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Confidential Inquiry in to Drug-Related Deaths January 2007 to December 2008 Karen Burch East Sussex DAAT Dr Anthony Glasper Sussex Partnership Trust Dr Bettina Baier Sussex Partnership Trust August 2009 Introduction Previous Confidential Inquiries into Drug related Deaths covering 2004-2005 and 2005-2006 were completed in April 07 and September 08 respectively. This subsequent inquiry exploring deaths where the Inquest was received by the DAAT between January 2007 and December 2008 is part of an ongoing inquiry process that will reflect on previous recommendations and practice. Aims and Objectives of the Inquiry East Sussex DAAT includes a multi-agency Drug Related Steering Group whose purpose is to reduce drug-related deaths in East Sussex. The aims and objectives of this group include: to monitor the number and causes of drug-related deaths in East Sussex; to ensure that information obtained form investigations into drug-related deaths and "near misses" inform practice and service development; to ensure that best practice guidance on reducing drug-related deaths is implemented locally; and to ensure that recommendations to reduce drug-related deaths are considered by the DAAT when commissioning treatment. 1 In the national programme of substance abuse deaths ("np-SAD"P, Ghodse et al (2005) defines a drug related death as: "…a relevant death where any of the following criteria are met at a completed inquest, fatal accident inquiry or similar investigation: One or more psychoactive substances directly implicated in death; History of dependence or abuse of psychoactive drugs; Present of Controlled Drugs at post mortem; or Cases of deaths directly due to drugs but with no inquest." Np-SAD relies on returns from coroners, which has implications for consistency of classification and for completeness of returns. Whist this makes it difficult to make direct comparisons between different areas, the national programme provides a useful basis for historical comparison of mortality rates. Table 1: Np-SAD death rate East Sussex Np-SAD annual death rate / 100,000 Year Rate / 100,000 N 2001 4.00 16 2002 5.97 24 2003 9.32 36 2004 5.68 23 2005 .098 4 2006 5.66 23 2007 3.60 15 The increase in 2003 to a reported annual death rate of 9.32/100,000 may be explained by a note in 2 the report of the local confidential inquiry, McDonnell and Bennett (2004) . The report notes that late in 2004 the coroner reported "a further 12 deaths [from 2003] which may have had an opiate associated with the death were submitted by the coroner, after re-checking the definition used [by St Georges Hospital]". This suggests that reports to Np-SAD in previous years may have been under- August 09 2 reported. None of the additional 12 deaths met the local (i.e. Office of National Statistics) definition, underlining the importance of monitoring and reporting locally to the commissioning process. With the 3 release of the 2006 report was included a revised text stating that the number of deaths in 2005 was under reported due to an administration error. The figure of 4 is incorrect and 20 deaths for 2005 were reported to the DAAT. It is of course possible that the Np-SAD figures will be revised to reflect the higher figure for 2005 in due course. Early in 2007 the Np-SAD contacted the East Sussex Coroner and deaths are now being correctly reported using a slightly broader definition and it is possible that this might result in a perceived increase in the number of drug related deaths across the county. Table 2: Deaths included in the local drug related deaths inquiries within the ONS definition 2004 15 2005 12 2006 19 2007 22 2008 22 2009 22 Total 80 The table above shows the total number of deaths, where Inquests have been received, that have been included in the drug related death inquiry process. Local Definition of a Drug Related Death This inquiry defines a drug-related death as "deaths where the underlying cause is poisoning, drug abuse, or drug dependence and where any of the substances are controlled under the Misuse of Drugs Act (1971) (Office of National Statistics, 2005). This definition excludes deaths involving alcohol, tobacco, volatile substances and drugs listed under the Misuse of Drugs Act which form part of an analgesic or cold remedy (e.g. co-proxamol); those deaths caused by secondary infections and deaths from road traffic accidents and other accidents which occurred under the influence of drugs. The reasons for using the above definition are twofold. Firstly, the Department of Health Action Plan (Department of Health, 2001) and the Update Drugs Strategy (Home Office, 2002) targets to reduce drug-related deaths are based on the identification of cases according to the ONS definition. Secondly, other definitions of drug-related deaths, such as that used by the National Programme of Substance Abuse Deaths, are over-inclusive; counting deaths caused by overdoses of antidepressants, anti-psychotics and anticonvulsants in individuals who do not have a history of drug abuse or dependency. st The inquests of all deaths in East Sussex that occurred between 1 January 2007 and 31 December 2008, where the inquest had been heard and identified as drug-related by the Coroner and the inquest received by the DAAT were reviewed. In addition to those, one death which occurred in 2005 was reviewed as the inquest was received by the DAAT after the previous inquiry was completed. – in August 09 3 total, 22 deaths reviewed in this inquiry. Those inquests not received at the time of this inquiry will be included in an ongoing process of review. Only those cases that met the ONS criteria of a drug-related death were selected for inclusion in the study. The cases excluded from this inquiry included one death that followed a fall where cannabis had been used but was not the cause of death and another where cocaine had been used but was not the cause of death. One other death was a verdict of misadventure where a non-controlled substance was implicated. Method A minimum dataset which includes a minimum data set which included the subject"s demographic details, their history of drug misuse, mental illness, contact with partner agencies housing or employment services, contact with any drug treatment service and the circumstances surrounding the death was extracted from the Coroner"s files and recorded in addition to the information provided by the Coroner on the Inquest form (appendix 1). The agencies involved in the care and management of people with substance misuse problems in East Sussex were, where appropriate, contacted and asked to provide information about each case. Statistical analyses were not used to compare the results from this local inquiry with those from national studies as the number of drug-related deaths that occurred in East Sussex were too small to be statistically significant, data was therefore analysed qualitatively and several broad themes identified as in the previous inquiry. Subjects Of the 22 drug related deaths 17 were male and 5 were female - two of the 5 females (40%), compared to 13 of the 17 males (76%), were known drug addicts or know drug abusers 20 were White, 1 was Pakistani and 1 was Black Other 8 (36%) lived in Hastings and Rother and 12 (55%) in Eastbourne, Downs and Weald, 1 (5%) lived in Hove and 1 (5%) individual was of no fixed abode 16 individuals died at home Age The most common age range associated with drug related deaths was 36 – 45, and 68% of all deaths occurred between the ages of 36 and 57 - the average age was 38, compared to 33 in the last inquiry. Table 3: Age at time of death Age Range 16 - 25 26 - 35 36 - 45 46 - 55 56 - 65 Number of DRDs 2 5 10 3 2 August 09 4 Employment Although the majority of the deceased were unemployed (9), 8 were recorded as being either employed (6) or self employed (2). The remaining 5 covered the categories retired, student, invalidity/sickness, other and not known. Accommodation The living arrangements of the deceased are shown in the table below which shows that 11 individuals were living alone. Table 4: Living Arrangements No Alone 11 With partner 4 With partner and children 2 With parents 2 NFA 2 Retired 1 The previous inquiry found that 3 of the deceased who died shortly after leaving prison were staying with others at the time of their death also that 7 of the 22 cases were subjects living with friends or staying at others houses. Findings Manner of Death The Coroner"s verdict of the manner of death is shown in the graph below Chart 1: Coroner's verdict on DRDs 14 12 10 8 Number of 6 DRDs 4 2 0 re n s s t en ug ug pe u d nt dr dr O ci ve Ac of on ad e ce is us M en ab nd p de e ep Coroner's Verdict on D N According to the Coroner"s files, the deaths of 13 individuals were as a result of dependence on drugs. Three more of the deaths were recorded as accidental, and another 2 were recorded as misadventure. There were also 2 verdicts of non dependent abuse of drugs as well as 2 open verdicts. August 09 5 Drugs Implicated in Main Cause of Death The main cause of death as recorded by the coroner was multiple drugs, with 8 of the 22 (35%) taking a fatal mixture of at least 3 substances prior to death. These deaths cannot therefore be associated with a single drug, as the coroner stated that is was the combination of drugs, as well as in some cases alcohol, that led to death. Five of the deceased took large amounts of Heroin prior to death which led to Heroin Poisoning. Chart 2: Main cause of death 9 8 7 6 5 Number of 4 DRDs 3 2 1 0 e is e ne in s A es in in ug ro ab DM do in ph ca dr He nn am ha M or Co le Ca M et et tip M ph ul Am M Main Cause of Death Toxicology and Drugs Implicated The drugs implicated in the 22 deaths, and the frequency with which they contributed to the death is shown in the chart below. Chart 3: Drugs Implicated 14 12 10 Number of 8 DRDs 6 drug is 4 implicated in 2 0 de l ne am e M e Am C o ne Di eta in e z e in O ine ha l Al s pa A Co do M tes oc es et h o Tr hin in ne ia ro Di DM no dr in a e a co a od He d pi od p oc hy m pi or pi M ph nz Be Reports showed that Heroin, Methadone or Codeine was implicated in 5 deaths and Morphine, in 9 of the deaths (only one case where morphine was prescribed). The recording of specific Opiates within the toxicology results was not defined. August 09 6 Alcohol Alcohol was implicated in 12 (55%) of the 22 deaths compared to 45% for deaths broadly in 04/05, and 55% in the previous inquiry where 12 of the 22 deaths showed alcohol to be implicated. Benzodiazepines According to the National Drug Treatment Monitoring System (NDTMS), 16% of drug users who began their treatment journey in East Sussex between 2004 and 2005 reported using benzodiazepines. The previous assessment highlighted that in 2007, 20% of drug users entering treatment reported using benzodiazepines, and the Drug Treatment Needs Assessment 2008 found that fewer, 14% of adults receiving treatment during 07/08 had reported using benzodiazepines as either a primary, secondary tertiary substance. Benzodiazepines were implicated in 3 deaths, compared to10 of 22 deaths in 04/05 and 6 of 22 in the previous inquiry. Only 1 individual in treatment had declared Benzodiazepines as their secondary substance of misuse at the time of their assessment. Methadone Methadone was implicated in 5 deaths and 3 of the 5 were "in treatment" and were being prescribed methadone. The remaining 2 individuals had not been assessed by treatment services. Substance Misuse Treatment 10 individuals showed that they had some contact with treatment services in East Sussex. Of the 10: 1 individual died 2 months after completing an aftercare intervention and having left treatment in a planned way . 1 person had been assessed and was waiting to start a treatment intervention. I presented to treatment wanting a subutex detox but refused to attend a medical assessment so was discharged as "treatment declined" 4 were discharged as "dropped out/left"[ between 6 and 24 months prior to their deaths 3 were in treatment (1 having been referred to a prescribing intervention but not started) At the time of presentation to treatment, 4 individuals had declared significant alcohol consumption at ranging from 20 units per day to 35 units per day. In one case, an inpatient detox had been completed prior to their death. In another case, following an appropriate recommendation for daily contact after being drunk on presentation for assessment, the individual refused treatment. Alcohol dependent patients will continue to have to attend the service daily to be breathalysed before being dispensed their medication for safety reasons as recommended in the national guidelines. However, access to alcohol treatment will have been made easier: instead of the only point of access being through the alcohol provider, opiate dependent patients can access alcohol treatment by seeing the alcohol liaison nurse who works regularly in the dispensing clinic. August 09 7 5 individuals declared that at presentation to treatment they used heroin daily and 1 declared that they used 2-6 times per week. 1 individual declared that they used cocaine daily, 1 declared benzodiazepines daily, and 2 declared that they used crack a few times a week. It is also noted that another individual completed a Treatment Outcome Profile three days before she died and her Psychological state was recorded as 9 (of a scale 1-20 1 being low and 20 being high). The previous inquiry found that 4 of the deceased had attended treatment services for an assessment, but lost contact with the treatment service before starting their treatment. The "single assessment" introduced in January 08 was intended to address this issue along with the co-location of the non- medical provider with the prescribing team with a focus to engage clients in treatment at an early stage. The indications are to date that since the introduction of the single assessment process, a lower proportion of individuals present to treatment and then drop out when compared to the period before the new assessment was introduced. Data in relation to Tier 2 interventions i.e. outreach has not been collated locally even though such interventions are more widely used than previously particularly when working with people who might be reluctant to engage with treatment services. An upgraded substance misuse case management system will enable local data collection to inform the effectiveness of this level of intervention at the beginning of 2010. Whilst undertaking this and previous inquiries and whilst using the quantitative data obtained from the case management system, often it is difficult to obtain more qualitative information about the individuals from those who might have been in contact with them at the time of their death due to staff changes for example. Discussions have explored the merits of an additional part to the process, to include recent information within these inquires and treatment providers have already agreed to provide such information soon after the death of a client in treatment. This will provide the opportunity for treatment providers and key workers involved in the care to offer information soon after the death that may inform service development and lessons that might be learned. Prison Of the 22 cases, 9 of the individuals had been in prison. Although 6 had been released at least 19 months before their deaths, 3 had died within 6 months of their release: One individual had been imprisoned 7 times between 1997 and 2007 and reported continued use of heroin and subutex whilst in prison. They were released from HMP Ford 1 day before he died however no files mentioned treatment at the prison and no records appear on Dirweb suggesting no contact with CJITs or transfer out of prison directly to CJITs. The coroner"s report stated that the cause of death was multiple drug toxicity, and a verdict of dependence on drugs was recorded. An individual was released from prison HMP Bullingdon 8 days prior to their death but no files mentioned treatment at the prison and no records appear on Dirweb suggesting no August 09 8 contact with CJITs or transfer out of prison directly to CJITs. The coroner"s report stated that the cause of death was Heroin poisoning, and recorded a verdict of dependence on drugs. The male was imprisoned for 3 weeks and released 6 months prior to their death, and the coroner noted that the individual had consumed alcohol, Methadone and Cocaine prior to death. A verdict of dependence on drugs was recorded. The Drug Treatment Needs Assessment (2008) showed that of those leaving prison who had been referred to treatment through the Drugs Intervention Programme (DIR), whilst access to treatment is generally within one week, approximately 50% of people did not start their treatment. The Needs Assessment also showed that of the people referred into treatment through the Criminal Justice route, of those discharged from treatment, 55% were discharged in an unplanned way without return to prison. The Integrated Drug Treatment System (IDTS) has been to some extent operational since April 2009 with clear links between the IDTS and community services particularly around the pathways from community into prison and continuity of care upon release. The DAAT treatment plan identifies objectives to ensure that the links between prison healthcare, CARAT and CJIT are reinforces to deliver effective continuity of care arrangements. At present all drug and alcohol users coming into custody are offered evidence based treatments that include Methadone, Suboxone and Lofexadine for opiate users, the former two being either a maintenance or detoxification regime depending on the individual circumstances. Diazepam and Chlordiazepoxide are used for benzodiazepine and alcohol misuse. There are robust regimes already in place ranging from 14 to 21 day detoxification programmes. All newly appointed health care staff spend time with the drug treatment nurses and are aware of the procedures of administering Suboxone and Methadone together with the implications and treatment of overdose etc. It is envisaged that more prisoners will be receiving a maintenance prescription and will be released from court or prison still being prescribed medication and already established good links with the local community clinics are being built on. Release planning will be an essential element of the treatment journey and as well as an established naltrexone policy a retoxification policy will also be developed to use as appropriate. The prisoners under the care of the drug treatment nurses will be encouraged to participate in the normal prison regime and activities which involves education and the workshops. The local DIP workers, AA, NA will be encouraged to visit the IDTS wing on a regular basis to develop a healthy working relationship. August 09 9 The CARAT team at HMP Lewes are starting pre-release clinics offering support with housing issues, benefit applications, medical interventions and access to services and this will involve the local DIP treatment providers prior to release. Resuscitation In June 2008, East Sussex substance misuse services began to implement a naloxone distribution programme where opiate dependent patients are trained to give basic life support and administer naloxone to an overdose victim. Treatment providers report that naloxone has been successfully used in a small number of cases since implementation. Inquiries show that resuscitation was attempted in 2 cases here. One patient had previously overdosed and had been resuscitated by a family member. Given the case history of overdose and the willingness of the family member to resuscitate, the patient would have been a very good candidate for naloxone training. Dual Diagnosis The coroner noted that 8 of the 22 (36%) were on prescribed psychoactive medication, and it is also noted that 6 of these individuals had been in contact with Mental Health Services at some stage. With regards to the other 8, they were either not on medication or not known, and 2 had previously either requested help or received help for mental health issues. Only one of the 10 individual with some treatment history was recorded as "dual diagnosis" which for National Drug Treatment Monitoring System purposes is broadly defined as receiving care from mental health services for a reason other than substance misuse (mental health service refers to any PCT/NHS provision as well as other privately provided services. Patient contacts are recorded on the Health Patient Information System shows that in 13 cases a contact was recorded in PIMS and that 7 records showed a history of referrals to the Crisis Home Resolution Teams (1 within 9 weeks prior to their death), in 2 cases, referrals to Mental Health in Primary Care and 2 to a Homeless Health Team. The Sussex Partnership NHS Trust Clinical Guidance (2008) states that should any individuals have received treatment from mental health in-patient care, any discharge with no enhanced mental health Care Programme Approach (CPS) but substance misuse care only would have been taken very 4 carefully due to medicolegal (of allegations of lack of follow-up and care) . The same guidance also states that where there is an opiate prescribing need, the care should be shared between the Mental Health Trust and the Substance Misuse Service and responsibility for prescribing agreed between the two teams. August 09 10 Graph 1: Number prescribed psychoactive medication 8 Yes 10 No Not Known 4 Children A recommendation from the previous inquiry is that children should be an area specifically explored within the inquiry process. It was noted from the Coroner"s file and other information that 4 of the deceased had children living with them, and 2 other individuals had children but not living with them at the time of their death. One individual had been assessed by East Sussex treatment providers but not started treatment at the time of their death. A new procedure of recording and advising on recent suspected drug related deaths will be introduced in East Sussex. Where Police Officers suspect that a death may be drug related, a standardised form will be sent to a defined group including the DAAT. This will enable both adult and young people"s substance misuse case management systems to be scanned in relation to any children who might be in contact with or living with the deceased and Children"s Services advised where appropriate. Summary of Previous Recommendations The majority of previous recommendations have been completed which included; Reducing the proportion of drug users who are prescribed benzodiazepines by discouraging clinicians from starting to prescribe, encouraging clinicians from other agencies to transfer responsibility for benzodiazepine prescribing to the substance misuse services for detoxification For those patient requiring benzodiazepines, encouraging the use of dispensing arrangements such as instalment prescribing and supervised consumption to restrict the diversion of benzodiazepines into the illicit market Conducting research to quantify the extend of benzodiazepine prescribing within primary care in East Sussex Forging links with local Accident and Emergency departments to encourage drug users at high risk of overdose being referred to treatment Improving data quality in relation to dual diagnosis and housing need for patients entering drug treatment through the National Drug Treatment Monitoring System data capture August 09 11 Continuing to increase the number of treatment places commissioned for opiate replacement therapy Ensuring that future inquiries into drug related deaths explore whether children were a factor in the home environment of the deceased so that Children"s Services can follow up the cohort if necessary There remain a small number of recommendations from previous inquiries where work is already underway but incomplete or yet to be started. The following table provides a summary of those outstanding or where work has completed since the previous inquiries. Recommendation Progress R/A/G Conduct research to quantify the This has been included in the DAAT"s treatment plan A extent of benzodiazepine for 2008/09 – the PCT ePACT (electronic prescribing within primary care in prescribing and cost trends) database will be used East Sussex for source data. Work is currently in progress. Forge improved links with local Nigel Hussey and Joanne Bernhaut (PCT [public A Accident and Emergency health and well being] are working with colleagues in departments to encourage drug ESHT to deliver training and develop more effective users at high risk of overdose care pathways, particularly in relation to alcohol being referred for treatment misuse. Further work is required as indicated in the Treatment Plan. Improve liaison with prisons to Processes in place to liaise on every drug related A investigate and rectify any death to investigate all possible prison leavers from failings in the referral system HMP Lewes. Expand the naloxone distribution Discussions have taken place with Debbie Parker, A program to include offenders Head of Healthcare, HMP Lewes to consider as part leaving prison of IDTS. If funding is not available from IDTS, the Joint Commissioning Group will consider funding from the ring fenced budget Recommendations As A Result of This Inquiry A number of new recommendations are summarised below. Introduce a "lessons learned" Treatment providers will provide an KB/ALL Sept approach following any death appropriate summary following such a 09 where the patient was in death to include information about any treatment lessons that might be learned and shared with other treatment providers Exploring dual diagnosis further A brief gap analysis to be explored within KB March the drug treatment needs assessment 10 and progressed further into a wider project Introduce a system of early An alert system will be introduced that KB/VF Dec notification by Police particularly will identify such cases for all case 09 where children are likely to have management systems to be cross been involved in each death checked and Childrens Services advised where appropriate. Data collection in relation to tier 2 The new case management system will KB/Providers Feb treatment interventions (i.e. be introduced and used by treatment 10 outreach, needle exchange and providers and it will collate tier 2 after care) to be implemented treatment data for analysis August 09 12 Acknowledgements We would like to thank all those who enabled us to conduct the Inquiry including the East Sussex Coroner and Colleagues, Drug Treatment Providers, GPs and Lewes Prison. 1 Ghodse H, Corkery, J, Schifano F, Oyefeso A, Bannister D, Annan J. (2005) Drug Related Deaths in the UK Annual Report 2005. International Centre for Drugs Policy 2 McDonnell, J. and Bennett, J. (2004) Drug Deaths in East Sussex. Unpublished. 3 Ghodse H, Corkery J, Oyefeso A, Schifano F, Tonia, T (2006) Drug-Related Deaths in the UK Annual Report 2006. International Centre for Drugs Policy. 4 Sussex Partnership NHS Foundation Trust - Policy on the Management of people with a Dual Diagnosis of Mental Health and Substance Misuse (inc. alcohol misuse) October 2008. Replacing 047/2007/Clinical/Policy on the management of people with a dual diagnosis of mental health and substance misuse August 09 13
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Weather Alert
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On Monday, the Chicago Transit Authority (CTA) began in-service testing of 5000-series prototype railcars on its Orange Line. The railcars are currently running on the Blue Line and had previously been tested on the Green and Red lines.
The 10 prototype railcars are being tested to determine how they perform when operating in the conditions that CTA's rail fleet is subjected to throughout the year. The prototypes must successfully complete testing on all eight rail lines before CTA will authorize the delivery of the remaining 396 rail cars.
Each car has seven networked security cameras, an event recorder system similar to a black box on an airplane and sensitive door sensors that will detect obstructions better than CTA's current rail fleet.
Meanwhile, the new aisle-facing seating configuration is designed to accommodate more customers per car and allow more room for customers carrying backpacks, packages, luggage, strollers and bikes. The configuration provides 38 seats and space for two wheelchair positions and added support poles and hand straps in the center of the car for standing customers.
Other amenities include: an LED station indicator map with lights that move in conjunction with the train's location and electronic destination signs — widened to increase the size of the text that improves readability — both inside and outside of the railcar; regenerative braking that returns braking energy to the third rail for reuse to help power other trains and on-board electrical systems; and an alternating current (AC) propulsion system that converts the direct current (DC) energy in the third rail to AC for the traction motors.
Economic development within one-half mile of the system has been stimulated by ridership that has exceeded original projections. Valley Metro began compiling development activity since construction started in 2005 as part of an economic development database.
The Coradia Polyvalent for Algeria is a dual-mode train (diesel and electric, 25 kV) able to travel at speeds up to 99 mph. The train has six carriages and provides capacity for 265 passengers.
The new bike car contains 14 racks that will provide more room to maneuver bicycles on and off the train. A set of seats were removed from the lower level of the vehicle to make room for the bike racks.
Sustainable features of the CRMF include efficient mechanics and lights for energy savings, water-efficient plumbing fixtures for reduction in water usage and specially designed windows that prevent thermal transfer.
Will work to increase the supply of new TODs and rail systems across America and will be holding a series of national and local events bringing together business and political leaders with planners and experts to advance knowledge sharing and project deal making.
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This property allows you to book online with a credit card. After submitting a reservation request, the owner or manager has 24 hours to accept, at which time your card will be charged and you will receive an email confirmation
Recent Sanibel Island reviews
"First time in Sanibel and renting a condo. Had a wonderful time. Condo was great - nicely decorated, clean and just what we needed. Right on the beach which was nice. Would highly recommend this to anyone and already have let some family and friends know. Very relaxing vacation - island was excellent, quiet and several unique and wonderful restaurants. You really felt like you were on a tropical island. Will certainly visit again"Guest: Amy L. Date of Stay: June 2015 Review Submitted: June 17, 2015View listing
"We just finished up our week long stay in this beautiful condo! The condo was immaculate and there was not a single thing that we needed (Kitchen was great). Our whole family (Kids ages 5-15) had a wonderful time. The pool was very nice and just a short walk from the condo. The beach was also very beautiful and we enjoyed shelling everyday! We will absolutely without a doubt rent this condo again! Thanks for the great vacation!"Guest: Melissa D. Date of Stay: June 2015 Review Submitted: June 22, 2015View listing
"OUR STAY IN OCTOBER 2014 AT THIS SPACIOUS, TASTEFULLY DECORATED HOME COULD NOT HAVE BEEN MORE PERFECT. THE BEDS ARE SO COMFORTABLE. I BROUGHT MY OWN EGYPTIAN COTTON SHEETS BUT DID NOT USE THEM AS THE OWNERS SHEETS WERE SO SOFT. WE HAVE BEEN VISITING SANIBEL FOR OVER 25 YEARS USUALLY STAYING IN GULF FRONT CONDOS. BUT THIS HOUSE IS DEFINITLY WORTH NOT BEING DIRECTLY ON THE OCEAN. CONNIE, THE OWNER HAS A WARM PERSONALITY AND WAS VERY HELPFUL. THE WALK TO THE BEACH DOWN A SHADY LANE WAS COOL AND ENTERTAINING. MY GRANDSONS FOUND SOMETHING NEW EVERYDAY ON THE PATH TO THE BEACH. [TURTLES, SALAMANDERS, GECCOS, FROGS, SNAKES ETC] WE ENJOYED USE OF THE OWNERS MANY BICYCLES, BEACH CHAIRS, UMBRELLAS AND CHILDRENS BEACH AND POOL TOYS. SHE HAS THOUGHT OF EVERYTHING. I FORGOT ALL MY PROBLEMS AND LIVED IN THE MOMENT FOR ONE WHOLE MONTH. MY HUBBY AND I LEFT OUR SHADOWS ON THE BEACH AND HOPE TO RECLAIM THEM NEXT YEAR. THANKS CONNIE AND WE HOPE TO BE BACK TO YOUR LOVELY HOME AWAY FROM HOME."Guest: glenda Date of Stay: October 2014 Review Submitted: November 14, 2014View listing
"We recently returned from another amazing trip to Sanibel Island! This was our first time staying in Coquina Beach Condo 1A and we LOVED IT! The condo was immaculate (we are 'clean freaks') and didn't feel like we had to 'clean' before we unpacked. We were thrilled that we were able to unload our car and immediately head to the beach! The owners have thought of everything that you might need for your vacation trip and have gone to great care to make their condo absolutely perfect!! The location in the complex is 'the best'! You simply walk out your door, down a short path and you are on the beach. We spent alot of time on the lanai that has a great yet private view of the ocean. We also enjoyed the heated salt-water pool within the complex. Our check-in at Royal Shell Vacations was effortless. The owners even emailed me while we were on our trip to make sure everything was okay and to see if we needed anything. I was amazed! We have booked again for next year and plan to make it a yearly vacation trip to Coquina Beach 1A. Believe me, you will not be disappointed!!"Guest: Southern Charm Date of Stay: September 2014 Review Submitted: September 18, 2014View listing
Featured Destinations: Dauphin Island, Isle of Palms, Bald Head Island, Destin Condo Rentals


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2008: Aubrey O'Day at the Danity Kane album release party at Tenjune in NYC.
Amber Rose is over all the Kardashian drama.
Maybe she's born with it. Maybe she just uses a lot of lotion.
If there is one lesson to be learned in 2015, it is the following: do not f*** with Nicki Minaj.


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My lo is 5 weeks old tomorrow, and the past couple days he will be sound asleep and wake up and cry and scream. Everytime except once he's fallen right back asleep like nothing happened, but the one time he cried for a few minutes and stayed awake for a while. He usually doesn't cry unless hes hungry or needs to be changed. Do any of you ladies have any idea as to what it could be? I'm freaking out sort of, with flu season & all I think every little issue means somethings horribly wrong. His temp is 97.4 under his armpit, so no fever. He's been sleeping a bit more yesterday & today. Sorry for such a long post, I was hoping for some advice to get me through the night and I was going to call the doctors office tomorrow. Thank you
5 week old waking up screaming?
Posted 01/13/2013
Comments (9)
Posted 01/13/2013
Bad dream?? My 5 week old sometimes whimpers or cries in her sleep. I think she's dreaming.
Posted 01/13/2013
Bad dream?? My 5 week old sometimes whimpers or cries in her sleep. I think she's dreaming.
Posted 01/13/2013
My lo does this in his sleep- or maybe he wakes up for a second and then falls back to sleep right away. Almost like he was having a nightmare. I was curious and googled it last night, and it seems that docs are split on whether infants dream or not, but that seems like what it is to me. My lo has no fever and is healthy otherwise too. But mention to your doc if you are worried.
hunkersmommy1210 · Original Poster
Posted 01/13/2013
That's what I figured at first, but it keeps happening so I'm not sure, unless he just keeps having bad dreams :( I thought gas, too, because after he cries like that he'll fart for a little bit lol
Posted 01/13/2013
My lo does the same. I never can figure out why so i give him a pacifier and he falls right back asleep
Posted 01/13/2013
Could be gas pains. Mine did it last night
TTC over 5 years Mini IVF was a success!
BF Mama-
Posted 01/13/2013
Oh, this also happens when he needs to poo or pass gas i noticed. Hell scream for a while and then poo or fart then is perfectly fine.
Posted 01/13/2013
Mine is also 5 weeks and she is doing this tonight. I check to see if she needs to burp if she doesn't fall right back to sleep - and she is needing to burp each time for some reason.... Just a gassy day I guess
Posted 01/13/2013
Mine whimpers and goes back to sleep. She also smiles, talks, pouts and nurses. I think it is dreaming. I am guilty of doing this too ever since I can remember (sans the nursing). She also scoots all over her crib and turns sideways, apparently just like I used to do.
What's on your mind?Create a new post
Your growing child
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How To Build Quad Coil
How To Build Quad Coil this feature is not available right now. please try again later. published on jun 4, 2013. category . people & blogs; license . standard license. hydra coil build tutorial - how to this coil build is named after the star hydra i thought that was a fitting name as is looks like a star when fired up. For more detail about How To Build Quad Coil posts, please read more by clicking the post below and don't forget to share the posts through share button inside the posts:


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View the current warnings for New South Wales
Forecast issued at 4:30 am EST on Saturday 1 August 2015.
Weather Situation
A cold front approaching Tasmania and southwest Victoria, will cross southern NSW today with rain areas associated, particularly over the southern inland. This front will combine with a weakening trough over central NSW on Sunday with patchy rain about central and southeastern parts of the state easing during the day. A weak high pressure ridge will persist over the northeast over the weekend with generally dry conditions expected. A stronger cold front is expected to bring a southwest to southerly change to eastern NSW during Monday though little rainfall is anticipated before a ridge extends across the state during Tuesday.
Forecast for the rest of Saturday
High chance of rain developing over the southern inland with snow lowering to about the 1600 metre level. Medium chance of rain about the central ranges and south coast later. Partly cloudy in the remainder. Early fog patches in the far northeast. Northwest to westerly winds, freshening and becoming strong and gusty about the southern and central ranges.
Sunday 2 August
Slight to medium chance of rain in the southern and central parts increasing to high chance on the western slopes of the southern ranges.. Snow above 1600 metres. Partly cloudy in the north. Gusty west to northwesterly winds ahead of a late south to southwesterly change in the west.
Monday 3 August
Slight to medium chance of rain in the eastern half contracting to the coast during the day. Partly cloudy in the west. Cold, south to southwesterly winds extending throughout.
Tuesday 4 August
Slight chance of morning showers on the western Alps and near the far north coast. Mostly sunny elsewhere. Early frost on the slopes and ranges. South to southwesterly winds.
The next routine forecast will be issued at 4:30 pm EST Saturday.
Product IDN10031


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Lilly-Sandra Model
carl potter wilsonPhotographer Male London, England, United Kingdom
My Website: carl wilsonMy MM URL: http://www.modelmayhem.com/carlpotterwilson
Mayhem # 2824490
About MeMy name is carl wilson, I live in west london. i was a pro skateboarder for 2 years which i still love, with this i traveled a lot to different places and got to see some rad things,i never really had a camera to catch these moments on film, so i got a camera. I have been shooting in a for about one year now and have done some lookbooks so far, but what i really like doing is shooting portraits and landscapes. my goal of this site is to build my portfolio up and get some contacts. Im am up for shooting anything really as long as its a good idea. i also dont mind traveling to most places.
Lilly-Sandra Model
Shialaskies Model
L e V a N Model
Taichi Hatano Retoucher
MakeUp BY Raj Makeup Artist
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I use gmail and legitimately wasn't receiving any emails from them. I emailed customer service and told them that, despite how my email preferences were set, I wasn't receiving anything. They said they would fix it. Today I received the "welcome to BB" email that I wasn't able to generate on my own, despite trying to sign-up more than once using the form on the website.
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When is the Next Brooks Brothers Sale? - Page 383
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I use gmail and legitimately wasn't receiving any emails from them. I emailed customer service and told them that, despite how my email preferences were set, I wasn't receiving anything. They said they would fix it. Today I received the "welcome to BB" email that I wasn't able to generate on my own, despite trying to sign-up more than once using the form on the website.
I also use Gmail, via a desktop client. I've looked in several spam filters and never found the emails. I guess I should ask BB--I'm always late to the Black Fleece sales.
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I am disappointed at the size of a pair of slim fit chino
i bought a pair of slim fit chino 33' 32' which I usually buy jeans/chinos with this size
I was so happy when it came. However, it is too big for me
I found out that the waist is not the same as its description. The waist is 34' instead of 33'
I took it to a tailor on my own to size it down!
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I am disappointed at the size of a pair of slim fit chino
i bought a pair of slim fit chino 33' 32' which I usually buy jeans/chinos with this size
I was so happy when it came. However, it is too big for me
I found out that the waist is not the same as its description. The waist is 34' instead of 33'
I took it to a tailor on my own to size it down!
I own several Brooks Brothers pants and size is not always accurate, I buy size 32 and most of the time they measure 33 inches and sometimes 32. Most of my jeans are size 30, so sizes are not really something to depend on much. I tailor my pants to a 32 waist, in my experience, the only pants that have an accurate size are italian made.
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I agree. I have measured hundreds of pairs of new BB trousers and have found that most are very close if not exactly what the tag says. I measure by putting a yardstick inside the waist and doubling the result.
The one exception to measurement accuracy is Milano, and the poster above had mentioned slim fit pants. Milanos always measure .75 to 1 inch over tagged size. There has been much discussion of this in the past and the consensus seems to be that they are making an adjustment to account for the fact that the low-rise Milanos ride lower on the hips, at a place where the circumference will be wider than at the natural waist.
Thus if you are a W32 in a higher rise trouser and you decide you want to try Milano, you order W32. The W32 Milano measures W33, but they ride lower so they fit you. The alternative would be that the Milano actually measures W32, and will not fit most people who normally wear that size so BB will be taking returns for wrong fit on most pairs that they sell. This is my theory FWIW.
I was responding to his post that today was a 15% off sale. He has since expanded on that original statement to indicate this sale is good for anyone looking at clearance items, but otherwise is no different from the everyday corporate discount.
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Capital flows into fresh ideas
|| Print |
|Articles - December 2010
|Wednesday, November 17, 2010
Among the companies vying for top honors in the annual event hosted by the Oregon Entrepreneurs Network were anti-malarial drug developer DesignMedix, wave energy specialist Columbia Energy Technologies and software developer GreenPrint, which has developed software to eliminate wasteful printing in the office.
Those finalists and the other businesses that made presentations all featured fresh ideas in growing markets ranging from e-commerce to DNA sequencers. Some are certain to join the growing list of Oregon companies that have scored venture funding, including Puppet Labs, Azuray Technology and G5 Search Marketing.
But the central theme from the gathering was that Oregon has a long way to go. Investments remain paltry compared to the money flowing into Seattle to the north and Silicon Valley to the south. Diane Fraiman of Voyager Capital ended the event with a call to action: "Do not settle for the status quo. We need to embrace innovation in new ways."
What that might entail remains to be seen. State representatives Bruce Starr and Tobias Read hinted at growing momentum to lower Oregon's capital gains tax burden. Newly elected state treasurer Ted Wheeler said he strongly supports using Oregon investment funds to support local businesses first. Portland mayor Sam Adams promised to build on the popularity of the city's new seed fund for start-ups.
Oregon University System Chancellor George Pernsteiner acknowledged that there is room for improvement in the transfer of technology from universities to companies. "We're slow and we know we're slow," he said. "That is a culture shift we will have to make."
As a rather stinging reminder of how far Oregon has to go, Luis Mejia of Stanford University's office of technology licensing pointed out that his program launched in 1970 and took 15 years to break even. But it eventually brought partnerships with Hewlett-Packard, Yahoo and Google.
Store BoughtJuly/August 2015
Friday, July 10, 2015
Market of Choice is on a tear. In 2012 the 35-year-old Eugene-based grocery chain opened a central kitchen/distribution center in its hometown. The market opened its third Portland store in the Cedar Mill neighborhood this year; another outpost in Bend broke ground in March. A fourth Portland location is slated for the inner southeast "LOCA" development, a mixed-use project featuring condos and retail. Revenues in 2014 were $175 million, a double-digit increase over 2013. CEO Rick Wright discusses growth, market trends and how he keeps new "foodie" grocery clerks happy.
Read more...
Urban renewerLinda Baker
Wednesday, June 24, 2015
One year after he was appointed chair of the Portland Development Commission, Tom Kelly talks about PDC's longevity, Neil Kelly's comeback and his new role as Portlandia's landlord.
Read more...
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Friday, July 10, 2015
Most of the food Americans consume is trucked in from hundreds of miles away. Eric Wilson, co-founder and CEO of Gro-volution, wants to change that. So this past spring, the Air Force veteran and former greenhouse manager started work on an alternative farming system he claims is more efficient than conventional agriculture, and also shortens the distance between the consumer and the farm.
Read more...
Downtime with Debra RingoldJuly/August 2015
Monday, July 13, 2015
Dean of the Atkinson Graduate School of Management, Willamette University
Read more...
Business partnerships: taming the three-headed monsterContributed Blogs
Monday, July 06, 2015
Picking a business partner is not much different than choosing a spouse or life partner, and the business break-up can be as heart-wrenching and costly as divorce.
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6 key things to know about summer baseball in OregonThe Latest
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As temperatures in Oregon creep into the 90s this weekend, Oregonians' thoughts are turning to — summer baseball.
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10 Innovators in Rural HealthJuly/August 2015
Monday, July 13, 2015
Telemedicine, new partnerships and real estate diversification make health care more accessible in rural Oregon.
Read more...
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Real Time - LANE POWELL
Tweets by @lanepowell
Court experience helps legal firm anticipate potential problems for clients and prevent expensive litigation.
When Garmin AT needed to consolidate operations for its 550 employees, it scanned its entire corporate map for possible sites.
The technology industry is always in flux. And this rapid rate of change poses challenges to companies ranging from nimble startups aiming to make their mark to established organizations fighting to remain relevant. This is particularly true in the competitive digital display market, where an Oregon company has been at the forefront of nearly every major breakthrough in the last three decades.
A look back at the shifting sands of Portland's growth and development.
Robert S. Wiggins has joined Lane Powell as a Shareholder in the Corporate/M&A Practice Group. Wiggins is a well-known lawyer, entrepreneur, and investor with more than 30 years of experience leading and advising established and emerging companies in the Pacific Northwest. Wiggins will focus his practice on offering outside general counsel services, including general corporate and board representation, business transactions and capital events.
DEDICATION PARTY: Help the Port of The Dalles celebrate its newest shovel-ready industrial land Friday, July 31, from 1:30 to 4 p.m.


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See Also:
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Wednesday, July 15, 2015
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Cohiba Bar Opens in Hong Kong
Gregory Mottola
Posted: February 22, 2008
The Cohiba Atmosphere is the first members-only cigar club created by the Pacific Cigar Co., the official Habanos distributor for the Asia Pacific region.
The 1,200-square-foot art deco lounge, which opened July, features a walk-in humidor stocked with Cuban cigars, full bar service and 110 humidified and temperature-controlled lockers. There is also a 700-square-foot rooftop garden for smoking al fresco. A VIP room equipped with flat-panel televisions and wireless Internet service can be pre-booked by club members.
The Cohiba Atmosphere is licensed by Habanos S.A., the worldwide distributor of Cuban cigars, and is part of the Pacific Cigar Company's effort to provide smoking asylum for aficionados in Hong Kong, where a smoking ban has been in effect for a little over a year.
From the current issue of Cigar Insider.
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Meat cleavers used in robbery
Relevant offers
The East
Police are hunting for two men who threatened staff at an Asian takeaway with meat cleavers and stole hundreds of dollars from their till.
The pairwalked into Gin's Takeaways on Hampshire St, Aranui brandishing the weapons about 8.15pm yesterday, police said.
One of the men leapt over the counter of the shop and demanded the cash. They then fled into the night with less than $500 cash.
Detective Sergeant Ashley Millen said a police dog tracked the two men, but lost their scent.
Neighbours reported seeing a silver or grey station wagon in the area at the time, which could be linked to the robbery, he said.
The Chinese family working at the takeaway were shaken, but unharmed.
The man who jumped the counter was described as an unshaven, skinny European, about 1.7m tall, and aged in his late 20s. He was wearing a green cap and dark hooded sweatshirt.
The other man was described as a skinny European, about 1.8m tall. He had long, black, curly hair, tied back in a ponytail. He was wearing a black beanie and a black hooded sweatshirt with a zip and grey logo on the front.
Millen warned shopkeepers to be on the lookout for suspicious activity in the evening, particularly close to closing time.
Anyone with information is asked to call Detective Constable Paul Wilson on 0211911521
- The Press
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New information casts doubts over Lisa Blakie murder, says her father
Labour has promised to revamp New Brighton. What do you think?Related story: New era for New Brighton?


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At right: The Main Street, A.K.A. Honkers attraction, fabulously rousing in the fading park light
Choose one of the 5 Main Street, A.K.A. Honkers mechanical wonders and go for a liesurely ride to the other end of a school. Whether you rename the vulture-drawn carriage, the double-decker cheetah, or the old-fashioned cake engine, you'll feel like you've stepped right into the college in the 1950's!
Shun Zombie Mode
© copyright 2011–2015
A Pants Aflame production


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This is a single blade 4" trapper I made with old yellow stag handles, and vine filework. brass liners, nickel bolsters, mirror polished blade of L6 high carbon tool steel, tang has some spotting and is marked with my mark. Very strong backspring with a half stop. deep swedge and short "long" pull
Contact Muskrat Man Knives & Tools
This knife has a stainless blade and bolsters, Brass screws and thumb post . There is a gem in the thumb post. This is a sweet knife, you can see to comb your hair in the blade. Nice file work all over.
Blade material-440C
Bolster material-420J w/gold screw
Handle material-Honey mother of pearl
Back Spacer- 420J
Thumb Stud-420J w/gem stone
Hanle size-3 5/8"
Tolal length-6 1/2"
Blade length-2 3/8"
Blade width-7/8"
Blade Thickness-1/8"
Contact B&B Knives
This is a large Bowie with stainless blade and diamond wood handle. The knife was assembled by me.For Sale By B&B Knives
This is a Russell Green River carbon steel blank with Peruvian Alder handle. Made by me. The finger guard is brass.For Sale By B&B Knives
This Bowie has an 8" stainless blade and is 13" overall. Has teak handles and brass finger guard. Handle done by me. For Sale By B&B Knives
This damascus blade has walnut handles and brass bolsters. I put the handle and bolsters on the blank. Blade is 3.25" with overall length 6.5". Comes with leather sheath.For Sale By B&B Knives
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If you are looking forward to hiring a cloud service provider for meeting your business needs and requirements, then you should be careful while selecting the cloud service provider. If you think that just by visiting the websites of different cloud service providers and by going through the reviews of their clients you will be able to know whether the companies on your list can provide you quality service or not then you should know this fact that most of the times you will end up making wrong conclusion. For getting the right answer to your questions, you will have to do thorough research over the cloud vendors. For sure there are a number of cloud service providers or companies out there in the market and finding a cloud company is not a difficult task but locating a cloud service provider who can offer quality services
is a daunting task.
There are some factors which you will have to consider for selecting the best cloud consultant. Some of the important factors which you should consider have been enlisted below:
You should select a service provider or company which is an expert in their field. The service provider you select should be able to provide you the required service with almost any software which you want. You should look at their reputation in the market for getting a clear picture about the service quality which they can provide and the type of services which they can offer you.
The next thing which you will have to take under consideration will be the service charge which the service providers will charge you in exchange of their services. You should consider going through the pricing plans before collecting any information about the service providers on your list in order to select the one which can offer you required service at a reasonable price and short listing the names of the services providers who can offer you required service in your pre-decided budget.
You should check if the cloud vendor which you are thinking to hire is reliable or not. Since, your business and all the work will depend on their services therefore you must check if the service provider you are going to select can handle the task of cloud computing efficiently and effectively or not. Can their servers hold the data exchange and robust bandwidth or not? It is important to make sure that they can efficiently manage the hosting environment for giving you the best experience.
Experience is one of the most important factors. You should always select a cloud computing service provider which is experienced.


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Photo SpecialWhat's in a Hollywood Baby Name?
Find out why Blake and Ryan kept "James" private and which former costar Vin Diesel is paying tribute to through his newborn daughter
Credit: Dillard family / www.duggarfamily.com
Updated: Friday Jan 23, 2015 | 06:00 AM EST By: Alison Schwartz
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Championship teams 'embrace' adversity
Jun 16, 2013, 10:02 PM EDT
The Boston Bruins and Chicago Blackhawks are in the Stanley Cup Final, yet both clubs faced their own separate demise in these playoffs.
The Bruins trailed the Toronto Maple Leafs by three goals in Game 7 of the first round, and the Blackhawks were down 3-1 to the Detroit Red Wings in the second round.
Yet, here they are, in what has become a best-of-five final, with the series tied 1-1 following the Bruins overtime victory on Saturday.
In fact, this series has been a testament to the difficulties of playoff hockey, and the perseverance needed to win. Both games have needed overtime to determine a winner, with the first game going three extra periods.
"Well, I think the championship teams, usually when there is adversity, they embrace it, they have fun with it. They're just
looking for the challenge," Blackkhawks forward Michal Handzus told reporters.
"I think you need that. It's a long road to win the Stanley Cup. It's four games. You get a lot of adversity, tough moments. You have to have fun with it, look at it as a challenge.
"I think that's what you need to go forward."
Former NHL forward Berezin arrested for alleged fraud
Jul 29, 2015, 10:40 PM EDT
He played in 502 games, primarily with the Toronto Maple Leafs.
Coyotes sign German League standout goalie Treutle
Jul 29, 2015, 9:12 PM EDT
The 24-year-old gives agreed to an entry-level deal.
Johansson on brink of big raise, but his role with Caps might decline
Jul 29, 2015, 7:49 PM EDT
Will he live up to his next contract?
Shero: Buying out Zubrus creates flexibility to add forward
Jul 29, 2015, 6:27 PM EDT
"It really wasn't about Dainius himself."
Got $1.5 million? Jim Craig is selling his 'Miracle on Ice' gold medal
Jul 29, 2015, 4:57 PM EDT
His collection can be had for $5.7 million.
Gillette Stadium will host Bruins-Habs alumni game ahead of Winter Classic
Jul 29, 2015, 3:31 PM EDT
The contest will air on Dec. 31 while the Classic itself is scheduled for 1:00 p.m. ET on Jan. 1.
Ryan Murray: 'I have to show up and prove it'
Jul 29, 2015, 2:28 PM EDT
Staying healthy would help, too.
Voynov serving sentence at jail that once advertised it had flat screen TVs
Jul 29, 2015, 1:22 PM EDT
The Seal Beach Detention Center isn't exactly Shawshank.
Campbell credits ECHL stint for turning his game around
Jul 29, 2015, 1:03 PM EDT
"I relaxed down there and came back with the same attitude and everything kind of took care of itself."
Zubrus on unconditional waivers for purpose of terminating his contract
Jul 29, 2015, 12:34 PM EDT
Veteran forward had just four goals and six assists in 74 games last season.
JayBo admits groin injury meant he 'couldn't do some of the things that I was used to doing'
Jul 29, 2015, 11:58 AM EDT
"So hopefully it's nothing that keeps coming back."
Talbot knows he has a 'great opportunity' in Edmonton
Jul 29, 2015, 11:09 AM EDT
Can he give the Oilers the goaltending they so badly need?
Report: Bernier and Leafs more than $2 million apart ahead of Friday's arbitration hearing
Jul 29, 2015, 10:21 AM EDT
The 26-year-old goalie is coming off a tough season.
Report: Rangers prospect Andersson headed to North America
Jul 29, 2015, 9:00 AM EDT
Spent last season with Lugano in the Swiss League.
PHT Morning Skate: 'Hawks fan hikes Machu Picchu, meets Jonathan Toews
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Y'know, everyday stuff.
Wild's Dumba asked Boogaard's family permission to wear No. 24
Jul 28, 2015, 10:30 PM EDT
Nice gesture.
Report: Visnovsky considering European options
Jul 28, 2015, 9:38 PM EDT
Potentially a move to Switzerland, or the Czech League.
Sabres name Cunneyworth AHL head coach
Jul 28, 2015, 8:39 PM EDT
Returning him to Rochester for a third time.
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Beauticians Christmas Ornaments
Every beautician deserves a "thank you." Give the hairdresser or barber in your life a gift to honor their hard work when you give them a personalized beautician ornament. We also have manicurist ornaments that are great for any spectacular nail technician.
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Need Help With Social Media?
Interested in discussing a strategic social media plan for your funeral home?
Join 18,000 Other Funeral Directors in the Know! Sign up for our Daily Funeral News Updates email!
Another Start Up Launching to Help People Finalize Their Funerals8 mins ago
IFDF designated as the exclusive distributor of DNA Memorial services38 mins ago
4 Tips For Kicking Butt In The Funeral Profession (That You Didn't Learn In Mortuary School)16 hours ago
Medicare Now Encouraging Doctors to Talk End of Life With Patients1 day ago
How Your Funeral Home Can Own Your Local Community on Facebook1 day ago
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Contributors News Ryan Thogmartin Social Media
[VIDEO]: What is Your Most valuable Service?
In multiple social media Idea Sessions I have held with funeral homes across the country over the past few weeks, I have talked in-depth about the "value" they (funeral directors) are providing client families through the services that they offer.
My goal is to get funeral professionals to think deeply about the repetitive tasks/services they engage in daily and examine the value these services add to the client families experience.
Watch the video from me below and please share, "What is your most valuable service?"
Ryan Thogmartin
Go to http://funeralsocial.com to find out more about the services we offer. Our clients who are apart of our FUNERAL Social Design Process are seeing an increase in post reach and engagement of over 300%.
Ryan is also the founder of ConnectingDirectors.com. ConnectingDirectors.com is the leading online daily publication for funeral professionals with a reader base of over 45,000 of the most elite and forward-thinking professionals in the profession. With ConnectingDirectors.com Ryan has created a global community through an online platform allowing funeral professionals to Stay Current. Stay Informed and Stay Elite.
Latest posts by Ryan Thogmartin (see all)
- The Mortician: Making Dead Bodies Beautiful [VIDEO] - July 21, 2015
- 7 Simple Steps To Reaching The Most Fans [White Paper] - May 19, 2015
- Obits.org: A FREE alternative to Tribute.com and Legacy.com - April 27, 2015
Kenneth Howe
I think the most valuable service that a funeral professional offers each day to our client families is "you." The fact tha you are available 24/7 to your families means more than we ever know. That explains why some professionals who mearly show up day after day can stay in business for generations…without keeping up, without all the bells and whistles that create a "wow" factor. That being said, IF you can put that dedication WITH creativity and genuine concern to stay up with the latest and the best that our profession has to offer..then you create a powerhouse professional that is a force to be reckoned with!
Howard Beckham
Or maybe a better question…what services do the families we serve value most?
Most funeral directors, independent and corporate see most everything they do as valuable, from the removal to the final disposition….but have you ever tried to explain to a family why your cremations is worth $2000.00 and well worth it, and the place down the street is $695.00?
We can provide videos, great memorial printed packages, beautiful and useful web applications, have a fantastic facility, or own crematory, and even our own cemetery, a great community service program and aftercare, and the best staff in town…all this will be a of value to some…but there seems to be an increasing number of families in the current economy who are very price sensitive. On top of that perceptions sometimes are perceived as reality with low end providers, but that is another story.
http://www.facebook.com/leah.yomtovianroush Leah Yomtovian Roush
Ryan, this is a great exercise that all businesses should practice regularly. If funeral directors can't explain their value proposition (i.e. the value that they will offer families in-need of funeral services), how will they be able to attract business? Relationships are important, but as Alan Creedy and Joe Joachim pointed out in another video, families are increasingly information-seeking and decreasingly loyal to businesses (even those with whom they've had positive experiences in the past). Funeral directors should do all they can to first identify the value they add and then get that message out.
Matt Jones
Great comment Kenneth. Part of our success is offering a hIgh level of convenience all throughout. For example, preparing the family for the initial arrangment meetIng, meeting them at their vehicle when they arrive to assist in carrying photos or clothing, offering one-stop shopping including monuments, delivering all flowers, photographing flowers and important parts of the event and takIng care of all paperwork Issues In quIck fashion. These are just a few of the high value points.
Question – do any of you offer a farewell prayer at the removal? This has proven to be very important to most all of our families. -Matt Jones
J Evans
In sometimes the darkest hour at night…even EMS, Nurses and Nursing Home aids are "relieved" from the stress of the death of a patient. When the funeral home staff arrive professionaly they assume the resposibilty of caring for the deceased and family. Many times comforting the caregiver, saying thank you for your time, saying "we'll take over from here"…makes people feel better about the situation. People "service" is what we can do best, and by assisting the grieving when they need us the most is Valuable. Yes we run a funeral business, but as long as we can keep people #1 and the business #2, we'll continue to serve our communities well. Secondly, being a "resource" for grieving families, preplanning and estate planning.
http://www.facebook.com/people/Jeff-Staab/100000281354570 Jeff Staab
I believe our biggest value is ability to create a healing
environment where people can come together for a memorable experience. This
experience should promote those in attendance to support each other in their
grief. The life of the deceased is the star and the theme is how that life effected
their world and the world of others.
How memorable the experience is will be directly related to
the ability of the funeral director to most important listen and also to ask
pointed questions that will both build trust as well as allow others to share.
As you may of heard we are now in a society that treasures the experience most
of all. Each funeral / memorial is a custom created event that draws from all involved
and weaves it into a special event that allows social healing and an open environment
that provides a safe haven for people to share in their support for each other.
On the surface, if using the latest bells and whistles
available to us such s video tributes, custom blankets, programs, funeral
favors, memorial websites ect. will help support the goal of creating a healing experience,
then why not use them to the best of our ability. If a specially trained MC
that knows just how to draw on all
aspects of a life lived and craft all that information into a well balanced and
touching ceremony would help, then you should be hiring the best Certified Life
Celebrant you can find. If you cannot find a good Celebrant in your area, you should find
a person that you think would be good and pay for their training.
All items listed here seem to be valuable increments of funeral service. Unfortunately, many death
care purchasers appear to not agree. Just look at the increasing numbers and success of no funeral low cost cremation only services.


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The most (and least) expensive fuel in the world
What will happen when UAE prices are linked to global markets?July 27, 2015 3:00
Register for our free newsletter
With nuclear deal done, Iran sets out to reassure wary Gulf Arabs
Dubai Holding unit seeking to sell stake in Maltese telco Go
MIDEAST STOCKS-Dubai falls, Emirates NBD the main drag
UAE June bank lending growth rises to 8.8 pct y/y
Abu Dhabi Islamic Bank rights offer to begin Aug. 23
Emaar Malls Q2 earnings may weigh on Dubai
Dubai's Emaar says committed to projects in India
UAE's Union National Bank Q2 net profit rises 10 pct, misses estimates
Oil prices fall as industry data points to rising U.S. crude stocks
Oil prices drop on ample supply, strong dollar
A plastic surgeon accusing a UAE hospital of negligence.
February 5, 2009 3:38 by Dana El Baltaji
Here's yet another reason why we'd rather staple our hands to our desks than have surgery at a hospital in the UAE:
An American plastic surgeon is seeking AED15 million in compensation from UAE hospital for causing the death of his Emirati patient. The hospital had previously blamed him for women's death, and his license was cancelled by the Department of Health and Medical Services (Dohms). The doctor claims he has endured unnecessary financial, emotional and moral loss.
According to an article in Gulf News, he is taking the hospital to court for negligence and for blaming him for his patient's death.
"On the day of the operation, a specialized doctor examined her and knew that she suffered [from] high blood pressure, but did not inform me. Before she was taken into the surgery room, the anesthesiologist re-examined her and discovered that she had high blood pressure, but also did not inform me. The operation was successful, but due to the high blood pressure, she bled … the patient died due to the doctors' negligence and because she did not receive the proper medical care. Thereafter, Dohms cancelled my license because of malpractice which the hospital's doctors committed," the surgeon declared in his lawsuit.
The surgeon handed the court a medical report that confirmed that his patient died due to the carelessness of the hospital's doctors.
"The cancellation of my license has cost me a lot … [I've] lost too many patients who were still in need of my consultations and prescriptions."
1 Comment
It is the surgeon's responsibility to screen patients for health problems BEFORE scheduling them for procedures. This American plastic surgeon should be responsible for this death. (I am a US citizen, born and lived here all my life. I doubt this surgeon would even consider such a lawsuit in his homeland. He would be laughed out of court, as I hope he is in this situation)
Total honesty in marriage? Not for Dubai's women
February 5 2009
Who framed Assud the rabbit?
February 7 2009


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