Cheats
Stuck on this game? Set a specific, clearly defined question and let others answer your question or view answers to previously asked questions. If you think you are an Virtual Families 2: Our Dream House expert then please try to help others with their questions.
Virtual Families 2: Our Dream House - Gameplay Review Trailer
- Oct 31, 2013, Views: 1007
Virtual Families 2: Our Dream House - Hack
- Nov 13, 2013, Views: 2610
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- Nov 13, 2013, Views: 2374
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Check this with the Japanese (#110010) and the German (#370911).
Also, "He didn't reply with a single word" is a confusing sentence. Potentially it could mean that "he did reply with more than one word"
It isn't a sentence I'd use myself.
@blay_paul: It may be ambiguous, but I don't find it confusing. An alcoholic stating that he hasn't had a single drop for eight years is usually understood to not having had any.
@CK: I didn't recognise this as an archaic, but passable sentence. Had I, I wouldn't have changed it. It is, indeed, Tatoeba policy to submit alternatives, rather than change acceptable sentences.
I didn't like this sentence terribly much either, hence I didn't adopt it. Please feel free to change it and add your own translations. Should you add archaic versions, just remember to tag them as such, in particular if they're linked to sentences using modern speech.
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text:
Charlotte CROP Hunger Walk
Sunday, October 19, 2014 • Charlotte, NC
We've raised $2,679.00 online so far!
Exact location to be determined
Specific times will be posted soon.
Ericka Ellis-Stewart
Charlotte CROP Director
Walk details are currently being finalized with the City of Charlotte. Check back here or visit www.charlottecropwalk.org for further details.
Recruiter Rally/Team Captain Orientation Dates (Location TBA):
Sunday, July 13th, 2:30 p.m.
Tuesday, August 5th, 6:15 p.m.
Sunday, September 14th, 2:30 p.m.


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Tuesday, September 2, 2014
First-day Take of $37M for 'Transformers: Dark of the Moon'
The visual-effects extravaganza Transformers: Dark of the Moon debuted Wednesday to about $37 million in ticket sales, marking the best debut of the year for any film. Based on the ... Continue Reading →
'Cars 2′ Co-Director Brad Lewis Heads to Digital Domain
Having navigated Pixar's Cars 2 to the finish line as co-director to John Lasseter, Brad Lewis has signed on to directed original animated feature films for Digital Domain Media ... Continue Reading →
Digital Domain Taps Barnes for In-Three Conversion Unit
Digital Domain has hired Jeff Barnes, co-founder and former CEO of The Computer Cafe Group, to lead its In-Three stereo conversion business. Barnes will assume the title of VP ... Continue Reading →
Rhythm & Hues Plans Vancouver, India Expansions
Rhythm & Hues is heading north, announcing plans to open a studio in Vancouver by Jan. 9, according to Variety. The new studio will start small but is expected to grow quickly, ... Continue Reading →
Digital Domain Buys In-Three
Digital Domain has reached a deal to acquire 3D conversion specialist studio In-Three. In-Three is the developer of a process called Dimensionalization that converts 2D movies into ... Continue Reading →


text:
Pratiggya (1975)
Plot Summary
Ajit Singh (Dharmendra) learns that his parents and younger sibling's death was due to a ruthless bandit massacring them in cold blood. Taking an oath that he will get revenge Ajit Singh ventures out to find the bandit Bharat Thakur (Ajit). However being wanted by the police for accidentally stealing goods Ajit goes into hiding and ends up witnessing a bloodbath shoot-out between the bandits and the police. The police were on their way to set up a police station in the rural town of which Bharat Thakur has control under in order to bring law and order for the people there. However Bharat has come to know of this plan and as a result all the policemen die in the shoot-out. After seeing this Ajit decides to pretend to be a policeman and carry out their mission. When he arrives at the village all he finds are village people who are too scared to face the bandits. Ajit Singh now faces the task of training them up in order to make his mission work - will he ever fulfill his 'pratiggya' against Bharat?- Written by gavin@email@example.com
Ajit lives with his widowed mother and drives a truck for a living. Before passing away, his mother tells him that his biological parents, a brother, and a sister were killed by a bandit named Bharat Thakur, and he makes a pledge to avenge their deaths in Dinapur. On the run from the police himself, he comes to the assistance of a dying Police Inspector D'Souza, takes on the guise of Inspector Inderjit Singh, converts an illicit liquor den into a makeshift police station, recruits uncouth residents as policemen, and falls in love with the local belle, Radha. He does not know that the authorities have deputed a real Police Inspector by the name of Abhijit Singh perhaps to apprehend him; that Radha is the niece of Bharat; and that he may have spies in his motley crew of policemen.- Written by rAjOo (email@example.com)
Be the first to contribute! Just click the "Edit page" button at the bottom of the page or learn more in the Synopsis submission guide.


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Good trade with gpenguins. Thanks!
Good trade with gpenguins. Thanks!
"Believe the word, I will unlock my door and pass the cemetery gates"
Had a great transaction with my fellow Michigander Andrew Lamprecht, thanks again for the 6l6s!
Excellent transaction with Dr. Lo for a TB-4.
Thumbs up!
2000 ES335LE Teal Blue, 2009 Gibson LP Trad Pro HCS, 2007 Edwards LP-130LTS/RE Lemon Drop, 2010 Gibson '50's Tribute Studio Goldtop.
Carvin V3, Bogner Alchemist, Egnater Rebel 30, Peavey Classic 30, Dave Hunter Two-Stroke, Digitech GNX3, Carvin T100
Bought some pedals from Agileguy_101. Super easy deal, quick shipment! Thanks!
Good deals with Andrew Lamprecht and Checo. Both were great communicators and very easy to deal with.
good dealing with bluesbend. good communication, fast shipping, nice guy. bought a ts9dx off him for $65!
Great deal with CHECO, bought a seth lover off him for a very good price and had the pup fast! recomended trader
Good deal with MUguy recently -
Grabbed some 6 in-line tuners - shipped quick with PM updates.
Thanks, Ed! Awesome to deal with!!
I just want to report on a great deal with ED HUNTER. Excellent communication, smooth transaction and a very nice guy. Looking forward to doing business with you again.
Just completed a nice deal with FuelGTRX. Smooth, clean transaction with fast shipping. I'd do business with Fuel anytime.
Sold a pedal to bigmack209.
Nice guy to deal with, prompt payment.
" you tell it like you're barefoot while you wear those hundred dollar shoes. Yeah, you can shuck and jive me all ya want to but, please please please, don't tell me 'bout the blues!"......Buddy Guy
Thanks for the trade you were easy to deal with and as luck had it,you had the exact logo'd TZ i wanted!
I received nothing less than excellent service from RayBarbeemusic and 51501984! Smooth transactions and excellent sellers!


text:
STARmeterSEE RANK
Up 26,531 this week
Alex Steyermark
Alex Steyermark is known for his work on I Know What You Did Last Summer (1997), Malcolm X (1992) and The Faculty (1998). See full bio »
More at IMDbPro » Contact Info: View legal
Represent Alex Steyermark? Add or change photos


text: Songs written by Ally Dawson Talk0 Category page Sorting type: Most visited Most visited Alphabetical Recently edited | There is currently no text in this page. You can search for this page title in other pages, or search the related logs. Subcategories Season 1 songs Season 2 songs Retrieved from "http://austinally.wikia.com/wiki/Category:Songs_written_by_Ally_Dawson"


text:
Roster unveiled for Mexico qualifier
August, 7, 2009
By Luke Cyphers and Doug McIntyre
The U.S. national team roster has been released for its upcoming game against Mexico. Check out the list for yourself, then check out our analysis.
To continue reading this article you must be an Insider
Become an insider and get access to all our articles and tools.View Insider Benefits »
Magazine subscribers: activate your Insider account.
Luke Cyphers is a former senior writer for ESPN The Magazine.
Doug McIntyre is a staff writer for ESPN The Magazine. He has covered American and international soccer since 2002.
U.S. National Soccer Team Blog
We're your regular source for all the inside info on the U.S. national team. Whether it's breakdowns of player pool developments, news and notes from the club soccer world and its impact on the American side, or game coverage, we'll bring you consistent, exclusive access and insight. Contact us with comments and tips at firstname.lastname@example.com.
Doug McIntyre
Doug McIntyre has watched or attended almost every U.S. national team game since Paul Caligiuri's "shot heard 'round the world" in 1989. He is a staff writer for ESPN The Magazine and has covered American and international soccer since 2002.
- USMNT Depth Chart
Who are the top four players at every position?
- Top 25 American players
Who are the best U.S. players right now?
- Top 25 U.S. U-21 prospects
Who are the top young players for the U.S.?
- The Brazil Board
What will Team USA look like in 2014?
SUBSCRIBE:Subscribe to this blog's RSS
- A shifting back four for the U.S.(6/3/2013 11:41 AM ET)
- Germany could be good test for Castillo(6/1/2013 2:06 PM ET)
- Sizing up impact of Belgium loss(5/30/2013 1:26 PM ET)
- Four things to watch versus Belgium(5/29/2013 12:41 PM ET)
- U.S. hopes defensive duo is dynamic(5/28/2013 12:49 PM ET)


text:
Limiting Contribution Io UN Operation* in Rwanda
the Rwanriim border would cause large-scale population movement and would favor the Rwandan Pairiotic Fromhey say UN forces should instead deploy to Kigali and other urban areas. Paris plans lo pcovide equipment to Ihe Senegalese UN corrtingcnl, bul no forces.
Para probably also it concerned thai sending UN forcet to border regiom might enable the KPF lo capture more territory. |
France's reluctance to participate in UN operations almost ctrtainly stems from its unsuccessful effom to shore up the government of the lau President IlabyarimanaFrench forces2
is pressingegional summit thai includes Zairianto move peace effortsThey say
lhai lhe French bclKvc Che previous Arusha accords were dominatedand that new regional peace effort* must be balancedinterests andOriginal document.
Comment about this article or add new information about this topic:


text:
Timing for Canon IR Remote Control
Last response: in Computer Peripherals
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text:
Sunday Slugfest: Star Trek--Assignment: Earth #1
"Brighter than a Thousand Suns" Marx Pyle: After a quick recap, we are thrust into a story of espionage in 1968.
"Brighter than a Thousand Suns" Marx Pyle: After a quick recap, we are thrust into a story of espionage in 1968.
As an artist who reveres Jack Kirby's work, Scott Kolins was given the opportunity of his lifetime when he was assigned to draw DC Comics' Countdown to Final Crisis #2.
Yes, late again.
"Life is at best bittersweet!" —Darkseid, Mister Miracle #18 Jack Kirby was the King of Comics, in great part because of his brilliant work on the Fourth World series.
Sorry, sorry, late again.
It seems like the hits just keep on coming from Red 5 comics.
This may shock and possibly even appall, but I don't use the internet to research this column.
"Batman in the Underworld" Writer: Grant Morrison Artists: Tony Daniel (p) Sandu Florea (i), Guy Major (colors) Publisher: DC Dave Wallace: Thom Young: Dave Wallace: The latest issue of Batman sees Grant Morrison build on the strong foundations of the opening chapter of "Batman R.I.P." driving his story forward as the Black Glove's Club of Villains make their most significant move yet against Batman.
As busy as David Hine has been the past year, 2008 is shaping up to be even bigger for him as a creator.
So, I'm back.


text:
Aventine Glen Ellen brings the neighborhood ambiance and exquisite cuisine of a traditional Italian Osteria to heart of Sonoma's
vibrant wine country. With our new takes on classic dishes, extensive wine menu and pairing options, and beautiful location along
the Sonoma Creek, Aventine Glen Ellen is the perfect setting to enjoy a memorable evening
—whether it's dinner for two or your own private event.
Catering & Events
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Aventine Glen Ellen: (707) 934-8911
14301 Arnold Drive
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To schedule your own event or ask us any questions you may have, use this form and our Events Manager will get back to you right away.


text:
I receive countless emails that start off like this…
In January I was 190 lbs at 25% body fat. 8 weeks ago I stopped seeing results. The last 8 weeks while cutting down I have dropped a few pounds (which I don't really want to do) and my body fat has remained the same.
What many people fail to realize when cutting is the concept of nutritional periodization. All too frequently, I get e-mails from frustrated weight loss seekers who have been on a calorie deficit forMONTHS. While they understand the basics of calorie cutting and what it means to be in a deficit, very few of them use a Zig-Zag method or fully comprehend the deficits or length a cutting cycle can have on their metabolism.
People who seek to lose weight grasp the very basics.
While that works, at some point they hit a wall and what's the 1st thing they want to do?
EXERCISE MORE and EAT LESS!
Which is the wrong approach. Nobody told them about the tips below.
The 3 best tips for fat loss are as follows:
1) Cycle your calories and your carbohydrates. This can be referred to as the Zig-Zag approach. In a nutshell, it's defined as days of maintenance calories mixed with days in a calorie deficit.
2) Understanding your personal level of tolerance to carbohydrates. There are great differences in the way people process foods. You can find yournutritional ratioand then adjust it according to your personal needs and tolerances that you will discover thru experience.
3)"If man made it, don't' eat it!"– Jack Lalanne. You need to eat natural foods and avoid refined foods. I notice in many meal plans, more than 20% of the daily protein requirements are coming from protein shakes. My own rule is not to get more than 20% of my daily protein from supplements.
The 3 biggest mistakes are as follows:
1) Too severe of a calorie deficit:
2) Too prolonged of a calorie deficit. More than 12-16 weeks of a calorie deficit could result in a lowered metabolism. The concept of nutritional periodization of cycling calories and carbohydrates comes into play after out 12 weeks depending on your overall progress.
3) Over-training while under-nourished. Long stints of high intensity work in a long period of calorie deprivation no matter how small.
I'd love to take credit for these weight loss tips. Unfortunately I can't. While I did adjust them and add some of my own tips, I pulled the real gems from pages 47-48 ofTHE FAT BURN FILES,a unique collection of by Tom Venuto. It gets 2 thumbs up from me because of the way it reveals everything that DOESN'T work as well as what DOES work for burning fat and gaining muscle… all in a fascinating, entertaining personal interview format.
Photo of the Perfect Weight byJill GreensethUsed under a Creative Commons license


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Arkansas State Police say an 82-year-old woman is dead after a single-vehicle crash in northeastern Arkansas.
State police say the crash happened Friday on I-55 near the 35 mile marker in Mississippi County. State police say Earlene French of Coldwater, Miss., lost control of her pickup truck and crashed into a tree.
State police say French's truck burst into flames after hitting the tree. A passenger was injured and taken to The Med in Memphis, Tenn.
The cause of the crash remains under investigation.
Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
208 DeBuys Road
Biloxi, MS 39531
(228) 896-1313
FCC Public File
EEO Report
Closed Captioning


text:
Arizona Cardinals wide receiver Larry Fitzgerald will be active versus the Seattle Seahawks on Thursday night, the team announced.
Fitzgerald has been working through hamstring injuries on both legs in recent weeks, and after being a game-time decision last Sunday, he will suit up despite a short week to recover. He was expected to be limited last week, but instead played all but six snaps versus the 49ers and wound up having his biggest game of the year. Fitzgerald's 117 receiving yards against San Francisco are the most he has put up in a game since 2011.
Fantasy Spin: Though it's encouraging that Fitzgerald will play this week, it's not under the most ideal circumstances. Having a short week and facing one of the league's top cover corners in Richard Sherman doesn't bode well for Fitzgerald's fantasy prospects. While he's certainly talented enough to win battles with the best, it's not likely that Fitzgerald will have the field day he had a week ago. He is worth a start, but owners would be wise to temper their expectations while he lines up across from a stout Seahawks defense.
More fantasy football news from SB Nation:
• Get live advice daily in the Fantasy War Room
• Today's fantasy football player updates
• Week 7 fantasy football rankings: QB | RB | WR | TE | D/ST


text:
A bank is opening a "pop up" branch in a day centre.
Barclays customers will be able to keep on top of their finances as they take part in community activities at Stansted Mountfitchet Day & Community Centre such as Scrabble competitions and card-making workshops.
Cllr Jonathan Rich, of Uttlesford District Council, understands it will open for a six-week trial on June 27.
He said: "It is essential that this service is a success and contributes to the role of the day centre at the heart of our community.
"Whilst no cash or cheque transactions can take place – this can be done at the Post Office in Chapel Hill – Barclays will be able to offer almost every other service.
"They will also be able to show people how to sign up for, and use, internet banking if they wish to."


text:
Added Feb 16, 2013
by Amber Barker
Las Vegas, Unite...
Ok. So I went a little crazy and I decided to make a white satin dress. (perfect for a summer wedding!) I thought it would be fabulous to base my design on the Elizabeth Gathered-Waist Dress and make a dress that can be fully functional anywhere, not just down the isle. I dropped myself into several situations to demonstrate this. It can be worn as a truly 50s inspired dress, or with a leather jacket for evening, as a wedding dress, on a stroll in the summertime, and it fits right in in both the retro style and the modern style of architecture and areas. I love my little cut out detail in the front and I added a tie that can be in a front or back bow, or just wrapped several times and tucked in for a sleeker look. I was going for some major versatility. This contest is all about who can make vintage modern again the best, and who can keep the essence of the era while still staying up to date and I think my cutout front white gathered waist dress does just that. I paired it with nude peep toe canvas wedges, black heels, a black leather jacket, and shocking red lipstick and vivid blue eyeliner for a retro-modern feel. Enjoy!
This dress is made from ivory satin with poly satin lining. Fully lined and under stitched with ivory zipper back.
Mar 2, 2013, 03.46 PMby Wendy Parthoens
I like the dress a lot (I think it would be stunning in red too…) and I really love your presentation! Unfortunately I'm to late to vote for your dress, but just wanted to say: job well done!
Feb 21, 2013, 09.08 PMby laura76
It is so adorable! Very nice job!
Feb 21, 2013, 08.49 PMby daisymomo
very pretty! hope you win x
Feb 21, 2013, 08.51 PMby Amber Barker
Thank you!
Don't forget to vote for my design to win! http://www.burdastyle.com/gallery/361?page=19. Thanks!!!!
Feb 18, 2013, 08.41 AMby missvalentine0601
Love the dollhouse photos!
Feb 18, 2013, 08.41 AMby missvalentine0601
Love the dollhouse photos!
Thank you!
Feb 17, 2013, 05.00 PMby flowergirl22
your dog? fab dress, love the leather jacket
Yes, she is a full size poodle named Lilah. Thanks!
Feb 16, 2013, 11.45 AMby merche
Great dress and absolutely amazing photos!
Feb 16, 2013, 10.08 AMby Mary Athey
This is gorgeous,.love.the cute.out and.the photos. Good luck x
Feb 16, 2013, 05.41 AMby smallone
oh my gosh…this is a wonderful dress…but you have to win the prize for best presentation of a project!!!!!!
Thank you so much!
Feb 16, 2013, 03.30 AMby runningwithscissors1
Cute dress! Love how you played it up with the pictures.
Yeah I love photoshop, and design so it just made sense. Thank you!
Feb 16, 2013, 01.15 AMby kisses
Nice dress
Feb 20, 2013, 04.16 AMby Amber Barker
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