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STATE OF NEW MEXICO DEPARTMENT OF HEALTH Annual Report July 1, 2003—June 30, 2004 Department of Health Annual Report Published by the New Mexico Department of Health 1190 S. St. Francis Dr. P.O. Box 26110 Santa Fe, New Mexico 87502-6110 Bill Richardson, Governor Diane D. Denish, Lieutenant Governor Michelle Lujan Grisham, J.D., Secretary Designate Gary Girón, M.B.A., Deputy Cabinet Secretary Fred Sandoval, M.P.A., Deputy Cabinet Secretary September 2004 Department of Health Annual Report Department Mission and Goals ...............................................1 Message from the Secretary ....................................................2 Program Areas Prevention & Health Promotion .............................................3-6 Health Infrastructure ..............................................................7 Surveillance, Response & Reporting ......................................8 Testing & Pharmaceuticals .....................................................9 Behavioral Health Services .....................................................10 Long Term Care Services ........................................................11 Developmentally Disabled Community Services ....................12-13 Licensing, Certification & Oversight ......................................14 Administration & Policy ..........................................................15 Contact Information ................................................................16 Department of Health Vision Statement Building a HEALTHY New Mexico! Department of Health Mission Statement The mission of the New Mexico Department of Health is to promote health and sound health policy, prevent disease and disability, improve health services systems and assure that essential public health functions and safety net services are available to New Mexicans. The Department accomplishes this through assessing New Mexico's health status, assuring access to coordinated systems of health care, creating health policy, and by providing critical safety net services and interventions. Department of Health Goals The following strategic goals were developed in the 2003 DOH planning cycle. These goals are presented below along with their associated program/ division level objectives. These goals and objectives drive all Department initiatives. • Comprehensive Health Service System: Assure the development of a comprehensive health service system that addresses the basic health needs, both acute and chronic, of New Mexicans, with emphasis on the needs of vulnerable and specialty populations. • Prevention, Promotion, and Education: Keep people healthy and give them tools to make healthier choices. • Fiscal Responsibility and Management: Manage fiscal and other resources responsibly. • Quality of Care: Assure high quality service delivery. Building A HEALTHY New Mexico! 1 A Message from the New Mexico Department of Health During the summer of 2003, the secretaries of the departments of Health, Human Services, Children, Youth and Families and Aging and Long-Term Services traveled to communities across the state to learn firsthand about the healthcare needs of New Mexicans. The 26 communities held some issues in common – keeping medical providers in rural areas and making healthcare accessible to everyone. Each community had its own needs, such as improving air quality in Clovis and providing transportation to services in Truth or Consequences. Since then, the Department of Health's employees have shared their own ideas about how to improve performance and operations. These contributions from the community and Department of Health staff have been directed toward improving quality and performance, all in an effort to improve the service the department provides to its customers, the residents of New Mexico. With the support of Governor Richardson, the department is fine-tuning a strategic plan that works to reduce teen suicides and pregnancies, childhood obesity, drug abuse and the spread of infectious diseases. These efforts will rely on a network of public and private partners, all of whom are committed to working on improving the quality of life for all of us. With a reorganization of department to better coordinate and prioritize programs, the Department of Health is improving the way it does business. The health of all New Mexicans will improve as a result. This annual report highlights a few of the Department's accomplishments over the past year that support the vision of Building A HEALTHY New Mexico! Patricia Montoya, R.N., M.P.A. Michelle Lujan Grisham Cabinet Secretary, Secretary Designate of Health Department of Health September 2004 Jan. 2003 – August 2004 Building A HEALTHY New Mexico! 2 Program Area 1: Prevention & Health Promotion Major Programs Division: Public Health Purpose: To provide a statewide system of prevention, health • Infectious Disease promotion and education, community health improvement and • Chronic Disease other public health services for the people of New Mexico. • Family Health • Community Health Health Status Priorities Improvement New Mexico has been identified as a state facing some of the • Health Promotion most difficult health problems in the nation. The New Mexico Comprehensive Strategic Health Plan has targeted five problem Budget areas that affect New Mexico's health status and the Department (in millions) of Health has developed strategies and interventions to improve General Fund – $32,009.3 them. Program Area One is the lead program in implementing Federal Funds – $60,260.8 these priorities: Other Funds – $15,794.1 • Childhood Immunizations Total – $108,064.2 • Teenage Pregnancy • Obesity Employees • Youth Suicide 617 • Hepatitis C Childhood Immunizations The Department of Health and the New Mexico Immunization Coalition have worked with First Lady Barbara Richardson to improve the state's immunization rates and to make childhood immunizations a front burner issue for Department of Health and its many partners. Childhood immunizations are one of the most New Mexico's First Lady Barbara Richardson with "Done by One" cofounders, cost-effective public health interventions. Betty Bumpers and Rosalynn Carter Strategies: • Increase the number of healthcare providers using New Mexico's Universal Vaccines for Children Program which ensures the lowest prices for the parents of children requiring immunizations • Send community health workers and Families First Case Managers on home visits to discuss the importance of up-to-date immunizations • Promote the Health Passport immunization record which was designed to help parents remember when their children's immunizations are due • Implement the New Mexico Statewide Immunization Information System (NMSIIS) which will give healthcare providers statewide immediate access to a child's immunization status • Increase the number of medical offices that remind clients that their children are due for immunization Building A HEALTHY New Mexico! 3 Accomplishments: • Advanced the Statewide Immunization Information System. By 2005, in alignment with the National Immunization program, this system will allow medical providers to check the immunization status of their patients to ensure that they are fully covered regardless of where the child might have gotten their shots in the state. • Improved childhood immunization ranking from 49th to 44th in the U.S. This represents a 14% increase in the rate in only two years. New Mexico's rate for 4:3:1:3:3 (4-DTP, 3-Polio, 1-MMR, 3- HIB, 3-HEP B among children 19-35 months) is currently 75.2%, the highest it has ever been. • Implemented an immunization media campaign with the New Mexico Immunization Coalition. These media spots promote the new Health Passport Immunization card that highlights required vaccinations and tracks the child's shots. Teenage Pregnancy There are many collaborative efforts currently in place within New Mexico to reduce teen pregnancy and risky behavior among school-age youth. Teen pregnancy is not only an issue for female adolescents. Often, teen fathers and teen males are not thought of as a piece of the prevention puzzle. New Mexico has several Public assistance to teen families in NM costs pregnancy prevention and parenting programs targeting males. taxpayers nearly $300 million annually. Strategies: • Improve the relationship of youth to their families or a responsible adult • Improve the relationship of youth to schools • Increase cooperation among providers that offer teen pregnancy services • Increase access to clinical reproductive health services for adolescents Accomplishments: • Improved teen pregnancy rates in 10 counties. In 2004, 10 New Mexico counties were recognized for reducing the teen birth rate by 16% from 1998-2002. These counties are on target to meet Challenge 2005, a joint effort of the Department and the New Mexico Teen Pregnancy Coalition to reduce New Mexico's teen birth rates 20% by 2005. • Obtained $100,000 to develop a comprehensive strategic plan for services for children birth to 8 years old. This award assists New Mexico to address access to health insurance and medical homes, mental health and social-emotional development, early care and education/child care, parent education and family support. It also supports the work of the Children's Cabinet, a group created by Governor Bill Richardson, that is made up of every secretary and department head dealing with children. 4 4 Building A HEALTHY New Mexico! Obesity From 1990 to 2001, more New Mexicans of all ages became overweight and obese. The number of children and adolescents who are overweight is double and triple the rate from 20 years ago. More than 10% of 2- to 5-year-olds and 15% of 6- to 19-year-olds are overweight. The number of 18- to 49-year-olds that are overweight has doubled. More than half of New Mexican adults have a Body Mass Index (a guide that uses a person's height and weight to Participants at "First Steps Toward Building a Healthy New Mexico!," a measure total body fat) that leaves them at increased risk for a community challenge to activity & fitness. number of chronic diseases. Strategies: • Ιncrease physical activity to at least three times a week • Promote healthy food choices Accomplishments: • Streamlined the Community Health Improvement process. In April 2004, the Department of Health created the Office of Health Promotion and Community Health Improvement (OHPCHI) to improve accountability and align the work of the maternal and child health and community health improvement councils. This change will result in more streamlined and collaborative services to New Mexico communities. • Implemented "New Mexico on the Move," which includes nutrition and physical activity promotion. • Was awarded $408,000 from the federal obesity prevention grant to help New Mexicans prevent and control obesity and related chronic diseases through nutrition and physical activity promotion services. US and NM Suicide Death Rates for Youth Ages Youth Suicide 15-24, 1990-2002 25 23.2 Youth suicide is a public health crisis. In New Mexico in 20 18.9 2001, 12.9% of adolescents said they had attempted suicide Rate per 100,000 Population in the previous 12 months and 22% had seriously 15 15.4 considered killing themselves in the previous 12 months. 10.2 9.9 9.7 10 In 2002, suicide was the second leading cause of death 5 among 15- to 24-year-old New Mexicans. Unfortunately, NM US only 36% of youth at risk for suicide receive treatment for 0 their problems. Notably, the mental health problems that 2000 2001 2002 underlie suicide also underlie homicide and accidents. Building A HEALTHY New Mexico! 5 Strategies: • Improve access and build a system of care to address adolescent mental health issues • Improve the relationship between youth and families • Reduce risk factors such as access to guns and impulsive behavior • Promote mental health awareness and stigma reduction Accomplishments: • Funded and developed a youth suicide prevention documentary. On December 15, 2004, a half- hour documentary will be broadcast statewide on the signs and symptoms of depression and suicide among youth with discussion on intervention options for family members, friends and others. Hepatitis C Hepatitis C is a viral disease of the liver that is spread through blood and other bodily fluids. Most cases have been linked to sharing of injection drug equipment. Recent scientific and medical advances have made treatment for hepatitis C effective for most infected persons, although not all. More than 32,000 New Mexicans are estimated to be infected with hepatitis C, compared Over 80% of injection drug users have hepatitis C. with approximately 3,000 persons infected with HIV, the virus that causes AIDS. Strategies: • Provide syringe exchange and disposal for injection drug users • Screen and test for early detection • Educate both medical professionals and private citizens about the virus • Treat, reduce health consequences and provide client/caregiver support for people living with hepatitis C • Improve the collection and analysis of data that will aid in prevention and treatment Accomplishments: • Developed statewide hepatitis C plan. New Mexico has the highest rate of deaths due to chronic liver disease and cirrhosis in the country, which is exacerbated by hepatitis C infection. In 2004, the hepatitis C Alliance created a set of strategies to address hepatitis C in New Mexico. 4 6 Building A HEALTHY New Mexico! Program Area 2: Health Infrastructure Major Programs Division: Public Health • Public Health District/ Purpose: To maintain and enhance a statewide public health Local Offices system and services that include district and local public health, • Health Systems rural health, primary care, dental care and school-based health • Rural Health services to ensure access to high quality healthcare for all • Primary Care New Mexicans. Accomplishments: Budget • Created task force to identify strategies to reduce (in millions) homelessness and to improve access for the homeless to services General Fund – $29,851.1 such as Social Security, Medicaid, food stamps and general Federal Funds – $1,166.7 assistance. Other Funds – $3,055.4 • Completed a review of DOH services that are provided to Total – $34,073.2 Native American Tribes & Tribal Organizations to find out if services and training are being provided where needed. Employees • Addressed New Mexico's health workforce needs. Recruited 30 physicians to practice in rural areas of New Mexico. 312 Received $50,000 in federal funds from Health Resources and Services Administration to implement a new rural hospital quality improvement initiative with eight participating hospitals. • Created a task force to address appropriate staffing of school nurses and to present recommendations. • Supported school based health centers by developing common protocols and procedures and integrating five centers into Medicaid/Salud. • Established an Oral Health Advisory Council that will work to improve New Mexico's dental health care. They have implemented an oral health surveillance system and added oral health professionals as eligible participants to the New Mexico Health Services Corps program, which provides stipends to providers for practicing in rural areas. • Held the first Southwest Conference on Disability in October 2003 which explored health-related aspects of disability and assessed the impact of disability on health. • Established hepatitis C training with University of New Mexico Hospital's Health Services Center. It will become the pilot site for the Hepatitis C Education & Training Network. • Identified Public Health Service Sites in seven counties in the northeast corner of the state who will serve in the event of a public health emergency requiring mass vaccination clinics. • Provided testing and counseling for HIV, syphilis and hepatitis to 100 high risk women inmates. DOH's Women's Inmate Program provides weekly classes on sexually transmitted diseases, HIV, hepatitis and other risk reduction topics. Counselors from the Santa Fe Battered Families Shelter visited during the program and met with fifty female inmates to address domestic violence issues. • The Health Office increased primary care, mental health and family planning services to teens in Taos County by expanding clinical days to two per week at Taos High School Health Center during the last six months. Approximately 180 students received 250 family planning visits during the first quarter of 2004. An on-site pharmacy was established to increase provider time spent with students rather than carrying supplies back and forth. • Opened five new school-based health centers in Maxwell, West Las Vegas, Taos, Raton and Farmington. Reproductive health and sexually transmitted disease prevention and family planning services are provided. Building A HEALTHY New Mexico! 7 • Doubled Evening Family Planning clinic slots at Las Vegas Health Office to meet demand in the last six months. Percent of teens seen in evening clinics is twice those seen in day clinic, and "no show" rates for these clinics are less than 10%, resulting in great savings in staff time. • Opened the Public Health Resource Center in Las Cruces to provide one-to-one counseling and small-group education for persons with chronic illnesses/conditions such as diabetes, obesity, asthma, and hepatitis C. • Collaborated with the New Mexico State University Cooperative Extension Services to develop and provide family-based pediatric weight loss program (KidShape) for eligible kids. • Advanced community prevention and early intervention of obesity. Healthier Communities monies funded obesity prevention and intervention programs in Fort Sumner. All participants were provided pedometers, diabetes and cholesterol tests and referrals, numerous exercise programs and nutrition education and counseling services. • Constructed a new Public Health Office in Ruidoso to meet the needs of the community. Program Area 3: Surveillance, Response & Reporting Major Programs Division: Epidemiology & Emergency • Office of Epidemiology Response • Emergency Preparedness • Injury Prevention Purpose: To maintain and enhance a statewide system of population-based surveillance, vital records and health statistics, • Emergency Medical emergency medical services, bio-terrorism, emergency Services preparedness and injury prevention. • Vital Records and Health Statistics Accomplishments: • Joined the National Emerging Infections Program Network Budget which assesses the public health impact of emerging infections (in millions) and evaluates methods for their prevention and control. General Fund – $9,869.9 • Implementing New Mexico Electronic Disease Surveillance Federal Funds – $11,846.9 System (NM-EDSS). The data collected will assist in Other Funds – $1,594.6 determining the magnitude of a health problem, show trends in Total – $23,311.4 its incidence and distribution and in formulating and evaluating control and prevention measures. Employees • Developing and implementing a $500,000 integrated 141 web-based birth and death certificate registration and issuance system. The E-Vitals project will develop this system that will automate the functions that are currently handled manually. Faster reporting of births and deaths will enhance the Department's ability to meet contractual requirements with agencies that provide funding, analyze health information, detect fraud and enhance homeland security. • Effectively contained flu epidemic, West Nile Virus and SARS. Surveillance for influenza has been in place since 1991. Surveillance systems for West Nile Virus and Severe Acute Respiratory Syndrome (SARS) were developed and implemented as those emerging infections threatened New Mexico. During 2003, over 400 equine cases occurred in 30 of 33 counties and 209 human cases were detected in 24 of 33 counties. Training of local mosquito control personnel and other prevention strategies such as respiratory infection control posters for healthcare facilities have been provided statewide. 4 8 Building A HEALTHY New Mexico! Program Area 4: Major Programs Testing and Pharmaceuticals Division: Scientific Lab Division (SLD) • State Scientific Lab for Health, Agriculture, Purpose: To provide core diagnostic and analytical services in Office of the Medical support of public and environmental health programs and to Investigator and Implied provide pharmacy services. Consent Lab • Pharmacy Accomplishments: • Received $907,828 for Public Health Laboratory Bio-monitoring Implementation Program. The Scientific Budget (in millions) Lab was awarded one of three grants given nationally by the Centers for Disease Control and Prevention to enhance the General Fund – $9,869.9 ability of epidemiologists to directly assess the impact of Federal Funds – $11,846.9 environmental hazards upon human health. Other Funds – $1,594.6 • Awarded FBI Director's Community Leadership Award Total – $23,311.4 for Premiere Scientific Lab. This award was given in recognition of the lab's outstanding contribution to the Employees community in partnership with the FBI. The Scientific Lab has 91 provided leadership in the enhancement of the state's planning and capacity to respond to bio-terrorism and chemical terrorism preparedness in New Mexico. • Instituted a Pharmacy Management Committee (PMC). The committee is made up of the individual pharmacy supervisors from each of the DOH pharmacies and will work to: − Improve communication among DOH pharmacies and pharmacists. − Develop, implement and ensure the standard use of best practices across DOH pharmacies. − Review drug purchase, inventory and return practices across DOH in order to maximize the use of departmental resources. − Carry out the recommendation in the Governor's Performance Review which calls for the coordination of the purchases of pharmaceuticals and other medical supplies across state government. This coordination will result in bulk purchasing which will cut costs by boosting buying power. • Achieved extremely low drug waste percentages, (0.37% of total drug purchases). • Recouped 63% of the value of unused or expired drugs via returned for credit programs. • Reduced drug disposal by the Public Health Pharmacy from $500,000 in June 2003 to $26,000 in June 2004 resulting in a $474,000 reduction in drug waste. • Purchased 97% of its drugs through discount purchasing. Building A HEALTHY New Mexico! 9 Program Area 5: Behavioral Health Services Major Programs Division: Behavioral Health Services (BHSD) • Community programs • Prevention services Purpose: To provide an effective, accessible, regionally based system of • System enhancement behavioral health prevention and treatment services that are consumer- • Sequoyah Adolescent- driven and provided in the least restrictive setting for eligible persons in Treatment Center New Mexico so that they may become stabilized and their functioning • NM Rehabilitation levels may improve. Center • Las Vegas Medical Accomplishments: Center • Received a $17.5 million five-year substance abuse prevention grant award. This federal state incentive grant is being used for Budget substance abuse prevention efforts among adolescents and adults. (in millions) The programs emphasize personal skills development and task- General Fund – $76,862.7 oriented training which has proved to reduce alcohol, tobacco and Federal Funds – $12,893.4 other drug abuse. Other Funds – $28,290.3 • Opened a new substance Abuse Social Detoxification program in Total – $118,046 Grant County. In partnership with the Long Term Services Division and with the use of federal fiscal relief funding, BHSD improved the Employees substance abuse program at Fort Bayard's Yucca Lodge. 1,348 • Launched a consumer oriented website. The site is designed to provide accurate and timely information to consumers, providers, advocates and families seeking local, regional and national behavioral health information and services. It provides a comprehensive directory of mental health, substance abuse programs, social services, and coalitions concerned with behavioral health issues. • Was awarded a $2.2 million, three-year substance abuse prevention grant. The State Incentive Enhancement Grant is being used to fund six community based prevention programs, which will focus efforts on parents and families of youth to 6 years old. The programs funded through this initiative will work to reduce risk factors and improve the relationship of children with their family and community. These outcomes will lead to long-term delays in the age of first use and reductions in adolescent use of substances. • Gained national recognition of three substance abuse prevention programs from the Substance Abuse and Mental Health Services Administration Center. Exemplary program status is given to newly developed or adapted programs which have rigorous evaluation protocols and have proven to be effective over multiple years. • Reduced the sale of tobacco products to minors. The sales rate of merchants selling tobacco products to minors was lowered from 14.8%, June 2003 to 6.3% in June 2004. • Received $22.8 million for additional supportive and recovery services using both faith and traditional providers to reduce substance abuse. Building A HEALTHY New Mexico! 10 Program Area 6: Long-Term Care Services Major Programs Division: Long-Term Services (LTSD) • Los Lunas Community Purpose: To provide an effective, efficient and accessible safety Program net system of long-term care facilities and services to maximize • Fort Bayard Medical the quality of life and independence of eligible New Mexicans. Center • NM State Veteran's Fort Bayard Medical Center Home Accomplishments: • LTSD's Performance • Provided 4,083 Medicare Part A, 8,927 high-risk nursing Improvement Office facility, 89,903 low-risk nursing facility, and 6,992 Chemical Dependency Treatment days, for a total of 109,905 total days. Budget • Improved survey readiness, reducing the number of (in millions) deficiencies and eliminated monetary fines. General Fund – $8,146.0 • Realigned nursing home license to reflect actual beds and Federal Funds – $3,276.6 adjusted the number of beds designated as Medicare Part A. Other Funds – $36,542.0 This will help adjust reimbursement rates and result in a Total – $476,964.6 significant increase in revenues. • Modified admissions process to ensure financial Employees responsibility documentation is in place prior to admission; 920 target and market long-term care services; better schedule admissions; and improve systems to ensure timely referrals. • Improved coordination between accounting, admission, nursing, and the Health Information Manager to improve timely and accurate completion of abstracts to reduce the number of rejected claims. • Replaced the aging inventory of lifts used to transfer residents, mostly for bathing. • Instituted a preventative maintenance program to ensure a proactive response to environmental needs. • Created a medical equipment coordinator position to ensure equipment is replaced in a timely fashion and remains in operable condition while in use. • Mural Project – Painting 10' x 30' murals on six residential units. • Installed equipment that should reduce natural gas consumption by 4% and reduce the scale build up in the pipelines. • Remodeled six resident rooms to (add benefits), six have been done. • Met ADA requirements by repairing flooring elevations on main hallway. • Established a one-year pilot program with the Southwest Continuum of Care committee to provide social detoxification services. New Mexico Veteran's Home Accomplishments: • Retained Joint Commission Accreditation for Healthcare Organizations accreditation. • Successfully completed the veteran's survey, which provides data that can be used to improve services. • Completed re-roofing project for entire facility. • Graduated seven certified Medication Aides. 4 11 Building A HEALTHY New Mexico! Program Area 7: FTE Major Programs Developmentally Disabled Community Services • Developmentally Disabled Waiver Division: Long Term Services • Medically Fragile Purpose: To provide a statewide system of community-based • Developmentally Disabled services and supports to improve the quality of life and increase the Community Program independence of individuals with developmental disabilities and • Family, Infant, Toddler children with or at risk of developmental delay or disability and their Program families. • Office of Disability & Health Family Infant Toddler (FIT) Program Accomplishments: Budget • Developed a new public awareness campaign "Ready! Set! (in millions) Grow!," which includes posters, brochures and development wheels and training for medical providers statewide about the General Fund – $82,215.8 importance of early intervention and how to make a referral. Federal Funds – $3,413.7 The number of children served increased by 14% between July Other Funds – $7,715.5 2003 to July 2004. Tota1 – $93,345.0 • Collaborated with the Public Education Department to publish a technical assistance document on serving young Employees children with Autism Spectrum Disorders and their families. 113 A statewide training was provided for managers of early intervention provider agencies and a series of intensive regional trainings for early intervention and preschool staff are planned. • Led a collaborative effort with the Public Education Department, CYFD, Head Start, NMSD, NMSVH, Parents Reaching Out and UNM - Center for Development & Disability to address early childhood transition from early intervention to preschool or other supports and services. Forty-three community transition teams have been supported to develop local inter-agency agreements, a statewide conference was held and a transition video/DVD was developed and distributed. According to a statewide survey, 86% of parents reported experiencing a smooth and effective transition. • Increased the use of early intervention services in "natural environments" (homes, communities, child care centers) from 63% in 2002 to 89% in 2004. New Mexico provides community-based long-term care services through the Developmental Disabilities (DD) Medicaid Waiver that serves as an alternative to an Intermediate Care Facility for the Mentally Retarded (ICF/ MR) program. The DD Waiver Program helps individuals live in their communities by providing services to enhance independence and achievement of personal goals, while providing necessary care and support. The number of individuals waiting for DD services increased by 15% (to 3,151) over the previous year. The length of wait did not increase appreciably (from 47 to 48 months), because of the Division's efforts to bring the people who have waited the longest into services. 4 12 Building A HEALTHY New Mexico! FY03 DD Waiver Accomplishments: • Served an additional 284 clients for a total of 3,086 individuals on the Developmentally Disabled (DD) waiver. • Increased self-directed pilot project areas served. • Implemented a more flexible and cost-effective funding system. • Worked towards implementation of Health Insurance Portability and Accountability Act (HIPAA). • Expanded Self-Directed Pilot Project into a statewide program. • Collaborated with public schools to register students for the DD Waiver and coordinate services of both entities, increasing the number deemed eligible by 8.5%. Medically Fragile Accomplishments: • Conducted statewide training for all Medically Fragile Waiver (MFW) Providers. • Provided training that helped improve services and define new policy/procedure changes. • Received and incorporated stakeholder input on MFW standards. • Updated information on clients and families that have been deemed eligible for MFW services. • Successfully recruited more therapists to work within the MFW. Building A HEALTHY New Mexico! 13 Program Area 8: Major Programs Licensing, Certification and Oversight Division: Health Improvement (DHI) • Licensing & Certification of facilities Purpose: To ensure high quality healthcare systems through • Caregiver Criminal licensing and certification, quality oversight and quality History Screening standards compliance by providers. • Oversight of DD Community Programs • Established State oversight of nursing home and hospital transitions. A new state law gave DOH the authority to require that providers give 60 days notice of a Budget proposed license change, or closure, sale or acquisition of (in millions) a nursing home, hospital or primary care clinic. General Fund – $4,284.5 • Took receivership of several residential healthcare Federal Funds – $1,633.8 facilities to assure zero tolerance for abuse, neglect and Other Funds – $3,550.9 exploitation of their residents. Tota1 – $9,469.2 • Implemented limited service hospital regulations. The Employees regulations ensure that limited service hospitals do not 133 turn away patients that rely on indigent care services. • Launched Phase One of a consumer oriented website, http://dhi.health.state.nm.us. This is the Division of Health Improvement's way of providing a quality information tool for consumers, providers and others interested in the provision of health care in New Mexico. The web site will be completed in three phases. Phase One introduces DHI and tells who we are and what we do. It provides information about each of the Division's bureaus, key contact names, addresses, phone numbers and e-mail addresses. Phase Two of this web site will provide consumers with immediate access to deficiency reports on New Mexico's providers. Studies have shown that when these reports are made publicly available, providers work harder to improve their services. Phase Three will automate manual processes such as facility licensure. This automation will provide a level of efficiency and accountability for both the applicant and the licensure bureau. 4 14 Building A HEALTHY New Mexico! Program Area 9: Administration & Policy FT Major Programs Divisions: Office of the Secretary, Office of E Planning, Policy & Evaluation, Office of General • Office of the Secretary P Counsel, Office of Internal Audit, Administrative • Office of Policy, erm Services Division, Information Technology Planning & Evaluation 56.0 • Office of General Services Division 0 Counsel Purpose: To provide leadership, policy development and administrative T • Office of Internal Audit support to the Department of Health. erm • Administrative Services 77.0 • IT Services Division • Negotiated a preliminary union agreement with the American 0 Federation of State, County and Municipal Employees and a final agreement with Community Workers of America. Budget • Established central control over administrative functions: (in millions) − Implemented a new financial management and budgetary control General Fund – $8,006.9 system Federal Funds – $3,190.6 − Conducted a Strategic Contract Review of over 1,000 contracts Other Funds – $900.5 − Implemented the Procurement Card Tota1 – $12,098.0 − Initiated a Master Capital Plan • Consolidated 23 independent IT organizational units within the Employees DOH into a single IT organizational unit, the IT Services Division. 58 • Moving towards uniform regions among Health and Human Services agencies: The Department of Health will work with consumers, communities, healthcare providers and the other Health and Human Services agencies to define and establish a coordinated and uniform statewide regional system that efficiently provides its programs and services. • Improved facility business plans. • Completed implementation of an integrated hospital information system to support the administrative, clinical and financial functions of the six DOH residential care facilities. • Completed New Mexico's first Comprehensive Strategic Health Plan. New Mexico's Comprehensive Strategic Health Plan provides a blueprint for collaboration among state, local and tribal partners from the public and private sector to determine health strategies and priorities, and identify activities for all partners to improve the health status of New Mexicans. • Participated in Immunization Week of the Americas and Bi-national Health Week to improve health along border region. "The Immunization Week of the Americas" is a hemisphere-wide campaign which marked the first time all countries in the Americas have carried out immunization activities at the same time. The Border Bi-national Health Week is an effort among two countries and 10 states that tackles important health issues along the U.S. - Mexico border that will uniquely involve some statewide activities in New Mexico. Both initiatives provide information and service to the community on critical health issues and further provide a means for the community to access the public health and health care systems. • Successfully implemented HIPAA privacy requirements. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that requires covered entities such as DOH to comply with several rules related to patient privacy. The first rule to be implemented, the Privacy Rule, requires covered entities to provide customers/clients with a notice of privacy practices that outlines their rights to restrict access to protected health information (PHI). Covered entities must have policies and procedures in place to safeguard PHI. Clients have the right to request an accounting of disclosures of PHI. DOH has policies and procedures in place, the work- force has been trained and clients receive a notice of privacy practices when they first receive services. Building A HEALTHY New Mexico! 15 http://www.health.state.nm.us/ DOH Contact Information Office of the Secretary (505) 827-2613 Public Information Office (505) 827-2619 Administration and Finance (505) 827-2555 Public Health Division (505) 827-2389 Border Health 1-800-784-0394 Immunization Program 1-888-231-2367 Division of Health Improvement (505) 827-2695 Long Term Services Division (505) 827-2574 1-800-283-5548 Behavioral Health Services Division (505) 827-2658 Office of Policy, Planning and Evaluation (505) 827-1053 Scientific Laboratory Division (505) 841-2500 Division of Surveillance and Response (505) 827-0006 Information Technology Services Division (505) 827-9690 16


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Events & Workshops
Upcoming Events
Sunday, June 7th 2015
What: Rain Barrel Workshop with CCST and the South Burlington Natural Resources Committee
When: Sunday, June 7th, time TBD (late morning/afternoon)
Where: City of South Burlington Office,
South Burlington, VT
Cost: $30
Past Events
September 18th, 2014: Vermont Master Composter Course
July 19th, 2014: Essex Junction Block Party Tabling and Rain Barrel Give-Away
July 11th, 2014: Essex Junction 5 Corners Market Tabling
June 25th, 2014: Winooski Rain Barrel Decorating with JFK elementary students
June 14th, 2014: Rain Barrel Workshop to kick off the Connecting the Drops stormwater outreach campaign in Essex Junction.
May 29th, 2014: Spring Webinar Series: Tree Planting 101. Presented by Brian Sullivan, Arborist Technician for the City of Burlington and Vice President of the New England Chapter of the International Society of Arboriculture.
May 22, 2014: Stream Clean-Up in Williston! Williston Central School joins the Stream Team to help clean up Allen Brook.
May 3rd, 2014: Green-Up Day! The Stream Team tabled at South Burlington's City Hall to talk to Green-Up Day volunteers about rain gardens and rain barrels.
April 24th, 2014: Spring Webinar Series: Tree Selection and Planting Site Assessment. Hosted by the Vermont & Urban & Community Forestry Program and presented by Warren Spinner, Burlington City Arborist.
Saturday, April 19th 2014: Rain Barrel Workshop in Shelburne! Hosted by CCST and the Shelburne Natural Resources Committee.
October 12th, 2013: Tabling at the Essex Fire Department Open House!
September 27th, 2013: Tabling at the Essex Junction Five Corners Farmers' Market Come meet our Urban Conservation Specialist and ask about how you can contribute to stormwater mitigation at home and in your town!
September 25th, 2013: Tabling at the Essex' Heart and Soul Action Summit and Volunteer Fair!
September 21st, 2013: Tabling at Shelburne Farms' Harvest Festival.
August 29/30th, 2013: Rain Garden Installation at Chamberlin Elementary School, South Burlington
August 7th, 2013: Tabling at the Williston Farmers' Market
July 27th, 2013: Tabling at the Shelburne Farmers' Market
July 21st, 2013: Tabling at Village of Essex and Essex Junction Block Party
June 26-July 31st (Wednesdays): Tabling at Connecting the Drops Concerts!
May 18th, 2013: Milton's Spring Into Service!
April 19th, 2012: Ice Cream Social - April 19, 2012
March 29th, 2012: Managing Runoff on your Property
September 27th, 2011: Build Your Own Rain Barrel Workshop

subset: commoncrawl


text:
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Latics host Rubin Kazan in the Europa League and we've got everything covered!
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The video above shows how to check for blown fuses in the interior fuse box of your 2008 Honda Accord and where the fuse panel diagram is located. If your map light, stereo, heated seats, headlights, power windows or other electronic components suddenly stop working, chances are you have a fuse that has blown out. If your Accord is experiencing electrical problems, you should always check the fuses first, because they are relatively easy to check and cheap to change. Some Hondas have multiple interior fuse boxes even the trunk - the video above will show you where the interior fuse box of your 2008 Accord is located. The more electronics your Accord has, the more fuses it has. Some components may have multiple fuses, so make sure you check all of the fuses that are linked to the component in question.
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2008 Honda Accord EX-L 3.5L V6 Sedan (4 Door)A few key tips will make jacking up your car much safer
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2008 Honda Accord EX-L 3.5L V6 Sedan (4 Door)Minor transmission fluid leaks can often be fixed with the right sealant - see how to do this
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It is 1667 and the mighty naval war between the Dutch and the English still rages. Sir Francis Courtney and his son Hal, in their fighting caravel, are on patrol off southern Africa, lying in wait for a galleon of the Dutch East India Company returning from the Orient laden with spices, timber and gold...'The scope is magnificent and the epic scale breathtaking ...Wilbur Smith is one of thos benchmarks agains whom others are compared' The Times 'Meticulous research supports constant excitement in a fast-moving tale' Washington Post
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Product ReviewSince I have been with MBC, I see the majority does product reviews. I am hoping that I can get a couple of Moms to do a review of our pro… Started by Denise Alberino |
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A follow for a followGood Morning Everyone, My name is Denise and my new job is to get our blog up and running. Our website is very successful so I have big… Started by Denise Alberino |
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Latest News, Product Listings and Discussion for Audio Assault.
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30 Mar 2015Audio Assault releases Free Defacer Plug-in for Win & Mac
23 Mar 2015Audio Assault updates XCTR Harmonic Exciter to v1.0.1
16 Mar 2015Audio Assault updates free Klipfreak plugin for Mac & Win to v1.0.1
#KVRDeal Expired 7 Mar 2015Get the full Audio Assault Bundle for $99.99
2 Mar 2015Audio Assault releases XCTR Harmonic Exciter for Windows and OS X
26 Jan 2015Audio Assault Updates Head Crusher to 1.2
12 Jan 2015Audio Assault Updates Multi Transient to 1.01
22 Dec 2014Audio Assault Releases FreaQ Analog Style Equalizer
#KVRDeal Expired 3 Dec 2014Audio Assault offers Bass Grinder for Free with purchase of Grind Machine
24 Nov 2014Audio Assault releases "Multi Transient" envelope shaper plugin for Mac & Win (and updates free Transient plugin)
10 Nov 2014Audio Assault updates HeadCrusher Saturation Plugin to v1.1
3 Nov 2014Audio Assault releases Transient - Free Transient Shaping Plug-in for Mac & Win VST, AU, RTAS & AAX
#KVRDeal Expired 17 Oct 2014Plugin Boutique Flash Weekend Sale: Save 35% off AudioRaiders Sasha SoundLab [Kontakt Instrument]
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Manufacturer: Chicks Saddlery
Model: Silver Royal Randall
Category: Barrel Saddles
Quality: Don't know have not received it yet
Summary: Ordered a working barrel saddle from Chicks Saddlery over 7 weeks ago and my CC was charged and I have still NOT received the saddle. Very disappointed in the customer service as they did not even offer to make it right or discount my order or shipping in any way. They told me the saddle would ship out some time in November and that my CC would not be charged until then, which is untrue my CC was charged 7 weeks ago! I will not order anything again from Chicks Saddlery, as there are many other good companies to order from.
Rating: 1
Author: Disappointed
Date: 2011-10-28
Usefulness Rating: 1.66667 out of 5.
9 reader(s) voted.
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UNICEF report highlights dramatic impact of Ebola on childrenA February 16, 2015file photo shows a student washing her hands before heading to her classroom at Don Bosco High School as schools reopen in the Liberian capital Monrovia. Liberia said on February 20, 2015, it was lifting nationwide curfews and ... Finland Times, 1 month ago |
65 images for don bosco school | ||||
Marwari Hindi triumphMarwari Hindi High school annexed the title, beating Don Bosco School by six runs in the final of Inter-school cricket tournament, organised by Dibrugarh District Sports Association at its outdoor stadium here today. Marwari School were all out for 103 in ... The Telegraph, 1 week ago
Sishu Bharati win
Calcutta Telegraph, 2 weeks ago
FAUTASI FIVA: DON BOSCO 200 - SEGAVAO III — READY TO SOAR SAYS CAPT. ZITABy email@example.com Vaimasenuu Zita Martel, Don Bosco's skipper looking at the map of Tutuila's waters in preparation for the fautasi race today. The only woman in the sport of men or faagatama i le tai brings her 14 years of experience and ... SamoaNews.com, 1 week ago
Hand in hand with Don Bosco
MaltaToday, 1 week ago
Don Bosco boat damaged in suspected act of vandalism
SamoaNews.com, 1 week ago
Don Bosco crowned champs
Goa Herald, 1 week ago
Pushpalata VidyaMandir team wins quizAn inter-school quiz competition titled DB KWIZIKL 2015 was conducted by Don Bosco Matric Hr. Sec. School, Egmore, Chennai, exclusively for students of class V, on 6{+t}{+h}March, 2015. Children from 34 schools in and around Chennai participated. The Hindu, 1 month ago
They Blinked, Cracked and Rejoiced
New Indian Express, 1 month ago
Don Bosco, Ganesh Nagar winGUWAHATI, April 3 Ganesh Nagar High School and Don Bosco School won their respective matches in the Guwahati Cricket Coaching Centre organised Nabin Chandra Tamuly Inter School Cricket Tournament today.Ganesh Nagar HS fetched a five-wicket victory against ... The Assam Tribune, 3 weeks ago
Ganesh Nagar crush Little Flower
Calcutta Telegraph, 2 weeks ago
Summer Lovin' comes early this yearProduced by Fr Ralin De Souza, sdb, for Don Boscos Oratory, Panaji, Grease will be staged at the Don Bosco school campus on March 14 and 15, at 7pm. Times of India, 1 month ago
Summer Lovin comes early this year
Times of India, 1 month ago
Former Boscoites relive old days at first alumni meetFormer students of Don Bosco Academy (DBA) walked down the memory lane at the first alumni meet of the school held on Sunday evening. Times of India, 1 month ago
Inter-school sports meet held
Sangai Express, 1 week ago
Teacher and students facing rape charge in American SamoaA teacher and two students from the Don Bosco school in Samoa who were in American Samoa for the Flag Day celebrations have been charged with having sex with a 15-year-old girl. The teacher and students made their initial appearances in the ... Radio New Zealand, 22 hours ago
Samoan visitors held over alleged assault in Pago Pago
Radio New Zealand, 2 days ago
First 2Samoas Trade Fair Kicks Off In Am. Samoa
Pacific Islands Report, 1 week ago
Ten fautasi will run in 2015 Flag Day Fautasi Race
SamoaNews.com, 1 month ago
Opponents of Operation Mangal are Pro-Capitalist: KCP (MC)IMPHAL, April 6: Contending that catholic mission schools including Don Bosco, St Joseph, Nairmala Bas, Little Flower, Secret Heart and Catholic School in the state are all based on Reli-care system devoid of organizational hierarchy, the proscribed ... Kangla Online, 2 weeks ago
DBA class X students given warm farewellThe outgoing Class X students of Don Bosco Academy were given a warm farewell at a graduation ceremony organized by the students of class IX on the school campus on Sunday. Times of India, 2 months ago


text:
46, Des Allemands, LAI enjoy spending time with family and friends, back yard BBQ's, Saints games and anything to do with the water. My daughter is now in college. I have a good home and steady jo...
57, New Orleans, LAI would describe myself as honest, caring , with much respect toward other people ; very fortunate to operate my own business for over twenty years, and happy .Financially sec...
26, Saint Rose, LAI am passionate about helping people I love life and love helping others. I enjoy being outside and I love to travel and see the world. I have never really done the online dat...
80, Norco, LAI love to cook ,eat and be merry,best TV programs ,westerns,bioragofies[spel?],love to fish ,lie water sports,fle markets,antiques,and brozing on the computer.Lots more we wil...
60, Kenner, LAOccupation: Computers / Software / Hardware; Height: 5' 8"; Eye Color: Brown; Hair Color: Salt-n-Pepper; &nbs...
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33, Kenner, LAI'm a divorced dad of a 4 year old son who is my world. I have realized that it's hard to date since being a "single dad" but looking to get out in the world and make some new...
27, Kenner, LAI'm looking for a good hearted honest respectable caring but somewhat tough smart funny thick chick so if you're reading this and you are looking for a good hearted caring hon...
51, Metairie, LAI dress well, speak well, on diverse topics,(not just sports)publically and privately. Play tennis well, wake up early, cook, I can fix anything. I'll make you proud in socia...
51, Metairie, LAI am a devout Catholic and enjoy travel, dancing, sports and ministry. My other interests are cooking, art and history museums, hiking and music. I consider myself as easy goi...
34, Metairie, LAI am outgoing, fun, hard working, and always open to new experiences in life. I enjoy spending time with family and friends, traveling, trying new food, listening to live mus...
33, Metairie, LASpending time with and cooking for family and friends are my favorite ways to express my appreciation for those closest to me. During Thanksgiving, I showed a couple friends ...
Catholic Dating By Major City:
- Destrehan,
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- New Sarpy,
- Paradis,
- Saint Rose,
- Hahnville,
- Norco,
- Ama,
- Kenner,
- New Orleans,
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- Metairie,
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Catholic Dating By Diocese:
- Archdiocese of New Orleans,
- Diocese of Alexandria,
- Diocese of Baton Rouge,
- Diocese of Houma-Thibodaux,
- Diocese of Lafayette,
- Diocese of Lake Charles,
- Diocese of Shreveport


text:
The Richard Majeste Home Page
The Richard Majeste Home PageUpdated August 24, 2011 | |
Richard Michael Majeste 1505 Northwold Drive, NE Atlanta,GA 30350-4106 United States | email@example.com |
I am researching the following names:Majeste, Majeste', Schlumbrecht, Campo, Schell, Schilling, Bonck, Campo, Cardona, Chatry (de Chatry), Deloune, Ferran, Ferrais, Ginart, Hau, Heno, Hesse, Hoffman, Keller, Labat, Loubet (Loubat), Manalla, Maraspino (Raspino), Metzler, Miller, Nicle, Parker, Peil, Prados (DePrados), Rocca (DaRoca, Rock, Roch), Traub, Vaughn, Vouaux, and Bossu.Most of these have connections to the New Orleans, Louisiana area including St. Bernard and Plaquemines parishes. Many of the immigrants were from France and Germany. | |


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Ebola: Heightened Alert Across America
Six people in the United States tested for signs of Ebola, Dr. Brantly showing signs of improvement.
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Spiced Hot Chocolate
- Total Time:
- 15 min
- Prep:
- 5 min
- Cook:
- 10 min
- Yield:
- 4 servings
- Level:
- Easy
- 6 cups milk (use whatever you like, I use unsweetened almond milk!)
- 1 teaspoon store-bought curry powder
- 2 green cardamom pods, crushed
- 1/2 cup unsweetened cocoa powder
- 1/2 cup honey
- 1/4 teaspoon salt
- Marshmallows or whipped marshmallow cream, for serving (optional)
In a medium heavy-bottomed saucepan, warm the milk, curry powder, and cardamom pods over medium heat, stirring every now and then so it doesn't burn.
Meanwhile, spoon the cocoa powder into a measuring cup. Once you see little bubbles forming around the perimeter of the saucepan, the milk is hot; turn off the heat. Pour a little milk, about 1 cup, into the cocoa powder, and whisk until smooth. Add back to the saucepan, and whisk in the honey and salt. Stir until well combined.
Pour the hot chocolate through a strainer into 4 individual mugs and top with marshmallows, if you like.
Recipe courtesy Aarti Sequeira
Cooking Tips
More Recipes and Ideas
Hot Spiced Sangria
Recipe courtesy of Sandra Lee
Spiced Chocolate Fondue with Fresh Strawberries
Recipe courtesy of Patrick and Gina Neely
Spiced Chocolate Budino
Recipe courtesy of Giada De Laurentiis


text:
Lil Wayne's first shoe with Supra, the Chimera, is a high top masterpiece including a clamshell heel panel, stash pocket in the tongue and over the top padding for the most comfortable fit possible. This edition is covered with Cheetah print around the upper of the shoe to go along with the mixture of black suede and mesh on the tongue, toebox, laces and SUPRAFOAM midsole. The purple accents add to the outrageous one of a kind shoe making it a must have for $125. Check out Supra for more of Weezy's Spectre line and stick to Sneakerfiles for all new updates on kicks and gear!
Supra Chimera "Cheetah"
Color: Black/Purple/Cheetah
Where: Supra
Price: $125
Via Supra
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Find records of Beulah Harris
Find records of BeulahBiography & Family History Add details
Beulah Harris (1912 - 1976) was born on June 27, 1912. She was born into the Harris family.
She died in November 1976 at 64 years old.
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Will the podsquad be having any meets at Mousefest or will they be staying away. Will you guys be attending any events at Mousefest?
It's bascily a bunch of arthurs, podcasters, and different people that gather for there love of disney. I thaught it would be cool to meet the DIS team there, but i guess the dont affiliate with this event.
oh thats sounds cool!!! maybe they'll do a meet when your down there ????? I seem to just miss the dates!!!!
Who cares about Mousefest. When you're the best, you don't need to participate in events like this. Not that The Dis is being "stuck up", however when your're the best Disney site on the net, you don't need to participate in these type events. IMHO Dennis-
While the DIS doesn't participate in MouseFest, there was a podcast last year at the same time as MouseFest. Wonder if that will be the case this coming year as well.
I went to MouseFest last year and had an absolutly FABULOUS time. Like a true Disney fan, I listen to many Disney podcasts (they all have something different to offer), I read alot of Disney books, and visit a couple of Disney forums. I met (and chatted for awhile) with Steve (author of book on Hidden Mickeys), Lou (author of Disney trivia books), David (author of Realityland) and I even met Charlie Ridgeway (he worked for Walt & has written a book). They autographed my copy of their books. Imagine riding POTC with someone who knows where to look for all of the secret inside details that most everyone misses. Imagine getting to go behind the scenes of Soarin and then getting to ride it with only your friends (bypassing even the FP line). Imagine walking behind ToT and RnRC for VIP seating for Fantasmic with dessert being served. Imagine riding the safari with 250 other people that all got to by-pass the regular line. Imagine enjoying a Dole Whip with 200 new friends. Imagine having a front row seat (yes, seat) for Illuminations while being served dessert. I met and made friends with podcastors, authors, fellow Disney friends. I'm making plans to meet up with some of these new friends in October. Did I say that I had a FABULOUS experience? It was the trip of a life time for this certifiable Disney fan. I wish that the DisUnplugged was involved with MouseFest. Then I wouldn't have to choose between the two events like I did last year. If you want more info on my experience, please PM me.
I debated about jumping in..... I don't think it is that they think they are to big or to good to do it. I imagine it is more time and effort to put into it. I have never been to Mousefest, so I don't know what it is like. But I have never thought Dis or Dreams thinks they bigger or better than anyone.
ITA, I HIGHLY doubt they think they are "too good" for Mousefest, maybe they don't have time, maybe it interfers with their business schedule, or who knows maybe they've never been invited.


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Zeroid added a post in a topic: Karate Robot (tomy) Repair-help
Thanks, I checked out the epoxy method from one of the links. I do something similar now but always wonder how long it will last.
Thanks for your help.
Zeroid added a post in a topic: Karate Robot (tomy) Repair-help
I have been collecting a small army of the Tomy Karate Robots that came out around 1970. They always have the same issue. One Nylon gear on the motor shaft and one nylon gear inside the gear box have spilt giving the motor no traction so the robot just sit there. I know this is common with Nylon gears.
Does anyone know where I can find replacement gears? I could use metal if I could find them or Nylon or plastic. I would almost rather use Nylon or plastic as it is original to the robot.
Thanks for your help!
Zeroid added a post in a topic: A Line Up Of Not So Rare Robots
I agree
Zeroid added a post in a topic: ROBERT THE ROBOT - IDEAL
Thanks for the response. Not sure if the rods are on backwards. They just bind at one point in the rotation. The hooks attached to the wheels seem to push them out too far to me.
Zeroid added a post in a topic: ROBERT THE ROBOT - IDEAL
Has anyone else noticed that the Robert repros don't work very well. The one I have has two problems. The cable keeps jumping off the back (disconnecting from the coupling) and the metal rods the run from the wheels to move the arms rubs against the inner frame at one point making operation less then smooth. Anyone else have this problem? ;)


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RATINGS: 2410 WEIGHTED AVG: 3.88 SEASONAL: Special IBU: 85 EST. CALORIES: 276 ABV: 9.2%
COMMERCIAL DESCRIPTION Like Hunter S. Thompson...Gonzo Imperial Porter is deep and complex. This turbo charged version of the Road Dog Porter is mysteriously dark with a rich malty body, intense roasted flavors, and a surprisingly unique hop kick. With Gonzo weighing in at 9.2% ABV, it will bite you in the ass if you dont show it the proper respect. IBUs: 85
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EL PASO – OCTOBER 21: Bob Carlton puts on an aerial display at Fort Bliss, Biggs Airfield, during the practice session at the 30th Anniversary Amigo Airsho on October 21, 2011 in El Paso, Texas.
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Well met at ringtone download service Audiko.net, where it's possible to download ringtones for free for your Android smartphone. Today we have a ringtone of "School Days" by Stanley Clarke as well as 70 other ringtones by Stanley Clarke. "School Days" is a top-rated song from the "The Bass-ic Collection" album that was released by Stanley Clarke at their studios together with other 6 tracks. You can listen to all 6 Stanley Clarke – "School Days" ringtone variations available here and download it for free right to your phone. You can also examine other 13 albums produced by Stanley Clarke for all time. "School Days" is referred to Jazz, and you can download a huge amount of Jazz albums absolutely for free. And finally, we have collected lyrics for this track and you can view it here as well. So feel free to browse, listen, download ringtones at Audiko.net. Make your phone sound cool!
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BENGHAZI, Libya — Doctors Without Borders has suspended its work in prisons the Libyan city of Misrata because it said torture was so rampant that some detainees were brought for care only to make them fit for further interrogation, the group said Thursday.
The announcement was compounded by a statement from Amnesty International saying it has recorded widespread prisoner abuse in other cities as well, leading to the death of several inmates.
The allegations, which come more than three months after former leader Moammar Gadhafi was captured and killed, were an embarrassment to the governing National Transitional Council, which is struggling to establish its authority in the divided nation.
Doctors Without Borders said that since August, its medical teams have treated 115 people in Misrata who bore torture-related wounds, including cigarette burns, heavy bruising, bone fractures, tissue burns from electric shocks and kidney failure from beatings. Two detainees died after being interrogated, the group's general director said.
"Patients were brought to us in the middle of interrogation for medical care, in order to make them fit for further interrogation. This is unacceptable," MSF general director Christopher Stokes said in a statement. "Our role is to provide medical care to war casualties and sick detainees, not to repeatedly treat the same patients between torture sessions."
Libya's Western-backed leadership, which has sought to assure the world of its commitment to democracy and human rights, has acknowledged that some prisoners held by revolutionary forces have been abused. It insisted the mistreatment was not systematic and pledged to tackle the problem.
But the transitional government has been unable to rein in the dozens of militias that arose during the war and have been reluctant to disband or submit to central authority.
Amnesty International said in a statement issued Thursday that it has met with a number of detainees in Tripoli, Misrata, and Gharyan who showed visible marks indicating torture, including open wounds on the head, limbs, back and other parts of the body. A number of detainees spoke to Amnesty about beatings with electric cables and metal chains, and they reported being suspended in contorted positions and given electric shocks.
The London-based group said the torture and mistreatment, mostly against suspected Gadhafi loyalists and sometimes foreign nationals from sub-Saharan African countries, is carried out by officially recognized military and security bodies as well as by a number of armed militias operating outside any legal framework. The group said several detainees died in custody from torture, detailing the death of at least two detainees.
Britain, which played a key role in the NATO-led air campaign that helped revolutionary forces overthrow Gadhafi, urged the new regime to "live up to the high standards they have set themselves."
"They need to ensure a zero tolerance policy on abuse. We are concerned about these reports and are taking them up with the Libyans as a matter of urgency," British Prime Minister David Cameron's office said in a statement.
The head of Amnesty International told The Associated Press the mistreatment of detainees in Libya showed the need for the international community to keep helping the country in its difficult transition. "It's not just a matter of sending in troops and then getting out again. Libya needs long term assistance," Salil Shetty said.
Stokes, of the MSF, told The Associated Press that those subjected to torture include ex-combatants and people accused of theft and looting.
"There is a significant number of people with darker skin, but there is really a wide mix," he said. "Whatever the motives, it is unacceptable to do this to human beings."
The interrogations were carried out by Libya's National Army Security Service at facilities outside the detention centers, MSF said in a statement.
The group, which operates in prisons but not interrogation centers, said it contacted authorities in Misrata, the port city that saw some of the fiercest fighting of the war, to demand an end to the abuse, but it received no official response, prompting MSF to halt its operations in the city's detention centers.
MSF said it will continue its support in Misrata hospitals and schools in addition to providing assistance to African migrants, refugees and internally displaced people in and around Tripoli.
In its statement, MSF said the most alarming case was on Jan. 3, when MSF doctors treated a group of 14 detainees returning from an interrogation center. It said nine of the detainees had numerous injuries, including broken arms and renal failure, and displayed obvious signs of torture.
Stokes said his group has informed the National Army Security Service that a number of patients needed to be transferred to hospitals for urgent and specialized care. All but one of the detainees were deprived of further medical care and hospitalization, and instead taken back to interrogation centers.
"Some of them couldn't even stand up, they were so badly beaten," he said.
El Deeb reported from Cairo. Associated Press writer Frank Jordans in Geneva contributed to this report.
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The tools available to us are pushing new limits. Here at EContent, we turned to our inboxes, our coverage, and our contributors to find out what those trendsetting products are in 2015. We hope that you find these tools as interesting and as potentially helpful as we do!
Theresa Cramer
May 14, 2014
Michelle Manafy's early career helped shape her for her latest position as the editorial director at the Online Publishers Association (OPA). "I promote the magic of media. ... My mission is to champion the content people love," says Manafy, whose long career in journalism saw her working for everyone from the Village Voice to Access Intelligence--and, of course, EContent. And as many journalists who have ventured into the realm of content marketing have figured out, the transition from journalism to marketing requires individuals to rethink the way they do business.
"The biggest difference out of the gate ... is that you don't look for the news," Manafy says. These days, her job is more about supporting the OPA marketing team's goals than it is about breaking news. "When you work with highly skilled marketers," she says, "they build storylines that are going to be their campaigns for the year." The content Manafy creates now has to support those campaigns-although that doesn't mean she completely turns off her journalistic instincts.
"I still try to bring content back around to the big trends, but it's turned on its side," she says. One of the hardest things about this, though, is ignoring the news. For a more general audience, Manafy might have covered Net neutrality, but because her organization's role is to represent the interests of its members--and those interests aren't necessarily aligned with one another on a topic such as net neutrality--she avoids covering such topics.
The other big change for Manafy has been the pace. She's used to the pace of a newsroom, where content is constantly being churned out. But in the world of brand journalism, quality is more important than quantity. This has turned out to be a bit of a blessing, because as Manafy prepared to launch the OPA's content hub, she had an important realization: No one pitches stories to content marketers. Instead of spending every morning weeding through dozens of pitches in her inbox, Manafy now reaches out to her member organizations looking for stories that help support the OPA's chosen themes.
"I'm going to have be proactive because I'm not even on their PR lists," says Manafy. Until she can forge a more conventional press relationship with these companies, she has set up monitors and alerts to make sure she isn't missing any initiatives from the companies she's tasked with covering. Content marketing experts have long been urging brands to hire reporters, and many journalists--such as Manafy--are seizing that opportunity. However, they may need to keep a few things in mind before jumping at the first job that comes along.
"Here's what I think you can bring to the craft of marketing from the craft of journalism: passion for your subject matter," Manafy says. "When you look at what you're going to be 'selling,' be sure you care about it. Be sure it's something you can align your personal brand with. You aren't just punching a time clock." In other words, in order to create the kind of great content that good content marketing demands, you need to be passionate about your subject matter. So whatever you do, don't settle.


text:
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Brooches, pearl bursts and bling cover your custom cake for that special day. Marina Sousa makes it look easy!
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Here are some details about my project: | |
Category | Cake Decorating |
Type | Three Tiers or More |
Material | Fondant |
Share a little about the materials, processes and techniques used to create this cake: buttercream, royal icing, fondant, gum paste
Great job on the tiara. Is there a template for it? If so, what is the link?


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Posted 3/26/2013 at 9:28 AM by Debie
Had this made for a family Christmas gift exchange, everyone fought over it. Can't wait till next year....
Sending the same ornament to different places? If you order more than one of an item and want them shipped to different addresses, please order them individually. We will ask you for the individual shipping addresses later in the ordering process.
Christmas Tree - 25
Personalized Christmas Table Top Decoration
The gangs all here! All twenty-five of these heads can be personalized with a name! What a wonderful gift for grandparents. There is room to include their children, grandchildren and even the family dogs with the optional pet dish available! This would be a great gift for a team to give to their coach too! A classroom teacher would appreciate this from her students and she could keep it on display in her classroom even after the Christmas holiday. We can personalize the base with a last name or holiday greeting.
Material: Wood, Clay, Resin
Ornaments shown on our site are personalized, as examples only, so you can see where we put the words/names you give us. Some ornaments allow you to select hair or uniform color. If there is no color choice, it is not available on that particular ornament. We will do everything possible to catch any mistakes in spelling, etc., but are not responsible if we do as you request, and it is then not correct. The ornament you see above is the way it will look when you get it, except for the personalizing instructions you give us and any optional attributes you select.
Read what our customers say about our Personalized Christmas Ornaments and their shopping experience!
Hover over testimonials to stop scrolling2/5/2015 - "Your ornaments are awesome and I am very happy with my purchases. I am so glad I found your website. Ginny"
10/21/2014 - "Ornaments arrived sooner than expected (pleasant surprise). Well packaged. Exactly what was expected.Anonymous Respondent "
12/1/2014 - "This was my first time ordering. I am very pleased with the ornament and impressed with the fast delivery. Thank you very much.? Pauline B"
10/8/2014 - "I was thrilled when I found Ornament Shop. Have purchased from here for several years and have recommended this place to several who also have purchased. I love the quality of the ornaments, the color and the design. I can't say enough good!!!!!! Nan D."
11/4/2014 - "I have been shopping with you for three years now. I wish I had known about you sooner. I have not been disappointed in the quality and I love the fact I have both the name and the year placed on each ornament. I would not hesitate in recommending Ornament Shop to others. Mary T."
9/25/2014 - "Lovely ornaments and fast delivery will recommend to others. Thomasina H."
5/16/2014 - "I was so very pleased that the owner not only called me about my contact, but took pictures of the item in question and emailed them me. I am very pleased to order from them and I WILL order again! Thank you! Dana T."
8/6/2014 - "Easy way to shop for my grandkids Christmas ornaments. I try to find ones that are not so heavy for the tree and I have found some nice ones on your site. Candace M."
8/25/2014 - "I give my family Christmas ornaments at the end of our big Thanksgiving Dinner. That gets our Christmas season started, as we hit the stores early on black Friday. I have ordered from Ornament Shop before and neither my family or I have never been disappointed. Good quality, and I always find what I want. Thanks. Jeanette R."
8/16/2014 - "I was excited awaiting my three orders, I always get that way, when waiting on my ornaments to arrive. As usual, they were even more beautiful, then they looked on line. I've been shopping the Ornament Shop for years started shortly after they opened for business. Never have had one I needed to return. They are fantastic, and the people who receives them as gifts, look forward every year to what I'm going to give them. Paulette P."


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Hi, my name is DJ-DasCool but you can call me Alex. My gamertag on xbox 360 is mcLovin8991. You can friend me if you want. Im here to make you happy in anyway I can.
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